The medical improvement review standard (MIRS) applies to adverse reopenings of prior determinations and decisions. The MIRS includes the exceptions to medical improvement (MI). When the MIRS applies and the determination in a particular case supports a Group I error exception, the MIRS review evaluation process requires a finding of current ability to engage in SGA, before making any unfavorable decision, including adverse reopening.
See DI 28005.001D for application of the MIRS.
If a Group I prior error exception applies, the adjudicator must consider whether reopening the prior determination is appropriate and is possible under the rules for reopening.
Reopening is only necessary if both criteria are met:
Evidence on the file establishes that the prior determination or decision was completed in error and the prior error exception applies.
Conditions for reopening meet the criteria as defined in DI
Reopening is NOT necessary if the prior error exception applies but the conditions for reopening in DI
27505.001A. are NOT met. The CDR sequential evaluation process still applies despite the ability to reopen.
If a decision made at a higher appeals level (for example, by an administrative law judge) is found in error and the individual can engage in substantial gainful activity (SGA), process the cessation on the pending CDR case first. After processing the cessation, if the time limit for reopening has not expired, refer the case for possible reopening at the prior appeal level.
• For an overview of considerations for reopening and revision a decision or determination, see DI 27501.005B.2.c. and DI 27501.005B.2.d.
• For reopening time limits, see DI 27505.001.
• For instructions routing reopened CDR cases, see DI 28501.030.