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Appendix A - Employee Annuities

Employer Restrictions, Conditions or Exceptions, if 

any

-AAkron & Barberton Belt RR

Akron Union Passenger Depot Co. Current examination conducted if applicant 

has current employee status.

Alameda Belt Line

Aliquippa and Southern RR

American Refrigerator Transit Co. See Attachment 3 to this Appendix.

Atchison, Topeka and Santa Fe Ry. Medical reports furnished for members of 

hospital associations. Release RL-11 direct to 

Chief Surgeon of Hospital Association (See 

Contact Official List) with copy to Contact 

Officer. Request that medical reports be 

returned through Contact Officer's office.

Atlanta & Saint Andrews Bay Ry. Current examinations conducted at company 

stations.

-BBangor and Aroostook RR

Beaufort and Morehead RR

Berlin Mills Ry.

Birmingham Southern RR

Board of Trustees of the Galveston 

Wharves

Current examinations conducted if applicant 

disabled in service, lives in or able to travel to 

Galveston area, and not out of service over 

one year.

Buffalo Creek RR (Lessees)
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Burlington Northern, Inc. Current examinations not usually conducted. 

Reports of past examinations will be 

furnished. Release RL-11 to the Chief 

Medical Officer in St. Paul, MN in all cases.

-CCape Fear Railways, Inc.

Carbon County Ry. Co.

Chattahoochee Valley Ry.

Chessie System (B&O, C&O and all

subsidiaries)

Current examinations not usually conducted. 

Release RL-11 to 

Chief Medical Officer, Chessie System, 100 

N. Charles St., Baltimore, MD 21201.

Chicago and North Western Ry. Current examination conducted if applicant 

can report to company dispensary at 127 N. 

Clinton St., Chicago, IL.

Chicago, Milwaukee, St. Paul and 

Pacific RR

Current examination not conducted for 

employees East of Mobridge, SD. For 

employees West of Mobridge, SD, see 

Milwaukee Hospital Assn.

Chicago Union Station Co. Current examination conducted if applicant 

has current employee status and can report 

to Chicago Union Station Depot, Chicago, IL.

Colorado and Southern Ry.

Colorado and Wyoming Ry.

CONRAIL See Attachment 2 to this Appendix.

-DDelray Connecting RR Current examination conducted if applicant 

has current employee status.

Denver and Rio Grande Western RR

Duluth Union Depot and Transfer Co.

-E-
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Elgin, Joliet and Eastern Ry.

-FFlorida East Coast Ry. Current examinations not conducted. Reports 

of past examinations will be furnished. 

Release RL-11 to Chief Medical Examiner, 

Florida East Coast Railway Company, 2442 

Atlantic Blvd., Jacksonville, FL 32207

Fonda, Johnstown and Gloversville RR Current examinations conducted if applicant 

has current employee status and located in 

vicinity of Gloversville or Amsterdam, NY.

Fort Worth and Denver RY. In addition to request for employer medical 

evidence, develop medical from designated 

examiner unless medical evidence is 

available from "applicant" sources.

-GGreat Western Ry.

Green Bay and Western RR Current examination conducted if DLW is not 

more than 6 months before the date of the 

request and if applicant has not worked in 

any other employment since leaving railroad 

service.

-HHarbor Belt Line RR Most applicants retain rights with company 

from which assigned - namely, AT&SF, UP, 

and SP. Request medical report from 

company with which applicant retained rights. 

If applicant does not retain rights with one of 

companies named, request report from SP.

Houston Belt & Terminal Ry. Current examination conducted if applicant 

has current employee status.

-IIllinois Terminal RR See Attachment 3 to this Appendix.

-K-
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Kelley's Creek and Northwestern RR

-LLong Island RR

Los Angeles Union Passenger Terminal

Ludington & Northern RY.

-MManufacturer's Ry. Co. (St. Louis) See Attachment 3 to this Appendix.

Milwaukee Hospital Assn. Employees of Chicago, Milwaukee, St. Paul 

and Pacific RR West of Mobridge, SD are 

members. Medical evidence will only be 

furnished for disqualified operating 

employees and other employees treated in 

Surgeon's office in Seattle, WA. Members of 

the Milwaukee Hosp. Assn. who have been 

examined by "on-line" assn. doctors should 

be furnished Form G-250 to be completed by 

the "on line" assn. doctor. Form G-250 should 

indicate the doctor is n assn. doctor.

