Updates made to multiple sections in DI 28010 for consistency with current regulations and related subregulatory policies, clarifications to multiple sections, updated references and hyperlinks, and expanded instructions, where applicable. General updates made for plain language throughout the sections of the subchapter.
DI 28010.029 - see summary of changes below for additional details.
DI 28010.035 - see summary of changes below for additional details.
DI 28010.040 - see summary of changes below for additional details.
DI 28010.010 – Archived
This content is archived, content moved to DI 28010.001. The content has been condensed to other pertinent sections for more robust policy sections to minimize switching between sections to find related content.
DI 28010.105 – Archived
The content in DI 28010.105 was moved to DI 28010.020. DI 28010.105 was previously titled “Comparison Point Decision (CPD),” and this is the content was moved to DI 28010.020.
The previous content in DI 28010.020 was moved to DI 28010.015. See summary of changes below for additional details.
Summary of Changes
DI 28010.001 Definition and Overview of Medical Improvement (MI)
Revised the title from “Medical Improvement (MI)” to “Definition and Overview of Medical Improvement (MI).”
Added citations to regulatory text at the beginning of section.
Created subsection A. Content includes definition of MI, related references, and a brief discussion of MI and the consideration of signs, symptoms, and laboratory findings.
Created subsection B, “Which impairment(s) is considered when evaluating MI.” This content was moved from DI 28010.010A, B1, and B2. Organized content and expanded instructions to differentiate between established impairments and unestablished impairments. Expanded instructions to elaborate on when these impairments are considered in the CDR sequential evaluation process.
Included pertinent references related to content within the section.
DI 28010.010 Which Impairment(s) to Consider in Medical Improvement (MI)
DI 28010.015 Comparison of Symptoms, Signs, and Laboratory Findings When Evaluating Medical Improvement (MI)
Revised the title from “Comparison of Symptoms, Signs, and Laboratory Findings” to “Comparison of Symptoms, Signs, and Laboratory Findings When Evaluating Medical Improvement (MI).”
Updated regulatory references.
A1: Expanded instructions and added several cross reference citations. Added text to explain concepts of evaluating MI in greater detail. Added clarification that it is not necessary to have changes in signs, symptoms, and laboratory findings to find MI has occurred, MI may be found if there is a change in a symptom(s), a sign(s), or specific laboratory finding.
A2: Moved previous A2 content that addressed changes in symptoms only to C2 in current version. Current A2 content is how to determine if MI has occurred, which is content moved from the previous version in C1, but with amendments for clarification and additional cross-reference citations. Moved this content for flow and sequence within the section.
A3: Content moved from C3 of previous version.
This content was moved from DI 28010.020. Information from this section, “Nature and Quantity of Change Needed to Find Medical Improvement (MI)” was very brief and fits well with the discussion of signs, symptoms and laboratory findings. Current subsection B discusses minor changes with examples, from DI 28010.020A1 and 2. Revised examples of minor changes to include additional detail, created a Title XVI child example.
C1: Discussion of how functional information may represent medical findings and how functional abnormalities are assessed in the medical improvement review standard (MIRS).
C2: Current C2 includes instructions for evaluating changes in symptoms only, this content was previously in DI 28010.015A2. Elaborated on information.
C3: New content in section for evaluating Title XVI child CDR cases, noting that children demonstrate different age-appropriate activities with growth and development, so the adjudicator must consider the relationship of prior and current findings to the individual's prior and current age.
Subsection D is now “Substitution of judgment.” This content was moved from DI
28010.010B3 and DI 28010.015C2. and condensed to this section so information is easier to locate. Condensed information about substitution of judgment (SOJ) and included a cross reference to DI 28005.007, which contains detailed information about SOJ in the CDR sequential evaluation process, including MI. Included example of SOJ from DI
This subsection discusses procedures and considerations when there is inadequate CPD documentation to compare symptoms, signs or laboratory findings. The prior version of DI
28010.015C4 contained information about inadequate CPD documentation, but did not include full instructions and sufficient detail. Content expanded, including information about when the flexible approach can be used to facilitate a continuance if CPD documentation is note adequate. A new table was created in this subsection that contains the continuance reasons and codes associated with these case types for completing the SSA-832 and SSA-833.
Subsection F now contains information about test error; this content was previously in DI 28010.020B.
Reference section previously was subsection D. Added additional reference to subsection.
DI 28010.020 Comparison Point Decision (CPD)
Previous section titled “Nature and Quantity of Change Needed to Find Medical Improvement (MI)”, now titled “Comparison Point Decision (CPD).”
The content on the nature and quantity to find MI is moved to DI 28010.015. The content has been condensed to other pertinent sections for more robust policy sections to minimize switching between sections to find related content.
The content that was in DI 28010.105 about the CPD was moved to section DI 28010.020. This content was moved because the concepts about the CPD should appear earlier in the subchapter.
