DI 280: Continuing Disability Review Cases

Effective Dates: 08/26/2015 - Present

BASIC (08-15)

The table below shows the issues in the current disability decision-making process that require rationalization, and where these issues are usually documented in the file.

NOTE: For claims documented in the Electronic Claims Analysis Tool (eCAT), this information is generally found in the Disability Determination Explanation (DDE) stored in the electronic folder case documents (A. Payment Documents/Decisions (Yellow Front)).

Issues Needing Rationalization		Usual Location of Documentation in File	Action Required if not Already in File
1.	Evidence Sources
	a. Continuances	Medical evidence
	b. Cessations	Medical evidence Personalized Disability Notice (PDN)
2.	Basis for the Most Recent Prior Favorable Medical Decision; i.e., Comparison Point Decision (CPD)
	a. Continuances	Prior SSA-831 item 22 Prior SSA-832/833 (6/85 edition or later) item 10 and 12 Prior determination; i.e. SSA-4268 (Explanation of Determination), eCAT DDE Administrative Law Judge (ALJ), Appeals Council (AC), or court decision SSA-5002 (Report of contact)
	b. Cessations	PDN Prior SSA-831 item 22 Prior SSA-832/833 (6/85 edition or later) item 10 and 11 Prior determination ALJ, AC, or court decision SSA-5002	Supplemental rationale -see DI 28091.010A.2.¹
3.	Date of CPD
	a. Continuances	Prior determination or decision; i.e. SSA-4268 (Explanation of Determination), ALJ Decision Prior SSA-831 item 31 and 33 Prior SSA-832/833 item 26 and 28 Development worksheet or SSA-5002
	b. Cessations	PDN Prior determination or decision Prior SSA-831 item 31 and 33 Prior SSA-832/833 item 26 and 28 Development worksheet or SSA-5002
4.	Reason for Current Review
	a. Continuances	SSA-832/833 (6/85 edition or later) item 20 Prior SSA-831 item 17, or SSA-832/833 item 23 SSA-847-U3 (Request for Case Action) SSA-5526 (Request for Assistance-Disability)
	b. Cessations	PDN SSA-832/833 (6/85 edition or later) item 20 Prior SSA-831 item 17, or SSA-832/833 item 23 SSA-847-U3 SSA-5526
5.	Individual's Condition(s) that Limit His or Her Ability to Work
	a. Continuances	SSA-454-BK (Continuing Disability Review Report) Report(s) of work activity, e.g.; SSA-820-BK (Work Activity Report-Self Employment) SSA-821-BK (Work Activity Report-Employee) Report(s) of contact
	b. Cessations	SSA-454-BK PDN Report(s) of work activity Report(s) of contact
6.	Statement of Nonmedical Issues
	a. Continuances	Report(s) of work activity SSA-454-BK SSA-832/833 SSA-899-U2 (Continuing Disability Review)
	b. Cessations	PDN Report(s) of work activity SSA-454-BK SSA-832/833 SSA-899-U2
7.	Medical Facts
	a. Continuances	Medical evidence SSA-5002 SSA-795 (Statement of Claimant or Other Person
	b. Cessations	Medical Evidence SSA-5002 SSA-795
8.	Discussion of Comparison of Medical Findings Under the Medical Improvement Review Standard
	a. Continuances	SSA-832/833 (6/85 edition) ² items 10 and 12 Medical assessment form(s): SSA-416 (Medical Evaluation) SSA-2506-BK (Psychiatric Review Technique (PRT)) SSA-4734-BK (Physical Residual Functional Capacity Assessment (RFC)) SSA-4734-F4-SUP (Mental Residual Functional Capacity assessment (MRFC))	Supplemental rationale - see DI 28091.010A.1.
	b. Cessations	SSA-832/833 (6/85 edition)² items 10 and 11 PDN Medical assessment form(s)	Supplemental rationale - see DI 28091.010A.1. ¹ Supplemental rationale - see DI 28091.010A.3.¹
9.	Pain-Related Issues
	a. Continuances	Any medical listing which specifically mentions pain Medical assessment form(s)
	b. Cessations	Medical assessment form(s)	Supplemental rationale - see DI 28091.010A.6.
l0.	Resolution of Conflicting Treating Source Opinion(s)
	a. Continuances	Resolved by the determination of a continuance (SSA-832/833)
	b. Cessations	Medical assessment form(s)	Supplemental rationale - see DI 28091.010A.4.
ll.	Resolution of Inconsistencies Material to Determination
	a. Continuances	Resolved by the determination of a continuance (SSA-832/833)
	b. Cessations	Medical assessment form(s)	Supplemental rationale - see DI 28091.010A.5.
12.	Vocational Rule Used for Medical-Vocational Decision
	a. Continuances	SSA-832/833 item 14	Supplemental rationale - see DI 28091.010A.7.
	b. Cessations	SSA-832/833 item 14	Supplemental rationale - see DI 28091.010A.7.
13.	Citation of Jobs and Incidence
	a. Continuances	Not applicable (unless the determination considers a social Security Ruling (SSR), or the absence of sufficient jobs.).	When relevant, supplemental rationale - see DI 28091.010A.8.
	b. Cessations	Report by a vocational specialist	Supplemental rationale - see DI 28091.010A.8.
14.	Assessment of Functional Abilities
	a. Continuances	RFC MRFC Medical evidence
	b. Cessations	RFC MRFC Medical evidence
15.	Basis for Determination
	a. Continuances	SSA-832/833 items 10 and 12
	b. Cessations	SSA-832/833 items 10 and 11 PDN

¹ A supplemental rationale is still required even if the required information is documented in the personalized disability notice.

² The 06/85 editions of the SSA-832 and SSA-833 shows the basis code only - a supplemental rationale is required to explain whether medical improvement has occurred.

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DI 280: Continuing Disability Review Cases