Missouri-Illinois RR See Attachment 3 of this Appendix.

Missouri-Kansas-Texas RR For members of the Missouri-Kansas-Texas 

Employees Hospital Assn., release RL-11b to 

the Administrator, Missouri-Kansas-Texas 

Hospital:

(1) At Parsons, KS 67357 for members 

residing north of the Oklahoma-Kansas 

border;

(2) At Denison, TX 75020 for members 

residing in Oklahoma and Texas.

In addition, if applicant disqualified by 

Missouri-Kansas-Texas Railroad Medical 

Director, release RL-11 to Medical Director, 

Missouri-Kansas-Texas, 101 E. Main St., 

Denison, TX 75020.
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Missouri Pacific RR Co. and all

Subsidiary Companies

See Attachment 3 to this Appendix.

Monongahela Connecting RR

-NNorthwestern Pacific RR See Southern Pacific

Transportation Co.

-OOgden Union Ry and Depot Co.

-PPacific Fruit Express No medical records available for off-line 

employees.

Pearl River Valley RR

Petaluma and Santa Rosa RR See Southern Pacific Transportation Co.

Pittsburgh & Conneaut Dock Co.

Port Terminal Railroad Assn. Current examination conducted if applicant 

has current employee status.

Portland Traction Co.Portland RR and 

Terminal Div.

Pueblo Union Depot and RR

-QQuanah, Acme & Pacific Ry.

-RRahway Valley Co., Lessee Do not request medical report if personal 

injury case.

Richmond, Fredericksburg and

Potomac RR

Current examination conducted if applicant 

has current employee status and able to 

report to company medical examiner.
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-SSalt Lake City Union Depot and RR

San Diego & Arizona Eastern Ry. See Southern Pacific Transportation Co.

Southern Pacific Transportation Co. If applicant has terminated service but is still 

carried on roster and retains rights, 

examination will be conducted for the 

following period after termination of service:

Less than 12 months service - same length of 

time as was in service.

1 year but less than 10 years service - not in 

excess of 1 year.

10 year but less than 25 years of service - not 

in excess of 18 months.

25 or more years service - not in excess of 24 

months.

If applicant has resigned or has been 

discharged, employer will not conduct current 

examinations but will furnish report of last 

examination prior to leaving service.

Staten Island Rapid Transit Ry. See Attachment 1 to this Appendix.

St. Louis Refrigerator Car Co. See Attachment 3 of this Appendix.

St Louis - San Francisco Ry. Current examination conducted for member 

of hospital association only.

St. Louis Southwestern Ry. (Cotton 

Belt)

Current examinations are not available and 

G-3EMP cannot be completed. Complete 

medical records for in- or out-patients of the 

St. Louis Southwestern Ry. Hospital through 

6/1972 are available on request, and will be 

furnished upon authorization by the 

employee. Address requests for these 

medical records to:

St. Louis-Southwestern Ry.

P.O. Box 778

Tyler, Texas 75701

Lines Hospital Trust
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St. Mary RR

-TTerminal RR Assn. of St. Louis See Attachment 3 of this Appendix.

Tidewater Southern Ry.

Toledo, Angola & Western Ry.

Tooele Valley Ry.

Trona Ry.

-UUnion Pacific RR Furnish employee applicant:

1.) Original of Form RL-11 (prepared in 

triplicate) addressed to the physician of 

the UPRREHA (Union Pacific Railroad 

Employees Hospital Association) who 

will conduct the examination. If the 

employee cannot report to the 

physician who last treated or examined 

him, he can be referred to any

company physician for the 

examination. (Amend Form RL-11 so 

that the completed Forms G-3EMP are 

returned to the district office;

2.) Form G-3EMP (properly headed up) in 

duplicate; and

3.) An envelope pre-addressed to the 

district office.

Instruct the employee to present all of the 

above forms to the physician shown on Form 

RL-11 as soon as possible.

Upon return of completed Forms G-3EMP, 

send the duplicate copy with a copy of Form 

RL-11 to the contact officer. Enter on the 

copy of Form RL-11, sent to the contact 

officer, the notation "Original report forwarded 
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to DBD." Forward the original Form G-3EMP 

with a copy of Form RL-11 to DBD.

Union RR (Pittsburgh, PA.) Current examination conducted if applicant 

has current employee status.

