Social Security may periodically conduct continuing disability reviews for persons who receive disability benefits. This process ensures that only those who remain disabled continue to receive benefits. There may be certain situations in which a formerly disabled person experiences medical improvement or obtains vocational rehabilitations such that they can go back to work.
In making a determination that a person’s medical disability has ceased, Social Security must make this determination based on a substantial evidence standard. So, for example, there must be substantial evidence that a person’s disability has improved to such an extent that they are not able to engage in significant profitable work activity. Or, as another example, that the person has undergone vocational therapy such that he can now go back to work.
If a person appeals a decision that his medical disability has ceased, the adjudicators must consider the issue of the person’s disability through the date of the determination. So, for example, it may be the case that a person indeed experienced medical improvement sufficient to allow him to return to work. However, during the appeal process, his condition may have worsened. Rather than having to start a new disability application, the adjudicator on appeal considers whether the person has been under a disability for all period up to the time of his or her decision.
So, for example, if the adjudicator determines that the initial disability cessation decision was correct, she will then determine if the person has again become disabled through the period of her determination, whether through a worsening of his condition or because of a new disabling impairment.
If the adjudicator determines the initial disability cessation decision was incorrect, she will determine if the evidence establishes medical improvement as a basis for disability cessation at any time through the date of the decision or determination.
This process is set forth in Social Security Ruling 13-3p.
This ruling arose out of a Sixth Circuit federal court case; namely, Difford v. Secretary of Health and Human Services, 910 F.2d 1316 (6th Cir. 1990). Social Security decided to adopt this decision as their nationwide policy by promulgating SSR 13-3p. It seems to be a sensible decision that streamlines procedures and avoids unnecessary paperwork and procedures.
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.