Introduction
Social Security Ruling (SSR) 05-03p, issued on April 27, 2005, provides crucial guidelines for the Social Security Administration (SSA) when reviewing the continuing disability of children under age 18. This ruling specifically addresses how “functional equivalence” is evaluated at step 2 of the Medical Improvement Review Standard (MIRS) sequential evaluation process. Understanding 05 Ssr is essential for anyone involved in Supplemental Security Income (SSI) disability claims for children, especially during continuing disability reviews. This article breaks down SSR 05-03p to clarify these policies.
Policy Interpretation: Step 2 MIRS and Functional Equivalence
When the SSA conducts a continuing disability review for a child, they follow a three-step MIRS process. Step 2 of this process is critical. SSR 05-03p focuses on how functional equivalence is applied at this stage, particularly because the rules for evaluating childhood disability and functional equivalence were updated on January 2, 2001.
Prior to January 2, 2001, functional equivalence was assessed by comparing a child’s impairments to specific listings of impairments. The 2001 rule changes simplified this by removing the reference to specific listings. Now, functional equivalence is determined by whether a child’s impairment(s) result in “marked” limitations in two areas of functioning or an “extreme” limitation in one area.
Because the existing rules for step 2 MIRS referred to the specific listings considered at the time of the initial disability determination (Continuing Presumptive Disability – CPD), SSR 05-03p was issued to clarify how functional equivalence rules apply at step 2, especially when the initial CPD was based on functional equivalence.
The application of step 2 MIRS, as clarified by 05 ssr, depends on when the CPD was established and its basis.
a. CPD Made Before January 2, 2001
If the initial disability determination (CPD) was made before January 2, 2001, it could have been based on:
- Meeting or medically equaling a specific listing.
- Functionally equaling a specific listing under the older functional equivalence rules.
In a continuing disability review (CDR) at step 2, the SSA first assesses if the child’s original impairment(s) still meets or medically equals the same listing that was initially met, medically equaled, or functionally equaled at the time of the CPD. This comparison uses the listing criteria as they were written at that earlier time. If the impairment still meets or medically equals this listing, disability is considered to be continuing.
If the original impairment(s) no longer meets or medically equals the original listing, the SSA then evaluates whether the impairment(s) currently functionally equals the listings under the current rules (from 20 CFR 416.926a). If it does, disability continues. If not, the review proceeds to step 3.
b. CPD Made On or After January 2, 2001
If the CPD was established on or after January 2, 2001, it was based on:
- Meeting or medically equaling a listing.
- Functionally equaling the listings under the current rules (20 CFR 416.926a).
(1) CPD Based on Meeting or Medically Equaling a Listing:
If the initial CPD was based on meeting or medically equaling a listing, the step 2 CDR process is similar to pre-2001 CPDs. The SSA first checks if the child’s impairment(s) still meets or medically equals that same listing (as written at the time of the CPD). If yes, disability continues.
If not, the SSA then assesses if the impairment(s) currently functionally equals the listings under the current rules (20 CFR 416.926a). If yes, disability continues. If not, proceed to step 3.
(2) CPD Based on Functionally Equaling the Listings:
When the initial CPD itself was based on functional equivalence, step 2 of the CDR focuses solely on whether the child’s original impairment(s) currently functionally equals the listings. The SSA does not re-evaluate if the impairment now meets or medically equals a listing at step 2 in this scenario, because the original determination was not based on a specific listing.
If the impairment(s) currently functionally equals the listings under current rules (20 CFR 416.926a), disability continues. If not, proceed to step 3.
Summary Charts for Step 2 MIRS Application
To summarize, SSR 05 ssr provides the following decision pathways at Step 2 of the MIRS process for children’s continuing disability reviews:
1. CPD Before January 2, 2001:
| Does CPD impairment(s) now meet or medically equal the CPD listing (as written then)? | → | YES | → | Disability Continues |
|---|---|---|---|---|
| ↓ | ||||
| NO | ||||
| ↓ | ||||
| Does CPD impairment(s) now functionally equal the listings (current rules)? | → | YES | → | Disability Continues |
| ↓ | ||||
| NO | ||||
| ↓ | ||||
| Proceed to Step 3 |
2. CPD On or After January 2, 2001:
(1) CPD impairment(s) met or medically equaled a listing:
| Does CPD impairment(s) now meet or medically equal the CPD listing (as written then)? | → | YES | → | Disability Continues |
|---|---|---|---|---|
| ↓ | ||||
| NO | ||||
| ↓ | ||||
| Does CPD impairment(s) now functionally equal the listings (current rules)? | → | 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 (current rules)? | → | YES | → | Disability Continues |
|---|---|---|---|---|
| ↓ | ||||
| NO | ||||
| ↓ | ||||
| Proceed to Step 3 |
Effective Date
SSR 05 ssr became effective upon its publication in the Federal Register on April 27, 2005.
Cross-References
For further information, refer to the Program Operations Manual System (POMS), sections DI 28005.020, 28005.025, and 28005.030.
This explanation of 05 ssr clarifies the SSA’s policy on evaluating functional equivalence at step 2 of the MIRS process for children’s continuing disability reviews, ensuring consistent and accurate application of these crucial guidelines.
