SSR 05-3p: Rescinded
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Text
Rescinded effective March 23, 2026 by SSR 26-1p
Effective/Publication Date: 04/27/2005
PURPOSE:
To explain our policies for determining continuing disability at step 2 of
the medical improvement review standard (MIRS) sequential evaluation
process for children under 20 CFR 416.994a(b)(2) and to explain how we apply the functional equivalence rule at step 2.
CITATIONS (AUTHORITY):
Sections 1614(a)(3) , 1614(a)(4) , and 1614(c) of the Social
Security Act; Regulations No. 16, subpart I, sections 416.924 , 416.925 , 416.926 , 416.926a , and 416.994a .
INTRODUCTION:
When we conduct a continuing disability review, we use a three-step MIRS
sequential evaluation process, outlined in 20 CFR 416.994a(b) .
- At step 1, we determine whether there has been medical improvement in the
impairment(s) that was present at the time of the most recent favorable
determination or decision.
( 20 CFR 416.994a(b)(1) ).
We refer to the most recent favorable determination or decision as the
“comparison point decision” (CPD), and we refer to the
impairment(s) that was present at the time of the most recent favorable
determination or decision as the “CPD impairment(s).” If there
has been no medical improvement in the CPD impairment(s), we find that the
child's disability continues. If there has been medical improvement, we
proceed to step 2. [1]
- At step 2, we determine whether the CPD impairment(s) still meets or
medically or functionally equals “the severity of the listed
impairment” that it met or equaled at the time of the CPD.
( 20 CFR 416.994a(b)(2) ).
If the CPD impairment(s) still meets or medically or functionally equals
the severity of the listing we considered at the CPD, we find that the
child is still disabled. As long as we determine that the CPD
impairment(s) currently meets or medically or functionally equals the
listing we considered before, we do not have to make the same finding we
made at the CPD
0 CFR 416.994a(b)(2) ).
If the CPD impairment(s) still meets or medically or functionally equals
the severity of the listing we considered at the CPD, we find that the
child is still disabled. As long as we determine that the CPD
impairment(s) currently meets or medically or functionally equals the
listing we considered before, we do not have to make the same finding we
made at the CPD. For example, if we found at the CPD that the child's
impairment(s) met a listing, and now it no longer meets that listing but
it medically equals that listing, we find that the child's disability
continues. Likewise, if we found that the child's impairment(s)
functionally equaled a listing, and now it meets that listing, we find
that the child's disability continues. If the CPD impairment(s) does not
still meet or equal the severity of that listed impairment, we proceed to
step 3.
- At step 3, we determine whether the child is currently disabled,
considering all current impairments.
( 20 CFR 416.994a(b)(3) ).
We determine if the child's current impairment(s) is severe, as defined in 20 CFR 416.924(c) . If the
impairment(s) is not severe, we find that the child's disability has
ended. If the impairment(s) is severe, we consider whether it meets or
medically equals a listing.
( 20 CFR 416.924(d) , 416.925 , 416.926 ). If it does, we
find that the child's disability continues. If not, we consider whether it
functionally equals the listings.
( 20 CFR 416.926a ). If it
does, we find that the child's disability continues. If not, we find that
the child's disability has ended.
impairment(s) is severe, we consider whether it meets or
medically equals a listing.
( 20 CFR 416.924(d) , 416.925 , 416.926 ). If it does, we
find that the child's disability continues. If not, we consider whether it
functionally equals the listings.
( 20 CFR 416.926a ). If it
does, we find that the child's disability continues. If not, we find that
the child's disability has ended.
At step 1, we determine whether there has been medical improvement in the
impairment(s) that was present at the time of the most recent favorable
determination or decision.
( 20 CFR 416.994a(b)(1) ).
We refer to the most recent favorable determination or decision as the
“comparison point decision” (CPD), and we refer to the
impairment(s) that was present at the time of the most recent favorable
determination or decision as the “CPD impairment(s).” If there
has been no medical improvement in the CPD impairment(s), we find that the
child's disability continues. If there has been medical improvement, we
proceed to step 2. [1]
At step 2, we determine whether the CPD impairment(s) still meets or
medically or functionally equals “the severity of the listed
impairment” that it met or equaled at the time of the CPD.
( 20 CFR 416.994a(b)(2) ).
If the CPD impairment(s) still meets or medically or functionally equals
the severity of the listing we considered at the CPD, we find that the
child is still disabled. As long as we determine that the CPD
impairment(s) currently meets or medically or functionally equals the
listing we considered before, we do not have to make the same finding we
made at the CPD. For example, if we found at the CPD that the child's
impairment(s) met a listing, and now it no longer meets that listing but
it medically equals that listing, we find that the child's disability
continues. Likewise, if we found that the child's impairment(s)
functionally equaled a listing, and now it meets that listing, we find
that the child's disability continues
we
made at the CPD. For example, if we found at the CPD that the child's
impairment(s) met a listing, and now it no longer meets that listing but
it medically equals that listing, we find that the child's disability
continues. Likewise, if we found that the child's impairment(s)
functionally equaled a listing, and now it meets that listing, we find
that the child's disability continues. If the CPD impairment(s) does not
still meet or equal the severity of that listed impairment, we proceed to
step 3.
