CDR Diaries NPRM

The National Association of Disability Examiners (NADE) applauds the efforts to review steps of the Continuing Disability Review (CDR) process.  NADE welcomes the opportunity to review and provide comment on the proposed changes to the Rules Regarding the Frequency and Notice of Continuing Disability Reviews.

NADE is a professional association whose mission is to advance the art and science of disability evaluation and to promote ongoing professional development for our members.  The majority of our members are employed in the State Disability Determination Service (DDS) agencies and are responsible for the adjudication of claims for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits.  Our membership also includes personnel from Social Security’s Central Office and its Field Offices, claimant advocates, physicians, attorneys, and many others.  This diversity, combined with our immense program knowledge and our “hands on” experience, enables NADE to offer a unique perspective that is reflective of a pragmatic realism.

NADE has reservations about the proposed changes to the diaries.  With the current Medical Improvement Review Standard, there will likely be minimal impact upon the proportion of CDRs that are ceased.  This would greatly increase the DDS workload, not just by the increased number of CDRs but also the appeals of any cessations.  CDR claims in general are handled by more experienced examiners.  Therefore, increasing the frequency of CDRs will force some states to have to train more examiners to be able to process CDR claims in order to better  manage the workload.  With no substantial changes to the Medical Improvement Review Standard and increasing the increase workload of CDRs, there will be a decrease in the return of investment for CDRs. 

The proposed rule change leans heavily upon medical intervention improving the individual’s level of functioning and their ability to work. It must be considered that an individual must be receiving SSDI for 24 months before being eligible for Medicare.  For those with no way to pursue medical treatment during the 2-year waiting period for Medicare, it is less likely they would have medical improvement related to the ability to work prior to a CDR initiated at 2 years. This may lead to benefits being continued, simply because the individual has not had adequate access to health care.

There are some beneficiaries who can successfully return to employment. Often these are people who have a support system, education or work experience that allows them to return to work which provides accommodations or is less physically demanding.  These individuals often chose to return to work when their condition has improved independently and not because their benefits were ceased.  A large amount of those ceased on review choose to appeal the decision and elect to have benefits continued during the appeal.  Perhaps due to exacerbation of the conditions or additional evidence obtained, many CDRs appealed eventually are continued at the Disability Hearing level or by an Administrative Law Judge.  

The NPRM lists insufficient examples of impairments that would be considered for a Medical Improvement Likely diary.  Before changing the diaries, a thoughtful consideration should occur of what impairments would fall into this new category. Depending on the impairments, an earlier diary could cause the opposite of the intended effect.  If a CDR occurs prior to the time period it takes for the condition to improve, benefits would continue and the claim would not be reviewed for two to three more years.

Consideration of the beneficiaries age at the time of review should be a factor in determining when a CDR should take place.  The disability program acknowledges that there are more barriers to work when the person is closer to retirement age. Even when a condition improves, there are often residual limitations, impacts from medical treatment and other existing conditions that still must be considered.  Even with improvement, the individual may still have limitations, that when their age is factored in, would prevent the successful return to employment.

NADE would not support decreasing the Medical Improvement Not Expected (MINE) diary from 7 years to 6 years. MINE diaries are intended to be used for conditions that are at least static or likely to progress in severity. If the disabling impairments are identified to be ones that are not expected to improve to allow increased functioning related to the ability to work, there is no reason to change the frequency of the MINE diaries. Since a claim with a MINE diary is more likely to be continued upon review, a change to 6 years would only serve to unnecessarily increase the CDR volume and workload for the DDS.

NADE suggests expanding the maximum review date of Medical Improvement Expected diaries instead of adding an additional diary type.  Allowing flexibility in MIE diaries from 6 months to 24 months would address the conditions that may improve prior to 3 years. This would have a similar effect to the proposed MIL diary but with less potential for error. Additional training on CDRs and exceptions to the medical improvement review standard would be a better investment in resources. There is potential for more meaningful changes by a review of the Medical Improvement Review Standard.

Respectfully Submitted,

The National Association of Disability Examiners