Effective Dates: 10/18/2023 - Present

Identification Number:
DI 22501 TN 29
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Introduction - Case Development Procedures
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 225 – Case Development Procedures

Subchapter 01 – Introduction - Case Development Procedures

Transmittal No. 29, 10/18/2023

Audience

PSC: DE, DEC;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy is updating this section to clarify the definition of evidence, the types of evidence we develop for a disability claim, and when to complete development.

Summary of Changes

DI 22501.001 Disability Case Development for Evidence

In this section we:

  • •

    Added a cross reference in subsection A. for development responsibilities;

  • •

    Added a cross reference in subsection B. for the definition of relevant evidence;

  • •

    Retitled subsection C. "Evidence the DDS develops in disability claims";

  • •

    Reorganized subsection C. into three subsections, "Available prior folders", "Medical sources", and "Nonmedical sources (including claimant)", and included cross references in each subsection;

  • •

    Changed the language in the REMINDER in subsection C.1 to mirror the language in DI 20505.010;

  • •

    Added a cross reference for development in children's claims after subsection C.3;

  • •

    Retitled subsection D. "When to stop development"; and

  • •

    Added cross references to subsection D. related to conflict and inconsistency, when evidence is inconsistent but sufficient, and when a fully favorable determination is supported and not supported.

DI 22501.001 Disability Case Development for Evidence

CITATIONS:

Social Security Act - Sections 223(d), 1614(a) , 1631(e)


Regulations - 20 CFR sections 404.1512 through 404.1516, 404.1520, 404.1520b, 416.912 through 416.916, 416.920, and 416.920b

A. Purpose of case development

The Disability Determination Services (DDS) develops evidence from medical and nonmedical sources, including the claimant, to establish:

  • •

    Whether the claimant is disabled or blind;

  • •

    The date disability or blindness began, if applicable; and

  • •

    The date disability or blindness ended, if applicable.

For more information on case development responsibilities, see DI 22501.002.

B. Definition of evidence

Evidence is anything the claimant or anyone else submits to the Social Security Administration (SSA) or the DDS, or that SSA or the DDS obtains, that relates to the claim for disability benefits.

For the categories of evidence, see DI 24503.005B.

For details on what is not considered evidence, see DI 24503.001B.

For the definition of relevant evidence, see DI 24501.016B2.

C. Evidence the DDS develops in disability claims

The DDS considers and develops all relevant evidence for the claim from multiple sources including:

1. Available prior folders

For prior folder evidence development requirements, see DI 20505.010.

REMINDER: The adjudicator must review all available prior folder(s), identify the evidence that is relevant to the current claim, and copy the relevant evidence from the prior folder(s) into the current case folder.

2. Medical sources

For development of medical evidence of record requirements, see DI 22505.000.

For development of consultative examination(s) (CE) requirements, see DI 22510.000.

3. Nonmedical sources (including claimant)

For information about development requirements for the claimant and other nonmedical sources, see DI 22505.008C4 and DI 22505.008C5.

For information about developing vocational evidence, see DI 22515.000.

REMINDER: For information about developing evidence in children's claims, see DI 25205.000.

D. When to stop development

The evidence the DDS develops should be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind, the date disability or blindness began, and if applicable, the date disability or blindness ended. Complete development includes information about all alleged and discovered impairments, onset, duration, and vocational issues.

The evidence must allow the adjudicator to determine:

  • •

    The nature and severity of the claimant's impairment(s);

  • •

    Whether the 12-month duration requirement is met;

  • •

    The claimant's residual functional capacity (RFC) when steps 4 and 5 of the sequential evaluation process apply; and

  • •

    How the claimant functions on a day-to-day basis.

Development is not complete if it contains a material conflict, inconsistency, or ambiguity in the evidence, see DI 24501.016B4. However, the DDS can make a determination if the evidence is inconsistent but sufficient, see DI 24501.016C4. For children's claims, see DI 25205.005.

1. Fully favorable determination supported

Adjudicators may process a fully favorable allowance determination without conducting further development if, in the judgment of the adjudicative team, the additional evidence would not affect the allowance determination. For details, see DI 24515.020 and DI 24505.030.

2. Fully favorable determination not supported

The DDS may also discontinue development of evidence in a claim that is not fully favorable after completing each of the following:

  • •

    Reviewing and copying available and relevant prior folder evidence to the file. See DI 20505.010.

  • •

    Making every reasonable effort to obtain the available and relevant medical evidence. See DI 22505.001A2.

  • •

    Completing supplemental development, if needed. See DI 22505.008.

  • •

    Completing vocational development, if needed. See DI 22515.000.

NOTE: If the claimant fails to cooperate under DI 23007.015, discontinue all development that requires claimant cooperation (i.e., scheduling a CE, requests for evidence or action). After completing other required development (i.e., following up on overdue medical evidence, developing a complete medical history based on the sources of evidence in file, and supplemental development of evidence), make a determination based on the evidence in file using the sequential evaluation process. For further instructions, see DI 23007.000.

 

DI 22501 TN 29 - Introduction - Case Development Procedures - 10/18/2023