TN 4 (10-15)
DI 28040.215 Full Continuing Disability Review (CDR) Required in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases
A. When to send case to field office (FO)
Send the case to the FO for a full CDR if:
The individual, payee, or representative reports medical improvement that raises a continuing disability (CD) issue.
Conflicts exist between statements made by the individual, payee, or representative and the evidence in file regarding the CPD, and such conflicts raise a CD issue.
The individual’s medical source or other third party contact indicates work activity since the CPD.
Based on disability determination services (DDS) review, a cessation appears appropriate.
The evidence does not clearly show existence of MINE or MINE-equivalent impairment (including lost folders).
Reported medical improvement does not automatically raise a CD issue. If it is clear that an individual’s impairment(s) still meets or equals the severity of a listing (e.g. a double amputee), then any reported medical improvement could not reasonably be expected to result in a cessation.
Where a listing is met or equaled, only the nonmedical exceptions such as fraud or similar fault, failure to cooperate or return to work would be expected to result in a cessation.
EXAMPLE: The evidence of record in the CPD shows the individual has ischemic heart disease which met Listing 4.04Al. Contact with the individual shows no work, but he indicates he has had heart surgery and reports some improvement in his condition. Contact with the medical source addresses the surgery and the issue of medical improvement. Because the medical source indicates that the surgery has significantly improved the individual’s condition, a medical cessation is possible. Send the case to the FO for a personal contact and a full CDR.
B. How to send the case to the FO for a full CDR
Clear any case for which there is a CD issue and remove it from the MINE or MINE-equivalent process. To initiate a full CDR:
If the file contains a form SSA-847 (SSA Request For Case Action), do not reclassify the case on the form as a medical improvement possible or expected (MIP or MIE) before routing it to the FO.
The DDS will refer the case as a no determination (ND). For processing “no determination” findings, see DI 28030.001E.
Alert the FO that the MINE or MINE-equivalent process does not apply (despite the annotation on the SSA-847).
Upon return of the case to the DDS, the MINE or MINE-equivalent criteria will no longer apply. The DDS will develop, evaluate and determine the case, applying the “regular” CDR determination process. The DDS will establish the proper diary for any continuances.
NOTE: Certified Electronic Folders (CEF) have different methods to use when closing or routing cases. For electronic case procedures, refer to the appropriate section in DI 81020.000.
DI 28030.001 Initial Receipt of Claim Folder by the DDS
DI 81020.127 Processing “No Determination” (ND) Claims
DI 81020.240 Electronic Continuing Disability Review (eCDR) Determinations
DI 81020.250 Closing and Routing Electronic Continuing Disability Review (eCDR) Cases