When is the Medical Improvement Review Standard (MIRS) Not Applicable?

The MIRS is the yardstick by which a disability beneficiary’s condition is measured over time; the Social Security Administration (SSA) cannot legally terminate someone’s benefits unless it can show medical improvement.

However, there are several exceptions to the MIRS. Here are a few of those exceptions:

1. There is evidence that the disability decision was made in error. Such evidence could include: misinterpreting test results, or misapplying a listing or a rule to the claimant’s condition, or lack thereof.
2. Required medical evidence of the severity of the claimant’s condition was missing when the last review took place. This exception is relevant when it is discovered that the missing evidence would have resulted in an unfavorable disability finding.
3. New evidence relevant to the last disability determination surfaces that negates the prior conclusions. An example of this exception would be finding out that a tumor initially believed to be malignant is later discovered to be benign.

It is important to note that no exception to the MIRS can be based on a substitution of current judgment for previous judgment that resulted in a favorable disability finding.