DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 1 of 26

7.1 Introduction

7.1.1 Scope of Chapter

This chapter focuses on the processing and disposition of requests for reconsideration 

and appeals of disability rating decisions rendered by the Disability Programs Section 

(DPS) under the Railroad Retirement Act (RR Act). The Reconsideration Section in 

Assessment and Training handles all reconsideration requests of disability decisions 

and appeals of decisions are charged to the Bureau of Hearings and Appeals.

This section contains procedures that are unique to disability reconsideration such as 

medical development, vocational documentation and preparing a rationale. RCM 6.1.1

contains procedures regarding all non-medical issues pertaining to reconsideration.

7.1.2 Right To Request Reconsideration

Every annuitant has the right to file a request for reconsideration of an initial or post 

disability decision made by DBD. See RCM 6.1 for exceptions, summary of the 

reconsideration and appeals process, and filing for reconsideration and appeals.

NOTE: An annuitant may request a reconsideration of a disability annuity onset 

decision based on Form RL-121f notice. For this reason, RL-121f letters must include 

information about reconsideration rights, even if additional medical evidence has been 

requested for a possible earlier onset date. Requests for reconsideration of the ABD or 

annuity rate must be based on the annuity award letter (RL-20 for retirement cases and 

RL-43 for survivor cases).

In addition, reconsideration rights are not to be included in letters when informing an 

annuitant that their annuity has been impacted by earnings and impairment related work 

expenses (IRWE) have been considered. The reconsideration rights will be provided in 

a letter when the annuity is adjusted by the adjudicating unit.

7.1.3 Types Of Reconsideration

A. Initial Denial Actions - A reconsideration request may be handled for cases 

where an initial disability annuity under the RR Act and/or "period of disability" 

(disability freeze) or early Medicare entitlement under the SS Act were denied. 

The disability denial may be based on service requirement not met, lack of 

disability severity, insufficient quarters of coverage (QC's) for disability freeze, 

etc. 

The handling of the reconsideration request pertains to the following beneficiary 

types: 

Employee's occupational disability 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 2 of 26

Employee's total and permanent disability (including DF)

Widow's disability 

Child's disability 

B. Partially Favorable Decisions - This type of reconsideration request involves 

disability decisions for each beneficiary where a partially favorable allowance 

was made. For example, we did not allow the earliest onset date, as claimed by 

the annuitant since the medical evidence of record did not permit it. Also, 

another situation is where the occupational disability annuity was allowed but the 

"period of disability" (disability freeze for early Medicare entitlement) was denied. 

The medical evidence of record did not support a finding of total and permanent 

disability.

C. Cessation of Disability Determinations - Regarding this reconsideration request, 

a CDR was conducted and it resulted in a termination of either disability benefits 

under the RR Act and/or disability freeze for early Medicare entitlement under the 

SS Act. The termination was made due to an annuitant's medical recovery, 

subsequent work for covered railroad carrier, substantial gainful activities (SGA), 

continued work activity after a trial work period (TWP) or failure to cooperate.

Also, a reconsideration request may be received after we have reopened to deny 

because a post review uncovered that an erroneous initial determination had 

been made for him/her.

7.1.4 Third Party Inquiry Relating To Adverse Decisions

If an inquiry is received from someone clearly representing the claimant, which refers to 

our adverse notice (denial letter) and indicates that the notice was incorrect, this may 

indicate an attempt by the claimant to ask for a reconsideration.

In such cases, the field office should be advised to contact the claimant to find out if a 

reconsideration request was intended. If so, the third party letter will preserve his/her 

appeal as long as the third party letter was received within the 60 day 

reconsideration/appeal period.

7.1.5 Reconsideration Handling By Reconsideration Examiners

A reconsideration examiner, not involved in the initial determination or post termination 

decision, performs the case review after Form RL-211a is released to the individual 

acknowledging the receipt of request for reconsideration.

If it is not already in file, request the field office to secure any medical evidence 

including evidence from the individual's treating physician(s). This request should also 

include records from hospitalizations or clinic treatments and/or non-medical evidence 

(vocational/work records) from him/her and/or employer(s).
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 3 of 26

It may be necessary to request that the individual undergo a consultative examination 

(CE) or refer the case to QTC when the medical evidence presented for use at the 

reconsideration level is in conflict with medical evidence of record.

Based on all the evidence, render a reconsideration decision.

If you determine that the initial denial, partially favorable or cessation decision should be 

reversed, prepare the appropriate screen(s) on OLDDS and/or paper forms. (G-325, G325.1, SSA-831-U3, or G-325a).

Also, prepare a letter advising the individual about the wholly/partially favorable 

allowance or continuance of disability decision.

After the reconsideration decision has been authorized the case should be handled as 

follows:

• Forward to the Director of the Retirement Benefits Division or the Director of the 

Survivor Benefits Division. The route slip should indicate the type of action needed 

by the payment examiner, such as awarding the initial disability annuity, recertifying 

the disability annuity payment based on an earlier onset date, enrolling for Medicare 

coverage, etc.

When the reconsideration decision still affirms the initial decision, prepare and release a 

letter affirming our earlier decision. Unless there is some other action needed after

reconsideration action has been taken, forward the folder to BHA.

