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Advocate's
name :

Client Info:

DLI in the
past only:

Opening
language:

Medical
sources:

Reconsideration or ALJ cases only:

Primary Dx:

Discussion of
Primary dx:

Discussion of Secondary dx:

Discussion of combined effect of primary and secondary dx:

Discussion of
vocational issues and your RFC:

Summation:

Memorandum Development Worksheet

Date:

Representative:
Claimant's name
Internal case #

This communiqué is a formal argument written on behalf of Social Security disability applicant
Mr./Ms., SSN: . This claimant is applying for
Social Security disability benefits on the application level.
Claimant's alleged onset of disability iswhich is the date the claimant stopped
working as a result of his/her impairments. Claimant's primary past work history includes
work as a:, . .
The duties of these jobs include,,
.

The date the claimant was last insured for Social Security disability benefits is .
This case review covers the period from the DLI or onset, to the most current date.

   Claimant is ay/o individual who alleges disability due to
   and . The medical
   evidence shows a significant impairment that does not meet or equal the medical listings.
   The medical evidence also shows that as a result of these impairments, claimant alleges an
   inability towhich has significantly reduced
   his/her ability to perform work. The claimant also alleges additional
   limitations which include a reduced ability to , which
   further reduce his/her ability to perform work activity.

   The following reports were used in the evaluation of this claim:

   Dr. Report dated ,
   Dr. Report dated ,
   Dr. Report dated ,
   Dr. Report dated ,
   Dr. Report dated ,
   Dr. Report dated ,

  Hospital report Report dated
  Hospital report Report dated
Hospital report Report dated
  Hospital report Report dated

Other Other report dated ,
Other Other report dated .

   Claimant was previously denied disability benefits at the application
   level on . In the previous decision, Social Security felt that the claimant's
   condition was, and did not prevent the performance of all work activity.
   Social Security felt that despite the claimant's condition, he/she was still capable of performing
   the duties of work. After careful review of the claimant's records, we
   strongly disagree with SSA's previous decision. We based our review of this case on the

   following evidence:

   Dr.      Report dated ,
   Dr .     Report dated ,

   Hospital report    Report dated ,
   Hospital report    Report dated .

   The medical evidence in file shows that claimant does suffers from severe
   which has significantly reduced his/her ability to perform work.
   This condition has also reduced the claimant's ability to perform ordinary activities of daily
   living which include a reduced ability tofor extended or
   prolonged periods of time. This condition was first diagnosed on or around
   and continues to the present time.   Additional restrictive symptoms of this disorder include:
   ,
   .

Discussion of secondary diagnosis and its limiting affects upon the claimant's ability to work.

   The medical evidence further shows that claimant also suffers from.
   This condition has also reduced the claimant's ability to perform work. Symptoms of this
   disorder include,.

When one considers the combined effects of the claimant's primary and secondary impairments,
it becomes clear that the claimant is not capable of performing any type of work activity.

   With consideration of the medical findings in this case, it is felt that this claimant would be
   limited to a residual functional capacity forwork. When one
   considers the claimant's current age, education and his remaining functional capacity, it is
   felt that this claimant would not be capable of performing past or other work as described
   by the claimant. This restriction includes work which would require less physical demand.
   This finding is consistent with vocational rule numberwhich directs a decision
   of disabled.

Summation:

   In summation, claimant is ay/o individual who has alleged total disability as a result
   of severeand . These conditions
   have resulted in significantlimitations that prevent claimant
   from adjusting to or performing past or other work activity. The Claimant's limitations are
   strongly supported by the medical evidence and are consistent with the claimant's
   activities of daily living.

   When one considers the limiting effects of each established impairment suffered by this
   claimant, it becomes clear that the claimant is not capable of sustaining any type of work
   activity as is required to maintain gainful employment. This decision was made with
   consideration of the claimant's age, education and what we feel is a fair and realistic
   residual functional capacity for work.

   As the authorized representative for Mr./Ms, I am respectfully
   requesting that this claimant be found disabled and awarded Social Security disability
   benefits with an onset date set on or about. Thank you for your consideration.

   Your name:
   Your Title:
   Your business:

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