TN 16 (04-23)

DI 28005.015 Step-by-Step Discussion of the Title II and Adult Title XVI Continuing Disability Review (CDR) Sequential Evaluation Process

A. Discussion of the 8-Step Title II and adult Title XVI CDR sequential evaluation process

This subsection corresponds with the numbered steps in the chart located in DI 28005.010. For adults originally allowed as children under Title XVI, see DI 28005.003. Consider the Group II exceptions at any point during the CDR sequential evaluation process.

On case receipt, thoroughly review the comparison point decision (CPD) and the CPD evidence that supports the CPD. The CPD is the most recent favorable decision, see DI 28010.020. The CDR adjudicator must not substitute their own judgment for that of the prior adjudicator when reviewing CPD evidence, see DI 28005.007.

NOTE: Reviewing only the assessment summary from the CPD is not a thorough review of the CPD evidence. The CDR adjudicator must review all of the CPD evidence that supports the CPD including the signs, symptoms, and laboratory findings.

1. Step 1 - substantial gainful activity (SGA)

The first step in the CDR evaluation process is to determine whether the individual is performing SGA. This is a field office (FO) responsibility and determination. The FO determines if disability ceases based on performance of SGA.

SGA cessation determinations are not applicable to Title XVI cases for work performed after June 30, 1987. For additional information on this issue, see DI 28075.600. Since SGA is not a consideration in the sequential evaluation process for Title XVI disability recipients, proceed directly to step 2 below.

In concurrent Title II and Title XVI cases, an individual whose Title II benefit ends due to performance of SGA may retain Title XVI eligibility:

  • during the trial work period (TWP), or

  • when deciding whether an individual continues to have a disabling impairment for purposes of an extended period of eligibility (EPE) or other work incentive benefits.

In concurrent case scenarios that contain documentation of a work incentive program such as a TWP or EPE, do not send the case to the FO for development of SGA.

Once the FO has resolved any work issues for SGA, the disability determination services (DDS) adjudicator must identify the CPD. After identifying the CPD, the adjudicator can continue to Step 2 of the CDR sequential evaluation process. For additional information on identifying the CPD, see DI 28010.020.

Although the SGA determination is primarily the FO responsibility, sometimes work issues may arise during the CDR at the DDS level. For details on DDS work activity development responsibilities, see DI 24001.005C.

2. Step 2 - meets or equals a current listing

Review the evidence in the file and document the individual’s current alleged impairment(s). Then, determine whether any impairment(s) meet or equal a listing in the current Listing of Impairments:

  • If yes, find that disability continues.

  • If no, go to Step 3.

NOTE: At step 2, we do not consider what the individual’s impairment(s) was at the time of the CPD, nor do we consider the basis for having found the individual disabled previously. We consider if any impairment(s) the individual currently has meets or equals a current listing.

3. Step 3 - medical improvement (MI)

Review the CPD evidence and identify relevant medical signs, symptoms, or laboratory findings for the same impairment(s) that were present at the CPD. Then, compare the signs, symptoms, or laboratory findings for the same impairment(s) at the CDR to determine whether there is a decrease in the medical severity of the impairment(s) at the CDR. For MI to occur, there must be a decrease in the medical severity of any of the impairments present at the time of the CPD. Minor changes in any CPD impairment do not demonstrate MI. For additional information relating to MI, see DI 28010.000.

Decide whether MI occurs:

  • If there is MI, go to Step 4.

  • If there is no MI, go to Step 5.

4. Step 4 - relating MI to the ability to work

When determining if MI relates to the ability to work, consider only the CPD impairment(s) and, if applicable, consider age and time on the rolls instructions in DI 28015.310. For detailed instructions on relating MI to the ability to work, see DI 28015.000

Two mechanisms to determine if MI relates to the ability to work:

  • Prior listing mechanism: If the basis of the CPD was meeting or equaling a listing and the individual still meets or equals that prior listing or any of the subsections of that listing as it appeared at the time of the CPD (including a listing that has since been revised or is now obsolete), then MI does not relate to the ability to work. For consideration of prior listings, see DI 28015.050 and DI 28015.055.A summary list of changes to the Listing of Impairments, and the effective date of the changes, is located in DI 27516.010F. Obsolete versions of the adult listings may be located at DI 34100.000 and DI 34200.000.

  • Residual functional capacity (RFC) comparison mechanism:If the CPD was based on medical and vocational factors, compare the findings in the evidence used to support the “CPD RFC” with the findings in the evidence for the same impairments evaluated in the “medical improvement review standard (MIRS) RFC” or other assessment document (such as a SSA-416 UF if the CPD impairment(s) is not severe at the CDR). Do not attempt to reassess the "CPD RFC." If there is no improvement in the individual's ability to perform work related tasks, then MI does not relate to the ability to work. For additional information on RFC assessments, see DI 28015.300 and DI 28015.855).