7.1.6 Reconsideration Request Filed Before The Initial Determination Is Made On 

An Initial Disability Claim

Under RRB's regulations, a claimant does not have a right to request a reconsideration 

in advance of an initial determination. For purposes of an appeal, an initial 

determination is made when the notice of such determination is dated for release.

In instances where a request for reconsideration is filed before the initial determination 

is made, Disability Initial Section (DIS) will dismiss the reconsideration request on the 

basis that an initial determination had not been made. Conversely, in those instances 

when the reconsideration request is filed before receipt of the notification (the denial 

notification is prepared but not released, or it is in transit), the reconsideration request 

should be processed as a valid request. 

In some situations, the field office will have to telephone DIS to ascertain the status of a 

claim before taking an action. Any new and material medical evidence submitted at this 

time should be forwarded to DIS for association and consideration with the pending 

unadjudicated claim. 

An example of the language which may be used in dismissing such a request is as 

follows, but may have to be modified to fit the particular case involved:
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 4 of 26

"We have dismissed your request for reconsideration dated _________________ 

because an initial disability determination has not been made in your case. The RRB 

regulations provide the right to reconsideration of a disability determination only after an 

initial determination has been made. You will be advised of this right in the initial 

disability determination notice. 

If you have any questions about your claim, you should get in touch with any RRB field 

office. Most questions can be handled by telephone or mail. If you visit the field office, 

please bring this notice with you.

7.1.7 New Disability Applications Filed While A Reconsideration Or Appeal Is 

Pending

RRB's regulations (20 CFR Section 217.9) states that the effective period of an 

application ends on the date of the notice of an initial decision denying the claim. Also, 

Section 217.9 states that if a timely appeal is made, the effective period of the 

application ends on the date of the notice of the decision of the hearings officer, on the 

date of the notice of the final decision of the Board or when the court review of the 

denial has been completed. After the effective period of an application ends, the person 

must file a new application for any annuity.

Due to varying circumstances, the time period involved in the handling of cases from the 

initial decision through the entire appeal process can become quite lengthy. For that 

reason, some claimants file a new application while they are still appealing the decision 

from the original application.

Section 5(b) of the RR Act provides that an application for any payment under the Act 

"shall be made and filed in such manner and form as the Board may prescribe." This 

statute thus expressly grants to the Board the discretion to determine the manner in 

which applications may be filed.

Based on the above, DBD can receive new applications filed while a reconsideration or 

appeal before the Board is pending, but should take no development action until the 

appeal process is completed. No additional development is necessary in those cases 

where the appeal is ultimately decided in the claimant's favor. Where the appeal is not 

decided in the claimant's favor, payments are prohibited on the application for the period 

covered by the initial application only (claimant's potential eligibility for receiving a 

benefit for up to twelve months prior to the filing date).

This approach conforms with procedures of SSA. See POMS GND1 12045.027 for 

specifics. 

When a claimant files a new application while a reconsideration of an initial 

determination is pending, process the case as follows:

A. New Application Filed While Initial Denial Being Reconsidered - If the claimant 

files a new application while the Reconsideration Section is reconsidering an 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 5 of 26

initial denial, and the new application represents the same issue as the previous 

claim, combine the application with the reconsideration request. Advise claimant 

that since his original application is still in an appeal process, it is active so no 

action will be taken on the second application filed.

B. New Application Filed While Cessation Being Reconsidered - When a 

Reconsideration examiner is preparing a reconsideration determination affirming 

a substantial gainful activity (SGA) cessation, and a new application is filed, the 

new application should be combined with the reconsideration request.

C. Dual Disability Claim Filed While An Initial Denial Or Cessation Is Being 

Reconsidered

When a claimant files a related claim (dual entitlement exists) while a 

reconsideration request is pending on another disability claim under the same 

entitlement, the new claim should be referred to DPS. DPS should complete the 

disability rating for the new application and then review the claim that had been 

denied. If this new rating shows that the previously denied rating should be 

reopened then DPS should take all necessary actions. For example:

An employee was denied a total and permanent disability and files a

reconsideration. In the interim the employee files for a disabled widower benefit. 

When the medical evidence is received for the widower claim, evidence that was 

unavailable when the denied rating was made, is submitted. This new evidence 

shows the claimant to be disabled for both a widower and total and permanent 

annuity. DPS should reopen the denied claim, make the appropriate disability 

determination, and inform the Reconsideration Section that the decision has 

been overturned.

However, if the decision on the new application does not affect the denied rating, 

DPS should complete their action and return the claim to the Reconsideration 

Section.

Prepare a personalized notice for each claim to include the claimant's right to 

request a hearing if dissatisfied with the reconsideration decision. 

D. Application Filed After Appeal Process Completed

If an application is filed after the appeal process has 

been completed, the medical determination cannot consider a 

period covered by the earlier application. To do so would 

in effect be reopening the original final decision. 

NOTE: The appeals process ends 60 days after notification 

to the applicant of a decision even if no request for 

reconsideration was filed. 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 6 of 26

7.2 Jurisdictional Handling Of Reconsideration / Appeals

7.2.1 General

There had been some questions raised about the manner in which a request for 

reconsideration should be processed. This section incorporates the interim procedure 

(A-91-05) issued to the disability claims examiners on February 15, 1991 that provided 

guidelines for the jurisdictional handling of reconsideration/appeals.

Some of the questions being raised referred to notifications advising annuitants of the 

reconsideration decision, which cases should be referred to hearings and appeals and 

what type of appeal backing should be on reconsideration letter. Procedure is provided 

in DCM 7.2.2 with examples on how to handle each issue.

