M21-1 Manual  /  Part XIII, Subpart ii, Chapter 1, Section A

Social Security Administration (SSA) Requests for Medical Evidence

M21-1, Part XIII, Subpart ii, Chapter 1, Section A

Overview

In This Section

 This section contains the following topics:
TopicTopic Name
1 Handling SSA Requests for Medical Evidence
2 Unique Circumstances Regional Offices (ROs) Might Face When Processing Form SSA-827, Authorization to Disclose Information to the Social Security Administration (SSA)

1. Handling SSA Requests for Medical Evidence

Introduction

 This topic contains information relevant to the handling of SSA requests for medical evidence, including
  • requirements of 38 U.S.C. 5105
  • where SSA sends requests for medical evidence in VA's possession
  • contents of an SSA request for medical evidence
  • statutory requirement to maintain the confidentiality of certain medical records
  • releasing medical records to SSA that are confidential
  • steps to follow when providing medical evidence to SSA, and
  • responding to follow-up requests from SSA for completion of Form SSA-827.

Change Date

June 14, 2015

XIII.ii.1.A.1.a. Requirements of 38 U.S.C. 5105

38 U.S.C. 5105 requires that evidence a claimant files with either the Social Security Administration (SSA) or the Department of Veterans Affairs (VA) must be made available to the other agency if needed. Notes:
  • A claimant is not precluded from submitting a duplicate set of records/evidence to one or the other agency.
  • VA does not charge for copies of records/evidence it provides to SSA.
Reference: For more information on the sharing of evidence between SSA and VA, see 38 CFR 3.201.

XIII.ii.1.A.1.b. Where SSA Sends Requests for Medical Evidence in VA’s Possession

 SSA sends requests for medical evidence in VA’s possession to the VA regional office (RO) of jurisdiction. These may include requests for medical evidence concerning the status of a child that is incapable of self-support. Exception: SSA sends requests for hospital reports on Veterans who are currently hospitalized, or who have been discharged within the last 30 days, directly to the VA medical center (VAMC) involved.

XIII.ii.1.A.1.c. Contents of an SSA Request for Medical Evidence

 An SSA request for medical evidence consists of Form SSA-827, Authorization to Disclose Information to the Social Security Administration (SSA), and a cover letter. The form should contain
  • the full name and Social Security number (SSN) of the individual who is the subject of the request
  • a description of the evidence SSA is requesting, and
  • the address of the SSA office that submitted the request.

XIII.ii.1.A.1.d. Statutory Requirement to Maintain the Confidentiality of Certain Medical Records

38 U.S.C. 7332 requires VA to maintain the confidentiality of medical records it possesses in connection with the performance of any program or activity if the medical records
  • identify the patient, and
  • contain a diagnosis, prognosis, or discussion of treatment involving
    • drug abuse
    • alcoholism or alcohol abuse
    • infection with the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), or
    • sickle cell anemia.
Note: The “program or activity” referenced in the above paragraph specifically includes
  • education
  • training
  • treatment
  • rehabilitation, and
  • research.

XIII.ii.1.A.1.e. Releasing Medical Records to SSA That Are Confidential

 If medical records SSA requests are “confidential,” according to M21-1, Part XIII, Subpart ii, 1.A.1.d, release them to SSA only if Form SSA-827 bears the signature of
  • the individual named on the form (or his/her representative), and
  • a witness (or two witnesses if the individual signed the form with an “X”).
Reference: For more information on the handling of records pertaining to the treatment of HIV or AIDS, alcohol abuse, drug abuse, or sickle cell anemia, see M21-1, Part II, Subpart ii, 2.B.3.

XIII.ii.1.A.1.f. Steps to Follow When Providing Medical Evidence to SSA

 Follow the steps in the table below when providing medical evidence to SSA.
StepAction
1 Annotate the cover letter that accompanied Form SSA-827 to show which records VA is providing.
2 Send the records SSA requested, along with a photocopy of the cover letter, to the SSA office that requested them.
3 File the original cover letter and Form SSA-827 in the corresponding claims folder. Note: If the claims folder is entirely paperless, upload the documents into the corresponding electronic claims folder (eFolder).
4 Clear end product (EP) 400 (for work credit).

XIII.ii.1.A.1.g. Responding to Follow-Up Requests From SSA for Completion of Form SSA-827

