Disability Doc

By law, any person who receives Social Security disability benefits will eventually have their case reviewed to see if they are still disabled under Social Security’s rules. How often a case is reviewed depends on the expectation of recovery from the disability. Each person’s case is generally given a diary date as follows:

• If medical improvement is “expected,” a case normally will be reviewed within six to 18 months.
• If medical improvement is “possible,” a case normally will be reviewed no sooner than three years.
• If medical improvement is “not expected,” a case normally will be reviewed no sooner than seven years.

In addition, if a person receiving Disability Insurance Benefits (DIB) begins to work; this will trigger a CDR once they have worked nine months. This is known as trial work period. During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. Social Security does not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2005, any month in which earnings exceed $590 is considered a month of services for an individual's trial work period. In 2006, this monthly amount increases to $620.

Those persons getting Supplemental Security Income (SSI) will trigger a CDR when they begin to earn above Substantial Gainful Activity (SGA), which is $830 a month in 2005. The fact that someone getting benefits is working is not a bad thing; it simply triggers the action, but doesn’t necessarily mean that person is going to lose benefits.

If there is evidence that someone getting benefits is working, Social Security will do a medical review of their case check to see if there has been significant medical improvement of their disability. For any person getting DIB who goes to work, the Social Security will review any work activity that is currently happening or has happened since the last review of their disability, and it will decide whether the individual is currently engaged in substantial gainful activity.

The CDR is a medical review in which Social Security looks at the medical evidence that first qualified an individual to be a recipient and compares it to his or her current medical evidence. Social Security is trying to decide if an individual’s level of disability has improved to the point where they have medically recovered and are able to work. If so, disability benefits may cease.

Even is a person hasn’t gone to work, they will still have a CDR because everyone eventually has a CDR based on their diary date as discussed above.

In 1993, in order to expedite the process and save the program money, Social Security began to use what is called a CDR mailer form. With the CDR process, Social Security does a computerized analysis of all persons whose diary dates will come due in a fiscal year. They develop a profile for each individual and put them in categories of high probability, medium probability, or low probability of medical improvement or recovery. Benefit recipients who have a medium or high likelihood of medical improvement undergo the full CDR process, much like the process they went through when they first applied for disability benefits. For those individuals with a low probability of medical improvement, a CDR mailer form is sent to them for completion.

If after a review of answers to the questions in the mailer, Social Security finds that there is no evidence of medical recovery or significant medical improvement, the CDR process is over and those individuals will continue to receive benefit payments. On the other hand, if the answers to those questions cause the reviewer at Social Security to think that this person may have had some medical improvement, the individual will get a letter and will be asked to come in for an interview and a full review of their case.

Keep in mind that not everyone gets a CDR mailer form, but all individuals up for review are sent a letter explaining that their case is going to be reviewed with instructions on what to do.

Depending on what type of CDR mailer is sent out, questions may include:

• Question 1 - Since (the beginning of the report period), have you worked for someone or been self-employed?
• Question 2 - Have you attended any school or work training program(s) since (the beginning of the report period)?
• Question 3 - Since (the beginning of the report period), have you and your doctor discussed whether you can work, and if so, what did the doctor tell you?
• Question 4 - Place an "X" in only one box (labeled Better, Same, and Worse) which best describes your health now as compared to (the beginning of the report period).
• Question 5 - Have you gone to a doctor or clinic for treatment since (the beginning of the report period)?
• Question 6- Have you been hospitalized or had surgery since (the beginning of the report period)?

"Report period" usually begins with the 24th month prior to the month the mailer is sent and continues to the present, but may be a longer or shorter time period.

The question referring to describing your health now as feeling the same, or better, or worse can be a tricky one for people with mental illnesses. With many of the mental illnesses, people have cycles in which they're doing quite well and cycles in which their symptoms are much worse. So an individual who happens to be doing quite well might answer, “I'm doing so much better than I was two years ago.” So when Social Security looks at that answer, there's a chance they're going to see it as evidence of improvement, rather than the fact that the individual is feeling well at that point in time.

Understand that CDRs happen, regardless of whether disability benefit recipients go to work. Individuals need to know that when they get a CDR notice with these questions, it's very important to answer the questions and return the form. For some, it may be important to have someone help answer the questions, especially if they're not certain what's being asked and why. This is where an attorney or other legal representative can help.

If an individual gets that CDR mailer and throws it in the trash, Social Security will send a second one, but individuals must not ignore the mailer. Continued failure to answer questions that Social Security is asking may result in termination of benefit payments.

To sum it up, everyone will have a CDR on their diary date. Some people will have a full CDR, and others will get the mailer. People who go to work will have a CDR at certain points in their working history, based on what’s called a work-triggered CDR.

The process for a CDR is the same sequential evaluation process that Social Security uses to determine initial eligibility for disability benefits. If a CDR occurs and the person is now engaged in Substantial Gainful Activity, consistently earning above about $830 a month in 2005, this may result in cessation of benefit payments.

Tips for a Continuing Disability Review:

Social Security will look at the original status of the medical condition(s) that resulted in you first getting approved for disability and compare it to the current status of your medical condition(s) to decide if there has been significant medical improvement. Because of that, it is helpful if you have continued to seek medical treatment for that condition(s) so Social Security can assess whether that condition(s) still causes you to be unable to work. If you have not continued to seek medical treatment, Social Security will most likely have to order a Consultative Exam to assess your current condition. It is usually more beneficial to you if your own doctor provides that information rather than a doctor hired by Social Security who really doesn't know you and your condition very well.

Be honest and don't exaggerate your symptoms caused by your current medical condition. And the reverse is also important - don't try to portray yourself as better from a functional standpoint than you truly are.

Keep in mind that Social Security is required to carefully evaluate any new medical conditions that have arisen since you were first allowed disability benefits, so be sure to tell your disability caseworker about any new conditions and treatment you have received since first allowed.

Age 18 redetermination

If you were allowed disability benefits as a child (under age 18), Social Security does not compare the status of your original medical condition to your current condition, but looks at your case like it is a brand new condition to see how it affects your ability to work as an adult.