TN 9 (05-23)

DI 28010.020 Comparison Point Decision (CPD)

CITATIONS:

20 CFR 404.1594(b)(7), 416.994(b)(1)(vii), and 416.994a(c)(1)

A. General CPD information

The CPD is the most recent favorable medical decision that the individual was disabled or continued to be disabled.

The most recent favorable medical decision is the latest final determination or decision involving a consideration of the medical evidence and whether the individual was disabled or continued to be disabled.

B. Which decision is the CPD?

1. CPD criteria met

The following types of decisions are CPDs (see DI 28010.020A) when they meet the following criteria:

  • Decisions (based on medical evidence that was current at the time of the decision) that the individual continues to have a disabling impairment, or

  • Adoption decisions (or decisions which led to the application of collateral estoppel on subsequent claim) where there was a usual level of development and current medical evidence that included consideration of medical, functional, or medical/vocational issues, or

  • The earlier medical decision (usually under a different title) used as the basis for an adoption decision (i.e., without development and consideration of medical evidence at the time of adoption).

2. CPD criteria not met

The following types of decisions do not involve development of current medical evidence or consideration of medical issues. They are not appropriate CPDs because the supporting evidence for the decision does not provide a suitable basis for medical improvement review standard (MIRS) comparisons. Therefore, do not use the following types of decisions as CPDs:

  • Collateral estoppel decisions without medical development completed. Use the decision that was the basis for collateral estoppel, such as the most recent prior favorable determination or decision based on meeting or equaling a listing (or functionally equaling a listing), an allowance based on medical-vocational rules, or a CDR related decision (such as a decision finding no MI) that included full medical development.

  • SSA-899-U2's (Continuing Disability Review) categorizing individuals as permanently impaired, without evaluation of then-current medical evidence

  • Reinstatement under a CDR moratorium

  • Decisions based solely on work

  • Decisions not involving consideration of the issue of current disability (e.g., most decisions on appeals requesting an earlier onset)

3. Closed period

a. CPD in closed period allowance cases

Use the established onset date as the comparison point. For further information on closed period cases, see DI 25510.001.

b. Adoption decision

Use the prior medical decision on the previously adjudicated claim that resulted in a favorable medical decision as the CPD, when adopting a prior decision results in:

  • A closed period decision on a new claim, and

  • Simultaneous cessation of benefits on a previously adjudicated claim.

4. Non-rollback conversion

a. Comparison points

Two comparison points may apply. DI 28001.045 explains when cases must be evaluated under the State plan, and DI 28035.025F discusses additional considerations related to comparison points in non-rollback conversion cases where evidence from the prior State decision is not available and cannot be reconstructed.

b. Federal criteria

Use the most recent favorable decision under the Federal criteria as the CPD, as discussed above. If there is no prior favorable Federal decision, use the most recent medical decision granting or affirming entitlement under the State criteria as the CPD.

c. State criteria

In considering State criteria, use the most recent medical decision granting or affirming entitlement under the State criteria as the CPD.

C. References

  • DI 22501.001 Disability Case Development for Evidence

  • DI 28001.045 Rollback and Non-rollback Conversion Cases

  • DI 28030.020 Development of Medical Evidence

  • DI 28035.025 Disability Determination Services (DDS) Reconstruction of Prior Folder Not Possible

  • DI 28055.045 Model Language: Impairment Severity Continuance Notice – Exhibit

  • DI 28075.010 Non-rollback Conversion Cases

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428010020
DI 28010.020 - Comparison Point Decision (CPD) - 05/08/2023
Batch run: 05/08/2023
Rev:05/08/2023