TN 11 (01-17)
DI 13005.022 Field Office (FO) Overview of the Continuing Disability Review (CDR) Process for Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases
A. Introduction to processing MINE or MINE-equivalent cases
The CDR workload consists of cases that have MINE diaries, which are sometimes referred to as “permanent impairment” cases. In these cases, the medical impairment is extremely severe, as determined by existing medical technology and our experience in administering the disability programs. These impairments do not improve over time, and are more likely to be progressive either by themselves or due to related complications. The likelihood of medical improvement to permit the individual to engage in substantial gainful activity (SGA) is extremely remote.
Public Law (P.L.) 96-265 amends the Social Security Act, and requires, in part, that the Secretary (now Commissioner) involves case review schedules for permanent impairments. The review schedule for MINE cases is no more often than every 5 years and no less often than every 7 years.
The primary purpose of the MINE review procedure is to minimize inconvenience to the disabled individual. The Social Security Administration (SSA) structures the review in a manner that is sensitive to the disabled individual’s concerns and needs. Since we consider these impairments permanent, we focus our development toward assuring that the original medical documentation was thorough and fully supports the MINE impairment classification. Therefore, we do not anticipate the need for extensive current medical development.
The impairments that SSA considers permanent and that warrant a MINE medical reexamination diary may change over time due to advances in new diagnostic procedures and new treatments. Due to our experience with prior CDRs, SSA’s policy responds to these advances. We have not realized the anticipated medical improvement in some cases. The result, in part, is that cases previously assigned medical improvement expected (MIE) or medical improvement possible (MIP) medical reexamination diaries may, in some instances, be considered "MINE-equivalent" cases for purposes of FO and disability determination services (DDS) CDR processing. For a complete discussion of medical reexamination diaries, review the following:
DI 13005.005 Field Office (FO) Procedures for Deciding Continuance of Disability and Medical Improvement Diaries, and
DI 26525.020 The MIE Diary – General through DI 26525.045 MINE or MINE-Equivalent Criteria.
For a complete discussion of DDS MINE CDR process, see DI 28040.000.
For electronic case procedures, see DI 81010.000.
B. Process for the FO to review folder(s) to identify MINE or MINE-equivalent cases
1. CDRs covered by these instructions
Apply these instructions to all full medical CDRs, whether the case is Title II only, concurrent (Title II and Title XVI) or Title XVI only. Use these instructions when an automated direct release (ADR) process sent the alert or when the CDR is the result of processing a CDR mailer form SSA-455 (Disability Update Report) or form SSA-455-OCR-SM.
2. Reasons why we created instructions for the MINE or MINE-equivalent cases
We created instructions for MINE or MINE-equivalent cases based on the following reason(s):
The current methods for alerting MINE CDRs to the FO differ from the prior routing described in DI 28040.005A.
Processing centers (PCs) no longer complete medical folder reviews of MINE cases, and will no longer route MINE cases requiring a CDR directly to the servicing DDS. As a result, the FO will receive alerts for MINE diary cases instead of the DDS.
When reviewing some cases with MIE or MIP medical diaries, the FO may find the CDR mailer responses and information obtained indicates that the disabled individual has a severe impairment;
Since we redefined the medical diary criteria, some cases with MIE or MIP diaries now meet the MINE criteria; or
Some cases have incorrect or no diary information on the Master Beneficiary Record (MBR) or the Supplemental Security Record (SSR).
NOTE: For the DDS to make a CDR determination, the instructions above eliminate unnecessary interviews for the FO when completing the Form SSA-454-BK (Continuing Disability Review Report). For electronic case procedures, see DI 81010.000.
C. Procedure for screening cases for MINE or MINE-equivalent processing
1. Complete the folder review and the screen-out process
Before determining whether it is appropriate to process MINE or MINE-equivalent cases, the FO will review the case folder(s) to determine:
that the comparison point decision (CPD) and supporting medical evidence are in the folder, and
that no other screen-out conditions apply, before determining whether MINE or MINE-equivalent processing is appropriate.
