TN 3 (08-16)

DI 28010.030 Medical Improvement (MI) in Cases Involving Listings with a Specified Timeframe

Citations:

Citation: 20 CFR 404.1594(b)(7)(c)(3)(i) and 416.994(b)(2)(iv)(A)

A. Definition of “listing with a specified timeframe”

1. Specified timeframes

A listing in the Listing of Impairments that has a specific length of time for the disability is a “listing with a specified timeframe.” For instance, listing 6.04 “Chronic Kidney Disease with kidney transplant” is a listing with a specified timeframe because the language of listing 6.04 indicates the impairment is disabling for 1 year following the transplant.

2. Non-specific periods of disability

Listings that contain the phrase “at least”, or have age requirements, are not specific enough to determine when medical improvement will occur. For example:

  • listing 7.17 states “Consider under a disability for at least 12 consecutive months from the date of transplantation.”

  • listing 102.11 states “Consider under a disability until the attainment of age 5 or for 1 year after initial implantation, whichever is later.”

  • listing 104.06D states “until the attainment of at least 1 year of age.” 

Listings such as these do not have a specified timeframe and must be processed, and a diary established, based on adjudicative judgment.

B. Current listings with a specified timeframe

The following table contains current listings that include a specified timeframe:

Listings with a Specified Timeframe

Adult

Child

Impairment

Specified Timeframe

Consider under a disability for…

2.11A

N/A

Hearing loss treated with cochlear implantation

1 year after initial implantation

3.11

103.05

Lung transplant

12 months following the date of surgery

4.09

104.09

Heart transplant

1 year following surgery

N/A

104.13

Rheumatic heart disease, with persistence of rheumatic fever activity…and other associated abnormal laboratory findings…

18 months from the established onset of impairment

5.02

105.02

Gastrointestinal hemorrhaging from any cause, requiring blood transfusion…

1 year following the last documented transfusion

5.05A

105.05A

Chronic liver disease, with hemorrhaging…and requiring hospitalization for transfusion…

1 year following the last documented transfusion

5.09

105.09

Liver transplantation

1 year following the date of transplantation

6.04

106.04

Chronic kidney disease, with kidney transplant

1 year following the transplant

N/A

106.07

Congenital genitourinary disorder requiring urologic surgical procedures at least three times in a consecutive 12-month period, with at least 30 days between procedures

1 year following the date of the last surgery

N/A

113.03A

Malignant solid tumors (initial diagnosis)

24 months from the date of initial diagnosis

N/A

113.03B

Malignant solid tumors (recurrence of active disease)

24 months from the date of recurrence of active disease

N/A

113.05A1 or B1

Lymphoma excluding all types of lymphoblastic lymphomas

24 months from the date of diagnosis

13.11D

N/A

All other cancers originating in bone with multimodal anticancer therapy

12 months from the date of diagnosis

NOTE 1: The phrase ‘‘consider under a disability’’ does not refer to the date on which disability began, only to the date on which we must reevaluate whether an impairment continues to meet a listing or is otherwise disabling.

NOTE 2: The Listings with a Specified Timeframe table may not be all-inclusive, and is subject to change due to updates and revisions in the listings. For the current medical listings, refer to DI 34000.000.

C. Using listings with a specified timeframe in the continuing disability review (CDR) determination

1. All CDRs involving listings with a specified timeframe

In all CDRs, after the specified timeframe expires, the impairment on which we based the comparison point decision (CPD) no longer meets or equals that same listing, and MI is demonstrated in that impairment.

NOTE: It is possible for an individual to meet the same listing, such as the kidney transplant listing, if the individual had another kidney transplant to meet the listing criteria.

In all CDRs, we may consider an impairment to be disabling when the medical and other evidence justifies it. However, after a specified timeframe has expired, any determination based on “no MI” is incorrect.

2. Adult CDRs involving listings with a specified timeframe

In any adult case that occurs after the specified timeframe in the listing expires, we must base the continuance or cessation determination on:

  1. Meeting or equaling a current listing (Step 2 of the CDR evaluation process as described in DI 28005.015); or

  2. Impairment and vocational factors (beginning at Step 6 in the CDR evaluation process).

If no impairment(s) meets or equals a current listing at Step 2 of the CDR evaluation process, we must find “MI” at Step 3, and that the “MI relates to the ability to work” at Step 4.

