TN 9 (05-23)

DI 28010.140 Psychiatric Review Technique (PRT) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings


20 CFR 404.1520a and 416.920a

A. Introduction to PRTs in CDRs

A PRT(s) is required any time severity of a mental impairment(s) is formally assessed using the adult mental disorders listing criteria. Due to the flexible nature of the CDR evaluation process, a few CDR continuances may not involve consideration of any step (or situation) that requires a SSA-2506-BK (PRT). Because of the wide variety of situations that may occur, it is impractical to list each case situation where a PRT(s) is (or is not) required. However, for each case situation, a decision as to whether a PRT(s) is needed can be made by:

  • Determining which steps in the appropriate CDR sequential evaluation process (DI 28005.010) are involved, and then

  • Considering the discussion in DI 28010.140C in this section, related to the steps and situations where a PRT(s) may be needed.

It may be necessary to apply the above process more than once to decide whether a PRT(s) is needed in a particular CDR.

B. When to use the PRT

Use the PRT to evaluate the severity of a mental impairment(s) when the adult mental disorders listing criteria apply. For information on assessment forms for evaluating medical improvement for mental impairments in Title XVI child CDR cases, see DI 28010.050.

C. Using the PRT

1. Meets or equals a current listing, or all mental impairments are not severe

If a medically determinable mental impairment(s) exists at the CDR, use the PRT to determine if the mental impairment(s) meet or equal the current mental listing, step 2 of the CDR sequential evaluation process. Consider all mental impairments, even if the impairment(s) is not severe. If evidence clearly supports no medical improvement (MI), a flexible approach may allow a continuance without performing this step and the PRT, see DI 28005.005.

2. Medical improvement (MI)

a. When a PRT is needed at this step

In unusual close-call situations, an MC/PC may wish to use the PRT as an aid in making the MI decision. When using the PRT to aid in assessing MI, use two forms:

  • one for the CPD (note: the form may be in the CPD), and

  • one showing the current status of (only) the mental impairment(s) present at the time of the CPD (note: the form may already be in file, in connection with the evaluation of whether the current impairment(s) meets or equals a listing).

While the PRT may be used as an aid, the MI decision must be based on actual changes (or absence of change) in symptoms, signs, or laboratory findings.

b. PRT usually not needed at this step

If there is no MI, enter this on either a PRT or SSA-416.

MC/PCs do not formally assess severity at the “MI” step but, rather, compare symptoms, signs, and laboratory findings. Therefore, MC/PCs usually do not prepare a PRT(s) for purposes of this step.

3. Relating MI to ability to work

a. Medical/vocational CPD allowance

If the individual's impairment severity resulted in a medical-vocational allowance at the CPD, we evaluate whether MI is related to the ability to work through the residual functional capacity comparison mechanism; see DI 28015.300 through DI 28015.855. The MC/PC will complete a PRT (and residual functional capacity (RFC) assessment, if appropriate). If there is a current RFC assessment, compare the MIRS RFC with the CPD RFC to determine whether MI is related to the ability to work. If the MIRS RFC has not increased from the CPD RFC, find MI not related to the ability to work, and continue benefits if no exception applies. If the MIRS RFC increased from the CPD RFC, find that MI is related to the ability to work and consider the remaining steps in CDR sequential evaluation process.

As noted in DI 28010.140C.2. in this section, a PRT(s) may be completed before this step is reached. If the CPD used a RFC assessment form different from the form used currently, the MC/PC may use current and prior PRTs (especially Section IV, Consultant’s notes) as an aid in judging whether MRFC increased.

b. Meets/equals CPD allowance

If the basis for the allowance at the CPD was that the individual's mental impairment met or equaled a listing, the MC/PC must complete a PRT at step 4 in the Title II and adult Title XVI CDR sequential evaluation process (see DI 28005.015A.4.) to determine if the individual's mental health impairment(s) present at the CPD still meets or equals the prior listing that was met or equaled at the CPD. See DI 28015.050 - DI 28015.060.

c. Rare situations involving the August 1985 mental disorder listings

  • If the CPD used August 1985 adult mental disorders listings- Use the PRT to decide whether the impairment(s) present at the time of the CPD continues to meet the August 1985 listing.

  • If the CPD used pre-August 1985 adult mental disorders listings or the childhood mental disorders listings- Do not use the PRT for this step.

4. Medical improvement not expected (MINE) continuances

The MINE procedures assume continuing disability given the CPD's basis. Therefore, a PRT is not needed. However, an assessment should document the basis for the continuance, a SSA-416 may be appropriate in these continuance situations. An SSA-416 may be appropriate in these continuance situations.

5. Completion of medical disposition (Section I.A)

In situations where there is no appropriate pre-printed block on the PRT to reflect the CDR disposition (e.g., “no MI”), leave this section blank. Record the CDR medical disposition elsewhere in an SSA-416. In most scenarios, the DDE will alleviate the need for this.

D. References

  • DI 28005.005 The Continuing Disability Review (CDR) Evaluation Process for Title II and Adult Title XVI Individuals

  • DI 28010.015 Comparison of Symptoms, Signs, and Laboratory Findings

  • DI 28040.001 MINE or MINE-Equivalent Cases -- Background

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DI 28010.140 - Psychiatric Review Technique (PRT) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings - 05/08/2023
Batch run: 05/08/2023