TN 12 (10-23)

DI 28010.030 Evaluating Listings with a Specified Timeframe at the Continuing Disability Review (CDR)

A. Definition of “listing with a specified timeframe”

A listing in the Listing of Impairments that indicates a specific length of time for the disability is a “listing with a specified timeframe.” For example, listing 6.04 (“Chronic kidney disease, with kidney transplant”) is a listing with a specified timeframe because the language of listing 6.04 indicates the impairment is disabling for 1-year following the transplant. Some listings direct the number of months or years the impairment meets the listing.

B. Current listings with a specified timeframe

The following table contains current listings that include a specified timeframe:

Listings with a Specified Timeframe

Adult

Child

Impairment

Specified Timeframe

Consider under a disability for…

2.11A

102.11A*

Hearing loss treated with cochlear implantation

Adult criteria: 1 year after initial implantation

Child criteria: Until the attainment of age 5 or for 1 year after initial implantation, whichever is later

N/A – Corresponding 2.11B does not indicate a time period for which the impairment is considered disabling

102.11B*

Hearing loss treated with cochlear implant with a word recognition score of 60 percent or less determined using the HINT or the HINT-C test

Upon the attainment of age 5 or 1 year after implantation, whichever is later

N/A- The corresponding adult listing does not contain a specified timeframe

103.02E*

Chronic Respiratory Disorders, with chronic lung disease of infancy (CLD), in children who have not attained age 2, requiring three hospitalizations within a 12-month period and at least 30 days apart

1 year from the discharge date of the last hospitalization or until the attainment of age 2, whichever is later

3.03B

103.03

Asthma

1 year from the discharge date of the last hospitalization

3.11

103.11

Lung transplant

3 years from the date of the lung transplant

4.09

104.09

Heart transplant

1 year following surgery

N/A

104.13

Rheumatic heart disease, with persistence of rheumatic fever activity…and other associated abnormal laboratory findings…

18 months from the established onset of impairment

5.02

105.02

Gastrointestinal hemorrhaging from any cause, requiring blood three transfusions…

1 year following the last documented transfusion

5.05A

105.05A

Chronic liver disease, with hemorrhaging…and requiring hospitalization for transfusion…

1 year following the documented transfusion

N/A

105.05H

Chronic liver disease, with extrahepatic biliary atresia

1 year following diagnosis

5.09

105.09

Liver transplantation

1 year from the date of the transplant

5.11

105.11

Small intestine transplantation

1 year from the date of the transplant

5.12

105.12

Pancreas transplantation

1 year from the date of the transplant

6.04

106.04

Chronic kidney disease, with kidney transplant

1 year following the transplant

N/A

106.07

Congenital genitourinary disorder requiring urologic surgical procedures at least three times in a consecutive 12-month period, with at least 30 days between procedures

1 year following the date of the last surgery

N/A

113.03A

Malignant solid tumors (initial diagnosis)

24 months from the date of initial diagnosis

N/A

113.03B

Malignant solid tumors (recurrence of active disease)

24 months from the date of recurrence of active disease

N/A

113.05A1 or B1

Lymphoma excluding all types of lymphoblastic lymphomas

24 months from the date of diagnosis

13.11D

N/A

All other cancers originating in bone with multimodal anticancer therapy

12 months from the date of diagnosis

NOTE: The Listings with a Specified Timeframe table may not be all-inclusive and is subject to change due to updates and revisions in the listings. For the current medical listings, refer to DI 34000.000. For additional information on evaluating listings that contain a specified time frame or an age-based period of disability (annotated with an asterisk in the table above), see DI 28010.029B.

C. Evaluating impairments that met or equaled a listing with a specified timeframe in the CDR determination

1. Title II and adult Title XVI CDRs involving a listing with a specified timeframe

a. Follow the Title II and adult Title XVI CDR sequential evaluation process

In any adult CDR that occurs after the specified timeframe in the listing expires, we must follow the steps in the CDR sequential evaluation process to make the determination. See DI 28005.015.

b. Considerations when evaluating an adult CDR with a listing with an expired specified timeframe

  • If no impairment(s) meets or equals a current listing at Step 2 of the CDR sequential evaluation process we must consider if there are any improvements in signs, symptoms, or laboratory findings at Step 3. See DI 28010.000 for evaluating medical improvement (MI).

