TN 31 (01-00)

DI 23570.020 Development and Evaluation of Age 18 Disability Redeterminations

A. Policy - evidence

Evidence will be developed under existing POMS procedures. Types and sources of evidence will remain the same under revised criteria. See DI 14510.010 if the FO has identified the case as a potential 301 case.

B. Policy - evaluation

1. Age 18

The adult standards for initial claims in DI 22001.001B, DI 22001.001C, and DI 24505.001 will apply to disability redeterminations for individuals who have attained age 18, except that the SGA step of the sequential evaluation process will not apply. These are new initial disability determinations. The DDS will considered all current impairments, including any new impairments even if they do not meet the duration requirement. See DI 28005.210B.1.

2. Failure to cooperate

Follow DI 28075.005 for age 18 cases.

3. Concurrent cases - adoptions

The DDS may not adopt a title II disability determination made before age 18 to a title XVI age 18 disability redetermination. The DDS may utilize the process outlined in DI 23570.020B.5. with regard to prior title II determinations.

For title II disability determinations made after age 18, the DDS will follow existing adoption policies unless the title II determination was an adoption of an earlier title XVI determination. If the title II determination was an adoption of a pre age 18 determination, it will be treated in the same manner as a determination made before age 18.

4. Concurrent cases - unfavorable determination

An unfavorable decision on title XVI disability redetermination could be reason to initiate a CDR on the title II claim. The evidence used could also establish a reason to consider reopening of the title II determination. However, because the initial standard employed in a disability redetermination differs from the MIRS employed in determining continuing disability, it is possible that entitlement could continue on the title II claim.

For cases that were not initiated as a CDR, notification is required prior to initiating the title II CDR. For concurrent cases initiated as a CDR, the disability redetermination and the title II CDR action can be processed at the same time. However, if a new notice is required, do not process the CDR until after the notice is sent. This means that there could be a later cessation date on the title II claim. Do not attempt to reconcile the dates and do not delay action on the title XVI disability redetermination.

Always prepare Form SSA-832-C3/U3 to document the CDR (continuation or cessation) for the concurrent title II claim if the title XVI disability redetermination results in an unfavorable determination.

5. Reduced development cases

The DDS may receive cases from the FO without the usual interview forms because the nature of the impairment is such that the FO felt that the interview would not be necessary. This process is intended to alleviate the burden on very severely disabled individuals. However, the DDS may, at its' discretion request the FO to fully develop and document the case. The type of cases in which this process is used are:

  • Cases which involve a very severe impairment which could be considered a permanent impairment in terms of duration of the condition and the unlikelihood that medical improvement will occur (i.e., total deafness; total blindness; cases involving amputation of more than one limb, or amputation of a leg at the hip; a longstanding condition which has resulted in bed confinement or the need for a wheelchair, and walker or crutches),

For age 18 disability redeterminations only, the DDS may incorporate and use the findings of a prior title XVI determination if the individual has a very severe impairment (as described above) that meets the adult criteria and there is no expectation or evidence of improvement. In these situations, the DDS need only confirm the individual's current status with the treating source and document the file. The documentation requirements are the same as those normally employed in such cases. Excluded from this process are any cases with any of the following:

  • There is any discrepancy between any current allegations and evidence and the evidence used in the prior determination;

  • there exists any reason to question the earlier determination; or,

  • a Medical Improvement Expected (MIE) or Medical Improvement Possible (MIP) diary is present.

C. Policy - unfavorable determinations

The law does not provide any special rules for the termination of benefits to individuals affected by the age 18 disability redeterminations. The normal cessation and termination rules apply. Disability ceases as of the date of the disability redetermination decision. Eligibility ends the last day of the second month following the month of cessation. As usual, benefits are paid for two months following the month of cessation if all other eligibility criteria are met.

Continued payment of disability or blindness benefits after an age 18 unfavorable determination may occur if the individual is participating in a VR or similar program. See DI 14505.010.

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DI 23570.020 - Development and Evaluation of Age 18 Disability Redeterminations - 05/16/2017
Batch run: 05/16/2017