Section 855.30  Content of Personalized Notice

a)         A personalized notice will contain the following elements:

1)         A list of the medical/vocational reports evaluated.

2)         A statement indicating that the Bureau obtained and evaluated those medical/vocational reports necessary to make a decision.  When sources of evidence are unresponsive (an unresponsive source is a source who has not responded to at least two Bureau requests for reports regarding the claimant), the statement will indicate that additional reports were not obtainable, but there is enough evidence to evaluate the claimant's condition.

3)         A paragraph explaining the basis for the decision.

4)         A list of the impairments evaluated in laymen's terms.

5)         An explanation of the evidence.  When the effects of pain and/or other symptoms have been considered in making the decision, a discussion will also be included of how often the symptom occurs and how long it lasts, what causes the symptom to appear or makes it worsen, third party and physician reports and/or observations and a medical opinion regarding the effects of the symptom on the individual's ability to function.  Where there are conflicting opinions in file about the individual's ability to function, a discussion will be included regarding the consideration given to the opinions and the basis for conclusions regarding the individual's ability to function.

6)         When the basis for an unfavorable decision of disability is the ability to do past work, the job to which the claimant can return.

7)         When the basis for an unfavorable decision is the ability to do work other than what the claimant has done in the past, a statement that although the individual is unable to do work done in the past considering age, education and past work experience, the individual retains the capacity to do other types of work which are less physically or mentally demanding.

8)         When the basis for an unfavorable decision is that the 12 month duration requirement is not met, an explanation of this issue.

9)         When an unfavorable decision is based on factors such as insufficient evidence or failure/refusal to submit to a consultative examination, an explanation of the decision based on these factors.

10)       When an unfavorable decision is based on failure to follow prescribed treatment, a discussion of the prescribed treatment the individual is not following and what the treatment would accomplish, if followed.

11)       When a partially unfavorable decision is made, a discussion of the evidence including dates and time periods involved.

b)         A personalized notice will be written in the following manner:

1)         Abbreviations, jargon, acronyms, technical terms or complex medical language will not be used.

2)         Information provided will be concise and relevant to the disability determination.

3)         Dates will be abbreviated by number (e.g., 12/14/81).

4)         Statements will be made as simply and clearly as possible using proper language.

5)         Language used will be sensitive to the claimant's feelings and needs.

6)         Language will be written in the third person when the notice will be sent to an individual filing on behalf of another person.