TN 8 (10-10)

A. Introduction

There are times when a Continuing Disability Review (CDR) results in a medical cessation determination. However, the CDR should never have been initiated (e.g., a medical CDR is completed on a case protected from a medical review because a Ticket to Work was assigned and in use, or in use SVR (State Vocational Rehabilitation) before the CDR was initiated.) When this occurs, the CDR determination must be vacated and the record restored to its prior status.

NOTE: See DI 13010.012H for FO processing instructions for cases where the medical review protection was not applicable due to protection based on work activity.

B. Procedure for benefits not yet terminated

1. Enter a date and remark on the Disability Control File (DCF) input remarks (IRMK) screen explaining that the cessation determination was vacated because the beneficiary was eligible for protection from medical CDR review (e.g., Ticket to Work in use – CDR completed in error)

2. Return the case to the Disability Determination Services (DDS) with an explanation that the CDR cessation determination must be vacated, along with the reason to vacate the determination.

   1. If the cessation was processed as an eCDR, reactivate the case in the Electronic Disability Collect System (EDCS) to return it to the DDS. Add an SSA-5002 with the following language: “Inappropriate medical CDR cessation determination was processed. The beneficiary had CDR protection based on his or her______ (example: Ticket to Work) status. Do not use any documentation contained in this file related to this CDR. Do not consider any medical evidence in file obtained for this CDR for future CDR/claim purposes.”

   2. If the case was a paper folder, include a paper SSA-5002 in the blue section of the modular disability folder, or on top of documents in a brown folder. The SSA-5002 should state that the case is being returned to the DDS to vacate the prior medical CDR cessation determination.

3. Use the Modify Medical Data (MMDS) screen in DCF to re-establish the prior medical information, found in the CDP folder. Over-key the zeroes with the information contained on the previous MMDS screen to re-establish the medical information, the previous CPD date, and the diary.

4. For Title II cases, if the Master Beneficiary Record (MBR) has the disability cessation annotated, but not yet effectuated, contact the processing center (PC), following established regional procedures, to correct the MBR.

5. For Title XVI cases, make the necessary corrections to the Supplemental Security Record (SSR).

C. Procedure for terminated benefits

1. Reinstate entitlement. If the case is concurrent, ensure that both titles are reinstated, as appropriate.

   NOTE: Be sure to check the pre-termination payment status. If payment was suspended for a reason other than a CDR medical termination (e.g., S7 suspension due to work and earnings), reinstate entitlement, as appropriate, but do not reinstate benefit payments.

2. Return the case to the DDS with an explanation that the CDR cessation determination must be vacated, along with the reason to vacate the determination.

   1. If the cessation was processed electronically in eCDR, reactivate the case in EDCS to return it to the DDS. Add an SSA-5002 with the following language: “Inappropriate medical CDR was initiated/processed in error. The beneficiary had CDR protection based on his or her______ (example: Ticket to Work) status. Do not use any documentation contained in this file related to this CDR. Do not consider any medical evidence in file related to this CDR for future CDR/claim purposes.”

   2. If the case is a paper folder, include a paper SSA-5002 stating the reason for the return to DDS to vacate the prior medical CDR cessation determination.

3. Enter a dated remark on the DCF IRMK screen explaining the cessation determination has been vacated because the beneficiary was eligible for protection from the medical CDR review (e.g., Ticket to Work in use – CDR completed in error).

4. Use the DCF MMDS screen to re-establish the prior medical information, found in the CDP folder. Over-key the zeroes with the information contained on the previous MMDS screen to re-establish the medical information, the previous CPD date and the diary.

5. Contact the PC, following established regional procedures, or if a public relations/dire need issue exists, use Manager to Manager to reinstate benefits and correct the MBR.

6. For Title XVI cases, make the necessary corrections to the SSR.

D. Procedure for a pending appeal

1. If an appeal is pending at the hearing level or above, request that the Office of Disability Adjudication and Review (ODAR) dismiss the hearing and return the case to the FO. Follow steps 2 – 5 below.

2. If an appeal is pending at the DDS, have the DDS vacate the initial cessation determination and then dismiss the appeal based on the vacated initial cessation determination.

3. If the beneficiary elected statutory benefit continuation during the appeal process, correct the MBR/SSR as appropriate.

4. Enter a dated remark on the DCF IRMK screen explaining that the cessation determination has been vacated because the beneficiary was eligible for protection from medical review (e.g., Ticket to Work in use – CDR completed in error).

5. Use the DCF MMDS screen to re-establish the prior medical information, found in the CDP folder. Over-key the zeroes with the information contained on the previous MMDS screen to re-establish the medical information, the previous CPD date and the diary.

6. Contact the PC, following established regional procedures, to reinstate benefits and correct the MBR.

7. For Title XVI cases, make the necessary corrections to the SSR.

E. Procedure for vacated CDRs returned to the DDS

Upon receipt of the case, the DDS will:

• review and vacate the medical cessation determination

• send a Notice of Vacated Medical Cessation Determination to the disabled person

• close the case in NDDSS with reason ND, and

• transfer jurisdiction of the case to the FO.

  Follow DI 81010.245 to close the case in EDCS.

See Also:

• DI 13010.012H, Policy - Medical cessation: medical review protection not applied

• DI 13010.630, The CDR Remarks Input (IRMK) Screen

• MSOM CDR 001.009,  CDR Remarks Input Screen (IRMK)

• DI 13010.640, The Modify Medical Information Data (MMDS) Screen

• MSOM CDR 001.017, Modify Medical Data (MMDS)