At step 3, we determine whether the child is currently disabled,
considering all current impairments.
( 20 CFR 416.994a(b)(3) ).
We determine if the child's current impairment(s) is severe, as defined in 20 CFR 416.924(c) . If the
impairment(s) is not severe, we find that the child's disability has
ended. If the impairment(s) is severe, we consider whether it meets or
medically equals a listing.
( 20 CFR 416.924(d) , 416.925 , 416.926 ). If it does, we
find that the child's disability continues. If not, we consider whether it
functionally equals the listings.
( 20 CFR 416.926a ). If it
does, we find that the child's disability continues. If not, we find that
the child's disability has ended.
On September 11, 2000, we published final rules (the “2001
rules”) for evaluating disability in children under the Supplemental
Security Income program. These rules became effective on January 2,
2001. [2] In section 416.926a of
the 2001 rules, ( 20 CFR
416.926a ), we clarified and simplified our prior rules for evaluating
functional equivalence [3] in a
number of ways. Under the functional equivalence policies that we applied
prior to January 2, 2001, we required a comparison of the child's
impairment(s) to a specific
listing. [4] One way in which we
clarified and simplified functional equivalence under the 2001 rules was
to no longer refer to specific listed impairments. Instead, we determine
whether a child's impairment functionally equals the listings
r the functional equivalence policies that we applied
prior to January 2, 2001, we required a comparison of the child's
impairment(s) to a specific
listing. [4] One way in which we
clarified and simplified functional equivalence under the 2001 rules was
to no longer refer to specific listed impairments. Instead, we determine
whether a child's impairment functionally equals the listings. To
functionally equal the listings, a child's impairment(s) must cause
“marked” limitations in two domains of functioning, or
“extreme” limitation in one such domain, as described in 20 CFR 416.926a .
Therefore, findings of functional equivalence made on or after January 2,
2001, are not based on a specific listing.
Because our current rules about step 2 of the MIRS sequential evaluation
process refer only to the specific listed impairment(s) that we considered
at the CPD, we are issuing this ruling to explain how we apply the
functional equivalence rules at step 2. We also explain how we apply step
2 when the CPD was based on functional equivalence to the listings.
POLICY INTERPRETATION:
When we evaluate functional equivalence at step 2 of the MIRS sequential
evaluation process for children in 20 CFR 416.994a(b) , we
use the current rules for evaluating functional equivalence.
How we apply step 2 of the MIRS sequential evaluation process for children
depends on the date of and basis for the CPD. A chart that summarizes our
policies on applying step 2 follows the text.
a. If the CPD was made before
January 2, 2001.
If the CPD was made before January 2, 2001, it was based either on a
finding that the child's impairment(s) met or medically equaled a specific
listing, or functionally equaled a specific listing under the rules for
functional equivalence that were in effect at the time of the CPD.
mmarizes our
policies on applying step 2 follows the text.
a. If the CPD was made before
January 2, 2001.
If the CPD was made before January 2, 2001, it was based either on a
finding that the child's impairment(s) met or medically equaled a specific
listing, or functionally equaled a specific listing under the rules for
functional equivalence that were in effect at the time of the CPD.
When we determine whether a child's disability continues at step 2, we
first consider whether the CPD impairment(s) now either meets or medically
equals the same listing that it met, medically equaled, or functionally
equaled at the CPD, as that listing was written at that time. If the CPD
impairment(s) now meets or medically equals the severity of that listed
impairment as it was written at that time, we find that the child is still
disabled.
If the CPD impairment(s) does not now meet or medically equal the CPD
listing, we consider whether the CPD impairment(s) now functionally equals
the listings under our current rules in 20 CFR 416.926a . If it
does, we find that the child is still disabled. If it does not, we proceed
to step 3.
b. If the CPD was made on or after
January 2, 2001.
If the CPD was made on or after January 2, 2001, it was based either on a
finding that the child's impairment(s) met or medically equaled a listing,
or functionally equaled the listings under the current rules in 20 CFR 416.926a .
FR 416.926a . If it
does, we find that the child is still disabled. If it does not, we proceed
to step 3.
b. If the CPD was made on or after
January 2, 2001.
If the CPD was made on or after January 2, 2001, it was based either on a
finding that the child's impairment(s) met or medically equaled a listing,
or functionally equaled the listings under the current rules in 20 CFR 416.926a .
