TN 2 (12-14)

DI 13001.005 Events That May Initiate a Continuing Disability Review (CDR)

Citations:

20 CFR §404.1590 and 20 CFR §416.990

EXCEPTION: Beneficiaries with a Ticket to Work in use, prior to the initiation of the CDR, are exempt from the normal medical CDR process. For medical CDR processing instructions for beneficiaries with Tickets to Work, see DI 55025.010.

A. Policy on initiating a CDR

Several events may initiate a medical CDR. The following is a list of the most common events that may initiate a medical CDR.

1. Medical review diary

A medical improvement expected (MIE), medical improvement possible (MIP), or medical improvement not expected (MINE) review diary matures.

2. Current evidence required

Initiate a CDR if a current medical or other report is needed to determine if the disability continues.

3. Trial work period (TWP) diary (Title II)

A TWP diary set at the first report of work matures, and the individual is not protected from a medical review as provided under Section 111 of P.L. 106-170. The Ticket to Work and Work Incentives Improvement Act of 1999, which provides the following “Protection from Medical Review Based on Work Activity”:

  1. Title II disability beneficiaries have the option to return to work by ensuring work activity alone will not trigger a medical CDR.

  2. Beneficiaries who are entitled to Title II, or concurrently entitled to both Title II and Title XVI benefits for at least 24 months will not be subject to a medical CDR triggered solely because of their work activity.

When a Title II beneficiary completes a TWP, it is necessary to investigate all work (including work performed during the TWP) to determine whether the work activity indicates the ability to perform substantial gainful activity and result in a continuance or cessation.

4. Earnings record postings

The CDR Enforcement Operation (CDREO) alerts records of Title II and concurrent beneficiaries with potentially uninvestigated substantial earnings after disability onset. Earnings posted for the year of onset will normally not initiate a CDR (unless a Section 1619 CDR is required, see section DI 13005.016, DI 13010.027, and DI 28075.600).

5. Voluntary reports

The individual notifies us orally or in writing that he or she has had recovery from the disability or has returned to work.

6. Vocational Rehabilitation (VR) notification

A VR agency notifies us that the individual completed VR services, and that the individual is now working, or is able to work. In addition, we determine the individual is no longer protected under the TWP.

7. Report from someone in a position to know

Someone in a position to know of the individual’s physical or mental condition tells us any of the following, and it appears the report could be substantially correct:

  1. the individual is not disabled;

  2. the individual is not following prescribed treatment;

  3. the individual has returned to work; or

  4. the individual is failing to follow the provisions of the Social Security Act.

8. Additional evidence received

We receive medical or other evidence in connection with a new claim or subsequent claim (Title II, Title XVI, Disability Insurance Benefits Childhood Disability Benefits (DIB-CDB), Disability Insurance Benefits Disabled Widow(er) Benefits (DIB-DWB)), or an existing claim that raises an issue as to whether disability continues on any other claim.

9. Vocational re-examination diary

A vocational re-examination diary is established when an individual is undergoing vocational therapy, training or an educational program that may improve the individual’s ability to work. Maturation of the vocational re-examination diary may initiate a medical CDR. Generally, the diary period will be set for the length of the therapy, training or educational program.

10. Extended Period of Eligibility (EPE)

In Title II cases, a report of work activity or any change in work during the EPE may prompt a work CDR. For