TN 10 (07-23)

DI 28040.215 Full Continuing Disability Review (CDR) Required in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

A. When to send a MINE or MINE-equivalent case to the field office (FO) for a full CDR

Send the case to the FO for a full CDR if:

  • The beneficiary or recipient, representative payee, or representative reports medical improvement that raises a continuing disability (CD) issue.

  • Conflicts exist between statements made by the beneficiary or recipient, payee, or representative and the evidence in file regarding the comparison point decision (CPD), and such conflicts raise a CD issue.

  • The beneficiary or recipient's medical source or other third-party contact indicates work activity since the CPD.

  • Based on disability determination services (DDS) review, a cessation appears appropriate.

  • The evidence does not clearly show the existence of a MINE or MINE-equivalent impairment (including lost folders).

Reported medical improvement does not automatically raise a CD issue. If it is clear that a beneficiary or recipient's impairment(s) still meets or equals the severity of a listing (e.g. a double amputee), then any reported medical improvement could not reasonably be expected to result in a cessation.

In a CDR review where a listing is met or equaled, only the non-medical exceptions such as fraud or similar fault, failure to cooperate, or return to work would be expected to result in a cessation.

EXAMPLE: The evidence of record in the CPD shows the beneficiary or recipient's has ischemic heart disease which met Listing 4.04Al. Contact with the beneficiary or recipient shows no work, but the individual indicates they have had heart surgery and reports some improvement in their condition. Contact with the medical source addresses the surgery and the issue of medical improvement. Because the medical source indicates that the surgery has significantly improved the beneficiary or recipient condition, a medical cessation is possible. Send the case to the FO for a personal contact and a full CDR.

B. How to send the case to the FO for a full CDR

Clear any case for which there is a CD issue and remove it from the MINE or MINE-equivalent process. To initiate a full CDR:

  • If the file contains a form SSA-847 (SSA Request For Case Action), do not reclassify the case on the form as medical improvement possible or expected (MIP or MIE) before routing it to the FO.

  • The DDS will refer the case as a no determination (ND). For processing “no determination” findings, see DI 28030.001E.

  • Alert the FO that the MINE or MINE-equivalent process does not apply (despite the annotation on the SSA-847).

Upon return of the case to the DDS, the MINE or MINE-equivalent criteria will no longer apply. The DDS will develop, evaluate, and determine the case, applying the “regular” CDR determination process as in DI 28005.015. The DDS will establish the proper diary for any continuances.

NOTE: Certified Electronic Folders (CEF) have different methods to use when closing or routing cases. For electronic case procedures, refer to the appropriate section in DI 81020.000.

C. References

  • DI 28030.001 Initial Receipt of the Case by the Disability Determination Services (DDS)

  • DI 81020.127 Processing “No Determination” (ND) Claims

  • DI 81020.240 Electronic Continuing Disability Review (eCDR) Determinations

  • DI 81020.250 Closing and Routing Electronic Continuing Disability Review (eCDR) Cases

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DI 28040.215 - Full Continuing Disability Review (CDR) Required in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 07/31/2023
Batch run: 07/31/2023