TN 23 (03-17)

DI 22505.001 Medical and Nonmedical Evidence

Citations: Social Security Act - Sections 216(i), 223(d), 1614(e), 1633(b) Regulations - 20 CFR sections 404.1502, 404.1512 through 404.1519h and 416.902, 416.912 through 416.919h

A. Definitions for medical and nonmedical evidence

1. Evidence

Evidence is anything the claimant or anyone else submits to us or that we obtain that relates to his or her claim for benefits.

For what we do not consider evidence, see DI 24503.001 Evaluating Evidence - Basic Policy.

For categories of evidence, see DI 24503.005 Categories of Evidence.

2. Every reasonable effort

Every reasonable effort means that we will:

  • Make an initial request for medical records from the claimant’s own medical sources and entities that maintains a medical source’s evidence. For Title XVI child cases, this includes evidence from the child’s school and teachers.

  • Make one follow-up request any time between 10 and 20 calendar days after the initial request if we do not receive the evidence.

  • Allow a minimum of 10 calendar days from the date of follow-up request for the medical source or entity to reply.

For situations where a 10-calendar day wait time is not appropriate, see DI 22505.035 Follow-up on Requests for Medical Evidence of Record (MER).

For developing evidence on functioning in Title XVI child cases, see DI 25205.010 Development of Evidence of Functioning.

3. Complete medical history

Before we make a determination that a claimant is not disabled, we will make every reasonable effort to develop a claimant’s complete medical history. Complete medical history means the records of the claimant’s medical sources covering at least the 12 months prior to whichever date is earliest:

  • The month of filing.

  • The protective filing date (PFD).

  • The date last insured (DLI) (disability insurance benefits case).

  • The prescribed period (PP) ending date (disabled widow(er) benefits case).

  • The attainment of age 22 (childhood disability benefits case).

If the claimant alleges disability began less than 12 months before the month of filing, PFD, DLI, end of the PP, or attainment of age 22, we will develop a complete medical history beginning with the alleged onset date, unless there is reason to believe that the disability began earlier.

For information on when to develop outside the 12-month period, see:

4. Medical source

A medical source is an individual who is:

  • Licensed as a healthcare worker by a State and working within the scope of practice permitted under State or Federal law, or

  • Certified by a State as a speech-language pathologist or a school psychologist and acting within the scope of practice permitted under State or Federal law.

IMPORTANT: The term medical source includes both acceptable medical sources and medical sources who are not acceptable medical sources. For information on who is an acceptable medical source, see DI 22505.003 Evidence from an Acceptable Medical Source (AMS).

5. Nonmedical source

A nonmedical source is any source of evidence who is not a medical source. This includes, but is not limited to, the claimant, educational personnel, public and private social welfare agency personnel, family members, caregivers, friends, neighbors, and clergy.

B. Overview of evidence responsibilities

1. Claimant responsibilities

In general, the claimant has to prove to us that he or she is blind or disabled. This duty applies throughout the claims process. The claimant must tell us about or submit all evidence known to him or her that relates to whether or not he or she is blind or disabled.

2. Disability Determination Services (DDS) responsibilities

Before we make a determination that the claimant is not disabled, we will make every reasonable effort to develop the claimant’s complete medical history. We will contact the claimant's medical sources and entities that maintain the claimant's medical evidence when we develop the complete medical history.

We will consider all relevant evidence about the claimant, including evidence in all available prior paper and electronic folders. For determining the need for a prior folder, see DI 20505.010 Determining Need for Prior Folder.

The rules for developing evidence apply at all levels of adjudication. Be alert to situations where the claimant may need assistance with case development. For case development responsibilities, see DI 22501.002 Responsibilities for Case Development of Disability Claims.

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DI 22505.001 - Medical and Nonmedical Evidence - 09/06/2016
Batch run: 03/24/2017