[Code of Federal Regulations]

[Title 20, Volume 1]

[Revised as of April 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 20CFR220.53]



[Page 271-272]

 

                      TITLE 20--EMPLOYEES' BENEFITS

 

                  CHAPTER II--RAILROAD RETIREMENT BOARD

 

PART 220_DETERMINING DISABILITY--Table of Contents

 

                   Subpart G_Consultative Examinations

 

Sec.  220.53  When the Board will purchase a consultative examination 

and how it will be used.



    (a)(1) General. The decision to purchase a consultative examination 

for a claimant will be made after full consideration is given to whether 

the additional information needed (e.g., clinical findings, laboratory 

tests, diagnosis, and prognosis, etc.) is readily available from the 

records of the claimant's medical sources. Upon filing an application 

for a disability annuity, a claimant will be required to obtain from his 

or her medical source(s) information regarding the claimed impairments. 

The Board will seek clarification from a medical source who has provided 

a report when that report contains a conflict or ambiguity, or does not 

contain all necessary information or when the information supplied is 

not based on objective evidence. The Board will not, however, seek 

clarification from a medical source when it is clear that the source 

either cannot or will not provide the necessary findings, or cannot 

reconcile a conflict or ambiguity in the findings provided from the 

source's records. Therefore, before purchasing a consultative 

examination, the Board will consider not only existing medical reports, 

but also the background report containing the claimant's allegations and 

information about the claimant's vocational background, as well as other 

pertinent evidence in his or her file.

    (2) When the Board purchases a consultative examination, we will use 

the report from the consultative examination to try to resolve a 

conflict or ambiguity if one exists. The Board will do this by comparing 

the persuasiveness and value of the evidence. The Board will also use a 

consultative examination to secure needed medical evidence the file does 

not contain such as clinical findings, laboratory tests, a diagnosis or 

prognosis necessary for decision.

    (b) Situations requiring a consultative examination. A consultative 

examination may be purchased when the evidence as a whole, both medical 

and non-medical, is not sufficient to support a decision on the claim. 

In addition, other situations, such as one or more of the following, 

will normally



[[Page 272]]



require a consultative examination (these situations are not all-

inclusive):

    (1) The specific additional evidence needed for adjudication has 

been pinpointed and high probability exists for obtaining it through 

purchase.

    (2) The additional evidence needed is not contained in the records 

of the claimant's treating sources.

    (3) Evidence that may be needed from the claimant's treating or 

other medical sources cannot be obtained for reasons beyond his or her 

control, such as death or noncooperation of the medical source.

    (4) Highly technical or specialized medical evidence which is needed 

is not available from the claimant's treating sources.

    (5) A conflict, inconsistency, ambiguity or insufficiency in the 

evidence must be resolved.

    (6) There is an indication of a change in the claimant's condition 

that is likely to affect his or her ability to function, but current 

severity is not documented.

    (7) Information provided by any source appears not to be supported 

by objective evidence.