TN 14 (12-10)

A. Background on using the SSA-392

Federal review medical consultants (MCs) use the SSA-392 to record their agreement or disagreement with the physical residual functional capacity (RFC) assessment established by the adjudicating component (AC) on the SSA-4734-BK, Physical Residual Functional Capacity Assessment.

Use the SSA-392 to:

• Identify findings of physical capacity and restriction that are the same as, or different from, those of the adjudicating component;

• Cite and discuss the evidence supporting the different finding(s);

• Discuss specific problems with the adjudicating component's completion of the SSA-4734-BK; and

• Record conclusions as to whether the adjudicating component’s findings on physical RFC are reasonable, consistent with program policy, and supported by the evidence.

For an exhibit of the SSA-392, see GN 04440.929.

B. Policy for completing of the SSA-392

Reviewing MCs complete the SSA-392 to record agreement or disagreement with the physical RFC assessment established by the adjudicating MC on an SSA-4734-BK. The MC completes the SSA-392 only when there is an SSA-4734-BK in file and a medical-vocational determination is appropriate.

1. When to complete an SSA-392

The MC completes an SSA-392 when:

• An SSA-4734-BK is in file; and

• A physical impairment of less than listing level severity requiring an RFC assessment is present.

For further explanation of when to use the SSA-392, see GN 04440.135.

NOTE: When the review component assumes jurisdiction, the reviewing MC prepares an SSA-4734-BK, when appropriate. Do not use the SSA-392 to make a physical RFC assessment, since it is only a review form.

2. When not to complete an SSA-392

The MC does not complete an SSA-392 when:

• The adjudicating component (AC) prepared an SSA-4734-BK, but MC review establishes that the AC should have made the disability determination on a medical-only basis (i.e., the impairment is a “not severe” physical impairment, or the impairment is of listing-level severity); or

• The disability determination is not supported by sufficient evidence and additional medical evidence is needed (i.e., a medical documentation deficiency), regardless of whether the AC decided the case on a medical-vocational basis.

NOTE: In these situations, the MC records case analysis and disagreement(s) with the RFC determination on an SSA-416 (Case Analysis).

C. Procedure for completing the SSA-392

1. Heading

The items in the heading are self-explanatory. For “Date(s) SSA-4734-BK Applicable,” show the date or range of time covered by the RFC assessment completed by the adjudicating component.

1. Part A – Evaluation

After review of all the evidence, complete Part A.

• Indicate whether you agree or disagree that the adjudicating component's conclusion is reasonable and supported by the evidence;

• If you agree with all the adjudicating component's findings, proceed to Part C; or

• If you disagree with any of the adjudicating component's findings, proceed to Part B.

2. Part B – Discussion and/or Comments

Cite the section and number of each item in dispute, and for each item cited, discuss why the adjudicating component's analysis fails to support particular findings or the RFC assessment in general. In addition:

• Explain why particular findings are inconsistent with policy.

• Show how the adjudicating component drew erroneous conclusions from the facts.

• Describe your findings, including additional limitations or restrictions.

• Cite the specific facts upon which you based your conclusions and discuss how and why the evidence in file supports these conclusions.

• Consider and discuss, as appropriate, alleged limitations imposed by symptoms such as pain or fatigue.

• Resolve all inconsistencies of evidence when the adjudicating component failed to do so.

3. Part C – Conclusion

• If you agree with all the adjudicating component's findings in Part A, check 1, “AGREE”; or

• If you disagree with any of the adjudicating component's findings in Part A and discuss the disagreement in Part B, check 2, “DISAGREE”.

NOTE: When the evidence is insufficient to assess RFC, the MC records case analysis and disagreement(s) with the RFC determination on an SSA-416.

4. MC signature

Sign and enter the MC code and date.