If applicable, the DDS Medical Consultant (MC) or Psychological Consultant (PC) may
adopt any of the initial level medical assessment(s) when evaluating reconsideration
cases. See Adoption of Initial RFC Assessment – DI 24510.066B. To determine if the initial level medical assessment(s) may be adopted, see the following
references:
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Options to Simplify Case Processing - DI 24510.066B, to adopt the prior SSA-4734-BK (Residual Functional Capacity Assessment Form), or
SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment Form);
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Evaluation of Mental Impairments Using the Psychiatric Review Technique (PRT) - DI 24583.005, to adopt the SSA-2506-BK (Psychiatric Review Technique Form); and
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Childhood Disability Evaluation Form (SSA-538) - DI 25230.001B.4. to affirm the SSA-538.
To adopt the prior initial level medical assessment:
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Prepare an SSA-416
The MC or PC may complete an SSA-416 (Medical Evaluation), or similar eForm identifying
which form(s) is adopted and include the reconsideration affirmation statement: “I
have reviewed all the evidence in file, and the assessment of (date) is affirmed as
written.” The reviewing MC or PC must sign and date the SSA-416 (or similar eForm)
using the approved electronic signature function. The eForm must be uploaded to the
CEF prior to the DDS case closure.
NOTE: The SSA-416, or similar eForm, cannot be used to affirm an SSA-538, a new SSA-538 must be created to reference the initial
SSA-538. For more information regarding affirmation of the initial level SSA-538 at
the reconsideration level, see DI 25230.001B.4.
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Prepare a New SSA-4734, SSA-4734-F4-SUP, SSA-2506, or SSA-538.
The MC or PC may create the following eForms to adopt an initial level medical assessment:
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SSA-538 (Childhood Disability Evaluation Form).
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To complete the adoption, the MC or PC creates a new eForm and types the reconsideration
affirmation statement (“I have reviewed all the evidence in file and the assessment
of (date) is affirmed as written”) in the remarks section of the eForm. The reviewing
MC or PC must sign and date the eForm using the approved electronic signature function.
The eForm must be uploaded to the CEF prior to the DDS case closure.