DI 28005: The CDR Evaluation Process
TN 5 (06-15)
A. Setting the cessation month
To set the cessation month in cases where disability ended, use the table in DI 28005.205C. Do not use this table in reopenings.
B. Cessation month procedure
The cessation month generally coincides with the month of the notice. Find retroactive cessation only in the situations outlined in DI 28005.205C, items 2-9, in this section.
C. Cessation month table
Use the following table to determine the cessation month in CDR cases:
|
|
If Cessation is Based On: |
Find that Disability Ended in the Month: |
Reference: |
|---|---|---|---|
|
1. |
ANY SITUATION NOT COVERED BY 2-8 BELOW (most cessations) |
The cessation notice is mailed to the individual (general rule). |
|
|
2. |
REPORT OF EARLIER MEDICAL CESSATION |
The treating physician told the individual of regained capacity to engage in substantial gainful activity (SGA), or, in a Title XVI child case, told the child's representative payee that the child could return to normal activities. |
|
|
3. |
CLEAR-CUT CESSATION (return to work in a medical improvement expected case) |
The individual returns to full-time work with no significant medical restrictions. |
|
|
4. |
FAILURE TO COOPERATE |
The individual fails, without good cause, to do what the Social Security Administration (SSA) or the Disability Determination Services (DDS) has requested and the individual was aware that he or she had to cooperate and the repercussions of failing to do so. |
DI 28075.005F; DI 25205.020 for Title XVI child cases |
|
5. |
WHEREABOUTS UNKNOWN |
SSA first knew that the individual's whereabouts are unknown but not earlier than the month a continuing disability issue arose. NOTE: Title XVI benefits are suspended rather than ceased. |
|
|
6. |
FAILURE TO FOLLOW PRESCRIBED TREATMENT |
The evidence clearly establishes the individual's unjustified failure to follow prescribed treatment. |
|
|
7. |
WORK ACTIVITY ONLY |
The individual first engages in SGA following completion of any applicable trial work period. DDSs do not decide this issue. Do not cease Title XVI cases on this basis. |
|
|
8. |
RECOVERY PRIOR TO INITIAL ALLOWANCE DECISION (closed period cases) |
Shown by the evidence. |
|
|
9. |
Fraud or similar fault |
When the individual is no longer disabled, if applicable, after the fraudulent evidence is removed during the redetermination. Base this determination on sequential evaluation for CDRs; also consider the information listed in the “Reference” column. |
SSR 16-1p; SSR 16-2p; DI 23025.000 |
D. Determining cessation months
1. Report of earlier medical cessations
The following situations involve the setting of earlier cessation months.
-
Find retroactive cessation in cases where there is no doubt that the individual was aware that he or she was able to work. Alternatively, in a Title XVI child case, there is no doubt that the child's representative payee (or the child, if the child is his or her own payee) was aware that the child could return to normal activities, but failed to report this change. That is, find retroactive cessation only if:
the individual (or Title XVI child's representative payee) reports that at an earlier date the treating source informed the individual that he or she had regained the capacity to return to work or, in a Title XVI child case, had informed the child's representative payee that the child could return to normal activities; or
the treating source voluntarily reports the individual was informed at an earlier date that he or she had the capacity to return to work or, in a Title XVI child case, the child's representative payee was informed that the child could return to normal activities.
Set cessation as of the month the individual was made aware he or she had regained capacity to engage in SGA or, in a Title XVI child case, the child's representative payee was made aware that the child could return to normal activities.
-
Do not set this type of retroactive cessation date if:
there is substantial conflict between statements from the treating source and the individual (or, in a Title XVI child case, the treating source and the child's representative payee) concerning the individual's awareness of capacity to work, or the child's ability to return to normal activities; or
inadequate (or no) objective medical evidence supports the statement from the treating source establishing the retroactive cessation date.
2. Cessation month in error exception cases
In cessations that rely on the error exception to medical improvement (MI), do not find retroactive cessation unless the conditions for reopening the prior decision are met.
3. Cessation month in low birth weight (LBW) infant cases
For LBW infants who are found no longer disabled, establish the cessation month no earlier than the month the baby attains age 1.
E. References
DI 25225.060 Examples of Impairments That Functionally Equal The Listings (Section 416.926a(m))
DI 25235.005 Medical Diary Criteria for Certain Title XVI Disabled Infants
DI 25235.006 Medical Diary Criteria for Low Birth Weight (LBW) Infants under Title XVI
DI 27501.001 Reopenings and Revisions: Pertinent Definitions and Related Policy
DI 28020.350 Prior Error - General
SSR 16-1p Titles II and XVI: Fraud and Similar Fault Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act
SSR 16-2p Titles II and XVI: Evaluation of Claims Involving the Issue of Similar Fault in the Providing of Evidence
DI 23025.000 Fraud or Similar Fault