Disability Determination Services (DDS)
If you are unable to make reasonable inferences about the severity of the impairment
based on the evidence in file, and additional relevant medical evidence is not available,
explore other sources of documentation. Do not routinely consider the first day the
claimant was seen by a medical provider as the onset date for a non-traumatic impairment.
Obtain information from family members, friends, and employers to determine why medical
evidence is not available for the pertinent period and to furnish additional evidence
regarding the course of the claimant’s condition. This additional third-party evidence
can provide insight that would help in pinpointing the exact onset. For more information
on contacting collateral sources, see DI 22511.011D.2. If you can make a reasonable inference about onset, after making reasonable efforts
to obtain additional evidence, infer onset using the available medical and other evidence
that describes the history, signs, and symptoms of the claimant’s disease process.
EXPEDIENT: We may infer onset within three years of the filing date if:
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the severity of the current impairment is fully documented
and
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the only missing evidence relates to earlier treatment.
We will not use this expedient to infer onset when:
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there is contrary evidence in the case record;
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medical judgment determines the impairment(s) was not disabling at the alleged onset
date (AOD); or
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the onset date clearly occurred after AOD.
To apply this expedient to infer an EOD, the evidence must show all of the following requirements:
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Evidence at the time of AOD appears to exist and was requested, but was not received.
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A minimum of 10 calendar days elapsed since the initial evidence request (see DI 22505.035), even if the adjudicator did not learn of the existence of this evidence until after
he or she requested other evidence.
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Evidence in the case record is complete enough to determine the impairment(s) is disabling
and satisfies the duration requirement.
and
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The adjudicator has documented that in his or her judgment that the unavailable evidence
would likely support the AOD documented in the case record.
EXAMPLE: Rhonda filed a Disability Insurance Benefit (DIB) claim on 05/01/2011 alleging disability
due to rheumatoid arthritis. Her alleged (and potential) onset date is 06/01/2009.
Two rheumatologists treated Rhonda from 2005 through the current period. Dr. Original
treated Rhonda from 2005 through 02/20/2010, and Dr. Present treated her from 03/15/2010
through the present. DDS requested medical evidence of record (MER) from both physicians
upon receipt of the case. Dr. Present provided medical records within five days of
the Medical Evidence of Record (MER) request. However, after 14 days, Dr. Original
had not responded to the request for MER. DDS sent a follow-up letter to Dr. Original,
again requesting the MER. After 10 days, DDS documented that Dr. Original still had
not responded to their MER request. DDS prepared a residual functional capacity (RFC)
that currently allows Rhonda on a medical-vocational basis. The medical evidence from
Dr. Present dated 03/15/2010 indicates that at the time of her first visit, she had
bilateral deformities in multiple joints in her hands. The first time she saw Dr.
Present, she was unable to use her fingers to tie her shoes and had very limited range
of motion in her fingers and wrists. DDS noted their RFC evaluation is effective retroactive
to the claimant’s AOD of 06/01/2009.
DDS correctly inferred onset using the expedient because:
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They requested all relevant medical evidence,
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10 days elapsed since the initial request (in the example the DDS chose to follow
up with Dr. Original, but the expedient does not require that.)
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the evidence was complete enough to satisfy the duration requirement,
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there was no contrary evidence in the case file, and
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the missing evidence would likely support the AOD based on the severity of the claimant’s
condition on 03/15/2010.
REMINDER: If inferring onset, explain your determination in the Findings of Facts and Analysis
of Evidence block in eCat or on an SSA-416 (Case Analysis Form) and download the rationale
into section F of the electronic folder. For more information about onset rationales,
see DI 25501.200.