Effective Dates: 06/01/2023 - Present Previous | Next

TN 10 (06-23)

DI 28015.320 Residual Functional Capacity (RFC) Comparison and Examples of Medical Improvement (MI) “Related” or “Not Related” to the Ability to Work

If use of different forms for the comparison point decision (CPD) and current assessments complicates RFC comparison, the Disability Determinations Services (DDS) medical consultant (MC) should prepare written comments on the SSA-416, SSA-4734-BK (part IV), or SSA-4734-F4-SUP (part III) on whether the RFC (considering only the CPD impairment(s) has increased.

A. Procedure for RFC comparison

1. General approach for RFC comparison

Use the general approach for RFC comparison decision in DI 28015.300.

For Title XVI recipients originally allowed as children and who attained age 18 before 08/22/96, apply the continuing disability review (CDR) evaluation process described in DI 28005.016 and DI 28005.017.

For Title XVI recipients originally allowed as children who attained age 18 on 08/22/96 or later, see Public Law 104-193 in DI 23570.006.

Certain cases require a disability redetermination instead of a CDR. If the recipient was originally allowed as a Title XVI child and no age-18 disability redetermination has been done, follow the instructions in DI 28005.003.

2. Changes in findings and RFC

a. Reasonable relationship considerations in assessment of “MI related”

The medical improvement review standard (MIRS) RFC assessment is an independent assessment, but before making a decision of “MI-related” based on RFC comparison, make sure there is a reasonable relationship among:

  • •

    the CPD RFC;

  • •

    changes in symptoms, signs, and laboratory findings; and

  • •

    MIRS RFC.

b. Avoid substitution of judgment

Do not find a significant increase in RFC from the CPD when relatively minor changes in symptoms, signs, and laboratory findings support a finding of MI. This would represent substitution of current judgment for the prior adjudicator, and would represent a reassessment of the prior RFC. This is prohibited per DI 28015.315.

c. When to reevaluate the MIRS RFC

If the interrelationship is not reasonable see DI 28015.320A in this section:

  • •

    Re-evaluate the MIRS RFC, and

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    Consider the appropriateness of finding MI related to ability to work.

d. Exercise judgment

Exercise judgment in deciding how much of a change in findings justifies a change in RFC.

3. Combined effect

Consider combined effect of all impairments present at the time of the CPD.

4. How much RFC change?

The adjudicative team need not find any particular quantity of RFC change to find MI related to ability to work. For example, an RFC consistent with sedentary work need not increase to an RFC consistent with light work. Find MI is related to ability to work if:

  • •

    Capacity to do any one particular basic work activity (e.g., reaching) increases;

  • •

    No change occurred in other capacities as they relate to the prior impairment(s); and

  • •

    Changes in findings support such a decision.

5. Comparing RFCs in mental impairment(s)

For information on forms completion in comparing RFCs in cases involving mental impairments, see DI 28010.140 and DI 28010.145.

B. Examples of MI “related” or “not related” to the ability to work

1. Example of venous insufficiency

a. CPD

The beneficiary is 65 inches tall and weighed 246 pounds. The beneficiary's venous insufficiency and persistent edema in their legs limited them to only occasional standing or walking. The beneficiary was able to sit for six hours.

b. CDR

The beneficiary underwent a vein stripping operation, now weighs 220 pounds, and has intermittent edema. The beneficiary is still able to sit for six hours at a time and to stand or walk only occasionally, although they report less discomfort on walking. MI has occurred based on the weight loss and improvement in edema. Find the MI not related to ability to work because RFC has not increased.

2. Example of back impairment

a. CPD

The beneficiary had a laminectomy to relieve nerve root impingement and weakness in their left leg. The beneficiary was able to stand less than six hours and sit no more than one-half hour at a time.

b. CDR

The beneficiary had a successful fusion operation one year ago. The weakness in the beneficiary's left leg decreased. The beneficiary now has no limitation in the ability to sit, stand or walk. Decreased weakness in the leg shows MI. Find MI related to ability to work based on increased RFC.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428015320
DI 28015.320 - Residual Functional Capacity (RFC) Comparison and Examples of Medical Improvement (MI) “Related” or “Not Related” to the Ability to Work - 06/01/2023
Batch run: 06/01/2023
Rev:06/01/2023