TN 4 (10-15)
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 process of reviewing a MINE or MINE-equivalent case consists of evaluating the evidence in the case; including information provided by the individual as recorded on the SSA-454-BK (Continuing Disability Review Report), and information from a medical source or other third party when available. 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 individual 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. 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 individual or 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 listing.
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 concludes a cessation is appropriate, return the case to the field office to initiate a full CDR. When the FO 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.
4. Processing the continuance
Any continuance processed because of this review, establishes the CPD for the next CDR. Process the continuance determination, including the form SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal).
B. CD issues
If a CD issue is raised, follow the instructions in DI 28040.215.
DI 28020.001 Initial Receipt of the Case by the Disability Determination Services (DDS)
DI 28020.900 Group II Exceptions
DI 28040.215 Full Continuing Disability Review (CDR) Required
DI 28040.220 Completion of Cessation or Continuance of Disability or Blindness Determination and Transmittal (Forms SSA-832 or SSA -833)
DI 28040.225 Rationale Preparation of the Continuing Disability Review (CDR) Determination
DI 81020.110 Medical Evaluation