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SOCIAL SECURITY ADMINISTRATION
Office of Hearings and Appeals

HALLEX
Volume I

Transmittal No. I-2-05

Chapter: I-2-500

Subject: Evidence

Action Notes

In I-2-501:

  • In the “Citations” section -

    add “404.1502,” after “404.941,”;

    add “404.1519 - 404.1519t,” after “404.1518,”;

    add “404.1527,” after “404.1520a,”;

    add “416.902,” after “410.475,”;

    add “416.919 - 416.919t,” after “416.918,”; and

    add “416.927,” after “416.920a,”;

  • In the second sentence of the second paragraph of text, insert “(as defined in 20 CFR §§ 404.1502 and 416.902)” after “treating source.”

On the page headed I-2-510 E. 1. cont.:

  • Delete “I-2-514 Securing Existing Medical Evidence…” and all the text that follows to the end of the page.

On the page headed I-2-522 A. cont.:

  • In item number 3 at the top of the page, change “I-2-520 B.” to “I-2-520 A.”

In I-2-528 A. 1.:

  • Change the citation to “I-2-514 C., Requesting Medical Evidence From a Medical Source Through the State Agency.”

In I-2-568:

  • Modify the last sentence of I-2-568 to read “Follow the procedures set forth in I-2-514 B., Requesting Evidence Directly From a Medical Source.”

Background

Section 9 of Public Law 98-460 (the Social Security Disability Benefits Reform Act of 1984) requires the Secretary to issue regulations establishing standards for Consultative Examinations (CEs). The Statute provides that the regulations must include standards for determining when to obtain a CE and the type of CE to be purchased, and monitoring procedures for both the purchase process and CE reports. Also, the regulations must reflect that the Secretary will make every reasonable effort to obtain necessary evidence from the claimant's medical sources before obtaining medical evidence from another source on a consultative basis; develop a complete medical history covering at least 12 months if deciding that the claimant is not under a disability; and consider all the evidence in the claimant's case record. The Social Security Administration published proposed rules in a Notice of Proposed Rulemaking in the Federal Register on April 20, 1987 (52 FR 13014). The final rules, published on August 1, 1991 (56 FR 36932), respond to comments, reflect and implement the statutory requirements, and clarify the Secretary's policy on giving weight to treating source opinions.

This issuance updates hearing office procedures based on the new regulations.

Explanation of Content and Changes

This issuance modifies sections I-2-501, I-2-514 and I-2-520 to incorporate the medical development, documentation and evaluation provisions of the new regulations, as follows.

In I-2-501:

  • Section I-2-501 now contains updated regulatory citations, and a cross-reference to 20 CFR §§ 404.1502 and 416.902, which define a “treating source.”

In I-2-514:

  • The title of the section now reflects that a claimant's medical sources consist of both “treating sources” and “sources of record.”

  • The introductory paragraph now emphasizes that the treating source is the preferred source of medical evidence.

  • Subsections A., B. and C. describe how hearing offices request medical evidence from claimants and their medical sources, and contain follow-up procedures if initial requests are not successful. These subsections now incorporate the request and follow-up procedures required by 20 CFR §§ 404.1512(c), (d) and (e), and 416.912(c), (d) and (e).

In I-2-520:

  • This section now reflects that, when requesting consultative examinations or tests, we will order only the specific examination(s) and/or test(s) we need to make a decision on the claim. We will not order a complete examination unless it is required (20 CFR §§ 404.1519f, 404.1519n(d), 416.919f and 416.919n(d)). Subsection A. 1. also reflects that “medical assessments” are now referred to as “medical source statements.”

  • New subsection B. contains instructions (some of which were formerly in I-2-520 D.) for requesting medical tests or procedures, and incorporates the regulatory prohibition from ordering tests or procedures which involve significant risk to the claimant (20 CFR §§ 404.1519m and 416.919m).

  • Subsection C. is expanded, and now reflects that the State agency will, whenever appropriate, use a treating source to conduct a CE or test.

  • New subsection D. outlines procedures for handling unsigned consultative examination reports (20 CFR §§ 404.1519o and 416.919o).

This issuance also makes minor editorial changes throughout these sections, and inserts additional reminders to retain in the claims file copies of all medical development requests.

Field Office personnel who have questions about this issuance should contact their Regional Office. Regional Office and Headquarters personnel should contact the Office of Policy, Planning and Evaluation at (FTS) 756-9254.

Remove

Remove from I-2-500:

Table of Contents I-2-500 through I-2-590, dated October 30, 1990 (2 pages); and

I-2-514 cont., dated October 30, 1990, through I-2-520 C. cont., dated October 30, 1990 (6 pages).

Insert

Insert in I-2-500:

Table of Contents I-2-500 through I-2-542, dated October 18, 1991, and I-2-544 through I-2-590, dated October 30, 1990 (2 pages); and

I-2-514, dated October 18, 1991, through I-2-520 D., dated October 18, 1991 (8 pages).

Date: October 18, 1991