Identification Number:
DI 22505 TN 35
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Development of Medical Evidence of Record (MER)
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 225 – Case Development Procedures
Subchapter 05 – Development of Medical Evidence of Record (MER)
Transmittal No. 35, 10/25/2021

Audience

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

Originating Component

ODP

Effective Date

Upon Receipt

Background

We are updating this POMS section to clarify the Disability Determination Services (DDS) instructions on when to consider developing for a broader longitudinal view of the claimant’s medical history.

Summary of Changes

DI 22505.010 Developing Longitudinal Medical Evidence

We retitled this section and made significant changes to improve clarity and focus on when adjudicators should consider developing for a broader longitudinal view of the claimant’s medical history. These changes were made in conjunction with updates to:

DI 22505.010 Developing Longitudinal Medical Evidence

A. Introduction

Longitudinal medical evidence refers to medical evidence covering a significant period that documents the claimant’s medical history. In developing the record, we are particularly interested in key parts of this history:

  • Whether there is sufficient objective medical evidence establishing one or more medically determinable impairments (MDI);

  • The duration of the claimant’s MDI(s) and response(s) to treatment;

  • The severity of a claimant’s MDI(s) and resulting functional limitations; and

  • The alleged onset date (AOD); the potential onset date (POD); and, if the medical evidence establishes disability, the established onset date (EOD).

Generally, we develop medical evidence for at least the applicable 12-month period. For more information on the applicable 12-month period, see DI 22505.001A.3. (initial claims); DI 28030.020 (continuing disability reviews); and DI 23570.020 (age 18 redeterminations).

However, in order to make fair and accurate findings about the key issues listed above, we sometimes need a longitudinal view that extends beyond that provided by the standard 12-month period of development. The following subsection discusses these circumstances.

REMINDER: Adjudicators may discontinue development when the evidence is consistent and sufficient to make a fully favorable determination. For more information, see DI 24505.030.

B. Situations that may require development beyond the standard 12-month period

1. MDIs frequently requiring longitudinal evidence beyond the 12-month period

Our rules generally require that claimants follow prescribed treatment (DI 23010.000), so it is important that we consider the severity of a claimant’s MDIs during periods of stability and compliance with treatment. Assessing the effects of MDI(s) over a significant period is sometimes necessary to make accurate findings on duration, residual functional capacity, and the disability onset date.

Some cases involve MDIs having periods of fluctuating severity in symptoms and functional effects as part of the ongoing disease process; after acute events; or during periods of trials with therapies, medications, and dosages. In order to make fair and accurate findings in such cases, we may need a longitudinal picture that extends beyond the standard 12-month period. This view of evidence over a longer period often includes previous symptom severity patterns and responses to treatment. These can help us make a better judgment about probable ongoing severity.

Examples of such MDIs:

NOTE: This list is not all-inclusive. Nor does it mandate development beyond the standard 12-month period in every case in which these MDIs are present. The need to develop for evidence beyond the standard 12-month period is a case-by-case judgment that must be guided by the ability to make fair and accurate findings based on the record before the adjudicator.

2. Unavailable folders for prior claims

When there are prior claims, review all available prior folders (paper or electronic) and copy, scan, or fax relevant evidence to the current folder. For more information on disability determination service (DDS) responsibilities for prior folders, see DI 20505.010. See also DI 24501.016B.2. for more information on relevant evidence.

If any prior folders are unavailable, consider the need to develop for longitudinal medical evidence beyond the standard 12-month period in accordance with the guidance in this section.

REMINDER: The review of prior claim folders must include prior allowances ceased for medical or nonmedical reasons (such as incarceration, excess income and resources, or failure to cooperate).


DI 22505 TN 35 - Development of Medical Evidence of Record (MER) - 10/25/2021