Continuing Disability Review (CDR)

Your case will be periodically reviewed to make sure you still qualify for benefits. You may lose your benefits in the event that your condition has improved significantly to the point that you are fit to return to work. This ongoing review process is called continuing disability review (CDR), and you are subject to it for as long as you continue to receive benefits.

When you are due for your CDR, you will receive prior notification through the mail or from someone from your Social Security office. This notification will brief you on the complex CDR process and your right to appeal.

CDRs are carried out by a team from Disability Determination Services (DDS), the state agency that reviews files for the Social Security Administration (SSA), along with a disability examiner and a doctor, known as a medical consultant (MC). The DDS team will review your file, ask you to provide documentation about treatments you have received and any work you have completed, and then proceed to gather information about you from the healthcare providers who have treated you. In the event that the DDS consultant requires additional medical information, you might be asked to participate in a consultative examination, paid for by the SSA.

If your condition has improved, the DDS will try to find out if you are fit to return to work; one of the goals of the CDR evaluation is to determine if and how your health affects your ability to work – this includes the kind of work you used to do, and the kind of work you are able to perform in your current medical state.

Child CDRs are more or less the same as adult CDRs with the exception of several minor differences; these differences will be outlined shortly.

A. Frequency of Reviews

The severity of your condition and your chances of improvement determine the frequency of the CDRs you are required to undergo. Frequency ranges from six months to seven years. When the SSA approves your initial claim and grants you benefits, you will receive a Certificate of Award. This document will alert you to the approximate date of your first review, though the specific details about the first review as well as those concerning subsequent reviews remain up to the SSA and depend upon which of the following categories you fall into:

Medical Improvement Expected (MIE)

 If the SSA expects your condition to improve, you will likely face a review within 6-18 months of your benefits starting. However, if you are at least 54.5 years old at the first scheduled review date, the SSA is unlikely to put you in this category unless one of the following is true:

1. If your condition is almost certain to resolve itself to the point of great improvement, or even full recovery (i.e. sprains, fractures, highly curable cancers), you can get an MIE review up to age 59.5.
2. If you receive SSI and are legally blind but expected to improve, you may be considered MIE up to age 64.5.

Medical Improvement Possible (MIP)

If the SSA thinks it possible for your condition to improve but cannot say for certain whether or not it will, you will face CDRs about every three years. Thyroid disorders and inflammatory intestinal diseases may render you MIP. However, if you are at least 54.5 years old at the first scheduled review date, the SSA will be unlikely to put you in this category unless your condition is almost certain to resolve itself fully.

Medical Improvement Not Expected (MINE)

If the SSA believes that your condition is not going to improve, you will face CDRs every five to seven years. You are most likely to find yourself in this category if you will be over 54.5 years old at the time of the CDR, have already undergone several CDRs, or have severe impairments and/or a serious medical condition with no known treatment. Conditions that earn you a MINE review include, but are not limited to: amputation, autism, blindness, deafness, Down syndrome, mental disorders, multiple sclerosis, Parkinson’s disease, spinal cord or brain injuries.

Do not be alarmed if you are expecting a CDR sometime soon but are not contacted by the SSA. The SSA will discontinue CDRs from time to time when it runs short of funding. If this is the case, your CDR may be temporarily delayed.

B. How the SSA Contacts You

The SSA will notify you when it begins reviewing your disability claim. This is a routine part of the CDR process for all claimants receiving benefits, so do not be alarmed or feel like you are being singled out. Furthermore, do not assume that a CDR means you will be cut off from your benefits.

The CDR notice will include a number of forms you will be required to fill out within 30 days. Be sure to read the SSA’s instructions before completing the forms. Be sure to use the forms provided by the SSA. Do not use any you may find elsewhere. The SSA forms you will receive include:

1. Form SSA-455: Disability Update Report

This form asks you for basic information about your work history and medical history.

Once the SSA Field Office receives this form from you, the SSA will decide whether your benefits should continue  (in which case the CDR process ends) or whether your case requires a more detailed medical review. In either case, you will receive written notification of the SSA’s decision. If it decides your claim requires a full medical review, you will receive notice of the SSA’s decision to continue or end your benefits when the review is complete.

2. Form SSA-454-BK: Continuing Disability Review Report

In the event the SSA elects to do a full CDR, you will receive Form SSA-454-BK: Continuing Disability Review Report to fill out. You may also request this form at any time by calling the SSA and asking for it.

Along with this form, you will receive notification that you may contact a Social Security representative at your local Field Office. The purpose of the invitation is to provide you with a liaison throughout the CDR process as well as to protect your rights as a claimant.