7.2.2 Issues

1. The first issue involves an initial disability denial.

An employee filed a disability application and his claim for a disability annuity is 

denied for a lack of medical severity. He disagrees with the decision and files a 

timely reconsideration request. After the reconsideration review is completed, if 

the determination affirms that the initial disability denial decision is correct, the 

employee should be provided an explanation including appeal rights.

2. The second issue involves a difference in the claimed onset date (wholly 

favorable).

An employee filed a disability application and claimed an onset date of October 

17, 1988. His application was denied for a lack of medical severity. He timely 

submitted a request for reconsideration along with medical evidence. Based on 

the new medical evidence, his disability annuity was allowed from October 17, 

1988, his alleged onset date. The employee should be sent a letter advising him 

of the wholly favorable decision. No appeal paragraph is required in this letter 

since the employee will be given appeal rights on the award letter.

3. The third issue involves a difference in the claimed onset date (partially 

favorable).

An employee filed a disability application and claimed an onset date of October 

17, 1988. His application was denied for lack of medical severity. He submitted a 

timely request for reconsideration along with additional medical evidence. Based 

on the new medical evidence, he was found disabled from October 17, 1989, one 

year after his alleged onset date. The employee should be sent a letter advising 

him of the partially favorable decision. The letter should also advise him of his 

appeal rights if he does not agree with the partially favorable decision and it 

should advise him that he will receive another notice in the mail with specific 

details about his annuity rate and beginning date. 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 7 of 26

4. The fourth issue involves a further protest about the reconsideration decision.

An employee filed a disability application and claimed an onset date of October 

17, 1988. His application was denied for lack of medical severity. He timely 

submitted a request for reconsideration along with additional medical evidence. 

Based on the new medical evidence, he was found to be disabled from October 

17, 1989. Since the decision was only partially favorable, the employee was sent 

a letter advising him of the partially favorable decision and his annuity was 

awarded as stated above in issue 3. He now files a protest about the 

reconsideration decision and wants his alleged onset date to be established 

based on his disabling conditions. That protest letter should be treated as an 

appeal request. The file containing the protest letter is to be sent directly to the 

Bureau of Hearings and Appeals.

5. The fifth issue involves a request for reconsideration of the earliest onset date 

and medical evidence is submitted.

An employee filed a disability application and claimed an onset date of October 

17, 1988. A disability annuity and/or a "period of disability" is granted with a later 

onset date of October 17, 1989. He timely submits a request for a 

reconsideration of the earliest onset date along with medical evidence. Based on 

the new medical evidence, no change is warranted. The employee should be 

advised of his appeal rights if he does not agree with the partially favorable 

decision. However, if the medical evidence does permit a wholly favorable 

decision, no appeal paragraph is required in the letter advising him of the 

reconsideration decision. 

7.3 Request For Reconsideration Development

7.3.1 General

The Reconsideration examiner has the responsibility for development of medical 

evidence in a reconsideration case. Use the general instructions on initial cases for 

development and tracing of medical evidence (DCM Chapter 4).

The reconsideration examiner will consider the issues of whether a claimant is disabled, 

the onset of disability and cessation of disability. Nonmedical aspects of disability, e.g., 

vocational consideration, may be fundamental to a proper decision. Resolve doubts 

about need for further documentation in favor of obtaining such documentation.

The primary requirement of a reconsideration determination is that it be legally and 

factually proper. A well documented folder gives sufficient evidence at higher appeal 

levels for validity of determination.

Reconsideration examiners will concentrate on the following for a reconsideration 

determination:
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 8 of 26

A. Examine file for all essential elements and proper documentation of all pertinent 

allegations.

B. Secure additional evidence if evidence is incomplete, insufficient, conflicting, 

subject to different conclusions, or subject to questionable assumptions.

C. Analyze total evidence in file. Check and resolve conflicts or discrepancies. 

Weigh the complete evidence and set forth in the determination, the findings, 

rationale and conclusion.

NOTE: When evaluating an occupational disability reconsideration with a filing date 

prior to January 1, 1998, use the Provisional Occupational Disability Rating Schedule 

(PODRS) (See DCM 3.4.2). If the filing date is January 1, 1998 or later use the 

Occupational Disability Standards a described in the Disability Manual. (See DCM 13.)

7.3.2 Development Techniques

Reconsideration examiners should use any development technique for handling 

reconsideration that will provide the best documentation such as mail, telephone calls 

and contact with field offices. To handle expedited cases, it may be necessary to call 

the field office, claimant, physician, employers, or other individuals knowledgeable 

about the claimant's situation.

The following is a suggested outline to resolve the problems presented in a case for 

reconsideration development.

A. Analyze the information obtained in the initial development and any new 

information obtained by any source as it relates to the claimant's disability 

determination.

B. Solicit medical evidence from prior or newly identified sources which could 

document the claimant's condition.

C. Secure a consultative examination (CE) and/or work history to fill in any 

remaining gaps in the medical and/or vocational evidence.

D. Have the field office arrange for a face-to-face interview whenever doubts remain 

about any fact which could affect the decision if the Reconsideration examiner 

believes that direct contact would help resolve the issue(s).

E. Follow instructions in DCM 4.3.8 when tracing for evidence necessary to 

complete the reconsideration decision.

