TN 20 (09-90)
DI 28055.020 Identifying EPE Cases Which Require A DDS Determination
1. ODIO/PSC-DRS Screening
ODIO/PSC-DRS reviews a case when a person is about to complete or has completed the TWP to determine if the person meets the criteria described in DI 28055.020B. This test permits the examiner to screen out cases where a DDS review is unnecessary because the impairment(s) is clearly disabling.
If the person meets the criteria, ODIO/PSC-DRS completes Form SSA-899-U2 (Continuing Disability Review) or annotates the Form SSA-833-U3 SGA determination in file with the remark “No Medical Issue”.
If the person does not meet the criteria,ODIO/PSC-DRS will advise the FO that the DDS needs to prepare a medical determination.
2. FO Referrals
ODIO/PSC-DRS generally refers work activity investigation cases to the FO via Form SSA-5526-U3. Cases are routinely sent to FO when it appears that a TWP has been or will be completed. These requests usually advise the FO whether “no medical issue” exists or whether a DDS medical determination is necessary.
3. FO Role
Unless an MIE diary is involved, the FO will prepare an Form SSA-833-U3 SGA determination before sending a case to the DDS. When ODIO/PSC-DRS indicates that a medical determination is needed,or there is no evidence of an ODIO/ PSC-DRS review,the FO will conduct a personal interview.
4. DDS Referrals
After the personal interview, the FO will refer the case to the DDS. The FO will annotate the Form SSA-408 with the remark “EPE Case.”
A person is screened out as “currently disabled” in the following situations:
1. Recent CDR
If a CDR was conducted within the 12-month period preceding the current medical folder review.
2. Medical Criteria
If his or her condition meets one of the following criteria:
Permanently disabled as explained in DI 26525.040.
Impairment (or combinations of impairments) currently meets or equals the criteria in the Listing of Impairments.
NOTE: Some medical listings require current,recent, or persistent symptoms or findings to support a conclusion that the listing is met/ equalled. For example, chronic anemia meets listing 7.02A if the person has one or more blood transfusions on the average of at least one every 2 months. Where such a case was allowed as meeting the listing, current information about blood transfusions would be necessary to verify the individual's condition currently meets the listing.
The allowance or most recent determination was based on vocational factors coupled with a medical condition which results from an anatomical loss or is otherwise irreversible,(e.g., deafness which is near total-not correctable) and there is no change in the person's vocational skills.
EXAMPLE: In a vocational allowance in which the impairment consists of the loss of a limb,such a person would be considered permanently impaired, but not necessarily permanently disabled, since a change in vocational skills could result in a finding of “not disabled”. However, in the absence of information that a change in vocational skills has occurred, the individual can be considered currently disabled.