How Does Social Security Use Continuing Disability Reviews?

The Social Security Administration (SSA) periodically reviews the claims of everyone receiving disability benefits to confirm they still fit the definition of disabled—that is, they're still unable to work enough to support themselves. These reviews are called continuing disability reviews (CDRs).

If you receive a letter saying Social Security needs to audit or review your case, it's likely just a routine CDR, which usually won't affect your benefits. But if the results of your CDR indicate that your medical condition has improved enough for you to return to work, Social Security will terminate your disability benefits.

When Are Continuing Disability Reviews Scheduled?

The Social Security disability award letter you received when you were first approved for benefits should have stated when you could expect your first review. CDRs generally take place every three, five, or seven years.

If Social Security believes your medical condition could improve over time—whether that's likely or not—your file will probably have been set for a three-year review. If Social Security doesn't expect your condition to improve, your file will have been set for review after five to seven years.

What Can Trigger an Unexpected CDR?

In some situations, Social Security can schedule a disability review before the expected three, five, or seven years have elapsed. The following situations might trigger an early CDR:

• You've been receiving Social Security disability insurance (SSDI) benefits for less than 24 months, and you start working again.
• You tell Social Security (or the SSA receives evidence showing) that your medical condition has improved.
• Someone accuses you of fraud or misrepresentation of the facts.
• Social Security learns that you're not following your prescribed treatment (without having a good reason).
• A new treatment becomes available for your disabling condition.

If you're receiving Supplemental Security Income (SSI) disability benefits, a change in your income or living situation could also trigger an unexpected review of your case.

At What Age Do Social Security Disability Reviews Stop?

Older SSDI and SSI recipients might have less frequent disability reviews than they did when they were younger. For example, Social Security will often reduce your disability reviews after age 55 or 60 to every five to seven years, even if you initially faced a CDR every three years.

You might not face an SSDI review at age 64 or older because you're nearing retirement age. And once you reach full retirement age, your SSDI benefits will convert to retirement benefits. You don't have to be disabled to be eligible for Social Security retirement benefits, so there's no need for additional CDRs after you reach retirement age.

If you're receiving SSI, your benefits can continue after you reach retirement age as long as you still meet the program's financial requirements.

What Is Social Security's CDR Process?

Social Security will mail you a notice when your CDR is due. For most people receiving SSDI or SSI, the review letter will ask you to complete a short questionnaire called a "Disability Update Report" (Form SSA-455). You can also complete the questionnaire online.

Social Security estimates the questionnaire should take 10-15 minutes to complete. It asks about the following:

• changes in your health
• whether you're attending school or working, and
• medical treatments you've received over the past two years, including hospitalizations.

Because Social Security generally sends the short form to disability recipients whose condition isn't expected to improve, there's little reason to worry about filling out a disability update report. If your answers indicate that nothing has changed, the short form will likely be the end of the disability review until your next CDR is due.

But you might have to complete the much longer Continuing Disability Review Report (Form SSA-454-BK). You're more likely to receive this form in the following situations:

• Social Security expects your condition to improve
• you're relatively young, or
• one or more of your answers on the short form indicated the need for a full CDR.

If you get the longer form, you should submit any new medical evidence you have showing that your condition is still debilitating. Social Security will usually review your medical records for the 12 months before your CDR, but can look back further.

As with your initial disability determination, if Social Security needs more information for your CDR, you might be sent for a consultative examination (CE) (at Social Security's expense).

When Can My Disability Benefits Be Terminated After a CDR?

Unless your condition has improved enough for you to return to full-time work, or you've been working full-time and you exhausted your trial work period, a continuing disability review isn't much to worry about. You won't have to prove your disability over again.

How to Pass a Continuing Disability Review

The point of a continuing disability review is to determine whether your medical condition still limits your ability to function enough that you can't return to work. But the burden of proof is on Social Security.

To terminate your benefits because of your CDR, Social Security would have to prove that you've had significant medical improvement—that is, your impairment has become less severe. Also, the medical improvement in your condition must relate to your ability to work.

In practical terms, this requirement means that you must have more residual functional capacity (RFC) than you had when Social Security first approved your disability benefits. If your RFC hasn't changed—for example, you still can't sit or stand for more than six hours—your benefits can't be terminated.

Social Security must also find that there's some kind of substantial gainful activity (full-time work) that you could do, given your remaining impairment(s). That becomes less likely as you age, thanks to the medical-vocational grid rules, which make it easier for older applicants to qualify as disabled.

When Is Social Security More Likely to Terminate Benefits?

If Social Security finds a clear error or fraud in the original decision awarding you SSDI or SSI disability, your benefits will likely be terminated. But only about 5% of disability recipients lose benefits after a review.

Social Security has been criticized in recent years for allegedly awarding disability benefits to people who shouldn't have qualified. That might result in more scrutiny of initial disability decisions in the near future. But unless policy and regulations change regarding disability reviews, it shouldn't make passing your CDR more difficult.

What Should I Do If My Benefits Are Terminated After a Disability Review?

If you lose your SSDI or SSI benefits after a continuing disability review, you can appeal the termination. If you lost your benefits because you tried to return to work but had to stop again because of your medical condition, you can probably get your disability payments reinstated.

You can request "expedited reinstatement" if both of the following are true:

• You had to stop working because of the same impairment that initially qualified you for disability, and
• Your condition isn't any better than when you first applied for benefits.

Getting your benefits reinstated is a much faster process than filing a new application for disability.

Learn more about getting expedited reinstatement, including how to get your SSI benefits back if they were terminated due to work.