BASIC (03-86)

DI 43535.020 Development Request to DDS

Under the terms of the international agreements, foreign countries should specifically request either that SSA develop MER or schedule a consultative examination (CE). When a CE is requested, the foreign agencies should provide us with detailed information as to the types of tests and examinations that are required. However, there is a marked difference in disability practices from country to country. Many of the requests we receive will be vague and non-specific. The disability examiner must, therefore, determine from the foreign medical request and/or physician's statements what tests and examinations are required to evaluate the claimant's impairments. If the claimant's alleged impairment(s) appears to be slight or inconsistent, the examiner may call the claimant directly for more information about the nature of the claimant's impairment(s). If the effort is not productive, and there is no clear-cut indication of the claimant's specific impairment(s), the examiner may simply ask the DDS to schedule a complete physical examination by an internist. As discussed below, it may be desirable to ask the DDS to contact the claimant before determining what type of CE is necessary.

If a claimant has alleged impairments in two body systems, or has indicated there are multiple impairments, the examiner should, as a general rule, request a complete physical examination by an internist. Whenever possible, the examiner should try to obtain the information needed by the foreign country through the results of one examination. This, of course, does not preclude, where indicated, obtaining a specific examination such as cardiological, orthopedic, or psychiatric, etc. It is in these situations that the examiner must use his or her ability and knowledge. Depending on the circumstances of the case, it may prove productive to ask the DDS to contact the claimant to clarify the nature of the impairment(s) and to ascertain what type of examination, tests, etc., may be indicated. In such cases, make clear to the DDS that generally only one CE is to be obtained. The DDS should be encouraged to telephone INTPSC to discuss whether additional examinations, tests, etc., may be required.

NOTE: If a specific examination is requested by a foreign agency, the examiner will obtain exactly that type of examination. This policy must be followed regardless of any information in SSA files that indicates the individual has a different impairment. SSA will not question the development expertise of any foreign agency. For example, if evidence in SSA files shows a claimant in benefit status with a period of disability established on the basis of findings in a psychiatric examination, and the foreign agency requests a neurological examination, the examiner will obtain the neurological examination. The totalization module will, as a routine procedure, forward a copy of such evidence as the psychiatric examination in the example above, or any other medical information in the folder, to the foreign country.

Where adequate medical evidence is available in a prior folder and the evidence is not more than one year old, the examiner should staple the material to the front of the folder and return it to the totalization module, Attn: Liaison Clerk. The liaison clerk will photocopy the material and forward it to the foreign agency. Foreign agencies have agreed to accept medical evidence up to a year old.

In rare instances, the examiner may find that the English interpretation of the foreign medical information is not consistent with our medical terminology, or the translation of a specific word or phrase is not clear. When it becomes necessary to verify a translation, the examiner should define the problem for the translator and forward the folder for additional review and interpretation to the Chief, Central Translation Section, INTPSC.

If the examiner is requesting medical evidence of record, a current authorization to release medical information to SSA must be in file, e.g., SSA-827, or SSA-L827F. Where there is no consent statement in file, the examiner may contact the claimant directly to obtain the SSA-827 consent statement. If the data pertaining to the claimant's treatment sources is insufficient, the examiner may also ask for information about the claimant's medical records at the same time.

Requests to the DDS will be prepared on Form SSA-847-U3 using a “1-P-48” identification code. (See DI 43535.025 for completion of this form in medical development requests for foreign countries.) The original copy of the SSA-847-U3 will be forwarded to the DDS along with copies of any additional material pertinent to the DDS medical development. The folder copy will be filed inside the folder as usual.

After the SSA-847-U3 is released, the examiner will return the folder to the totalization module while the evidence is being developed. Because of the sensitive nature of the foreign medical requests, a brief diary period is in order. The initial diary (by means of an SSA-382-U2 (see DI 43520.015 for completion)), will be for 60 days. One followup will be made in 30 days. If the DDS does not respond to the medical request, the examiner will telephone the DDS for status. If the DDS does not respond to the request for medical evidence within 90 days, refer the problem to the disability examiner consultant.