SSA - POMS: DI 28010.029 - Overview of How to Evaluate Listings with Time Periods for Which an Impairment is Considered Disabling at the Continuing Disability Review (CDR)

A. Overview of listings with time periods

There are three categories that provide time periods for which an impairment meets a listing:

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Listings with a specified timeframe;
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Listings which indicate a minimum period of disability that the impairment meets the listing; and
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Listings with an age-based period of disability.

1. Definitions and examples

a. Listings with a specified timeframe

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Definition: A listing in the Listing of Impairments that has a specific length of time the impairment meets the listing. The adjudicator establishes the medical re-examination diary using the specified timeframe.
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Examples:

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Listing 6.04 “Chronic kidney disease with kidney transplant” is a listing with a specified timeframe. The language of listing 6.04 states: “Consider under a disability for 1 year following the transplant; after that, evaluate the residual impairment.” The impairment meets the listing for 1 year following the transplant.
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Listing 105.02 “Gastrointestinal hemorrhaging from any cause, requiring three blood transfusions” is a listing with a specified timeframe. The language of listing 105.02 states: “Consider under a disability for 1 year following the last documented transfusion; after that, evaluate the residual impairment(s).” The impairment meets the listing for 1 year following the last documented transfusion.

NOTE: A subsequent transfusion could start a new 1-year period.

Listings with a specified timeframe are explicit in terms of the length of the diary assigned. They do not contain phrases indicating that varying timeframes are possible, such as “at least.”

For additional information, see DI 28010.030.

b. Listings with a minimum period of disability

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Definition: Listings with a minimum period of disability designate a minimum length of time an impairment meets the listing. These listings often contain the phrase “at least” and are not specific enough to determine when medical improvement will occur. We establish the medical re-examination diary based on the minimum period and adjudicative judgment. At CDR, it is possible that "medical findings could show the impairment still meets the listing after the end of the minimum period designated in the listing.
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Example: Listing 7.17 “Hematological disorders treated by bone marrow or stem cell transplantation” is a listing with a minimum period of disability. The language of listing 7.17 states the individual must be considered “under a disability for at least 12 consecutive months from the date of transplantation.”

For additional information, see DI 28010.035.

c. Listings with an age-based period of disability

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Definition: A Listing with an age-based period of disability designates an age as a period that an impairment meets the listing. Some child listings that designate age-based periods of disability will vary in terms of scheduling a diary, as the length of the diary will vary based on the individual’s age at the time of adjudication and the age criteria designated in the listing. The listing may indicate the impairment should be considered disabling until the child reaches a specific age.
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Example: Listing 103.02D1 "Chronic respiratory disorders" with "the presence of a tracheostomy," is a listing with an age-based period of disability. The language of listing 103.02D1 states that the Title XVI child must be considered under a disability until the attainment of age 3.

For additional information, see DI 28010.040.

B. Listings that provide alternatives for the period an impairment meets the listing

1. Evaluation at CDR

Some Part B listings designate an age for which an impairment should meet the listing OR a timeframe after a procedure or treatment an impairment meets the listing, whichever is more favorable to the individual (i.e., “whichever is later”).

For example:

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Listing 102.11“Hearing loss treated with cochlear implant” - states that the child must be considered “under a disability until the attainment of age 5 or for 1 year after initial implantation, whichever is later.”

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If a 3-year-old received the transplant, the listing is met until attainment of age 5.
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If a 4½-year-old received the transplant, the listing is met for 1 year.

Although Listing 102.11 above contains age criteria, the intent of scheduling a diary for this listing is to use the age criteria (age 5) or 1 year after implantation of the cochlear implant, whichever is more favorable to the child. The diary length will vary due to the age designated in the listing and the child’s age at the time of adjudication. At the CDR, it may be appropriate to use the flexible approach to facilitate a continuance at Step 3 if the “later” time period criteria have not passed at the time of the CDR; see DI 28005.005C.

For evaluation purposes at the CDR, once the child has passed the age designated in the listing or the time period after the procedure or treatment has passed, the impairment cannot continue to meet the comparison point decision (CPD) listing with that age criteria when considering the prior listing step in the CDR sequential evaluation process.

2. Current examples in the Listing of impairments

Listings with Alternatives for the Period an Impairment Meets the Listing

Title XVI Child Listing	Impairment	Time Period in Listing Consider under a disability...
102.11A	Hearing loss treated with initial implantation of a cochlear implant (applies to Title XVI child cases from infant through the attainment of age 5)	Until the attainment of age 5 or for 1 year after initial implantation, whichever is later.
102.11B	Hearing loss treated with cochlear implant with a word recognition score of 60 percent or less determined using the HINT or the HINT-C test	Upon the attainment of age 5 or 1 year after implantation, whichever is later.
103.02E	Chronic Respiratory Disorders with chronic lung disease of infancy (CLD)	1 year from the discharge date of the last hospitalization or until the attainment of age 2, whichever is later.

Title XVI Child Listing

Impairment

Time Period in Listing

Consider under a disability...

102.11A

Hearing loss treated with initial implantation of a cochlear implant (applies to Title XVI child cases from infant through the attainment of age 5)

Until the attainment of age 5 or for 1 year after initial implantation, whichever is later.

