TN 2 (06-15)
DI 28010.135 Medical Improvement Review Standard (MIRS) Issues in Adult and Child Cases Involving Mental Impairments
A. Background of mental disorders listings
Significant regulatory changes include:
August 1985, SSA made significant changes in the adult mental disorders listings (Listing 12.00).
December 1990, SSA made significant changes in the childhood mental disorders listings (Listing 112.00).
February 1997, pursuant to P.L. 104-193, SSA made further changes to the childhood mental disorders listings (The “paragraph B” criteria were changed. References to “maladaptive behaviors” in 112.00C2 and 112.02B2.c.(2) were removed, and the “personal/behavioral” area of functioning was redesignated as the “personal” area of functioning).
B. Introduction to MIRS and mental disorders
Evidence supporting pre-August 1985 comparison point decisions (CPDs) based on the adult mental disorders listing criteria, or pre-December 1990 CPDs based on the childhood mental disorders listing criteria, often does not focus on the factors relevant to severity assessment under the revised mental disorders listings. This complicates the evidence-to-evidence comparisons needed under the MIRS. This section addresses this problem and outlines factors relevant to MIRS decisions in cases involving mental impairments.
C. Consideration of MIRS and mental disorders
1. Evidence consideration
All of the factors considered in assessing mental impairments (e.g., the paragraph A, B, and C criteria in the mental disorders listings) meet the regulations' definition of symptoms, signs, or laboratory findings (12.00B/112.00B of the listing). Consider all these factors in making MIRS comparisons.
2. “Maladaptive behaviors” changes
References to “maladaptive behaviors” were removed from 112.00C and prior 112.02B2.c.(2) of the childhood mental disorders listings on February 11, 1997.
Title XVI child cases with CPDs prior to August 22, 1996, in which such “maladaptive behaviors” in the prior “personal/behavioral” area of functioning were material may require a disability redetermination rather than a continuing disability review (CDR). For more information on these redeterminations, see DI 28005.003.
Whether or not a disability redetermination is required, note that “maladaptive behaviors” still constitute medical findings, even though such behaviors are no longer an explicit severity criterion in listing 112.02.
3. Specialist review
Apply the principles in DI 24505.025 for cases involving the evaluation of mental impairments.
D. Reviewing mental disorders using MIRS
1. Comparison for medical improvement (MI)
Apply DI 28010.010 in the comparison of symptoms, signs, and laboratory findings.
2. Incomplete CPD evidence
a. Consider evidence
When CPD evidence is incomplete on points emphasized in current documentation requirements (e.g., concentration or pace), carefully examine all the prior documentation to discover information that is present, but may not be immediately evident.
b. Assumption in undocumented areas
Assume no (or minimal) prior limitation or abnormality of finding in areas where a thorough search of CPD evidence provides no information about the factor in question.
Apply this assumption only in assessing MI and comparing residual functional capacity.
3. Related procedure
Before making an unfavorable MIRS decision in a case involving a mental impairment(s), carefully consider the following: