Frequency of Reviews

How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. The Certificate of Award of benefits you received when the SSA approved your claim shows when you can expect your first review. Exactly when that review will occur, and the times of subsequent reviews, is left to the judgment of the SSA, depending on which of the following categories you fall into:

Medical improvement expected (MIE). If, when your benefits first start, the SSA expects your medical condition to improve, your first review is likely to be six to 18 months later. Your age can affect whether you will be put into this category. If you will be at least 54^2 years old at the scheduled review date, the SSA will generally not use this category unless either of the following is true:

• You have an impairment that is almost certain to result in great improvement, or even full recovery, such as sprains and fractures, as well as cancers with a high cure rate like certain lymphomas and types of leukemia. You could get an MIE review up to age 59^.

• You receive SSI, are legally blind but are expected to improve. You could get an MIE review up to age 64^2.

EXAMPLE: Betty was in an automobile wreck and suffered severe fractures in her leg and arm, along with other injuries. Six months after her injury, her fractures had not healed properly and she developed an infection in her bone. She cannot walk without help. Her orthopedic surgeon plans several more operations to restore function and predicts that she will need at least six more months to heal. Because of the high probability that she will improve, the SSA would schedule a CDR as soon as six months after she was granted benefits.

Medical improvement possible (MIP). If, when your benefits first start, the SSA believes it is possible for your medical condition to improve but the SSA cannot predict when that improvement might happen, your case will be reviewed about every three years. Examples of disorders in which improvement is possible would be conditions such as increased thyroid gland activity (hyperthyroidism) and inflammatory intestinal diseases like regional enteritis or ulcerative colitis. Your age can affect whether you will be put in this category. If you will be at least 54^ years old at the scheduled review date, the SSA will generally not use this category unless the following is true:

• You have an impairment that is almost certain to result in great improvement, or even full recovery, such as a sprain, fracture or a cancer with a high cure rate like certain lymphomas and types of leukemia. You could get an MIE review up to age 59^2.

EXAMPLE 1: For several weeks, Livan was having dull, aching pains in the center of his chest, especially when he exerted himself or got excited. Sometimes, he'd sweat with these pains and even get short of breath. Although they at first lasted only a few minutes after he stopped to rest, they eventually lasted up to ten minutes even when he'd stop walking. Livan ignored the warning signs, and woke up one morning with a smothering chest pain like an elephant on his chest. Livan was rushed to the nearest hospital in the middle of a life-threatening heart attack. Treatment stabilized his condition, but he has severe blockages in multiple major arteries supplying his heart muscle. Despite optimum medical treatment, his heart disease is crippling and his symptoms of chest pain, shortness of breath, weakness and fatigue are so severe that the SSA considers him disabled. Livan has refused heart surgery because he is scared—his uncle died on the operating table during a similar procedure. Livan is relatively young at age 50 and medical improvement with surgery could make a big difference in his ability to work. The SSA knows that medical improvement is possible if Livan has surgery, and that there's a good chance Livan will change his mind about the operation. His case will be reviewed within a few years of his being allowed benefits.

EXAMPLE 2: Sharon has had high blood pressure for years, as well as diabetes. She tried to treat herself with various herbal remedies. Her kidneys were progressively ravaged by disease and complete kidney failure qualified her for disability benefits. The SSA knows that a kidney transplant could result in marked medical improvement, and so her case is put in the MIP category. If, during Sharon's application for benefits, her doctor reported that she was soon going to have a kidney transplant, the SSA might put her in the MIE category.

Medical improvement not expected (MINE). If the

SSA does not expect your medical condition to improve, your case will be reviewed about every five to seven years. You are most likely to fall into this category if you will be over 54^ years old when the CDR is scheduled, you already have had several CDRs or you have multiple severe impairments or an irreversible condition with no known treatment. Some disorders that the SSA puts into a MINE category include the following:

• amputation

• ankylosing spondylitis of the spine

• blindness, such as glaucoma

• cerebral palsy

• chronic myelogenous leukemia

• degenerative nervous system diseases

• diabetes mellitus

• diabetic eye disease

• diabetic nerve damage

• Down syndrome

• major mood disorders, such as major depression

• mental disorders caused by organic brain disease

• mental retardation

• multiple sclerosis

• Parkinson's disease

• peripheral vascular disease (arteries or veins)

• polio with permanent residuals

• psychotic mental disorders, such as schizophrenia

• rheumatoid arthritis

• traumatic spinal cord or brain injuries.

EXAMPLE 1: Doug is 55 years old, has degenerative arthritis throughout his lower spine and suffers pain and stiffness. Surgery would not relieve his symptoms and other forms of treatment have been only moderately effective. Doug has a limited education and has worked only in jobs lifting and carrying 50 pounds or more. In his condition, he can't lift more than 20 pounds, and he is not qualified for jobs with that kind of light work. He's already had two CDRs and his disability continued. The SSA will put him in the MINE category.

EXAMPLE 2: Sally is 52 years old and was diagnosed with severe depression at age 40. Following an initial recovery, Sally's medical record shows years of only partially successful treatment with a variety of medications and six hospitalizations. She continues to live with her elderly parents, but doesn't help much with chores; she spends much of her day watching television, but has poor recall of the programs. Her parents manage her disability benefits, and she cannot function outside of the protective environment of her parents' home without worsening of her condition. She continues to show serious signs of depression, such as lack of pleasure, weight loss, feelings of hopelessness, poor sleep, lack of general interests and some continuing suicidal thoughts. She has had two CDRs, and is seen weekly at a community mental health center with only marginal improvement.

Don't be surprised if you are not notified for a CDR when you are expecting it, based on the MIE, MIP or MINE time limits. When the SSA runs short of operating money, it typically stops performing CDRs rather than cut back on vital operations. The result is that your CDR might come later than would otherwise be the case—sometimes years later.

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