TN 1 (12-18)

DI 40505.100 Medical Improvement Expected (MIE) Cases with Work Activity

Events other than a medical alert, for example, work activity or voluntary report of medical improvement (MI), may initiate a Continuing Disability Review (CDR). If an individual with a Medical Improvement Expected (MIE) diary alleges medical recovery, conduct a CDR. A disabled individual may voluntarily report medical improvement or recovery. Unless the report clearly indicates no medical improvement, initiate a CDR. If the diary date does not show in the Disability Control File (DCF), refer to MS 001.017.

During the trial work period (TWP), do not conduct a medical CDR in Title II-only Medical Improvement Possible (MIP) or Medical Improvement Not Expected (MINE) cases. The field office (FO) will obtain an SSA-454-BK (Continuing Disability Review Report) and other necessary CDR information and then send this information to the Processing Center (PC) for folder association and CDR action. If the PC cannot take final action, they will send the folder back to the FO for needed development. When the FO completes development, they will send the folder to the Disability Determination Services (DDS).

A. Policy for Medical Improvement Expected (MIE) cases

Return to work in a MIE case may indicate medical recovery. In this situation, the Office of Disability Operations (ODO) will initiate a medical CDR and apply current MIE diary criteria listed in DI 26525.025, MIE Criteria. If the case does not meet current MIE criteria, adjudicate it under diary criteria in effect at the time of the allowance.

If an individual with a MIE diary returns to work and meets all of the following conditions, consider a clear-cut cessation, that is, a determination without full medical development. For instructions on clear-cut cessations, see DI 28030.035, Cessation Without Full Medical Development (Clear-Cut Cessations):

  • Returns to work full-time without significant medical restrictions;

  • Acknowledges that he or she had medical improvement as of the month he or she returned to work;

  • Expects to be able to continue to work;

  • Does not want us to consider medical evidence from the last 12 months before we make a determination; and

  • Does not have a mental impairment.

The PC or DDS may prepare a clear-cut cessation.

NOTE: We do not cease Title XVI cases for work activity; however, we may prepare a Title XVI clear-cut cessation if all of the criteria meet.

B. Folder review for MIE cases

1. MIE diary appropriate

Determine if a MIE diary is appropriate. Although the diary is appropriate, work activity may require investigation regardless of the medical issue.

2. MIE diary not appropriate

If the MIE diary is not appropriate, follow these instructions:

  1. a. 

    Cancel the MIE diary; establish a medical improvement possible (MIP) or medical improvement not expected (MINE) diary as appropriate, per DI 26525.001, Scheduling Continuing Disability Reviews (CDRs) – General Policies.

  2. b. 

    Take action on Title II work activity. (For instructions, see DI 13010.023, Processing Center (PC) Responsibilities for Continuing Disability Reviews (CDRs) involving Work Activity.)

  3. c. 

    Alert the FO of earnings if it is not clear whether the individual has reported earnings.

3. MIE diary appropriate; clear-cut cessation case

If the case is a clear-cut cessation case, follow these instructions:

  1. a. 

    Prepare a clear-cut cessation determination if the case meets all the criteria per DI 28030.035, Cessation Without Full Medical Development (Clear-Cut Cessations).

  2. b. 

    Prepare cessation notice with benefit continuation language.

  3. c. 

    Release the notice to the individual.

  4. d. 

    Forward folder to the FO for appeals period. Tell the FO to handle as a medical cessation and that benefit continuation rights apply.

4. MIE diary appropriate; not a clear-cut cessation case

If the case contains a detailed report of work, but it does not meet the clear-cut cessation provisions:

  1. a. 

    Document trial work period (TWP) months and date via the disability control file (DCF). If DDS does not establish a medical cessation, they will apply a TWP.

  2. b. 

    Explain the issue on SSA-847-U3 Social Security Administration Request for Action or SSA-5526-U3 Request for Assistance - Disability if the PC has not done the CDR interview; forward the folder to FO for necessary development.

5. MIE diary appropriate; case needs work investigation

If the report of work lacks the detail necessary for an evaluation:

  1. a. 

    Forward case to the FO via SSA-847-U3 or SSA-5526-U3 for development and CDR interview. Explain what information the FO should obtain;

  2. b. 

    If Title XVI is involved, request income and resources (I&R) decision and necessary I&R adjustment; and

  3. c. 

    Tell the FO to forward case to DDS for a medical determination after FO completes necessary actions.

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DI 40505.100 - Medical Improvement Expected (MIE) Cases with Work Activity - 12/18/2018
Batch run: 08/07/2019