TN 1 (09-16)

CITATIONS: Social Security Act, Section 205(b) 404.1525 - 404.1569, 416.1414 — 416.1422

A. PH reviewer responsibilities

PH reviewers should do the following:

1. Review the reasons the individual is appealing the CDR determination. These reasons may appear on the following:

   • SSA-789 (Request for Reconsideration-Disability Cessation Right to Appear).

   • SSA-3441-BK (Disability Report - Appeal)

   • Other documentation in the case file.

2. Review the initial CDR to ensure development and determination were complete and conformed to the Social Security Administration’s (SSA) policy on developing evidence and addressing the individual’s alleged impairment(s) and work history. Consider the following:

   • Any additional information submitted with the request, including the SSA-3441-BK ( Disability Report – Appeal)

   • All pertinent information in the case folder

3. Develop new allegations or the individual’s worsening condition. For additional information on developing evidence, see DI 22505.035.

4. Determine the need for any additional medical or vocational information, e.g., medical evidence of record, or consultative examinations (CE). For information on vocational evidence see DI 22515.001, and for information on CE and medical evidence, see DI 28030.020.

5. Develop additional pertinent evidence including medical sources where the individual received an examination or treatment since the initial CDR determination. For additional information on evaluation, development, and documentation, see DI 28030.020.

6. Resolve all conflicts and discrepancies.

7. Complete the necessary assessment forms. For information on preparation of the assessment forms, see DI 29025.001.

8. Refer the case folder to the medical or psychological consultant for assessment.

B. When the individual is working

When the DDS identifies the individual as working, do the following:

• For electronic cases, send an assistance request (AR) to the FO requesting substantial gainful activity (SGA) development. The DDS may continue evidence development; however, the adjudicator cannot make a favorable determination until the work issue is resolved.

• For paper cases, send the folder to the FO for evidence development and resolution of the work issue. Notify the disability hearing unit (DHU) to postpone the disability hearing pending the FO's resolution of the SGA issue.

If the DDS has sufficient information to affirm the initial cessation based on medical or vocational grounds, the DDS forwards the case to the DHU.

C. A fully favorable reconsideration determination is warranted

When a fully favorable determination exists, do not send the case to the DHU. The adjudicator within the DDS will do the following:

1. Prepare a SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal). Be sure to check block ‘B’ in item 8 of the form(s). For additional information on completing the forms, SSA-832 and SSA-833, see DI 28084.000.

2. Prepare the Notice of Favorable Determination as appropriate:

· SSA-L1412-U2 (Retirement, Survivors, and Disability Insurance Notice of Reconsideration)

· SSA-L1414-U2 (Retirement, Survivors, and Disability Insurance Notice of Reconsideration)

· SSA L1438-U2 (SSI Notice of Reconsideration)

· SSA L1439-U2 (SSI Notice of Reconsideration)

Do not release the notice(s) due to the possibility of preeffectuation review.

3. Route all favorable electronic folder cases to the servicing field office (FO). Route all paper folders using the instructions in DI 32010.060 through DI 32010.075.

D. A fully favorable reconsideration determination is not warranted

If a fully favorable determination is not possible based upon a PH review, follow the guidelines in DI 29025.001.

E. References

• DI 10005.010 Field Office (FO) and Disability Determination Services (DDS) Exchange of Information and Coordination of Actions

• DI 10501.025 Clearly Not SGA