After you are approved for disability benefits, the Social Security Administration (SSA) will conduct a continuing disability review every few years to see if your condition has improved. Continuing disability reviews are also called continuing disability re-evaluations, or CDRs.
Most individuals with impairments serious enough to be approved for disability in the first place do not medically improve, nor do they return to regular employment. However, for individuals who were approved for disability benefits based upon some type of injury or medical condition in which improvement was likely (such as a fracture or early-stage cancer), it is more likely their disability benefits may not be continued. It depends upon your impairment, the likelihood of medical improvement, and if you have returned to regular work activity.
Although it is possible to lose benefits after a CDR, for most people, it's unlikely. In the most recent statistics published by the SSA, SSDI recipients were able to keep their disability benefits 85% of the time. Benefits were continued for adult SSI recipients, however, only 83% of the time.
For children, the chances of losing SSI benefits are much greater than for adults. SSI benefits after a CDR are continued only about one-third of the time for children. The chance of losing benefits is highest for children who were approved as infants (for example, for low birth weight) and for those who are turning 18 (in age 18 redeterminations—more on this below). Benefits for these children are continued less than half of the time following a CDR.
A CDR can be triggered if you begin earning too much money from working (the SSA checks whether you are making over the SGA amount during periodic "redeterminations"), unless you are enrolled in a return-to-work plan for disability recipients. In most cases, however, your CDR will occur every three years, but if you are over 55 or if you have a condition that is unlikely to get better, your CDR will occur every seven years. (For more, see our article on how often disability reviews happen.)
If you face a CDR, your case will be sent to the Disability Determination Service (DDS) in your area, where your case will undergo a process similar to when you first applied for disability. You will have to fill out a Form SSA-454 and a claims examiner at DDS will review any new medical evidence added to your file since the time of your initial approval and may require you to undergo an examination with a doctor hired by Social Security.
What could cause you to "fail" your Social Security disability re-evaluation? Your disability benefits can be taken away only if the evidence shows that:
Medical improvement. The main test used in the CDR is the medical improvement review standard (MIRS). Your condition must show medical improvement—that is, the severity of your impairment(s) must have lessened. The medical improvement must be related to your disabling impairment, not just to any condition you have. There are a couple of situations that indicate an individual has had medical improvement. The claims examiner could determine you have medically improved after reviewing your current medical records or the examiner could say you have had medical improvement if you have returned to regular employment.
"Related to your ability to work." Not only must the claims examiner find that your disabling condition has medically improved, but he or she must also find that the improvement is related to your work; in other words, that it has resulted in an increase in your residual functional capacity (RFC).
To determine this, the examiner will compare your current RFC to your prior RFC. For example, suppose you were approved for disability based on chronic back pain that prevented you from sitting for more than a half an hour at a time, and at the time you were given an RFC of "less than sedentary work." After a successful spinal fusion, your ability to sit was increased to four hours, so can now do some types of sedentary work. The SSA would consider this medical improvement "related to your ability to work."
On the other hand, suppose you were first approved for disability based on painful edema in your legs that limited your ability to sit or stand to less than six hours. Following a weight loss regime, your pain decreased, and the SSA found your condition medically improved. However, because you still could not sit or stand for more than six hours, your RFC did not change, and your benefits would continue because you have the same work-related restrictions.
The ability to do substantial work. Even if the SSA finds that you have experienced medical improvement as it relates to your ability to work, the SSA must also find that you can work at the SGA level before ending your benefits. To make this decision, the SSA will consider both your original impairments and any new restrictions you have developed since your initial approval for disability.
The SSA does not need to show that your impairment has medically improved if:
In these cases (called Group I Exceptions), the examiner does not need to find medical improvement in your case. However, the examiner still must find that you are not currently disabled to deny you benefits; that is, that you are capable of performing substantial gainful activity.
Sometimes Social Security can stop benefits after a CDR even without having to show that you can engage in SGA. The examiner can use these exceptions to the regular standard of review (called Group II Exceptions) to stop your benefits if you:
Like adult recipients, these requirements are waived if there has been fraud, failure to cooperate, the location of the child is unknown, or the child has failed to follow prescribed treatment.
Alternatively, if a CDR occurs because the child has turned 18, the child will have to undergo a new determination under adult disability standards. This is called an age 18 redetermination.
If your benefits are stopped, you can appeal the decision and request that your claim be re-heard in front of an Administrative Law Judge (ALJ). And if you are denied benefits at your CDR, you can ask that they be continued until your hearing. However, if the hearing judge agrees with the CDR, you may have to repay these benefits. For more information, see our article on the continuation of disability benefits during appeal.