I-3-2-11.Referral to the Medical Support Staff (MSS)

Last Update: 2/23/15 (Transmittal I-3-98)

A. When to Refer to MSS

The analyst may refer a case to the MSS in the Office of Appellate Operations when the Appeals Council (AC) needs:

  • Medical advice or an interpretation of clinical findings or test results in the medical evidence;

  • Medical advice about conflicts in the medical evidence;

  • Medical advice about specific testing, a medical opinion regarding multiple consultative examination (CE) findings, or medical advice on the type of CE that needs to be requested on remand;

  • A medical opinion as to whether the severity of the claimant's impairment(s) meets or equals a listing; or

  • A medical assessment of the claimant's ability to perform work related activities.

B. How to Refer a Case to MSS

1. Prepare Copies of Medical Evidence (When Applicable)

In certain circumstances, the analyst must prepare copies of the relevant medical evidence before preparing a MSS referral form in the Appeals Review Processing System (ARPS). Copies of the relevant medical evidence are necessary when:

  • the case is paper; or

  • the claimant filed a subsequent application.

When there is a subsequent application and:

  • the current claim(s) file is paper, the analyst will send MSS paper copies of the applicable medical evidence from the subsequent claim(s) file with the other medical evidence from the current paper claim(s) file.

  • the current and subsequent claim(s) file are electronic, the analyst will electronically copy the documents from the subsequent file to the file currently pending with the AC (specifically identifying the documents in the Pertinent Factors or Remarks text box and adding a “CC” to show the information was copied from a subsequent file).

  • the claim(s) file is electronic but the subsequent application claim(s) file is paper, the analyst will consult with the branch chief to determine the most efficient process of forwarding all the relevant information to MSS.

2. Create an ARPS Diary

The analyst will create a “New MSS Referral Diary” in ARPS, specifically:

  • Indicating the period at issue;

  • Identifying only the body system(s) to be evaluated by the MSS consulting physician;

  • Entering specific instructions in the “Pertinent Factors” text box, including the listing(s) and body system(s) the MSS consulting physician should analyze;

  • Discussing relevant medical history, records, findings, examinations, and/or tests in the “Pertinent Factors” text box, including specific references (by exhibit and page number) to relevant objective evidence and a summary of relevant oral testimony;

  • Noting in the “Pertinent Factors” text box that paper copies of evidence have been forwarded to MSS (when a paper file is involved); and

  • Completing the “Medical questions or problems” and “Remarks” sections with adequate specificity.


Do not abbreviate words in an MSS referral. For example, the abbreviation “MS” could mean mental status, musculoskeletal, or multiple sclerosis.

3. Route Referral

The analyst must route referrals to MSS through the branch chief. The branch chief will ensure that the analyst properly completed the referral before forwarding the request to MSS.


The analyst will hold the claim(s) file until the MSS responds to the request.

C. Receipt of an MSS Report

1. Receiving the Opinion

The AC only exhibits an MSS opinion if the AC issues a decision that relies on the opinion. Therefore, until the AC evaluates the opinion and determines the appropriate course of action, the opinions are associated with the record as follows:

  • In electronic cases, MSS will upload the opinion to the Private section of the electronic folder.

  • In paper cases, MSS will route the opinion to the analyst in a private AC paper folder.

2. Evaluating the Opinion

Analysts must keep in mind that MSS opinions are advisory in nature. The analyst must consider the entire file, including MSS opinions, in making a recommendation to the AC.

3. Proffering the Opinion

When the AC intends to issue a less than fully favorable decision that will rely on an MSS opinion, the AC must proffer the MSS report, as set forth in Hearings, Appeals and Litigation Law (HALLEX) manual I-3-6-1.

4. Exhibiting the Opinion

When the AC relies on an MSS opinion, the AC must exhibit the opinion. However, when the AC does not rely on the opinion, the AC does not exhibit the opinion or associate the opinion with the record.

To exhibit an MSS opinion:

  • In electronic cases, the analyst will move the MSS opinion from the Private section of the electronic folder to the F section, and add the opinion to the exhibit list at the time the AC decision is drafted.

  • In paper cases, the analyst will add the paper copy of the MSS opinion to the F section of the folder, and add the opinion to the exhibit list at the time the AC decision is drafted.