 Use the table below to determine actions to take upon receipt of a follow-up request from SSA for completion of Form SSA-827.Note: Follow-up requests from SSA consist of
  • a photocopy of the original Form SSA-827, and
  • a cover letter with an annotation that reads Second Request.
If the RO ...Then ...
already sent a response to the SSA office that submitted the follow-up request
  • annotate the cover letter with the statement VA reply forwarded[insert date]
  • return a copy of the cover letter to the SSA office that submitted the follow-up request
  • file the original version of the cover letter in the corresponding claims folder (or eFolder, if the claims folder is entirely paperless), and
  • dispose of the duplicate copy of Form SSA-827 in accordance with RCS VB-1, Part I, Item number 13-052.200.
is awaiting the collection of evidence that SSA requested
  • annotate the cover letter with
    • a statement indicating the RO can take no further action on the request pending collection of the evidence SSA requested, and
    • an explanation of the reason for the delay in providing the evidence
  • return a copy of the cover letter to the SSA office that submitted the follow-up request
  • file the original version of the cover letter in the corresponding claims folder (or eFolder, if the claims folder is entirely paperless), and
  • dispose of the duplicate copy of Form SSA-827 in accordance with RCS VB-1, Part I, Item number 13-052.200.
referred the initial request for evidence to a VAMC
  • annotate the cover letter with a statement that identifies the VAMC to which the RO referred the request, and
  • return both the cover letter and the Form SSA-827 to the SSA office that submitted the follow-up request.

2. Unique Circumstances ROs Might Face When Processing Form SSA-827

Introduction

 This topic discusses unique circumstances ROs might face when processing Form SSA-827, including
  • misdirected SSA requests for hospital reports
  • Veterans who have an insurance folder only
  • Veterans with claims folders that are unavailable
  • claims folders that contain only a VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, and
  • actions to take if medical evidence is in the custody of an RO and a VAMC.

Change Date

June 14, 2015

XIII.ii.1.A.2.a. Misdirected SSA Requests for Hospital Reports

 Follow the steps in the table below if
  • the Veteran SSA identifies on Form SSA-827 has been discharged from a VAMC more than 30 days following a recent period of hospitalization, and
  • the corresponding hospital report does not exist in the claims folder or eFolder.
StepAction
1 Make a copy of the cover letter that accompanied Form SSA-827.
2 Annotate the copy with a statement that
  • acknowledges receipt of Form SSA-827
  • identifies the VAMC with possession of the hospital report, and
  • notifies SSA that the form has been referred to that VAMC for a reply.
3 Return the copy of the cover letter to the SSA office that requested the medical evidence.
4 Forward Form SSA-827 and the original cover letter to the appropriate VAMC.

XIII.ii.1.A.2.b. Veterans Who Have an Insurance Folder Only

 Follow the steps in the table below if the subject of an SSA request for medical evidence has an insurance folder only.
StepAction
1 Make a copy of the cover letter that accompanied Form SSA-827.
2 Annotate the copy with a statement that
  • acknowledges receipt of Form SSA-827, and
  • notifies SSA that the form has been referred to the VA Insurance Center in Philadelphia for a reply.
3 Return the copy of the cover letter to the SSA office that requested the medical evidence.
4 Forward Form SSA-827 and the original cover letter to the VA Insurance Center.

XIII.ii.1.A.2.c. Veterans With Claims Folders That Are Unavailable

 Use the table below to determine the actions an RO must take when it receives a request for medical evidence from SSA but the corresponding paper claims folder is unavailable.
If the claims folder is …Then the RO must …
located at another RO
  • annotate the cover letter that accompanied Form SSA-827 with the name and location of the RO that has custody of the claims folder, and
  • return the cover letter and Form SSA-827 to the SSA office that sent it.
on temporary transfer to VA Central Office send the Form SSA-827 and cover letter that accompanied it to the service within VA Central Office that has possession of the folder. Note: The service having possession of the folder is responsible for processing the request.
on temporary transfer to the Board of Veterans Appeals send the Form SSA-827 and cover letter that accompanied it to the Director of Compensation Service (211B) for processing.

XIII.ii.1.A.2.d. Claims Folders That Contain Only a VA Form 10-7131

 Follow the steps in the table below if only a VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, relating to the disability and date of onset referenced on Form SSA-827, is in the claims folder.
StepAction
1 Make a copy of the cover letter that accompanied Form SSA-827.
2 Annotate the copy with the statement VA Form 10-7131 only on file.
3 Return the copy of the cover letter to the SSA office that submitted the Form SSA-827.
4 forward the original cover letter and Form SSA-827 for processing to the hospital or clinic that executed the VA Form 10-7131.

XIII.ii.1.A.2.e. Actions to Take if Medical Evidence Is in the Custody of an RO and a VAMC

 Follow the steps in the table below if
  • SSA requests both a hospital report and a physical examination report from an RO
  • the RO possesses only the physical examination report, and
  • the VAMC possesses the hospital report.
StepAction
1 Make a copy of the cover letter that accompanied Form SSA-827.
2 Annotate the copy with a statement that
  • acknowledges receipt of the form, and
  • explains that the form has been referred to the VAMC that possesses the hospital report.
3 Return the copy of the cover letter to the SSA office that submitted the Form SSA-827.
4 Forward the Form SSA-827, original cover letter, and a copy of the physical examination report SSA requested to the appropriate VAMC. Note: The VAMC is responsible for
  • attaching the hospital report to the documents the RO provided, and
  • returning all of the documents to the SSA office that requested the medical evidence.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XIII, Subpart ii, Chapter 1, Section A (U.S. government work, reproduced for reference). Browse all sections →