7.3.3 New Medical Documentation Needed

A. Claimant's Medical Sources - The claimant for a disability annuity is responsible 

for providing evidence of the claimed disability. The Board will assist the 

claimant, when necessary, in obtaining medical evidence. All medical sources 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 9 of 26

from which the claimant has received examination or treatment since the initial 

decision should be obtained. Also any medical evidence not developed as part 

of the initial decision should be requested. These sources of evidence should be 

developed in the most expeditious manner.

B. Worsening of Condition or New Allegations - Often new 

allegations are made or new evidence presented on 

reconsideration which indicates a worsening of the 

claimant's condition. When this occurs, Reconsideration 

examiner should obtain the additional information needed to 

provide a clear picture of the claimant's current 

condition. This information may be available from the 

claimant's medical sources or through a CE. 

C. Consultative Examination - CE's should be obtained when 

needed, but not routinely. A CE should not, if possible, 

be performed by the same physician used in the initial 

claim. 

D. Signing of Medical Reports - If reconsideration permits 

allowance, the case can be paid while the signature is 

being obtained. Medical evidence obtained by telephone 

during the reconsideration process must be sent to the 

medical source(s) for confirming signature. Unsigned 

reports secured in connection with the initial decision 

which are material to the reconsideration determination 

must also be sent to the medical source(s) for signature. 

The confirming signatures are necessary to perfect the 

record in case of future appeal if the reconsideration 

determination affirms an initial denial or cessation 

(including partial denials such as disability onset 

established later than alleged). 

7.3.4 Vocational Documentation Required

In cases in which the severity of an impairment does not meet a "D" finding in the 

Occupational Disability Tables (January 1, 1998 or later) or meet or equal the 

disqualifying criteria for the claimant's appropriate family group as identified in the 

PODRS (prior to January 1, 1998) or the Listings or Impairments, as shown in RRB or 

Social Security Administration (SSA) regulations, a finding of "disabled" cannot be made 

on medical considerations alone. When this occurs, full consideration must be given to 

the vocational factors. (See DCM 4 for a discussion of sequential evaluation.)

The folder should always contain complete vocational development including a full 

description of the claimant's work history during at least the 15 years prior to alleged 

onset (or past the alleged onset date if the claimant is still working). The information 

secured should include the job titles, types of business (both railroad or non-railroad), 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 10 of 26

dates worked, usual job in the last 5 years (both railroad or non-railroad), which job 

claimed as regular railroad occupation, physical demands, basic duties, nature and 

extent of supervision, independent judgment required and the types of tools, machinery 

and equipment used, if any.

If more than one job was performed during this 15-year period, separate descriptions of 

each job must be secured. Use Form G-251 (Vocational Report) for obtaining additional 

vocational history.

See DCM Chapter 5 for additional information about vocational development.

7.4 Reconsideration Determinations

7.4.1 Preparation Of The Reconsideration Determination

When the development of the reconsideration request has been finished, prepare a new 

determination revising or affirming the original determination as appropriate. This 

requires careful attention to the following:

A. Examination of the file in detail to ensure that all required elements are present 

and all pertinent allegations are properly documented.

B. Determination that evidence in file is sufficient, without conflict and not subject to 

different conclusions.

C. Analysis of the total evidence, resolving conflicts and discrepancies, weighing the 

complete evidence and setting forth the findings and conclusions in the disability 

decision rationale.

7.4.2 Affirming A Previous Determination

A previous denial determination may be affirmed as written if any of the following 

conditions are satisfied:

A. There is no allegation of a worsening of any previously documented impairment;

B. There is no allegation of any new impairment; 

C. There has been no treatment of any impairment subsequent to the prior 

determination;

D. The prior denial determination was substantively and technically correct;

E. The rationale for the prior denial determination was correctly presented and it 

resolved all the pertinent issues to be adjudicated.

F. The applicant failed to submit additional evidence.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 11 of 26

In the event a previous denial determination is affirmed and the rationale for the 

reconsideration determination would merely be a verbatim repetition, the following 

statement may be considered as an adequate rationale for the file:

The original (or prior) determination of ___(date)___ for ___(claimant)___ is hereby 

affirmed as written.

The letter should also include railroad retirement claim number, date of affirmation and 

name of disability examiner involved in decision.

7.4.3 Revision Of Prior Determinations

In the event the reconsideration examiner revises any part of a prior determination, the 

revision must be explained in the rationale or letter to the claimant. The criteria for 

reconsideration case rationale are generally the same applicable criteria for initial case 

rationale.

The rationale may include the following elements:

A. A review of the claimant's allegations, including his/her basis for requesting a 

reconsideration. This should include worsening of documented impairments; 

new impairment; different onset date; no medical recovery; sheltered 

employment; new evidence, etc.

B. A discussion of any technical issues which have arisen since the prior 

determination.

C. A discussion of the findings produced by the sequential 

evaluation process. 

D. A statement of the basis for the revised disability 

determination (cite any specific listing, standard, rule, 

etc. that supports the revision). 

7.4.4 Points To Consider In The Reconsideration Process

A. Treating Source Opinion Differs - When the total evidence does not support an 

opinion furnished by the claimant's treating physician that he or she is "unable to 

work," "disabled," etc., cite the findings or evidence which rebut(s) the treating 

source opinion.

