In the unusual circumstance when despite a complete and comprehensive clinical examination and description of activities of daily living, you are unable to assess whether a claimant has the ability to function in a competitive work environment on a sustained basis, consider ordering a work evaluation. Generally, we use a work evaluation in connection with the last two steps of the sequential evaluation process, to help us determine the nature and extent of the physical and mental abilities that the individual retains in a work setting.

In limited circumstances, we may also use work evaluations to help determine or resolve the level of severity of a mental impairment, where, after comprehensive development, findings are still inconclusive about the claimant's ability to perform activities of daily living, maintain social functioning, etc.

These guidelines apply to disability cases at all levels of adjudication.

A qualified work evaluation source is one recognized (e.g., licensed) by a:

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  State government agency, or

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  Federal government agency, or

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  nationally recognized accrediting organization.

NOTE: A work evaluation source may also be qualified by training, experience or recognized specialization.

You may not use in the disability program any work evaluation source that:

1. 1. 

   is excluded, suspended, or otherwise barred from participation in any Federal or federally-assisted program.

2. 2. 

   has been convicted, under Federal or State law, in connection with the delivery of services, of fraud, theft, embezzlement, breach of fiduciary responsibility or financial abuse.

3. 3. 

   has had its license to provide services revoked or suspended by any State licensing authority for reasons bearing on professional competence, professional conduct, or financial integrity.

4. 4. 

   has surrendered such a license while formal disciplinary proceedings involving professional conduct are pending.

5. 5. 

   has had a civil monetary assessment or penalty imposed for any activity described herein or as a result of formal disciplinary proceedings.

Make payments to sources in accordance with CFR §§ 404.1624 and 416.1024 (Medical and other purchased services).

See Also:

DI 39545001 Purchased Medical Services – Introduction

DI 39545.600 Fee Schedules

All implications of conflict of interest between SSA adjudicators (or reviewers) and work evaluation sources must be avoided.

See Also:

DI 39569.100 Conflict of Interest

DDS is responsible for establishing and maintaining the following:

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  Recruit qualified sources.

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  Review the qualifications of sources, including determining what agencies, organizations and geographic areas a source normally serves.

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  Decide which sources are best able to provide the services needed to conduct proper work evaluation.

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  Maintain a good working relationship with sources of work evaluations.

Obtain a complete picture of the facility's scope and operation to determine the appropriateness of referral in the case. For example, do not refer a claimant whose impairments are primarily physical, to a source servicing principally those with intellectual disabilities or emotionally disturbed clients.

Sources may specialize in services for:

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  children,

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  hearing and speech problems,

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  the blind or visually impaired,

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  persons with neuropsychiatric problems, or

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  physical medicine and rehabilitation.

Discuss the referral with a DDS medical consultant (MC) in any case where there may be a medical question as to the claimant's ability to undergo the testing or work evaluation.

Consult with the claimant’s physician to obtain his or her opinion regarding potential medical contraindication. Document the MC’s resolution of the issue(s).

IMPORTANT: If the MC directly consults with the claimant’s physician to obtain his or her opinion regarding potential medical contraindication, the MC must document resolution of the issue(s).

Explain to the claimant:

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  the reason for the evaluation.

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  what he or she can expect from the work evaluation.

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  about any travel involved.

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  estimated length of stay.

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  what he or she should bring.

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  that we will pay for travel, food and lodging while he or she is being evaluated.

If the claimant alleges inability to travel without a companion or attendant services, pay such expenses if it the:

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  expenditures are necessary, and

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  anticipated cost is reasonable.

Schedule the work evaluation as close to the claimant's home as possible.

If there is no source available in the desired locality, make reasonable arrangements for the claimant to travel to the closest suitable source.

Use a work evaluation source in a neighboring State where necessary.

Arrange for payment for food and lodging when the claimant must stay away from home. Use work evaluation facilities that have a boarding arrangement, if possible, as this is less expensive than motel accommodations and the boarding facility may have experience dealing with impaired persons.

Furnish the work evaluation source with:

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  all available medical and vocational information.

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  a detailed explanation of the questions the evaluation is expected to resolve.

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  the specific information that the DDS needs to more accurately determine the claimant's RFC.

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  the claimant's prescriptions for medication (if any).

Inform the source at the outset of the provisions of the Privacy Act concerning the necessity for maintaining confidentiality of information about claimants for disability insurance benefits.

NOTE: The report should avoid rendering conclusions on the ultimate issue of disability, which necessarily entails legal and administrative considerations reserved to the agency responsible for administering the program.