TN 10 (07-23)

DI 28040.125 Determining the Need for a Medical Source or Third-Party Contact in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases


A. Introduction to sources in MINE and MINE-equivalent cases

The disability determination services (DDS) must contact a current medical source when possible. However, DDS may use other third-party contacts if there is no medical source and certain conditions are met. The actions required in these cases depend on the nature of the impairment(s) and on the availability of other knowledgeable third parties who can verify the beneficiary or recipient statements. The main purpose of the third-party contact is to verify the continued severity of the impairment(s) as alleged by the disabled individual.

B. Is a medical source needed?

1. Medical source not available; third-party contact not necessary

The DDS should contact current medical sources, if available. However, there are certain impairments which may not require frequent medical attention, but are nonetheless so obviously severe that full continuing disability review (CDR) development is not necessary. In these cases, and after ensuring no work issues exist, the DDS may process a continuance based on the evidence in the folder and the contact with the beneficiary or recipient if no medical source is available for verification.

The DDS may prepare a continuance based on the evidence in the folder, if the beneficiary or recipient, representative payee, or representative indicates that there is no medical source and the folder clearly establishes one of the following impairments. A non-medical third-party contact is not required in these cases.

The specific impairments are:

  1. a. 

    Amputation of both hands (Listing 1.05A, 101.05A; Listing 1.20A, 101.20A)

  2. b. 

    Amputation of leg at hip (Listing l.05D, 101.05D; Listing 1.20B, 101.20B)

  3. c. 

    Statutory blindness; except if due to cataracts, detached retina, keratoconus, corneal scar opacity or vitreous hemorrhage (Listing 2.02, 2.03A, 102.02, 102.03A).

  4. d. 

    Loss of visual efficiency (visual efficiency of better eye after best correction 20 percent or less) (Listing 2.04); except if due to cataracts, retinal detachment, keratoconus, corneal scar opacity, or vitreous hemorrhage.

  5. e. 

    Hearing loss not treated with cochlear implantation (Listing 2.10). The disability examiner should be alert to situations where surgery such as stapedectomy, or cochlear implantation have improved the individual’s ability to hear. In such cases, a current personal contact interview is required.

  6. f. 

    Severe intellectual disability, with manifestations as required by the applicable listing (12.05A or B, 112.05A).

2. Medical source contact is mandatory

For some MINE impairments, the lack of a medical source may indicate some possibility of improvement. For the diagnoses given below, if the beneficiary or recipient cannot provide any medical source for verification of continued impairment severity, refer the case, to the field office (FO) with a request to initiate a full CDR with a personal contact. If the FO is aware of some compelling reason not to complete the CDR, it may be deferred under the regular deferral procedures outlined in DI 28003.010.

The specific impairments are:

  1. a. 

    Ischemic Heart Disease with Chest Pain of Cardiac Origin ( Listing 4.04 A or B);

  2. b. 

    Peripheral Arterial Disease (Listing 4.12);

  3. c. 

    Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis (Listing 6.03, 106.03); Chronic kidney disease, with impairment of kidney function (Listing 6.05);

  4. d. 

    Diabetes Mellitus with manifestations as required by the applicable listing;

  5. e. 

    Age 55 and over with Major Dysfunction of a Joint(s) (due to any cause) (Listing 1.02A; 1.18);

  6. f. 

    Age 55 and over with Ischemic Heart Disease (Chest Pain of Cardiac Origin) (Listing 4.04C); or

  7. g. 

    Age 55 and over with two substantiated Myocardial Infarctions.

3. Non-medical third-party contact when a medical source is not available and the medical source contact is not mandatory

If the beneficiary or recipient reports no medical sources, and the diagnosis is not one of those listed in DI 28040.125B.1. or DI 28040.125B.2. in this section, the DDS must contact any third-party the beneficiary or recipient believes can verify their statements. When there is no other non-medical third-party, see DI 28040.125B.4. A signed permission to contact a non-medical third-party is not necessary.

Contact any non-medical third-party that has knowledge of the beneficiary or recipient's condition and can provide an objective assessment of the condition.

Non-medical third-party contacts may include:

  • Custodial institutions,

  • Sheltered workshop administrators,

  • Schools or organizations for persons with the same type of impairment as the individual,

  • Social service organizations that provide some form of assistance,

  • Members of the clergy,

  • Caretaker organizations,

  • Family members, and

  • Neighbors.

Explain to the third-party that we are conducting a CDR on the beneficiary or recipient as required by law. Assure the person that we have permission from the beneficiary or recipient to contact them. Do not tell the third party any information about the beneficiary or recipient other than that we are conducting a CDR. Ask the contact how recently they saw the beneficiary or recipient, and whether the person remains impaired and unable to work or, in a Title XVI child case, unable to return to normal activities.

Prepare a summary of the statement (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 cannot complete a determination (if the determination is based on the non-medical third-party statement) prior to receiving the statement back from the non-medical third-party source. If the third-party statement:

  • Verifies the beneficiary or recipient's statements, the DDS may process a continuance.

  • Creates a continuing disability issue, the DDS should send the case to the FO for a full CDR in accordance with DI 28040.215.

  • Is not received by 14 calendar days from the date of the cover letter, follow up with the non-medical third-party contact via telephone. If applicable, return the case to the FO in accordance with DI 28040.125B.4. in this section, or schedule a consultative examination if possible.

The DDS will include the third-party statement in the folder if it is received prior to completing the case. When receiving evidence in certified electronic folder (CEF) cases, see DI 81020.060. The DDS will process statements or other evidence received after the determination as “trailer material”, see DI 81020.140.

4. Referral to the FO when a non-medical third-party is not available

In rare situations, the FO may serve as the non-medical third-party in cases where:

  • There is no medical source available;

  • A third-party contact who can confirm the beneficiary or recipient's statement(s) is necessary but not available; and

  • The impairment is not listed in DI 28040.125B.2. in this section.

In these instances, send an assistance request to the FO requesting a field office contact and documentation of their findings. Indicate what specific observations would be helpful and provide specific questions for the FO to ask the beneficiary or recipient, or a third party (for example, neighbor) based on the impairment involved and the beneficiary, recipient or representative payee's statement. For more information on field contacts, see DI 13005.110C.

C. References

  • DI 13005.030 Field Office (FO) Personal Contacts and Exceptions

  • DI 22510.005 When to Purchase a Consultative Examination (CE)

  • DI 28003.010 Deferrals of Continuing Disability Review (CDR) Process

  • DI 28030.020 Development of Medical Evidence

  • DI 28030.040 Disposition of Trailer Material

To Link to this section - Use this URL:
DI 28040.125 - Determining the Need for a Medical Source or Third-Party Contact in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 07/31/2023
Batch run: 07/31/2023