The Railroad Retirement Board sends this body-system assessment to a railroad employee's treating physician when the employee applies for a disability annuity under the Railroad Retirement Act. It walks through musculoskeletal findings with range-of-motion tables, then cardiovascular, respiratory, neurological, vision, hearing, speech and mental findings, and ends with exertional and environmental restrictions that the RRB uses to decide the claim.
The patient's treating physician completes the whole form, from patient identification through the Section 13 certification, and signs it. The employee does not fill in any part.
Download the current version from the source each time; forms change without notice.
Medical Assessment
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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The Railroad Retirement Board mails it to the treating physician with cover letter RL-250 when a railroad employee claims a disability annuity. It is not posted on rrb.gov, so physicians normally receive it for a specific patient rather than downloading a blank copy.
No. The Section 13 certification says the report must be signed and that a stamped signature is not acceptable. Print your name and title, add your National Provider Identifier, and give an address and daytime telephone number so the RRB can follow up.
Return it with copies of your office records. Where a system is abnormal, the form also asks for imaging reports for musculoskeletal findings, EKG tracings for cardiac findings, pulmonary function tracings, visual field charts and audiometric charts.