Complete the form and mail it back to your local Field Office. While the SSA prefers face-to-face contact, telephone is acceptable, and, under the following conditions, you may waive your personal contact:

1. If your relationship with your representative payee is in an official capacity (i.e. an institution or government agency).
2. If you and/or your representative payee agree or request to conduct the CDR via mail.
3. If contact is impractical for some reason (i.e. weather or travel) and your or your representative payee agrees to the personal contact waiver and to conduct the CDR via mail.
4. If you live in a foreign country without a U.S. District Office.

Form SSA-454-BK is 11 pages long, but is not difficult to fill out. Moreover, your SSA Field Office can help answer questions you may have about completing it, and you may also get an attorney or other representative to help you fill it out. The SSA wants to know about your history since making the claim or since you had your last CDR.

The SSA Field Office representative can complete the code boxes asking for Types of Entitlement, so don’t worry about those.

If someone besides the recipient of the benefits is filling out the form, be sure to note the name, address, and relationship of the person who is reporting, as well as why the beneficiary is not doing the reporting on his or her own behalf.

The following bullet points provide brief descriptions of the types of information required in each section of the form:

*Section 1 asks for your name and basic contact information.

*Section 2 asks for a description of your medical condition(s) for which you are receiving benefits. Do not use this section to note new conditions that have arisen since your initial claim was approved or since your last CDR, but do use this section to describe how, if at all, your condition has changed (either negatively or positively). If you require more room to describe these changes, use Section 10 of the form (on page 16). Do your best to be concise.

*Sections 3A and 3B ask you to provide information about treatment you have received in the last year. Use Section 3C if you have medical records under a different name. Section 3D asks you to list the contact information for the healthcare providers you have seen. In Section 3E you will need to provide information about hospitals and clinics you have visited in the last year (and the SSA will require those records). Section 3F asks for any additional contact information for people and institutions (other than those you’ve already listed) that have medical records or information about your condition that is current as of the past year, such as attorneys and insurance companies.

*Section 4 asks you for information about the medications you are taking.

*Section 5 asks you for information about tests you have had in the last year. Ask your doctor if you’re unsure whether or not you have had these tests. You do not need to know the results of these tests, but if you’ve had a test that isn’t listed on the form, use Section 10 to describe it.

*Section 6 asks you for information about your education level and any additional schooling or training you have received since your initial claim was approved, or since your last CDR.

*Sections 7A-7D ask you about your work history (and current job, if you have one) since your last disability decision. List every job you have had, no matter how minor, and be sure to note if you attempted to work but were unable to. In Section 7E, you will be asked to assess your ability to work based on your current condition. Section 7F asks you about your doctor or doctors’ assessments of your ability to work, and for the contact information of these doctors. The SSA will contact them for medical records.

*Section 8 asks you about your participation, or lack thereof, in the Ticket to Work program.

*In Section 9, you will be required to describe the difficulties you’ve had performing the activities of daily living (ADLs). This is a very important section, so take your time and be thorough. Things to describe include personal mobility difficulties, your ability to see to your personal care and grooming needs, trouble performing household maintenance duties, how your condition has limited your recreational activities and hobbies, how your condition has affected your social life, and anything else ADL-related such as seizures, balance difficulties, or memory loss.

*Section 10 gives you the opportunity to provide further details related to earlier questions if you required more room to explain, and to provide any additional information you think might be important for the SSA to know about your condition.

*Page 14 asks you to sign and date the form, and to provide your phone number and mailing address. Write an “X” in the signature space if you cannot sign your name (if you’ve had a stroke, for example), and have two witnesses who know you sign the form and enter their mailing addresses. Your signature gives the SSA, their doctors, the DDS, and any relevant vocational institutions permission to review your medical records. Your signature also constitutes your agreement to notify the SSA if your medical condition improves or you return to work.

Leave the rest of the form blank. If you got help from the Field Office in filling out the form, the SSA representative who helped you will record his or her experience with you in Items 15-20. If you filled it out yourself, mail it back to your local SSA Field Office. You can find the appropriate address in the government section of the phone book, or find it at www.ssa.gov.

C. Medical Improvement Review Standard (MIRS)

The Medical Improvement Review Standard (MIRS) is the benchmark that the SSA uses to evaluate your cases during a CDR. The MIRS exists to help make sure no one is unfairly terminated from receiving benefits, but it is important for you to understand the MIRS in case you encounter an evaluator who has not been properly trained in the MIRS. Do note that the MIRS does not apply in all circumstances (these circumstances will be discussed in Section C2).

*If your benefits are terminated, insist on a full medical review by a DDS medical consultant.

