TN 4 (10-15)

A. Introduction to the development guidelines

The guidelines in this section, discuss individual MINE or MINE-equivalent impairments, groups of impairments, and situations in which there may be documentation deficiencies or contradictory situations, or a greater possibility of medical improvement.

These guidelines will assist the disability examiner (DE) in making appropriate judgments about the level of documentation required and the questions to ask medical source contacts.

Certain impairments are noted for which the lack of any medical source indicates a possibility of improvement; these require a full continuing disability review (CDR) if there is no medical source to verify impairment severity.

NOTE: Not all MINE or MINE-equivalent impairments are discussed below. For the most current list of MINE or MINE-equivalent impairments, see DI 26525.045. The principles illustrated in the examples below are generally applicable to those MINE or MINE-equivalent impairments not specifically discussed.

B. Medical improvement and the listings

1. Listing 1.05A or D

Amputation of both hands; or hemipelvectomy or hip disarticulation

These cases will not improve. Only an actual return to work would call for a full CDR.

2. Listing 2.02, 2.03A, 2.04, 102.02, 102.03A

Statutory blindness except due to cataracts or detached retina...not correctable by surgery, other treatment or glasses; loss of visual efficiency

Identify the etiology of each instance of statutory blindness or loss of visual efficiency to separate those conditions not expected to improve, from those in which improvement might be possible.

3. Listing 2.10

Hearing loss not treated with cochlear implantation

In cases where hearing loss is sensori-neural there is no possibility of improvement. These cases should require only minimal development, such as contact with the individual or payee. However, the original decision must be reviewed to determine whether proper methodology was used during the audiological testing in the prior favorable determination. If proper methods were not used, repeat testing may be indicated.

The DE should be alert to situations where surgery such as stapedectomy, or cochlear implantation have improved the individual’s ability to hear. In such cases, personal contact for CDR development is required.

4. Listing 3.02

Chronic pulmonary insufficiency

These cases are not expected to show significant medical improvement.

5. Listing 4.04A or B

Ischemic heart disease with chest pain of cardiac origin

If there has been no surgical intervention and the individual reports chest pain of cardiac origin, no significant improvement would be expected.

However, if the individual no longer reports cardiac chest pain or has had surgery performed, the telephone contact with the medical source should address the effects of the surgery. After evaluation of the information secured during this contact, personal contact for CDR development may be necessary. Lack of any medical source indicates the need for a full CDR.

6. Listing 6.03 and 6.05

Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis and chronic kidney disease, with impairment of kidney function

In cases where the individual remains on dialysis and no transplantation surgery is contemplated (6.03), no significant medical improvement is expected.

In cases allowed under 6.05, where the individual is not on dialysis and has not had kidney transplantation, personal contact may be needed for CDR development. Lack of any medical source indicates the need for a full CDR.

7. Listing 11.04, 11.06, 11.07, 11.08, 11.09, 11.10, 11.11, 11.13 and 11.17

Central nervous system vascular accident, parkinsonian syndrome, cerebral palsy, spinal cord or nerve root lesions, multiple sclerosis, amyotrophic lateral sclerosis, anterior poliomyelitis, muscular dystrophy, degenerative disease such as huntington’s chorea, friedrich’s ataxia, and spino-cerebellar degeneration, with manifestations as required by the applicable listings.

Medical improvement is not expected.

8. Listing 12.02

Organic mental disorders

In cases where the individual is institutionalized, contact with a medical source should resolve any inconsistencies, or indicate that a personal contact for CDR development may be necessary.

9. Listing 12.03 and 12.04

Schizophrenic, paranoid and other psychotic disorders and affective disorders, if institutionalized in a licensed mental hospital for past 12 months without releases that would indicate improvement

If the individual remains institutionalized, the only development needed is a contact with the mental institution confirming the period of institutionalization.

Contact a medical source if the individual was discharged. After evaluation of the information secured during that contact, personal contact for CDR development might be required (e.g., a patient formerly hospitalized at a licensed mental hospital now discharged to a nursing home would not necessarily indicate medical improvement).

However, discharge to an independent living arrangement program may indicate improvement. Following the source contact, the DE should decide with the assistance of a DDS psychiatrist or psychologist, whether to undertake personal contact for CDR development of the case.

10. Listing 12.05A or B, and 112.05B

Severe intellectual disability

Medical improvement is not expected. However, if there are inconsistencies in the file or the contact raises an issue, an individual assessment of the need for personal contact for CDR development should be made with the assistance of a DDS psychiatrist or psychologist.

C. Age 55 or over

In cases involving individual age 55 or over, it is unlikely that that the individual will return to substantial gainful activity due to medical improvement. Cases involving individuals of advanced age will be processed using the same criteria found in DI 28040.000, to include obtaining evidence and contact of the individual. Process a continuance unless there is contradictory information in the file or from the medical source, or the claimant indicates medical improvement.