Decide whether MI relates to the ability to work:

  • If MI does not relate to the ability to work, go to Step 5.

  • If MI relates to the ability to work, go to Step 6.

5. Step 5 - exceptions

Group I and Group II exceptions to MI permit a finding that disability ceased in situations where even though there has been no MI or MI is not related to the ability to work, evidence clearly shows that the person should not longer be considered disabled or never should have been considered disabled.

There must be evidence supporting the finding that a Group I or Group II exception are applicable. If the evidence does not support the finding, then the adjudicator should not apply an exception.

The Group I exceptions apply at step 5 of this sequential evaluation process and may result in a finding that an individual is no longer disabled. For information on Group I exceptions, see DI 28020.001B1.

Group II exceptions can apply at any step of the CDR sequential evaluation process and do not require a determination that an individual has medically improved or can engage in SGA. For information on Group II exceptions, see DI 28020.900.

Decide whether an exception to MI applies:

  • If no exception applies, find that disability continues.

  • If one of the Group I exceptions applies, go to Step 6.

  • If one of the Group II exceptions applies, then the adjudicator may find that disability ceases at any point in the 8-Step CDR evaluation process without a medical determination.

6. Step 6 - severity of current impairment(s)

Decide whether the individual has any severe impairment(s) and assess the current RFC considering all current impairments. Our policy defines a “severe” impairment as an impairment that causes limitations having more than a minimal effect on an individual’s capacity to perform basic work activities, see DI 24505.001. For more information on the RFC assessment, see DI 28015.850. If applicable, consider age and time on the rolls instructions, see DI 28015.310.

If the individual’s impairment(s) has medically improved but remains severe or a current impairment is not severe, the DE proceeds to step 7.

Conversely, if the individual’s CPD impairment(s) has medically improved and there is no evidence of a current severe impairment(s), a cessation is appropriate.

Determine if the individual currently has any severe impairment(s):

  • If yes, prepare the RFC assessment and go to Step 7.

  • If no, find that disability ceases.

7. Step 7 - past work

If the individual's combined medical conditions impose limitations on their current RFC, consider the individual's capacity to do their past relevant work (PRW). Do not consider work during the current period of disability (or current period of extended Medicare) as relevant work experience, see DI 25001.001A.64. For expedited reinstatement (EXR) cases, do not consider work that has occurred since the CPD; this will not be considered PRW.

If the vocational evidence is not sufficient to evaluate past work at step 7, adjudicators may consider use of a vocational expedient, see DI 25005.005 .

Decide whether the individual has the ability to perform past relevant work:

  • If yes, find that disability ceases.

  • If no, go to Step 8.

8. Step 8 - other work

If the individual's current medical condition precludes performing PRW or there is insufficient evidence regarding the individual’s PRW, consider the individual’s ability to adjust to other work existing in the national economy by considering the RFC and the vocational factors of age, education, and work experience, as appropriate in the case. Decide whether the individual has the ability to do other work:

  • If yes, find that disability ceases.

  • If no, find that disability continues.

NOTE: Consider borderline age situations if an individual is within a few days to a few months of reaching a higher age category and using the chronological age results in a cessation. Consider using the higher age category if it results in a continuance, after RFC, age, education, and work experience have all been evaluated. Specific criteria must be met, see DI 25015.006C for information on identifying a borderline age situation.

B. References

  • DI 24001.005 Work Activity Development Responsibilities

  • DI 25010.000 Special Medical-Vocational Profiles Showing an Inability to Adjust to Other Work

  • DI 25015.000 Ability to Perform Other Work

  • DI 28005.010 The Continuing Disability Review (CDR) Evaluation Process Summary Chart for Title II and Adult Title XVI Individuals

  • DI 28010.000 Medical Improvement and Related Medical Issues

  • DI 28015.000 Relating Medical Improvement to the Ability to Work – Title II and Adult Title XVI Beneficiaries

  • DI 28020.000 Exceptions to Medical Improvement

  • DI 28055.001 Extended Period of Eligibility (EPE) and Related Medicare Provisions – General

  • DI 28075.000 Special CDR Issues

  • DI 34001.001 Listing of Impairments -- Purpose, Parts and Use


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DI 28005.015 - Step-by-Step Discussion of the Title II and Adult Title XVI Continuing Disability Review (CDR) Sequential Evaluation Process - 04/14/2023
Batch run: 04/14/2023
Rev:04/14/2023