TN 10 (07-23)

DI 28040.100 Disability Determination Services (DDS) Review of Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

A. Receipt of the case in the DDS

On receipt of the continuing disability review (CDR) case, the DDS will:

  • Review the evidence in folder to ensure that a MINE or MINE-equivalent impairment exists. To review the MINE criteria, see DI 26525.045.

  • Screen the folder for correctness of the CDR diary category. (For example, make sure the case is not a medical improvement expected (MIE) or medical improvement possible (MIP) case.)

  • If necessary, route the folder to the proper location if information received since the prior decision or determination raises an issue of jurisdiction or need for review (for example, the beneficiary or recipient has died or moved to another state).

B. DDS development and responsibilities

The DDS will complete the majority of MINE or MINE-equivalent case reviews with limited field office (FO) involvement. The DDS responsibilities include:

  • Reviewing the evidence in the folder to assure that a MINE or MINE-equivalent impairment exists and is properly documented.

  • Contacting the beneficiary or recipient to alert them that a notice will be mailed regarding a periodic review and answering any questions the beneficiary or recipient raises.

  • Sending a formal notice of periodic review as required by law. For more information on this notice, see DI 28040.105.

  • Re-contacting the beneficiary or recipient to update the folder with focused information concerning the current condition of the impairment(s), daily activities, work activity, and current medical sources (all this information may be developed during the first phone call, if the beneficiary or recipient prefers and is prepared to provide the necessary answer).

  • Verifying the existence of the continued impairment severity with a medical source, evaluating the information received, and preparing the appropriate determination.

The medical evidence from the last favorable decision and information obtained from current source(s) forms the basis for determining the existence of a continued MINE or MINE-equivalent impairment. A continuance processed due to this review will establish the comparison point decision for future CDRs.

C. MINE or MINE-equivalent CDR procedures do not apply

The MINE or MINE-equivalent CDR procedure does not apply to any case in which:

  • The evidence in folder does not clearly show existence of MINE or MINE-equivalent impairment, (including lost folder cases); or

  • Information received since the last favorable decision raises an issue of continued impairment severity.

The DDS will return the case to the FO if the MINE or MINE-equivalent CDR procedures do not apply. For more information on returning cases to the FO for a full CDR, see DI 28040.215.

D. Deferral of the CDR process

It may not always be possible to complete a CDR immediately. The DDS may defer a CDR, if it falls into one of the following categories:

  • Reasons unrelated to the disability (for example, weather, travel, hospitalization (short duration)); or

  • Life-threatening situations (but only upon regional office approval).

The DDS will contact the regional office for guidance on any case they believe needs deferral. For further information on the CDR deferral process, see DI 28003.010.

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DI 28040.100 - Disability Determination Services (DDS) Review of Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 07/31/2023
Batch run: 07/31/2023