TN 3 (11-13)

DI 23001.015 Disability Determination Services (DDS) Procedures for Documenting Capability

A. Policy on documenting capability

When developing capability, DDS will document the folder to indicate whether capability is resolved or unresolved.

To find capability resolved, the DDS must use evidence from an acceptable medical source. When capability is unresolved, the DDS provide a capability opinion using information from third-party sources to support the opinion. For additional information on medical and other evidence of an individual’s impairment(s). See DI 22505.003.

B. Procedures for documenting the DDS capability opinion

1. Capability resolved

Enter “Claimant (in)capable per Dr.         , report dated          ” in item 34 of the SSA-831 (Disability Determination and Transmittal) or item 24 of the SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal).

2. Capability unresolved

a. DDS provides capability opinion

If evidence in the folder suggests the claimant is capable or incapable, but the claimant’s own medical source(s) did not offer an opinion about capability:

  • Enter “Capability unresolved – review of the medical evidence (identify source and date) suggests claimant is (in)capable” in the remarks section (item 34) of the SSA-831, SSA-832, or SSA-833;

  • Post a “U” in the CDF field of the Disability Determination Services Query (DDSQ); and

  • Create a Special Message in eView regarding capability.

b. DDS does not provide a capability opinion

If the DDS cannot provide an opinion regarding the claimant’s capability:

  • Document the folder to show you contacted the medical source(s) and the reason an opinion could not be obtained; and

  • Enter “Capability Unresolved” in the remarks section (item 34) of the SSA-831, SSA-832, or SSA-833.

3. Incapability presumed when claimant meets medical listing

If the claimant meets a listing:

  • Enter “Claimant incapable — meets Listing 12.05A in the remarks section of the SSA-831, SSA-832, or SSA-833;

  • Create a Special Message in eView regarding capability; and

  • Document the folder if the claimant has been in a coma for at least 30 days.

For additional information on mental disorders, see DI 34001.032.

4. Developing evidence of capability by telephone

When you receive evidence of incapability by telephone:

  • Document the folder with an SSA-795 (Statement of the Claimant or Other Person) eForm describing the evidence obtained;

  • Send a copy of the SSA-795 to the acceptable medical source for review and signature;

  • Finish processing the claim; and

  • Forward the claim to the FO or Program Service (PC) along with a copy of the medical report.

NOTE: Obtaining evidence of capability by telephone permits the DDS to adjudicate fully favorable claims while waiting for the signed copy of the SSA-795. Also see additional telecommunication instructions in DI 22505.030D.

5. DDS responsibility after receipt of the signed medical report

After the DDS receives the signed medical report:

  • Review the signed report for consistency; and

  • Place the signed report in the folder according to the electronic folder procedures on document management architecture (DMA) barcodes and document indexing in DI 81020.035. Also see the instructions on electronic case documentation in DI 81020.065 or the paper folder procedures in DI 70005.005.

NOTE: If the signed report contains a revision that may affect the determination, follow the telecommunication instructions in DI 22505.030D.

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