TN 35 (09-97)
DI 28001.001 What is a Continuing Disability Review (CDR)?
After an individual is determined to be disabled, we are required by statute to perform a review from time to time to determine if the individual continues to be disabled. To carry out this statutory requirement, a continuing disability review (CDR) will be conducted at selected intervals.
The individual will be notified of the nature of the review and why it is being conducted. The individual will be notified that the medical improvement (MI) standard will apply and that medical and other evidence, as applicable, may be submitted for consideration during the review and that the review could result in the termination of benefits. The purpose of the review is to determine if a person's impairment(s) has improved since the most recent favorable determination (or if an exception to MI applies), and in title II and adult title XVI cases, to determine if the person can perform substantial gainful activity (SGA) or, in title XVI child cases, to determine if the child's impairment(s) currently causes marked and severe functional limitations. (See DI 25201.001B. for the definition of a “child” .) During the review, every reasonable effort will be made to develop a complete 12-month medical history and obtain current information about the disabled individual's physical and/or mental impairment(s) and any work activity. Different procedures apply in cases where MI was not expected (MINE cases) as discussed in DI 28040.000. Information concerning the individual's prior impairment(s) is reviewed in deciding whether the individual is still disabled under the medical improvement review standard (MIRS) (see DI 28005.000). If an individual is found not to meet the disability eligibility criteria of the law, benefits and freeze periods must be suspended or terminated. If a determination is made that disability has ended and that benefits should be terminated, the individual will be sent notice of the cessation determination and given an opportunity to appeal and to request that benefits be continued during the appeal until the administrative law judge renders a decision. These procedures relating to continuing disability apply to both title II and title XVI unless otherwise noted.
For a title II or adult title XVI beneficiary, disability will cease only when, (1) There has been any MI (related to the ability to work) in the individual's impairment(s) or certain exceptions to MI apply, and(2) The physical and/or mental impairment(s), together with the vocational profile (i.e., age, education and work experience), where appropriate, does not prevent the individual from engaging in SGA, unless a “Group II” exception applies -- see DI 28020.900.
For a title XVI child beneficiary, disability will cease only when (1) There has been any MI in the child's impairment(s) or certain exceptions to MI apply, and (2) The child's impairment(s) does not result in marked and severe functional limitations; i.e., does not meet, or medically or functionally equal the severity of a listing; unless a “Group II” exception applies -- see DI 28020.900.
Also, irrespective of MI, where an individual has worked in accordance with the trial work period (TWP) provisions of the law (see DI 28050.001) 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 (SI 02302.001). Determinations on whether the individual is engaging in SGA are made by the local Social Security office.
Benefits will be stopped only when required by applicable law and regulations, and will be consistent with due process (DI 28080.001) and administrative procedures. Care will be exercised in fully developing and completely evaluating evidence for each person. Disability entitlement will continue for the month of cessation and the following 2 months.
Finally, it should be noted that certain CDR cases are subject to special development and processing requirements. Among these are lost folder cases; cases in which a permanent, severe impairment is present and medical improvement is not expected to occur (MINE cases); cases involving judicial decisions (Decision Review Cases); cases involving work activity during a trial work period; cases involving an extended period of eligibility (EPE) or other work incentive provisions; and cases which may involve VR participation, an individual convicted of a felony, or drug abuse or alcoholism. A separate subchapter has been devoted to the special handling of each of these categories of cases.
NOTE: The application of the MIRS is different in the evaluation of title XVI children. See DI 28005.020.