B. Inconsistencies Material to the Decision - Explain any inconsistencies material to 

the decision, i.e., evidence which might indicate a different decisional outcome.

C. Pain-Related Issues - Any allegation(s) or report(s) of pain must be considered in 

(1) determining whether the claimant has a severe impairment, and (2) at each 

step in the sequential evaluation process. If there are inconsistencies in the 

evidence concerning pain, i.e., the claimant alleges limitations or restrictions 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 12 of 26

greater than that reasonably expected based on the objective medical findings, 

there are conflicts in the evidence, etc. Then these differences must be 

reconciled and explained in the file.

D. Closed Period Cases - In closed periods of disability, explain how medical 

improvement is demonstrated.

E. Vocational Rule - In a medical vocational decision, if no vocational rule is met, 

but the vocational rules are used as a framework for the decision, explain what 

rules have been considered.

F. Consideration of Jobs and Incidence - In unfavorable decisions, a citation of jobs 

may be stated. For example, "You are considered able to perform your past 

work..." or "You are considered able to perform medium..." etc.

G. Court Cases - Explain any specific issues as required by court decision that 

impacts either positively or negatively on reconsideration determination, e.g., 

RRB's legal opinion on alcoholism L79-232.

7.5 Reconsideration Rationale Preparation

7.5.1 General

The rationale is a statement of the fundamental reasons serving to account for the 

reconsideration determination of disability. It is used as a supporting statement for a 

disability decision and contains a complete, concise discussion of the analysis and 

opinions used as a basis for a decision. It also includes citation of applicable rules and 

codes. The rationale for a disability reconsideration decision must be written, keeping 

the audience that will be reading it in mind, so that a clear picture of the case can be 

obtained. The rationale should follow an orderly pattern and show clearly how specific 

evidence leads to a conclusion. Any significant inconsistencies in medical and nonmedical factors must be reconciled. Reasonable inferences may be drawn, but 

presumptions, speculations and suppositions must not be used.

If a reconsideration request results in a reversal of a disability determination a formal 

rationale should be prepared on the form G-325.1. If the initial disability decision is 

being sustained the rationale for sustaining that decision is included in the letter to the 

annuitant. 

The purpose of the disability determination/reconsideration decision rationale is multifold: to identify all the medical and non-medical factors which have been considered; to 

explain the thought process which was used to arrive at the determination; and to 

provide a permanent evidentiary record of the reasons underlying the conclusion. The 

rationale further serves to inform subsequent reviewers, including quality assessment 

groups, of the basis for the determination.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 13 of 26

When a favorable determination or decision is based on meeting a "D" in the Tables of 

the Occupational Disability Standards, or equaling the disqualifying criteria in the 

PODRS, or the listing of impairments, the applicable criteria must be cited. Also, state 

the medical findings that support that decision.

If the reconsideration determination is based on medical vocational rules, the rationale

should include the claimant's age, education level, work experience and the impairment 

severity level (i.e. heavy, medium, light or sedentary work). The impairment severity 

level is determined by the claimants RFC and must be supported by objective medical 

evidence.

A reversal based on a mere conclusion that the claimant is "not able to perform a 

regular railroad job or to engage in SGA" is insufficient. The rationale must state fully 

the reasons that the claimant cannot perform his/her regular railroad occupation or 

engage in SGA and it must be based on the evidence of record, the applicable 

regulations and the determinative step in the sequential evaluation process.

If a decision is sustained no rationale is provided. However, a letter to the applicant, or 

his representative, provides the rationale for the decision to be sustained. In this letter a 

conclusion that "the applicant's impairment(s) is not severe enough to prevent him or 

her from performing a regular railroad occupation or from engaging in SGA" is 

insufficient. If the evidence establishes that the impairment(s) is "not severe," the 

rationale must show that the impairment(s) would not significantly affect the 

performance of a regular railroad job or a basic work-related function. If a denial may 

not be made on this basis, the rationale must reflect the remainder of the sequential 

evaluation process.

Remember that you are to consider the effect of all the claimant's medically 

documented impairments in a disability determination. 

7.5.2 Processing Of Joint Freeze Cases Involving Reconsideration

A. No formal action will be taken by the agency that did not receive the request for 

reconsideration or appeal, unless the other agency decides that its previous 

decision should be revised. In the event, before a final decision is made, the 

other agency will be given an opportunity to review its decision in the light of new 

evidence or information received at whatever level the "protest" is being handled.

B. The Great Lakes Program Service Center (GLPSC) - Disability Review Section 

(DRS) has the responsibility for handling claims of career railroad workers who 

request reconsideration of initial and continuing disability determinations on 

claims filed through any SSA district office and on those claims which were jointly 

coordinated and rated. CE may be obtained from SSA.

We should coordinate our reconsideration decision with SSA before our decision 

is finalized. While they are not bound by our decision, nor are we bound by 

theirs, an attempt to coordinate is required. 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 14 of 26

7.6 Personalized Reconsideration Disability Letters

7.6.1 General

The law requires that when a totally or partially unfavorable disability decision is 

rendered, the determination letter must be written in understandable language 

discussing the evidence and stating the RRB's determination and the reasons for it.

Where a written personalized explanation has been provided explaining why the 

individual is not or will no longer be entitled to disability benefits and/or disability freeze - 

early Medicare entitlement (e.g., disability cessation, adverse reopenings), it will not be 

necessary to repeat the same information in the initial determination notice. 

