TN 42 (04-24)

DI 23570.020 Disability Determination Services (DDS) Procedures for Processing an Age-18 Redetermination

When the DDS processes an age-18 redetermination, the DDS must follow the guidelines in the policy below.

A. Timeliness of processing an age -18 redetermination

The law requires the Social Security Administration (SSA) to conduct an age-18 redetermination within one year of the Title XVI recipient's 18th birthday or, in lieu of a continuing disability review (CDR), whenever we determine that an age-18 redetermination was required and had not been initiated. The field offices (FO) and DDS must initiate and complete the actions timely. The FO and DDS will diligently pursue development and age-18 redetermination on any case identified as being subject to an age-18 redetermination.

B. Procedures for processing an age-18 redetermination

1. FO actions

The FO will complete the following actions when processing an age-18 redetermination:

  • conduct the disability interview in the same manner as an initial claim;

  • will not take a new application;

  • will not develop medical information back to the original onset date; and

  • will obtain completed disability reports and functional reports appropriately to initiate the disability determinations.

2. DDS actions

The DDS will complete the following actions when processing an age-18 redetermination.

  1. a. 

    Evaluate the individual’s disability using the initial disability standard for adults.

  2. b. 

    Do not apply Step 1 substantial gainful activity (SGA) of the sequential evaluation process.

  3. c. 

    Do not apply the medical improvement review standards (MIRS) in an age-18 redetermination.

  4. d. 

    Although the cases will be evaluated using the rules for initial adult claims (except for Step 1(SGA)), they will be processed in a manner similar to a CDR.

  5. e. 

    Document and input the age-18 redetermination in the same manner as a CDR using the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal- Title XVI).

C. Receipting an age-18 redetermination in the DDS

The DDS must complete the following procedures when receiving an age-18 redetermination.

1. Receiving the case in the DDS

The FO will create and transfer electronic cases in the Electronic Disability Collect System (EDCS) to the DDS and should be identified as an age-18 redetermination, see DI 81020.205. The DDS must review the Supplemental Security Income Display (SSID) query upon receipt of the folder , see DI 28030.010. When reviewing the SSID query, the TMR data should reflect the change from disabled child (DC) to disabled individual (DI) status. For example, “TMR:DC, DI-mm/yy,” where mm/yy are the month and year following the month and year in which the individual attained age 18, see DI 81010.232. However, some cases age 18 and over, may be received as a CDR and then identified by the DDS as requiring an age-18 redetermination instead of a CDR. For additional information on cases that require a disability redetermination instead of a CDR, see DI 28005.003. In paper cases, if the prior paper folder is not available, the FO should place the new disability material in a yellow MDF folder and route it to the DDS.

2. Reviewing the prior folder

An age-18 redetermination is a new determination using the initial standards of disability for adults. If the case has a prior paper folder create the age-18 redetermination in EDCS, see DI 81010.232. The DDS will develop the current evidence as though it is a new claim and make a disability determination without regard to the previous determination.

The DDS may decide that a child case initiated as a CDR should have an age-18 redetermination after reviewing the prior folder and the SSID query. Generally, the prior folder is not as critical as it is in a normal CDR; however, scan all relevant school and medical records into the current age-18 redetermination folder. For additional information on documenting and copying relevant evidence, see DI 81020.230 and DI 22501.001.

3. When a case initiated as a CDR requires an age-18 determination

An age-18 redetermination decision is appropriate instead of a CDR if:

  • the coding shows that a CDR or age-18 redetermination was not done after age 18; or

  • if a CDR was done after age 18, it is clear from the coding that the prior continuance was not based on consideration of the adult standard applicable to initial claims. The additional information on system coding identification, see DI 23570.010B.1.

Receipt the case as a CDR using the following codes:

  • CDT:

    • 02 - Childhood Disability Redetermination Case

      NOTE: Once the original child redetermination workload is completed, it will be unusual to receive a case from the FO identified as a child disability redetermination.

    • 04 - Age 18 Disability Redetermination Case

  • SLC: 8

D. Processing a pending CDR

The DDS must use the following procedures when processing a pending CDR by each case type.

1. Child under age 18

Review the case to see if the CDR meets the child disability redetermination requirements, if a CDR is pending on a child under age 18, see DI 25201.001. If so, process the case as a DC redetermination, see DI 28005.030. If the disabled child turns age 18 prior to a determination, notify the individual and the representative payee of the disability standards using the special notice provided as mentioned in DI 23570.100 and make an age-18 redetermination. For additional information on a case that require a disability redetermination instead of a CDR, see DI 28005.003.

2. Child attained age 18

An age-18 redetermination is required, if a CDR is pending on any individual who attained age 18:

  • who was eligible as a child in the month before the month of attainment of age 18; and

  • who has not had a medical determination under the initial adult standard after attaining age 18, see DI 23570.010A.

If the disabled child turns age 18 prior to a disability determination, send a notice of the medical redetermination using the special notice provided in DI 23570.100.

3. Pending CDR for a child age 18 or who will attain age 18 within 2 months

The FO may initiate an initial level CDR in EDCS when the claimant is age 17 and 10 months until the day before the claimant reaches age 19, the information is collected in EDCS as an age-18 redetermination. The DDS must process the case as an age-18 redetermination, if a CDR is pending on a child, and the child is now or will attain age 18 within 2 months. However, do not make an age-18 determination on the case until the child attains age 18. The DDS must verify eligibility and provide a notice of the need for an age-18 redetermination before rendering the disability determination since the case was sent to the DDS as a child CDR. The DDS must hold the case and make the age-18 redetermination after the disabled individual attains age 18.

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DI 23570.020 - Disability Determination Services (DDS) Procedures for Processing an Age-18 Redetermination - 04/29/2024
Batch run: 04/29/2024