TN 5 (06-15)
DI 28005.016 The Continuing Disability Review (CDR) Evaluation Process for Title XVI Adults Originally Allowed as Children Who Attained Age 18 before August 22, 1996
A. CDR policy on adults originally allowed as children
Public Law (P.L. 104-193) eliminated the individualized functional assessment (IFA) previously used in the evaluation of Title XVI childhood cases. It also mandated that we conduct disability redeterminations for adults originally allowed as children and who attained age 18 on or after August 22, 1996. For recipients who attained age 18 before August 22, 1996, the effective date of the legislation, we will perform CDRs (not disability redeterminations). This section contains instructions on how to perform a CDR in these cases.
B. Use of the CDR process
1. Eligibility of adults for CDRs
When we review the eligibility of recipients who have been eligible for Supplemental Security Income (SSI) since they were children and who attained age 18 before August 22, 1996, we will perform a CDR using the adult medical improvement review standard (MIRS) sequential evaluation process. For more information on the CDR evaluation process, see DI 28005.015.
2. Special procedure for certain IFA comparison point decision (CPD) cases
The MI-related-to-the-ability-to-work step requires special procedures if:
The CPD was based on an IFA; and
The current impairment (s) does not meet or equal a current listing; and
There is medical improvement (MI).
The Disability Examiner (DE) must prepare a special CPD residual functional capacity (RFC) assessment form based on the CPD evidence. The DE will then compare this CPD RFC assessment to a current MIRS RFC assessment to determine whether the MI is related to the ability to work. We will use this CPD RFC assessment for comparison purposes only. We will not use it to change any prior determination. For further information on these CPD RFC assessments, see DI 28005.017.
NOTE: We define all references to “RFC”, in this section, as what an individual can still do despite his or her limitations. “RFC assessment” refers to the annotation of this function on an SSA approved document.
C. Applying the evaluation process
Apply the adult sequence in DI 28005.015. For convenience, we summarized in this section all of the MIRS steps applicable to adults. The special material concerning the MI-related step is outlined in DI 28005.016C.3. with more discussion in DI 28005.017.
To make a current decision, it may be necessary to update the evidence. For information on developing medical evidence, see DI 28030.020A.3.
1. Meets or equals step
Consider all current impairments and current Part A listings at the meets/equals step. Do not consider Part B listings for an adult at this step. Decide whether the impairment(s) meets or equals a listing:
2. Medical improvement step
Consider CPD impairment (s) only. Compare symptoms, signs, and laboratory findings from the time of the CPD to symptoms, signs, and laboratory findings now. For a detailed discussion of MI, see DI 28010.001. Decide whether there is MI:
If there is no MI, find that disability continues (unless a group I or group II exception applies).
If there is MI, consider whether it is related to the ability to work, per DI 28010.015.
3. MI related step
REMEMBER: Consider this step only if there is MI. Consider the CPD impairment(s) only.
a. If CPD met or equaled a listing
Determine whether CPD impairment(s) still meets or equals the listing it met or equaled then, even if it was a Part B listing, or has changed or become obsolete. For detailed discussion of the MI-related step in meets or equals cases, see DI 28015.005 through DI 28015.060.
If the CPD listing included disabling functional limitations in its criteria (for example, if it required an extreme limitation or two marked limitations) also consider functional equivalence in determining whether the listing is still met or equaled. For details on determining functional equivalence, see DI 25225.000.
Consider functional equivalence for any subsequent CDR if:
disability is found to continue because the impairment still meets or equals the listing it did before, and
the listing included disabling functional limitations in its criteria.
NOTE: This is the only circumstance in which we consider functional equivalence in an adult case.
If the CPD impairment(s):
still meets or equals that prior listing, find that the MI is not related to the ability to work, and that disability continues (unless a Group I or Group II exception applies).
no longer meets or equals that prior listing, find that MI is related to the ability to work Consider the last steps concerning current disability from DI 28005.016C.4. in this section.
b. If CPD was based on an IFA
If an IFA case reaches the MI-related step (if current impairment(s) does not meet or equal a current listing, and there is MI), special procedures apply:
Prepare a CPD RFC assessment based on the child's functioning at the CPD. The CPD RFC is not just a translation of the prior IFA, but rather an actual assessment based on evidence of the child's functioning at the CPD (Use the CPD RFC assessment for comparison purposes only; do not use this RFC assessment to change any prior determination). For more discussion on how to prepare this assessment, see DI 28005.017;
Prepare a current MIRS RFC assessment based on CPD impairments only;
Compare the CPD RFC and the MIRS RFC assessments. For RFC assessments, see DI 28015.300, DI 28015.315 and DI 28010.145;
If RFC has not improved, find that MI is not related to the ability to work and that disability continues (unless a group I or group II exception applies);
If RFC has improved, find that MI is related to the ability to work, and consider the last steps concerning current disability, per DI 28005.016C.4. in this section.
4. Preparing a current determination
Consider all current impairments. Determine whether the individual has a severe impairment(s) and if so, whether he or she can do past relevant work or other work (remember, the meets/equals step was already considered). Prepare a current RFC assessment. For information on how to do this, see DI 24510.001. Updating the evidence may be necessary to make a current decision.
Note that some cases in which the CPD was based on an IFA will require an RFC assessment beyond the MIRS RFC assessment done at the MI-related step, and some will not:
a. IFA CPD with no new impairment(s) since CPD
If there is no new impairment(s), the MIRS RFC assessment prepared at the MI-related step may also serve for the “currently disabled?” steps.
b. IFA CPD with new impairment(s) since CPD
The MIRS RFC assessment, done at the MI-related step, does not take into account new impairment(s). Therefore, if the individual has a severe impairment(s), prepare a current RFC assessment considering all current impairments. In such cases, clearly annotate each RFC assessment (CPD RFC; MIRS RFC; or Current RFC, all impairments) as appropriate.
If the individual does not have a severe impairment(s), or can do past relevant work or other work, find that disability ceases.
If the individual has a severe impairment (s) that prevents performance of past relevant work and other work, find that disability continues (unless a group II exception applies).
5. Remark on form SSA- 832 Cessation or Continuance of Disability or Blindness Determination and Transmittal
Enter “Age 18 before 08/22/96” in Item 24 REMARKS section of the SSA-832.
DI 24505.001 Individual Must Have a Medically Determinable Severe Impairment
DI 24501.021 Considering Allegations of Pain and Other Symptoms in Determining Whether a Medically Determinable Impairment is Severe (SSR 96-3p)
DI 24505.005 Evaluation of Medical Impairments that are Not Severe
DI 24510.001 Residual Functional Capacity (RFC) Assessment - Introduction
DI 25015.001 General - Ability to Perform Other Work
DI 25020.001 Introduction - Functional Limitations
DI 28005.017 Preparation of Comparison Point Decision (CPD) Residual Functional Capacity (RFC) Assessments for Title XVI Adults Found Disabled before Age 18 Based on an Individualized Functional Assessment (IFA)
DI 28015.855 Residual Functional Capacity (RFC) Form SSA-4734–BK Documentation in Continuing Disability Reviews (CDRs)
DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement
DI 28020.900 Group II Exceptions
DI 28030.020 Development of Medical Evidence