TN 32 (05-21)

DI 22505.001 Medical and Nonmedical Evidence

CITATIONS:

Social Security Act - Sections 216(i), 223(d), 1614(e), and 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 24503.001B.

For categories of evidence, see DI 24503.005.

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 maintain 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.

Allow more time for a particular source when experience with that source indicates a longer period is advisable. For follow ups on requests for medical evidence, see DI 22505.035B.

For developing evidence on functioning in Title XVI child cases, see DI 25205.010.

3. Complete medical history

Before we make a determination that a claimant is not disabled, we will make every reasonable effort to develop the 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 that his or her 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 DI 22505.006A.2.

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 22505.003A.

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.

6. Entity

An entity refers to an organization that maintains a medical source's records. Generally, entity means the medical clinic, medical facility, or hospital where a medical source evaluated, examined, or treated the claimant.

B. Overview of evidence responsibilities

1. Claimant responsibilities

Generally, the claimant has to prove to us that he or she is blind or disabled. This duty is ongoing and applies at each level of the administrative review 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 (see DI 22505.001A.2 in this section),

  • Contact the claimant's medical sources and entities that maintain the claimant's medical records when developing the complete medical history (see DI 22505.001A.3 in this section),

  • Review all available prior paper and electronic folders,

  • Copy, scan or fax the relevant evidence from the prior folder(s) into the current folder, and

  • Consider all relevant evidence about the claim, including relevant evidence from prior folders, when making a determination.

For determining the need for a prior paper folder, see DI 20505.010. For the definition of relevant evidence, see DI 24501.016B.2. For developing vocational evidence, see DI 22515.001. For more information on case development responsibilities, see DI 22501.002.

NOTE: The rules for developing evidence apply at all levels of adjudication. Be alert to situations where the claimant may need assistance with case development.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422505001
DI 22505.001 - Medical and Nonmedical Evidence - 05/24/2021
Batch run: 05/24/2021
Rev:05/24/2021