Step 4: Relating Medical Improvement to the Ability to Work

Step 4 of the CDR evaluation process considers if any medical improvement is related to ability to work. Only the impairments that were present at the Comparison Point Decision (CPD) are considered. There are two ways to determine whether improvement is related to work. Specifically, if the CPD finding of disability was based on the individual meeting or equaling a listing, the Listing of Impairments (A) is used at the CDR, and if the CPD finding of disability was based on a functional assessment, a functional assessment (B) is used at the CDR, as described below. (A) Listing of Impairments: If the individual’s current impairment(s) still meet or equal the previous Listing of Impairments (the listing in effect at the time of the initial determination, not the current listing), medical improvement is found not related to the ability to work, and benefits are continued without further evaluation (unless an exception applies). (B) Functional Assessment: If the individual’s functional capacity has not increased since the last CPD, any medical improvement is found not related to ability to work and benefits are continued (unless an exception applies).

7.	In your opinion, to what extent, if at all, does the requirement to use the previous listing to assess an individual’s current impairment at Step 4 (A) result in individuals being continued for benefits whereas under a de novo review, benefits would have been ceased? (Select one.)
	1.		To a very great extent – Continue.
	2.		To a great extent – Continue.
	3.		To a moderate extent – Continue.
	4.		To a minor extent – Continue.
	5.		Not at all (Click here to skip to question 9.)
	6.		No basis to judge or no opinion (Click here to skip to question 9.)

8.	In your opinion, why does the requirement to use the previous listing to assess an individual’s current impairment at Step 4 (A) result in individuals being continued for benefits whereas under a de novo review, benefits would have been ceased?

9.	In your opinion, to what extent, if at all, does the requirement to find an increase in an individual’s functional capacity at Step 4 (B) in order to show that medical improvement is related to work result in individuals being continued for benefits whereas under a de novo review, benefits would have been ceased? (Select one.)
	1.		To a very great extent – Continue.
	2.		To a great extent – Continue.
	3.		To a moderate extent – Continue.
	4.		To a minor extent – Continue.
	5.		Not at all (Click here to skip to question 11.)
	6.		No basis to judge or no opinion (Click here to skip to question 11.)

10.	In your opinion, why does the requirement to find an increase in an individual’s functional capacity at Step 4 (B) result in individuals being continued for benefits whereas under a de novo review, benefits would have been ceased?

11.	The POMS does not require a specific quantity of increase in functional capacity, but guides examiners to ensure a “reasonable relationship” between the prior and the current functional assessments. In your DDS, how much of an increase in the individual’s functional capacity do you need to show that medical improvement is related to the individual’s ability to work at Step 4 (B)? (Select one.)
	1.		Very large (significant) increase
	2.		Large increase
	3.		Moderate increase
	4.		Minor increase
	5.		Any increase at all
	6.		No basis to judge

12.	Based on your experience, over the past 24 months, in about how many of the cases where medical improvement was found at Step 3 were you able to show that the medical improvement was related to work at Step 4? (Select one.)
	1.		All
	2.		Almost all
	3.		Most
	4.		About half
	5.		Some
	6.		Few
	7.		None
	8.		No basis to judge

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Full Report: GAO-07-8

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