POMS Reference

DI 28015: Relating Medical Improvement to the Ability to Work - Title II and Adult Title XVI Beneficiaries

TN 3 (07-15)

A. Definitions of a listing and listing section

The terms “listing” and “listing section” used in this subchapter refer to listing headings such as Listing 5.05 (chronic liver disease), including all subsections such as 5.05A. and 5.05B.

B. Deciding if a comparison point decision (CPD) listing is now met or equaled

In deciding whether a CPD listing is currently met or equaled, consider all subsections, not just the particular one used in the CPD. Consider the prior listing section in light of the relevant prior introductory material under that body system heading (e.g., read Listing 5.05 in light of 5.00).

C. What section to use if a CPD equals decision does not cite a listing

If a CPD equals decision does not cite a specific listing section (e.g., CPD says “equals 11.01,” which is merely a heading, rather than specifying a section -- e.g., 11.02, 11.03), use the section applicable to the primary impairment. If undecided between two (or more) listing sections, use one that the beneficiary currently meets or equals.

D. Some sections are always met

1. Structure

Parts of some obsolete listing sections were structured so that once it was initially established that the impairment met the provisions in question, the beneficiary would always meet that listing.

2. Examples of sections that are always met

  • Listing 4.04B from August 1968 through March 26, 1979--two myocardial infarctions within six months; and

  • Listing 5.05B from March 27, 1979 through January 5, 1986--chronic liver disease with performance of a shunt operation.

3. Decision at “related” step

When the CPD used such listing provisions and the impairment met (and, therefore, currently meets) the provisions in question, find any medical improvement (MI) not related to ability to work.

E. Other sections documented at CPD

In most cases, when this “listing section” mechanism applies, consider only the listing section cited in the CPD. If CPD documentation clearly shows another listing section(s) was met or equaled at CPD, also consider other section(s) used in the CPD.

F. Multiple medical improvement review standard (MIRS) continuing disability reviews (CDRs)

If this mechanism applies, consider the listing section used in the latest pre-CPD “listing” decision as having been used in the “no MI (related)” CPD per DI 28015.055E.

G. Examples of CPD decisions

1. Pre-CPD listing decision

A 1977 allowance used Listing 3.10 as it appeared then--Laryngectomy with inability to produce, by use of any anatomical part, speech that can be heard, understood, and sustained.

2. MIRS CPD

Before a 1987 CDR, the beneficiary learned to produce effective speech, but only by use of a mechanical device. Listing 2.09 replaced the previous provisions of Listing 3.10, and the beneficiary did not meet or equal Listing 2.09 in 1987 because he was able to produce effective speech “by any means.” MI was not related to the ability to work because the impairment continued to meet Listing 3.10 as it appeared in 1977. No exception applied, and disability continued.

3. Subsequent CDR

Use the 1987 continuance as the CPD for the next CDR. In relating MI to ability to work in that CDR, consider Listing 3.10 as it appeared in 1977 -- the 1987 CPD used that section.