TN 14 (12-10)

GN 04440.525 Completing the SSA-392-SUP, Medical Consultant's Review of Mental Residual Functional Capacity Assessment

A. Background on using the SSA-392-SUP

Federal review medical contractors (MC) and psychological contractors (PC) use the SSA-392-SUP to record agreement or disagreement with the mental residual functional capacity (MRFC) assessment established by the adjudicating component on an SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment). The MC or PC completes the SSA-392-SUP only when there is an SSA-4734-F4-SUP in file and a medical-vocational determination is appropriate.

For an exhibit of an SSA-392-SUP, see GN 04440.930.

1. When to complete an SSA-392-SUP

The MC or PC completes an SSA-392-SUP when:

  • An SSA-4734-F4-SUP is in file; and

  • A mental impairment of less than listing level severity requiring an RFC assessment is present.

For a further explanation of when to use the SSA-392-SUP, see GN 04440.135.

NOTE: When the review component assumes jurisdiction, the reviewing MC or PC prepares an SSA-4734-F4-SUP, when appropriate. Do not use the SSA-392-SUP to make an MRFC assessment, since it is a review form.

2. When not to complete an SSA-392-SUP

The MC or PC does not complete an SSA-392-SUP when:

  • The adjudicating component prepared an SSA-4734-F4-SUP, but MC or PC review establishes that the adjudicating component should have made the disability determination on a medical basis only, (i.e., the impairment is a “not severe” mental impairment, or the impairment is of listing level severity.); or

  • The disability determination is not supported by sufficient medical evidence and additional medical evidence is needed (i.e., a medical documentation deficiency), regardless of whether the adjudicating component decided the case on a medical-vocational basis.

NOTE: In these situations (GN 04440.525A.2.), the MC or PC records case analysis and disagreement(s) with the MRFC determination on an SSA-416, Case Analysis.

B. Procedure for completing the SSA-392-SUP

1. Heading (SSN through Level of Claim)

The items in the heading are self-explanatory. For “DATE OF SSA-4734-F4-SUP BEING REVIEWED,” show the date or range of time covered by the MRFC assessment completed by the adjudicating component.

2. Section I - Summary of Agreement/Disagreement

After you review all the evidence, complete Section I.

  • If you agree with the narrative statement regarding all four mental areas, (Understanding and Memory; Sustained Concentration and Persistence; Social Interaction; and Adaptation), and with the adequacy of documentation, indicate these agreements by checking the appropriate "agree" block, and do not complete Section II;

  • Sign and enter the MC code and date;

  • If you disagree with any of the four mental areas, check the "disagree" box and the reason for disagreement in Section II of the SSA-392-SUP;

  • If the adjudicating component’s narrative is inadequate or insufficient to address the side effect(s) of an impairment in a particular mental area (A,B,C, or D), indicate this by checking the block following the mental area; and

  • Indicate if documentation is sufficient to support the assessment provided by checking the block for "yes" or "no" following each of these items.

3. Section II. - Narrative Discussion

Complete Section II only for substantive disagreement with the SSA-4734-F4-SUP narrative statement of the four areas of mental impairment(s) or for incomplete documentation in support of that narrative statement.

  • If there is a substantive disagreement, present a complete, detailed narrative discussion of the basis for disagreement for each mental area in which disagreement or the need for documentation is indicated in Section I;

  • Include in your discussion a citation of the specific evidence that supports mental capacity conclusions that differ substantively from those presented in the SSA-4734-F4-SUP narrative statement;

  • If the deficiency is for missing or incomplete evidence, explain what evidence is needed; and

  • Sign and enter the MC code and date on page 2.