DI 27536.010 Required Information for Reopening Continuing Disability Review Determinations

There is no need to duplicate information documented elsewhere in the file. Use the tables below to locate the information required to reopen continuing disability review (CDR) determinations; and, what actions are necessary if the information is not already contained in the file.

Required information for reopening a CDR determination includes:

•

Assessment of functional abilities
•

Basis for determination
•

Basis for the most recent prior favorable medical determination, i.e., comparison point decision (CPD)
•

Beneficiary's reason for continued entitlement or cessation
•

Citation of jobs and incidence
•

Date of CPD
•

Discussion of comparison of medical findings under medical improvement review standards (MIRS)
•

Evidence sources
•

Medical facts
•

Pain-related issues
•

Reason for current review
•

Resolution of conflicting medical opinions
•

Resolution of inconsistencies material to the determination
•

Statement of nonmedical issues
•

Vocational rule used for medical-vocational determinations

A. Location of required information

Use the table below to locate required information.

Information	Determination	Where Usually Documented In File
Assessment of functional abilities	Continuance	• Medical evidence • SSA-4734-BK Physical Residual Functional Capacity Assessment (RFC) • SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment (MRFC)
	Cessation	• Medical evidence • MRFC • RFC
Assessment of functional abilities	Continuance	• Medical evidence • MRFC • RFC
	Cessation	• Medical evidence • MRFC • RFC
Basis for determination	Continuance	Items 10 and 12 on the SSA-832/833
	Cessation	• Items 10 and 11 on the SSA-832/833 • Personalized cessation notice (PCN)
Basis for the most recent prior favorable medical determination, i.e., CPD	Continuance	• Administrative law judge (ALJ) decision • Appeals Council (AC) decision • Federal court decision • SSA-831 Item 22 (Regulation basis code) • SSA-832 or SSA-833 item 10 • SSA-5002 Report of Contact
	Cessation	• ALJ, AC or court decision • PCN • Regulation basis code • SSA-832 or SSA-833 item 10 • SSA-5002
Beneficiary's reason for continued entitlement or cessation	Continuance	• SSA-454-BK Continuing Disability Review Report • SSA-820-F4 Work Activity Report (Self-Employed Person) • SSA-821-BK Work Activity Report • SSA-5002 or SSA-553 Special Determination
	Cessation	• PCN • SSA-454-BK • SSA-820-F4 • SSA-821-BK • SSA-5002 or SSA-553
Citation of jobs and incidence	Continuance	Not applicable
	Cessation	Report by a vocational specialist
Date of CPD	Continuance	• Case summary, developmental worksheet, or disability determination evaluation • Prior determination or decision • SSA-5002
	Cessation	• Case summary, developmental worksheet, or disability determination evaluation • PCN • Prior determination or decision • SSA-5002
Discussion of comparison of medical findings under MIRS	Continuance	• MRFC • RFC • SSA-832 or SSA-833 item 10 • SSA- 2506-BK Psychiatric Review Technique (PRTF)
	Cessation	• MRFC • PCN • PRTF • RFC • SSA-832 or SSA-833 item 10
Evidence sources	Continuance	Medical evidence
	Cessation	• Medical evidence • Personalized cessation notice
Medical facts	Continuance	• Medical evidence • SSA-5002
	Cessation	• Medical evidence • SSA-5002
Pain-related issues	Continuance	• Any medical listing that specifically mentions pain • PRTF • RFC • MRFC
	Cessation	• MRFC • PRTF • RFC
Reason for current review	Continuance	• Diary matured • SSA-831, SSA-832, or SSA-833 diary block • SSA-832 or SSA-833 item 20 • SSA-847 Request for Case Action • SSA-5526 Request for Assistance-Disability
	Cessation	• Diary matured • Personal decision notice • SSA-831, SSA-832, or SSA-833 diary block • SSA-832 or SSA-833 item 20 • SSA-847 • SSA-5526
Resolution of conflicting medical opinions	Continuance	Resolved by the determination of a continuance (SSA-832 or SSA-833
	Cessation	• MRFC • PRTF • RFC
Resolution of inconsistencies material to the determination	Continuance	Resolved by the determination of a continuance (SSA-832 or SSA-833
	Cessation	• MRFC • PRTF • RFC
Statement of nonmedical issues	Continuance	• SSA-820-F4 • SSA-821-BK • SSA-454-BK • SSA-832/833 • SSA-899 Continuing Disability Review (Completed by the PSC's)
	Cessation	• PCN • SSA-820-F4 • SSA-821-BK • SSA-454-BK or SSA-832/833 • SSA-899
Vocational rule used for medical-vocational determinations	Continuance	Item 14 on the SSA-832 or SSA-833
	Cessation	Item 14 on the SSA-832 or SSA-833

B. Rationale documentation required

A rationale must address specific information not already documented in the case file.

Use the table below to determine how you need to document the missing information.

Information	Where Usually Documented In File	Action Required If Not Already In File
Basis for the most recent prior favorable medical determination, i.e., comparison point decision (CPD) (cessation determination)	Personalized cessation notice	See DI 27536.001C.3.
Discussion of comparison of medical findings under MIRS (cessation determination)	Items 10 and 12 on the SSA-832 or SSA- 833	See DI 27536.001C.1.
	Personalized cessation notice	See DI 27536.001C.2.
	• SSA- 2506-BK Psychiatric Review Technique • SSA-4734-BK Physical Residual Functional Capacity Assessment • SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment	See specific instructions for: • Pain-related issues • Resolution of conflicting medical opinions • Resolution of inconsistencies material to the decision

C. References

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DI 28501.001 Question of Reopening Arises
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DI 28501.005 Reopening of Prior Cessation Determination
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DI 28501.010 Processing Charts: CDR Reopenings Under Administrative Finality (Revision of Prior Cessation)
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DI 28501.015 Reopening in Continuing Disability Cases
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DI 28501.020 Unfavorable Reopening of Prior Continuance Determination
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DI 28501.025 Reopening and Revision of a Prior CDR Reconsideration Determination
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DI 28501.030 Routing Reopened Cases

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427536010

DI 27536.010 - Required Information for Reopening Continuing Disability Review Determinations - 03/24/2017
Batch run: 01/15/2019
Rev:03/24/2017

Social Security

Program Operations Manual System (POMS)

DI 27536.010 Required Information for Reopening Continuing Disability Review Determinations

A. Location of required information

B. Rationale documentation required

C. References