Subject: Mandatory Reconsideration request — [benefit] — decision dated [date]

I am asking for Mandatory Reconsideration of the decision dated [date].

I disagree because:
1. [specific finding and why it is wrong]
2. [evidence supporting this]
3. [real example showing functional impact]

Please reconsider the decision using the attached evidence. If the decision is not changed, please send the Mandatory Reconsideration Notice and explain the evidence and rules relied upon.