TN 2 (09-85)
GN 01704.810 Requests for Medical Examinations/Evidence
DSEs will screen all foreign agency requests for assistance, and route all requests for medical examinations or evidence to BETs.
INPS' requests should be on a Form IT/USA 2 or IT/USA 11.
Germany's requests may be on a Form D/USA 3, an A D/USA 6A or any combination of these forms.
Switzerland's requests should be on a Form CH/USA 3, a CH/USA 6, a CH /USA 6A or any combination of these forms.
Norway's requests will be on a Form N/USA 3.
Belgium's requests will be on a Form BE/USA 3.
Ottawa's requests will be on a Form CAN/USA 2.
Quebec's requests will be on a Form QUE/USA 2.
Obtain consent statements (see GN 01704.500) when requests are received if no claim has been filed under the agreement and there is no consent statement in the file or attached to the request.
Some foreign agencies may request either medical examinations or medical evidence, although the Belgian and Norwegian agencies will seldom, if ever, request medical exams. Ottawa/Quebec should never request medical examinations and should rarely request medical evidence from SSA records. Unless a claimant specifically submits medical evidence in support of an Ottawa/Quebec claim, do not routinely forward medical evidence to Ottawa or Quebec.
However, if any other foreign agency requests a medical examination, if “pertinent medical evidence” exists in OIO, send copies of that evidence in lieu of obtaining a medical examination. For the purpose of this instruction, “Pertinent Medical Evidence” is evidence which was obtained by SSA in response to a CDI or DIB claim filed or adjudicated within a year of the date claim filed shown on the foreign agency request or within a year of the date for which the foreign agency has specifically requested medical evidence.
B. Requests for medical examinations
If an RSDI folder is in OIO, obtain the folder and review it to determine whether “pertinent medical evidence” is present:
If “pertinent medical evidence” is present, photocopy it and route the photocopies to the foreign agency via a Form SSA-2960.
If there is no “pertinent medical evidence” in the RSDI folder, route the TF folder and the RSDI folder to a foreign disability examiner (FDE) in the International Disability Unit (IDU) requesting a medical examination. (See 2. below.)
If there is no RSDI folder in OIO, route the TF folder to an FDE in IDU requesting a medical examination. Be sure the TF folder contains the following information and forms before routing it to the FDE.
The Form SSA-1278-U3-IT, GE, SZ, etc., Request for Payment of Reimbursable Expenses Under the U.S.A.-(Name of Country) Agreement on Social Security. This form will be used to bill the foreign agencies for the cost of the medical examinations they request. BETs must complete items 1 through 4 and place the form in the folder before it is sent to the FDE. (Item 1 is preprinted on the Italian and Swiss versions.)
The SSN of the person on whose earnings record the claim is filed, if he/she has an SSN.
The foreign agency's request form; e.g., D/USA 3, D/USA 6A, CH/USA 3, CH/USA 6A, IT/USA 11 or the translated letter from Italy.
The Form CH/USA 6 if Switzerland requests the completion of this form.
A translation of any medical evidence supplied by the foreign agency.
When the report of the medical examination is received, the FDE will complete item 5 of Form SSA-1278-U3, sign and date the form, file it in the totalization folder and route the folder to the BET, who will prepare and release the response to the foreign agency. Be sure to include all medical evidence, test results, etc. secured by the Disability Determination Services. Retain a copy of the medical evidence in the folder.
NOTE: For Italian cases, show the INPS office that requested the exam in item 2.d. of the Form SSA-1278-U3-IT; place a disposition note, your initials and the date in the lower right-hand corner of the file copy.
DO NOT send Form SSA-1278-U3 to the foreign agency. Authenticate all copies of Form SSA-1278-U3 and strip the form. Reverse file the second copy on the right side of the folder. Place the original and the first copy in an interoffice envelope addressed to:
C. Requests for medical evidence from the records of SSA
If there is an RSDI folder in OIO, obtain and review the folder to determine whether or not “pertinent medical evidence” is present.
If “pertinent medical evidence” is present, BETs photocopy it and route the photocopies to the foreign agency via a Form SSA-2960.
If pertinent evidence is not in the folder, inform the agency via a Form SSA-2960.
If there is no RSDI folder in OIO, inform the agency with an appropriate remark via a Form SSA-2960.
D. Requests for medical evidence from records of U.S. physicians and U.S. hospitals
Obtain medical evidence from the records of U.S. physicians and hospitals via Forms SSA-4766-U3 requesting assistance from the appropriate DOs. The applicant's consent is necessary for the physician or hospital to release the medical records to SSA.
If the claimant resides in the U.S.A., obtain a completed Form SSA-827. If the claimant resides outside the U.S.A., obtain a completed Form SSA-827F. Either of these forms authorizes physicians and hospitals to release medical information to the Social Security Administration. If no claim has been filed under an agreement, consent statements allowing SSA to release the information to a foreign agency must also be obtained.
Note: Consent forms are not required if the person is scheduled for a consultative medical examination requested by a foreign agency.
Send medical evidence to the foreign agency via a Form SSA-2960.