TN 2 (09-21)

DI 27001.010 Development of Medical Evidence of Record (MER) at the Reconsideration Level

A. MER development at the reconsideration level

The DDS makes accurate and complete reconsideration determinations that include sufficient evidence to assess impairment severity and limitations.

The reconsideration process involves a thorough, independent examination of all evidence of record, including any new evidence received after the initial determination. The person reviewing the case makes an independent reconsideration determination, based on the evidence of record. The examiner and physician must be different from the reviewers who made the initial determination.

B. Evidence - MER policies - General

1. General MER policies

  • The rules that apply for developing evidence at the initial level also apply at the reconsideration level of review. However, disability examiners must submit MER requests to sources that were contacted, but did not submit MER, at the initial level, see DI 22505.001

  • For additional instructions on MER development, see DI 27001.001E.2. — The Reconsideration Process.

2. Prior folder

  • If the DDS determines a folder from a prior filing is necessary to adjudicate the reconsideration review, the DDS must request the prior folder, see DI 20505.010.

3. Requesting evidence

  • For example-- If the evidence mentions a recent hospital discharge, the adjudicator must request updated records and consider a change in circumstance.

  • Request medical evidence from each medical source that the claimant identifies as having evaluated, examined, or treated him or her, see DI 22505.006.

  • Develop all evidence related to the claimant's impairment(s). Do not develop evidence clearly unrelated to the impairment(s), such as routine dental care.

4. Developing functional information

  • Contact the claimant during reconsideration development to determine if there have been any changes since the last filing. If the initial claimant reports are current, there is no need to request additional reports. The adjudicator must consider any allegations of worsening impairment and clarify the finding with the claimant.

5. Consultative Examination (CE) development

  • The determination must contain sufficient evidence to assess impairment severity.

  • If a claimant’s medical source(s) cannot or will not provide sufficient medical evidence about a claimant’s impairment(s), you may purchase one or more CEs.

6. When to process a Failure To Cooperate (FTC) determination

  • The reconsideration determination is independent of the initial determination. The reconsideration level determination is not based on FTC issues at the initial level.

  • The reconsideration determination is a de novo review, the examiner has to go through all of the appropriate steps of development.

  • Provide the claimant all necessary opportunities to cooperate at the reconsideration level.

7. Sufficiency of Medical Evidence

  • Sufficiency of medical evidence must be considered during the additional adjudicative period of the reconsideration process. See DI 22511.009.

  • For additional instructions on MER development, see DI 27001.001E.2. — The Reconsideration Process.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427001010
DI 27001.010 - Development of Medical Evidence of Record (MER) at the Reconsideration Level - 09/08/2021
Batch run: 09/09/2021
Rev:09/08/2021