DI 270: Reconsideration Case Processing
BASIC (03-10)
The chart below shows the evidence source issues that require documentation and rationalization in the disability decision process. If the Disability Determination Services (DDS) discovers that a required evidence source was not documented during the prior determination, follow the instructions under “Action Required if Not Already in File” to prepare a supplemental rationale.
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Evidence Sources |
Where Usually Documented In File |
Action Required If Not Already In File |
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1. |
a. Allowances |
Medical evidence Personalized notice (partially unfavorable decisions) |
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b. Denials |
Medical evidence Personalized notice |
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2. |
Allegations |
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a. Allowances |
SSA-3441-BK (Disability Report-Appeal) Report of Contact (SSA-5002) SSA-795 (Statement of Claimant or Other Person) Personalized notice (partially unfavorable decisions) |
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b. Denials |
SSA-3441-BK (Disability Report-Appeal) Report of Contact (SSA-5002) SSA-795 (Statement of Claimant or Other Person) Personalized notice |
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3. |
Evidence of SGA/SGA Findings |
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a. Allowances |
SSA-820-F4 (Work Activity Report - SE) SSA-821-F4 (Work Activity Report - EE) Report of contact or SSA-553 (Special Determination) |
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b. Denials |
SSA-820-F4 (Work Activity Report - SE) SSA-821-F4 (Work Activity Report - EE) Report of contact or SSA-553 (Special Determination) |
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4. |
Medical Facts |
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a. Allowances |
Medical evidence Reports of contact |
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b. Denials |
Medical evidence Reports of contact |
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5. |
Interpretation of Medical Findings |
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a. Allowances |
SSA-416- Case Analysis 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 27021.015D. (closed period cases only) |
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b. Denials |
Regulation basis code (SSA-831-U5) Personalized notice In some cases, the PRTF and RFC form |
See items 6, 7 and 8 |
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6. |
Pain-Related Issues |
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a. Allowances |
RFC form PRTF ADL’s Pain Questionnaire Medical Evidence Symptom Evaluation |
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b. Denials |
RFC form PRTF ADL’s Pain Questionnaire Medical Evidence Symptom Evaluation |
Supplemental rationale - see DI 27021.015E. |
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7. |
Resolution of Conflicting Medical Opinions |
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a. Allowances |
Resolved by the determination of an allowance (SSA-831-U5) Medical Evidence Symptom Evaluation |
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b. Denials |
RFC form PRTF Medical Evidence Symptom Evaluation |
Supplemental rationale - see DI 27021.015A. |
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8. |
Resolution of Inconsistencies Material to Decision |
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a. Allowances |
Personalized notice (partially unfavorable decisions - later onset date and closed period cases) Resolved by the determination of an allowance (SSA-831-U5) |
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b. Denials |
RFC form PRTF |
Supplemental rationale - see DI 27021.015B. |
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9. |
Vocational Rule Used for Medical/Vocational Decisions |
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a. Allowances |
Item 27 on the SSA-831-U5 |
Supplemental rationale - see DI 27021.015G. |
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b. Denials |
Item 27 on the SSA-831-U5 |
Supplemental rationale - see DI 27021.015G. |
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10. |
Citation of Jobs and Incidence |
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a. Allowances |
Not applicable |
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b. Denials |
Report of Vocational Analysis |
Supplemental rationale - see DI 27021.015H. |
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11. |
Duration of Impairment |
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a. Allowances |
Favorable decision would indicate duration met |
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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 |
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12. |
Assessment of Functional Abilities |
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a. Allowances |
RFC form Medical evidence |
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b. Denials |
RFC form Medical evidence |
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13. |
Basis for Decision |
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a. Allowances |
Regulation basis code (SSA-831-U5) |
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b. Denials |
Regulation basis code (SSA-831-U5) Personalized notice |