The following changes were made to the existing content about the CPD:
General updates for grammar and plain language throughout section.
B1 and B2: Reversed order of content, starting with “CPD criteria met” (now in B1) and “CPD criteria not met” (in B2). Added additional explanation about consideration of collateral estoppel decisions in B2.
DI 28010.025 Examples of Cases With and Without Medical Improvement (MI)
Added examples and updated existing examples.
DI 28010.029 Overview of How to Evaluate Listings with Time Periods for Which an Impairment is Considered Disabling at the Continuing Disability Review (CDR)
New section created. The content of this section discusses how to evaluate listings with time periods for which an impairment is considered disabling at the CDR. The section provides an overview of CDR related evaluation for listings with a specified timeframe, listings that have age-based periods of disability, and listings with minimum periods of disability. This new section is an overview of evaluation issues, and later sections get into more detailed specifics based on the type of listing. This section also provides an overview of different considerations when evaluating cancer listings at CDR when the individual’s impairment met or equaled a cancer listing at the comparison point decision (CPD), and discusses evaluation of CPD listings that have become obsolete at the CDR when the CPD listing included a time period for which an impairment is considered disabling.
DI 28010.030 Evaluating Listings with a Specified Timeframe at the Continuing Disability Review (CDR)
Revised the title from "Medical Improvement (MI) in Cases Involving Listings with a Specified Timeframe" to "Evaluating Listings with a Specified Timeframe at the Continuing Disability Review (CDR)."
Subsection B - Updated current listings with a specified timeframe in the summary table
Subsection C - Provided additional clarification for evaluation at the time of the CDR when an impairment met or equaled a listing with a specified timeframe at the comparison point decision (CPD).
Subsection D - Updated case examples and expanded detail in the examples for additional clarity.
Subsection E - Added clarification of setting a diary if the continuance is based on meeting or equaling a listing with a specified timeframe.
Subsection F - Updated references.
DI 28010.035 Evaluating Listings with Minimum Time Periods at the Continuing Disability Review (CDR)
New section created. The content of this section discusses CDR evaluation for impairments that met or equaled a listing with a minimum period of disability at the comparison point decision (CPD). This section includes a definition, current listings with minimum time periods, CDR evaluation instructions, case examples, diary scheduling considerations, and references.
DI 28010.040 Evaluating Listings with Age-Based Periods of Disability at the Continuing Disability at the Continuing Disability Review (CDR)
Created new section specifically addressing the evaluation of listings with age-based periods of Disability at CDR. New section created. The content of this section discusses CDR evaluation for impairments that met or equaled a listing with an age-based period of disability at the comparison point decision (CPD). This section includes a definition, current listings with age-based periods of disability, CDR evaluation instructions, a case example, and references.
DI 28010.050 Adjudicator and Medical or Psychological Consultant (MC/PC) Roles in Considering Medical Improvement (MI)
Revised the content in this section entirely. Revised the section title from "Functional Abnormalities or Limitations May Constitute Symptoms, Signs, and Laboratory Findings" to "Adjudicator and Medical or Psychological Consultant (MC/PC) Roles in Considering Medical Improvement (MI)."
The content previously in subsection A that discussed consideration of findings is now in DI
28010.015C, the content previously in subsection B that discussed the comparison of findings in regard to age and MI is now in DI 28010.015C.
The content in this section is titled “Adjudicator and Medical or Psychological Consultant (MC/PC) Roles in Considering Medical Improvement (MI),” which expands and replaces the content in DI 28010.015A.3. that included a discussion of the role of the MC/PC in considering MI. The new content in this section includes the roles of evaluating MI by adjudicators and by MCs and PCs, including instructions for documenting MI. This section also includes more detailed explanations about MC/PC evaluation, including a new table of assessment forms that shows which forms are appropriate in different MI scenarios.
DI 28010.055 Medical Improvement (MI) in the Continuing Disability Review (CDR) Evaluation Process When Drug Addiction or Alcoholism (DAA) Is Involved
Expanded content and organized into three sections. Specifically:
A1: Discusses the definition of DAA, which was previously in subsection B.
A2: Contains information on when a DAA material determination is needed in a CDR. This information was previously in subsection B.
A3: This subsection provides an overview of instructions for the DAA sequential evaluation process in CDR cases with related references for additional information. This information was previously in subsection A, but is discussed in greater detail here.
Subsection B: Subsections B1 and B2 from previous version moved to Subsection A.
B1: Contains information of MI with DAA involvement.
B2: Includes information about which impairments are considered in evaluating MI in DAA evaluation.
Subsection C: Expanded content to differentiate between adjudicator and MC/PC roles in DAA evaluation.
D3a: Content was expanded for evaluating physical impairments with DAA.
D4: Expanded instructions for evaluating DAA in lost folder or reconstructed cases.
Subsection E: Updated examples.
Subsection F: Updated references.
