TN 5 (06-15)
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)
A. Introduction to CPD RFCs based on IFAs
From 02/11/91 until the enactment of Public Law (P.L.104-193) on 08/22/96, the disability evaluation process for Supplemental Security Income (SSI) claimants under the age of 18 required an IFA for claimants whose impairment(s) was severe but did not meet, medically equal, or functionally equal a listed impairment. The IFA determined if the claimant's impairment(s) substantially reduced his or her ability to function independently, appropriately, and effectively in an age-appropriate manner and was therefore of “comparable severity” to an impairment(s) that would disable an adult.
P.L. 104-193 eliminated the IFA, and mandated disability redeterminations for adults originally allowed as children and who attained age 18 on or after August 22, 1996. However, per DI 28005.016, we will perform a continuing disability review (CDR), not a disability redetermination, for recipients who attained age 18 before August 22, 1996.
When we perform a CDR for one of these recipients, he or she is subject to the adult medical improvement review standard (MIRS). We must determine if the medical improvement (MI) is related to the ability to work, if the recipient's impairment is found not to meet or equal a current adult listing, and MI is established. If the CPD was not based on meeting or equaling a listing, this finding of fact is based on comparison of the RFC done at the CPD and a current RFC considering only the CPD impairments.
All references to “RFC” in this section are defined as what an individual can still do despite his or her limitations, in accordance with DI 24510.006B.1. “RFC assessment” refers to the annotation of this function on an SSA approved document. For preparation of the RFC Assessment, see DI 24510.001.
Because recipients for whom CPDs were based on an IFA will not have had an RFC assessment at the CPD, this section addresses how to make a finding of fact at the "MI-related” step of the adult CDR evaluation process.
To make a current decision it may be necessary to update evidence. For development of medical evidence, see DI 28030.020.
B. When to prepare a CPD RFC based on an IFA
Affected recipients will meet the following criteria:
The recipient was allowed as a Title XVI child between 02/91 and 08/96; and
The allowance was based on an IFA; and
The recipient attained age 18 before 08/22/96; and
At CDR, the impairment(s) does not meet or equal an adult listing; and
There is MI in the impairment(s) that was present at the time of the CPD.
If a functional comparison is required, compare the CPD functioning to current functioning based on CPD impairments to determine whether the MI is related to the ability to work for the previously described adults described.
Prepare a CPD RFC based on an IFA if a CPD RFC assessment was required at the “MI related to the ability to work” step. Because there will be no CPD RFC assessment for adults originally found disabled on the basis of an IFA, it is necessary to prepare a special CPD RFC assessment for purposes of comparison with the MIRS RFC assessment. The CPD RFC assessment is for comparison purposes only and will not change any prior determination.
C. How to prepare a CPD RFC based on an IFA
1. Medical consultant/psychiatric or psychological consultant (MC/PC)
Assess the individual's prior functioning based on all available evidence concerning the impairment(s) and particular limitation(s) at the time of the CPD, and prepare an RFC assessment using an appropriate SSA form SSA-4734-BK (Physical Residual Functional Capacity Assessment) or SSA-4734-F4 SUP (Mental Residual Functional Capacity Assessment).
Do not merely translate the CPD IFA. Make a full functional analysis based on all of the CPD evidence in order to make a reasonable comparison with the current MIRS RFC assessment, relative to any changes in symptoms, signs or laboratory findings of the CPD impairment(s).
The general rules for assessment of residual functional capacity in DI 24510.006 apply. As in any other case, consider only functional limitations and restrictions that result from an individual's medically determinable impairment or combination of impairments, including the impact of any related symptoms at the time of the CPD. Do not find that an individual has limitations beyond those caused by his or her medically determinable impairment(s) and any related symptoms, due to such factors as age and natural body build, or other factors unrelated to the impairment(s).
Enter the following remark in Section IV “ADDITIONAL COMMENTS” of the SSA-4734-BK or in Section III “FUNCTIONAL CAPACITY ASSESSMENT” of the SSA-4734-F4 SUP:
“This CPD RFC assessment shows the RFC as of the determination dated [enter date of CPD], considering all impairments present in determining the CPD IFA. See DI 28005.016 and DI 28005.017.”
Enter the following in Item 24 “REMARKS” section of the SSA-832:
“Age 18 Before 08/22/96. See DI 28005.016 and DI 28005.017.”
2. CPD RFC/MIRS RFC comparison decision
Compare the findings of the current MIRS RFC assessment to those of the CPD RFC assessment. Decide whether the MI is related to the ability to work. If not, consider whether exceptions apply per DI 28020.001. Make sure any changes you find in work-related functioning are reasonably related to change(s) in symptoms, signs, and laboratory findings. Do not make unreasonable increases in assessment of function that are not consistent with the degree of change in the symptoms, signs, and laboratory findings.
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
DI 28015.320 Residual Functional Capacity (RFC) Comparison and Examples of Medical Improvement (MI) “Related” or “Not related” to the Ability to Work