TN 18 (01-24)

DI 24515.020 Curtailing Development of Fully Favorable Claims

A. Policy for curtailing case development

Adjudicators may process a fully favorable allowance determination without awaiting receipt of, or continuing to follow up on, requests for evidence that should not, in the judgment of the adjudicative team, affect the allowance determination. Curtail development if the evidence is sufficient to establish that:

  • the claimant meets the medical or medical and vocational criteria for disability, including duration, and

  • the Established Onset Date (EOD) is fully favorable.

For an explanation of when EOD is not fully favorable, see DI 25501.280A.

EXCEPTION: Do not curtail development of the claimant’s visual impairment allegation if statutory blindness is possible and the case requires a statutory blindness finding. For policy about when the DDS must make a statutory blindness determination, see:

REMINDER: This instruction does not change the requirements regarding the initial request for evidence or the final determination.

B. Duration considerations when curtailing case development

In cases where evidence indicates onset less than 12 months prior to adjudication, you may have sufficient evidence to project the disabling level of severity to meet the 12-month duration requirement.

If evidence is sufficient to establish that impairment severity is static (not changing over time) or progressive (worsening over time), it may be appropriate to project severity to make a fully favorable determination.

For more information about evaluating the duration requirement, see DI 25505.030.

C. Examples of evidence to support a fully favorable determination

The following are examples of situations where, if case evidence is otherwise sufficient (i.e., supports a fully favorable EOD, meets the duration requirement, and contains no material inconsistency or insufficiency), you may discontinue development and make a fully favorable determination.

REMINDER: Case evidence must be sufficient and consistent enough to allow the adjudicator to determine the nature and limiting effects of the impairment for any relevant period; see details in DI 22501.001D.

1. Fully favorable determination without considering all alleged impairments

When the medical evidence supports a fully favorable allowance, do not pursue additional evidence to establish or evaluate additional alleged impairments.

2. Documenting listing level carcinoma without pathology or operative reports

A hospital discharge summary (or the report from an attending physician), describing listing level carcinoma, is sufficient evidence to establish disability without corroborating pathology and operative reports.

REMINDER: During initial development, request available operative and pathology reports.

3. Establishing ischemic (coronary) heart disease without a complete description of the claimant’s chest discomfort

Medical evidence documenting the claimant’s chest discomfort symptoms, while on a regimen of prescribed treatment for ischemic heart disease, is sufficient evidence to establish ischemic heart disease without the claimant’s complete description of chest discomfort symptoms.

4. Establishing end stage renal disease

Medical source evidence describing chronic renal disease and evidence of ongoing dialysis is sufficient evidence to establish end stage renal disease under listing 6.03.

REMINDER: During initial development, request available evidence from the claimant’s medical sources, as outlined in listing 6.00C.

5. Updated IQ testing not required

a. Adult listing 12.05

IQ scores tend to stabilize by the age of 16. Regardless of the claimant’s age at adjudication, reliable IQ testing obtained at age 16 or older is valid to support the IQ findings required under listing 12.05. For more information about IQ tests, see DI 24583.055.

b. Childhood listing 112.05

If a child IQ testing is not “current” as explained in DI 24583.060C, you may equal listing 112.05 with outdated IQ scores, up to six months, and the other case evidence confirms the child’s functioning is consistent with the IQ score. For more information about finding disability based on medical equivalence, see DI 24508.010 and DI 24583.010.

6. Deferment not necessary

Do not defer medical development for duration when medical and other evidence shows the claimant has little or no chance of regaining significant function. For more information about medical deferment, see DI 25505.035.

7. Imaging evidence not required

If clinical evidence shows the claimant has gross structural or functional joint abnormalities that are apparent on examination, you do not have to obtain imaging evidence (e.g., x-ray or MRI) to corroborate the clinical exam.

REMINDER: Request relevant imaging evidence when developing initial evidence.

8. Additional pulmonary function studies not required

If the pulmonary function tests (PFT) in the file do not adhere to our protocol, but indicate a possible listing level impairment, you do not have to purchase additional PFTs, if other clinical findings document a severe impairment of respiratory function. You can use these other clinical findings in lieu of a PFT that adheres to our protocol to provide a claimant with a fully favorable determination by equaling a listing or at step 5 of sequential evaluation. These other clinical findings may include, but are not limited to, dyspnea at rest with chronic wheezing and rhonchi despite therapy and use of accessory muscles for respiration.

9. Residual Functional Capacity (RFC) precludes Past Relevant Work (PRW) and evidence supports a medical-vocational allowance

If the RFC limitations supported by the case evidence show the claimant cannot do any PRW and the claimant’s vocational factors (i.e., age, education, and work experience) direct a fully favorable allowance using the special medical-vocational profiles or the medical-vocational profiles at step 5 of sequential evaluation, do not develop additional evidence to evaluate whether an impairment meets or equals a listing.

10. SSA-3373 (Function Report – Adult) development not required

If the medical and other evidence in the claims folder demonstrates sufficient functional loss to support a finding of disabled, process a fully favorable determination involving pain or mental impairments without obtaining a completed SSA-3373 (Function Report - Adult).

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DI 24515.020 - Curtailing Development of Fully Favorable Claims - 01/24/2024
Batch run: 01/24/2024