DI 28010.115 Impairment Subject to Temporary Remission
Removed “Consider the concept of temporary remission at the following CDR sequential evaluation steps.” An impairment that is subject to temporary remission is not just limited to assessment at MI and MI related steps, as we assess the nature of the impairment and listing criteria at the meets/equals a current listing step as well.
B4c: Included a note about specific diary considerations and MI. This note includes discussion of evaluating listings with a minimum time period and potential remission issues and includes a reference for additional information.
Subsection D: New section that includes two examples relating to section content.
DI 28010.120 Title XVI Child Cases - Functionally Equivalent Impairments Subject to Specified Reexamination
Subsection A: replaced the term “specified timeframe” with “time periods for which an impairment should be considered disabling” to cover different scenarios for Title XVI functional equivalence, because a specified timeframe is not the same as a minimum timeframe in terms of MI evaluation.
Subsection C: Added reference section.
DI 28010.130 Role of Exercise Tolerance Tests (ETTs) in Medical Improvement Review Standard (MIRS) Comparisons
Minor edits made, such as specifying listings in the cardiovascular system and correcting grammar. Deleted the sentence about evidence-to-evidence comparisons being more “difficult” when evidence from either the CPD or CDR (not both) contains ETT results.
DI 28010.135 Medical Improvement Review Standard (MIRS) Issues in Adult and Child Cases Involving Mental Impairments
Subsection A: Condensed information from subsection B about maladaptive behavior and assessment prior to the establishment of age 18 redetermination policy. Added to the February 1997 changes that for recipients who attained age 18 before August 22, 1996, we will perform CDRs (not disability redeterminations) and included links to pertinent POMS sections. Updated list of history of mental disorder listing updates to reflect the changes made to the listings in 2017.
Subsection B: Moved information about evidence consideration to subsection C for better organization and flow. Moved information about specialist review to subsection C3.
C1: Includes general information for evidence consideration and assessing mental impairments using the MIRS.
C3: Included information about assessment of mental impairments and related references.
C4: Created a section for evaluating mental disorders involving MINE impairments.
C5: In the related procedure section, revised text for more complete development references and related procedures.
DI 28010.140 Psychiatric Review Technique (PRT) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings
Revised title from "Psychiatric Review Technique Form (PRTF) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings" to "Psychiatric Review Technique (PRT) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings." The title and terminology was updated for consistency with current related policy on the form in DI 24583.005 and related sections.
Subsection B: Included a sentence with reference to the newly revised section for assessment forms.
C1: Expanded text about scenarios for using a PRT in CDRs.
C2a and C2b: Included additional text to more clearly identify when a PRT would be necessary or appropriate when evaluating MI. A PRT is not usually required to evaluate MI, but discussed when this may be necessary. Instructions also direct that the PRT is typically completed at step 4.
C3: Expanded content about different scenarios for evaluating MI related to the ability to work. Included additional instructions about scenarios and assessment forms to use when the CPD was based on a medical/vocational favorable allowance or meets/equals at the CPD.
Subsection D: Updated references.
DI 28010.145 Mental Residual Functional Capacity Assessment Form (MRFC) (SSA-4734-F4-Sup) in Continuing Disability Reviews (CDRs)
Revised the title from “Mental Residual Functional Capacity Assessment Form (MRFC) (SSA-4734-F4-Sup) in Continuing Disability Reviews (CDRs) for Adults and Disabled Minor Child(ren)” to ““Mental Residual Functional Capacity Assessment Form (MRFC) (SSA-4734-F4-Sup) in Continuing Disability Reviews (CDRs)” for brevity.
Updated cross-reference citations. Additionally:
B1: Moved content in current version that appears later in the subsection B about “relating MI to the ability to work” to B1. Organized content chronologically based on the sequential evaluation process.
B2: Subsection now contains information about completing an MRFC at the severity assessment step of the CDR sequential evaluation process at step 6 for Title II and adult Title XVI individuals, not at the past relevant work/other work steps. The section previously referenced generating this assessment at past relevant work and other work steps, however, those are not medical evaluation steps. This is not a change in procedure or policy, rather this statement is more consistent with policy.
Removed reference section (Section C in previous version), as the references listed already occur within the section and there are no other pertinent references to list.
DI 28010.150 Intelligence Quotient (IQ) Scores in Medical Improvement Review Standard (MIRS) Comparisons
Subsection A: Replaced the term “by age 16” to “after age 16” for consistency with existing policy guidance in DI 24583.060.
Subsection B: Updated testing methods in examples in B1 and B2. Minor revisions to sentences for clarity. Removed B3, which referenced new or improved IQ tests in the list in DI 33535.035. Since the IQ testing method in that POMS has not been updated since 1984, this information is not relevant in a standalone subsection and may be misleading. Instead, included pertinent references in the reference section for users.
Subsection C: Updated references.