102.11B

Hearing loss treated with cochlear implant with a word recognition score of 60 percent or less determined using the HINT or the HINT-C test

Upon the attainment of age 5 or 1 year after implantation, whichever is later.

103.02E

Chronic Respiratory Disorders with chronic lung disease of infancy (CLD)

1 year from the discharge date of the last hospitalization or until the attainment of age 2, whichever is later.

C. How to evaluate listings with time periods at the CDR

Develop the evidence following guidelines in DI 28030.020 and follow the CDR sequential evaluation process to evaluate the individual’s impairment(s).

If an individual’s impairment met or equaled a listing that established a time period for which the impairment(s) was disabling at the CPD, the prior listing cannot be met at the prior listing step (Step 4 for Title II and adult Title XVI individuals and Step 2 for Title XVI child CDR cases) if the time period has passed. Although the impairment can no longer meet or equal the CPD listing at the CDR due to the expiration of the time period in the listing criteria, the adjudicator still needs to develop for medical improvement (MI) and follow the CDR sequential evaluation process.

D. Special considerations for cancer listings

1. Evaluating cancer listings with time periods at CDR

Some cancer listings include a specified timeframe and some cancer listings indicate a minimum period of disability in the listing criteria.

Listings with a specified timeframe include a specific fixed point for establishing how long an impairment will be considered disabling. This may be ‘x’ year(s) from the date of a transplant or surgery, etc. Examples of listings with specified timeframes are provided in DI 28010.030B.

Minimum periods of disability will not always occur at a fixed point for establishing a diary length based on the nature of the disabling impairment(s) and the individual’s age or treatment status. There is variance in the specific length of the diary assigned based on the factors involved in the listing criteria. Examples of such listings are provided in DI 28010.035B. For additional information on evaluating listings with minimum periods of disability at the CDR, see DI 28010.035.

Regardless of whether the listing indicates a time period for which the listing is met, we must follow the CDR sequential evaluation process, including consideration of MI and related issues.

If the listing at CPD that was met or equaled was a cancer listing with a specified timeframe, follow the instructions and guidelines in DI 28010.030. For related instructions involving cancer listings with a minimum time period, see DI 28010.035.

2. Remission period considerations

The 3-year remission rule that applies to most cancers is not the same as the specified timeframe of disability directed by some cancer listings.

If an individual’s impairment(s) meets or medically equals the cancer listings (13.00 and 113.00), a 3-year period of remission is generally required before cessation under the Medical Improvement Review Standard (MIRS) is possible. However, there are exceptions to considering a 3-year remission period.

The 3-year period of remission does not apply to cases where:

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The listing indicates a specified timeframe, or
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The listing indicates a minimum period of disability.

Cancer impairments that meet or equal a cancer listing that does not indicate a specified timeframe or a minimum period of disability in the listing criteria will require a 3-year period of remission prior to considering whether there is medical improvement. After the 3-year remission period in these listings has expired at the CDR, the impairment no longer meets the cancer listing. However, it is possible that the individual may continue to be disabled at the CDR when their impairment(s) meets a current cancer listing criteria at Step 2 of the Title II and adult Title XVI CDR sequential evaluation process or Step 3 of the Title XVI CDR sequential evaluation process.

In most cases, a medical improvement possible (MIP) diary would have been set at the CPD for listings when the remission rule applies. The remission rule applies at the time of the CDR unless the cancer was in remission at the time of the CPD.

For additional information, see DI 26525.010.

E. Obsolete listings with time periods

A listing with a specified timeframe, a minimum period of disability, or an age-based period of disability at the CPD may be obsolete at the time of the CDR.

At the CDR, an impairment cannot continue to meet or equal the prior obsolete CPD listing for the listings described in DI 28010.030B, DI 28010.035B, or DI 28010.040, once the time period in the listing has passed. However, the impairment could meet or equal a different subsection of that prior listing.

If the impairment met or equaled a listing with a specified timeframe, minimum period of disability, or an age-based period of disability at the CPD and the CPD listing is obsolete at the CDR, the following guidance applies:

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Title II and adult Title XVI CDR cases: Follow the normal sequential evaluation process, see DI 28005.010. If evaluation through sequential evaluation leads to Step 4 based on the evidence, find that MI is related to the ability to work if the obsolete listing with a time period cannot be met or equaled and another subsection of the obsolete CPD listing does not apply. If a Group II exception does not apply, proceed to Step 6.
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Title XVI child CDR cases: Follow the normal sequential evaluation process, see DI 28005.025. If the child has MI in any of the CPD impairments, find that the CPD impairment(s) does not meet or medically equal the now obsolete CPD listing at Step 2 (unless the child obtained a new age category within a subsection of the prior obsolete listing or another subsection of the obsolete CPD listing is met). Also consider whether the CPD impairment(s) functionally equals the listings. If a Group II exception does not apply, proceed to Step 3.

If the CPD listing that was met or equaled did not contain a specified timeframe, a minimum period of disability, or an age-based period of disability and the CPD listing is obsolete at the time of the CDR, follow the instructions in DI 28015.050 for Title II and adult Title XVI CDR cases and DI 28005.030C.2.a. for Title XVI child CDR cases.

Social Security

Program Operations Manual System (POMS)

DI 28010.029 Overview of How to Evaluate Listings with Time Periods for Which an Impairment is Considered Disabling at the Continuing Disability Review (CDR)