We do not consider Step 5 because Group I exceptions apply only when there is “No MI” or when “MI is not related to ability to work.” Therefore, we resume the evaluation process at Step 6.

NOTE: Group II exceptions may apply at any point in the process. For information on Group II exceptions, see DI 28020.900.

3. Child CDRs involving listings with a specified timeframe

With childhood impairments that met or equaled a listing with a specified timeframe at CPD, adjudicators must find:

  • MI at Step 1 of the child CDR evaluation process as discussed in DI 28005.030; and

  • The CPD impairment does not now meet, medically equal, or functionally equal the CPD listing at Step 2

The adjudicator must proceed to Step 3 of the evaluation process to make a CDR determination.

4. Obsolete listings with a specified timeframe

A listing with a specified timeframe at CPD may be obsolete at CDR. Once the specified timeframe in the listing has expired, an impairment cannot currently meet or equal the prior (obsolete) listing (or sub-sections of that listing). In all cases that do not meet or equal a current listing and the CPD listing is obsolete, adjudicators must find MI, and evaluate residual functioning in order to make a determination. To review the obsolete listings, refer to DI 34100.000 and DI 34200.000.

D. Examples involving listings with a specified timeframe

1. MI related to the ability to work occurred

CPD: A younger individual underwent a heart transplant in 03/2015 that met listing 4.09. His ejection fraction (EF) was 16% pre-transplant, and greater than 65% post-transplant. The language of the listing specified “consider under a disability for 1 year…”

CDR: Conducted in 04/2016: The individual reports intermittent chest pain and inability to stand for extended periods. Examinations indicate he has good strength; his heart has regular rate and rhythm, and a recent echocardiogram shows an EF of 60%.

Discussion: The specified timeframe in listing 4.09 has expired, therefore his heart condition no longer meets that listing. Evidence does not show a condition that meets or equals any other current listing at Step 2. The adjudicator must find that MI occurred at Step 3, and the MI is related to the ability to work at Step 4. The adjudicator must proceed to Step 6 and evaluate residual functioning.

2. Currently meets or equals a listing

CPD: In 04/2014 a 24-year-old man was diagnosed with profound bilateral hearing loss. In 07/2014 he underwent bilateral cochlear implantation. His condition met the criteria of listing 2.11A and considered to be disabling for 1 year following implant.

CDR: Conducted in 09/2015: Current medical evidence indicates that his word recognition score is 52% based on valid Hearing in Noise Test (HINT), and his hearing loss currently meets listing 2.11B.

Discussion: The individual’s condition no longer meets listing 2.11A due to expiration of the 1-year time constraint. However, disability will continue at Step 2 of the evaluation process because his hearing loss now meets listing 2.11B.

3. Obsolete listing

CPD: A 56-year-old man had complaints of fatigue and abdominal pain. He underwent a kidney transplant in 10/2014. His condition met listing 6.02B and the language of the listing indicated, “Consider under a disability for 12 months following surgery.”

CDR: Conducted in 01/2016: The transplanted kidney is functioning well, based on laboratory values. However, he still complains of fatigue and abdominal pain.

Discussion: The individual does not have a condition that meets or equals any current listing at Step 2 of the evaluation process, and listing 6.02B is obsolete at the time of the CDR. Due to expiration of the 12-month timeframe in the CPD listing, the impairment cannot meet or equal the obsolete listing. Therefore, the adjudicator must find that MI occurred and it is related to the ability to work. The adjudicator must proceed to Step 6 and evaluate residual functioning.

4. Child case

CPD: On 06/12/13, a 14-year old boy was diagnosed with Hodgkin lymphoma with bone marrow involvement, meeting listing 113.05B1. The language of the listing specifies “Consider under a disability for 24 months from the date of diagnosis...”

CDR: Conducted in 12/2015. The child maintains normal weight, strength, and range of motion. He underwent bone marrow transplant on 01/2014 and current laboratory findings show no evidence of disease.

Discussion: The 24-month timeframe has expired, therefore the adjudicator at CDR must find MI at Step 1 of the evaluation process. At Step 2, the CPD impairment