How Difficult Is it to Pass a Social Security Continuing Disability Re-Evaluation (CDR)?

After you're 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.

This article discusses when and why Social Security conducts CDRs, the standards used to decide if you're still qualified to receive disability benefits, and the exceptions to the rules.

Your Chance of Losing Benefits After a CDR

Most people who have impairments that are serious enough to qualify for disability in the first place don't medically improve and don't usually return to regular employment. But, if you were approved for disability benefits based on a condition that's likely to improve (like a fracture or early-stage cancer), you're more likely to lose those benefits at some point.

Whether or not Social Security stops your benefits after a CDR will depend on:

• the type of impairment you have
• if (and by how much) your condition has improved medically, and
• whether you've returned to regular work activity.

Although it's possible to lose benefits after a CDR, for most people, it's unlikely. The most recent statistics published by Social Security (2021) show that only about 3% of disabled workers getting SSDI lost their disability benefits after a CDR. And benefits were stopped for only about 4% of adults receiving SSI.

For children, the chances of losing SSI benefits are much greater than for adults. After a CDR, children lose SSI benefits about a third of the time (33% in 2021). Some groups of children are more likely to lose benefits than others, including:

• children approved for benefits as infants (for example, for low birth weight) and
• children turning 18 (in age 18 redeterminations—more on this below).

Following a CDR, Social Security stops paying SSI benefits to children in these two groups more than half the time.

How Often Will You Face a CDR?

Most people receiving disability benefits can expect a continuing disability review about every three years. But some things can trigger a CDR sooner.

For instance, Social Security limits how much money you can earn from work and still be considered disabled. If you earn more than the limit ($1,470 per month in 2023), Social Security calls that "substantial gainful activity" or SGA. If you're engaged in SGA, you might face a CDR sooner, unless you're enrolled in one of Social Security's return-to-work plans.

In certain circumstances, your continuing disability reviews could be less frequent. You might face a CDR only every five to seven years in the following situations:

• you have a condition that's unlikely to get better,
• your condition has worsened since your initial determination (or your last CDR), or
• you're 55 or older (more on this below).

Learn more about how often Social Security conducts disability reviews.

How Are CDRs Conducted?

What your continuing disability review will entail (and how long it will take) depends on what type of CDR you're facing. Your CDR will involve one or both of the following:

• You'll fill out a short questionnaire called the "Disability Update Report" (Form SSA-455), or
• You'll fill out the much longer Form SSA-454, called the "Continuing Disability Review Report," and you'll face a full medical review.

Most adults getting SSDI or SSI benefits will receive only the short form (77% of people in 2021). The rest will face a full medical review. And CDRs for children always involve full medical reviews.

If your CDR involves a full medical review, your case will be sent to the Disability Determination Service (DDS) in your area, and the process will be similar to when you first applied for disability. A DDS claims examiner will review any new medical evidence added to your file since your initial approval (or your last CDR). And you might have to undergo a consultative examination (CE) with a Social Security doctor.

Learn more about when your CDR might include a full medical review.

CDR Standard for Denying Benefits

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:

• you've had medical improvement
• that medical improvement is related to your ability to work, and
• you now have the ability to engage in substantial gainful activity.

The Medical Improvement Standard

The main test used in the CDR is the medical improvement review standard (MIRS). For medical improvement under the MIRS, both of the following must be true:

• the severity of your impairment(s) has lessened, and
• the medical improvement is related to your disabling impairment, not just to any condition you have.

There are a couple of ways the claims examiner could determine you've medically improved:

• your current medical records show medical improvement, or
• you've returned to regular employment.

Improvment Must Be Related to Your Ability to Work

Not only must the claims examiner find that your disabling condition has medically improved, but the improvement must be related to your ability to work. In other words, your medical improvement has resulted in an increase in your residual functional capacity (RFC) compared 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 half an hour at a time. During your initial determination, you were given an RFC of "less than sedentary work."

Suppose also that after a successful spinal fusion, your ability to sit was increased to four hours. That would mean that you can now do some types of sedentary work. The SSA would consider this a 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 Social Security found your condition had medically improved. But because you still can't sit or stand for more than six hours, your RFC hasn't changed, and your benefits would likely continue because you have the same work-related restrictions.

Ability to Engage in Substantial Gainful Activity

Even if Social Security finds that you've 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, Social Security will consider both your original impairments and any new restrictions you have since your initial approval for disability (or your last CDR).

Exceptions to the CDR Standards for Denial

There are some limited circumstances when Social Security can stop your disability benefits after a CDR—even if your medical condition hasn't changed.

Exceptions to the Medical Improvement Standard

Social Security doesn't need to show that your impairment has medically improved before stopping your disability benefits after a CDR in the following situations:

• you're working over the SGA level
• you've had vocational training that makes it possible for you to return to work (For example, your prior RFC limited you to sit-down work, but you weren't qualified for any sit-down work, and you now are because of a class you took)
• a new method for evaluating the severity of your condition shows you're not disabled, or
• there was an error in the initial determination, and you shouldn't have been found disabled in the first place (this exception requires clear evidence in your file that shows you didn't qualify for disability, or new evidence that clearly disproves prior evidence that you were disabled).

In these cases (called Group I Exceptions), the DDS examiner doesn't need to find medical improvement in your case. But to deny you benefits, the examiner must find that you're no longer disabled—that is, that you're capable of doing substantial gainful activity.

Exceptions to Being Capable of Performing SGA

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. Group II Exceptions apply if you've done any of the following:

• committed fraud
• failed to cooperate with the disability review
• failed to follow your doctor's prescribed treatment, or
• can't be found.

Having a CDR After Age 55

Social Security considers anyone over age 55 to be of "advanced age" and uses slightly different standards to determine disability. So if you're 55 or older, you're not likely to face CDRs as often. And when you do, you're only likely to have to fill out the short Disability Update Report and not have a full medical review.

In fact, whether you're receiving SSI or SSDI benefits, you might not get a CDR after age 55—even if Social Security expects your medical condition to improve. (But if you're very likely to improve, the CDR cut-off is closer to age 60.)

Your reviews may stop altogether when you reach age 55 (or 60) because Social Security bases your ability to work on two things:

• whether you can do your past job (based on your RFC), and
• your ability to use your existing job skills in a new kind of work.

Social Security believes that it's much more difficult for older workers to adapt to doing a new type of work. So, the closer you get to full retirement age (67 for those born in 1960 or later), the less restrictive your RFC needs to be for Social Security to consider you disabled.

Learn more about how your age affects your ability to get Social Security disability.

CDRs for Children

Continuing disability reviews for child recipients are handled somewhat differently, due to the different definitions of disability for children. Social Security will discontinue a child's disability payments if the following criteria are met:

• the child has had medical improvement, and
• the child's impairments no longer cause "marked" or "severe" functional limitations.

Like adult recipients, Social Security can stop a child's benefits without meeting those criteria in the following circumstances:

• fraud
• failure to cooperate
• the child hasn't followed the prescribed treatment, or
• the child can't be found.

Alternatively, if a CDR occurs because the child has turned 18, the child will have to undergo a new determination under adult disability standards. Social Security calls this an "age 18 redetermination."

Appealing If SSI or SSDI Was Denied After a CDR

Anytime Social Security terminates your benefits—including after a continuing disability review—you can appeal the decision. Like with an initial SSI or SSDI denial, there are several levels of appeal for a cessation of benefits after a CDR.

But the appeal process is somewhat different after a CDR. For instance, there are two reviews that must be done before you can get your case in front of an administrative law judge (ALJ). To appeal a termination of benefits after a CDR, you must first have:

• a review of your CDR by DDS (to check for errors), and
• a hearing in front of a DDS disability hearing officer (DHO).

Only if the DHO upholds the CDR decision to stop your benefits can you request an ALJ appeal hearing. If the ALJ denies your claim, you can continue to appeal to the Appeals Council and then the federal court, just as you would appeal an initial denial.

Note that if you're denied SSI or SSDI benefits after your CDR, you can ask Social Security to continue your disability payments while you appeal. But if you lose your appeal, you might have to repay these benefits.

Learn more about getting your disability benefits continued while you appeal.

_{Updated February 7, 2023}