1. MIRS Requirements

Whereas during your initial application for disability benefits the burden of proof of disability fell to you, in a CDR, it falls to the SSA. Consequently, the evaluation process during a CDR is quite different from that during an initial application. This means that unless the SSA can prove that you’re medically sound enough to return to work, you will continue to receive benefits. The MIRS requires two forms of proof before the SSA can terminate your benefits. The SSA must show that:

1. Your medical condition has improved enough to restore your ability to work, as determined by a DDS medical consultant (see subsection a below).
2. You can capably perform substantial, gainful activity, as determined by a DDS claims examiner or vocational specialist (see subsection b below).

1. Medical Improvement Related to Your Ability to Work

Medical improvement is defined as a decrease in the severity of your disabling impairments since your last CDR. Federal regulations stipulate that medical improvement must be significant in order to fulfill this requirement. Minor medical improvement does not constitute sufficient evidence that your ability to work has been restored.

Significant improvement will usually, but not always, relate to your capacity to work. This means that significant improvements in the medical severity of certain aspects of your condition or conditions, aspects that do not relate to your ability to work, do not count toward fulfillment of the significant improvement requirement stipulated by the MIRS.

The comparison point decision (CPD) is the date that your claim was last reviewed and a benefit decision rendered. The CPD can be the date of your initial approval, the date of an appeal, or the date of a past CDR.

If you have not experienced significant medical improvement, your benefits will continue. However, if you do have significant medical improvement, it does not necessarily indicate an overall improvement in your condition. You may, for example, have developed new disabilities since your last CPD, in which case your medical consultant will take these new impairments into consideration when he or she assesses your ability to work.

In order to decide whether or not your condition has improved, the SSA will consider your symptoms (according to your own description), signs (observable physical or psychological issues apart from your self-described symptoms), and laboratory findings (the results of diagnostic tests you have undergone).

The MIRS applies to physical disorders, psychological disorders, and conditions encompassing both physical and psychological impairments.

Physical Disorders

When the SSA uses the MIRS to evaluate physical disorders, it uses a measure called residual functional capacity (RFC), which is a scale of exertional levels. A jump of one level, such as from light work to medium work, or sedentary work to light work, qualifies as significant medical improvement. However, medical improvement that stays within the same exertional level can, in some cases, also be considered significant.

Mental Disorders

The RFC also includes ratings for mental skill levels. A jump of one mental skill level, such as from unskilled work to semiskilled work, or from semiskilled work to skilled work, constitutes significant medical improvement. However, as is the case with physical disorders, medical improvement that stays within the same mental RFC skill level can, in some cases, also be considered significant.

Physically healthy individuals with mental impairments but who are capable of semiskilled or skilled work never receive benefits. Those capable of unskilled work are seldom granted benefits without mitigating vocational factors (age, education, work experience).

Combined Physical and Mental Disorders

If you suffer from a disorder combining physical and mental impairments, a significant improvement in either a physical or a mental aspect of your condition can qualify as significant medical improvement.

Significant improvement in a trivial impairment unrelated to your work ability does not constitute a finding of significant medical improvement by the DDS.

b. Your Ability to Work

Before terminating your benefits, a DDS representative must, taking into account your original and/or new disabling impairments, prove that you are able to perform a type of work currently in demand in the national marketplace.

The skill level of work you can capably perform is directly influenced by your mental impairment, if you have one, or vocational factors such as education level and work history. The SSA bases its assessment of your ability to work on your lower skill level. For example, you may be mentally healthy but incapable of performing skilled labor based on your level of education and/or work experience. Conversely, if you are highly educated and have a work history that supports skilled labor, but you have suffered a mental impairment, you may be capable of only unskilled work.

3. Age and Time Receiving Disability

Your age does not usually enter into the SSA’s consideration of your physical capacity on an RFC, except during CDRs. If you are over age 50 and have been receiving disability benefits for at least seven years, the SSA will consider your age and inactivity when making its assessment.

2. When the MIRS Doesn’t Apply

There are some circumstances in which the SSA will not apply the MIRS to your CDR. In such cases, you might not have to undergo a DDS review in order to continue receiving benefits. However, you may also lose your benefits absent the protection provided by the MIRS. Cases in which the MIRS does not apply are as follows:

1. Your Impairment Meets or Equals a Listing
   

If your listing meets or equals the same listing in the Listing of Impairments as it did when you had your last comparison point decision (CPD) or when you first started receiving benefits, then the SSA will not apply the MIRS to your case, and you will continue to receive benefits. Keep in mind that you cannot be cut off from your benefits if you were granted a listing in the past and the listing requirements have since been changed. Be aware that new or insufficiently trained DDS examiners may not be aware of this grandfathering clause, so it’s important that you are.

This applies to newer listings in effect at the time of your CDR (as you may have initially qualified under older or different listings) and includes new impairments you might have developed since your last evaluation.

These rules apply to adults only. The rules for children are different, and will be detailed in section D.

