TN 9 (05-23)

DI 28010.135 Medical Improvement Review Standard (MIRS) Issues in Adult and Child Cases Involving Mental Impairments

A. Historical background of mental disorders listings

A brief history of significant regulatory changes include:

  • August 1985: SSA made significant changes in the adult mental disorders listings (Listing 12.00).

  • December 1990: SSA made significant changes in the childhood mental disorders listings (Listing 112.00).

  • February 1997: Pursuant to P.L. 104-193, SSA made further changes to the childhood mental disorders listings (The “paragraph B” criteria were changed. References to “maladaptive behaviors” in 112.00C2 and 112.02B2.c.(2) were removed, and the “personal/behavioral” area of functioning was redesignated as the “personal” area of functioning). For recipients who attained age 18 before August 22, 1996, SSA performs continuing disability reviews (CDRs) (instead of disability redeterminations). See DI 28005.016 and DI 28005.017.

  • January 2017, SSA made significant changes to evaluating the mental disorder listings based on the Final Rule "Revised Medical Criteria for Evaluating Mental Disorders." SSA changed the paragraph A criteria in each listing, revised the paragraph B criteria, revised the paragraph C criteria, simplified listing 12.05 for evaluating intellectual disorder, and added three listings for adults and children.

B. Introduction to MIRS and mental disorders

Evidence supporting pre-August1985 comparison point decisions (CPDs) based on the adult mental disorders listing criteria, or pre-December 1990 CPDs based on the childhood mental disorders listing criteria, often does not focus on the factors relevant to severity assessment under the revised mental disorders listings. This complicates the evidence-to-evidence comparisons needed under the MIRS. This section addresses this problem and outlines factors relevant to MIRS decisions in cases involving mental impairments.

C. Reviewing mental disorders using MIRS

1. Evidence consideration

All of the factors considered in assessing mental impairments (e.g., the paragraph A, B, and C criteria in the mental disorders listings) meet the regulations' definition of symptoms, signs, or laboratory findings (12.00B/112.00B of the listing). Consider all these factors in making MIRS comparisons.

2. Comparison for medical improvement (MI)

Apply DI 28010.015 in the comparison of symptoms, signs, and laboratory findings.

3. Assessment

Apply the principles in DI 24583.005 for cases involving the evaluation of mental impairments. For information about which assessments may be used in CDR cases for different scenarios (i.e. no MI, meets a listing, etc.), see DI 28010.050.

  • For specific information about completion of the psychiatric review technique (PRT) or mental residual functional capacity (MRFC) in CDR cases, see DI 28010.140 and DI 28010.145, respectively.

  • For information about completing the assessment documents and documenting determinations on the prescribed form for Title XVI child cases, see DI 25230.001, DI 25230.005, and DI 28005.030C4.

4. Evaluating Medical Improvement Not Expected (MINE) impairments

Several mental impairments are considered permanent and severe enough to warrant a MINE diary, such as intellectual disability (listing 12.05A or B or 112.05A) and autistic or other pervasive developmental disorders (listing 12.10 or 112.10); see DI 26525.045. If the individual had a MINE impairment established at the CPD, evidence development at the CDR can often be abbreviated, and the adjudicator may use nonmedical evidence without new medical evidence to find that disability continues if evidence is consistent with such a conclusion; see DI 28030.020A. Functional information may fully support a continuance without the need for extensive development of medical records at the time of the CDR. For additional information about MINE or MINE-equivalent cases, see DI 28040.125.

5. Related procedure

Before making an unfavorable MIRS decision in a case involving a mental impairment(s), carefully consider the following:

  • Consider the longitudinal history from the evidence, including both medical and non-medical evidence sources. For purposes of evaluating medical improvement, a medically determinable impairment (MDI) does not need to be re-established. Rather, consider sources of medical evidence and functional evidence to evaluate MI; see DI 22511.000.

  • Rating the degree of functional limitations resulting from a mental impairment(s) considering different factors; see DI 24583.005D

  • Consider whether the evidence has been developed sufficiently so that medical improvement and related issues can be evaluated; see DI 28005.009.

  • If the impairment is subject to temporary remission, consider whether any improvement demonstrated may actually only represent temporary remission or improvement of an impairment where symptoms wax and wane, see DI 28010.115.

  • Consider whether the individual's impairment(s) still meets or equals the listing met or equaled at CPD, see DI 28015.050. The flexible approach to the CDR sequential evaluation process may be appropriate to potentially expedite development; see DI 28005.005C

  • Consider whether age and time on the rolls is an applicable factor in Title II and adult Title XVI CDR cases; see DI 28015.310.


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DI 28010.135 - Medical Improvement Review Standard (MIRS) Issues in Adult and Child Cases Involving Mental Impairments - 05/08/2023
Batch run: 05/08/2023