TN 11 (06-23)

DI 28010.115 Impairment Subject to Temporary Remission


20 CFR 404.1594(c)(3)(iv), 416.994(b)(2)(iv)(D), and 416.994a(c)(3)

A. Introduction to temporary remissions

Some impairments are subject to temporary remissions, which can give the appearance of medical improvement (MI) when in fact there has been none. These types of impairments can appear to be in remission when, in fact, the impairments are only stabilized. If the impairment is subject to temporary remissions, carefully consider the longitudinal history of the impairment, including the occurrence of prior remissions and prospects that the impairment will worsen again in the future, when deciding whether there has been any MI. Temporary improvements in impairments will not warrant a finding of MI.

NOTE: The wording concerning temporary remissions in the three relevant sections of the regulations is slightly different, but the substance and intent is the same.

B. Consideration of temporary remissions

1. To decide whether temporary remission is an issue in a particular case, carefully consider:

  • The longitudinal history of the impairment (including the occurrence of prior remissions and prospects that the impairment will worsen again in the future),

  • All available evidence, including medical evidence and opinions, and

  • Medical literature about the nature of the impairment.

2. Which impairments are subject to temporary remission?

Examples of impairments subject to temporary remission include (but are not limited to):

  • Multiple sclerosis,

  • Rheumatoid arthritis,

  • Many mental impairments,

  • Sickle cell anemia,

  • Epilepsy, and

  • Asthma.

3. How long is “temporary”?

To determine whether the remission is temporary, consider the longitudinal history of the impairment (including the occurrence of prior remissions and prospects that the impairment will worsen again in the future), in relationship to the particular impairment and the changes that have occurred.

Consider improvement temporary unless it has been sustained long enough to have a significant impact on the individual's functioning, or, in a Title XVI child case, on the child's functioning under ordinary conditions on a sustained basis.

4. Listing timeframes

a. Relationship to medical improvement review standard (MIRS) issues

Several listing sections (e.g., the cancer listings) presume disability for different time periods, but require direct evaluation of the residual impairment after that time, see DI 28010.029.

b. Comparison point decision (CPD) during remission

In some CDRs, the CPD occurred during remission of the impairment(s) but within a timeframe specified by one of these listing sections. In such cases, the signs, symptoms, and laboratory findings relevant to medical severity include findings prior to the remission. These pre-remission findings often control the decision (e.g., continuance under the cancer listings based on evidence of metastases within the last 3 years, even though current examination does not show recurrence).

c. Remission continues after specified timeframe

The current adjudicator must consider relevant history at each point, and must not focus on a particular day. Find MI:

  • If evidence shows that remission continues after the time specified by the listing (see DI 28010.030), and

  • There has been an improvement in symptoms, signs, or laboratory findings relevant to current severity, when compared to the symptoms, signs, or laboratory findings relevant to severity at the time of the CPD.

NOTE: An impairment(s) that met or equaled a listing identifying a minimum time period of disability may not demonstrate MI despite remission continuing after the minimum time specified by the listing. Since these listings only designate a minimum period of time for which an impairment is disabling, the adjudicator must consider the case facts to determine whether MI has occurred. For additional information, see DI 28010.035C.

C. Processing of temporary remissions

1. Continuance if remission not yet long enough

When remission has not yet lasted long enough, find that disability continues. For more information on length of temporary remission, see DI 28010.115B.3. in this section.

Consider setting a medical improvement expected (MIE) diary for a time when evidence will provide a better basis for determining whether the remission is long enough to demonstrate MI.

  • When a listing timeframe currently applies, consider setting the MIE diary to be due after the end of the period specified by the listing.

  • In other situations where remission has not yet lasted long enough, consider setting a MIE diary due in about 1 year.

2. Notice preparation

Include a special paragraph in continuance notices in the above situations. Inform the individual that while their health improved, it appears to be too early for an accurate medical decision about the degree of improvement; therefore, disability is found to be continuing and a reevaluation will be scheduled for (date).

3. Future reviews

If remission continues until the time of the next scheduled CDR, apply the policies in subsections A. and B., and, if appropriate, find the MI more than temporary.

D. Examples

1. MI in impairment subject to temporary remission

CPD evidence: The individual's rheumatoid arthritis met listing 14.09. The individual had persistent swelling and tenderness of the fingers and wrists of both hands, and laboratory tests were positive for rheumatoid arthritis. The individual had difficulty dressing and had to wear loose fitting clothing that did not require buttons, zippers or fasteners, they would frequently drop items in either hand, and had joint pain that made it difficult to pick up items when grocery shopping and had switched to a grocery delivery service for this reason.

CDR evidence: Laboratory tests are still positive for the presence of rheumatoid arthritis. The individual has engaged in therapy with different medications for treatment for the last year and has responded favorably. The individual reports continued joint pain, but an improvement in pain and a reduction in swelling. The individual is now able to grocery shop and will buy necessary items a few at a time so they do not have problems lifting and carrying the items. The progress notes from the individual's medical source also demonstrate continued improvement in signs and symptoms over the last year with therapy.

Discussion: Find MI. Medical improvement has occurred because there has been a decrease in the severity of the individual's impairment as documented by the current symptoms and signs reported by the individual's physician. Although the individual's impairment is subject to temporary remission and exacerbations, the improvement that has occurred has been sustained long enough to permit a finding of medical improvement. We would then determine whether this medical improvement is related to the individual's ability to work.

2. No MI in impairment subject to temporary remission

CPD evidence: At the CPD, the individual's impairment(s) met listing 11.02 for epilepsy. Despite adherence to prescribed treatment, the individual was experiencing grand-mal seizures at least once a month consistently for three months in a row.

CDR evidence: The CDR is initiated in August. The individual has continued compliance with prescribed treatment. Within the last 4 months from the date of the CDR initiation in August, the records indicate the following number of seizures despite medication compliance: 2 seizures in April, 1 seizure in May, 2 seizures in June, 0 seizures in July.

Discussion: Find no MI. Despite no seizures for one month in July, the evidence supports the conclusion that there has been no improvement in the pattern of seizures. While the individual did not have any seizures in July, this anomaly may represent a temporary remission, the individual experienced seizures for three consecutive months despite compliance with medication.

E. References

  • DI 28005.005 Overview of Development in the Continuing Disability Review (CDR) Sequential Evaluation Process

  • DI 28005.030 Step-by-Step Discussion of the Title XVI Child Continuing Disability Review (CDR) Sequential Evaluation Process

  • DI 28010.015 Comparison of Symptoms, Signs, and Laboratory Findings When Evaluating Medical Improvement (MI)

  • DI 28015.001 Context and Scope — Relating MI to Ability to Work

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DI 28010.115 - Impairment Subject to Temporary Remission - 06/07/2023
Batch run: 06/07/2023