TN 2 (06-15)

Citations:

20 CFR 404.1594(b)(7), 416.994(b)(1)(vii), and 416.994a(c)(1)

A. General CPD information

The CPD is the most recent favorable medical decision indicating that the individual was disabled or continued to be disabled.

The most recent favorable decision is the latest final determination or decision involving a consideration of the medical evidence and whether the individual was disabled or continued to be disabled.

NOTE: The wording concerning the most recent favorable decision in the three relevant sections of the regulations is slightly different, but the substance and intent are the same.

B. Which decisions are CPDs?

1. CPD criteria not met

The following types of decisions do not involve development of current medical evidence or consideration of medical issues. They are not appropriate CPDs because the supporting evidence for the decision does not provide a suitable basis for medical improvement review standard (MIRS) comparisons. Therefore, do not use as CPDs:

• Adoption decisions (or decisions that applied collateral estoppel, either correctly or incorrectly) without the medical development needed for a “regular” disability decision.

• Curtailed development.

• SSA-899-U2's (Continuing Disability Review) categorizing individuals as permanently impaired, without evaluation of then-current medical evidence.

• Reinstatement under continuing disability review (CDR) moratorium

• Decisions based solely on work.

• Decisions not involving consideration of the issue of current disability (e.g., most decisions on appeals requesting an earlier onset).

2. CPD criteria met

Use the following types of decisions as CPDs when they meet the criteria in DI 28010.105A in this section:

• Decisions (based on then-current medical evidence) that the individual continues to have a disabling impairment, such as in DI 28055.045.

• Adoption decisions (or decisions which applied collateral estoppel, either correctly or incorrectly) that included development of the usual level of current medical evidence and consideration of medical, medical/functional, or medical/vocational issues.

• The earlier medical decision (usually under a different title) used as the basis for an adoption decision (i.e., without medical evidence at the time of adoption).

3. Closed period

a. General usage

Use the established onset date as the comparison point. For further information on closed period cases, see DI 25510.001

b. Adoption decision

Use the prior medical decision on the previously adjudicated claim as the CPD, when adopting a prior decision results in:

• a closed period decision on a new claim, and

• simultaneous cessation of benefits on a previously adjudicated claim.

4. Non-rollback conversion

a. Comparison points

Two comparison points may apply. DI 28001.045 explains when cases must be evaluated under the State plan, and DI 28035.025F discusses additional considerations related to comparison points in non-rollback conversion cases where evidence from the prior State decision is not available and cannot be reconstructed.

b. Federal criteria

Use the most recent favorable decision under the Federal criteria as the CPD, as discussed above. If there is no prior favorable Federal decision, use the most recent medical decision granting or affirming entitlement under the State criteria as the CPD.

c. State criteria

In considering State criteria, use the most recent medical decision granting or affirming entitlement under the State criteria as the CPD.

C. References

• DI 22501.001 Disability Case Development for Medical and Other Evidence

• DI 28001.045 Rollback and Non-rollback Conversion Cases

• DI 28030.020 Development of Medical Evidence

• DI 28035.025 Disability Determination Services (DDS) Reconstruction of Prior Folder Not Possible

• DI 28055.045 Model Language: Impairment Severity Continuance Notice – Exhibit

• DI 28075.010 Nonrollback Conversion Cases