TN 13 (05-02)

A. Introduction

1. Adjudicators' responsibilities

a. Adjudicator

You the adjudicator, play a key role in scheduling CDRs. Consequently, you must evaluate the facts of the individual case and exercise great care in determining when a future review is appropriate.

b. Adjudicator team

We expect the adjudicative team to establish:

• medical improvement expected (MIE) diaries only for individuals who, by the proposed diary date, will probably no longer be eligible for benefits under the medical improvement review standard (MIRS), and

• medical improvement not expected (MINE) diaries for individuals who will almost always continue to be disabled under the MIRS.

NOTE: See DI 28010.000 for MIRS guidelines. See DI 26525.001B.1.b. for the types of scheduled diaries.

2. Application of diary criteria

The examiner and medical or psychological consultant each have a role in scheduling appropriate CDRs.

We expect adjudicators to evaluate the individual case facts within the context of the MIRS, rather than to apply the diary criteria mechanically.

However, we intend for adjudicators to:

• interpret the MIE criteria for children more broadly than for adults, since children may have a greater potential for improvement with age, and

• closely adhere to the revised MINE criteria. This is because program experience has shown infrequent cessation for individuals with the case characteristics specified in the MINE criteria. Consequently, these types of cases do not generally warrant expenditure of administrative dollars for reviews.

3. Scope

The instructions in this subchapter apply when setting diaries for initial and CDR cases allowed or continued at all levels of adjudication and review.

B. Policy

1. Scheduled reviews

a. Legal requirement

SSA is required by law to review cases of title II beneficiaries and certain title XVI childhood disability beneficiaries as follows:

• Nonpermanent Impairments - at least once every 3 years.

• Permanent Impairments - at times the Secretary determines to be appropriate.

b. Diary types

• MIE - medical diary for less than 3 years (see DI 26525.020 - DI 26525.030).

• Medical Improvement Possible (MIP) - medical diary for 3 years (see DI 26525.035).

• MINE - medical diary for no less frequently than once every 7 years but no more frequently than once every five years (see DI 26525.040 - DI 26525.045).

• Vocational — diary following completion of vocational therapy (see DI 26525.050).

• Trial Work Period (TWP) — diary for end of TWP (see DI 26525.055).

c. Change of diary type

• Conduct the CDR utilizing the diary established, even if it was established under previous criteria. Do not screen out CDRs by resetting diaries under the revised diary guidelines.

• Conduct each CDR as appropriate to the type of diary scheduled following the last determination (i.e., do not apply abbreviated MINE procedures in cases given MIE or MIP diaries under previous diary guidelines).

• Adjudicators may change the diary type following a CDR if: the evidence obtained before the CDR determination demonstrates the impairment(s) should improve (e.g., recent surgery for the impairment); the impairment can no longer be expected to improve; or new and/or improved tests, treatment, therapies, or other medical or scientific advances may result in medical improvement.

2. Unscheduled reviews

SSA may conduct a CDR at any time an issue of continuing disability is raised, regardless of when the scheduled diary will mature (see DI 28001.015).

C. Procedures

In determining when to schedule a CDR, ask, in the following sequence:

• Is cessation under the MIRS probable within 3 years of adjudication, taking into account the case facts and the MIE guidelines, or will a vocational therapy diary apply? If so, set the MIE or vocational diary, as appropriate.

• If not, is a continuance under the MIRS probable, taking into account the case facts and the MINE guidelines? If so, set a MINE diary.

• If a MIE, Vocational, or MINE diary is not appropriate, schedule the 3-year medical improvement possible diary.