TN 1 (07-11)

Citations:

20 CFR 404.1512 through 20 CFR 404.1519t , and 20 CFR 416.912 through 20 CFR 416.919t

A. Exceptions to instructions in this section

B. Refusal to attend a CE appointment defined

Refusal to attend a CE appointment means the claimant states orally or in writing that he or she WILL NOT attend a CE appointment, and does not provide a good reason why he or she will not attend the CE appointment. If the claimant provides a good reason why he or she will not cooperate with a scheduled CE appointment, reschedule it. For examples of good reasons for not attending a CE appointment, see DI 23007.009C.

NOTE: If the claimant’s treating source advised the claimant not to attend the CE appointment due to a health reason or health risk, do not persist in attempting to have the CE performed.

C. Good reasons for refusal to attend a CE appointment

Examples of good reasons include:

• personal illness,

• death or serious illness in the family, and

• transportation problems.

NOTE: The items in this list are only examples. You must exercise judgment and take into account the facts of each claim.

D. Special efforts required for title XVI childhood disability claims

For instructions on Failure Issues for title XVI childhood disability cases, see DI 25205.020.

E. Review and documentation of the claim

Regardless of the nature of the claimant’s impairment(s), if the claimant refuses to attend a CE appointment, you may discontinue development that requires evidence from or action by the claimant (e.g., consultative examinations and claimant forms completion).

You must:

• review the file again to determine if you need the requested evidence;

• develop medical evidence of record (MER) from other medical sources;

• make every reasonable effort as explained in DI 22505.001A.2;

• complete development of functional evidence indicated by the facts of the case, if the available MER substantiates mental impairment; and

  See details:

  DI 22511.007, Sources of Evidence

  DI 22511.009, Sufficiency of Evidence

  DI 22511.011, Contacting Claimants and Collateral Sources

• document the case development summary worksheet with the details of the development undertaken; see case development summary instructions in DI 20503.001E. If the claimant explained why he or she would not attend the CE appointment, include the reason.

NOTE: Review by a Medical consultant or psychological consultant is not necessary if there is no medical evidence.

F. Procedure for refusal to attend a CE appointment determination

After you review and document the claim:

• make a disability determination based on the evidence in file; and

• if you cannot make a fully favorable determination, send a personalized disability notice (PDN). NOTE: The PDN must include an explanation that the adjudicator requested the claimant attend a CE appointment, but the claimant refused, and we made a determination based on the evidence in file.