2. You Are No Longer Disabled or Never Were
   

The SSA can terminate your benefits without using the MIRS if the DDS discovers that you are no longer disabled or that you were never disabled at all, and are capable of, or actively performing substantial gainful activity (SGA). These are Group I exceptions and include the following:

You have participated in work ability-related vocational therapy.

If you have recovered in full, or so much so that you are capable of SGA, the SSA can terminate your benefits without using the MIRS. Note that this exception does not apply to those receiving SSI with cash benefit eligibility.

Changing evaluative techniques, and/or diagnostics have rendered your impairment less disabling than it was deemed at the time of your CPD.

The SSA can terminate your benefits without applying the MIRS if your impairment is no longer classified as disabling based on improved evaluative techniques and/or diagnostics. Said techniques must have become available for use since the last CPD in order for this exception to apply.

A prior disability decision was made in error.

The SSA can terminate your benefits without using the MIRS if the DDS finds clear evidence that an earlier disability decision was erroneous. The DDS can make this finding in three ways:

1. Documentation in your file indicates that the decision in question should not have been made; this documentation counts as clear evidence not subject, or open, to judgment.
2. Material evidence of the severity of your condition that was required at the time of the CPD was then missing, but has since been collected and clearly shows that had it been present during the CPD, there would not have been a disability finding.
3. New evidence that contradicts the conclusions made based on prior evidence used in the CPD has since been collected and clearly indicates that a finding of disabled would not ever have occurred had this evidence existed at that time.

You are currently performing SGA

If the DDS discovers you are performing work above the SGA level, the SSA can terminate your benefits without applying the MIRS. This does not apply to SSI recipients or to those who receive SSI or SSDI while in a trial work period or reentitlement period.

You have benefitted from advances in medical or vocational therapies related to your ability to work.

The nature of such advances renders this exception almost moot, as these advances often result in significant medical improvement. This exception does not apply to SSI recipients with cash benefit eligibility.

c. You are Disqualified Because of Something Other than Disability

Group II exceptions are those that allow the SSA to terminate your benefits without considering your medical condition or work ability. If (1) the SSA cannot locate you, (2) if you fail to cooperate with the SSA (i.e. refusing to undergo an examination without providing a reasonable explanation or failing to turn over medical evidence as requested), (3) if you refuse or fail to follow to abide by a prescribed treatment designed to restore your ability to perform SGA, or (4) you commit fraud (i.e. knowingly giving the SSA false information at any time), the SSA can apply Group II exceptions to terminate your benefits.

d. New Impairments

When evaluating adults, the SSA will consider new impairments only after deciding upon your level of medical improvement or if these new impairments meet or equal a listing in the Listing of Impairments. New impairments that arise after the CPD date are not included in the medical improvement decision.

For children, new impairments are considered after the SSA rules on whether or not there is significant medical improvement.

If you develop a new impairment at or near the time of your CDR, be sure to work closely with your DDS medical consultant to make sure you do not undergo a CDR prematurely.

D. CDRs for Children

What follows does not apply to children under 18 who are dependents of an SSDI recipient and receive benefits accordingly. Rather, the following information applies solely to CDRs for children who are SSI recipients.

Children do not receive RFCs; consequently, their CDR evaluations differ from adult evaluations in that medical improvement determinations for children do not involve changes in RFS. Furthermore, the chronology of a child CDR is different from an adult evaluation in that before it is decided whether the child meets or equals a listing, the evaluator will first assess medical improvement. Finally, a child CDR does not involve a finding related to work ability.

The SSA uses the following steps to determine significant medical improvement in a child’s condition:

Step 1: If the child has not experienced significant medical improvement in impairments existing at the time of the CPD, benefits will continue so long as none of the exceptions apply. If the child has experienced significant medical improvement, continue to Step 2.

Step 2: If the impairments maintain their prior-determined severity in the Listing of Impairments at the time of the CPD, benefits will continue so long as none of the exceptions apply. If they do not, continue to Step 3.

Step 3: If the child’s current impairments meet or equal a current listing in the Listing of Impairments, the benefits will continue. If not, benefits will be terminated.

E. Appealing a CDR Decision

You will be notified when the SSA makes a CDR decision. Your benefits will continue if you are found disabled.

If the SSA finds you are no longer disabled, you will receive an explanation detailing the reasons for the finding and your benefits will end three months after the SSA said your disability ended, but not earlier than the date the SSA decided to end your benefits. This is so the SSA cannot demand back payment from you by claiming that your disability ended prior to the date the CDR was conducted. However, if the SSA discovers that you committed fraud in order to gain benefits, it can demand repayment of all benefits paid.

Normal
0

false
false
false

EN-US
X-NONE
X-NONE

Continuing Disability Review (CDR)

Your case will be periodically reviewed to make sure you still qualify for benefits. You may lose your benefits in the event that your condition has improved significantly to the point that you are fit to return to work. This ongoing review process is called continuing disability review (CDR), and you are subject to it for as long as you continue to receive benefits.

