TN 4 (10-15)

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 individuals' 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 which are nonetheless so obviously severe that full continuing disability review (CDR) development is not necessary. In those cases, and assuming no work issues exist, the DDS may process a continuance based on the evidence in file and the contact with the individual if no medical source is available for verification.

The DDS may prepare a continuance on the evidence of record, if the individual, payee, or representative indicates that there is no medical source and the file clearly establishes one of the following impairments. A nonmedical third party contact is not required in these cases. The specific impairments are:

  1. Amputation of both hands (1.05A, 101.05A)

  2. Amputation of leg at hip (l.05D, 101.05D)

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

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

  5. Hearing loss not treated with cochlear implantation (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. Severe intellectual disability, with manifestations as required by the applicable listing (12.05A or B, 112.05B)

2. Medical source contact mandatory

For some MINE impairments, the lack of a medical source may indicate some possibility of improvement. For the diagnoses given below, if the individual cannot provide any medical source for verification of continued impairment severity, refer the case, as instructed in DI 28040.125B.4. in this section, 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. Ischemic Heart Disease with Chest Pain of Cardiac Origin (4.04 A or B)

  2. Peripheral Arterial Disease (4.12)

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

  4. Diabetes Mellitus with manifestations as required by the applicable listing

  5. Age 55 and over with Major Dysfunction of a Joint(s) (due to any cause) (1.02A)

  6. Age 55 and over with Ischemic Heart Disease (Chest Pain of Cardiac Origin) (4.04C)

  7. Age 55 and over with two substantiated Myocardial Infarctions

3. Nonmedical third party contact when medical source is not available and medical source contact is not mandatory

If the individual 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 should contact any third party the individual believes can verify his or her statements. A signed permission to contact a nonmedical third party is not necessary.

Contact any nonmedical third party that has knowledge of the individual's condition and can provide an objective assessment of the individual's condition. Nonmedical 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.

Explain to the third party that we are conducting a CDR on the individual as required by law. Assure the person that we have permission from the individual to contact them. Do not tell the third party any information about the individual other than that we are conducting a CDR. Ask the contact how recently he or she saw the individual, and whether the individual 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 nonmedical third party statement) prior to receiving the statement back from the nonmedical third party source. If the third party statement:

  • Verifies the individuals 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 nonmedical 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 file, 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”.

4. Referral to FO when a nonmedical third party is not available

In rare situations, the FO may serve as the nonmedical third party in cases where:

  • There is no medical source available.

  • A third party contact who can confirm the individual'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 contact and documentation of their findings. Indicate what specific observations would be helpful, and provide specific questions for the FO to ask the individual or a third party (e.g., neighbor) based on the impairment involved and the individual's or payee's statement. For more information on field contacts, see DI 13005.110C.

C. References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428040125
DI 28040.125 - Determining the Need for a Medical Source or Third Party Contact in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 10/13/2015
Batch run: 10/13/2015
Rev:10/13/2015