1. 1. 

   The DDS will prepare a personalized disability explanation with an interim notice (SSA-L1157) for initial title II and title XVI closed period and unfavorable onset date allowances. (See DI 26530.005D.3. for when the explanation is not required in these situations.

2. 2. 

   In initial concurrent title II/title XVI and DIB/DWB, DIB/CDB closed period and unfavorable onset date allowances, the DDS will prepare a separate notice and personalized disability explanation for each claim. However, when the basis for the decision is the same for both claims (e.g., DIB/CDB medical/vocational allowance) and the contents of the personalized disability explanation are the same, the personalized disability explanation may be photocopied and attached to each interim notice. The correct SSN must be shown on each copy.

The personalized disability explanation must contain the following elements:

1. 1. 

   List all medical (not necessary when work activity is the only reason for the unfavorable onset) and nonmedical sources evaluated Identify medical sources by name and date of receipt of the evidence. Nonmedical sources (e.g., school guidance counselors, welfare departments, vocational rehabilitation agencies, day treatment facilities, sheltered workshops, social workers, and third party lay evidence) will be listed as evidence sources but will not be identified by name. Excluding third party lay evidence, nonmedical sources should be identified by position and organization (e.g., Vocational Rehabilitation Counselor, Department of Rehabilitation Services, report received XX/XX/XX). Third party lay evidence (e.g., family members, neighbors, coworkers, etc.) will be identified under the list of reports using the following statement: “Information from other people who know about your health.” If the lay evidence is the only evidence, omit the word “other.” Reports may be listed in paragraph form if saving space becomes a consideration or more than three reports are used;

   NOTE: It is permissible to include unresponsive sources or sources who respond indicating there are no records or the claimant is not a patient in the personalized disability explanation.

2. 2. 

   When the medical sources were unresponsive, the disclaimer statement in DI 26530.055 provides an optional fill-in to say that additional reports were not obtainable; however, we had enough information to evaluate the claimant's condition;

3. 3. 

   (Optional) A statement that “The determination on your claim was made by an agency of the State. It was not made by your own doctor or by other people or agencies writing reports about you. However, any evidence they gave us was used in making this determination. Doctors and other people in the State agency who are trained in disability evaluation reviewed the evidence and made the determination according to Social Security law and regulations;”

4. 4. 

   A list of the impairments evaluated. Do not use technical terms unless the claimant uses and appears to understand them. When information in file suggests that the claimant has a terminal illness, mental impairment or is unaware of the exact nature of his/her condition, the examiner will use his/her judgment as to what, if anything, will be listed in the explanation concerning the impairments. If the claimant is unaware of an impairment, use general terms such as “The reports do not show any other conditions which would significantly limit your ability to work;”

5. 5. 

   A brief description of medical severity as of the month of cessation in closed period allowances or a brief description of the medical or medical/vocational basis for this established onset date in unfavorable onset date allowances. However, care must be taken in discussing medical evidence (address unconfirmed allegations by stating that evidence does not reveal any other disabling conditions). A later onset may be established because a prior ALJ or AC decision is binding. In this case explain that the later onset is established because of an administrative law judge or Appeals Council decision which found him/her not disabled through the date of the decision;

6. 6. 

   For claims filed before March 27, 2017, explain how you considered a treating source’s medical opinion(s) and any opinion(s) that you gave more weight than a treating source’s medical opinion. For additional information, see DI 24503.035, for claims filed on or after March 27, 2017, see DI 24503.030.

7. 7. 

   When vocational factors were considered in a closed period allowance; provide a brief description of the job the claimant can do or a statement that although the person cannot do past relevant work, he or she can adjust to other work which is less demanding (refers to nonexertional limitations or restrictions including mental) or requires less physical effort (specify in general terms, e.g., lighter work). Do not cite other jobs;

8. 8. 

   When vocational factors were considered in an unfavorable onset date allowance; provide a brief description of the job the claimant could do or a statement that although the person could not do past relevant work, he or she could adjust to other work that was less demanding; (refers to nonexertional limitations or restrictions including mental) or requires less physical effort) (specify in general terms, e.g., lighter work). Do not cite other jobs;

9. 9. 

   When the claimant's work activity is the reason for the closed period or unfavorable onset determination, the information provided in the attachment must cover this issue.