TN 4 (10-15)
DI 28040.120 Contact with Medical Source(s) in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases
A. Using telephone contact to expedite the determination
MINE or MINE-equivalent impairments are considered permanent. Therefore, extensive current medical development is not needed. However, the disability determination services (DDS) must contact a current medical source when possible. The DDS may obtain evidence quickly for expedited processing by telephone contact with the medical source, or the source’s representative (e.g., nurse, secretary, etc.). If no medical source is available, see DI 28040.125.
This section contains information specific to continuing disability reviews (CDRs) and MINE or MINE-equivalent impairments. However, general information on obtaining medical evidence by telephone is located in DI 22505.030.
B. Explaining the reason for contacting the source
When speaking with a medical source:
Identify yourself as an employee of an agency of the disabled individual's State, calling on behalf of the Social Security Administration (SSA).
Explain that we are conducting a CDR as required by law, and that we have permission from the individual or payee to contact them to verify current impairment severity.
Explain a summary of the source’s statement will be prepared and sent for the source’s review and signature, along with a copy of the individual’s permission.
NOTE: If required, mail or fax a copy of the signed SSA-827 (Authorization to Disclose Information to the Social Security Administration) to the source. Re-contact the source in 5 days if mailed, or as soon as possible after faxing.
The DDS should mail a request for medical information if requested by the medical source or, if the DDS experience shows, the source will not honor a request by telephone or fax. Include the SSA-827 with the request using the local DDS cover letter.
C. Requesting a medical source’s statement
Ask the medical source to make a statement concerning primary findings that relate directly to the MINE or MINE-equivalent impairment. Detailed information should not usually be required or asked for in these cases, since the basic purpose of the development is minimal verification that the MINE or MINE-equivalent impairment still exists and that none of the impairment related exceptions to the medical improvement review standard exists. For example, a brief statement that visual acuity remains at 20/200 or less in the better eye for a statutorily blind individual, or a brief statement that the patient is cyanotic at rest and requires supplemental oxygen where listing 3.02 was met should be adequate for these impairments. Refer to the developmental guideline in DI 28040.130 for additional examples of questions related to the impairment.
D. Preparing the CDR determination while waiting for the signed statement
Prepare a summary of the medical source’s statement (using Form SSA-795 or other locally approved form), and forward it to the source for review and signature; include a business reply envelope. The DDS may process a favorable CDR determination, based on the telephone contact without waiting for the signed statement. However, follow-up and obtain the signed statement to associate with the case, as this is a critical part of the process and serves as documentation for future CDRs.
The DDS will include the source’s statement, if received prior to completing the case, in the file. When receiving evidence in certified electronic folder cases, see DI 81020.060. The DDS will process statements or other evidence received after the determination as “trailer material” in accordance with instructions in DI 28030.040.
E. Payment for the medical source’s statement
If a medical source contact requires payment, arrange as appropriate per the established fee schedule.