TN 3 (06-05)

DI 28005.021 Title XVI: Determining Continuing Disability at Step 2 of the Medical Improvement Review Standard Sequential Evaluation Process for Children Under Age 18 - - Functional Equivalence

A. Background

On April 27, 2005, SSA published SSR 05-03p, “Title XVI: Determining Continuing Disability at Step 2 of the Medical Improvement Review Standard Sequential Evaluation Process for Children Under Age 18 – Functional Equivalence.” The entire SSR is in DI 28005.021B. Refer to the Policy Interpretation section of the SSR whenever functional equivalence must be considered at step 2 of the childhood CDR process.

B. Policy – SSR 05-03p

Social Security

Ruling

SSR 05-03p

TITLE XVI: Determining Continuing Disability at Step 2 of the Medical Improvement Review Standard Sequential Evaluation Process for Children Under Age 18 – Functional Equivalence

PURPOSE: To explain our policies for determining continuing disability at step 2 of the medical improvement review standard (MIRS) sequential evaluation process for children under 20 CFR 416.994a(b)(2) and to explain how we apply the functional equivalence rule at step 2.

CITATIONS (AUTHORITY):

Sections 1614(a)(3), 1614(a)(4), and 1614(c) of the Social Security Act; Regulations No. 16, subpart I, sections 416.924, 416.925, 416.926, 20 CFR 416.926a, and 416.994a.

INTRODUCTION:

When we conduct a continuing disability review, we use a three-step MIRS sequential evaluation process, outlined in 20 CFR 416.994a(b).

  1. At step 1, we determine whether there has been medical improvement in the impairment(s) that was present at the time of the most recent favorable determination or decision. (20 CFR 416.994a(b)(1)). We refer to the most recent favorable determination or decision as the “comparison point decision” (CPD), and we refer to the impairment(s) that was present at the time of the most recent favorable determination or decision as the “CPD impairment(s).” If there has been no medical improvement in the CPD impairment(s), we find that the child's disability continues. If there has been medical improvement, we proceed to step 2.[1]

  2. At step 2, we determine whether the CPD impairment(s) still meets or medically or functionally equals “the severity of the listed impairment” that it met or equaled at the time of the CPD. (20 CFR 416.994a(b)(2)). If the CPD impairment(s) still meets or medically or functionally equals the severity of the listing we considered at the CPD, we find that the child is still disabled. As long as we determine that the CPD impairment(s) currently meets or medically or functionally equals the listing we considered before, we do not have to make the same finding we made at the CPD. For example, if we found at the CPD that the child's impairment(s) met a listing, and now it no longer meets that listing but it medically equals that listing, we find that the child's disability continues. Likewise, if we found that the child's impairment(s) functionally equaled a listing, and now it meets that listing, we find that the child's disability continues. If the CPD impairment(s) does not still meet or equal the severity of that listed impairment, we proceed to step 3.

  3. At step 3, we determine whether the child is currently disabled, considering all current impairments. (20 CFR 416.994a(b)(3)). We determine if the child's current impairment(s) is severe, as defined in 20 CFR 416.924(c). If the impairment(s) is not severe, we find that the child's disability has ended. If the impairment(s) is severe, we consider whether it meets or medically equals a listing. (20 CFR 416.924(d), 416.925, 416.926). If it does, we find that the child's disability continues. If not, we consider whether it functionally equals the listings. (20 CFR 416.926a). If it does, we find that the child's disability continues. If not, we find that the child's disability has ended.

On September 11, 2000, we published final rules (the “2001 rules”) for evaluating disability in children under the Supplemental Security Income program. These rules became effective on January 2, 2001.[2] In section 416.926a of the 2001 rules, (20 CFR 416.926a), we clarified and simplified our prior rules for evaluating functional equivalence[3] in a number of ways. Under the functional equivalence policies that we applied prior to January 2, 2001, we required a comparison of the child's impairment(s) to a specific listing.[4] One way in which we clarified and simplified functional equivalence under the 2001 rules was to no longer refer to specific listed impairments. Instead, we determine whether a child's impairment functionally equals the listings. To functionally equal the listings, a child's impairment(s) must cause “marked” limitations in two domains of functioning, or “extreme” limitation in one such domain, as described in 20 CFR 416.926a.

