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

    Where Usually Documented In File Action 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)

  • Supplemental rationale - see DI 26516.010 D. (closed period cases only)

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