TN 12 (08-22)

DI 28005.009 Evidence and Basis for a Continuing Disability Review (CDR) Decision by a Disability Determination Services (DDS) Adjudicative Team

A. Role of DDS adjudicative teams

The DDS adjudicative teams evaluate medical improvement review standard (MIRS) issues when conducting a CDR. These teams consist of a medical or psychological consultant a disability examiner, trained in the disability evaluation process. In deciding MIRS issues, the team members have the same responsibilities as when making initial determinations.

B. Development of evidence in a CDR

1. Evidence requirements to assess medical improvement (MI)

Consider evidence submitted from medical and nonmedical sources when determining if MI has occurred. This includes evidence of functioning. The sufficiency of the evidence at the CDR must allow the adjudicative team to determine if there has been any decrease in the current medical severity of the impairment(s) which was present at the time of the most recent favorable medical decision, known as the comparison point decision (CPD).

For additional information on the development of evidence at the CDR, see DI 28030.020.

2. Evidence development for medical improvement not expected (MINE) or MINE-equivalent impairments at CDR

Extensive current medical development at CDR may not be needed in MINE or MINE-equivalent impairments because they are considered permanent. While medical development in MINE and MINE-equivalent cases may not require extensive current evidence, the DDS must contact a current medical source when possible. If no medical source is available, see DI 28040.125.

For additional development guidelines, see DI 28040.120 and DI 28040.125.

3. Basis for a determination and analysis of the evidence

DDS adjudicative teams:

  1. a. 

    Make CDR determinations considering all available evidence.

  2. b. 

    Do not draw any initial inference as to the presence or absence of disability from the fact that:

    • The individual was previously found disabled, or

    • A CDR is being conducted.

  3. c. 

    Determine if disability continues based on the supportability and consistency of the evidence.

  4. d. 

    Do not:

    • Substitute current judgment for that of the prior adjudicator (see DI 28005.007),

    • Re-adjudicate the prior determination or decision, or

    • Re-establish a medically determinable impairment that has already been established.

4. Consider all evidence

Consider all evidence concerning the individual's impairment(s) at the CPD and current impairment(s) (and vocational profile where applicable). Consider:

  • All evidence already in file, and

  • Any new evidence presented by the individual or secured by the Commissioner. For information on the development of medical evidence, see DI 28030.020.

5. Determining which medical evidence rules to use to evaluate the CDR evidence

a. Background on the medical evidence rules

The medical evidence rules were revised effective March 27, 2017. The changes in the medical evidence rules impacted the evaluation of different aspects of medical evidence evaluation, including who is considered to be an acceptable medical source and how we consider medical opinions and prior administrative medical findings. A detailed list of specific evidence rules that were revised can be found in DI 24503.050A.2.

b. Which medical evidence rules to use

At CDR, we might have to use the “prior rules” or the “current rules,” as described in DI 24503.050.

Initial claim filed before March 27, 2017

  1. 1) 

    If there has not been a prior CDR, use the prior rules.

  2. 2) 

    If there has been a prior CDR:

    • Use the prior rules if the comparison point decision (CPD) is before March 27, 2017, see DI 24503.035.

    • Use the current rules if the CPD is on or after March 27, 2017, see DI 24503.025 and DI 24503.035.

Initial claim filed on or after March 27, 2017

To determine which medical evidence rules to apply, we must look at the filing date of the initial claim associated with the CDR. The same rules will apply throughout the entire CDR determination or decision, including the appeals process. Detailed instructions can be found in DI 24503.050D.7.

C. The cessation or continuance determination

To determine whether a continuance or cessation is appropriate, follow the applicable continuing disability review sequential evaluation procedures in DI 28005.015 or DI 28005.030.

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DI 28005.009 - Evidence and Basis for a Continuing Disability Review (CDR) Decision by a Disability Determination Services (DDS) Adjudicative Team - 08/25/2022
Batch run: 08/25/2022