DI 43530.025 Disability Cases--FAM 241.6-3
An applicant for social security disability benefits must furnish medical evidence in support of a claim. On occasion, SSA will ask the post to obtain medical evidence at SSA's expense. Such requests will be made on Form SSA-423-U6, Request for Services (Foreign Disability Case). The request will indicate the type of examination, special tests, or additional information needed and at whose expense it is to be obtained.
Posts should arrange to obtain such evidence as soon as possible. If it is not possible to obtain the evidence within 90 days from the date on the Form SSA-423-F6 the facts should be reported by operations memorandum addressed to SSA.
Additional supplies may be requested directly from SSA by operations memorandum. (See FAM 241.8-1b for other social security forms stocked by all posts.)
Persons who visit the post to inquire about filing a claim for social security benefits should be given an SSA-784F (Retirement or Disability Insurance) or SSA-485 (Questionnaire Regarding Survivors Insurance Benefits), whichever is appropriate. Both forms ask for the worker's social security account number which should be copied from the person's social security account number card, if available. Otherwise, the number may be copied from other documents, such as the W-2, Wage and Tax Statement, a copy of the worker's tax return, etc. Every reasonable effort should be made to locate the correct number.
Care should be taken to provide as complete and exact information as possible on the questionnaire, including the full names of parents, exact place of birth, etc. These details will enable SSA to take prompt action on the inquiry.
The post should assist the claimant in preparing the form if assistance is needed. While the form may be completed in the local language since SSA has a translation service, the post should advise the claimant that completion of the form in English may result in an earlier reply.
The post should check all questionnaires for accuracy and completeness and then forward them to SSA, P.O. Box 17769, Baltimore, Maryland 21203, U.S.A. Correspondence should be sent by international airmail at the claimant's expense. No reference to the Department of State or Office of Special Consular Services should appear on the envelope.
Subsequent correspondence normally will be handled directly between the claimant and SSA. If the claimant later requests aid in completing additional forms, the post will render assistance and advice on the types of documentary evidence which may be submitted to prove age, death, marriage, divorce, dependency, or other facts.
If a medical examination is requested by SSA, the post should ascertain whether the applicant's physician is a duly-licensed member of the medical profession in good standing and professionally qualified in the specialty covered in the examination report.
The report of medical examination:
Should be furnished in the form of a narrative summary containing sufficient details as to the pertinent history, clinical and laboratory findings, therapy administered, functional capacities before and after therapy and diagnosis in order to enable SSA to determine the nature and severity of impairment as well as the residual functional capacities of the individual; and
Under no circumstances is to be shown to or discussed with the applicant or any unauthorized individual. The examining physician or medical facility should be cautioned in this regard.
If a supplemental report from the applicant's medical source is needed, the request will state what additional information is required. The physician or other source should be told that it is the applicant's responsibility to provide the additional evidence at the applicant's own expense unless otherwise specified. SSA will furnish a photocopy of the original report for use in obtaining supplemental data.
B. Field investigations
Determinations of disability are not based solely on medical evidence. Facts relating to an applicant's personal and vocational background must be taken into consideration.
SSA may, therefore, ask a post to make an investigation of certain background or nonmedical factors. “Nonmedical” areas of inquiry may include any of the following: the applicant's educational background, work experience and skills, job adaptability, daily activities, reaction to impairment, social or mental adjustment, family or social environment, or economic and industrial conditions in the community.
SSA will specify the nature and extent of the nonmedical investigation required. Any facts or circumstances noted in the course of the investigation which appear to be inconsistent with the alleged disability or which indicate capacity to engage in substantial work activity should be reported. In addition, certain events may occur subsequent to the approval of a disability application which may require investigation to determine whether the applicant's disability continues or has ceased to exist.
C. Travel expenses
In some unusual situations, it may be necessary, because of the applicant's physical condition or possible risk to health, to have the applicant examined or interviewed at home or transported to the place of examination. All expenses, including overnight accommodations, when required, will be reimbursed by SSA.
If the circumstances require that a companion accompany the applicant to the place of examination, the travel and related expenses of such companion will also be payable by SSA. Similarly, travel and related expenses including per diem, incurred by Foreign Service personnel in the performance of a field examination or other requested service, shall be chargeable to SSA.
Any travel in connection with such cases shall be performed in accordance with 6 FAM 100. When travel in connection with a proposed examination would entail substantial costs, however, the post shall consider all alternative means of obtaining the information and respective costs.
D. Charges for services
Expenses in connection with the performance of services in disability cases will be authorized either when the original request is made, or later as circumstances dictate. In many instances, payment for expenses will be the claimant's responsibility, in which event SSA will so specify in its letter of authorization. SSA will not specify the exact amount to be spent because costs vary throughout the world. All charges must, of course, be reasonable and customary and not in excess of prevailing costs for such services in the locality concerned. Costs of travel for claimants, local attendants, or physicians shall not exceed those which the persons concerned would incur were they traveling at their own expense.
E. Payment procedures
Payments in connection with disability cases for which expenditures have been authorized by SSA shall be made in accordance with 4 FAM 335. Requests for services sent to the post will show the appropriation number, allotment and organizational codes, and a control number for use by the post in preparing vouchers. Copies of paid vouchers should be mailed to: SSA, Division of Finance, OFR, OMBP, P.O. Box 47, Baltimore, Maryland 21203.
F. Report of direct expenditures
Form SSA-423 includes data on direct expenditures for medical development. When medical evidence is obtained at SSA's expense, the bottom portion of Form SSA-423 should be completed by checking the appropriate boxes and indicating the amount spent in U.S. dollars. If the actual amount is not known at the time the case is otherwise completed, an estimate should be used, since the figures are for administrative and program analysis use only, not for audit purposes. It is not necessary to submit corrections of estimates. In supplemental request cases, only additional expenditures need be reported. A copy of the completed Form SSA-423 should be returned with the medical report.