United Transportation Union Will conduct medical examinations for officers 

and employees who work at the international 

office. Forward Form RL-11 to the contact 

official.

-VVisalia Electric RR See Southern Pacific Transportation Co.

-WWalla Walla Valley Ry.

Ware Shoals RR

Washington Terminal Co. Current examination conducted if applicant 

has current employee status.

Western Pacific RR

Wichita Union Terminal Ry.

-YYoungstown and Northern RR

Attachment 1 The Chessie System

The Chessie System, which includes the Baltimore and Ohio Railroad, the Chesapeake 

and Ohio Railway, and the Western Maryland Railway, requests that all forms RL-11 be 

released to the offices listed below for completion.

The following is a list of the Chessie medical offices, their mailing addresses, and the 

major cities located in each district. The medical district also includes areas adjacent to 

or between the cities listed. Released Form RL-11 to the office of district in which the 

applicant resides. Current examinations may be arranged at these locations.

Medical Examiner

Cities Located in Medical District

Regional Medical Examiner Ashland, KY
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Chessie System

Box 1800

Operating Headquarters Bldg.

801 Madison Avenue

Hunting, WV

Raceland, KY

Russell, KY

Portsmouth, OH

Charleston, WV

Huntington, WV

Chief Medical Officer

Chessie System

100 N Charles Street

Baltimore, MD 21201

Washington, D.C.

Wilmington, DE

Chicago, IL

E. St. Louis, IL

Garrett, IN

Indianapolis, IN

Covington, KY

Louisville, KY

Newport, KY

Stevens, KY

Baltimore, MD

Dearborn, MI

Detroit, MI

Flint, MI

Grand Rapids, MI

Ludington, MI

Saginaw, MI

St. Louis, MO
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New York, NY

Chillicothe, OH

Cincinnati, OH

Columbus, OH

Dayton, OH

Fostoria, OH

Hamilton, OH

Lima, OH

Toledo, OH

Wallbridge, OH

Philadelphia, PA

Charlottesville, VA

Newport News, VA

Norfolk, VA

Richmond, VA

Parkersburgh, WV

Current examinations will not always be conducted; however, when the applicant has a 

current employee status and could report, at his own expense for examination by an 

employer medical examiner, enter the following postscript on Form RL-11:

"If requested, applicant can report for examination at ______________."

Advise the applicant to comply promptly if the employer requests that he report for 

examination.

The following is a list of the medical examiners, their addresses, and the major cities 

located in each district. These facilities do NOT have a full time medical examiner, and 

current examinations can usually not be arranged. They may, upon receipt of Form RL11, however, be able to provide records of pertinent past examinations.
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Medical Examiner Cities Located in Medical District

Medical Examiner

Chessie System

YMCA Building

720 Virginia Ave.

Cumberland, MD; Hagerstown, MD;

Martinsburg, WV, Grafton WV, 

Fairmont, WV, Clarksburg, WV, 

Pittsburgh, PA, Connellsville, PA, 

Buffalo, NY, Rochester, NY

Medical Examiner

Chessie System

Metropolitan Building

39 S. Main Street

Akron, OH 44308

Akron, OH; Youngstown, OH; Newark, 

OH, Zanesville, OH, New Castle, PA, 

Willard, OH

When the applicant does not indicate recent examination by a company doctor, release 

RL-11 to proper source, but do not wait for response from the Chessie - schedule 

appropriate examinations immediately.

Attachment 2 The CONRAIL System

CONRAIL will conduct a current medical exam for a disability applicant provided:

(1) He has a current employee status, and

(2) He can report to one of the CONRAIL medical offices listed below.

If the applicant can report to one of the medical offices listed below, indicate in a 

footnote on Form RL-11:

Applicant can report for examination at (location). 

The employer will notify the applicant to contact the appropriate medical office within 10 

days for an appointment. Explain to the applicant the importance of complying with the 

employer's request to report for examination.

If the applicant states he was disqualified by a CONRAIL medical officer, question him 

closely to find out where he was examined, when, and by what doctor. Enter this 

information in the space provided on Form RL-11.
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CONRAIL medical offices are located in the following cities:

Chicago, IL

Conway, PA

Indianapolis, IN

Philadelphia, PA

Pittsburgh, PA

Selkirk, NY

DO NOT DIRECT FORM RL-11 TO THE CONRAIL MEDICAL OFFICER; SEND IT TO 

THE CONTACT OFFICIAL.

