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DI 27536.010: Required Information for Reopening Continuing Disability Review Determinations

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  • Effective Dates: 03/24/2017 - Present
  • BASIC (01-12)
  • DI 27536.010 Required Information for Reopening Continuing Disability Review Determinations
  • There is no need to duplicate information documented elsewhere in the file. Use the tables below to locate the information required to reopen continuing disability review (CDR) determinations; and, what actions are necessary if the information is not already contained in the file.
  • Required information for reopening a CDR determination includes:
  • * Assessment of functional abilities
  • * Basis for determination
  • * Basis for the most recent prior favorable medical determination, i.e., comparison point decision (CPD)
  • * Beneficiary's reason for continued entitlement or cessation
  • * Citation of jobs and incidence
  • * Date of CPD
  • * Discussion of comparison of medical findings under medical improvement review standards (MIRS)
  • * Evidence sources
  • * Medical facts
  • * Pain-related issues
  • * Reason for current review
  • * Resolution of conflicting medical opinions
  • * Resolution of inconsistencies material to the determination
  • * Statement of nonmedical issues
  • * Vocational rule used for medical-vocational determinations
  • See Also:
  • DI 27536.001 Reopening Rationale Preparation
  • A. Location of required information
  • Use the table below to locate required information.
  •  Information
  • Determination
  • Where Usually Documented In File
  • Assessment of functional abilities
  • Continuance
  • * Medical evidence
  • * SSA-4734-BK Physical Residual Functional Capacity Assessment (RFC)
  • * SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment (MRFC)
  •  
  • Cessation
  • * Medical evidence
  • * MRFC
  • * RFC
  • Assessment of functional abilities
  • Continuance
  • * Medical evidence
  • * MRFC
  • * RFC
  •  
  • Cessation
  • * Medical evidence
  • * MRFC
  • * RFC
  • Basis for determination
  • Continuance
  • Items 10 and 12 on the SSA-832/833
  •  
  • Cessation
  • * Items 10 and 11 on the SSA-832/833
  • * Personalized cessation notice (PCN)
  • Basis for the most recent prior favorable medical determination, i.e., CPD
  • Continuance
  • * Administrative law judge (ALJ) decision
  • * Appeals Council (AC) decision
  • * Federal court decision
  • * SSA-831 Item 22 (Regulation basis code)
  • * SSA-832 or SSA-833 item 10
  • * SSA-5002 Report of Contact
  •  
  • Cessation
  • * ALJ, AC or court decision
  • * PCN
  • * Regulation basis code
  • * SSA-832 or SSA-833 item 10
  • * SSA-5002
  • Beneficiary's reason for continued entitlement or cessation
  • Continuance
  • * SSA-454-BK Continuing Disability Review Report
  • * SSA-820-F4 Work Activity Report (Self-Employed Person)
  • * SSA-821-BK Work Activity Report
  • * SSA-5002 or SSA-553 Special Determination
  •  
  • Cessation
  • * PCN
  • * SSA-454-BK
  • * SSA-820-F4
  • * SSA-821-BK
  • * SSA-5002 or SSA-553
  • Citation of jobs and incidence
  • Continuance
  • Not applicable
  •  
  • Cessation
  • Report by a vocational specialist
  • Date of CPD
  • Continuance
  • * Case summary, developmental worksheet, or disability determination evaluation
  • * Prior determination or decision
  • * SSA-5002
  •  
  • Cessation
  • * Case summary, developmental worksheet, or disability determination evaluation
  • * PCN
  • * Prior determination or decision
  • * SSA-5002
  • Discussion of comparison of medical findings under MIRS
  • Continuance
  • * MRFC
  • * RFC
  • * SSA-832 or SSA-833 item 10
  • * SSA- 2506-BK Psychiatric Review Technique (PRTF)
  •  
  • Cessation
  • * MRFC
  • * PCN
  • * PRTF
  • * RFC
  • * SSA-832 or SSA-833 item 10
  • Evidence sources
  • Continuance
  • Medical evidence
  •  
  • Cessation
  • * Medical evidence
  • * Personalized cessation notice
  • Medical facts
  • Continuance
  • * Medical evidence
  • * SSA-5002
  •  
  • Cessation
  • * Medical evidence
  • * SSA-5002
  • Pain-related issues
  • Continuance
  • * Any medical listing that specifically mentions pain
  • * PRTF
  • * RFC
  • * MRFC
  •  
  • Cessation
  • * MRFC
  • * PRTF
  • * RFC
  • Reason for current review
  • Continuance
  • * Diary matured
  • * SSA-831, SSA-832, or SSA-833 diary block
  • * SSA-832 or SSA-833 item 20
  • * SSA-847 Request for Case Action
  • * SSA-5526 Request for Assistance-Disability
  •  
  • Cessation
  • * Diary matured
  • * Personal decision notice
  • * SSA-831, SSA-832, or SSA-833 diary block
  • * SSA-832 or SSA-833 item 20
  • * SSA-847
  • * SSA-5526
  • Resolution of conflicting medical opinions
  • Continuance
  • Resolved by the determination of a continuance (SSA-832 or SSA-833
  •  
  • Cessation
  • * MRFC
  • * PRTF
  • * RFC
  • Resolution of inconsistencies material to the determination
  • Continuance
  • Resolved by the determination of a continuance (SSA-832 or SSA-833
  •  
  • Cessation
  • * MRFC
  • * PRTF
  • * RFC
  • Statement of nonmedical issues
  • Continuance
  • * SSA-820-F4
  • * SSA-821-BK
  • * SSA-454-BK
  • * SSA-832/833
  • * SSA-899 Continuing Disability Review (Completed by the PSC's)
  •  
  • Cessation
  • * PCN
  • * SSA-820-F4
  • * SSA-821-BK
  • * SSA-454-BK or SSA-832/833
  • * SSA-899
  • Vocational rule used for medical-vocational determinations
  • Continuance
  • Item 14 on the SSA-832 or SSA-833
  •  
  • Cessation
  • Item 14 on the SSA-832 or SSA-833
  • B. Rationale documentation required
  • A rationale must address specific information not already documented in the case file.
  • Use the table below to determine how you need to document the missing information.
  •  Information
  • Where Usually Documented In File
  • Action Required If Not Already In File
  • Basis for the most recent prior favorable medical determination, i.e., comparison point decision (CPD)
  • (cessation determination)
  • Personalized cessation notice
  • See DI 27536.001C.3.
  • Discussion of comparison of medical findings under MIRS
  • (cessation determination)
  • Items 10 and 12 on the SSA-832 or SSA- 833
  • See DI 27536.001C.1.
  •  
  • Personalized cessation notice
  • See DI 27536.001C.2.
  •  
  • * SSA- 2506-BK Psychiatric Review Technique
  • * SSA-4734-BK Physical Residual Functional Capacity Assessment
  • * SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment
  • See specific instructions for:
  • * Pain-related issues
  • * Resolution of conflicting medical opinions
  • * Resolution of inconsistencies material to the decision
  • C. References
  • * DI 28501.001 Question of Reopening Arises
  • * DI 28501.005 Reopening of Prior Cessation Determination
  • * DI 28501.005 Reopening of Prior Cessation Determination
  • * DI 28501.010 Processing Charts: CDR Reopenings Under Administrative Finality (Revision of Prior Cessation)
  • * DI 28501.015 Reopening in Continuing Disability Cases
  • * DI 28501.020 Unfavorable Reopening of Prior Continuance Determination
  • * DI 28501.025 Reopening and Revision of a Prior CDR Reconsideration Determination
  • * DI 28501.030 Routing Reopened Cases
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