PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 280 – Continuing Disability Review CasesSubchapter 10 – Medical Improvement and Related Medical IssuesTransmittal No. 4, 04/01/2021
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
DI 28010.120 Title XVI Child Cases - Functionally Equivalent Impairments Subject to Specified Reexamination
Revision to update the example and language cited in DI 28010.120B1. The language following "...(because of residual impairment following surgery, or the recovery time required or both)" will be updated to include "until attainment of 1 year of age" for policy clarity and consistency. Additionally, the citation reference "DI 25225.060, example 8" will be updated to "example 3," for consistency with projected updates associated with musculoskeletal listing update revisions. Musculoskeletal listing updates effective April 2, 2021.
The regulations contain specified timeframes for the review of certain conditions that have been determined to functionally equal the listings for title XVI child claims (e.g., infants weighing less than 1200 grams at birth). The instructions in DI
28010.120B explain how to determine the CPD findings for these cases.
The regulations provide for eligibility at least until the attainment of age 1 in cases where a child has major congenital organ dysfunction that could be expected to result in death within the first year of life without surgical correction and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both) until attainment of 1 year of age- see DI 25225.060, example 3. If the CPD occurred after the surgery, the findings relevant to medical severity include findings prior to the surgery. In these cases, the pre-surgery findings should be used to determine if there has been a change in symptoms, signs, and/or laboratory findings relevant to current severity.