• •

  The longitudinal history of the impairment (including the occurrence of prior remissions and prospects that the impairment will worsen again in the future),

• •

  All available evidence, including medical evidence and opinions, and

• •

  Medical literature about the nature of the impairment.

Examples of impairments subject to temporary remission include (but are not limited to):

• •

  Multiple sclerosis,

• •

  Rheumatoid arthritis,

• •

  Many mental impairments,

• •

  Sickle cell anemia,

• •

  Epilepsy, and

• •

  Asthma.

To determine whether the remission is temporary, consider the longitudinal history of the impairment (including the occurrence of prior remissions and prospects that the impairment will worsen again in the future), in relationship to the particular impairment and the changes that have occurred.

Consider improvement temporary unless it has been sustained long enough to have a significant impact on the individual's functioning, or, in a Title XVI child case, on the child's functioning under ordinary conditions on a sustained basis.

When remission has not yet lasted long enough, find that disability continues. For more information on length of temporary remission, see DI 28010.115B.3. in this section.

Consider setting a medical improvement expected (MIE) diary for a time when evidence will provide a better basis for determining whether the remission is long enough to demonstrate MI.

• •

  When a listing timeframe currently applies, consider setting the MIE diary to be due after the end of the period specified by the listing.

• •

  In other situations where remission has not yet lasted long enough, consider setting a MIE diary due in about 1 year.

Include a special paragraph in continuance notices in the above situations. Inform the individual that while their health improved, it appears to be too early for an accurate medical decision about the degree of improvement; therefore, disability is found to be continuing and a reevaluation will be scheduled for (date).

If remission continues until the time of the next scheduled CDR, apply the policies in subsections A. and B., and, if appropriate, find the MI more than temporary.

CPD evidence: The individual's rheumatoid arthritis met listing 14.09. The individual had persistent swelling and tenderness of the fingers and wrists of both hands, and laboratory tests were positive for rheumatoid arthritis. The individual had difficulty dressing and had to wear loose fitting clothing that did not require buttons, zippers or fasteners, they would frequently drop items in either hand, and had joint pain that made it difficult to pick up items when grocery shopping and had switched to a grocery delivery service for this reason.

CDR evidence: Laboratory tests are still positive for the presence of rheumatoid arthritis. The individual has engaged in therapy with different medications for treatment for the last year and has responded favorably. The individual reports continued joint pain, but an improvement in pain and a reduction in swelling. The individual is now able to grocery shop and will buy necessary items a few at a time so they do not have problems lifting and carrying the items. The progress notes from the individual's medical source also demonstrate continued improvement in signs and symptoms over the last year with therapy.

Discussion: Find MI. Medical improvement has occurred because there has been a decrease in the severity of the individual's impairment as documented by the current symptoms and signs reported by the individual's physician. Although the individual's impairment is subject to temporary remission and exacerbations, the improvement that has occurred has been sustained long enough to permit a finding of medical improvement. We would then determine whether this medical improvement is related to the individual's ability to work.

CPD evidence: At the CPD, the individual's impairment(s) met listing 11.02 for epilepsy. Despite adherence to prescribed treatment, the individual was experiencing grand-mal seizures at least once a month consistently for three months in a row.

CDR evidence: The CDR is initiated in August. The individual has continued compliance with prescribed treatment. Within the last 4 months from the date of the CDR initiation in August, the records indicate the following number of seizures despite medication compliance: 2 seizures in April, 1 seizure in May, 2 seizures in June, 0 seizures in July.

Discussion: Find no MI. Despite no seizures for one month in July, the evidence supports the conclusion that there has been no improvement in the pattern of seizures. While the individual did not have any seizures in July, this anomaly may represent a temporary remission, the individual experienced seizures for three consecutive months despite compliance with medication.