Identification Number:
DI 28005 TN 8
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:The CDR Evaluation Process
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 280 – Continuing Disability Review Cases
Subchapter 05 – The CDR Evaluation Process
Transmittal No. 8, 04/01/2021

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: BET, CR, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 28005.035 General Drug Addiction or Alcoholism (DAA) Material Continuing Disability Review (CDR) Evaluation Processes for Title II and Adult Title XVI Cases

DI 28005.035B2a:

-Revised sentence regarding no medical improvement (MI) to remove grammatical error. Removed "on" from the sentence "...does not impact on the other impairments", as the term "on" is not needed in the context of the sentence.

- Updated the listing in "other impairment(s) meets/equals" to reflect updated listings congruent with musculoskeletal listing changes effective April 2, 2021. Updated listing in example from 1.04B to 1.20A.

DI 28005.035 General Drug Addiction or Alcoholism (DAA) Material Continuing Disability Review (CDR) Evaluation Processes for Title II and Adult Title XVI Cases

A. Introduction to the DAA CDR evaluation process

The chart in DI 28005.040 shows the 7-step DAA material CDR evaluation process to follow when there is medical evidence of DAA. For the definition of medical evidence of DAA, see DI 90070.050C. For discussion of the seven steps, see DI 28005.045. Follow this process only after you have followed the 8-step CDR evaluation process shown in DI 28005.010 to decide whether disability is continuing. Step 1 of the chart in DI 28005.040 represents the conclusions reached in applying the CDR evaluation process shown in DI 28005.010.

B. Development of cases with DAA involvement

1. General development of cases with DAA involvement

Follow the general disability case development guides in DI 28030.020. Do not undertake further development on the material issue if you can make a favorable disability determination with regard to other impairments and you can make a reasonable inference that the additional evidence on the impact of DAA would not result in a finding that DAA is material.

2. Skipping evaluation steps

After you have determined that disability continues under DI 28005.010, follow the DAA material CDR evaluation process in the order shown. However, you may skip an evaluation process step(s) if doing so would not affect the finding that DAA is, or is not, material; i.e., it would not affect the outcome of the CDR.

a. When to skip evaluation steps

We may skip CDR evaluation steps at several points in the process.

  • No medical improvement (MI). If there is medical evidence of DAA, but DAA currently imposes no limitations and does not impact the other impairment(s), find no MI at step 3. Find that DAA is not material and disability continues.

  • Other impairment(s) meets/equals. If there is medical evidence of DAA, but a listing would still be met or equaled if DAA stopped (e.g., listing 1.20A or 13.13B), skip step 3 and find no MI related to the ability to work at step 4. Find that DAA is not material and disability continues. The step skipped does not affect the outcome.

  • DAA only. If there is medical evidence of DAA, and it is the only impairment, find MI at step 3 and skip to step 5 (severe impairment(s)). If the individual were to stop using drugs/alcohol, DAA would no longer exist and there would be no direct effects or residuals. Find that there would be no severe impairment, DAA is material, and disability ceases. The step skipped does not affect the outcome.

b. When not to skip

If there would be MI related to the ability to work if DAA stopped and the individual would not be able to do other work (step 7), do not skip the past relevant work step (step 6). This could affect the DAA material finding and thus the CDR outcome. Obtain any additional evidence needed to determine whether the individual would retain the ability to do past relevant work. If so, find that DAA is material and disability ceases.

3. Medical improvement (MI) involving DAA

For the definition of MI, and when to find MI under the DAA material CDR evaluation process, see DI 28010.055.

4. DAA condition

When an individual has a medically determinable substance use disorder and DAA is not material, he or she will be found to have a “DAA condition”. For claims filed on or after July 1, 1996, Public Law (P.L. 104-121) contains special treatment referral provisions for individuals with a DAA condition who are determined to be incapable of managing their benefits.


DI 28005 TN 8 - The CDR Evaluation Process - 4/01/2021