DI 23010.025 Failure to Follow Prescribed Treatment - Special Title XVI Issues - Blindness
A. Policy - Requirements
Do not find “failure,” unless:
The evidence establishes that the individual is blind;
Treatment which is clearly expected to restore vision to the extent that the individual will no longer be blind has been prescribed by a treating sources; and
The evidence of record discloses that there has been refusal to follow prescribed treatment.
B. Procedure - Development and Adjudication
When all the criteria described in A. above are present:
1. Failure Issue
Prepare a favorable decision and start payments pending resolution of the “failure” issue. Duration is not a factor.
Initiate development per DI 23010.005 and DI 23010.010.
NOTE: The ALJ or AC will request the effectuating component to continue development and resolve the issue.
2. Good Cause Not Found
Continue payments for 2 months effective with the date of the adverse determination of cessation of blindness.
Notify the beneficiary using a Notice of Planned Action (SSA-L8156-U2). Model language is provided:
“Supplemental Security Income – Notice of Cessation Due to Failure to Follow Prescribed Treatment - Blindness”
This is about your claim for supplemental security income payments.
To get supplemental security income payments because of blindness, your vision must be severely limited as defined in the law. However, a person will not continue to be considered blind for supplemental security income purposes if he or she willfully refuses to follow prescribed treatment that can be expected to restore his or her vision to the point where he or she is no longer blind as defined by law.
The evidence shows that you are blind, but are not following the treatment which has been prescribed for you. Therefore, benefits cannot be paid to you. If you should decide to follow the prescribed treatment, or if you have more information showing why you should not, please get in touch with any Social Security office.
On the basis of the evidence we have, we find that your eligibility to supplemental security income payments as a blind person ceased in (month/ year). However, if you meet all other requirements of the law, you can receive payments for a 2 month period after your blindness eligibility ends. Therefore, (month/year) is the last month you will be eligible for payments.
3. Vocational Rehabilitation
For title XVI claimants who have not attained age 16, when the prescribed treatment is recommended only by a medical source who is not a treating source (DI 23010.005), refer the case to VR in accordance with DI 26520.010C. with a special note. Establish an MIE diary (DI 26525.020) for followup.