TN 1 (01-01)

A. Background

The Social Security Administration (SSA) is required by law to periodically review the continuing eligibility of all disability beneficiaries and recipients. In performing this review, the severity of the beneficiary/recipient"s medical condition at the time of the most recent favorable medical decision (i.e., comparison point decision (CPD)) is compared to the severity of his/her current medical condition. The CPD is the most recent favorable decision that determined the individual was disabled or continues to be disabled. If there has been no medical improvement (MI), benefits are continued with limited exceptions. The Disability Determination Services (DDS) needs to review the prior folder containing the medical evidence supporting the favorable CPD decision to conduct a CDR in an efficient and timely manner.

B. Policy

The FO is responsible for obtaining/securing the title XVI medical folder(s) and the Processing Center (PC) is responsible for obtaining/securing the title II or the title II portion of a concurrent title II/XVI medical folder(s) so the continuing disability review (CDR) can be initiated. Ultimately the FO is responsible for reviewing the folder received to determine whether the necessary prior medical information is in the file. If multiple folders are received, the FO needs to examine each file to determine which folder contains the needed medical evidence. See DI 13015.080 if no medical evidence is received.

Regardless of title, if the DDS finds the beneficiary/recipient is not currently disabled (see DI 13015.070), the DDS will return the file to the FO to prepare a replacement folder under the full reconstruction process (see DI 13015.090). The replacement folder must contain sufficient medical evidence/leads for the DDS to complete a medical improvement review standard (MIRS) determination.

Studies have shown when every effort is made to find a lost folder, in most cases the folder is found.

The instructions in this subchapter discuss the FO actions in the medical review process.