Personalized letters should be brief and understandable to the claimant or his/her 

representative.

7.6.2 Personalized Explanation Requirements

A. Basic Tests - A personalized explanation sent to annuitants must meet two basic 

tests. First, it must be legally sufficient and secondly, it must not be offensive in 

any way.

1. The first test will be consistently met by following the instructions 

contained in this chapter for preparation of personalized explanations in 

the various claims affected.

2. The second test involves what is written and how it is written. 

Abbreviations, acronyms, jargon, technical terms and complex medical 

phrases must not be used unless they are properly qualified. The 

information provided must be relevant, concise and meaningful. Dates 

may be abbreviated numerically (e.g., 12/14/92), if necessary, to save 

space. The reconsideration examiner must be sensitive to the claimant or 

annuitant's feelings and needs. Information in the personalized 

explanations must not be offensive to the applicant in any manner. The 

personalized explanations should be written in the third person when it is 

to a person filing on behalf of a claimant or a representative payee for an 

annuitant.

B. Clarity - In addition to meeting the two basic tests it is equally important that the 

personalized explanation be written as simply and clearly as possible, i.e., 

understandable to anyone with a least a 6th grade education. Proper wording is 

also important to avoid conveying an unintended negative message to the 

claimant or annuitant. Poorly written letters can have a negative impact on RRB 

and impair its ability to serve the railroad public interest.

C. Impairments Addressed - The personalized explanation should address alleged 

impairments and other impairments which are discovered during the course of 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 15 of 26

the evaluation provided that the impairments are known by the claimant. Closely 

related impairments may be grouped by body system. 

D. Letter Preparation

1. The reconsideration examiner is responsible for preparing the 

personalized explanation for reconsideration since they are responsible for 

making the reconsideration determination.

2. The personalized explanation may be typewritten from the Form G-835 

(PC Assembly Form for Disability Notices), or a personal computer.

3. The reconsideration disability determination rationale will continue to be 

prepared based on instructions in DCM 7.5. 

7.6.3 Explanations In Reconsideration Denials

A. General

1. The reconsideration examiner will prepare a personalized explanation with 

a denial letter for reconsideration based on medical and/or 

medical/vocational issues.

2. When an insured status or a prescribed period is last met prior to the date 

of the determination, the explanation should reflect the period of time 

considered and specify the date through which the insured status or the 

prescribed period was met.

3. Medical reports and non-medical reports listed on the initial personalized 

explanation do not need to be repeated.

4. The wording of a personalized reconsideration explanation should not be 

the same as that of the initial notice even if the denial is sustained on the 

same basis. The wording should be rephrased to avoid the erroneous 

impression that the claim was not independently review on the 

reconsideration level.

5. The Reconsideration examiner will notate in the decision notice that all 

medical evidence in the file has been reviewed;

6. When the medical sources were unresponsive, a disclaimer statement 

may be provided, e.g., additional reports were not obtainable; however, 

we had enough information to evaluate the claimant's condition;

7. (Optional) Give a statement that "the determination on your claim was 

made by the RRB. It was not made by your own doctor or by other 

people, hospitals, or agencies writing reports about you. However, any 

evidence they gave the RRB was used in making this determination. 
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 16 of 26

Doctors and other people employed by the RRB who are trained in 

disability evaluations reviewed the evidence and made the determination 

according to the Railroad Retirement law and regulations;"

8. Provide a list of the impairments evaluated. Do not use technical terms 

unless the claimant or annuitant uses and appears to understand them. 

When information in file suggests that the claimant or annuitant has 

terminal illness, mental impairment or is unaware of the exact nature of his 

or her condition, the reconsideration examiner will use good judgment as 

to what will be listed in the explanation concerning the impairments. If the 

claimant or annuitant is unaware of an impairment, use general terms 

such as the reports do not show any other conditions which would 

significantly limit your ability to work;"

9. Furnish a brief description of medical severity as of the month of cessation 

in closed period of disability allowances or a brief description of the 

medical or medical/vocational basis for the established onset date in 

unfavorable onset date allowances. However, care must be taken in 

discussing medical evidence (address unconfirmed allegations by stating 

that evidence does not reveal any other disabling condition). 

10. When vocational factors are considered in a closed period of disability 

allowance, a brief description must be given of the job the railroad 

claimant can return to, or a statement must be provided advising that 

although the person cannot do any of the work he or she did during the 

period evaluated he or she still has the capacity to do other work which is 

less demanding (exertion, mental, skill levels) or has the ability to do less 

physical work (specify in general terms, e.g., lighter work) based on his or 

her age, education and past work experience. Do not cite other jobs;

11. When vocational factors were considered in an unfavorable onset date 

allowance, explain why the vocational factors permit the claimant to work 

prior to the onset date; and

12. If the claimant's work activity is the reason for the closed period of 

disability or unfavorable onset determination, that information must be 

covered in the letter.

B. Special Situations

1. Insufficient evidence, failure/refusal to submit to a CE, does not wish to 

continue development of claim.

You will prepare a personalized explanation based on the instructions in 

DCM 7.5.4.A (items 6-8). The explanation should also include:
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 17 of 26

a. A brief description of the evidence needed to adjudicate the claim; 

and

b. A brief description of the attempts to obtain evidence and the 

response received (if any).

