TN 2 (09-14)

IMPORTANT: These instructions incorporate policy and procedure for both electronic continuing disability review (eCDR) and eCDR exclusion (paper) cases when there is a lost folder involved.

A. Medical improvement review standard (MIRS)

The DDS cannot determine medical improvement without the comparison point decision(CPD) folder or medical evidence. If you are unable to locate the appropriate CPD folder or medical evidence, bypass MIRS temporarily.

When you receive current medical evidence covering at least the last 12 months, evaluate the evidence using the initial sequential evaluation process (subject to trial work period, extended period of eligibility and 1619 provisions, if the individual is working).

B. DDS procedures for adult CDRs

1. Beneficiary does not have a severe impairment

If the beneficiary does not have a severe impairment, follow the instructions on DDS prior folder reconstruction in DI 28035.020.

2. Beneficiary has a severe impairment

Determine if the impairment meets or medically equals the severity of a listed impairment, according to the instructions in DI 22001.001D.3 Impairment(s) Meets or Medically Equals a Listing.

3. Impairment meets or medically equals listing

If the current impairment(s) meets or medically equals the severity of impairment in the current Listing of Impairments, disability continues:

• prepare a determination with the appropriate reexamination diary;

• use appropriate meets or equals continuance code; and

NOTE: Do not use “Disability Continues – Data From Most Recent Prior Favorable Medical Determination Insufficient to Assess Medical Improvement.”

• show listing code 256 (Lost Folder Case) in item 34 of the SSA-832/833-U5 (Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal - Title II).

NOTE: The field office will pay retroactive benefits after it fully develops all non-disability factors of entitlements, including work issues, if appropriate.

REMINDER: You must complete an SSA-538 (Childhood Disability Evaluation Form) for all title XVI child CDRs.

4. Impairment does not meet or medically equal listing

If the current impairment(s) does not meet or medically equal the severity of impairment in the current Listing of Impairments, determine if the beneficiary can perform past relevant work or other work.

5. Beneficiary cannot perform past relevant work or other work

Prepare a determination to continue disability:

• Use appropriate impairment plus vocational factors continuance code;

  NOTE: Do not use “Disability Continues – Data from Most Recent Prior Favorable Medical Determination Insufficient to Assess Medical Improvement.”

• enter list code 256 (Lost Folder Case) in item 34 of the SSA-832/833-U5 (Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal - Title II); and

• document the file on Form SSA-5002 (Report of Contact) that you have not formally considered MIRS.

6. Beneficiary can perform past relevant work or other work

If the beneficiary can perform either past relevant work or other work, do not cease disability on this finding alone.

• continue the process to include consideration of the MIRS; and

• attempt to reconstruct the prior medical evidence, provided you can determine the date of the CPD.

For information on reconstructing prior medical evidence, see:

• DI 28035.015 – DDS Identification of the Comparison Point Decision Date;

• DI 28035.020 – DDS Reconstruction of Prior Folder.

7. Medical or Medical/vocational allowances

If, based on current medical or medical/vocational evidence, disability continues, this determination becomes the CPD for the next CDR.

NOTE: Group II Exceptions to Medical Improvement are not controlled by sequence, and may result in a cessation at any point.

For information on exceptions to medical improvement, see:

• DI 28020.001 – General Groups I and II of Exceptions to Medical Improvement;

• DI 28020.900 – Group II Exceptions.

C. DDS procedures for child CDR determinations

1. Child does not have a severe impairment

If the child does not have a severe impairment, determine if you can reconstruct the prior folder according to the procedures in DI 28035.020.

2. Child has severe impairment

If the child has a severe impairment, determine if the impairment medically meets or functionally equals the listings for Title XVI child cases according to the instructions in DI 25201.005 How We Determine Disability for Children and DI 25225.001 Functional Equivalence – Policy (Section 416.926a(a)).

3. Child’s impairment(s) medically meets or functionally equals listing(s)

Prepare a determination to continue disability:

• prepare a determination with the appropriate reexamination diary;

• use appropriate meets or equals continuance code for DC or BC.

NOTE: Do not use “Disability Continues – Data from Most Recent Prior Favorable Medical Determination Insufficient to Assess Medical Improvement.”

• show listing code 256 (Lost Folder Case) in item 34 of the SSA-832/833-U5 (Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal - Title II).

REMINDER: You must complete an SSA-538 (Childhood Disability Evaluation Form) for all title XVI child CDRs.

4. Child’s impairment(s) does not medically meet or functionally equal listing(s)

If the child’s current impairment(s) does not medically meet or functionally equal the severity of the listings, determine whether to reconstruct the prior folder according to the instructions in DI 28035.020.

D. References

DI 22001.001 Impairment(s) Meets or Medically Equals a Listing

DI 25201.005 How we determine Disability for Children

DI 25220.005 Determining if a Child Has a Severe Impairment

DI 25220.010 Meets or Medical Equals

DI 25225.001 Functional Equivalence – Policy (Section 416.926a(a))

DI 28035.015 Disability Determination Services (DDS) Identification of the Comparison Point Decision Date

DI 28035.020 Disability Determination Services (DDS) Reconstruction of Prior Folder

DI 28035.025 Disability Determination Services Reconstruction of Prior Folder Not Possible

DI 28020.001 General – Groups I and II of Exceptions to Medical Improvement

DI 28020.900 Group II Exceptions