BASIC (03-10)

DI 27021.005 Reconsideration Documentation and Supplemental Rationale Preparation

The chart below shows the evidence source issues that require documentation and rationalization in the disability decision process. If the Disability Determination Services (DDS) discovers that a required evidence source was not documented during the prior determination, follow the instructions under “Action Required if Not Already in File” to prepare a supplemental rationale.

 

Evidence Sources

Where Usually Documented In File

Action Required If Not Already In File

1.

a. Allowances

Medical evidence

Personalized notice (partially unfavorable decisions)

 

b. Denials

Medical evidence

Personalized notice

 

2.

Allegations

  

a. Allowances

SSA-3441-BK (Disability Report-Appeal)

Report of Contact (SSA-5002)

SSA-795 (Statement of Claimant or Other Person)

Personalized notice (partially unfavorable decisions)

 

b. Denials

SSA-3441-BK (Disability Report-Appeal)

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

SSA-416- Case Analysis

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 27021.015D. (closed period cases only)

b. Denials

Regulation basis code (SSA-831-U5)

Personalized notice

In some cases, the PRTF and RFC form

See items 6, 7 and 8

6.

Pain-Related Issues

  

a. Allowances

RFC form

PRTF

ADL’s

Pain Questionnaire

Medical Evidence

Symptom Evaluation

 

b. Denials

RFC form

PRTF

ADL’s

Pain Questionnaire

Medical Evidence

Symptom Evaluation

Supplemental rationale - see DI 27021.015E.

7.

Resolution of Conflicting Medical Opinions

  

a. Allowances

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

Medical Evidence

Symptom Evaluation

 

b. Denials

RFC form

PRTF

Medical Evidence

Symptom Evaluation

Supplemental rationale - see DI 27021.015A.

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

RFC form

PRTF

Supplemental rationale - see DI 27021.015B.

9.

Vocational Rule Used for Medical/Vocational Decisions

  

a. Allowances

Item 27 on the SSA-831-U5

Supplemental rationale - see DI 27021.015G.

b. Denials

Item 27 on the SSA-831-U5

Supplemental rationale - see DI 27021.015G.

10.

Citation of Jobs and Incidence

  

a. Allowances

Not applicable

 

b. Denials

Report of Vocational Analysis

Supplemental rationale - see DI 27021.015H.

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/0427021005
DI 27021.005 - Reconsideration Documentation and Supplemental Rationale Preparation - 04/07/2017
Batch run: 04/07/2017
Rev:04/07/2017