Therefore, findings of functional equivalence made on or after January 2, 2001, are not based on a specific listing.

Because our current rules about step 2 of the MIRS sequential evaluation process refer only to the specific listed impairment(s) that we considered at the CPD, we are issuing this ruling to explain how we apply the functional equivalence rules at step 2. We also explain how we apply step 2 when the CPD was based on functional equivalence to the listings.

POLICY INTERPRETATION:

When we evaluate functional equivalence at step 2 of the MIRS sequential evaluation process for children in 20 CFR 416.994a(b), we use the current rules for evaluating functional equivalence.

How we apply step 2 of the MIRS sequential evaluation process for children depends on the date of and basis for the CPD. A chart that summarizes our policies on applying step 2 follows the text.

a. If the CPD was made before January 2, 2001.

If the CPD was made before January 2, 2001, it was based either on a finding that the child's impairment(s) met or medically equaled a specific listing, or functionally equaled a specific listing under the rules for functional equivalence that were in effect at the time of the CPD.

When we determine whether a child's disability continues at step 2, we first consider whether the CPD impairment(s) now either meets or medically equals the same listing that it met, medically equaled, or functionally equaled at the CPD, as that listing was written at that time. If the CPD impairment(s) now meets or medically equals the severity of that listed impairment as it was written at that time, we find that the child is still disabled.

If the CPD impairment(s) does not now meet or medically equal the CPD listing, we consider whether the CPD impairment(s) now functionally equals the listings under our current rules in 20 CFR 416.926a. If it does, we find that the child is still disabled. If it does not, we proceed to step 3.

b. If the CPD was made on or after January 2, 2001.

If the CPD was made on or after January 2, 2001, it was based either on a finding that the child's impairment(s) met or medically equaled a listing, or functionally equaled the listings under the current rules in 20 CFR 416.926a.

(1) If the CPD impairment(s) met or medically equaled a listing:

If our determination or decision at the time of the CPD was that the child's impairment(s) met or medically equaled a listing, we consider whether the CPD impairment(s) now either meets or medically equals that same listing, as it was written at that time. If it does, we find that the child is still disabled.

If the CPD impairment(s) does not now meet or medically equal the CPD listing, we consider whether the CPD impairment(s) now functionally equals the listings under our current rules in 20 CFR 416.926a. If it does, we find that the child is still disabled. If it does not, we proceed to step 3.

(2) If the CPD impairment(s) functionally equaled the listings:

When we determine whether a child's disability continues at step 2 and the CPD was based on functional equivalence to the listings, we consider only whether the CPD impairment(s) now functionally equals the listings. We do not consider whether the impairment(s) now meets or medically equals the CPD listing, because there is no specific CPD listing. If that impairment(s) now functionally equals the listings under our current rules in 20 CFR 416.926a, we find that the child is still disabled. If it does not, we proceed to step 3.

Chart: This chart summarizes the explanations above. Follow a. or b. as appropriate.

a. If the CPD was made before January 2, 2001:

G-DI_28005.021-1

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b. If the CPD was made on or after January 2, 2001, follow (1) or (2) as appropriate:

(1) CPD impairment(s) met or medically equaled a listing:

G-DI_28005.021-2

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(2) CPD impairment(s) functionally equaled the listings

G-DI_28005.021-3

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C. EFFECTIVE DATE:

This SSR is effective upon publication in the Federal Register.

D. CROSS-REFERENCES:

Program Operations Manual System, sections DI 28005.020, DI 28005.025, and DI 28005.030.

[1] At each step of the process certain “exceptions to medical improvement” may apply, under which disability can be found to have ended even though medical improvement has not occurred. (20 CFR 416.994a(e)-(f)). Although we apply the exceptions when appropriate, further discussion of the exceptions is unnecessary in this Ruling.

[2] 65 FR 54747-54790 (2000).

[3] We have included the policy of functional equivale