When you are due for your CDR, you will receive prior notification through the mail or from someone from your Social Security office. This notification will brief you on the complex CDR process and your right to appeal.

CDRs are carried out by a team from Disability Determination Services (DDS), the state agency that reviews files for the Social Security Administration (SSA), along with a disability examiner and a doctor, known as a medical consultant (MC). The DDS team will review your file, ask you to provide documentation about treatments you have received and any work you have completed, and then proceed to gather information about you from the healthcare providers who have treated you. In the event that the DDS consultant requires additional medical information, you might be asked to participate in a consultative examination, paid for by the SSA.

If your condition has improved, the DDS will try to find out if you are fit to return to work; one of the goals of the CDR evaluation is to determine if and how your health affects your ability to work – this includes the kind of work you used to do, and the kind of work you are able to perform in your current medical state.

Child CDRs are more or less the same as adult CDRs with the exception of several minor differences; these differences will be outlined shortly.

A. Frequency of Reviews

The severity of your condition and your chances of improvement determine the frequency of the CDRs you are required to undergo. Frequency ranges from six months to seven years. When the SSA approves your initial claim and grants you benefits, you will receive a Certificate of Award. This document will alert you to the approximate date of your first review, though the specific details about the first review as well as those concerning subsequent reviews remain up to the SSA and depend upon which of the following categories you fall into:

Medical Improvement Expected (MIE)

If the SSA expects your condition to improve, you will likely face a review within 6-18 months of your benefits starting. However, if you are at least 54.5 years old at the first scheduled review date, the SSA is unlikely to put you in this category unless one of the following is true:

1. If your condition is almost certain to resolve itself to the point of great improvement, or even full recovery (i.e. sprains, fractures, highly curable cancers), you can get an MIE review up to age 59.5.
2. If you receive SSI and are legally blind but expected to improve, you may be considered MIE up to age 64.5.

Medical Improvement Possible (MIP)

If the SSA thinks it possible for your condition to improve but cannot say for certain whether or not it will, you will face CDRs about every three years. Thyroid disorders and inflammatory intestinal diseases may render you MIP. However, if you are at least 54.5 years old at the first scheduled review date, the SSA will be unlikely to put you in this category unless your condition is almost certain to resolve itself fully.

Medical Improvement Not Expected (MINE)

If the SSA believes that your condition is not going to improve, you will face CDRs every five to seven years. You are most likely to find yourself in this category if you will be over 54.5 years old at the time of the CDR, have already undergone several CDRs, or have severe impairments and/or a serious medical condition with no known treatment. Conditions that earn you a MINE review include, but are not limited to: amputation, autism, blindness, deafness, Down syndrome, mental disorders, multiple sclerosis, Parkinson’s disease, spinal cord or brain injuries.

Do not be alarmed if you are expecting a CDR sometime soon but are not contacted by the SSA. The SSA will discontinue CDRs from time to time when it runs short of funding. If this is the case, your CDR may be temporarily delayed.

B. How the SSA Contacts You

The SSA will notify you when it begins reviewing your disability claim. This is a routine part of the CDR process for all claimants receiving benefits, so do not be alarmed or feel like you are being singled out. Furthermore, do not assume that a CDR means you will be cut off from your benefits.

The CDR notice will include a number of forms you will be required to fill out within 30 days. Be sure to read the SSA’s instructions before completing the forms. Be sure to use the forms provided by the SSA. Do not use any you may find elsewhere. The SSA forms you will receive include:

1. Form SSA-455: Disability Update Report

This form asks you for basic information about your work history and medical history.

Once the SSA Field Office receives this form from you, the SSA will decide whether your benefits should continue  (in which case the CDR process ends) or whether your case requires a more detailed medical review. In either case, you will receive written notification of the SSA’s decision. If it decides your claim requires a full medical review, you will receive notice of the SSA’s decision to continue or end your benefits when the review is complete.

2. Form SSA-454-BK: Continuing Disability Review Report

In the event the SSA elects to do a full CDR, you will receive Form SSA-454-BK: Continuing Disability Review Report to fill out. You may also request this form at any time by calling the SSA and asking for it.

Along with this form, you will receive notification that you may contact a Social Security representative at your local Field Office. The purpose of the invitation is to provide you with a liaison throughout the CDR process as well as to protect your rights as a claimant.

Complete the form and mail it back to your local Field Office. While the SSA prefers face-to-face contact, telephone is acceptable, and, under the following conditions, you may waive your personal contact:

1. If your relationship with your representative payee is in an official capacity (i.e. an institution or government agency).
2. If you and/or your representative payee agree or request to conduct the CDR via mail.
3. If contact is impractical for some reason (i.e. weather or travel) and your or your representative payee agrees to the personal contact waiver and to conduct the CDR via mail.
4. If you live in a foreign country without a U.S. District Office.

