TN 14 (12-10)
GN 04440.520 Completing the SSA-3023-F3, Medical Consultant's Review of Psychiatric Review Technique Form
A. Background on using the SSA-3023-F3
1. Purpose of the SSA-3023-F3
Use the SSA-3023-F3 to:
facilitate the medical consultant’s (MC) or psychological consultant’s (PC) review of the SSA-2506-BK, Psychiatric Review Technique Form (PRTF), prepared by the adjudicating component; and
record MC or PC agreement or disagreement with the PRTF in file.
See GN 04440.925 for an exhibit of the SSA-3023-F3.
2. When to complete an SSA-3023-F3
The MC or PC completes an SSA-3023-F3 only when an adjudicating component's PRTF is in the file. Each completed PRTF in file requires an SSA-3023-F3.
NOTE: Multiple PRTFs may be filed for separate periods of disability, or for different titles within the same claim.
NOTE: Only use the SSA-3023-F3 to establish agreement or disagreement with the adjudicating component prepared PRTF. If the review component assumes jurisdiction, the reviewing MC or PC completes an SSA-2506-BK, as described in GN 04440.135B.1.
3. When not to complete an SSA-3023-F3
The MC or PC does not complete an SSA-3023-F3 when:
the adjudicating component should have prepared a PRTF, but did not; or
the PRTF in file is unsigned.
NOTE: The MC or PC use an SSA-416 (Case Analysis) to address the issue(s), as described in GN 04440.520A.3.
B. Procedure for completing the SSA-3023-F3
1. Heading (SSN through Level of Claim)
The items in the heading are self-explanatory. It is important this information is accurate.
2. Part I - Summary of Agreement/Disagreement
Complete Part I after review of the case and the completed PRTF in file;
Record only substantive disagreements. A substantive disagreement exists when the adjudicating MC or PC's conclusion is not supported by the evidence; and
Check the N/A block if any item I.A. through I.D. does not apply to the case.
NOTE: A substantive disagreement does not exist when the evidence is appropriate to the adjudicating MC or PC's conclusions, but the reviewing MC or PC disagrees with the interpretation of that evidence. This is a difference of medical opinion.
3. Part I.A. - Categories of Disorders
This item refers to section II.A.-I., "Documentation of Factors That Evidence the Disorder" in the PRTF.
A substantive disagreement exists when the reviewing MC or PC disagrees with the category(ies) of disorders that was used to evaluate the case, not with the individual signs, symptoms, and findings that follow the category(ies) of disorders and capsule definition(s), except 12.05 and 12.09.
NOTE: You can only conclude the existence of a particular category of disorder when the capsule definition that follows the category of disorder is satisfied.
For impairment category 12.05, the signs, symptoms, and findings contained in items 1. through 4. of section II.D. of the PRTF serve both to substantiate the existence of the disorder and establish its severity. Therefore, a substantive disagreement exists when the reviewing MC or PC disagrees with the adjudicating MC or PC's assessment of these items.
Under impairment category 12.09, a substantive disagreement exists when the reviewing MC or PC disagrees with the adjudicating MC or PC's selection of the reference listing(s) under which he or she evaluated the substance addiction disorder.
4. Part I.B. - Rating of Functional Limitations
This item refers to section III.A.1.-4., "Rating of Functional Limitations," of the PRTF;
The "degrees of limitation" found in section III.A of the PRTF can be selected to differentiate the major levels of functional limitation; and
If the reviewing MC or PC disagrees with the rating of these functional limitations, a substantive disagreement may exist.
5. Part I.C. - Listing 12.02C, 12.03C, or 12.04C in Remission
6. Part I.D. - Listing 12.06C
This item refers to section III.B.2. of the PRTF; and
If the reviewing MC or PC's evaluation differs from that found on the PRTF, a substantive disagreement exists.
7. Part I.E. - Medical Disposition
This item refers to the final outcome of the case, which is found in section I.B.1.through 8. of the PRTF; and
A substantive disagreement is present when the reviewing MC or PC's final evaluation differs from that shown on the PRTF.
8. Part II - Narrative Discussion
Present a detailed, narrative discussion citing specific evidence (history, signs and symptoms, daily activities, etc.) that supports the reviewing MC or PC's differing conclusions; and
If the disagreement is due to missing or incomplete evidence, identify the needed evidence and explain why the evidence is necessary.
NOTE: The reviewing MC or PC may discuss in Part II any other issue believed to be pertinent in review of the PRTF (e.g., onset, duration).
9. Medical Consultant Signature
Sign and enter the MC code and date.
C. Process for Central Office (CO) MC or PC for the SSA-3023-F3
If the CO MC or PC directly reviews an adjudicating component’s case that contains a PRTF, the MC or PC completes an SSA-3023-F3.