2. Failure to follow prescribed treatment, which can restore the claimant's 

ability to work, without good reason.

You will prepare a personalized explanation based on the instructions in 

DCM 7.5.4.A (items 6-8). The explanation should also include:

a. A description of vocational limitations (e.g., age, education) if 

vocational factors are considered; and 

b. A description of the prescribed treatment the claimant refuses to 

follow and what the treatment will allegedly accomplish.

Appendices

Appendix 1 - AB-25 Reconsideration And Appeal Rights

If you believe that this decision is not correct, you may request that the decision be 

reconsidered. If you wish this reconsideration, you must request it in writing and your 

request must be received by the Board within 60 days from the date of this notice. You 

may file your request at any district office of the Board. If you wish any additional 

evidence to be considered, please include it with your request.

If you disagree with the reconsideration decision, you may then appeal to the Bureau of 

Hearings and Appeals within 60 days from the date of the reconsideration decision. 

If you do not request a reconsideration within 60 days from the date of this notice, you 

may not file an appeal at a later date.

Appendix 2 - RECON - Initial Denial Affirmed

Sample Letter

In reply refer to

R.R.B. No.

(EE's Name)

Dear
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 18 of 26

This refers to your letter requesting reconsideration of the denial of (insert 1).

We have again carefully reviewed all of the medical evidence in your file and are still of 

the opinion that you are not disabled for (insert 2).

(Narrative insert)

If you disagree with this decision, you have the right to appeal to the Bureau of Hearings 

and Appeals. If an appeal is made, it must be submitted on Form HA-1 and must be 

received at an office of the Railroad Retirement Board (RRB) within 60 days from the 

date of this notice. A Form HA-1 may be obtained from any field office of the RRB or by 

writing directly to the Director of Hearings and Appeals at the following address: 

Railroad Retirement Board, Bureau of Hearings and Appeals, 844 North Rush Street, 

Chicago, Illinois 60611.

If you need to personally visit one of our field offices, you are urged to call for an 

appointment. You will not be refused service if you do not have an appointment, but 

Railroad Retirement Board representatives can serve you better when an appointment 

is made. Most Railroad Retirement Board offices are open to the public from 9:00 a.m. 

to 3:30 p.m., Monday through Friday.

Very truly yours,

John R. Feldheim

Director of Disability

and Medicare Operations

cc: Field Office

G-835 Items To Complete

A-1 Recon . . . Denial

Check RECON box at top.

Check DENIAL box in RECON section
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 19 of 26

Enter the name/address of any other party that will be sent a copy of this letter next to 

OTHER.

Enter employee's name next to EE NAME.

Enter the addressee's name to ADDRESSEE NAME if other than the employee.*

Enter the address in the lines below ADDRESS.

Enter claim number next to RRB CLAIM NO.

Enter the salutation next to DEAR.

INSERT 1 - Enter the type of claim that is being reconsidered, e.g., an occupational 

disability annuity, a total and permanent disability annuity, a "period of disability," etc. 

INSERT 2 - Enter either "your regular railroad occupation" or "all regular work."

Check the box next to NARRATIVE INSERT ON REVERSE and write your personalized 

rationale for sustaining denial decision on the reverse side of the worksheet. Note that 

this narrative will appear as the third paragraph in your denial letter.

Enter your name under DPS-EXAMINER NAME on the reverse side.

Enter the date under DATE on the reverse side.

* This letter can only be addressed directly to the claimant and cannot be addressed to 

a representative of the claimant. However, a carbon copy could be sent to the 

representative, if appropriate.

Appendix 3 - RECON - Allowance Wholly Favorable

Sample Letter

In reply refer to

R.R.B. No.

(EE's Name)

Dear

This is to advise you that we have reconsidered our decision regarding your disability 

application. Based on the evidence in file, you qualify for (insert 1) effective (insert 2). 

You will receive another notice in the mail with specific details about your annuity rate 

and beginning date.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 20 of 26

Very truly yours,

John R. Feldheim

Director of Disability

and Medicare Operations

cc: Field Office

G-835 Items To Complete

A-3 Recon . . . Allowance (Wholly Favorable)

Check RECON box at top.

Check ALLOWANCE (Wholly Favorable) box in RECON section.

Enter the name/address of any other party that will be sent a copy of this letter next to 

OTHER.

Enter employee's name next to EE NAME.

Enter the addressee's name to ADDRESSEE NAME if other than the employee.*

Enter the address in the lines below ADDRESS.

Enter claim number next to RRB CLAIM NO.

Enter the salutation next to DEAR.

INSERT 1 - Enter the type of annuity claimant qualifies for, e.g., an occupational 

disability annuity, a total and permanent disability annuity, etc. . .

INSERT 2 - Enter the effective date (annuitant's alleged onset date).

Enter your name under DPS-EXAMINER NAME on the reverse side.

Enter the date under DATE on the reverse side.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 21 of 26

* This letter can only be addressed directly to the claimant and cannot be addressed to 

a representative of the claimant. However, a carbon copy could be sent to the 

representative, if appropriate.

Appendix 4 - RECON - Partially Favorable Decision

Sample Letter

In reply refer to

R.R.B. No.

(EE's Name)

Dear

This refers to your letter requesting reconsideration of the denial of (insert 1).

We have carefully reviewed all of the medical evidence in your file and are now of the 

opinion that you are disabled for (insert 2) effective (insert 3).