CONRAIL has closed many medical offices since they became an employer in April 

1975. If an applicant, for a disability annuity claims employer disqualification for medical 

reasons prior to the closing of one of the medical facilities, send an RL-11 to the contact 

official and specifically request a copy of the disqualification notice in a post script to 

that letter.

Attachment 3 Other Railroads

Developing medical evidence for an employee of one of the employers listed below:

EMPLOYERS

American Refrigerator Transit Missouri Pacific RR

Illinois Terminal RR St. Louis Refrigerator Car Co.

Manufacturers Ry. Co. (St. Louis) Terminal RR Assn. of St. Louis

HOSPITAL ASSOCIATIONS

Chief Surgeon Chief Surgeon

Missouri Pacific Employee's Hosp. Assn. Gulf Coast Lines Employee's Hosp. Assn.

St. Louis-Little Rock Hospitals, Inc. 1601 West Alabama

If treated in the Little Rock Houston, TX 77006
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Hospital, send request:

Missouri Pacific Employee's

Hosp. Assn.

Little Rock, AR 72201

1. If applicant claims disqualification by employer, he should have a letter to that 

effect. If so, release RL-11 to disability contact officer as shown in contact official 

list.

2. If applicant is not disqualified by employer and is a member of one of the hospital 

associations shown above, release RL-11b direct to hospital association where 

treated. (If your experience indicates difficulty in securing medical reports form 

hospital association, schedule appropriate medical examination(s) with 

designated examiner simultaneously with release of request to hospital 

association.) 3. If applicant is not disqualified by employer and is not a 

member of one of the hospital associations shown above, schedule appropriate 

medical examination(s).. 

Take the same tracer action on hospital associations as is taken on employers.

Appendix B - Field Guide

Appendix_B

Medical Evidence Development And Evaluation

The following guide is used by field offices to evaluate the adequacy of existing 

evidence and to determine which exams, tests, and X-rays are needed to supplement 

existing evidence.

Field Office Guide For Developing Medical Evidence

SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

1. Musculoskeletal

A. Inflammatory Arthritis Orthopedic Antinuclear Antibody, or 

Erythrocyte

Sedimentation Rate, or

Rheumatoid Factor
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SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

X-ray of the most affected 

joints (maximum of three), 

you must specify the joints to 

be X-rayed.

B. Osteoarthritis Orthopedic X-ray of the most affected 

joints (maximum of three), 

you must specify the joints to 

be X-rayed.

C. Disorders of Spine Orthopedic X-ray of the portion of Spine 

affected.

D. Fractures Orthopedic X-ray of the fractured area

E. Amputation Orthopedic

F. Osteomyelitis Orthopedic Erythrocyte

Sedimentation Rate

X-ray of the affected area 

(maximum of three), you 

must specify the area to be 

X-rayed.

2. Sensory

A. Visual Disorders

(1) Visual Acuity

Ophthalmology

(2) Visual Field

Ophthalmology

B. Hearing Disorders

(1) Meniere's

Disease

Otolaryngology

(with audiometric

and caloric test)
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SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

(2) Deafness Otolaryngology

(with audiometric

test, and with air

and bone condition

pure tone studies)

3. Respiratory

A. Obstructive Disorders Internist Ventilatory Studies, Chest Xray

B. Restrictive Disorders Internist Chest X-ray

C. Pulmonary

Tuberculosis

Internist Ventilatory Studies, Chest Xray

D. Other Infectious

Lung Diseases

Internist Ventilatory Studies, Chest Xray

E. Occupational Lung

Diseases

Internist Ventilatory Studies, Chest Xray

F. Diseases of Larynx Internist

4. Cardiovascular

A. Congestive Heart

Failure

Internist Electrocardiogram (EKG), 

Chest X-ray

B. Ischemic Heart Internist Electrocardiogram

C. Conduction

Disturbances

Arrhythmias

Internist Electrocardiogram

D. Other Cardiovascular

Conditions

Internist Electrocardiogram

(1) High Blood

Pressure

Internist Electrocardiogram

(2) Aneurysms Internist Affected area, specify the 

area to be X-rayed.
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SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