  • If there is MI at Step 3, find that MI relates to the ability to work through the prior listing mechanism at Step 4, see DI 28005.015A.4.

  • Follow the remaining steps in the CDR sequential evaluation process.

NOTE: In all CDRs that involve a listing with a specified timeframe, after the specified timeframe expires, the impairment no longer meets or equals the comparison point decision (CPD) listing unless there has been an intervening recurrence.

2. Title XVI child CDR cases involving a listing with a specified timeframe

a. Follow the Title XVI child CDR sequential evaluation process

In a Title XVI child CDR that occurs after the specified timeframe in the listing expires, we must follow the steps in the CDR sequential evaluation process to make the determination. See DI 28005.030.

b. Considerations when evaluating child CDR cases that met or equaled a listing with an expired specified timeframe

  • Consider if MI has occurred in the child’s impairment(s), see DI 28010.001 for a definition of MI. If MI has occurred, at Step 1, find that the prior listing is no longer met or equaled at Step 2 because the timeframe in the listing has expired.

  • Evaluate any resulting impairment(s) under the appropriate body system criteria as designated in the introductory language or as directed in the individual listing(s).

  • Continue to Step 3.

NOTE: In all CDRs that involve a listing with a specified timeframe, after the specified timeframe expires, the impairment no longer meets or equals the CPD listing unless there has been an intervening recurrence.

D. Case examples involving a listing with a specified timeframe

1. Currently meets or equals a listing

CPD evidence: A 24-year-old individual was diagnosed with profound bilateral hearing loss and they underwent bilateral cochlear implantation. The individual’s condition met the criteria of listing 2.11A and the adjudicator scheduled the diary to expire 1 year following implantation.

CDR evidence: The CDR is initiated 14 months after the cochlear implantation. Current medical evidence indicates that the individual’s word recognition score is 52% based on valid Hearing in Noise Test (HINT), and the individual’s hearing loss currently meets listing 2.11B.

Discussion: The individual’s impairment currently meets listing 2.11B at Step 2 of the Title II and adult Title XVI CDR sequential evaluation process. MI and the CPD listing are not considered in this example because the impairment meets a current listing earlier in the sequential evaluation process.

2. MI related to the ability to work occurred

CPD evidence: A 45-year-old individual underwent a heart transplant in 03/2021 that met listing 4.09. The individual’s ejection fraction (EF) was 16% pre-transplant, and greater than 65% post-transplant. The language of the listing specified “consider under a disability for 1 year…” Due to the individual’s heart failure, they exhibited a decreased ability to perform activities of daily living, including limitations in standing and walking to only 10 yards before experiencing shortness of breath and fatigue.

CDR evidence: The individual reports intermittent chest pain and inability to stand for extended periods. The evidence indicates the individual’s heart has regular rate and rhythm, and a recent echocardiogram shows an EF of 60%. At the CDR, the individual also experienced an improvement in the ability to perform daily activities and standing and walking. Evidence indicates the individual walks a mile each day for exercise without shortness of breath or significant fatigue.

Discussion: Evidence does not show a condition that meets or equals any other current listing at Step 2 and MI is demonstrated at Step 3 based on the improved EF, improvement in daily functional activities such as standing and walking, and the improvement in shortness of breath and fatigue with activity. The specified timeframe in listing 4.09 has expired; therefore, the individual’s heart condition no longer meets the CPD listing at Step 4 and the MI is related to the individual’s ability to work. The adjudicator must proceed to Step 6 and evaluate residual functioning if a Group II exception does not apply.

3. Obsolete listing

CPD evidence: A 56-year-old individual had complaints of fatigue and abdominal pain. The individual underwent a kidney transplant in 10/2014. The individual’s condition met listing 6.02B and the language of the listing contained the following language: “Consider under a disability for 12 months following surgery.” At the CPD, the pre-transplant laboratory values documented stage 4 kidney disease. The individual experienced fatigue, unintended weight loss of 15 pounds from their baseline, swelling in the feet and ankles, and abdominal pain. Due to their fatigue and painful swelling, the individual reported that they were only able to stand and walk to perform activities for approximately 15 minutes at the time before needing to rest at least 45 minutes before resuming activities.

