Identification Number:
CJB 22-01
Intended Audience:All Office of Hearings Operations (OHO) Personnel
Originating Office:Office of Hearings Operations
Title:Changes to Guidance Concerning Evaluation of Medical Evidence in Continuing Disability Reviews (CDR)
Type:Chief Judge Bulletins
Program:Disability
Link To Reference:See References at the end of this CJB.
 
Retention Date: May 13, 2022

Descriptive Summary: The purpose of this Chief Judge Bulletin (CJB) is to inform you of immediate changes regarding the processing of CDR cases due to an August 25, 2021 update to Hearings, Appeals, and Litigation Law Manual (HALLEX) I-5-3-30.

Updated Rules on Evaluating Medical Evidence in a CDR.

In January 2017, the Social Security Administration published revised rules regarding the evaluation of medical evidence (82 Fed. Reg. 5844). The agency then issued corresponding guidance on the evaluation of medical evidence in CDR cases.

Under the prior HALLEX instructions, in effect through August 24, 2021, adjudicators would use the current medical evidence rules in all CDR cases unless:

    · The agency had not conducted a prior CDR for the claim(s) after March 27, 2017, and
      · There was no medical improvement related to the ability to work. Or if a Supplemental Security Income (SSI) child’s claim, the comparison point decision (CPD) impairment(s) still met or equaled the severity of the listed impairment that it met or equaled before (or functionally equaled), and
        · All full medical determination(s) made in the claim(s) under review were made using the prior rules.

      The updated HALLEX I-5-3-30 and POMS DI 24503.050, effective August 25, 2021, simplify the guidance on determining which medical evidence rules apply in a CDR case. Under the revised guidance, if the initial claim was filed before March 27, 2017, and there has not been a prior CDR, the adjudicator will use the prior rules. If there has been a prior CDR, the adjudicator will:
        · Use the prior rules if the CPD is before March 27, 2017.
        · Use the current rules if the CPD is on or after March 27, 2017.

      If the initial claim was filed on or after March 27, 2017, the adjudicator will use the current rules.

      When determining whether to apply the prior or current rules, the adjudicator no longer needs to consider whether an adult beneficiary or recipient has medical improvement related to the ability to work or whether a child SSI recipient’s “CPD impairment(s) still meets or equals the severity of the listed impairment that it met or equaled before (or functionally equals the listing)” (POMS DI 24503.050).

      Medical Cessation with a New Period of Disability on Appeal

      The updated HALLEX instructions also specify that “if the individual’s disability has medically ceased, the determination or decision must also address the individual’s eligibility (or ineligibility) for a new period of disability through the date on which the appeal determination or decision is being made” (HALLEX I-5-3-30 IV.E.3).

      When considering whether the claimant is eligible for a new period of disability:
        · If the initial request for review of the disability determination was before March 27, 2017, adjudicators should use the prior rules to evaluate the new period of disability.
        · If the initial request was on or after March 27, 2017, adjudicators should use the same rules for evaluating evidence as they did when finding medical cessation.

      If adjudicators use the prior rules in finding medical cessation, they should use the prior rules in evaluating eligibility for a new period of disability. Conversely, if adjudicators use the new rules in finding medical cessation, they should also use the new rules in considering the claimant’s eligibility for a new period of eligibility.

      Drafting Decisions

      For some cases, the revisions to HALLEX I-5-3-30 require decision drafters to temporarily update the Findings Integrated Template (FIT) CDR Adult Decision 2018-V3 and the FIT Child SSI CDR Decision 2018-V3 templates by searching and replacing decisional template text. Those who draft decisions (Decision Writers, Senior Attorney Advisors, and ALJs who draft decisions per Standard Hearings Operations Procedure (SHOP) Section 6.2)) will need to manually change portions of the FIT generated text and citations noted in the table below so that the language reflecting the prior medical evidence rules will appear for any cases that use the prior rules. Please note that the Hearings Appeals Case Processing System (HACPS) does not currently provide CDR templates.

      Drafters should do the following: Generate a decisional template for a CDR decision (a FIT CDR Adult Decision 2018-V3 or FIT Child SSI CDR Decision 2018-V3). Choose either "DGS Menu" under the Add-ins tab or "New SSA Doc" under the File tab. Choose "Decisions" in the folders, and select the FIT CDR Adult Decision 2018-V3 or FIT Child SSI CDR Decision 2018-V3.


      Select the decision, fill out the form and generate a decision as normal. As soon as the decision finishes generating, press CTRL+F, choose the triangle icon on the right of the search bar. Click and choose "Replace."



      Using this screen, type in the text to be replaced with your desired text. Follow the table below to replace text, as appropriate.



