TN 9 (06-13)

Citations:

20 CFR §§ 404.1619, 416.1019

A. Making the medical determination

After receiving sufficient medical and vocational evidence that indicates the claimant’s impairment(s) meets or equals criteria in the Listing of Impairments or that medical and vocational factors indicate a favorable determination, no further development is necessary.

In these cases, take one of the following two actions:

1. submit the evidence to a medical or psychological consultant (MC/PC) to determine the sufficiency of the evidence and to assess the severity of the impairment(s); or

2. process the case using disability examiner (DE) authority for Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) cases, as detailed in DI 23023.001.

In concurrent cases, if there is not at least one fully or partially favorable claim in the case, remove the case from CAL and QDD processing, using as a removal reason, “All Claims in the case are denials”.

IMPORTANT: CAL and QDD cases are NOT subject to single decisionmaker (SDM) processing rules. An MC/PC must review ALL CAL and QDD medical determinations not processed using DE authority as described in DI 23023.001.

NOTE: MCs and PCs must give priority to QDD and CAL cases.

References:

• DI 23022.055 Adding, Removing, Modifying, and Reinstating Compassionate Allowances, and Removing Quick Disability Determination Fast-Track Cases

• DI 23023.001 Disability Examiner Authority for Quick Disability Determinations and Compassionate Allowance Initiative Cases

• DI 26500.000 Initial Case Processing

• DI 26510.000 Completion of Form SSA-831-C3/U3 – Title II, Title XVI, and Concurrent Claims

B. Case routing

When you obtain all necessary evidence and make a medical determination, complete the:

• processing,

• disposition, and

• route the case (For routing instructions see DI 32005.025) .

Ensure that the Certified Electronic Folder (CEF) Indicator is correct and that you forward any paper folders associated with the CEF to the next location.

NOTE: If the Office of Quality Performance (OQP) selects this case for Federal quality review and the electronic file also has a paper folder, the disability determination services must mail the folder to the reviewing office.