TN 4 (10-15)

Citations: Sections 221(i)(1) and 1614(a)(3)(H)(ii)(I) of the Social Security Act, as amended; 20 CFR 404.1590(c) and 416.990(c)

Permanent impairment -- medical improvement not expected - refers to a case in which any medical improvement in a person’s impairment(s) is not expected. This means an extremely severe condition determined, by our experience in administering the disability programs, as follows:

• To be at least static but more likely to be progressively disabling either by itself or by reason of impairment complications, and

• Unlikely to improve so as to permit the individual to engage in substantial gainful activity, or

• If the recipient is a child, unlikely to improve to the point that he or she will no longer have marked and severe functional limitations.

Sections 221(i)(1) and 1614(a)(3)(H)(ii)(I) of the Social Security Act, as amended, require the Social Security Administration review these cases on a schedule to be determined by the Commissioner. The review schedule for MINE or MINE-equivalent cases is established in the regulations as between 5 and 7 years.

A primary objective of the MINE or MINE-equivalent review procedure is to minimize inconvenience to the individual by structuring the review in a manner that is sensitive to the individual’s concerns and needs. Since these impairments are considered irreversible, development is geared toward assuring that the original medical documentation was thorough and fully supports the MINE or MINE-equivalent impairment classification. Hence, we do not anticipate the need for extensive current medical development.

Disability determination services (DDS) will complete the majority of MINE or MINE-equivalent case reviews with limited field office (FO) involvement. The DDS responsibilities include:

• Reviewing the evidence in the file to assure that a MINE or MINE-equivalent impairment exists and is properly documented.

• Making a call to the individual alerting him or her that a notice will be coming soon regarding periodic review and answering any questions the individual raises.

• Sending a formal notice of periodic review as required by law. For more information on this notice, see DI 28040.105.

• Re-contacting the individual to update the file concerning the current condition of the impairment(s), daily activities, work activity, and current medical sources (all this information may be developed during the first phone call, if the individual prefers and is prepared to provide the necessary answer).

• Verifying the existence of the continued impairment severity with a medical source, evaluating the information received, and preparing the appropriate determination.

The medical evidence from the last favorable determination and information obtained from current source(s) forms the basis for determining the existence of a continued MINE or MINE-equivalent impairment. A continuance processed due to this review will establish the comparison point decision for future continuing disability reviews.