Provided that there is not enough evidence to justify a continuance, in FTC cases
(both titles II and XVI), disability ceases in the first month in which the individual
was aware that he or she had to cooperate, the repercussions of failing to do so and
failed, without good cause, to do what SSA/DDS has requested.
Title II, Title XVI and concurrent cases
EXAMPLE 1: The FO sends the claimant a letter requesting completion and return of the CDR forms
within 10 days. The claimant returns the necessary CDR forms. The FO sends the file
to the DDS for processing. The DDS reviews the file, obtains the necessary records
from the claimant's treating source. The records are insufficient to make a CDR decision.
The claimant has a mental impairment, has no representative, and no payee. There is
no third party source identified in file. Activities of daily living (ADLs) and a
CE are necessary to complete the work on the claim. The examiner calls the claimant
on two different days at two different times to attempt to get ADLs and to determine
if the claimant is willing to attend a CE. There is a busy signal both times. The
examiner sends a call-in letter on March 14, 2006, advising the claimant that if he
or she does not call the examiner within 10 days, a decision will need to be made
on the evidence in the file and benefits may be stopped. The claimant does not call
within 10 days. The examiner prepares a cessation using 03/06 as the cessation month
since this is the first month in which the claimant was first aware (03/14 + 5 days
mailing time = 03/19) that he had to cooperate, that failure to do so could result
in cessation of benefits, and failed, without good cause, to do what SSA/DDS has requested.
EXAMPLE 2: On July 13, 2006, the DDS sent a letter to the claimant explaining that a CE is necessary
and has been scheduled for August 21, 2006. The letter also explained that if the
claimant fails to keep the appointment, it might be necessary to find that the claimant
is no longer disabled or blind. The claimant failed to attend the CE, and good cause
for failing to keep the appointment was not demonstrated. Unlike Example 1, the claimant
can neither cooperate with the CE appointment nor demonstrate FTC until he fails to
attend the CE. In Example 1, the claimant could have cooperated as early as the date
the notice requesting information was received. In the case of a CE, the claimant
cannot comply with the request, or FTC, until the date of the CE. In this case, the
DDS would prepare a cessation determination using August 2006 as the cessation month.
EXAMPLE 3: On April 10, 2006, the DDS sent a letter to the claimant explaining that a CE is necessary
and one has been scheduled for May 2, 2006. The letter also explained if the claimant
fails to keep the appointment, it might be necessary to find that the claimant is
no longer disabled or blind. The claimant failed to attend the CE, but contacted the
DDS explaining why he or she was unable to attend the CE. The CE was rescheduled for
June 19, 2006. The claimant again failed to attend the CE. Good cause is not demonstrated
for failure to attend the rescheduled CE.
In this case, the DDS would prepare a cessation determination using June 2006, as
the cessation month. This is the first month that the claimant did not comply with
the request and good cause for the failure to attend the CE was not demonstrated.
NOTE: If the beneficiary refuses, without good cause, to attend the CE before the actual
date of the CE resulting in a cancellation of the CE, the FTC cessation date is the
date of refusal.
EXAMPLE 4: A CE was scheduled for May, 2011. The claimant calls the DDS in April, 2011, and
tells the adjudicator that they refuse to attend the CE. The claimant does not provide
a reason that can be accepted as “good cause.” The CE is cancelled. In this case,
DDS would prepare a cessation determination using April, 2011 as the cessation month.
This is the first month that the claimant did not comply with the request and good
cause for refusal to attend the CE was not demonstrated.”