TN 9 (06-13)

Citations:

20 CFR §§ 404.1619, 416.1019

A. Initial development

The disability determination services (DDS) must initiate development within one working day of case receipt for Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) fast-track cases. The field office (FO) faxes an SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)) into the Electronic Disability Collect System (EDCS) prior to sending the case for processing. If the case includes a title XVI claim, the DDS also needs to consider if presumptive disability (PD) or presumptive blindness (PB) applies. For DDS responsibilities in PD or PB claims, see DI 23535.010.

If the FO receives medical evidence of record (MER) prior to the electronic transfer of a case, they fax up to 15 pages of MER into EDCS. For cases with more than 15 pages of MER, the FO mails evidence to the DDS via REGULAR mail. As these cases are time critical, The DDS scans the mail in MER upon receipt and does not send to a national scanning contractor.

For CAL cases, refer to the Impairment Summaries for the CAL conditions listed for guidance. The Office of Disability Programs (ODP) CAL website provides more information on CAL, and houses the Impairment Summaries.

B. Obtaining additional information from the claimant

Do not tell the claimant that we selected his or her case for CAL or QDD unless he or she specifically asks the question.

If necessary, contact the claimant or third party upon receipt of the case to:

1. verify allegations and claimant or third party contact information;

2. identify current medical source(s), obtain medical source contact information, and obtain dates of any pending medical appointments;

3. request assistance in obtaining medical evidence from medical sources, including a request for fax contact information; and

4. obtain information about activities of daily living (ADLs).

C. Obtaining evidence from the medical source

Follow these steps to obtain evidence from the medical source(s):

1. Review the disability claim to identify the primary medical provider or specialist(s) who can provide the evidence necessary to fast-track the determination.

2. Fax, telephone, or express mail requests for medical evidence, whenever possible, to immediately obtain the evidence. Request medical evidence by mail only if no other means of obtaining it are available. If you mail the request, ensure the DDS address is the return address (i.e. not the scanning contractor).

3. Include a return envelope with the DDS address; do not include a return envelope with the national scanning contractor address. You may also request medical evidence via the Electronic Records Express (ERE) website, if the medical source is a registered user.

NOTE: If you are unable to obtain the necessary medical evidence via fax, telephone, mail, or ERE, follow the Disability Case Development for Medical and Other Evidence procedures in DI 22501.001 and Requesting Evidence – General procedures in DI 22505.006.

D. Follow-up for medical evidence

To obtain necessary medical evidence, expedite follow-up procedures with the medical source and claimant.

1. Medical source

Take the following actions to follow-up on requests for evidence from the medical source:

1. Follow-up no later than 7 calendar days from the date of the request;

2. Fax or telephone all subsequent requests for evidence, if possible;

3. Consider contacting the claimant for assistance in obtaining required evidence, as per DI 23022.040D.2., in this section.

4. Initiate a second follow-up after an additional 7 days, if you do not receive the evidence after the initial follow-up;

2. Claimant

Take the following actions to follow-up requests for evidence from the claimant or representative:

1. After the DDS makes all attempts to obtain the medical evidence needed to make the determination, make an attempt to contact the claimant or representative to request assistance.

2. When appropriate, mail or fax medical forms to the claimant to take to his or her medical source for completion.

3. Include a return envelope with the DDS address; do not include a return envelope with the national scanning contractor address. If the medical source is a registered user, you may also request medical evidence via the ERE Website.

4. After subsequent request(s) for evidence, provide the claimant and medical source an opportunity to fax or mail any necessary evidence.