TN 7 (09-97)

DI 33025.075 Age 18 Redetermination Cases Under P.L. 104-193

A. Background

Pursuant to P.L. 104-193, all childhood disability beneficiaries who were eligible as children in the month before the month in which they attained age 18 must have their eligibility redetermined under the adult standards for initial claims.

The disability redeterminations will be done using the adult disability criteria for initial claims, except for the first step of sequential evaluation, substantial gainful activity. The medical improvement review standard will not apply.

B. Policy

Claimants found not disabled in an age 18 disability redetermination based on the application of the adult disability criteria may appeal the determinations that they are not disabled. Reconsiderations of the age 18 disability redetermination cases will be conducted under the regulations that govern the disability hearing process. See§§20 C.F.R. 416.1414-416.1418.

C. Process

Except as set out in this section, age 18 redetermination reconsiderations will be conducted according to DI 33001.000.

For example:

  • The DDS will first perform a case review to determine whether a fully favorable determination can be issued based on the evidence in the record.

  • If a fully favorable determination cannot be reached based on the DDS's case review, any residual functional capacity assessment forms (SSA-4734-U8 or SSA-4734-F4) or Psychiatric Review Technique Form (SSA-2506-BK) obtained for the case review will be marked “Advisory.”

  • The DDS or DHU will prepare a Summary of Evidence (SSA-887).

  • The DHU will send the claimant or his or her representative, if any, notice of the time and place of the disability hearing at least 20 days before the date of the hearing.

  • The claimant or his or her representative, if any, should be encouraged to review the evidence in the case file on the date of the hearing or at an earlier time.

  • If, for any reason, additional evidence is obtained after a hearing, and all evidence, taken together, supports an unfavorable determination, the claimant is notified, in writing, and given an opportunity to review and comment on the additional evidence within 10 days of the date the notice is received, unless there is good cause found for granting additional time.

D. Procedure - preparing the disability hearing officer’s report of disability hearing

During the hearing, complete an SSA-1205-BK (Disability Hearing Officer's Report of Disability Hearing) to record the proceeding. In conducting the hearing and completing the SSA-1205-BK, delete or cross-out any reference to to the comparison point date (CPD) or the medical improvement review standard (MIRS). These concepts are not applicable in age 18 redetermination cases.

E. Procedure - fully favorable age 18 redetermination cases

1. SSA-1207 or SSA-4268-U4/C4

Complete an SSA-1207-BK-OP1 or SSA-4268-U4/C4 to document a fully favorable determination. Regardless of which form the DHO uses, concisely discuss the evidence and provide a rationale that explains the basis of the determination. If the determination is documented on an SSA-4268-U4/C4, the SSA-4268-U4/C4 should contain the information similar to that which would have been entered in the “Analysis of Evidence and Findings of Fact” section of the SSA-1207-BK-OP1.

2. SSA-832

Complete an SSA-832 in every case in which a determination is reached. Enter in the remarks section, “This determination is based on the hearing held on (date of hearing) .” See DI 23570.025 for special coding instructions.

F. Procedure - partially or fully unfavorable age 18 redetermination cases

1. SSA-1207–BK-OP1

Complete an SSA-1207-BK-OP1 to document a partially or fully unfavorable determination.

2. SSA-832

Complete an SSA-832 in every case in which a determination is reached. Enter in the remarks section, “This determination is based on the hearing held on (date of hearing) .”

G. DHO cover notice

Prepare and release the DHO cover notice with the DHO decision. See DI 33015.025, and DI 33095.100-DI 33095.116. Do not use a fill-in that refers to medical improvement. In most cases, the appropriate fill