The MI determination must be based on improvements in the symptoms, signs, or laboratory findings associated with the individual’s established comparison point decision (CPD) impairment(s). Evaluating MI requires a comparison of the symptoms, signs, or laboratory findings that were documented in connection with the CPD impairment(s) at the time of the CPD with closely related symptoms, signs, or laboratory findings that are associated with the same impairment(s) currently.

To find MI has occurred, it is not necessary to have improvement in symptoms, and signs, and laboratory findings. It may be possible to find MI if there is an improvement only in a symptom(s), a sign(s), or specific laboratory finding. For example, if an individual was allowed at the CPD due to a back disorder causing them to ambulate with a walker and the continuing disability review (CDR) evidence shows that the individual is no longer ambulating with an assistive device yet some of the symptoms and laboratory findings remain unchanged, a finding of MI may be appropriate. When evaluating if MI has occurred, the adjudicator must disregard minor changes in symptoms, signs, or laboratory findings that do not obviously represent medical improvement and could not result in a finding that an individual's disability has ended, see DI 28010.015C.

For examples of cases with MI and no MI, see DI 28010.025.

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  Consider the symptoms, signs, and laboratory findings related to the impairment(s) established at the time of the CPD.

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  Consider current (CDR) symptoms, signs, and laboratory findings related to the impairments that were established at the time of the CPD.

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  Identify changes or improvement in symptoms, signs, or laboratory findings, and evaluate their medical severity according to current guidelines for assessing severity (e.g., the instructions in DI 24515.000 on the evaluation of specific issues and the guidance on considering symptoms in SSR 16-3p, “Titles II and XVI: Evaluation of Symptoms in Disability Claims”). For detailed information about symptoms, signs, or laboratory findings, see DI 24501.020.

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  Decide whether the changes reflect a decrease in medical severity. Note that a decrease in medical severity of any one of the impairments present at the time of the CPD shows MI. See DI 28010.001A for additional information.

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  Follow the instructions in DI 28010.029 if the CPD involved an impairment that met a listing with a period for which the impairment is considered disabling.

Consider all the evidence relevant to a disability determination at each point in considering prior and current symptoms, signs, and laboratory findings; this includes consideration of a 12-month medical history but may involve a different period, depending on the impairment involved. Do not focus on a particular day, i.e., the day of the CPD. For information on the 12-month developmental policy, see DI 28030.020D.

For example, adjudicators should view impairments like fractures with a narrower focus than neoplasms, which require longer timeframes to evaluate the success or failure of treatment. For information concerning impairments subject to exacerbations and remissions, see DI 28010.115

Disregard minor changes in an individual’s symptoms, signs, or laboratory findings that do not represent MI and could not result in a finding that disability has ended, see DI 28010.001A. This guidance applies to adults as well as to children. For additional information on comparing symptoms, signs, and laboratory findings, see DI 28010.015C.

Symptoms, signs, and laboratory findings include any evidence of physical and mental functioning used with medical findings at the time of the CPD. For example, in the adult and child mental disorders listings, the “paragraph B” criteria refer to function that may be affected by a mental impairment and therefore demonstrate medical severity. As such, they may constitute medical findings. If the CPD considered such abnormalities as medical findings, the adjudicator must also consider evidence about such function when considering whether there is MI. Consideration of abnormalities in function as part of determining if MI has occurred also applies to the criteria in listings that have been revised since the CPD or are now obsolete.

Symptoms are the individual's own description or statement of their physical or mental impairment(s), and cannot always be measured through objective medical evidence (signs or laboratory findings). However, objective medical evidence is a useful indicator to help make reasonable conclusions about the intensity and persistence of symptoms, which includes the effects those symptoms may have on medical improvement.

Adjudicators must consider whether an individual's statements about the limiting effects of their symptoms are consistent with the medical signs or laboratory findings of record.

Improvement in symptoms alone, without associated changes in signs or laboratory findings, may, however, support finding MI. If a sign or laboratory finding remains unchanged but the individual’s symptoms have improved and resulted in an increase in function, a finding of MI may be appropriate. Although improvement in symptoms alone may support an MI determination, the adjudicator must continue with the remainder of the required CDR analysis in order to reach a determination. For more information on the evaluation of symptoms, see DI 24501.021 and SSR 16-3p: “Titles II and XVI: Evaluation of Symptoms in Disability Claims.”

