TN 4 (10-15)

DI 28040.005 Referral of Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases from the Field Office (FO) to the Disability Determination Service (DDS)

A. Overview of FO MINE or MINE-equivalent continuing disability review (CDR) referral procedures

The FO will determine whether MINE or MINE-equivalent procedures apply. If MINE or MINE-equivalent processing is appropriate, the FO does not need to conduct the SSA-454-BK (Continuing Disability Review Report) interview.

NOTE: Once an SSA-454-BK interview has been initiated, the MINE or MINE-equivalent procedures are no longer applicable and the interview must be completed.

1. FO review of the case

Before determining whether MINE or MINE-equivalent processing is appropriate, the FO will:

  • Determine no “screen out” conditions apply.

  • Review the claims folder to determine that the comparison point decision (CPD) and medical evidence are in the file.

The FO will stop the CDR if the case meets one or more "screen out" criteria.

NOTE: The screen-out instructions in DI 28003.005 apply to all cases, including MINE or MINE-equivalent cases.

Once the FO determines that the case cannot be screened-out, the FO then determines if the case should be referred to the disability determination services (DDS) as a MINE or MINE-equivalent case.

2. FO identifies a MINE or MINE-equivalent case

In addition to cases with a scheduled 5 to 7 year diary, the FO may consider cases previously assigned medical improvement expected (MIE) or medical improvement possible (MIP) medical reexamination diaries as "MINE or MINE-equivalent" cases for purposes of FO and DDS CDR processing. For more information on these FO considerations, see DI 13005.022.

The FO proceeds as follows upon identifying a MINE or MINE-equivalent case:

  • Do not send the notice of CDR or the SSA-454-BK interview.

  • Prepare an SSA-5002 (Report of Contact) to the DDS explaining the basis for the FO’s conclusion that the DDS should process the case under DI 28040.000 MINE or MINE-equivalent procedures.

  • Associate the SSA-5002 with the file.

  • Include a reference to the SSA-5002 on the “Alerts/Messages” tab in the electronic folder, or on the cover/route sheet for paper folders.

  • Refer the case to the servicing DDS.

B. DDS review of cases to identify screen out conditions

It is important that the DDS understands the criteria under which the FO does the MINE or MINE-equivalent review. Upon receipt, the DDS conducts a screening similar to the FO, and, as appropriate, the CDR is processed or stopped. For additional information on the DDS screening, see DI 28003.005.

If the DDS determines the case is not a MINE or MINE equivalent, the case is referred back to the FO for the regular CDR development (a full SSA-454-BK interview or other development).

C. References

  • DI 13005.020 Processing and Screening Continuing Disability Review (CDR) Folders and Alerts

  • DI 13005.022 Overview of the CDR Process for MINE or MINE-equivalent Cases

  • DI 28001.003 An Overview of Processing Continuing Disability Review (CDR) Mailer Forms SSA-455 and SSA-455-OCR-SM

  • DI 28040.215 Full Continuing Disability Review (CDR) Required

  • DI 32001.015 Disability Determination Services Systems Input and Clearance of Claims

  • DI 32005.020 Disability Determination Services “No Determination” Routing – Paper Case Only

  • DI 32010.005 No Decision Continuing Disability Review (CDR) Cases – Routing Instructions (Paper Cases Only)

  • DI 80630.020 eView

  • DI 81020.205 Receipting an Electronic Continuing Disability Review (eCDR)