Identification Number:
DI 33025 TN 18
Intended Audience:See Transmittal Sheet
Originating Office:ODP
Title:Procedures for Special Cases and Handling
Type:POMS Transmittals
Program:
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 330 – Disability Hearing Unit Procedures
Subchapter 25 – Procedures for Special Cases and Handling
Transmittal No. 18, 05/23/2022

Audience

PSC: DEC, RECONR;
OCO-OEIO: CTE, FCR, FDE, RECONE;
OCO-ODO: DE, RECONE;
ODD-DDS: DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal is a part of an ongoing rewrite of the program operations manual system (POMS) sections related to disability processing at the disability hearing unit (DHU). We are adding a new section to DI 33025 that provides instructions on how to process a case at the DHU when the recipient attains age 18 during the continuing disability review (CDR) reconsideration process.

Summary of Changes

DI 33025.073 Processing Title XVI Childhood Continuing Disability Review (CDR) Reconsideration Cases Involving Attainment of Age 18 at the Disability Hearing Unit (DHU)

This new section provides instructions for the DHU on how to process a case when the recipient attains age 18 during the CDR reconsideration process.

DI 33025.073 Processing Title XVI Childhood Continuing Disability Review (CDR) Cases Involving Attainment of Age 18 at the Disability Hearing Unit (DHU)

 

A. Statutory and regulatory background

When we review a determination that disability has medically ceased, we consider the recipient's disability through the date of the current determination. We determine whether the recipient was or has again become disabled at any point through the current date. Social Security Act, Sec. 1614(a)(4); SSR 13-3p

Pursuant to Public Law (P.L.) 104-193, all Title XVI childhood disability recipients who attained age 18 on or after August 22, 1996 and 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. We must notify the recipient in writing prior to completing the disability redetermination. 20 CFR 416.987(d)

B. Policy overview

1. Applicable standard

When the recipient attains age 18 during a childhood CDR reconsideration, the disability hearing officer (DHO) must use different standards for disability evaluation that are dependent on the recipient's age throughout the review period. The DHO will use:

  • the childhood medical improvement standard (MIRS) (DI 28005.020) to evaluate the period prior to the attainment of age 18, and

  • the adult disability standards to evaluate the period after attainment of age 18 (DI 23570.020B).

    Reminder: Individuals receiving Title XVI benefits based on disability or blindness, including age 18 recipients whose disability is determined to have ended because of an age-18 redetermination, may be eligible for payments under Section 301. See DI 14505.010.

     

2. Assessment forms

The DHO must complete the SSA-1209-BK Disability Hearing Officer’s Decision (Title XVI Disabled Child (DC)) – Continuing Disability Review and the SSA-1207-BK-OP1 Disability Hearing Officer’s Decision (Medical Improvement Review Standard Not Applicable).

It is important that the case clearly reflects the full assessment period. The SSA-1209-BK and SSA-1207-BK-OP1 are part of the determination package issued to the recipient. An unfavorable determination may be reviewed at higher levels of appeals, whereas a favorable determination will become the comparison point decision (CPD) folder for the next CDR.

3. General conclusions

Generally, there are four conclusions when the individual attains age 18 during the appeal of a childhood cessation:

  • NOT DISABLED- Cessation under childhood MIRS and not disabled under adult rules,

  • DISABLED, but with a new period of disability; the earlier determination that the recipient's disability has ceased is correct- Cessation under child MIRS and the individual is determined to be disabled under adult rules,

  • NOT DISABLED, but with a later cessation date- Continuance under childhood MIRS and cessation under adult rules, or

  • DISABLED- Continuance under childhood MIRS and continuance under adult rules.

 

C. Steps when the evidence supports a continuance of the childhood CDR and the recipient has attained age 18 or will attain age 18 within 2 months

The DHO will complete the following actions when the evidence supports a continuance of the childhood CDR and the recipient is at least 17 years and 10 months of age.

  1. 1. 

    Send a notice to the recipient to notify him or her that the case will be evaluated under the adult rules for the period after attainment of age 18. The notice should be sent prior to the date of the determination. See DI 29025.008 for notice exhibit. Exception: Do not send the notice if the DDS sent the notice while the case was pending at the pre-hearing (PH) level.

  2. 2. 

    Complete the SSA-1209-BK and the SSA-1207-BK-OP1. Ensure the fields clearly explain both the childhood CDR under appeal and assessment under the adult rules after attainment of age 18.

  3. 3. 

    On the SSA-832 Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI, use Age 18 Redetermination cessation or continuance codes. See DI 28084.015B.3.e. and DI 28084.020C.5.

  4. 4. 

    On the SSA-832, include the remarks "P.L. 104-193" and " Period starting with attainment of age 18 adjudicated under adult rules." (In the case of a fully favorable determination, this will allow the field office (FO) to screen out an Age 18 Redetermination.)

  5. 5. 

    Do not make an adult determination on the case until the recipient attains age 18.

  6. 6. 

    Unless otherwise indicated above, follow normal procedures for the form completion.

NOTE: If the evidence supports a continuance of the childhood CDR and a cessation as an age 18 redetermination, the overall conclusion is "not disabled but with a later cessation date." Generally, the cessation date will be the month of adjudication. See DI 28005.205 and DI 23570.025C for additional information on cessation dates.

D. Steps when the evidence supports a cessation of the childhood CDR and the recipient has attained age 18

The DHO will complete the following actions when the evidence supports a cessation under the childhood MIRS and the recipient has attained age 18.

  1. 1. 

    Complete the SSA-1209-BK and the SSA-1207-BK-OP1. Ensure the fields clearly explain both the childhood CDR under appeal and assessment under adult rules after attainment of age 18.

  2. 2. 

    Use discretion and select the most appropriate regulation basis code (RBC).

    NOTE: In most cases, if the evidence supports the cessation of the childhood CDR it will also support a cessation under the adult rules. However, if the evidence supports the prior cessation date under the childhood MIRS but a new period of disability under adult rules, use the appropriate allowance RBC. The overall outcome is "DISABLED, but with a new period of disability; the earlier determination that claimant's disability has ceased is correct." See DI 33015.020C.9. for additional information.

  3. 3. 

    On the SSA-832, include the remark "Period starting with attainment of age 18 adjudicated under adult rules."

  4. 4. 

    Unless otherwise indicated above, follow normal procedures for the form completion.

    NOTE: If the evidence supports a cessation under the childhood MIRS and the recipient has not attained age 18, proceed with a determination. In this situation, there is no need to delay case processing.


DI 33025 TN 18 - Procedures for Special Cases and Handling - 5/24/2022