Complete question 12, Interviewer/Reviewer Checklist by answering yes to question E. for IRWE. In the discussion field record the following items:

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  The item or service alleged as IRWE;

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  The alleged impairment(s) to which each item or service applies; and

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  The cost of each alleged item or service.

Follow established procedures by either entering “IRWE Case” in the SSA-831 remarks section or completing the disability transmittal screens. Forward the case to the DDS for disability determination.

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  If the alleged IRWE correlates with the person’s impairment(s), establish the need for the item or service and proof of payment per DI 10520.025.

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  If correlation, need, and proof of payment are established, make a determination on non-SGA level work and trigger payment for the case by making the proper allowance inputs.

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  After payment is triggered, code the VERN screen on the DCF with monthly wages and IRWE amounts.

If the alleged IRWE does not correlate with DDS established diagnosis(es), determine if the person has another impairment that is being treated by a physician or health care provider per DI 10520.020E.

Obtain and review the medical file for any medical records or statements from a treating physician or health care provider that will confirm:

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  the existence of the alleged impairment; and

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  the person is being treated by a physician or health care provider for the impairment; and

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  the identity of the physician or health care provider.

If correlation is found, follow procedures in DI 10520.020B and DI 10520.020C for adjudicating initial claims. For continuing disability reviews, follow procedure in DI 10520.020D.

When the beneficiary’s or claimant’s alleged IRWE does not correlate with either the DDS diagnosis or medical records in the medical file, ask the beneficiary to provide medical records or a statement from the treating physician or health care provider that establishes correlation.

If the beneficiary is unable to provide documentation, contact the physician or health care provider directly to determine if the person is being treated for the alleged impairment and that the alleged IRWE is needed due to the impairment.

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  Obtain a signed SSA-827 from the beneficiary.

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  Include customized language that fits the person’s case.

For example: “(Beneficiary name) has reported that they (take/use item or service) due to (impairment(s)) in order to work. We need your assistance to determine if we can deduct the cost of these items from their countable earnings. Attached is a signed release of information.

1) Are you currently treating (beneficiary name) for (impairment(s)? (Yes or no checkbox.)

2) Are you prescribing or providing the following due to this/these impairment(s)? List items or services. (Yes or no checkbox.)”

If no medical records or statements are provided to establish correlation, consult the regional office before disallowing the IRWE. If the regional office should require any assistance in making the IRWE determination, it may contact DCRDP, ORDES, Employment Policy Team.