TN 9 (05-22)

DI 28040.210 Evaluation and Determination When Reviewing Medical Evidence in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

A. Making the determination

The MINE or MINE-equivalent case review process consists of evaluating the case evidence, including the following:

  • Information provided by the beneficiary or recipient as recorded on the SSA-454-BK (Continuing Disability Review Report),

  • Information from a medical source when available or required

  • Information received by another third-party when available or required

When the disability determination services (DDS) receives all evidence, process MINE or MINE-equivalent continuing disability reviews (CDRs) as follows:

1. Review medical evidence

Review the medical evidence in file to establish that there is sufficient reliable medical or vocational documentation in the comparison point decision (CPD) to establish that the medical condition of the beneficiary or recipient is one that meets the criteria for MINE or MINE-equivalent impairments. Criteria for establishing a MINE or MINE-equivalent diary are in DI 26525.040 and DI 13005.022. MINE or MINE-equivalent impairments are listed in DI 26525.045.

2. Evaluate evidence

Evaluate the evidence obtained during the CDR for:

  • Verification from a medical source or other third-party of the beneficiary, recipient or representative payee’s statement.

  • Any possible work activity.

  • Exceptions to the medical improvement review standard.

    NOTE: Do not consider Group I exceptions for individuals whose impairments currently meet or equal the severity of a listing. However, Group II exceptions (e.g., fraud or similar fault, whereabouts unknown or failure to cooperate) may lead to a cessation without regard to current disability.

  • Continued severity, or indications of possible medical improvement, that may raise a continuing disability (CD) issue.

    NOTE: A report of medical improvement does not raise a CD issue if it is clear the individual’s impairment(s) currently meets or equals the severity of a current listing or the listing met at the CPD.

3. Preparing the determination

If no CD issues are raised, prepare a continuance determination and a written rationale that substantiates the continuance.

If the DDS cannot find that disability continues based on evidence from MINE development, return the case to the field office (FO) to initiate a full CDR. When the FO initiates a full CDR and returns the case to the DDS, MINE or MINE-equivalent criteria will no longer apply. The DDS will develop, evaluate, and determine the case as a “regular” CDR determination.

DDS will make all systems input and release the case according to the usual procedures.

4. Processing the continuance

Process the continuance determination, including the form SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal).

Any continuance processed because of this review establishes the CPD for the next CDR.

B. CD issues

If a CD issue is raised, follow the instructions in DI 28040.215.

C. References

  • DI 28020.001 General - Group I and II Exceptions to Medical Improvement (MI)

  • DI 28020.900 Group II Exceptions

  • DI 28040.215 Full Continuing Disability Review (CDR) Required in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

  • DI 28040.220 Completion of the SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) in Medical Improvement Not Expected or MINE-Equivalent Cases

  • DI 28040.225 Rationale Preparation of the Continuing Disability Review (CDR) Determination in Medical Improvement Not-Expected (MINE) or MINE-Equivalent Cases

  • DI 81020.110 Medical Evaluation


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428040210
DI 28040.210 - Evaluation and Determination When Reviewing Medical Evidence in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 05/04/2022
Batch run: 05/04/2022
Rev:05/04/2022