TN 3 (07-15)
DI 28015.310 Consider Age and Time on the Rolls When Assessing Residual Functional Capacity (RFC) in Continuing Disability Reviews (CDRs)
A. Age and time on the rolls
Consider age and time on the rolls, when appropriate, in assessing RFC in CDRs.
B. Medical literature shows:
There is a gradual decrease in organ function with age;
Major losses and deficits become irreversible over time;
Maximum exercise performance diminishes with age;
Other changes related to sustained periods of inactivity and the aging process include:
degenerative joint changes,
decreased range of motion, and
changes in the cardiac and respiratory systems, which limit exertional range.
A wide variation exists in the degree and time of life when major losses (e.g., muscle atrophy) occur. Evaluate each beneficiary individually, giving due consideration to the effects of aging.
Studies show that the longer an individual is away from the workplace and is inactive, the more difficult it becomes to return to ongoing gainful employment.
D. Effect of age
When the beneficiary is age 50 or over and received disability benefits for a considerable period of time, consider the factors in this section along with his or her age in assessing RFC.
Generally, use a period of at least seven years as “a considerable period of time.”
E. Effect of inactivity
Consider the disadvantages resulting from inactivity and the aging process during a long period of disability.
F. Work evaluations
Consider a work evaluation or other appropriate testing only when available evidence does not resolve what the beneficiary can or cannot do on a sustained basis.
For additional information regarding work evaluations, see DI 22515.035.
G. Evaluating function
Consider age and time on the rolls when evaluating current function in an RFC assessment. Consider this concept when you would otherwise make a finding that the impairment(s) is currently not severe.
Do not consider this concept as a vocational factor.
H. Job existence
After RFC assessment, at step 7 (and 8) of the adult CDR sequential evaluation process, consider the RFC assessment within the context of the usual vocational evaluation policies and procedures in DI 25005.001.
This may include consideration of the beneficiary’s age, education, and work experience in deciding what jobs may exist in the national economy that the beneficiary can do.
Do not consider age and time on the rolls as a separate vocational factor. Consider concept only when providing a current functional assessment (RFC).
Use a period of at least seven years as “a considerable period of time.”
J. Count from the established onset date
Use the onset date in counting time on the rolls, since this is when the impairment prevented work. Use the earlier date when there are different onsets on the prior decision due to program requirements (e.g., insured status). In Title XVI-only cases where onset is set as of the filing date, count time on the rolls from the beginning of the current disability period as established by available evidence.
K. Considerations in assessing RFC
Carefully consider the evidence as it relates to the beneficiary’s current ability to perform work-related activities when:
deciding if the beneficiary has a severe impairment(s), and
considering whether to request a work evaluation.
Apply judgment to assure that the RFC assessment realistically reflects the beneficiary’s ability to function on a sustained basis.
L. Documenting age and time on the rolls in RFC assessment
Discuss the impact of age and time on the rolls in the RFC assessment when the beneficiary is age 50 or over and received disability benefits for seven years or more. If the adjudicative team finds these factors do not affect RFC, make a note in the assessment to assure you have not overlooked these factors.
M. Example of using a work evaluation when assessing the beneficiary’s RFC assessment
1. CPD at age 46
The CPD allowance decision seven years ago was based on a back impairment.
2. CDR at age 53
The field office interviewer noted that the beneficiary moved about frequently and did not stay in any one position for more than a few minutes. The beneficiary complained of stiffness and soreness in his back and said he was uncomfortable when he had to stay in any one position for too long.
3. CDR by disability determination services (DDS) evaluation and referral
The DDS team initially thought the beneficiary retained the functional capacity to perform exertional activities consistent with the requirements of light work. However, because of the interview information and the fact that the beneficiary is age 50 or older and received disability benefits for a considerable time, the DDS referred the beneficiary to a work evaluation facility for more comprehensive evaluation. The work evaluation was necessary as there was no available evidence to resolve the issue of what the beneficiary could do on a sustained basis.
4. CDR work evaluation report
The beneficiary had a great deal of difficulty maintaining a consistent work pace throughout a normal workday. He tired easily and requested many rest periods during a typical workday. He could perform activities in a standing position for only about two hours before he complained of extreme back soreness and general fatigue. Working in a sedentary position for more than two hours at a time produced pain that required him to get up and walk around. The report showed acceptable levels of:
Ability to follow directions, remember workday procedures, and respond appropriately to changes in procedures and to potential hazards;
Self-expression and sociability; and
Motivation and perseverance.
5. CDR RFC decision
Based on the work evaluation report, the DDS medical consultant (MC) found the beneficiary's RFC consistent with the requirements for sedentary work.