[Title 20 CFR 404.1590]
[Code of Federal Regulations (annual edition) - April 1, 1996 Edition]
[Title 20 - EMPLOYEES' BENEFITS]
[Chapter III - SOCIAL SECURITY ADMINISTRATION]
[Part 404 - FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )]
[Subpart P - Determining Disability and Blindness]
[Sec. 404.1590 - When and how often we will conduct a continuing disability review.]
[From the U.S. Government Publishing Office]
20
EMPLOYEES' BENEFITS
2
1996-04-01
1996-04-01
false
When and how often we will conduct a continuing disability review.
404.1590
Sec. 404.1590
EMPLOYEES' BENEFITS
SOCIAL SECURITY ADMINISTRATION
FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )
Determining Disability and Blindness
Sec. 404.1590 When and how often we will conduct a continuing disability review.
(a) General. We conduct continuing disability reviews to determine
whether or not you continue to meet the disability requirements of the
law. Payment of cash benefits or a period of disability ends if the
medical or other evidence shows that you are not disabled as determined
under the standards set out in section 223(f) of the Social Security
Act.
(b) When we will conduct a continuing disability review. A
continuing disability review will be started if--
(1) You have been scheduled for a medical improvement expected diary
review;
(2) You have been scheduled for a periodic review (medical
improvement possible or medical improvement not expected) in accordance
with the provisions of paragraph (d) of this section;
(3) We need a current medical or other report to see if your
disability continues. (This could happen when, for example, an advance
in medical technology, such as improved treatment for Alzheimer's
disease or a change in vocational therapy or technology raises a
disability issue.);
(4) You return to work and successfully complete a period of trial
work;
(5) Substantial earnings are reported to your wage record;
(6) You tell us that you have recovered from your disability or that
you have returned to work;
(7) Your State Vocational Rehabilitation Agency tells us that--
(i) The services have been completed; or
(ii) You are now working; or
(iii) You are able to work;
(8) Someone in a position to know of your physical or mental
condition tells us that you are not disabled, that you are not following
prescribed treatment, that you have returned to work, or that you are
failing to follow the provisions of the Social Security Act or these
regulations, and it appears that the report could be substantially
correct;
(9) Evidence we receive raises a question as to whether your
disability continues; or
(10) You have been scheduled for a vocational reexamination diary
review.
(c) Definitions. As used in this section--
Medical improvement expected diary--refers to a case which is
scheduled for review at a later date because the individual's
impairment(s) is expected to improve. Generally, the diary period is set
for not less than 6 months or for not more than 18 months. Examples of
cases likely to be scheduled for medical improvement expected diary are
fractures and cases in which corrective surgery is planned and recovery
can be anticipated.
Permanent impairment--medical improvement not expected--refers to a
case in which any medical improvement in the person's impairment(s) is
not expected. This means an extremely severe condition determined on the
basis of our experience in administering the disability programs to be
at least static, but more likely to be progressively disabling either by
itself or by reason of impairment complications, and unlikely to improve
so as to permit the individual to engage in substantial gainful
activity. The interaction of the individual's age, impairment
consequences and lack of recent attachment to the labor market may also
be considered in determining whether an impairment is permanent.
Improvement which is considered temporary under Sec. 404.1579(c)(4) or
Sec. 404.1594(c)(3)(iv), as appropriate, will not be considered in
deciding if an impairment is permanent. Examples of permanent
impairments taken from the list contained in our other written
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guidelines which are available for public review are as follows and are
not intended to be all inclusive:
(1) Parkinsonian Syndrome which has reached the level of severity
necessary to meet the Listing in appendix 1.
(2) Amyotrophic Lateral Sclerosis which has reached the level of
severity necessary to meet the Listing in appendix 1.
(3) Diffuse pulmonary fibrosis in an individual age 55 or over which
has reached the level of severity necessary to meet the Listing in
appendix 1.
(4) Amputation of leg at hip.
Nonpermanent impairment--refers to a case in which any medical
improvement in the person's impairment(s) is possible. This means an
impairment for which improvement cannot be predicted based on current
experience and the facts of the particular case but which is not at the
level of severity of an impairment that is considered permanent.
Examples of nonpermanent impairments are: regional enteritis,
hyperthyroidism, and chronic ulcerative colitis.
Vocational reexamination diary--refers to a case which is scheduled
for review at a later date because the individual is undergoing
vocational therapy, training or an educational program which may improve
his or her ability to work so that the disability requirement of the law
is no longer met. Generally, the diary period will be set for the length
of the training, therapy, or program of education.
(d) Frequency of review. If your impairment is expected to improve,
generally we will review your continuing eligibility for disability
benefits at intervals from 6 months to 18 months following our most
recent decision. Our notice to you about the review of your case will
tell you more precisely when the review will be conducted. If your
disability is not considered permanent but is such that any medical
improvement in your impairment(s) cannot be accurately predicted, we
will review your continuing eligibility for disability benefits at least
once every 3 years. If your disability is considered permanent, we will
review your continuing eligibility for benefits no less frequently than
once every 7 years but no more frequently than once every 5 years.
Regardless of your classification, we will conduct an immediate
continuing disability review if a question of continuing disability is
raised pursuant to paragraph (b) of this section.
(e) Change in classification of impairment. If the evidence
developed during a continuing disability review demonstrates that your
impairment has improved, is expected to improve, or has worsened since
the last review, we may reclassify your impairment to reflect this
change in severity. A change in the classification of your impairment
will change the frequency with which we will review your case. We may
also reclassify certain impairments because of improved tests,
treatment, and other technical advances concerning those impairments.
(f) Review after administrative appeal. If you were found eligible
to receive or to continue to receive disability benefits on the basis of
a decision by an administrative law judge, the Appeals Council or a
Federal court, we will not conduct a continuing disability review
earlier than 3 years after that decision unless your case should be
scheduled for a medical improvement expected or vocational reexamination
diary review or a question of continuing disability is raised pursuant
to paragraph (b) of this section.
(g) Waiver of timeframes. All cases involving a nonpermanent
impairment will be reviewed by us at least once every 3 years unless we,
after consultation with the State agency, determine that the requirement
should be waived to ensure that only the appropriate number of cases are
reviewed. The appropriate number of cases to be reviewed is to be based
on such considerations as the backlog of pending reviews, the projected
number of new applications, and projected staffing levels. Such waiver
shall be given only after good faith effort on the part of the State to
meet staffing requirements and to process the reviews on a timely basis.
Availability of independent medical resources may also be a factor. A
waiver in this context refers to our administrative discretion to
determine the appropriate number of cases to be reviewed on a State by
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State basis. Therefore, your continuing disability review may be delayed
longer than 3 years following our original decision or other review
under certain circumstances. Such a delay would be based on our need to
ensure that backlogs, reviews required to be performed by the Social
Security Disability Benefits Reform Act of 1984 (Pub. L. 98-460), and
new disability claims workloads are accomplished within available
medical and other resources in the State agency and that such reviews
are done carefully and accurately.
[51 FR 16825, May 7, 1986]