TN 38 (07-23)

DI 23570.025 Disability Determination Services (DDS) Development and Evaluation of an Age-18 Redetermination

A. Developing evidence for an age-18 redetermination

The DDS must develop evidence under the existing procedures for initial claims. If the field office (FO) potentially identifies the case to involve vocational rehabilitation (VR) or similar program or Section 301, see DI 14510.010.

B. Evaluating evidence for an age-18 redetermination

The DDS should evaluate each case based on the case type as described below.

1. Age-18 redetermination

The adult standards for initial claims will apply to an age-18 redetermination for individuals who have attained age 18, except the Step 1 substantial gainful activity (SGA) of the sequential evaluation process will not apply, see DI 22001.001B, DI 22001.001C, and DI 24505.001. These are new initial disability determinations. The DDS will consider 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 (FTC) cases

For an age-18 redetermination case involving FTC, follow the instructions in DI 28075.005.

3. Concurrent cases (adoptions)

The DDS may not adopt a Title II medical determination made before the individual attains age 18 for a Title XVI age-18 redetermination. The DDS may use the reduced development process regarding prior Title II determinations as outlined in DI 23570.025B.5. in this section.

For Title II medical determinations made after the individual attains age 18, the DDS will follow existing adoption policies, see DI 27515.000.

4. Concurrent cases (unfavorable medical determination)

An unfavorable decision on a Title XVI age-18 redetermination could be reason to initiate a continuing disability review (CDR) on the Title II claim. The evidence used could also establish a reason to consider reopening the Title II disability determination. For additional information on when to raise a CDR issue, see DI 27515.050.

However, because the initial standard employed in an age-18 redetermination differs from the MIRS employed in determining continuing disability, it is possible that entitlement could continue the Title II claim. For Title II cases not initiated as a CDR, the DDS must send notification prior to initiating the Title II CDR.

NOTE: The DDS must send a separate notice to the disabled individual and the individual's representative payee.

For concurrent cases initiated as a CDR, process the age-18 redetermination and the Title II CDR actions at the same time. However, if a new notice is required, send notification prior to processing the CDR. 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 age-18 redetermination. For additional information on conflicting determinations or decisions, see DI 27520.030.

Always use the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title XVI) to document the CDR medical determination for the concurrent Title II claim if the Title XVI age-18 redetermination results in an unfavorable determination.

5. Reduced development cases

The DDS may receive cases from the FO without the usual forms because the nature of the impairment is such that the FO felt that the interview would not be necessary. The reduced development process is to alleviate the burden on severely disabled individuals. However, the DDS can request the FO to fully develop and document these types of cases when it is not evident that the case meets the requirements for disability.

Cases that fall under the medical improvement not expected (MINE) or MINE-equivalent criteria may use the reduced development process. These are cases:

  • that involve a very severe impairment that could be considered a permanent impairment in terms of duration of the condition and the unlikelihood that medical improvement will occur (for example, 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 walker or crutches); or

  • the DDS may incorporate and use the findings of a prior Title XVI medical 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 status with the treating source and document the folder. The documentation requirements are the same as those normally employed in MINE or MINE-equivalent cases. For additional information on documenting and copying relevant evidence, see DI 81020.230 and DI 22501.001.

    Cases excluded from the reduced development process are any cases that involve the following:

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

    • any reason exist that questions the earlier determination; or

    • the presence of a medical improvement expected (MIE) or medical improvement possible (MIP) diary.

C. Unfavorable age-18 determinations

The law does not provide any special rules for the termination of benefits to individuals affected by the age-18 redetermination. The normal cessation and termination rules apply. Disability ceases as of the date of the age-18 redetermination decision unless there is a reason for a retroactive cessation date, such as FTC. Eligibility ends the last day of the second month following the month of cessation. As usual, the individual will continue to receive benefits for two months following the month of cessation if the individual meets all other eligibility criteria. Continued payment of disability or blindness benefits after an unfavorable age18 redetermination may occur if the individual is participating in a VR or similar program, see DI 14505.010.

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DI 23570.025 - Disability Determination Services (DDS) Development and Evaluation of an Age-18 Redetermination - 07/28/2023
Batch run: 07/28/2023