For complete instructions on folder review and the screen-out process, see DI 13005.020. To determine and locate the appropriate CPD, see DI 28035.015.
You can find the CPD on the following forms:
SSA-831-U3 (initial claims, all titles),
SSA-832 (Title XVI) CDRs, and
SSA-833 (Title II) CDRs.
If the Office of Disability Adjudication and Review (ODAR) issues a multi-page decision, subsequently a SSA-831-U3, SSA-832 and SSA-833 is prepared to reflect the medical decision. These forms include key identifying information such as the:
onset date of disability,
basis for the medical determination, and
date of the determination.
The type of determination (medical or non-medical) often describes the consideration of the medical evidence in making the determination.
The medical evidence used in making the CPD is located in the claim folder(s).
To view the medical determination forms in reference to the medical dairy type and date information, see:
For a thorough discussion of the MDF, see DI 70005.005.
2. Review the claim folder(s) before initiating the SSA-454-BK contact and interview
We expect that most of these cases can be processed under the MINE or MINE-equivalent procedures, without and FO interview. The FO must review the claim folder(s) to determine if the FO can process the case under the MINE or MINE-equivalent procedures before sending the CDR notice and SSA-454-BK package.
NOTE: After initiating personal contact or an SSA-454-BK interview, the MINE or MINE-equivalent procedures can no longer apply and the FO must complete the interview.
3. Identification of MINE or MINE-equivalent cases
To reduce the FO’s work burden and to facilitate completion of a CDR on these cases, the FO has authorization to route the CDR, without a CDR interview and a SSA-454-BK package to the DDS to invoke the MINE procedures in DI 28040.000 if:
|Diary Impairment Requirements||Exceptions|
MINE cases - Review the most recent prior SSA-831-U3, SSA-832, or SSA-833 (all versions) in the claim folder that show a MINE (5 or 7 year) diary established on the case.
MINE-equivalent cases – Given a MIE or MIP diary, but the case involves a very severe impairment which could be considered a permanent impairment in terms of duration of the condition and the unlikelihood of medical improvement occurring. Some examples are:
cases involving amputation of more than one limb;
amputation of a leg at the hip or amputation as a consequence of diabetes; or
a long-standing condition which has resulted in bed confinement or the need for a wheelchair, walker or crutches.
Do not invoke this process if:
Information (including answers to questions on an SSA-455 CDR mailer) received since the date of the most recent SSA-831-U3, SSA-832 or SSA-833 (all versions), show one or more of the following:
A report of medical improvement by the beneficiary or a third party;
A report that a physician has told the beneficiary he or she can work;
The beneficiary has attended school or received vocational training or services;
The beneficiary has performed SGA in the last 3 years (SEQY query mandatory);
The CPD medical evidence is not in the folder and efforts to obtain it have not been successful; or
The FO has initiated the CDR interview.
4. FO actions upon identification of a MINE or MINE-equivalent case
Do not send the CDR notice or the Form SSA-454-BK interview.
Instead, send the Form SSA-5002 (Report of Contact) to the DDS with an explanation for the basis of the FO’s decision to process the case under the MINE procedures in DI 28040.000.
Add the SSA-5002 (Report of Contact) in the claim folder(s) and include a reference to these instructions.
Enter the remark, "MINE or MINE-equivalent CDR case-process per DI 28040.000." on the route slip when sending the claim folder(s) to the DDS.
Clear the system case controls to reflect the referral of a CDR to the servicing DDS.
NOTE: For information on creating an electronic CDR (eCDR) in the Electronic Disability Collect System (EDCS), see DI 81010.230.
5. DDS returns the MINE or MINE-equivalent referral to the FO for a full Form SSA-454-BK interview
The DDS may disagree with the FO’s identification of the case as MINE or MINE-equivalent and the DDS may determine not to process the case under the MINE procedures in DI 28040.000. If this occurs, the DDS will return the case(s) to the FO for full development and a CDR interview, see DI 13005.025. For more information on this process, see DI 13005.105 through DI 13005.115, and DI 28040.205 through DI 28040.215.