TN 37 (05-15)
DI 28001.020 Frequency of Continuing Disability Reviews (CDRs)
A. Introduction to frequency of CDRs
Individuals receiving disability benefits must continue to meet the disability requirements of the law. To ensure this, the Social Security Administration (SSA) must conduct CDRs. Under the law, we must review all disability beneficiaries at least once every three years, unless they are permanently disabled. The frequency of scheduled review determines the likelihood of improvement of the impairment(s). We must review permanently disabled beneficiaries on a schedule determined to be appropriate by the Commissioner. The policy and review schedules governing the frequency of a CDR are discussed in DI 28001.020B in this section.
B. Policy for the frequency of CDRs
1. Medical improvement expected (MIE)
We will schedule a review of an individual, with an impairment expected to improve, at intervals from 6 to 18 months following the most recent determination or decision that the individual is disabled, or that disability is continuing. This review will apply to individuals with impairments, which, at the time of initial entitlement or after further review, are expected to improve sufficiently to permit the individuals to engage in substantial gainful activity (SGA). This review is also applicable to Title XVI children whose impairments expect to improve to the extent in which they no longer meet or equal a medical listing.
2. Medical improvement not expected (MINE)
SSA schedules reviews of an individual with an impairment not expected to improve no less frequently than once every seven years but no more frequently than once every five years. These reviews apply to individuals with impairments at initial entitlement or after further review in which any improvement is not expected. These are extremely severe impairments shown, on the basis of administrative experience, to be at least static but more likely to be progressively disabling of themselves or by reason of impairment complications. The individual is unlikely to engage in SGA. We consider the interaction of the individual's age, impairment consequences, and the lack of recent attachment to the labor market in determining whether impairment expects to improve.
3. Medical improvement possible (MIP)
We will schedule a review (at least once every three years) of an individual with an impairment in which any improvement is possible, but which cannot be accurately predicted within a given period of time (see DI 28001.020A). This review is applicable to individuals with impairments at the time of initial entitlement or after subsequent review in which we consider any improvement possible. In these cases, improvement may occur to permit the individuals to return to SGA, but we cannot predict improvement with accuracy based on current experience and the facts of the particular case. Such impairments are not at the level of severity of impairments in which improvement is not expected.
4. Review after administrative appeal
If we find an individual eligible to receive, or to continue to receive disability benefits based on decision by an administrative law judge, the Appeals Council or a Federal court; a CDR will not be conducted earlier than three years after the decision. This will not change if we schedule a review because medical improvement is expected or a question of continuing disability is raised pursuant to Events That May Initiate a Continuing Disability Review (CDR) in DI 13001.005.
5. Vocational reviews
SSA schedules reviews for an individual undergoing a vocational program for the length of the training, therapy or program of education. These reviews apply to Title II and adult Title XVI beneficiaries who are in vocational therapy, training or other educational programs at the time of initial or CDR decisions to determine if the programs have benefited the individuals by enhancing their ability to work so that the disability requirement of the law is no longer met.
6. Medical reviews and the trial work period (TWP)
MIP and MINE diaries are different from MIE diaries. MIE diaries are established in cases based on anticipated medical improvement that will likely result in termination of entitlement after completion of a medical CDR.
Therefore, when work activity is reported in a case in which a MIE diary is established, a medical/work CDR will be initiated because medical improvement was expected. If the medical review indicates the individual is working despite a severe impairment, and if the earnings reflect service months, we will establish a TWP diary.
When work activity is reported in a case in which a MIP or MINE diary has been established, a medical CDR will not be initiated because medical improvement was not expected or, though possible, could not be predicted. In such cases, we will establish a TWP diary without medical review, see DI 13010.012.
If a MIP or MINE case is received by Disability Determination Services (DDS) in which a TWP diary is scheduled for the future, the case will be sent to Office of Earnings and International Operations (OEIO)/Office of Disability Operations (ODO)/ Disability Review Section (DRS). Cases involving Title XVI to should be routed the FO via an SSA-408 (Route Slip) with the explanation “Future TWP Review Scheduled -- Medical CDR not necessary at this time. Input necessary.” If the TWP diary has already matured, the case will be sent to the FO. For electronic cases and special instructions in reference to an SSA-408 (Route Slip), see DI 81010.100D.
If the DDS discovers work activity after they initiate medical development, they will discontinue development. We will not process a medical determination. Instead, they will send the case to the FO via an SSA-408 (Route Slip) with the remark “Develop work activity and establish TWP if appropriate--Medical CDR not necessary at this time. Input necessary.” If appropriate, we will return the case to the DDS at the expiration of the TWP to determine if impairment severity continues for 1980 amendment work incentive purposes (EPE, extended Medicare coverage).
7. Unscheduled reviews
Immediate initiation of a CDR will occur if any of the events in DI 28001.015 raises a question of disability, regardless of an individual's medical classification.
8. Low birth weight (LBW) infants
We complete reviews by a child's first birthday if the child's LBW is a contributing factor to the determination that the child is disabled. Reviewing this information will determine if we would find the child disabled if we had not considered the child's LBW under listing 100.4.
However, the requirement for a CDR (such as a child's first birthday) will not apply in the case of a child who at the time of the initial disability determination, had an impairment that was not expected to improve within 12 months after the birth and is scheduled for a CDR after the child attains 1 year of age.
NOTE: Babies who meet the LBW criteria in under listing 100.4 are considered to be disabled until attainment of age 1. Thus, any disability cessation date in an LBW infant case must be established at, or after, attainment of age 1. (An individual attains a given age on the first moment of the day preceding the anniversary of his birth corresponding to such age -- Section 416.120(c)(4).)
9. Classification change of impairment
If evidence developed during a CDR demonstrates that the individual's impairment has improved, may improve, or has worsened since the last review, we will reclassify the impairment to reflect this change in severity. A change in classification will change the frequency of future reviews. We will reclassify certain impairments because of improved tests, treatment, and other technical advances concerning those impairments.
10. Medical improvement review standard (MIRS)
Under the law, we find a disabled beneficiary no longer disabled only if the evidence shows both:
a. medical improvement (MI) related to the ability to work (or an exception to MI); and
b. ability to engage in SGA (unless an exception applies).
For discussion of MIRS and the exceptions to MI, see DI 28005.001 through DI 28020.001.
11. Administrative finality
A final decision remains final unless reopened under the rules of administrative finality. If a medical or work issue casts doubt on the correctness of a prior determination, action which must be taken and guided by the rules of administrative finality, see work-issue re-openings in DI 27505.001 and DI 13010.125.
For medical CDR processing instructions for beneficiaries with Tickets to Work, see DI 55025.010.
28001. 040 Cases with Vocational Rehabilitation (VR) Involvement (301 Cases)
Section 301 of the Social Security Disability Amendments of 1980, P.L. 96-265, provides that in certain disability cases in which disability ceases in December 1980, or thereafter, payment may continue after the physical and mental disability ceases, and if the beneficiary/recipient is participating in an approved Vocational Rehabilitation (VR) program.
In addition to payments to the beneficiary/recipient and any auxiliaries, hospital insurance benefits, State services, Medicaid, and State supplementation, when applicable, will continue until the objective of the VR program is reached or the beneficiary stops participating. This provision is applicable to disability insurance benefit (DIB), disabled widow(er) benefit (DWB), childhood disability benefit (CDB) beneficiaries, career railroad workers or Railroad Retirement Board (RRB) annuitants, and Title XVI recipients except blind recipients.
For procedures involving cases with participation in a VR or similar program, see DI 14510.000.