TN 46 (01-17)
GN 00502.030 Lay Evidence of Capability
A. Policy for lay evidence of capability
Lay evidence (nonmedical and nonlegal evidence) of capability helps you understand how the beneficiary has been managing any benefits and other funds that have been available to them to meet daily needs (food, shelter, clothing, and medical care).
Absent evidence of legal incompetence, lay evidence must be developed and considered in every capability determination.
Lay evidence may support or disprove the medical evidence in a case. As the decision maker, you must carefully evaluate all lay and medical evidence when making a determination of the beneficiary's capability. For component responsibilities, see DI 23001.005.
1. What are some examples of lay evidence?
Lay evidence is nonmedical and nonlegal evidence, which gives insight into a beneficiary's ability to manage or direct the management of his or her benefits. Some common examples of lay evidence include:
your observations (during a face-to-face interview) of the beneficiary's behavior, reasoning ability, how he or she functions with others, and how effectively he or she pursues the claim;
a statement made by the beneficiary that he or she is capable or incapable of managing his or her benefits;
documentation or reports that the beneficiary has been unable to meet his or her basic needs in the past, despite available income;
signed statements from, or contacts with, third-party sources with direct knowledge of facts or circumstances regarding the beneficiary’s daily living (e.g. beneficiary's relatives, custodian, close friends, neighbors, landlord, representatives of community groups, social workers, therapists, clergy, and adult protective services workers) that describe the beneficiary's ability to manage benefits and meet daily needs;
the payee applicant's answer to question 2 on the Form SSA-11-BK (Request to be Selected as Payee) (see GN 00502.115) or the similar question on the electronic Representative Payee System (eRPS) Capability screen (MS INTRANETERPS 009.017)); and
in disability cases, the beneficiary’s answer to question 17 on the Form SSA-3373-BK (Function Report-Adult) – Ability to handle money.
REMEMBER: The beneficiary is probably capable if he or she can tell you the amount of money received monthly, the source of the money, the amount of rent/mortgage, or the amount spent on groceries. The beneficiary is also capable if he or she can direct someone else to manage his or her benefits.
2. How do lay evidence and medical evidence work together?
Lay and medical evidence will both lead you to a clear understanding of a beneficiary's ability to manage or direct the management of benefits.
Sometimes, they may conflict. Nevertheless, you must evaluate both lay and medical evidence and make a capability determination based on the most convincing evidence.
3. How much lay evidence do I need to make a determination?
You need as much evidence as necessary to have a clear understanding of the beneficiary's abilities. This will vary from case to case.
B. Examples of capability determinations
Here are some examples using lay evidence and medical evidence:
1. Example 1 - Significant medical evidence available
Mr. Green's doctor submitted a Form SSA-787 (Physician’s/Medical Officer’s Statement of Patient’s Capability to Manage Benefits) describing Mr. Green's condition and stating that Mr. Green is incapable.
Mr. Green's brother, who is also his custodian, files a payee application. In answer to question #2 on the SSA-11-BK, Mr. Green's brother states that Mr. Green does not know the value of money and frequently gives it away to strangers.
At the interview, Mr. Green does not seem to understand your questions and answers them incoherently.
In this case, lay evidence of capability would be your observations of Mr. Green's incoherent speech and his brother's statement in answer to question #2 on the SSA-11-BK. Both the medical and lay evidence seem to agree that Mr. Green needs a payee.
2. Example 2 - Medical evidence is not convincing or not available
Mr. Brown's doctor submitted a Form SSA-787 stating that Mr. Brown is incapable.
However, Mr. Brown filed his own application for benefits and, to your observations, seemed able to handle his own affairs.
Therefore, the medical evidence is not consistent with the lay evidence (your observations).