TN 13 (04-13)

Citations: 20 CFR sections

404.1519a; 404.1520b; 416.919a; 416.920b

A. Policy for when to purchase a CE

Generally, do not request a CE before you make every reasonable effort to obtain needed evidence from the claimant’s medical sources. You may order a CE:

• when case evidence is insufficient to evaluate the claim, or

• to obtain evidence needed to resolve a conflict, inconsistency, or ambiguity in the evidence.

If the case is a continuing disability review, also see DI 28030.020D.

B. Situations that generally require a CE

You may order a CE:

1. When you cannot obtain sufficient evidence from claimant’s medical source(s)

You cannot obtain evidence from the claimant's medical source(s) for reasons beyond the claimant's control, such as death or noncooperation of the medical source. For policy on safeguarding against denial in this situation, see DI 22505.012A.1.

2. When evidence from an acceptable medical source is needed to establish a medically determinable impairment

For a detailed explanation of this policy, see DI 22505.012.

3. When you need highly technical or specialized medical evidence

Highly technical or specialized medical evidence needed to evaluate the claimant’s impairments under our listings is unavailable from the claimant’s medical sources. For example, a claimant alleges deafness, but his or her medical sources do not have the audiological testing required to evaluate a hearing impairment under our listings.

4. When you need additional evidence to establish current severity

Evidence indicates a change in severity of the claimant's medical condition that is likely to affect the claimant's ability to work (or for a title XVI childhood disability claimant, the child’s ability to function), BUT available evidence is insufficient to establish current severity of the claimant’s impairment.

5. When case evidence contains a material conflict, inconsistency, or ambiguity

You must resolve a conflict (either internally or with other evidence in the case record), inconsistency, or ambiguity in the evidence and you are unable to do so by recontacting the claimant, his or her medical source(s), or other appropriate source(s).