SSA - POMS: DI 28005.005 - Overview of Development in the Continuing Disability Review (CDR) Sequential Evaluation Process

A. Introduction to the CDR sequential evaluation process

Regulations require the use of the 8-step evaluation process for Title II and adult Title XVI CDRs and a 3-step evaluation process for Title XVI child CDRs. For additional information on this process, see DI 28005.015 for Title II and adult Title XVI individuals, or DI 28005.030 for Title XVI child CDR cases. Although we refer to an 8-step evaluation process for Title II and adult Title XVI CDRs, the first step of this evaluation process (evaluation of substantial gainful activity) does not apply to Title XVI adult CDRs. Do not use the 5-step initial claims sequential evaluation process discussed in DI 22001.001.

The 5-step initial claims sequential evaluation processed is used to evaluate age 18 redeterminations, see DI 28005.003.

NOTE: It would be rare to encounter a CDR for adults who:

•

were originally allowed as children, and
•

attained age 18 before August 22, 1996 (which prevents an age-18 redetermination), and
•

were previously evaluated based on an individualized functional assessment.

For those rare cases, refer to DI 28005.016 and DI 28005.017.

B. Overview of evidence development for CDRs

1. Development of evidence

For CDRs, the medically determinable impairment (MDI) is established in the comparison point decision (CPD). Do not develop solely to establish the same MDI again during the CDR. Follow the development guides for evidence in DI 28030.020. The adjudicator must consider all evidence the individual submits, including all evidence obtained from medical and non-medical sources.

Do not focus development on a particular impairment(s); develop evidence for all alleged impairments. Although the medical improvement review standard (MIRS) sequence for Title XVI child CDR cases first considers the CPD impairment(s) and the current impairment(s) later in the sequential evaluation process, initiate development of all current evidence simultaneously. Additional development may be curtailed once evidence clearly supports a finding that disability continues; see DI 28005.005C below.

•

For guidelines on developing vocational evidence in Title II and adult Title XVI CDR cases, see DI 28030.030.
•

For guidelines on developing functional evidence in Title XVI child CDR cases, see DI 28030.031.
•

For a more detailed discussion of evidence development and assessment for CDRs, see DI 28005.009.

2. Evidence received after the determination

When handling any additional evidence (trailer material, or “trailer mail”) the disability determination services (DDS) receives after processing the determination, follow instructions in DI 22520.001.

C. The flexible approach in the CDR sequential evaluation process - when skipping steps may be appropriate

1. Overview of the flexible approach in the CDR sequential evaluation process

Follow the CDR sequential evaluation process in the order shown, in most cases. However, use a flexible approach as a way to facilitate appropriate continuances.

If the DDS receives evidence that clearly establishes continuing disability, stop development and process a continuance. Skip the sequential evaluation process steps as appropriate and discussed in this section to process a continuance, but do not skip steps in a cessation.

Develop all impairments and vocational issues before making a cessation determination (except for Group II exceptions). If a Group II exception applies, find that disability ceases without proceeding to steps that determine whether the individual can engage in SGA, or for a Title XVI child, that the child's impairment(s) no longer results in marked and severe functional limitations. Do not skip consideration and development of a Group II exception to support a continuance in the sequential evaluation process if evidence suggests a Group II exception may apply. For information about Group II exceptions, see DI 28020.900.

Do not skip any step that could affect the outcome, and do not use this flexibility as a way to routinely consider steps out of order. Exclusions to using the flexible approach are discussed in DI 28005.005D.

2. Skipping the "meets or equals" step - Title II or adult Title XVI individuals

We consider if an individual's impairment(s) meets or equals a medical listing at two steps in the Title II or adult Title XVI CDR sequential evaluation process. We consider if the individual's impairment(s) meets or equals the severity of a current listing at step 2, and we consider if the individual's impairment(s) still meets or equals the severity of the listing that was met or equaled at CPD at step 4. See DI 28005.015A for a detailed explanation of the Title II or adult Title XVI CDR sequential evaluation process steps.

If evidence does not show whether an impairment(s) meets or equals the listing requirements, but clearly shows:

•

No medical improvement (MI) related to the ability to work, and
•

No exception to MI applies, then:

Find that disability continues on that basis, the skipped step does not affect the outcome.

NOTE: If the evidence demonstrates that the impairment(s) still meets or equals the prior listing criteria that was met at the CPD but the adjudicator cannot determine whether the impairment(s) meets or equals a current listing at step 2 or determine if MI has occurred at step 3, consider whether using the flexible approach would be appropriate to facilitate a continuance.

References for evaluating the medical listings:

•

For the current listing of impairments, see DI 34001.000.
•

For obsolete versions of the listing of impairments, see DI 34100.000.

3. Skipping MIRS related steps

a. Title II or adult Title XVI individuals - skipping MIRS evaluation steps to support a continuance

If a physical residual functional capacity (RFC) assessment or mental residual functional capacity (MRFC) assessment evaluating current impairments clearly shows the individual cannot do past relevant work or other work and no exception to MI applies, but the DDS cannot resolve issues of:

•

MI, or
•

MI related to the ability to work, then

Find that disability continues due to the inability to perform other work (referred to as "impairment plus vocational factors" in the continuance coding instructions for the SSA-832 and SSA-833 in DI 28084.020C), because development of the above steps will not affect the outcome of the decision or determination.

b. Title XVI child CDR cases - skipping MIRS evaluation steps to support a continuance

If the child's medically determinable severe impairment(s) clearly meets, medically equals, or functionally equals the severity of a current listing and no exception to MI applies but the DDS cannot resolve issues of the following:

•

MI, or
•

Determining if the impairment(s) meets/equals the severity of the listing it met at the CPD; then

Find that disability continues on the basis of meeting, medically equaling, or functionally equaling the severity of a current listing, whichever applies, because the development of the above steps will not affect the outcome of the determination.

D. When the flexible approach is not appropriate

1. Title II or adult Title XVI individuals

If the DDS receives evidence that shows MI related to the ability to work and shows that the individual cannot do other work, do not skip the past relevant work step. Doing so could affect the CDR outcome. Obtain any additional evidence needed and consider whether disability ceases based on the ability to do past relevant work. The same principles in DI 25005.005 apply to CDRs when considering expedited vocational assessment.

2. Evaluation of statutory blindness

Since there are special considerations for blindness, the adjudicator should use caution in using the flexible approach. This is due to higher substantial gainful activity (SGA) limits that may benefit the Title II beneficiary if they are able to work, and for possible payment advantages of Title XVI recipients. If an issue of blindness exists, the examiner should ensure appropriate development and evaluation of a blindness or vision impairment instead of using the flexible approach to facilitate evaluation of a non-blind individual’s impairment(s).

For additional information on evaluating statutory blindness in CDRs, see DI 28005.090.

3. Group II exceptions

Do not use the flexible approach if criteria for a Group II exception applies or there is evidence that a Group II exception may apply, see DI 28005.005C1.

Social Security

Program Operations Manual System (POMS)

DI 28005.005 Overview of Development in the Continuing Disability Review (CDR) Sequential Evaluation Process