TN 3 (06-05)

A. Policy - Evaluation Of Continuing Disability, In General (Section 416.994a(a))

There is a statutory requirement that, if you are eligible for disability benefits as a disabled child, your continued eligibility must be reviewed periodically. There are a number of factors we consider when we decide whether your disability continues.

1. Description of Sequential Evaluation for Childhood CDRs

We will first consider whether there has been medical improvement in your impairment(s). We define “medical improvement” in DI 28010.015. If there has been no medical improvement, we will find you are still disabled unless one of the exceptions in DI 28020.250 through DI 28020.900 applies. If there has been medical improvement, we will consider whether the impairment(s) you had at the time of our most recent favorable determination or decision now meets or medically or functionally equals the severity of the listing it met or equaled at that time. If so, we will find you are still disabled, unless one of the exceptions in DI 28020.250 through DI 28020.900 applies. If not, we will consider whether your current impairment(s) is disabling under the rules in DI 25201.005C and DI 25201.005D. These steps are described in more detail in DI 28005.020B. Even where medical improvement or an exception applies, in most cases, we will find that your disability has ended only if we also find that you are not currently disabled.

2. Determination Will Be Made on a Neutral Basis

Our determinations and decisions under this section will be made on a neutral basis, without any initial inference as to the presence or absence of disability being drawn from the fact that you have been previously found disabled. We will consider all evidence you submit, as well as all evidence we obtain from your treating source(s) and other medical and non-medical sources. What constitutes evidence and our procedures for obtaining it are set out in DI 22505.001 through DI 22505.012 and DI 22510.001 through DI 22510.065. Our determinations regarding whether your disability continues will be made on the basis of the weight of the evidence.

B. Policy - Sequence Of Evaluation (Section 416.994a(b))

To ensure that disability reviews are carried out in a uniform manner, that decisions of continuing disability can be made in the most expeditious and administratively efficient way, and that any decisions to stop disability benefits are made objectively, neutrally, and are fully documented, we follow specific steps in determining whether your disability continues. However, we may skip steps in the sequence if it is clear this would lead to a more prompt finding that your disability continues. For example, we might not consider the issue of medical improvement if it is obvious on the face of the evidence that a current impairment meets the severity of a listed impairment. If we can make a favorable determination or decision at any point in the sequence, we do not review further. The steps are:

1. Has There Been Medical Improvement in Your Condition(s)?

We will determine whether there has been medical improvement in the impairment(s) you had at the time of our most recent favorable determination or decision. (The term medical improvement is defined in DI 28010.015.) If there has been no medical improvement, we will find that your disability continues, unless one of the exceptions to medical improvement described in DI 28020.250 through DI 28020.900 applies.

• If one of the first group of exceptions to medical improvement applies, we will proceed to step 3.

• If one of the second group of exceptions to medical improvement applies, we may find that your disability has ended.

2. Does Your Impairment(s) Still Meet or Equal the Severity of the Listed Impairment That It Met or Equaled Before?

NOTE: Social Security Ruling (SSR) 05-03p (DI 28005.021) explains how we apply the functional equivalence rules at this step, and how we apply the step when the CPD was based on functional equivalence to the listings. Along with the guidance below, follow the Policy Interpretation section of the SSR whenever functional equivalence must be considered at step 2.

If there has been medical improvement, we will consider whether the impairment(s) that we considered at the time of our most recent favorable determination or decision still meets or equals the severity of the listed impairment it met or equaled at that time. In making this decision, we will consider the current severity of the impairment(s) present and documented at the time of our most recent favorable determination or decision, and the same listing section used to make that determination or decision as it was written at that time, even if it has since been revised or removed from the Listing of Impairments.

If that impairment(s) does not still meet or equal the severity of that listed impairment, we will proceed to the next step. If that impairment(s) still meets or equals the severity of that listed impairment as it was written at that time, we will find that you are still disabled, unless one of the exceptions to medical improvement described in DI 28020.250 through DI 28020.900 applies.

• (i) If one of the first group of exceptions to medical improvement applies, we will proceed to step 3.

• (ii) If one of the second group of exceptions to medical improvement applies, we may find that your disability has ended.

3. Are You Currently Disabled?

If there has been medical improvement in the impairment(s) that we considered at the time of our most recent favorable determination or decision, and if that impairment(s) no longer meets or equals the severity of the listed impairment that it met or equaled at that time, we will consider whether you are disabled under the rules in DI 25201.005C and DI 25201.005D (discussed in more detail in DI 25220.005, DI 25220.010, and DI 25225.001 through DI 25225.065). In determining whether you are currently disabled, we will consider all impairments you now have, including any you did not have at the time of our most recent favorable determination or decision, or that we did not consider at that time. The steps in determining current disability are summarized as follows:

• (i) Do you have a severe impairment or combination of impairments? If there has been medical improvement in your impairment(s), or if one of the first group of exceptions applies, we will determine whether your current impairment(s) is severe, as defined in DI 25201.005C. (and discussed in DI 25220.005). If your impairment(s) is not severe, we will find that your disability has ended. If your impairment(s) is severe, we will then consider whether it meets or medically equals the severity of a listed impairment.

• (ii) Does your impairment(s) meet or medically equal the severity of any impairment listed in the Listing of Impairments? If your current impairment(s) meets or medically equals the severity of any listed impairment, as described in DI 25220.010, we will find that your disability continues. If not, we will consider whether it functionally equals the severity of a listed impairment.

• (iii) Does your impairment(s) functionally equal the severity of any listed impairment? If your current impairment(s) functionally equals the severity of any listed impairment, as described in DI 25225.001, we will find that your disability continues. If not, we will find that your disability has ended.

C. Procedure

1. Development

Follow the development guides in DI 28030.020. Do not focus development on a particular impairment(s). Although the MIRS sequence as it applies to title XVI children focuses first on the CPD impairment(s) and later on the current impairment(s), initiate development of all current evidence simultaneously.

NOTE: See DI 28005.003 if the CPD was prior to August 22, 1996, and a disability redetermination may be required.

2. Basic Approach

Follow the CDR evaluation process shown and summarized in the chart in DI 28005.025. There is a step-by-step discussion of the MIRS sequence for title XVI children in DI 28005.030. As with CDRs for other categories of claimants, use a flexible approach (DI 28005.005B.2.). If evidence in a particular case clearly documents a continuance at a later step in the process, earlier steps may be skipped. Skip evaluation process steps as necessary to process a continuance (but not a cessation). Do not skip any step that could affect outcome, or routinely consider steps out of order.

3. Subsequent Action

Follow DI 22520.001through DI 22520.020 for handling any additional evidence received after processing the decision.