DI 27505.001 Conditions for Reopening a Final Determination or Decision

The time limits and conditions for reopening described in DI 27505.001A.1. – DI 27505.001A.4. are met.

A determination or decision, which may have appeared to be correct based on the available evidence at the time it was made, may be reopened if it is later shown to have been incorrect (e.g., DDS discovers new and material evidence showing the field office made a failure to cooperate determination, but did not recognize the claimant has a mental impairment that prevented him or her from cooperating). Refer to New and Material Evidence (DI 27505.010B) for clarification of when new and material evidence can be used to reopen a prior determination or decision.

There are exceptions to the general rule that only incorrect determinations or decisions may be reopened and revised. See:

Policy – Only Incorrect Determinations Can Be Reopened and Revised (SI 04070.010C.) for when a determination or decision which was correct when made may be reopened and revised.

Do Not Reopen Correct Determinations — Operating Policy (GN 04001.070) for additional reopening information and general guidance on this subject.

For discussion about the requirements for adverse reopening of a disability determination under the “error” exception as part of the Medical Improvement Review Standard (MIRS), see error and reopening (MIRS) (DI 28020.375).

1. 1-Year Reopening Rule (Title II and Title XVI)

A final determination may be reopened within 1 year from the date of notice of the initial determination “for any reason.” However, certain adverse reopenings and revisions cannot occur unless the medical improvement regulations permit a finding that disability has ceased or does not exist. See Policy - When the MIRS Applies (DI 28005.001D.).

Reopening within 12 months is not “automatic.” A request to reopen within 12 months can be denied if there is no reason to revise the prior determination or decision.

2. 2-Year Reopening Rule (Title XVI)

A title XVI determination may be reopened within 2 years from the date of notice of the initial determination for “good cause.”