(3) Chronic Venous

Insufficiency

Internist

(4) Arteriosclerosis

Obliterans

Internist Doppler Ultrasound

Blood Flow Study

(5) Transient

Ischemic

Attacks

Internist or

Neurologist

Electrocardiogram

5. Gastrointestinal

A. Recurrent Upper

Gastrointestinal

Hemorrhage

Internist

B. Stricture Stenosis

Obstruction of

Esophagus

Internist

C. Peptic Ulcer Internist

D. Chronic Liver Disease Internist Liver Function Studies

E. Chronic Ulcerative

Colitis

Internist

F. Regional Enteritis Internist

6. Genito-Urinary

A. Chronic Renal Failure Internist Serum Creatinine

B. Nephrotic Syndrome Internist Serum Albumin**

7. Hemo-Lymphatic

A. Disorders of Red

Blood Cell

Internist Red Blood Cell Count

B. Disorders of White

Blood Cell

Internist Complete Blood Count

C. Hemorrhagic

Disorders

Internist Platelet Count**
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SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

D. Lymphomas Internist

E. Plasma Cell Disorders Internist Complete Blood Count,

Serum Protein

Electrophoresis**

8. Skin Dermatologist

9. Endocrine

A. Thyroid Disorders Internist Thyroid Evaluation

(T3-T4)

B. Diabetes Mellitus Internist Serum Glucose

C. Diabetes Insipidus Internist Urinalysis

D. Hyperparathyroidism Internist Serum phosphorus,

Bone X-ray (maximum of 

three), you must specify the 

area to be X-rayed.

E. Hypoparathyroidism Internist Serum Phosphorus

10. Neurological

A. Epilepsy (seizures) Neurological* Anti-convulsant serum level

B. Cerebrovascular

Accident (stroke)

Neurological*

C. Cerebral Palsy Neurological*

D. Head Injury Neurological*

E. Intracranial Tumor Neurological*

F. Parkinsonism Neurological*

G. Chorea Neurological*

H. Multiple Sclerosis Neurological*

I. Diseases of Spinal

Cord

Neurological*
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SYSTEM/IMPAIRMENT EXAMINATION LAB TEST and/or X-RAY

J. Peripheral Neuropathy Neurological*

11. Mental

A. Mental Retardation I.Q. Evaluation

B. Other Mental Psychiatric*

12. Malignant Tumors Internist

13. Multiple Organ Systems

A. Systemic Lupus

Erythematosus

Internist Antinuclear Antibody

B. Obesity Internist

C. All other multiple

systems disorders

Exams, tests, and X-rays of 

one or more body systems 

as necessary. You must 

specify the type of X-ray.

*All available medical evidence must be sent by overnight delivery to 

the contracted provider the same day the examination is 

ordered.Appendix C - Medical Exam Reference Chart

NO. DESCRIPTION

001 Dermatology (skin) exam

003 Otolaryngology (ear) exam including audiometric test with air and bone 

condition pure tone studies and with speech discrimination

005 Otolaryngology (ear) exam with Caloric test [i.e. test measuring 

balance]) including audiometric test

007 Ophthalmology (eye) exam

011 I.Q. Evaluation with psychometric testing

012 Neurology exam

013 Psychiatry exam

014 Minnesota Multiphasic Personality Inventory (MMPI) test 
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016 Orthopedics exam

017 Internal medicine exam with Orthopedic involvement

SCHEDULE THIS IF CONCURRENT ORTHOPEDIC AND

NONORTHOPEDIC IMPAIRMENTS

018 Internal medicine exam

020 Serum Protein Electrophoresis

023 Arterial Blood Gas (Resting) test 

024 Prothrombin Time and International Normalized Ratio (PT/INR)

026 Glycated Hemoglobin (also known as an “A1C” Test)

028 Hematocrit

030 Complete Blood Cell Count (CBC)

032 Serum Creatinine

033 Serum Albumin

034 Erythrocyte Sedimentation Rate

036 SMA series (SMA-12, etc.)

037 Anti-convulsant serum level

038 Liver Function Studies (SGPT, total protein, LDH, serum bilirubin and 

alkaline phosphatase)

039 Thyroid evaluation, T3-T4

040 Electro-encephalogram (EEG)

041 Ventilatory Function Studies (Pulmonary function test, spirometry)

042 Diffusing Capacity/Lungs (DLCO)
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043 Stress (treadmill or bicycle) test with monitoring

