TN 2 (06-15)

Citations:

20 CFR 404.1594(c)(3)(iv), 416.994(b)(2)(iv)(D), and 416.994a(c)(3)

A. Introduction to temporary remissions

Some impairments are subject to temporary remissions, which can give the appearance of medical improvement (MI) when in fact there has been none. These types of impairments can appear to be in remission when, in fact, the impairments are only stabilized. If the impairment is subject to temporary remissions, carefully consider the longitudinal history of the impairment, including the occurrence of prior remissions and prospects for future worsening, when deciding whether there has been any medical improvement. Temporary improvements will not warrant a finding of MI.

NOTE: The wording concerning temporary remissions in the three relevant sections of the regulations is slightly different, but the substance and intent is the same.

B. Consideration of temporary remissions

1. When do we consider temporary remissions?

a. Consider the concept of temporary remission at the following continuing disability review (CDR) sequential evaluation steps:

• in deciding MI,

• in relating MI to ability to work, or

• in a Title XVI child case, in deciding whether the CPD impairment still meets or equals a listing.

b. To decide whether temporary remission is an issue in a particular case, carefully consider:

• the longitudinal history of the impairment (including the occurrence of prior remissions and prospects for future worsening),

• all available evidence, including medical source evidence and statements, and

• medical literature about the disease.

2. Which impairments do we consider?

Examples of impairments subject to temporary remission include (but are not limited to):

• multiple sclerosis,

• rheumatoid arthritis,

• many mental impairments,

• epilepsy, or

• asthma.

3. How long is “temporary”?

To determine whether the remission is temporary, consider the longitudinal history of the impairment (including the occurrence of prior remissions and prospects for future worsening), in relationship to the particular impairment and the changes that have occurred.

Consider improvement temporary unless it lasts long enough to have a significant impact on the individual's ability to work, or, in a Title XVI child case, on the child's functioning under ordinary conditions on a sustained basis.

4. Listing timeframes

a. Relationship to medical improvement review standard (MIRS) issues

Several listing sections (e.g., the cancer listings) presume disability for a specific period, but direct evaluation of the residual impairment after that time.

b. Comparison point decision (CPD) during remission

In some CDRs, the CPD occurred during remission of the impairment(s) but within a timeframe specified by one of these listing sections. In such cases, the findings relevant to medical severity include findings prior to the remission. These pre-remission findings often control the decision (e.g., continuance under the cancer listings based on evidence of metastases within the last 3 years, even though current examination does not show recurrence).

c. Remission continues after specified period

The current adjudicator must consider relevant history at each point, and must not focus on a particular day. Find MI (if otherwise appropriate):

• If evidence shows that remission continues after the time specified by the listing, and

• there has been a change in symptoms, signs, or laboratory findings relevant to current severity, when compared to the symptoms, signs, or laboratory findings relevant to severity at the time of the CPD.

C. Processing of temporary remissions

1. Continuance if remission not yet long enough

When remission has not yet lasted long enough, find that disability continues. For more information on length of temporary remission, see DI 28010.115B.3. in this section.

Consider setting a medical improvement expected (MIE) diary for a time when evidence will provide a better basis for determining whether the remission is long enough to demonstrate MI.

• When a listing timeframe currently applies, consider setting the MIE diary due after the end of the period specified by the listing.

• In other situations where remission has not yet lasted long enough, consider setting a MIE diary due in about 1 year.

2. Notices preparation

Include a special paragraph in continuance notices in the above situations. Inform the individual that while his or her health improved, it appears to be too early for an accurate medical decision about the degree of improvement; therefore, disability is found to be continuing, with a reexamination scheduled for (date).

3. Future reviews

If remission continues until the time of the next scheduled CDR, apply the policies in subsections A. and B., and, if appropriate, find the MI more than temporary.

D. References

• DI 28005.005 The Continuing Disability Review (CDR) Evaluation Process for Title II and Adult Title XVI Individuals

• DI 28005.020 The CDR Evaluation Process -- Title XVI Child – General

• DI 28010.015 Comparison of Symptoms, Signs, and Laboratory Findings

• DI 28015.001 Context and Scope — Relating MI to Ability to Work