TN 11 (01-17)

A. Policy for deciding continuance of disability

The 1984 disability amendments (P.L. 98-460) establish a medical improvement review standard (MIRS) for all continuing disability determinations made after October 9, 1984. These amendments ensure benefits continue for beneficiaries whose disabling condition(s) has not medically improved. The 1984 amendment requires the period of disability to continue unless:

• the disabling condition(s) improved since the last favorable disability determination, and

• the individual can now engage in substantial gainful activity (SGA), when relevant.

NOTE: MIRS does not apply in an Age-18 Redetermination, see DI 11070.001.

B. Exceptions to the MIRS

When conducting a CDR, the disability determination services (DDS) can make a determination to cease benefits without showing medical improvement in some situations known as Group I and Group II exceptions, see DI 28020.001. Similar provisions reflecting the ability to engage in gainful activity (rather than SGA), apply to a CDR that involves widow(er), surviving divorced spouse, and childhood disability beneficiaries. FOs and processing centers (PCs) use the SGA exception to find that a disabled individual’s disability ceases based on work activity. The SGA exception does not apply until the individual completes an applicable trial work period (TWP). For more information on the TWP, see DI 13010.035.

We use the MIRS in any DDS determination to determine whether the disabled individual continues to have a disabling impairment(s) for purposes of continuing entitlement under the work incentive provisions, such as extended period of eligibility (EPE), extended Medicare eligibility and Title XVI Section 1619.

NOTE: Group I exceptions in DI 28020.001, do not apply to Title XVI cases when the individual is eligible under Section 1619 at the time of the continuing disability decision, or has been eligible at any time within the last 12 months.

Do not apply the SGA exception in:

• the DDS determination for medical severity during the EPE, or

• any Title XVI case because if the Supplemental Security Income (SSI) recipient engages in SGA he or she may still be eligible for benefits under the Section 1619 work incentive provisions, see DI 13005.016.

NOTE: For more information on the procedures to the exceptions of MIRS, see DI 28020.000.

C. Medical improvement diaries

At the time of an initial allowance and after a medical review, the DDS establishes diaries based on the individual’s impairment(s). The three types of medical diaries are:

• medical improvement expected (MIE),

• medical improvement possible (MIP), and

• medical improvement not expected (MINE).

NOTE: For additional information on the frequency of medical improvement diaries, see DI 28001.020.

When there is a report of work activity in a case with a MIP or MINE diary, we will not initiate a medical CDR (unless medical improvement is alleged) because we did not expect and could not predict medical improvement (MI).

Without a medical review, we can establish a TWP on the basis of the disabled individual’s work earnings. Establish a flag using form SSA-1208 in these cases, so that if the individual do not complete his or her TWP (work stopped), we can initiate a medical review under the overdue MIP or MINE diary. The concept of clear-cut cessation does not apply to cases with a set diary of MIP and MINE.

NOTE: To create an alert or flag for a case in the Electronic Disability Collect System (EDCS), see DI 81010.080.

D. References:

• SI 02302.010 1619 Policy Principles

• DI 11070.001 Public Law (P.L.) 104-193 - General

• DI 13005.016 Section 1619 CDRs for Title XVI Recipients

• DI 13010.012 Protection from Medical Review Based on Work Activity

• DI 13010.035 The Trial Work Period (TWP)

• DI 13010.210 Extended Period of Eligibility (EPE) – Overview

• DI 55001.001 Ticket to Work and Work Incentives Improvement Act of 1999 (P. L. 106-170) – Overview

• DI 81010.000 FO Procedures - Electronic Process