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SSA and the Continuing Disability Review Backlog

SSA and the Continuing Disability Review Backlog

When the COVID crisis was in full-swing in the United States, Social Security Administration (SSA) suspended many of its non-essential functions for a time. One of those involved Continuing Disability Reviews (CDR). CDRs are required to be performed on a set schedule, however, so the suspension has already started to result in a backlog of reviews, which compounds the backlog that already existed before COVID.

SSA conducts two kinds of CDRs: work CDRs and medical CDRs. Work CDRs are when SSA looks to your earnings to see if you are earning more than the substantial gainful activity (SGA) threshold; if your earnings exceed SGA, your benefits may be terminated. Medical CDRs determine if you continue to meet the criteria to qualify for disability benefits.

The frequency with which medical CDRs are conducted is based on the severity of your condition and the likelihood that it will improve. There are currently three categories of potential improvement. If your condition is expected to improve, a CDR will be conducted within the first 6-18 months. If it is possible that your condition will improve, CDRs will be conducted every 3 years. If it is not expected that your condition will improve, CDRs will be conducted every 5-7 years. Former President Trump proposed a rule that would add a fourth classification requiring reviews every 2 years, but President Biden recently reversed it.

You can see how the specificity of the schedule creates problems if the CDRs cannot be conducted when they are supposed to be. To help alleviate the situation, you may receive a Disability Update Report questionnaire instead of a notice of a full review.

The questionnaire is a report that you complete on your own health status. You will indicate if your condition has improved and provide any recent medical records, training activity, or employment developments. CDRs generally focus on the last 12 months, but if it needs to, SSA can go back to when you were first awarded benefits.

If you report that your condition has improved or that you are engaged in work activity, you may trigger a full review; you can also trigger a full review if you fail to complete the questionnaire. If you do not report any work changes or improved health status, and SSA does not have any other reason to believe that your condition has improved, SSA will defer a full review.

When completing the questionnaire or undergoing the full review, please note a few important aspects of CDRs. First, SSA cannot stop your benefits if the medical criteria for your condition to be considered disabling changed between the time you were awarded benefits and now. Additionally, reviewers are barred from substituting their own judgment for that of the adjudicator who originally approved you for benefits.

Your benefits also cannot be terminated unless SSA finds substantial evidence that your medical condition has improved to the point where you can engage in SGA and are, by definition, no longer disabled. SSA can terminate your benefits if it determines that you obtained benefits fraudulently in the first place, you cannot be located or you did not provide good cause for your failure to cooperate with a CDR, or you do not follow your prescribed medical treatment anymore, which may have allowed you to work again.