Effective Dates: 07/27/2015 - Present Previous | Next

TN 15 (12-04)

DI 26525.025 MIE Criteria

A. Procedure - general

1. Initial Claims

Set a MIE diary in initial allowances to mature at a time when the MIRS criteria will probably be met.

a. Title II Cases and Title XVI Adult Cases

For all title II cases and title XVI adult cases, this means that all the following conditions will probably be met:

  • •

    The individual's impairment(s) will have medically improved, and

  • •

    The medical improvement will be related to the ability to work, and

  • •

    The individual will have the ability to work.

b. Title XVI Child cases

For title XVI child cases, this means that all the following conditions will probably be met:

  • •

    The child's impairment(s) will have medically improved, and

    • —

      The impairment(s) will no longer meet or equal the comparison point decision listing, and

    • —

      The impairment(s) will no longer cause marked and severe functional limitations.

c. To Make Judgment

To make this judgment:

  • •

    evaluate the case facts under the criteria in DI 26525.025B.

  • •

    take into account other impairments or any adverse vocational factors (at the time of diary maturity) which would preclude cessation.

d. Set MIE Diary

When warranted per DI 26525.025A.1., set the MIE diary for the most appropriate reason in DI 26525.025B.

NOTE: See DI 26525.030 for examples of impairments, which may warrant a MIE diary when a criterion in DI 26525.025B. is met.

2. CDRs

Set a MIE diary after a CDR only when MIRS criteria will almost certainly be met (e.g., the 3-year remission rule will be met in a case which meets or medically equals the cancer listings (13.00 or 113.00)).

3. Exclusions

a. General

Generally exclude from MIE diary cases which will mature at age 54 1/2 or later. Set a MINE diary in these cases.

b. Exceptions

Set the MIE diary to mature up to age 59 1/2 for individuals whose case facts indicate that remission or recovery is almost certain (e.g., the individual is currently in remission; recent or scheduled surgery will resolve the impairment; current significant, sustained, and progressive improvement will lead to full recovery). Examples include certain cases involving:

  • •

    fractures, sprains, or dislocations

  • •

    cancers (see DI 26525.010), lymphomas, or leukemias

  • •

    title XVI statutory blindness when the individual is expected to no longer be statutorily blind (set the MIE diary to mature up to age 64 1/2 in these cases). CDRs are necessary in these cases to determine if these individuals continue to be eligible for special blindness benefits.

B. Procedure - MIE criteria

Set a MIE diary when cessation under the MIRS is expected and one or more of the following MIE criteria are met:

1. Adults and Children

The following criteria apply to adults and children.

SITUATION

MIE CRITERIA

MIE REASON CODE

CURRENT MEDICAL IMPROVEMENT

The disabling impairment of any medical onset is:

  • •

    demonstrating significant, sustained, and progressive improvement, and

  • •

    severe, irreversible functional limitations are not anticipated after healing, which would preclude the ability to work in adults, or no longer result in marked and severe functional limitations in children.

Q

IMPROVEMENT UNPREDICTABLE

Initial medical onset of the disabling impairment is within 3 months of adjudication, and:

  • •

    no severe, irreversible organ or structural damage is confirmed, and

  • •

    the outcome is highly unpredictable due to the nature of the impairment(s).

O

INTERVENTION

A recent or planned treatment, therapy, or remediation (excluding surgery) should result in significant and sustained medical improvement. (Recent or planned means within 3 months of the current determination.)

S

MULTIPLE MIE CRITERIA

More than one MIE criterion applies

T

ONSET WITHIN 12 MONTHS

Initial medical onset for the disabling impairment is within 12 months of adjudication, and

  • •

    no severe, irreversible organ or structural damage has been confirmed, and

  • •

    the impairment is responding favorably to treatment or therapy.

P

REMISSION

The disabling impairment is in remission or is likely to remit for sustained periods with prescribed treatment or therapy (e.g., inflammatory arthritis without irreversible joint destruction when the individual is responding to therapy).

NOTE: See DI 26525.010 for guidelines in neoplastic cases.

R

SURGERY

Adjudication takes place in the post-surgical convalescent period or surgery is scheduled within 3 months of adjudication, and the surgery should either:

  • •

    resolve the impairment, or

  • •

    result in no permanent severe, irreversible structural damage, which would preclude the performance of work in adults, or no longer result in marked and severe functional limitations in children.

H

2. Children Only

The following criteria apply to children only.

SITUATION

MIE CRITERIA

MIE REASON CODE

MEDICAL IMPROVEMENT EXPECTED

When medical improvement and the impairment(s) should no longer result in marked and severe functional limitations (i.e., should no longer meet, or medically or functionally equal the severity of the listings). See DI 25235.005B.2.c.

A

IMPROVEMENT UNPREDICTABLE

When improvement cannot be predicted because of the child's age at adjudication.

NOTE: Children in the following two categories are considered disabled until age 1 per DI 25215.010A. MIE diary should ordinarily be set in these cases. However, a MIE diary is not appropriate if it is clear that the child will remain disabled regardless of life-saving surgery or maturation.

The timing of the diary date is a matter of adjudicative judgment as to when medical improvement is likely to occur. Set the diary to mature at age 1 if medical improvement is expected by that time, or at any appropriate later date within 3 years of adjudication.

B

MAJOR CONGENITAL ORGAN DYSFUNCTION

When the child has a major congenital dysfunction which could be expected to result in death within the first year of life without surgical correction and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both) until attainment of 1 year of age.

(See DI 25235.005B.2.a. for additional discussion of this MIE criterion.)

C

LOW BIRTH WEIGHT

When the infant meets the low birth weight criteria for listing 100.04, set the diary in accordance with the instructions in DI 25235.006.

D
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0426525025
DI 26525.025 - MIE Criteria - 07/27/2015
Batch run: 12/19/2017
Rev:07/27/2015