Children demonstrate different age-appropriate activities as they grow and develop. Given these changes, the adjudicator must consider the relationship of prior and current findings to the individual's prior and current age. Do not base the MI decision solely on the presence or absence of change in such findings.

Do not decide MI by formally assessing current severity, and then comparing current severity to the prior assessment made by the CPD adjudicator. To evaluate MI, the adjudicator must carefully evaluate signs, symptoms, and laboratory findings to determine whether MI has occurred, as discussed in DI 28010.001A. For additional information on substitution of judgment, see DI 28005.007.

Do not substitute judgment based on the prior adjudicator or medical consultant or psychological consultant’s (MC/PC) assessment to find MI by formally assessing current severity, and then comparing current severity to the prior assessment made by the CPD adjudicator. For example, a MC at the time of a CDR feels the individual was capable of standing and walking six-hours as opposed to the CPD MC’s rating of standing and walking four-hours. If the signs, symptoms and laboratory findings present at the CPD were discussed and evaluated appropriately, the current MC must not substitute their judgment for the supported evaluation and rationale completed by the MC at the CPD.

To appropriately assess MI, we look carefully at findings (signs, symptoms, or laboratory findings) that were used to support the medical assessments (SSA-416, residual functional capacity (RFC), psychiatric review technique (PRT), mental residual functional capacity (MRFC), SSA-538, etc.) at CPD to see if there are any changes to those signs, symptoms or laboratory findings. The RFC and other aforementioned assessments provide administrative medical findings of fact. This is not to be confused with the medical findings in the evidence, such as signs and laboratory findings.

CPD evidence: The individual reported difficulty standing and walking due to a back disorder, exhibited by ambulating with a limp. The individual was taking medicine prescribed by their pain management doctor to mitigate pain symptoms associated with their back impairment. X-rays showed mild-to-moderate spinal stenosis. The CPD adjudicator prepared an allowance based on a sedentary RFC due to back pain.

CDR evidence: The individual currently complains of back pain and is taking over-the-counter medications because the individual no longer has a regular doctor. The individual reports difficulty standing due to the pain, but they are able to perform some light household chores. Exams show ambulation with a slight limp on the right side. Recent x-rays show mild-to-moderate lumbar stenosis. Based on this evidence the current adjudicator prepares a light RFC assessment. The individual’s benefits are ceased because the vocational rules indicate “not disabled.”

Discussion: In the example provided, the individual currently complains of back pain, difficulty standing and walking due to pain, and is taking pain medications for their symptoms, the individual walks with a limp (signs), and x-rays (lab findings) are consistent with films from the CPD. The current adjudicator substituted judgment (a light RFC) for that of the CPD adjudicator (a sedentary RFC). There was no need for a current RFC assessment since the symptoms, signs and lab findings have not improved since the CPD. The current adjudicator should have prepared a “no MI” determination.

When the CPD folder is inadequate to permit a reasonable determination about MI or whether MI is related to the ability to work, and current evidence clearly supports finding the individual is disabled (i.e., impairment(s) currently meets or medically equals a listing or can be a current medical-vocational continuance), use the flexible approach to skip steps in sequential evaluation. See DI 28005.005C.

If the evidence from the CPD is available but is inadequate to permit a reasonable determination of whether there is MI, or whether MI is related to the ability to work, then:

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  Do not find MI,

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  Make sure current documentation is adequate for future CDRs, and

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  Find that disability continues (in the absence of an exception).

Code such continuances as "insufficient to assess MI", please see the table below.

For additional instructions on completing the SSA-832 or SSA-833 and scheduling a reexamination diary, see DI 28035.025E.

When CPD evidence is adequate, but is incomplete on points emphasized in current available evidence (for example, functional information about concentration or pace), carefully examine all the prior documentation for related information that may have been present at the CPD but is not immediately evident.

Assume no (or minimal) prior limitation or abnormality of finding in areas where a thorough search of CPD evidence provides no information about the factor in question. Apply this assumption only in assessing MI and comparing residual functional capacity.

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  The adjudicative team must disregard changes within the SEM of the particular test involved.

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  If questions arise, a DDS medical or psychological consultant with the appropriate specialty should analyze the SEM of the test or equipment used.

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  If necessary, the DDS must re-contact the source(s) of the evidence for clarification as needed.

For procedures on test error of IQ scores, see DI 24583.055 and DI 28010.150.