TN 2 (08-16)
DI 12026.001 Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening
Social Security Act Section 205(b);
20 CFR 404.907 - 404.922, 404.993, 404.999a - 404.999d, 404.1546, 404.1597, 404.1597a,416.946, 416.995, 416.996 , 416.1407 - 416.1422, 416.1492 - 416.1493, 416.1495 - 416.1499, and 422.140
A. Levels in the appeal process
Individuals have the right to appeal an unfavorable CDR determination.
This subchapter focuses on the reconsideration level only.
There are four levels of appeal:
Reconsideration. This includes:
Pre-hearing - review by an adjudicative team, or designated person, that was not involved in the initial unfavorable determination
Disability hearing - review within a disability hearing unit (DHU) by a disability hearing officer (DHO)
Hearing by an administrative law judge
Review by the Appeals Council
Federal Court review
B. The disability hearing at the reconsideration level
A disability hearing is a face-to-face evidentiary meeting that enables the individual to review the evidence, introduce new evidence, and present his or her objections to a medical determination before a DHO.
NOTE: The disability hearing at the reconsideration level applies only to CDR determinations, and does not apply to determinations based on an initial disability claim.
For information on initial disability claims, see DI 12005.001.
C. Basics of the reconsideration CDR
The Social Security Act affords an individual the right to a disability hearing at the reconsideration level of appeal in certain Title II and Title XVI cases.
1. Types of cases with appeal rights
Cases include an appeal of a medical determination that resulted in a(n):
Adverse medical reopening;
Reopening that changes only the basis of the cessation; or
Reopening that proposes an adverse revision.
The disability hearing process applies to the medical determinations noted here, including the medical issues involving:
2. When a reconsideration CDR applies
Reconsideration applies when:
An initial CDR determination finds, based on medical or medical-vocational factors, an individual's impairment ceased, did not exist, or is no longer disabling; or
The Social Security Administration (SSA) proposes to adversely reopen and revise a favorable determination based on medical or medical-vocational factors. For more information on reopenings, see DI 33020.025.
3. When a reconsideration CDR does not apply
A disability hearing is NOT applicable for:
Initial determinations made on a new application, (including closed period cases), unless it is forwarded for association with a prior case that is subject to the reconsideration CDR process.
Reconsideration of initial determinations made on new applications, including partially favorable determinations (e.g., closed periods and later onsets).
Cases involving non-medical issues, e.g., substantial gainful activity, overpayment of benefits, amount of income and resources (Title XVI), or reconsideration of cessations based on whereabouts unknown.
DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim
DI 29001.001 The Right to a Disability Hearing at the Medical Continuing Disability Review (CDR) Reconsideration Level
DI 29001.005 The Scope of the Disability Hearing
DI 29001.010 Overview of Component Responsibilities Related to Medical Continuing Disability (CDR) Disability Hearings
DI 29005.022 New Application and Request for Reconsideration—Disability Cessation
DI 33020.025 Reopenings