If you determine a claimant meets, medically equals, or functionally equals the Listings
at step 3, and there is evidence of all three conditions listed in DI 23010.009 Necessary Conditions to Make a Failure to Follow Prescribed Treatment Determination,
make an FTFPT determination (unless one of the below exceptions apply). Generally:
Step 3
Claim Type
|
Assessment
|
Action
|
An adult or child claim
|
Either:
-
•
We would not expect the prescribed treatment, if followed to reduce the severity of
the individual's impairment (s) to the extent that the impairment(s) would no longer
meet, equal, or functionally equal the Listings; or
-
•
A good cause exception applies.
|
Allow the claim.
|
An adult claim
|
Both:
-
•
We would expect the prescribed treatment, if followed to reduce the severity of the
individual's impairment(s) to the extent that the impairment(s) would no longer meet,
equal, or functionally equal the Listings; and
-
•
No good cause exception applies.
|
Proceed to the next step in the sequential evaluation process by determining the individual's
residual functional capacity (RFC).
|
A child claim
|
Both:
-
•
We would expect the prescribed treatment, if followed to reduce the severity of the
individual's impairment(s) to the extent that the impairment(s) would no longer meet,
equal, or functionally equal the Listings; and
-
•
No good cause exception applies.
|
Deny the claim.
|
Exception 1:
Allowance
based solely on laboratory findings
If you determine a claimant meets, medically equals, or functionally equals a Listing
at step 3 based on a listing that requires only the presence of laboratory findings,
do not make an FTFPT determination. Allow the claim.
Current examples of Listings that can be met based solely on laboratory findings include:
-
-
-
•
11.10
– amyotrophic lateral sclerosis (ALS)
Exception 2: Adherence to prescribed treatment
has
been
considered
We will not make an FTFPT determination when we find the individual is disabled based
on a listed impairment which requires us to consider whether the individual was following
that specific treatment as part of the required listing analysis. If you already considered
and determined that the individual was following the prescribed treatment required
by a listing during your step 3 analysis, do not make an FTFPT determination about
that same treatment. Allow the claim.
Current examples of Listings that include consideration of prescribed treatment during
the step 3 analysis include:
-
-
•
4.10 - aneurysm of aorta or major branches
-
•
6.06 - nephrotic syndrome
-