(1) If the CPD impairment(s) met or medically equaled a listing:
If our determination or decision at the time of the CPD was that the
child's impairment(s) met or medically equaled a listing, we consider
whether the CPD impairment(s) now either meets or medically equals that
same listing, as it was written at that time. If it does, we find that the
child is still disabled.
If the CPD impairment(s) does not now meet or medically equal the CPD
listing, we consider whether the CPD impairment(s) now functionally equals
the listings under our current rules in 20 CFR 416.926a . If it
does, we find that the child is still disabled. If it does not, we proceed
to step 3.
(2) If the CPD impairment(s) functionally equaled the listings:
When we determine whether a child's disability continues at step 2 and the
CPD was based on functional equivalence to the listings, we consider only
whether the CPD impairment(s) now functionally equals the listings. We do
not consider whether the impairment(s) now meets or medically equals the
CPD listing, because there is no specific CPD listing. If that
impairment(s) now functionally equals the listings under our current rules
in 20 CFR 416.926a , we find
that the child is still disabled. If it does not, we proceed to step 3.
Chart: This chart summarizes the explanations above. Follow a. or b. as
appropriate.
sider whether the impairment(s) now meets or medically equals the
CPD listing, because there is no specific CPD listing. If that
impairment(s) now functionally equals the listings under our current rules
in 20 CFR 416.926a , we find
that the child is still disabled. If it does not, we proceed to step 3.
Chart: This chart summarizes the explanations above. Follow a. or b. as
appropriate.
- If the CPD was made before January 2, 2001: Does CPD impairment(s) now either meet or medically equal the CPD
listing? → YES → Disability Continues [5] ↓ NO ↓ Does CPD impairment(s) now functionally equal the listings? → YES → Disability Continues ↓ NO ↓ Proceed to Step 3
- If the CPD was made on or after January 2, 2001, follow (1) or (2) as
appropriate: (1) CPD impairment(s) met or medically equaled a listing: Does CPD impairment(s) now either meet or medically equal the CPD
listing? → YES → Disability Continues ↓ NO ↓ Does CPD impairment(s) now functionally equal the listings? → YES → Disability Continues ↓ NO ↓ Proceed to Step 3 (2) CPD impairment(s) functionally equaled the listings Does CPD impairment(s) now functionally equal the listings? → YES → Disability Continues ↓ NO ↓ Proceed to Step 3.
If the CPD was made before January 2, 2001:
Does CPD impairment(s) now either meet or medically equal the CPD
listing?
→
YES
→
Disability Continues [5]
↓
NO
↓
Does CPD impairment(s) now functionally equal the listings?
→
YES
→
Disability Continues
↓
NO
↓
Proceed to Step 3
If the CPD was made on or after January 2, 2001, follow (1) or (2) as
appropriate:
(1) CPD impairment(s) met or medically equaled a listing:
Does CPD impairment(s) now either meet or medically equal the CPD
listing?
→
YES
→
Disability Continues
↓
NO
↓
Does CPD impairment(s) now functionally equal the listings?
→
YES
→
Disability Continues
↓
NO
↓
Proceed to Step 3
d to Step 3
If the CPD was made on or after January 2, 2001, follow (1) or (2) as
appropriate:
(1) CPD impairment(s) met or medically equaled a listing:
Does CPD impairment(s) now either meet or medically equal the CPD
listing?
→
YES
→
Disability Continues
↓
NO
↓
Does CPD impairment(s) now functionally equal the listings?
→
YES
→
Disability Continues
↓
NO
↓
Proceed to Step 3
(2) CPD impairment(s) functionally equaled the listings
Does CPD impairment(s) now functionally equal the listings?
→
YES
→
Disability Continues
↓
NO
↓
Proceed to Step 3.
EFFECTIVE DATE:
This SSR is effective upon publication in the Federal Register.
CROSS-REFERENCES:
Program Operations Manual System, sections DI 28005.020, 28005.025, and
28005.030.
[1] At each step of the process
certain “exceptions to medical improvement” may apply, under
which disability can be found to have ended even though medical
improvement has not occurred.
( 20 CFR 416.994a(e)-(f) ).
Although we apply the exceptions when appropriate, further discussion of
the exceptions is unnecessary in this Ruling.
[2] 65 FR 54747-54790 (2000).
[3] We have included the policy
of functional equivalence in our childhood disability rules since 1991.
See 56 FR 5534, 5543, 5561-5562 (1991).
[4] 20 CFR 416.926a(b) (1997);
20 CFR 416.926a(b) (1993); 20 CFR 416.926a(b) (1991).
[5] The conclusion that
disability continues here and elsewhere on this chart is subject to any
applicable exceptions to the MIRS standard. See footnote 1 above.
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.