(Narrative insert)

If you disagree with this decision, you have the right to appeal to the Bureau of Hearings 

and Appeals. If an appeal is made, it must be submitted on Form HA-1 and must be 

received at an office of the Railroad Retirement Board (RRB) within 60 days from the 

date of this notice. A Form HA-1 may be obtained from any field office of the RRB or by 

writing directly to the Director of Hearings and Appeals at the following address: 

Railroad Retirement Board, Bureau of Hearings and Appeals, 844 North Rush Street, 

Chicago, Illinois 60611.

You will receive another notice in the mail with specific details about your annuity rate 

and beginning date.

If you need to personally visit one of our field offices, you are urged to call for an 

appointment. You will not be refused service if you do not have an appointment, but 

Railroad Retirement Board representatives can serve you better when an appointment 

is made. Most Railroad Retirement Board offices are open to the public from 9:00 a.m. 

to 3:30 p.m., Monday through Friday.

Very truly yours,
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 22 of 26

John R. Feldheim

Director of Disability

and Medicare Operations

cc: Field Office

G-835 Items To Complete

A-4 Recon . . . Allowance (Partially Favorable)

Check RECON box at top.

Check ALLOWANCE (Partially Favorable) box in RECON section.

Enter the appropriate field office below FIELD OFFICE.

Enter the name/address of any other party that will be sent a copy of this letter next to 

OTHER.

Enter employee's name next to EE NAME.

Enter the addressee's name to ADDRESSEE NAME if other than the employee.*

Enter the address in the lines below ADDRESS.

Enter claim number next to RRB CLAIM NO.

Enter the salutation next to DEAR.

INSERT 1 - Enter the type of annuity claimant qualifies for, e.g., an occupational 

disability annuity, a total and permanent disability annuity, etc. . .

INSERT 2 - Enter either "your regular railroad occupation" or "all regular work."

INSERT 3 - Enter the effective date (other than annuitant's alleged onset date).

Check the box next to NARRATIVE INSERT ON REVERSE and write your personalized 

rationale advising why a partially favorable decision was made regarding the effective 

date on the reverse side of the worksheet.

Enter your name under DPS-EXAMINER NAME on the reverse side.

Enter the date under DATE on the reverse side.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 23 of 26

* This letter can only be addressed directly to the claimant and cannot be addressed to 

a representative of the claimant. However, a carbon copy could be sent to the 

representative, if appropriate.

Appendix 5 - RECON - No Change In Initial Decision Based On New Evidence - 

Sample Letter

In reply refer to

R.R.B. No.

(EE's Name)

Dear :

This refers to your letter requesting reconsideration of your annuity beginning date of 

(insert 1) and/or your disability freeze onset date of (insert 2).

We have carefully reviewed all of the medical evidence in your file and are still of the 

opinion that you are disabled for (insert 3) and/or disability freeze as of (insert 4).

(Narrative insert)

If you disagree with this decision, you have the right to appeal to the Bureau of Hearings 

and Appeals. If an appeal is made, it must be submitted on Form HA-1 and must be 

received at an office of the Railroad Retirement Board (RRB) within 60 days from the 

date of this notice. A Form HA-1 may be obtained from any field office of the RRB or by 

writing directly to the Director of Hearings and Appeals at the following address: 

Railroad Retirement Board, Bureau of Hearings and Appeals, 844 North Rush Street, 

Chicago, Illinois 60611.

If you need to personally visit one of our field offices, you are urged to call for an 

appointment. You will not be refused service if you do not have an appointment, but 

Railroad Retirement Board representatives can serve you better when an appointment 

is made. Most Railroad Retirement Board offices are open to the public from 9:00 a.m. 

to 3:30 p.m., Monday through Friday.

Very truly yours,
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 24 of 26

John R. Feldheim

Director of Disability

and Medicare Operations

cc: Field Office

G-835 Items To Complete

A-5 Recon . . . Allowance (Wholly Favorable)

Check RECON box at top.

Check ALLOWANCE NO CHANGE IN ONSET DATE box in RECON section.

Enter the appropriate field office below FIELD OFFICE.

Enter the name/address of any other party that will be sent a copy of this letter next to 

OTHER.

Enter employee's name next to EE NAME.

Enter the addressee's name to ADDRESSEE NAME if other than the employee.*

Enter the address in the lines below ADDRESS.

Enter claim number next to RRB CLAIM NO.

Enter the salutation next to DEAR.

INSERT 1 - Enter the disability date used for allowance (other than annuitant's alleged 

onset date.)

INSERT 2 - Enter the established onset date based on initial medical evidence.

INSERT 3 - Enter the type of annuity, e.g., an occupational disability, a total and 

permanent disability annuity, etc.

INSERT 4 - Enter the disability date based on all medical evidence.

Check the box next to NARRATIVE INSERT ON REVERSE and write your personalized 

rationale advising why a partially favorable decision was made regarding the effective 

date on the reverse side of the worksheet.

Enter your name under DPS-EXAMINER NAME on the reverse side.
DCM Part 7

DCM Part 7 Reconsideration and Appeals of Disability Decisions Revised Dec 02, 2022 Page 25 of 26

Enter the date under DATE on the reverse side.

* This letter can only be addressed directly to the claimant and cannot be addressed to 

a representative of the claimant. However, a carbon copy could be sent to the 

representative, if appropriate.