Insufficient Documentation to Show Conformance to Procedural Requirements When A Disability Determination is Based on Unresolved Work Activity That Could Affect the Decision
ISSUE
Step 1 of Sequential Evaluation is not satisfied. The record does not reasonably document if, and when substantial gainful activity (SGA) ended.
CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES)
This 57-year-old claimant is filing a DI claim alleging disability since 1/1/2014 due to arthritis in the knees and hands, right knee pain, and a rapid heartbeat.
The DDS assessed a RFC for lifting/carrying 20 pounds occasionally, 10 frequently, standing/walking 2 hours, and sitting 6 hours, with additional postural limitations. The evidence in file supports …show more content…
However, the claim was returned to the DDS on 5/16/17 with a SSA 5002 in the file. The form indicates, “NH is eligible for the T16 program. He was denied for DIB claim due to SGA. He is under income and resources level to be eligible for SSI”. This is not policy compliant as DI 24001.015.B.1 states, when an individual is actually engaging in substantial gainful activity, and there is no possibility of a closed period of disability, a finding shall be made that the individual is not disabled. Therefore, additional information regarding his current SGA level work is required before a disability determination can be …show more content…
Job # 1 is titled maintenance supervisor. He indicated he worked here 1993-2003. This job is not listed on the SSA 3369 or elsewhere in the file. Job # 3 is titled Sill tech. He indicated he worked this position 2006 -2007. It is unclear if this work is listed on the SSA 3369; however, there are no dates that correspond to this position or title. It is also unclear if his current work is listed on the SSA 3369, as there is no work listed as to present on the form. Therefore, additional vocational details are required. DI 22515.001B4 states a complete and detailed description of all past work is required for all past relevant work. This includes job title, dates worked (month and year,) rate of pay, and job duties and work processes.
At Step 4 of Sequential Evaluation, a function-by-function comparison must be made between a claimant's PRW and their RFC/MRFC before proceeding to Step 5. It is critical for the adjudicator to make a sound and supportable determination of what the claimant can do functionally and how this relates to the physical, mental and environmental demands of PRW (POMS DI 25005.001A & B; SSR
ISSUE
Step 1 of Sequential Evaluation is not satisfied. The record does not reasonably document if, and when substantial gainful activity (SGA) ended.
CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES)
This 57-year-old claimant is filing a DI claim alleging disability since 1/1/2014 due to arthritis in the knees and hands, right knee pain, and a rapid heartbeat.
The DDS assessed a RFC for lifting/carrying 20 pounds occasionally, 10 frequently, standing/walking 2 hours, and sitting 6 hours, with additional postural limitations. The evidence in file supports …show more content…
However, the claim was returned to the DDS on 5/16/17 with a SSA 5002 in the file. The form indicates, “NH is eligible for the T16 program. He was denied for DIB claim due to SGA. He is under income and resources level to be eligible for SSI”. This is not policy compliant as DI 24001.015.B.1 states, when an individual is actually engaging in substantial gainful activity, and there is no possibility of a closed period of disability, a finding shall be made that the individual is not disabled. Therefore, additional information regarding his current SGA level work is required before a disability determination can be …show more content…
Job # 1 is titled maintenance supervisor. He indicated he worked here 1993-2003. This job is not listed on the SSA 3369 or elsewhere in the file. Job # 3 is titled Sill tech. He indicated he worked this position 2006 -2007. It is unclear if this work is listed on the SSA 3369; however, there are no dates that correspond to this position or title. It is also unclear if his current work is listed on the SSA 3369, as there is no work listed as to present on the form. Therefore, additional vocational details are required. DI 22515.001B4 states a complete and detailed description of all past work is required for all past relevant work. This includes job title, dates worked (month and year,) rate of pay, and job duties and work processes.
At Step 4 of Sequential Evaluation, a function-by-function comparison must be made between a claimant's PRW and their RFC/MRFC before proceeding to Step 5. It is critical for the adjudicator to make a sound and supportable determination of what the claimant can do functionally and how this relates to the physical, mental and environmental demands of PRW (POMS DI 25005.001A & B; SSR