60RRBH25R0009 CMOS Form G-137 Attachment 1.pdf

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Consultative Medical Opinion Services
Solicitation number
60RRBH25R0009
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This document is a Medical Consultant Opinion form for a disability claim. The form contains details about a claimant named Jane Doe, with an alleged onset date of 02/10/2025. The document is specifically a T & P (Title and Purposes) type application focusing on a severity assessment and Residual Functional Capacity (RFC) evaluation. The examining disability officer is requesting a medical opinion to determine if the claimant meets or equals listing 1.04, which relates to severe Degenerative Disc Disease (DDD). An exam opinion from Dr. ABC is referenced, and the examiner seeks clarification on the claimant's medical condition and earliest potential onset date.

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MEDICAL CONSULTANT OPINION

NAME: Jane Doe CLAIM NUMBER: SSN xxx-xx-xxx

EXAMINER: Disability Examiner DATE: Current Date

MEDICAL OPINION REQUEST

A. Type of Application/Decision

Occupational T & P Child Widow(er) Single Freeze Dual Freeze Reconsideration Continuing Disability Review

B. Type of Request

Re-evaluation for Significant Medical Improvement Onset Date Severity Assessment & RFC Rep Payee Needed Alleged Onset Date: 02/10/2025

C. Examiner Summary/Questions/Comments

The claimant has severe DDD, does she meet or equal listing 1.04? If not meet/equal, please provide RFC with earliest onset.

D. Treating Source RFC(s) in file (See Below)

E. Examining Source RFC(s) in file (See Below) Exam opinion from Dr. ABC for 20/10/4/6

File details come from the government source that posted it. Updated .