Form SSA-454-BK is 11 pages long, but is not difficult to fill out. Moreover, your SSA Field Office can help answer questions you may have about completing it, and you may also get an attorney or other representative to help you fill it out. The SSA wants to know about your history since making the claim or since you had your last CDR.

The SSA Field Office representative can complete the code boxes asking for Types of Entitlement, so don’t worry about those.

If someone besides the recipient of the benefits is filling out the form, be sure to note the name, address, and relationship of the person who is reporting, as well as why the beneficiary is not doing the reporting on his or her own behalf.

The following bullet points provide brief descriptions of the types of information required in each section of the form:

*Section 1 asks for your name and basic contact information.

*Section 2 asks for a description of your medical condition(s) for which you are receiving benefits. Do not use this section to note new conditions that have arisen since your initial claim was approved or since your last CDR, but do use this section to describe how, if at all, your condition has changed (either negatively or positively). If you require more room to describe these changes, use Section 10 of the form (on page 16). Do your best to be concise.

*Sections 3A and 3B ask you to provide information about treatment you have received in the last year. Use Section 3C if you have medical records under a different name. Section 3D asks you to list the contact information for the healthcare providers you have seen. In Section 3E you will need to provide information about hospitals and clinics you have visited in the last year (and the SSA will require those records). Section 3F asks for any additional contact information for people and institutions (other than those you’ve already listed) that have medical records or information about your condition that is current as of the past year, such as attorneys and insurance companies.

*Section 4 asks you for information about the medications you are taking.

*Section 5 asks you for information about tests you have had in the last year. Ask your doctor if you’re unsure whether or not you have had these tests. You do not need to know the results of these tests, but if you’ve had a test that isn’t listed on the form, use Section 10 to describe it.

*Section 6 asks you for information about your education level and any additional schooling or training you have received since your initial claim was approved, or since your last CDR.

*Sections 7A-7D ask you about your work history (and current job, if you have one) since your last disability decision. List every job you have had, no matter how minor, and be sure to note if you attempted to work but were unable to. In Section 7E, you will be asked to assess your ability to work based on your current condition. Section 7F asks you about your doctor or doctors’ assessments of your ability to work, and for the contact information of these doctors. The SSA will contact them for medical records.

*Section 8 asks you about your participation, or lack thereof, in the Ticket to Work program.

*In Section 9, you will be required to describe the difficulties you’ve had performing the activities of daily living (ADLs). This is a very important section, so take your time and be thorough. Things to describe include personal mobility difficulties, your ability to see to your personal care and grooming needs, trouble performing household maintenance duties, how your condition has limited your recreational activities and hobbies, how your condition has affected your social life, and anything else ADL-related such as seizures, balance difficulties, or memory loss.

*Section 10 gives you the opportunity to provide further details related to earlier questions if you required more room to explain, and to provide any additional information you think might be important for the SSA to know about your condition.

*Page 14 asks you to sign and date the form, and to provide your phone number and mailing address. Write an “X” in the signature space if you cannot sign your name (if you’ve had a stroke, for example), and have two witnesses who know you sign the form and enter their mailing addresses. Your signature gives the SSA, their doctors, the DDS, and any relevant vocational institutions permission to review your medical records. Your signature also constitutes your agreement to notify the SSA if your medical condition improves or you return to work.

Leave the rest of the form blank. If you got help from the Field Office in filling out the form, the SSA representative who helped you will record his or her experience with you in Items 15-20. If you filled it out yourself, mail it back to your local SSA Field Office. You can find the appropriate address in the government section of the phone book, or find it at www.ssa.gov.

C. Medical Improvement Review Standard (MIRS)

The Medical Improvement Review Standard (MIRS) is the benchmark that the SSA uses to evaluate your cases during a CDR. The MIRS exists to help make sure no one is unfairly terminated from receiving benefits, but it is important for you to understand the MIRS in case you encounter an evaluator who has not been properly trained in the MIRS. Do note that the MIRS does not apply in all circumstances (these circumstances will be discussed in Section C2).

*If your benefits are terminated, insist on a full medical review by a DDS medical consultant.

1. MIRS Requirements

Whereas during your initial application for disability benefits the burden of proof of disability fell to you, in a CDR, it falls to the SSA. Consequently, the evaluation process during a CDR is quite different from that during an initial application. This means that unless the SSA can prove that you’re medically sound enough to return to work, you will continue to receive benefits. The MIRS requires two forms of proof before the SSA can terminate your benefits. The SSA must show that:

1. Your medical condition has improved enough to restore your ability to work, as determined by a DDS medical consultant (see subsection a below).
2. You can capably perform substantial, gainful activity, as determined by a DDS claims examiner or vocational specialist (see subsection b below).