044 Rheumatoid Factor

045 Electrocardiogram (EKG) with interpretation

046 Doppler Ultrasound Flow Detection Technique

047 Urinalysis (including chemical and microscopic examination)

048 Antinuclear Antibody

052/152 Left / Right ankle joint (X-ray)

Anteroposterior, lateral views, and oblique

053/153 Left / Right upper arm (humerus) (X-ray)

Anteroposterior, lateral views, and oblique

055 Chest, plain (X-ray)

058/158 Left / Right elbow (X-ray)

Anteroposterior, lateral views and oblique

062/162 Left / Right foot (X-ray)

Anteroposterior, lateral views and oblique

063/163 Left / Right forearm (radius and ulna) (X-ray)

Anteroposterior, lateral views

067/167 Left/Right hand (X-ray)

Anteroposterior, lateral views and oblique

068 Hip joints (right and left on one film) (X-ray)

Anteroposterior view

073/173 Left/Right knee joint (X-ray)

Anteroposterior, lateral views, and oblique

075/175 Left/Right lower leg (tibia and fibula) (X-ray)

Anteroposterior and lateral views

079/179 Left/Right shoulder joint (X-ray)

Anteroposterior view, internal and external rotation

085 Skull (X-ray)

Anteroposterior, right and left lateral frontal and basal odontoid
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087 Cervical spine (upper spine [i.e. neck area]) (X-ray)

Anteroposterior and lateral views, odontoid

088 Dorsal spine (middle spine [i.e. upper-middle back area]) (X-ray)

Anteroposterior and lateral views

089 Lumbar spine (lower spine [i.e. lower back area] (X-ray)

Anteroposterior and lateral views

092/192 Left/Right thigh (femur) (X-ray)

Survey film

094/194 Left/Right wrist (X-ray)

Anteroposterior and lateral views

101 Cardiology Exam

102 Oncology Exam

103 Otolaryngology Exam

104 Endocrinology Exam

105 Otolaryngology –ENG Exam

106 Otolaryngology –HINT Exam

107 Ophthalmology Exam

108 Pulmonology Exam

109 Gastroenterology Exam

110 Hematology Exam

111 Urology Exam

112 Neurologist Specialist Exam

113 Psychiatric Specialist Exam

116 Orthopedic Specialist Exam

(Prior to July 1, 2015, this exam was limited only to Hearings Officers. 

Effective July 1, 2015, this limitation was removed). 

123 Arterial Blood Gas (Exercise)

200 Functional Capacity Exam
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Appendix D - Activities of Daily Living (ADL)Worksheet

See FOM1 1720 form G-31

Refer to RRAILS to view the current copy of a blank G-31.

Appendix E – Guide to High Risk Disability Case Interviews

Appendix_E 

In an effort to enhance the application process, the Railroad Retirement Board will 

conduct comprehensive in-person interviews with disability applicants who meet one or 

more of the five following criteria shown below. Refer to FOM 1310 for information on 

Field Service In-Person Interviews. 

1. Prior Earnings Fraud: Applicant was previously reviewed for earnings fraud due to 

unreported work activity and such action was determined to be fraudulent (review 

Contact Log to determine if “Prior RUIA Fraud G-626A required for Disability EE 

applicants – see FOM 1 Article 13 Appendix E” alert message is present); 

2. LAG Earnings Needed: Applicant needed lag earnings to attain 240 cumulative 

service months (except for settlement cases) and the employee is under age 51 at 

time of filing or is entitled to a private pension from the railroad employer and is 

under age 56 at time of filing (refer to FOM 209.1 for the definition of Lag);

3. Possible Work/Earnings: Field office staff identifies possible work/earnings from 

an incorporated business, limited liability corporation, or self-employment with 

reported levels of income below the earnings limitations established for disability 

annuitants. See FOM1 1125.5.2 for the annual earnings limitation amount; 

4. No Earnings in Last 5 Years: In the five years prior to filing date of the disability 

application, the applicant lacked railroad and/or social security earnings;

5. Uniform Responses/Patterns: Entries on the applicant’s disability application are 

uniform or other material information provided by the applicant appears inconsistent 

or is in need of further review in the opinion of the disability examiner and his/her 

supervisor (refer to DCM 8.8.2, Elements of Fraud).

