Comparison point decision (CPD): At the time of the CPD, the adjudicator found the individual disabled based on listing
7.05A for sickle cell anemia crises requiring parenteral narcotic medication. The
individual's own medical source, Dr. J. Smith, documented the appropriate amount of
crises with prescription and treatment with narcotic medication to meet the listing
criteria.
Continuing disability review (CDR) decision: At the time of the CDR, Dr. J. Smith, the same doctor who submitted evidence at the
CPD, submits records for the current CDR period and includes records from the CPD
period as well.
-
•
The CPD period records from Dr. J. Smith were the same records used to support the
allowance decision when the claimant originally met 7.05A.
-
•
The adjudicator notices that several pages of records from the CPD period included
the beneficiary’s name and date of birth, but referred to a 56 year old female and
the beneficiary was only 42 at that time of the CPD.
-
•
The adjudicator contacts Dr. Smith's office to clarify the discrepancy in the records.
Dr. Smith reviewed the records and determined the error, that the beneficiary’s sister
was a patient at the facility during that time and also was treated for sickle cell
anemia.
-
•
Dr. Smith determined that the records were mistakenly entered under the beneficiary’s
file for several visits due to a computer error. Dr. Smith's office corrected and
re-sent the records, indicating that the beneficiary did not meet listing criteria
at the CPD.
Explanation: Find the prior decision in error given the clarification received in the new evidence.