If the claimant is not found to have ALS,
complete the following entries:
-
•
Item 10 - Check block D “OTHER.”
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•
Item 12 – Enter Reason for Continuance Code “46” and enter the Medical Listing Number
of the original (non-ALS) impairment, if applicable (i.e., if original allowance not based on medical/vocational factors).
-
•
Item 20 - Enter WRM code 21 (defined as “OTHER”).
-
•
Item 21 - Enter the Primary and Secondary Diagnosis, Body System codes, and Diagnosis
codes from the previous favorable determination or decision.
-
•
Item 23 A-C - Enter the same diary category and date already on file from the previous
favorable determination or decision. The diary should be set to mature from the most
recent full medical determination or decision date, not from the date of the ALS post-entitlement
determination.
-
•
Item 24 - Enter remark "ALS Onset Not Established – Waiver of Medicare Waiting Period
Denied. ALS notice sent.” (See DI 23580.005 Exhibit 3 Prototype DDS and DI 23580.007 Exhibit 5 Non-Prototype DDS for notice.)
Send the completed SSA-833 in the brown folder with the ALS coversheet flag to the
FO for the appeals period.
If the claimant is found to have ALS
after the
24-month Medicare waiting period has expired,
complete the following entries:
-
•
Item 10 - Check block D “OTHER.”
-
•
Item 12 - Enter Reason for Continuance Code “30” and Medical Listing Code “11.10”
-
•
Item 20 - Enter WRM code 21 (defined as “OTHER”).
-
•
Item 21 - Enter Primary Diagnosis of "Amyotrophic Lateral Sclerosis," Body System
code of "11," and Diagnosis code of "3350." Enter the Secondary Diagnosis, Body System
code, and Diagnosis code from the Primary Diagnosis of the previous favorable determination
or decision.
-
•
Item 23A-C - Enter 7-year diary coding
-
•
Item 24 - Enter remark "ALS Onset Not Within 24-month Medicare Waiting Period. ALS
notice sent.”
Send the completed SSA-833 in the brown folder with the ALS coversheet flag to the
processing center (PC). For PC jurisdiction, see GN 01070.245. Instruct the PC that the 24-month Medicare waiting period is not waived, but the DIG and/or SDIG must be changed to 3350 and the medical re-exam diary
must be changed to 7 years.
Also send a copy of the SSA-833 to the FO as notification that the DDS determination
is complete, and the FO can close out the outstanding Modernized Development Worksheet
(MDW) ALS control.