Effective Dates: 11/15/2022 - Present Previous | Next

TN 13 (11-22)

DI 28005.001 Legal Standard for Determining if Disability Continues

CITATIONS: 

20 CFR 404.1594, 20 CFR 416.994, 20 CFR 416.994a

A. Introduction to the medical improvement review standard (MIRS)

Under the continuing disability review (CDR) instructions in effect before October 9, 1984, adjudicators only considered the individual's current ability to engage in substantial gainful activity (SGA) and did not consider medical improvement (MI) in deciding if disability continued. The “Social Security Disability Benefits Reform Act of 1984” (P.L. 98-460), provided the MIRS in CDR cases. The MIRS is a series of steps in the CDR sequential evaluation process.

B. Definition of the MIRS

The MIRS refers to the legal standard for determining if disability continues in a CDR. The MIRS includes consideration of both MI and the exceptions to MI.

For policy on when the MIRS applies, see DI 28005.001C.

C. When the MIRS applies

MIRS applies in the following cases:

  • •

    All CDRs after October 8, 1984.

  • •

    Any determination or decision with an adjudicative date on or after December 6, 1985, apply MIRS to establish that a closed period of disability ended. See DI 25510.001C for additional information.

  • •

    Reopenings to a cessation or denial with an adjudicative date of October 8, 1984, or later, based on a revised determination or decision concerning the individual's disability, except as noted in DI 28005.001F below.

D. How to apply the MIRS

The adjudicator will consider the MIRS at different steps in the CDR sequential evaluation process depending on whether an adjudicator is evaluating a Title II or adult Title XVI CDR case or a Title XVI child CDR case.

For an overview of the steps in the Title II or adult Title XVI CDR sequential evaluation process, see DI 28005.010.

For an overview of the steps in the Title XVI child CDR sequential evaluation process, see DI 28005.025.

E. When the MIRS leads to a cessation

1. When an individual (adult or child) is no longer disabled under the MIRS

a. Title II or adult Title XVI individual

We will determine that individuals receiving Title II and adult Title XVI benefits are no longer disabled only if the evidence demonstrates either:

  • •

    MI related to the ability to work and the ability to engage in SGA, or

  • •

    a Group I exception to MI applies and results in a finding of the ability to engage in SGA, or

  • •

    a Group II exception applies.

b. Title XVI child

We will determine that a Title XVI child is no longer disabled only if the evidence demonstrates either:

  • •

    MI and the child has no medically determinable severe impairment(s) that meet, medically equal, or functionally equal the severity of any listed impairment (see DI 25220.010 and DI 25225.001), or

  • •

    a Group I exception to MI applies and results in a finding of no longer disabled (no marked and severe functional limitations), or

  • •

    a Group II exception applies.

2. MIRS exceptions discussion

Our regulations provide exceptions to MI, see 20 CFR 404.1594(d) and (e), 20 CFR 416.994(b)(3)and(b)(4), 20 CFR 416.994a(e) and (f), and DI 28020.001. There are two groups of exceptions to MI, Group I and Group II exceptions. The MIRS includes evaluation of the exceptions.

If a Group I exception applies, the adjudicator will apply the exception and continue with the sequential evaluation process. If a Group I exception applies, it may lead to a finding that disability has ceased. The Group I exceptions are discussed in DI 28020.100 through DI 28020.365.

The Group II exceptions do not require a finding of the ability to engage in SGA for Title II or adult Title XVI individuals, or that the impairment(s) no longer results in marked and severe functional limitations for a Title XVI child. The Group II exceptions also do not require a finding of MI. The Group II exceptions are discussed in DI 28020.900.

F. When MIRS does not apply

MIRS does not apply in the following cases:

  • •

    Initial claims where the requirements for a closed period of disability are not met.

  • •

    Appeals of partially favorable disability determinations. For example, the individual files for reconsideration, requesting an earlier onset date and, on reconsideration, the claim is denied.

  • •

    Adverse reopenings to a later onset based on medical or non-medical issues, whether status as a recipient of disability benefits is preserved or not. For example, revised medical onset after date last insured may result in revision to a denial.

  • •

    Adverse reopenings based on a revised determination or decision concerning insured status or other non-disability issues.

  • •

    Title XVI Age-18 Redeterminations, which are processed like CDRs, but evaluated using the 5-step sequential evaluation process for new applicants (except for the rules related to performance of SGA). See DI 22001.001 for the 5-step sequential evaluation process for new applicants.

  • •

    Lost folder cases where the CPD folder or medical evidence are not able to be reconstructed. See DI 28035.010A.

G. References

Public Law 98-460 – Social Security Disability Benefits Reform Act of 1984

DI 23570.020 Disability Determination Services (DDS) Procedures for Processing an Age-18 Redetermination

DI 25510.001 Closed Period of Disability

DI 28005.003 When to Complete an Age-18 Redetermination Instead of a Continuing Disability Review (CDR)

DI 28005.010 The Continuing Disability Review (CDR) Evaluation Process Summary Chart for Title II and Adult Title XVI Individuals

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428005001
DI 28005.001 - Legal Standard for Determining if Disability Continues - 11/15/2022
Batch run: 10/22/2024
Rev:11/15/2022