CDR evidence: Conducted in 01/2016: The transplanted kidney is functioning well, based on laboratory values within the normal range. The individual no longer has swelling in the feet and ankles and has gained approximately 10 pounds from the CPD due to increased appetite. However, the individual still complains of fatigue and abdominal pain. Evidence indicates that the individual is able to stand and walk to perform activities, such as grocery shopping, for about one hour before needing to rest.

Discussion: The individual does not have a condition that meets or equals any current listing at Step 2 of the Title II and adult Title XVI CDR sequential evaluation process. MI is demonstrated at Step 3 based on improved laboratory values, an increase in functional ability, and reduced swelling in the feet and ankles. At Step 4, it is important to recognize that listing 6.02B, which was met at the CPD, is obsolete at the time the CDR is initiated. The impairment cannot meet or equal subsection B of obsolete listing 6.02 because it is more than one year post-transplant. The impairment also does not meet the other subsections of obsolete listing 6.02. Therefore, the adjudicator must find that MI relates to the ability to work. The adjudicator must proceed to Step 6 and evaluate residual functioning if a Group II exception does not apply.

4. Child case

CPD evidence: A 14-year-old child was diagnosed with Hodgkin lymphoma with bone marrow involvement, meeting listing 113.05B1. The listing contains the following language: “Consider under a disability for 24 months from the date of diagnosis.” The evidence documented fevers occurring approximately twice a month, decreased energy, loss of appetite with accompanying weight loss, and chest pain. The child had swollen lymph nodes in the neck and armpit, causing limitations in reaching objects.

CDR evidence: The CDR is initiated 26 months from the date of the Hodgkin lymphoma diagnosis. The child maintains normal weight, strength, and range of motion with the improved ability in reaching objects. The child received bone marrow transplant on 07/2021 and current laboratory findings show no evidence of disease. The evidence indicates the child has not experienced a fever over the last 4 months and there is no swelling present in the lymph nodes in the armpit or neck. The child has increased energy and appetite, and has gained five pounds since the CPD.

Discussion: MI is demonstrated at Step 1 based on the improvement in signs and symptoms and the laboratory findings that show no evidence of disease. At Step 2, the CPD impairment (Hodgkin lymphoma) does not meet or equal the CPD listing or any subsections of the listing due to expiration of the timeframe. The adjudicator must proceed to Step 3 of the sequential evaluation process if a Group II exception does not apply.

E. Considerations for setting a new diary when the continuance is based on a listing with a specified timeframe

In any continuance based on a listing with a specified timeframe, the adjudicator must establish a medical improvement expected (MIE) diary.

A MIE diary may be set to mature up to age 59 1/2 for individuals whose case facts indicate that recovery or remission is almost certain (e.g., surgery or current significant, sustained, and progressive improvement will result in cessation under the MIRS). Examples include certain cancers (follow DI 26525.010), leukemias, and lymphomas; fractures, dislocations, sprain; etc.

Generally, set the MIE diary to mature only up to age 54 1/2. The MIE diary cannot exceed 30 months due to system limitations. Generally, set a MINE diary for individuals who will be age 54 1/2 or older at the time a MIE diary would mature, except in the limited situations above.

For additional information about the use of MIE diaries, see DI 26525.020B and DI 26525.020C.

F. References

  • DI 26525.001 Scheduling Continuing Disability Reviews (CDRs) - General Policies

  • DI 26525.010 Cancer - Special Instructions

  • DI 26525.020 The MIE Diary – General

  • DI 26525.025 MIE Criteria

  • DI 28010.029 Overview of How to Evaluate Medical Improvement (MI) Involving Listings with Time Periods for Which an Impairment is Considered Disabling at the Continuing Disability Review (CDR)

  • DI 28010.035 Evaluating Listings with Minimum Time Periods at the Continuing Disability Review (CDR)

  • DI 28010.040 Evaluating Listings with Age-Based Period of Disability at the Continuing Disability Review (CDR)

  • DI 28015.050 Consideration of Prior Listing

 


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DI 28010.030 - Evaluating Listings with a Specified Timeframe at the Continuing Disability Review (CDR) - 10/06/2023
Batch run: 10/06/2023
Rev:10/06/2023