For Title XVI disability purposes, an adult refers to a person who is aged 18 or older. A child refers to a person who has not attained age 18 20 CFR 416.902(c).

Follow the development of medical evidence guide in DI 28030.020. Do not focus development on a particular impairment(s). Although the medical improvement review standard (MIRS) sequence as it applies to Title XVI children focuses first on the comparison point decision (CPD) impairment(s) and later on the current impairment(s), initiate development of all current evidence simultaneously.

For Title XVI child CDR cases, wherever the term “equals” (and related terms, e.g., “equaled”) appears without “medically” or “functionally” as a modifier, it includes both of those concepts.

P.L. 104-193, enacted August 22, 1996, changed the MIRS exceptions that apply to Title XVI children.

The following Group I exceptions that are applicable to Title II CDR cases and adult Title XVI CDR cases do not apply to Title XVI child CDR cases:

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  Advances in Medical or Vocational Therapy or Technology, see DI 28020.100;

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  Substantial Gainful Activity (SGA) (applicable to Title II CDR cases only, see DI 28020.050); and

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  Vocational Therapy, see DI 28020.150.

SGA is not a reason for disability cessation for title XVI child CDR cases because of the 1619 provisions, see DI 28005.015B.

The first step in the sequential evaluation process for evaluating Title XVI child CDR cases is to determine whether MI has occurred, see DI 28010.015 for a definition of MI, in any impairment(s) the child had at the time of the CPD.

If there has been no MI, we will find that disability continues, unless one of the exceptions applies in DI 28020.250 through DI 28020.900.

If the evidence shows there has been MI, the adjudicator will go to the next step in the sequential evaluation process.

At step 1, determine whether there has been MI in any impairment(s) the child had at the time of the CPD.

1. a. 

   If there is no MI, consider whether a Group I or Group II exception applies, see DI 28020.001.

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     If no exception applies, find that disability continues.

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     If a Group I exception applies, see DI 28020.001B1, go to step 3.

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     If a Group II exception applies, see DI 28020.900, find that disability has ended. Group II exceptions may apply at any point in the CDR sequential evaluation process.

2. b. 

   If MI has occurred, go to step 2.

If MI was found at step 1, we then consider whether the impairment(s) that we considered at the CPD still meets or medically equals the listing it met or medically equaled at that time. Consider the current severity of that impairment(s), and the same listing section and any subsections of that listing used to make that determination or decision as it was written at that time, even if it has since been revised or removed from the Listing of Impairments.

If the child's impairment(s) met a listing with a time period at the CPD, for additional information, see DI 28010.029.

If the child's impairment(s) met a listing at the CPD with a time period requirement, for additional information, see DI 28010.029.

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  For cases involving listings with a specified time frame, see DI 28010.030.

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  For cases involving listings with a minimum period of disability, see DI 28010.035.

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  For cases involving listings with an age-based period of disability, see DI 28010.040.

At step 2, determine if the CPD impairment(s) that met or medically equaled the severity of a listing still meets or medically equals the same listing at the CPD.

1. a. 

   If the impairment(s) still meets or equals the listing met or equaled at the CPD, consider whether a Group I or Group II exception applies, see DI 28020.001.

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     If no exception applies, find that disability continues.

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     If a Group I exception applies, see DI 28020.001B1, go to step 3.

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     If a Group II exception applies, see DI 28020.900, find that disability has ended. Group II exceptions may apply at any point in the CDR sequential evaluation process.

2. b. 

   If the impairment(s) does not still meet or equal the listing met or equaled at the CPD, go to step 3.

3. c. 

   If there is MI in the impairment(s) at step 1 and the child's CPD impairment(s) functionally equaled the listings at the CPD, go to step 3.

NOTE: Functional equivalence is not based on a specific listing or a specific listed impairment; instead, it applies when a child has “marked” limitations in two domains of functioning or an “extreme” limitation in one domain. For additional information regarding functional equivalence, see DI 25225.001. For information and guidance when applying functional equivalence rules when the CPD was based on functionally equaling the listings, see Social Security Ruling 26-1p.

If there has been MI, and the impairment(s) no longer meets or equals the severity of the listing it met or equaled at the time of the CPD, or if a Group I exception applies, consider whether the child is currently disabled under the rules in DI 25220.010 and DI 25225.001; taking into account all factors relevant to assessing impairment severity e.g., basic consideration DI 25210.001 through DI 25210.040 and pain and other symptoms DI 24501.021. Consider all impairment(s) the child now has, including any impairment(s) that existed but was not considered at the time of the CPD. The steps in determining current disability are summarized as follows:

1. a. 

   Is the current impairment(s) severe? DI 25220.005

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     If the impairment(s) is not severe, find that disability has ended.

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     If the impairment(s) is severe, go to b.

2. b. 

   Does the current impairment(s) meet or medically equal any current listing? DI 25220.010

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     If the impairment(s) meets or medically equals a current listing, find that disability continues.

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     If the impairment(s) does not meet or medically equal a current listing, go to c.

3. c. 

   Does the current impairment(s) functionally equal the listings? DI 25225.001

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     If the impairment(s) functionally equals the listings, find that disability continues.

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     If the impairment(s) does not functionally equal the listings, find that disability has ended.

Explain the CDR determination on the SSA-538 or the CDE for cases processed in the Electronic Claims Analysis Tool (eCAT) or in the Disability Case Processing System (DCPS). For additional information on completing these forms, see DI 25230.001 and DI 25230.005.

An SSA-538 or CDE is only required if the severe impairment(s) requires a domain evaluation. There are certain scenarios where an SSA-416-UF may be used instead of the SSA-538 or the CDE, see in this subsection D2.

Conversely, there are times where two SSA-538 or CDE assessments may be necessary, for details see in this subsection D2.

A CDEF or CDE is not necessary in all Title XVI child CDR cases processed in eCAT or DCPS. Consistent with the instructions in DI 25230.001B1, a CDE or CDEF is only required if the severe impairment(s) require a domain evaluation.

A CDEF or CDE is not necessary in CDRs in situations where a child’s impairment(s):

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  Meets, medically equals, or functionally equals a listing based on example (this may be for a current listing or if the CPD listing continues to be met), or

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  Demonstrates no MI, or

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  Are all considered not severe (i.e., no limitation) in all domains.

If one of the three scenarios above are met and the CDE or CDEF are not completed, the medical consultant or psychological consultant must use the SSA-416-UF to document their full claim analysis in eCAT or DCPS.