If a disability applicant meets one of the criteria indicated above, further interview by 

Field Service claims representative is required. Discuss the details of the criteria 

identified with the individual. Examples of identifying questions to ask when individuals 

meet one of the five criteria can be found below. 
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Through your interview (either in-person or over the telephone), you may learn that the 

individual meets another criteria. If so, you should pursue questions in that criteria, in 

addition to the other criteria initially identified. Use Form G-626A, Field Office 

Personal Observation Record, to record personal observations and additional 

information obtained from the interview. See FOM1 1720 for information on Form G626A. Identify which criteria the individual met in the remarks section of Form G-626A.

Scan the G-626A and all relevant documents to imaging.

DBD staff will also review the G-626A when adjudicating the case. Should DBD staff 

have additional questions or need clarification on some of the responses, DBD staff 

may contact the Field Service claims representative for clarification and/or contact the 

disability applicant. 

Examples 

Criteria # 1 - Prior Earnings Fraud: Applicant was previously reviewed for earnings 

fraud by the RRB, OIG or external agency such as SSA due to unreported work activity 

and such action was determined to be fraudulent. (Review Contact Log to determine if 

“Prior RUIA Fraud G-626A required for Disability EE applicants – see FOM 1 Article 13 

Appendix E ” alert message is present). Questions and statements to ask when 

individuals meet this criteria include, but are not limited to:

1. All types of work should be reported, including railroad and non-railroad jobs. 

This includes but is not limited to Self-Employment, Officer of a Company, Public 

Office and work for income or services. Does your application include all work 

you performed in the last fifteen years or that you intend to perform this year? 

Criteria # 2 - Lag Earnings Needed: Applicant needed lag earnings to attain 240 

cumulative service months (except for settlement cases) and the employee is under age 

51 or is entitled to a private pension from the railroad employer and is under age 

Questions to ask when individuals meet this criteria include, but are not limited to:

 

1. Are you receiving or do you expect to receive a private railroad pension? (Based 

on response, ask questions per pension requirements. For example: Age, Years 

of Service, Specific Job (engineers only))

2. What are the age and service requirements for your Private Pension with your 

company? Did this influence your decision in any way? 

3. What was your most pressing reason for filing at this time? 

4. What prompted you to see a doctor at this time? (This should be asked if the 

applicant has little to no historical medical evidence)

5. Are you filing now because you expect your condition to last 12 months? What is 

the prognosis of your condition?
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Criteria # 3 - Possible Work/Earnings: Field office staff identifies possible 

work/earnings from an incorporated business, limited liability corporation (LLC), or selfemployment with minimal reported earnings. Questions to ask when individuals meet 

this criteria include, but are not limited to:

1. Are you aware that earnings are shown under your name? (This relates to 

identity theft)

2. Are the earnings correct and if so, what type of work did you perform? 

3. Have you received any special payments (lump sum payouts/bonus)?

4. Did you receive special considerations or conditions to complete your work? If 

so, please describe them. 

5. Does any member of your family own the business? 

Criteria # 4 - No Earnings in 5 Years: In the five years prior to the filing date of the 

disability application, the applicant lacked railroad and/or social security earnings. 

Questions to ask when individuals meet this criteria include, but are not limited to:

1. You mentioned that you have not worked for several years. Have you had any 

income from other sources to assist with your living expenses? 

2. Are you eligible for and/or receiving any State assistance, either due to your 

condition or services you may be performing, like providing homecare?

3. Are you receiving any additional pay or special considerations based on your 

impairment? (Examples: Payment of rent, utility bills, room and board, or 

receiving stipend in lieu of pay.)

4. Do you receive any assistance from friends or family? 

Criteria # 5 - Uniform Responses/Patterns: Entries on the applicant’s disability 

application are uniform or other material information provided by the applicant appears 

inconsistent or is in need of further review in the opinion of the disability examiner and 

his/her supervisor. Questions to ask when individuals meet this criteria include, but are 

not limited to:

1. Did anyone assist you with this form?

2. I am unclear on some of the terms you used in your application. Could you 

explain to me the meaning of (pick one from the application)? 

3. If the person can’t explain a term he/she used, follow-up by asking why they 

picked that term. 

4. If any of the answers from questions above indicate that someone other than the 

family helped with answers to the application, a question to address this could be 

worded in the following manner: You advise that you received assistance from a 
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professional. How did you hear about this person and were you satisfied with 

their help? (If they were not satisfied, ask what issues they have.) 

5. How do your conditions listed on your application impact on your ability to 

perform your job duties?