1. Medical Improvement Related to Your Ability to Work

Medical improvement is defined as a decrease in the severity of your disabling impairments since your last CDR. Federal regulations stipulate that medical improvement must be significant in order to fulfill this requirement. Minor medical improvement does not constitute sufficient evidence that your ability to work has been restored.

Significant improvement will usually, but not always, relate to your capacity to work. This means that significant improvements in the medical severity of certain aspects of your condition or conditions, aspects that do not relate to your ability to work, do not count toward fulfillment of the significant improvement requirement stipulated by the MIRS.

The comparison point decision (CPD) is the date that your claim was last reviewed and a benefit decision rendered. The CPD can be the date of your initial approval, the date of an appeal, or the date of a past CDR.

If you have not experienced significant medical improvement, your benefits will continue. However, if you do have significant medical improvement, it does not necessarily indicate an overall improvement in your condition. You may, for example, have developed new disabilities since your last CPD, in which case your medical consultant will take these new impairments into consideration when he or she assesses your ability to work.

In order to decide whether or not your condition has improved, the SSA will consider your symptoms (according to your own description), signs (observable physical or psychological issues apart from your self-described symptoms), and laboratory findings (the results of diagnostic tests you have undergone).

The MIRS applies to physical disorders, psychological disorders, and conditions encompassing both physical and psychological impairments.

Physical Disorders

When the SSA uses the MIRS to evaluate physical disorders, it uses a measure called residual functional capacity (RFC), which is a scale of exertional levels. A jump of one level, such as from light work to medium work, or sedentary work to light work, qualifies as significant medical improvement. However, medical improvement that stays within the same exertional level can, in some cases, also be considered significant.

Mental Disorders

The RFC also includes ratings for mental skill levels. A jump of one mental skill level, such as from unskilled work to semiskilled work, or from semiskilled work to skilled work, constitutes significant medical improvement. However, as is the case with physical disorders, medical improvement that stays within the same mental RFC skill level can, in some cases, also be considered significant.

Physically healthy individuals with mental impairments but who are capable of semiskilled or skilled work never receive benefits. Those capable of unskilled work are seldom granted benefits without mitigating vocational factors (age, education, work experience).

Combined Physical and Mental Disorders

If you suffer from a disorder combining physical and mental impairments, a significant improvement in either a physical or a mental aspect of your condition can qualify as significant medical improvement.

Significant improvement in a trivial impairment unrelated to your work ability does not constitute a finding of significant medical improvement by the DDS.

b. Your Ability to Work

Before terminating your benefits, a DDS representative must, taking into account your original and/or new disabling impairments, prove that you are able to perform a type of work currently in demand in the national marketplace.

The skill level of work you can capably perform is directly influenced by your mental impairment, if you have one, or vocational factors such as education level and work history. The SSA bases its assessment of your ability to work on your lower skill level. For example, you may be mentally healthy but incapable of performing skilled labor based on your level of education and/or work experience. Conversely, if you are highly educated and have a work history that supports skilled labor, but you have suffered a mental impairment, you may be capable of only unskilled work.

3. Age and Time Receiving Disability

Your age does not usually enter into the SSA’s consideration of your physical capacity on an RFC, except during CDRs. If you are over age 50 and have been receiving disability benefits for at least seven years, the SSA will consider your age and inactivity when making its assessment.

2. When the MIRS Doesn’t Apply

There are some circumstances in which the SSA will not apply the MIRS to your CDR. In such cases, you might not have to undergo a DDS review in order to continue receiving benefits. However, you may also lose your benefits absent the protection provided by the MIRS. Cases in which the MIRS does not apply are as follows:

1. Your Impairment Meets or Equals a Listing
   

If your listing meets or equals the same listing in the Listing of Impairments as it did when you had your last comparison point decision (CPD) or when you first started receiving benefits, then the SSA will not apply the MIRS to your case, and you will continue to receive benefits. Keep in mind that you cannot be cut off from your benefits if you were granted a listing in the past and the listing requirements have since been changed. Be aware that new or insufficiently trained DDS examiners may not be aware of this grandfathering clause, so it’s important that you are.

This applies to newer listings in effect at the time of your CDR (as you may have initially qualified under older or different listings) and includes new impairments you might have developed since your last evaluation.

These rules apply to adults only. The rules for children are different, and will be detailed in section D.

2. You Are No Longer Disabled or Never Were
   

The SSA can terminate your benefits without using the MIRS if the DDS discovers that you are no longer disabled or that you were never disabled at all, and are capable of, or actively performing substantial gainful activity (SGA). These are Group I exceptions and include the following:

You have participated in work ability-related vocational therapy.

