DI 265: Initial Case Processing

Effective Dates: 02/14/2017 - Present

		Where Usually Documented In File	Action Required If Not Already In File
1.	Evidence Sources
	a. Allowances	Medical evidence Personalized notice (partially unfavorable decisions)
	b. Denials	Medical evidence Personalized notice
2.	Allegations
	a. Allowances	SSA-3368-F8 (Disability Report of Medical Evidence) Report of Contact (SSA-5002) SSA-795 (Statement of Claimant or Other Person) Personalized notice (partially unfavorable decisions)
	b. Denials	SSA-3368-F8 (Disability Report of Medical Evidence) Report of Contact (SSA-5002) SSA-795 (Statement of Claimant or Other Person) Personalized notice
3.	Evidence of SGA/SGA Findings
	a. Allowances	SSA-820-F4 (Work Activity Report - SE) SSA-821-F4 (Work Activity Report - EE) Report of contact or SSA-553 (Special Determination)
	b. Denials	SSA-820-F4 (Work Activity Report - SE) SSA-821-F4 (Work Activity Report - EE) Report of contact or SSA-553 (Special Determination)
4.	Medical Facts
	a. Allowances	Medical evidence Reports of contact
	b. Denials	Medical evidence Reports of contact
5.	Interpretation of Medical Findings
	a. Allowances	Regulation basis code (SSA-831-U5) In some cases, the Psychiatric Review Technique Form (PRTF - SSA-2506-BK) and Residual Functional Capacity (RFC - SSA-4734-F4 and Supplement) Personalized notice (partially unfavorable decisions - later onset date and closed period cases)	Supplemental rationale - see DI 26516.010 D. (closed period cases only)
	b. Denials	Regulation basis code (SSA-831-U5) Personalized notice In some cases, the PRTF and RFC forms	See items 6, 7 and 8
6.	Pain-Related Issues
	a. Allowances	Any medical listing which specifically mentions pain RFC form PRTF form
	b. Denials	RFC form PRTF form	Supplemental rationale - see DI 26516.010 C.
7.	Resolution of Conflicting Medical Opinions
	a. Allowances	Resolved by the determination of an allowance (SSA-831-U5)
	b. Denials	PRTF form RFC Form	Supplemental rationale - see DI 26516.010 A
8.	Resolution of Inconsistencies Material to Decision
	a. Allowances	Personalized notice (partially unfavorable decisions - later onset date and closed period cases) Resolved by the determination of an allowance (SSA-831-U5)
	b. Denials	PRTF form RFC form	Supplemental rationale - see DI 26516.010 B.
9.	Vocational Rule Used for Medical/Vocational Decisions
	a. Allowances	Item 27 on the SSA-831-U5	Supplemental rationale - see DI 26516.010 E.
	b. Denials	Item 27 on the SSA-831-U5	Supplemental rationale - see DI 26516.010 E.
10.	Citation of Jobs and Incidence
	a. Allowances	Not applicable
	b. Denials	Report by a Vocational specialist	Supplemental rationale - see DI 26516.010 F.
11.	Duration of Impairment
	a. Allowances	Favorable decision would indicate duration met
	b. Denials	Regulation basis code on the SSA-831-U5 if duration is the reason for the denial RFC form indicating a duration projection was made Personalized notice
12.	Assessment of Functional Abilities
	a. Allowances	RFC form Medical evidence
	b. Denials	RFC form Medical evidence
13.	Basis for Decision
	a. Allowances	Regulation basis code (SSA-831-U5)
	b. Denials	Regulation basis code (SSA-831-U5) Personalized notice

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DI 265: Initial Case Processing