Based on the claimant’s allegation(s), information, or evidence obtained during or
after the claims interview, determine if a finding of PD/PB applies or is likely based
on the categories in DI 11055.231. If a claimant meets one of the criteria as a potential PD/PB claim, do the following:
document the PD/PB findings;
place evidence sent by the medical source in the folder for forwarding to the Disability
Determination Services (DDS), if applicable; and
transfer the case to the DDS.
If evaluation of medical evidence of record (MER) is needed, e.g., to determine listing-level
severity, request MER from the medical source. For FO evaluation of MER for certain
PD/PB categories, see DI 11055.240A.2. in this subsection.
To acquire opinions from third-party contacts regarding an alleged illness that may
meet a PD/PB category, you must:
explain the PD or PB procedures to the claimant and the need to contact the source
to verify the allegation to make a presumptive finding; and
ask the claimant or person filing on the claimant’s behalf for the name and telephone
number of a reliable source who is able to verify the allegation to determine if a
PD/PB criterion is met.
Reliable sources could be public or private schools, social agencies, the clergy,
or other members of the community having knowledge of the claimant’s condition based
on frequent contacts or a long-term association with the claimant. Take the following
contact the appropriate source to determine if the PD/PB criterion is met;
record the information on the Report of Contact page or Form SSA-5002 (Report of Contact);
upload or barcode and fax the SSA-5002 into the Electronic Disability Collect System
If the official folder is a paper modular disability folder (MDF), add the SSA-5002
to the paper folder.
2. Evaluating MER for certain PD categories
When you receive MER in the FO, fax the documents into the certified electronic folder
(CEF). Follow your Regional guidelines regarding page limits. For faxing instructions,
see DI 81010.090.
a. Documenting MER received in the FO
Evaluate the MER and determine if certain PD/PB criteria in DI 11055.231 are met and annotate the CEF per DI 81010.125.
b. MER received from at least one acceptable source
If MER from one or more acceptable medical sources (DI 22505.003A) is received and it permits a PD/PB decision, initiate PD/PB payments without awaiting
receipt of outstanding MER from other sources.
c. Incomplete, inconclusive, or conflicting MER
If MER is incomplete, inconclusive, or if more than one piece of MER is being evaluated
at the same time and the evidence conflicts as to whether or not PD/PB criteria are
met, do not initiate PD/PB payments.