If you have recovered in full, or so much so that you are capable of SGA, the SSA can terminate your benefits without using the MIRS. Note that this exception does not apply to those receiving SSI with cash benefit eligibility.

Changing evaluative techniques, and/or diagnostics have rendered your impairment less disabling than it was deemed at the time of your CPD.

The SSA can terminate your benefits without applying the MIRS if your impairment is no longer classified as disabling based on improved evaluative techniques and/or diagnostics. Said techniques must have become available for use since the last CPD in order for this exception to apply.

A prior disability decision was made in error.

The SSA can terminate your benefits without using the MIRS if the DDS finds clear evidence that an earlier disability decision was erroneous. The DDS can make this finding in three ways:

1. Documentation in your file indicates that the decision in question should not have been made; this documentation counts as clear evidence not subject, or open, to judgment.
2. Material evidence of the severity of your condition that was required at the time of the CPD was then missing, but has since been collected and clearly shows that had it been present during the CPD, there would not have been a disability finding.
3. New evidence that contradicts the conclusions made based on prior evidence used in the CPD has since been collected and clearly indicates that a finding of disabled would not ever have occurred had this evidence existed at that time.

You are currently performing SGA

If the DDS discovers you are performing work above the SGA level, the SSA can terminate your benefits without applying the MIRS. This does not apply to SSI recipients or to those who receive SSI or SSDI while in a trial work period or reentitlement period.

You have benefitted from advances in medical or vocational therapies related to your ability to work.

The nature of such advances renders this exception almost moot, as these advances often result in significant medical improvement. This exception does not apply to SSI recipients with cash benefit eligibility.

c. You are Disqualified Because of Something Other than Disability

Group II exceptions are those that allow the SSA to terminate your benefits without considering your medical condition or work ability. If (1) the SSA cannot locate you, (2) if you fail to cooperate with the SSA (i.e. refusing to undergo an examination without providing a reasonable explanation or failing to turn over medical evidence as requested), (3) if you refuse or fail to follow to abide by a prescribed treatment designed to restore your ability to perform SGA, or (4) you commit fraud (i.e. knowingly giving the SSA false information at any time), the SSA can apply Group II exceptions to terminate your benefits.

d. New Impairments

When evaluating adults, the SSA will consider new impairments only after deciding upon your level of medical improvement or if these new impairments meet or equal a listing in the Listing of Impairments. New impairments that arise after the CPD date are not included in the medical improvement decision.

For children, new impairments are considered after the SSA rules on whether or not there is significant medical improvement.

If you develop a new impairment at or near the time of your CDR, be sure to work closely with your DDS medical consultant to make sure you do not undergo a CDR prematurely.

D. CDRs for Children

What follows does not apply to children under 18 who are dependents of an SSDI recipient and receive benefits accordingly. Rather, the following information applies solely to CDRs for children who are SSI recipients.

Children do not receive RFCs; consequently, their CDR evaluations differ from adult evaluations in that medical improvement determinations for children do not involve changes in RFS. Furthermore, the chronology of a child CDR is different from an adult evaluation in that before it is decided whether the child meets or equals a listing, the evaluator will first assess medical improvement. Finally, a child CDR does not involve a finding related to work ability.

The SSA uses the following steps to determine significant medical improvement in a child’s condition:

Step 1: If the child has not experienced significant medical improvement in impairments existing at the time of the CPD, benefits will continue so long as none of the exceptions apply. If the child has experienced significant medical improvement, continue to Step 2.

Step 2: If the impairments maintain their prior-determined severity in the Listing of Impairments at the time of the CPD, benefits will continue so long as none of the exceptions apply. If they do not, continue to Step 3.

Step 3: If the child’s current impairments meet or equal a current listing in the Listing of Impairments, the benefits will continue. If not, benefits will be terminated.

E. Appealing a CDR Decision

You will be notified when the SSA makes a CDR decision. Your benefits will continue if you are found disabled.

If the SSA finds you are no longer disabled, you will receive an explanation detailing the reasons for the finding and your benefits will end three months after the SSA said your disability ended, but not earlier than the date the SSA decided to end your benefits. This is so the SSA cannot demand back payment from you by claiming that your disability ended prior to the date the CDR was conducted. However, if the SSA discovers that you committed fraud in order to gain benefits, it can demand repayment of all benefits paid.

/* Style Definitions */
table.MsoNormalTable
{mso-style-name:”Table Normal”;
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-qformat:yes;
mso-style-parent:””;
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin-top:0in;
mso-para-margin-right:0in;
mso-para-margin-bottom:10.0pt;
mso-para-margin-left:0in;
line-height:115%;
mso-pagination:widow-orphan;
font-size:11.0pt;
font-family:”Calibri”,”sans-serif”;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;}