DI 26516.005 Issues Requiring Rationalization/Documentation in the Disability Decisionmaking Process

  Where Usually Documented In FileAction Required If Not Already In File
1.Evidence Sources  
 a. Allowances
  • Medical evidence

  • Personalized notice (partially unfavorable decisions)

 
 b. Denials
  • Medical evidence

  • Personalized notice

 
2.Allegations  
 a. Allowances
  • SSA-3368-F8 (Disability Report of Medical Evidence)

  • Report of Contact (SSA-5002)

  • SSA-795 (Statement of Claimant or Other Person)

  • Personalized notice (partially unfavorable decisions)

 
 b. Denials
  • SSA-3368-F8 (Disability Report of Medical Evidence)

  • Report of Contact (SSA-5002)

  • SSA-795 (Statement of Claimant or Other Person)

  • Personalized notice

 
3.Evidence of SGA/SGA Findings  
 a. Allowances
  • SSA-820-F4 (Work Activity Report - SE)

  • SSA-821-F4 (Work Activity Report - EE)

  • Report of contact or SSA-553 (Special Determination)

 
 b. Denials
  • SSA-820-F4 (Work Activity Report - SE)

  • SSA-821-F4 (Work Activity Report - EE)

  • Report of contact or SSA-553 (Special Determination)

 
4.Medical Facts  
 a. Allowances
  • Medical evidence

  • Reports of contact

 
 b. Denials
  • Medical evidence

  • Reports of contact

 
5.Interpretation of Medical Findings  
 a. Allowances
  • Regulation basis code (SSA-831-U5)

  • In some cases, the Psychiatric Review Technique Form (PRTF - SSA-2506-BK) and Residual Functional Capacity (RFC - SSA-4734-F4 and Supplement)

  • Personalized notice (partially unfavorable decisions - later onset date and closed period cases)

 b. Denials
  • Regulation basis code (SSA-831-U5)

  • Personalized notice

  • In some cases, the PRTF and RFC forms

  • See items 6, 7 and 8

6.Pain-Related Issues  
 a. Allowances
  • Any medical listing which specifically mentions pain

  • RFC form

  • PRTF form

 
 b. Denials
  • RFC form

  • PRTF form

7.Resolution of Conflicting Medical Opinions  
 a. Allowances
  • Resolved by the determination of an allowance (SSA-831-U5)

 
 b. Denials
  • PRTF form

  • RFC Form

8.Resolution of Inconsistencies Material to Decision  
 a. Allowances
  • Personalized notice (partially unfavorable decisions - later onset date and closed period cases)

  • Resolved by the determination of an allowance (SSA-831-U5)

 
 b. Denials
  • PRTF form

  • RFC form

9.Vocational Rule Used for Medical/Vocational Decisions  
 a. Allowances
  • Item 27 on the SSA-831-U5

 b. Denials
  • Item 27 on the SSA-831-U5

10.Citation of Jobs and Incidence  
 a. Allowances
  • Not applicable

 
 b. Denials
  • Report by a Vocational specialist

11.Duration of Impairment  
 a. Allowances
  • Favorable decision would indicate duration met

 
 b. Denials
  • Regulation basis code on the SSA-831-U5 if duration is the reason for the denial

  • RFC form indicating a duration projection was made

  • Personalized notice

 
12.Assessment of Functional Abilities  
 a. Allowances
  • RFC form

  • Medical evidence

 
 b. Denials
  • RFC form

  • Medical evidence

 
13.Basis for Decision  
 a. Allowances
  • Regulation basis code (SSA-831-U5)

 
 b. Denials
  • Regulation basis code (SSA-831-U5)

  • Personalized notice

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0426516005
DI 26516.005 - Issues Requiring Rationalization/Documentation in the Disability Decisionmaking Process - 02/14/2017
Batch run: 02/14/2017
Rev:02/14/2017