TN 8 (11-15)

DI 24515.001 Evaluating the Evidence

CITATIONS:

Social Security Act §§ 205(a), 205(b), 221(k), 223, 1614(a), 1631(c), 1631(e), and 1633

20 CFR §§ 404.1502, 404.1503, 404.1504, 404.1512 through 404.1523, 404.1527, 416.902, 416.903, 416.904, 416.912 through 416.924(b, 416.927, and 416.1013

A. Introduction to evaluating the evidence

Evaluate all the evidence in the case record, as explained in this section, before making a disability determination.

Consider not only objective medical evidence, but also other kinds of evidence as described in DI 22501.001B.

When evaluating medical-vocational steps, consider the claimant’s residual functional capacity with:

  • Evidence about the demands of the claimant’s past relevant work at step 4 of sequential evaluation.

  • Evidence about the claimant’s vocational factors (i.e., age, education, and skills and abilities acquired from past relevant work) at step 5 of sequential evaluation.

REMINDER: When appropriate, consider an expedited vocational assessment at Steps 4 and 5, per DI 25005.005.

B. Definitions for evaluating the evidence

1. Evidence

Evidence is any medical or non-medical information the claimant or anyone else submits, or we obtain, that relates to the claim.

2. Relevant evidence

Relevant evidence is a type of essential material related to the issues in the claim, including, but not limited to:

  • establishing one or more medically determinable impairments;

  • assessing the severity of the impairment;

  • determining the duration of the impairment;

  • establishing the onset date of disability; and

  • documenting fraud or similar fault.

NOTE: For additional information on evaluating the evidence, see DI 22501.001B.

3. Sufficient evidence

Evidence is sufficient when it contains all the information we need to make the determination.

4. Inconsistent evidence

Evidence is inconsistent if it:

  • conflicts with other evidence;

  • contains an internal conflict;

  • is ambiguous; or

  • is medical evidence that does not appear to be based on medically acceptable clinical or laboratory diagnostic techniques.

IMPORTANT: If the file contains materially inconsistent evidence, the case evidence is insufficient. Evidence is materially inconsistent only if the inconsistency presents an issue that (1) makes a difference between the decision to allow or deny or (2) affects the determination of established onset date (EOD).

C. Procedure for evaluating the evidence

1. Compare the evidence with the claimant’s allegations

Analyze each piece of evidence. Consider its:

  • completeness;

  • relevance;

  • internal consistency;

  • interrelationship with other evidence; and

  • consistency with other evidence.

2. Case evidence is consistent and sufficient

If all of the case evidence is consistent and there is sufficient evidence to make a disability determination, make the required findings based on all of the evidence and complete the determination.

REMINDERS:

  • Case evidence must be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind; see details in DI 22501.001D.

  • Before making a determination that is not fully favorable to the claimant, first make every reasonable effort to develop the claimant’s complete medical history; see DI 22505.001A.3.

3. Case evidence is inconsistent, but you have sufficient evidence

If any of the case evidence is inconsistent but you have sufficient evidence, consider all the evidence under the appropriate guidelines in DI 24515.000 and make a determination supported by the case evidence. Document how you resolved any inconsistencies in the evidence on the electronic claims analysis tool disability determination explanation (eCAT DDE) or on the Case Disability Summary Worksheet.

4. Case evidence is insufficient

If the case evidence contains any material inconsistencies(s), or is otherwise insufficient:

a. Complete supplemental development

For supplemental development requirements, see DI 22505.008.

b. Evaluate the supplemental evidence with the other evidence in file

Make determination findings supported by the case evidence.

REMINDER: If unable to resolve an insufficient evidence situation through supplemental development, do not make a fully favorable determination.

5. Supplemental development

Supplemental development is how we attempt to resolve any material inconsistencies or insufficiencies in the case evidence. If the file contains materially inconsistent evidence then the case evidence is insufficient.

6. Documenting evidentiary development and follow up efforts

In all cases, document the details of all developmental efforts on the electronic claims analysis tool disability determination explanation (eCAT DDE) or on the Case Disability Summary Worksheet. See details, DI 20503.001 Documenting the Disability Folder – Disability Determination Services (DDS).

D. When to stop certain evidentiary development and follow-up activities

1. Sufficient evidence for an allowance

If the case contains sufficient evidence to make a fully favorable determination, discontinue development. Do not await receipt of, or follow-up on, outstanding medical evidence requests. See details in DI 24515.020.

2. Medical source clearly will not provide evidence

If circumstances of contact with a medical source clearly indicate that the medical source cannot or will not at any time provide the requested MER, discontinue development from the source. See details in DI 22505.008C.1.

3. Claimant fails or refuses to cooperate

If the claimant fails or refuses to cooperate or to attend a consultative examination (CE), discontinue development that requires claimant action (e.g., CEs and claimant forms completion). See details in:

DI 23007.004E (Refusal to Cooperate With Requests to the Claimant for Evidence or Action)

DI 23007.005H (Failure to Cooperate With Requests to the Claimant for Evidence or Action)

DI 23007.009E (Refusal to Attend a Consultative Examination (CE) Appointment)

DI 23007.010G (Failure to Attend a Consultative Examination (CE) Appointment)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0424515001
DI 24515.001 - Evaluating the Evidence - 03/24/2017
Batch run: 03/28/2017
Rev:03/24/2017