      Replace this text
      With this text
      For all Title II cases
      The undersigned has also considered the medical opinion(s), prior administrative medical finding(s), and additional relevant evidence in accordance with the requirements of 20 CFR 404.1520c.The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 404.1527 and SSR 17-2p.
      For all Title XVI cases
      The undersigned has also considered the medical opinion(s), prior administrative medical finding(s), and additional relevant evidence in accordance with the requirements of 20 CFR 416.920c.The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 416.927 and SSR 17-2p.
      For all SSDC cases
      The undersigned has also considered the medical opinion(s), prior administrative medical finding(s), and additional relevant evidence in accordance with the requirements of 20 CFR 404.1520c and 416.920c.The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 404.1527 and 416.927 and SSR 17-2p.

      In addition to the above changes, for unfavorable decisions, follow the table below to replace text:

      Replace this text
      With this text
      For all Unfavorable Decisions
      As for the medical opinion(s) and prior administrative medical finding(s), we will not defer or give any specific evidentiary weight, including controlling weight, to any prior administrative medical finding(s) or medical opinion(s), including those from your medical sources. We fully considered the medical opinion(s) and prior administrative medical finding(s) in your case.
      **[EXPLAIN THE PERSUASIVENESS OF MEDICAL OPINIONS IN THE RECORD FOLLOWING THE REQUIREMENTS IN 20 CFR 404.1520c(b) AND/OR 416.920c(b): CONSIDER MEDICAL OPINIONS OR PRIOR ADMINISTRATIVE MEDICAL FINDINGS FROM THE SAME SOURCE IN A SINGLE ANALYSIS. FOR ALL MEDICAL SOURCES, EVALUATE THE FACTORS OF SUPPORTABILITY AND CONSISTENCY. WHEN APPROPRIATE, CONSIDER THE REMAINING FACTORS IN 20 CFR 404.1520c(c) AND 416.920c(c), RELATIONSHIP WITH THE CLAIMANT, SPECIALIZATION, AND OTHER FACTORS. PLEASE NOTE: Use the prior medical evidence rules (20 CFR 404.1527(c) AND/OR 416.927(c)) only if ALL the following apply: 1) all full medical determination(s) made in the claim(s) under review were made using the prior rules, 2) this is the first CDR after March 27, 2017 for the claim(s), and 3) there is no medical improvement related to the ability to work (See HALLEX I-5-3-30 ).]**
      **[EXPLAIN WEIGHT GIVEN TO MEDICAL OPINIONS AND OPINIONS ON ISSUES RESERVED TO THE COMMISSIONER FROM ACCEPTABLE MEDICAL SOURCES. IN DOING SO, CONSIDER THE FACTORS IN THE MEDICAL OPINION REGULATIONS (EXAMINING RELATIONSHIP, TREATMENT RELATIONSHIP, SUPPORTABILITY, CONSISTENCY, SPECIALIZATION, ETC).

      ALSO, AS APPROPRIATE UNDER 20 CFR 404.1527(f) and/or 416.927(f), EXPLAIN WEIGHT GIVEN TO: (1) OPINIONS FROM MEDICAL SOURCES WHO ARE NOT ACCEPTABLE MEDICAL SOURCES; (2) OPINIONS FROM NON-MEDICAL SOURCES WHO HAVE SEEN THE CLAIMANT IN THEIR PROFESSIONAL CAPACITY; (3) EVIDENCE, INCLUDING TESTIMONY FROM NON-MEDICAL SOURCES WHO HAVE NOT SEEN THE CLAIMANT IN A PROFESSIONAL CAPACITY (E.G., SPOUSES, PARENTS, FRIENDS, NEIGHBORS); AND (4) DECISIONS ON DISABILITY BY OTHER GOVERNMENTAL OR NONGOVERNMENTAL AGENCIES.]**

      Draft the decision as normal. We will update the FIT Adult CDR Decision 2018-V3 and FIT Child SSI CDR Decision 2018-V3 templates soon. The manual search and replace instructions are temporary until we can permanently update these templates to automatically reflect the guidance.

      References:

      20 CFR 404.1520c; 416.920c - How we consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017.

      20 CFR 404.1527; 416.927 - Evaluating opinion evidence for claims filed before March 27, 2017.

      HALLEX I-5-3-30 - Revisions to Rules Regarding the Evaluation of Medical Evidence

      POMS DI 24503.050 - Determining the Filing Date for Evaluating Evidence
      CJB 22-01 - Changes to Guidance Concerning Evaluation of Medical Evidence in Continuing Disability Reviews (CDR) - 12/13/2021