Which types of medical records and documentation satisfy SSA requirements for initiating a medical CDR?
Executive summary
The Social Security Administration (SSA) initiates medical Continuing Disability Reviews (CDRs) using beneficiary responses (SSA‑454 or SSA‑455) plus medical records such as treating‑provider notes, test results, treatment histories, and medication lists; full medical reviews require new medical evaluations and disability determinations while mailer CDRs rely largely on form responses and recent records (SSA guidance on CDR forms and full vs. mailer reviews) [1] [2] [3]. Agency program instructions and POMS pages frame the process and paperwork the SSA will expect when it opens a full medical CDR [4] [5].
1. How the SSA starts a medical CDR — forms, mailers and profiling
The SSA almost always begins a periodic CDR by sending beneficiaries an update form: the long SSA‑454 (Continuing Disability Review Report) or the short SSA‑455 (Disability Update Report); beneficiaries’ answers can trigger either a mailer review or a referral to a full medical CDR that demands more documentation [1] [6]. The agency also uses computer profiling to select cases more likely to show medical improvement and to decide whether a full medical review or a mailer will be used [2].
2. Records the SSA cites as central to initiating a medical CDR
Available SSA materials and practitioner guides emphasize treating‑physician notes, diagnostic test results, treatment records, medication lists, and documented functional limitations as the core evidence the agency expects when a CDR moves beyond the mailer phase [3] [7]. The SSA’s public guidance on SSI CDRs explains that the long form asks for current medical condition, treatments and ability to work — indicating the agency relies on contemporaneous clinical documentation [1].
3. When a “full medical review” is required: new evaluations and disability determinations
A full medical CDR requires a fresh medical evaluation and a new disability determination; these reviews are resource‑intensive and the SSA’s program instructions and POMS set out how field offices and adjudicators handle that workload [2] [4]. Agency policy memos and the EM instruction series govern one‑time workloads and prioritization when many full medical CDRs are processed [5].
4. Practical list practitioners and advocates tell clients to keep ready
Attorney and advocacy sources consistently advise beneficiaries to keep copies of: recent doctor progress notes; lab and imaging results; operative and hospitalization reports; medication lists and therapy notes; letters from treating clinicians describing functional limits; and evidence of attempts to work or work‑related activity, because these documents are what the SSA will request if the case advances beyond the mailer [3] [7] [8].
5. Mailer CDRs vs. records‑driven full reviews — different evidentiary expectations
Mailer CDRs (short form SSA‑455) are designed for conditions unlikely to improve and often can be resolved by answers on the form supplemented by limited records; by contrast, the SSA will open a full medical review when forms or profiling suggest possible improvement, and then it will require more comprehensive medical documentation and possibly new consultative exams [6] [2].
6. Areas where the public sources leave questions open
Available sources explain the categories of records SSA accepts and the forms used, but they do not detail exhaustive checklists of every acceptable document type or the precise formatting SSA prefers; nor do the provided materials specify how much historical vs. recent evidence is required in every case — those operational details are handled in field office practice and individual POMS instructions not quoted here (not found in current reporting) [4] [5].
7. Conflicting perspectives and hidden incentives to collect more evidence
Advocates and private lawyers emphasize assembling extensive treating‑source evidence to avoid terminations, reflecting a cautious, beneficiary‑protective stance; SSA guidance balances that by using profiling to limit costly full medical reviews and relying on mailer forms where appropriate, which can create tension between agency resource management and individual claimants’ need to document ongoing disability [3] [2].
8. Bottom line for beneficiaries preparing for a CDR
Respond promptly to the SSA’s SSA‑454/SSA‑455 forms; gather treating‑provider notes, test results, medication and therapy records, and clear statements about functional limitations; expect mailers to be resolved with form answers but be prepared for a full medical review that will demand complete clinical documentation or new evaluations [1] [3] [2].