The MC may complete an SSA-392 when:

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  An SSA-4734-BK is in file, and

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  A physical impairment of less than listing. level severity requiring an RFC assessment is present.

For further explanation of when to use the SSA-392, see GN 04440.130.

NOTE: When an RFC is not in the file, but one is required, the reviewing MC will prepare the assessment on an SSA-4734-BK. The reviewing MC should not use the SSA-392 to prepare an RFC assessment..

The MC may not complete an SSA-392 when:

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  The adjudicating component prepared an SSA-4734-BK, but MC review establishes that the adjudicating component should have made the disability determination on a medical basis only (i.e., the impairment is a “not severe” physical impairment, or the impairment is of listing-level severity), or

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  The disability determination is not supported by sufficient evidence and additional medical evidence is needed (i.e., a medical documentation deficiency), regardless of whether the adjudicating component decided the case on a medical-vocational basis.

NOTE: For situations in GN 04440.524B2, the MC records case analysis and disagreement(s) with the RFC determination on an SSA-416, Case Analysis.

The items in the heading are self-explanatory. In the field, “Date(s) SSA-4734-BK Applicable”, enter the RFC date(s) or date range, as documented by the adjudicating component.

After review of all the evidence, complete Part A.

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  Indicate whether you agree or disagree with the adjudicating component's RFC conclusion, considering reasonableness and evidence support.

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  If you disagree with any of the adjudicating component's findings, proceed to Part B; or

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  If you agree with all the adjudicating component's findings, proceed directly to Part C.

Cite the section and number of each item in dispute.

For each disputed item:

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  Explain why particular findings are inconsistent with policy.

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  Show how the adjudicating component drew erroneous conclusions from the facts.

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  Describe your findings, and include additional limitations or restrictions, if applicable.

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  Cite the facts and discuss how and why the evidence supports your conclusions.

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  As appropriate, evaluate and discuss limitations imposed by symptoms, such as pain or fatigue.

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  Resolve all inconsistencies in the evidence when the adjudicating component failed to do so.

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  If you agree with all the adjudicating component's findings in Part A, check 1, “AGREE”; or

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  If you disagree with any of the adjudicating component's findings in Part A, and provide a discussion in Part B, check 2, “DISAGREE”.

NOTE: See GN 04440.524B2 for disagreement involving insufficient evidence or support for medical assessment other than RFC.

Sign, date, and enter the MC code.