PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 230 – Special IssuesSubchapter 20 – Priority CasesTransmittal No. 6, 10/04/2019
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
DI 23020.050 Disability Determination Services (DDS) Instructions for Identifying, Developing, and Processing Military Casualty/Wounded Warrior (MC/WW) Cases
23020.050.B.3.d.1., there are references DI 22511.001, .003, and .005. These three references need to be replaced with DI 24583.005.
MC/WW is a claim involving any current or former member of a military service who:
sustained an illness, injury, or wound while on active duty status on or after October 1, 2001; and
alleges a physical or mental impairment, regardless of how the impairment occurred, or where it occurred (i.e., United States or on foreign soil).
Receipt the case within two business days of field office (FO) transfer (seven business days for non-certified electronic folders).
If the FO has not added an MC/WW flag to the case, see the instructions on adding the flag, Certified Electronic Folder (CEF) Flags in DI 81020.085.
For MDF cases not flagged by the FO, attach a printable flag to the front of the folder. For a printable flag, see the Exhibit of MC/WW Flag in DI 11005.006I and click the link for “View PDF Version.”
Give MC/WW cases priority processing using the expedited terminal illness (TERI) instructions through all levels of case development and adjudication.
NOTE: Although we expedite MC/WW cases following the same procedures as TERI cases, do not use the TERI flag unless the claim meets the TERI guidelines; i.e., there is evidence of a terminal illness.
For guidance on expedited processing, see Terminal Illness (TERI) Cases in DI
Fully address and develop all physical and mental allegations, including any possible impairment(s), either referenced or implied in any of the medical evidence, or other evidence in the claimant’s file.
When requesting medical records from a Military Health System, follow these instructions:
For Developing Medical Evidence of Record (MER) from Military Health Sources, see DI 22505.023, and
For Developing Medical Evidence of Record (MER) from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Medical Facilities, see DI 22505.022.
Properly complete all required disability assessment forms:
SSA-2506-BK (Psychiatric Review Technique), and
SSA-4734-BK (Physical Residual Functional Capacity Assessment).
Work activity is primarily the responsibility of the FO. However, DDS is responsible for reviewing the FO documentation to ensure they documented the work activity appropriately. If not, DDS should contact the FO for clarification.
DDS is responsible for the documentation when work activity is clearly not substantial gainful activity (SGA). For guidance, see Clearly Not SGA in section DI 10501.025, and for Special Employment Situations, see DI 10505.025.
Obtain information about the claimant’s ADLs to determine the functional effects of the physical and mental impairment(s) on the claimant’s ability to work.
ADLs with mental impairment allegations
ADLs are important in developing claims involving mental impairments, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Adjudicators should be alert to the possibility of PTSD and TBI conditions even if they are not alleged. For information on developing claims involving mental impairments, refer to the following sections:
DI 34001.032 Mental Disorders,
24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)
ADLs with physical impairment allegations
ADLs are particularly useful in assessing how well a claimant with a traumatic injury is functioning at the time of the disability determination. For claims involving amputations(s), adjudicators should fully document the claimant’s ability or inability to use prosthetic devices effectively.
For additional information when developing ADLs with physical impairment allegations, refer to Evaluating Lay Evidence in DI 24515.012.
The development of third-party ADLs is highly encouraged in all cases, especially those involving mental impairments and traumatic injuries. For guidance, see the following sections:
DI 22511.011 Contacting Claimants and Collateral Sources,
DI 22511.007 Sources of Evidence, and
DI 22511.013 Technical Requirements When Securing Collateral Evidence.
Many of these military service members may be in transit and their addresses may have changed since the FO received their claims. For additional information on jurisdiction, see Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions for Initial and Subsequent Cases in DI 20101.001.
Be alert to the possibility of a closed period of disability as many of these claimants could have extended hospital and rehabilitation stays.
For additional information on closed periods of disability, see the following POMS sections:
DI 25510.010 Closed Period Under Title II, and
DI 25510.015 Closed Period Under Title XVI.
Follow regular processing instructions for completion of the SSA-831-C3/U3 in sections DI 26510.001 through DI 26510.095. For blindness cases, see completion of the SSA-831-U5 in sections DI 26010.001 through DI 26010.070. In addition, enter a listing code of 108 in item 26 of the SSA-831 for all MC/WW cases.
While not mandatory, it is recommended that all denied MC/WW cases receive a special review by the DDS Quality Assurance Unit or unit supervisor similar to that described in TERI Case Denials in DI 23020.045E.2.