TN 37 (05-15)
DI 28001.001 What is a Continuing Disability Review (CDR)?
20 CFR §404.1594, 20 CFR §416.994
A. Background of a CDR
Under the “Social Security Amendments of 1956,” section 225 of the Social Security Act (Act) authorized the agency to suspend benefits and review the medical conditions of those individual’s believed by the agency to no longer have a disabling condition on the basis of information obtained by or submitted to the agency. These reviews determine whether the individual’s disability had ceased, or had not ceased, and were performed promptly by the State agencies. The “Social Security Disability Amendments of 1980” added section 221(i) of the Act that required the agency to perform periodic reviews for purpose of continuing eligibility, at least once every three years for individuals with nonpermanent disabilities, and at a time determined by the Commissioner to be appropriate for individuals with permanent disabilities. The “Social Security Disability Benefits Reform Act of 1984,” sections 223(f) and 1614(a)(4) of the Act, sets forth the standard of review for termination of disability benefits when a case is being reviewed for purposes of continuing disability and establishes the “medical improvement review standard (MIRS)” in CDR cases.
B. Introduction to CDRs
A statute requires us to perform a periodic review to determine if any individual entitled to disability benefits continues to be disabled. To carry out this statutory requirement, we will conduct CDRs at selected intervals.
C. Policy for conducting CDRs
We will notify the individual of the nature of the review, why we are conducting the review, and that the medical improvement (MI) standard will apply, for the definition of “MI”, see DI 28090.045. The individual or representative may submit medical and other evidence, as applicable, for consideration during the review. The purpose of the review is to determine if an individual’s impairment(s) has improved since the most recent favorable determination, called the comparison point decision (CPD). When appropriate, we also determine if an exception to MI applies. During this review, the final decision could result in termination of benefits. The termination date is two months after the cessation date.
D. CDR Process
The CDR process is to determine if an individual’s impairment(s) has improved since the most recent favorable determination (or if an exception to MI applies). In Title II and adult Title XVI cases, we will determine if the person can perform substantial gainful activity (SGA). In Title XVI child cases, we will determine if the child's impairment(s) currently causes marked and severe functional limitations. For the definition of a “child”, see DI 25201.001D. During the review, we will make every reasonable effort to develop a complete 12-month medical history, obtain current information about the disabled individual's physical and mental impairment(s), and any work activity.
Different procedures apply in cases where MI is not expected (MINE); see “Medical Improvement Not Expected (MINE) or Medical Improvement Not Expected – Equivalent (MINE-Equivalent) Cases” in DI 28040.000.
We review information concerning the individual's prior impairment(s) to decide whether the individual remains disabled under the MIRS, see DI 28005.000. If we find that an individual does not meet the disability criteria of the law, we must suspend or terminate benefits and freeze periods. If we determine that an individual is no longer disabled, we will send the individual a notice of the cessation determination. We will give the individual an opportunity to appeal the cessation and to request that benefits continue during the appeal process until the administrative law judge or Disability Hearing Officer renders a decision. The procedures that relate to continuing disability apply to both Title II and Title XVI, unless otherwise noted.
E. When to cease benefits
1. Adult CDR cessations
For a Title II or adult Title XVI beneficiary, disability will cease only when:
there has been MI in the individual's impairment(s) related to the ability to work or certain exceptions to MI apply, and
the physical and mental impairment(s), together with the vocational profile (age, education, and work experience), does not prevent the individual from engaging in SGA, unless a “Group II” exception applies, see DI 28020.900.
2. Child CDR cessations
For a Title XVI child beneficiary, disability will cease only when:
there has been any MI in the child's impairment(s) or certain exceptions to MI apply, and
the child's impairment(s) does not result in marked and severe functional limitations; does not meet, or medically or functionally equal the severity of a listing; unless a “Group II” exception applies, see DI 28020.900.
F. How work affects a CDR
Regardless of MI, when an individual has worked in accordance with the trial work period (TWP) Title II provisions of the law, see DI 13010.035 through DI 13010.090, and is engaging in SGA, disability will cease (except in certain Title II or Title XVI cases based on blindness or cases of participants in Title XVI work incentive projects per SI 02302.001). The local Social Security office makes determinations on whether the individual is engaging in SGA. We will stop benefits only when required by applicable law and regulations. We will apply due process and administrative procedures consistently, see DI 28080.001 “Due Process for Continuing Disability Review Cases”. We will exercise care in fully developing and completely evaluating evidence for each individual disability entitlement. Eligibility will continue for the month of cessation and the following two months. The termination date is the third month following the month in which the impairment is not disabling (cessation).
G. Special development cases
Certain CDR cases are subject to special development and processing requirements. Among these types of cases are:
cases involving a lost folder, see DI 28035.000;
cases involving a permanent, severe impairment and medical improvement is not expected (MINE cases) to occur, see DI 28040.000;
cases involving judicial decisions (Decision Review Cases) (HALLEX I-5-3-18);
cases involving work activity during a trial work period, see DI 28050.010;
cases involving an extended period of eligibility (EPE) or other work incentive provision, see DI 13010.210;
cases involving vocational rehabilitation (VR) participation, see DI 14510.010);
cases involving an individual convicted of a felony, see DI 28065.001; and
cases involving an individual with drug abuse or alcoholism, see DI 90070.041.
DI 28005.000 The CDR Evaluation Process
DI 28005.020 The CDR Evaluation Process - Title XVI Child - General
DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement