BASIC (10-15)

DI 28084.015 Reason for Cessation Codes (Item 11)

A. Introduction to completing Item 11

Follow these instructions to complete Item 11 when processing a continuing disability review (CDR) on the Forms SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal –Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II).

B. Title II and Title XVI cessation basis codes (Item 11 of SSA-832 and SSA-833)

1. Entering the cessation basis code

Enter the following information:

  • the appropriate reason for cessation code from the lists in this section;

  • only one code even if more than one code could apply. Use the code that best describes the basis for the determination;

  • for Title II cases, if a Group 1 exception applies, use codes 02, 03, 04, or 05; and

  • for Title XVI cases, if a Group 1 exception applies, use codes 51, 52, 53, or 54 for adults, or codes 91 or 92 for children.

2. One-position cessation codes for Title II CDR

NOTE: When the field office (FO) or Office of Disability Operations (ODO)/ Program Service Center (PSC) has made a determination and is manually processing the SSA-833, enter both (a one-position and two-position code) with the SSA-4648-U3 (Title II/Title XVI Disability Claims Control and Determination Input). Choose the most specific two-position code and then convert it to the more general one-position code. If more than one code applies for either of the two types of cessation codes, choose only one code for each type:

Reason Code

Medical

M

SGA/EPE

E

SGA (No EPE, Pre 1980 Amendment Cases)

S

Failure to Cooperate

F

Whereabouts Unknown

W

Vocational Rehabilitation (301)

V

NOTE: The disability determination services (DDS) will not enter the one-position code on the SSA-833 for their CDR determination.

3. Reason for two-position cessation codes

You may use the following reason for cessation codes for Item 11 in this list:

a. Cessation codes for Title II and Title XVI adult medical CDR

Reason Title II Code Title XVI Code

Medical Condition Not Disabling - Medical Improvement Relates to Ability to Work - Able to Engage in SGA

01

50

Medical Condition Not Disabling - Individual Has Benefited From Advances in Medical or Vocational Therapy or Technology - Able to Engage in SGA

02

51

Medical Condition Not Disabling - Vocational Profile Enhanced By Vocational Therapy - Able to Engage in SGA

03

52

Medical Condition Not Disabling - New or Improved Diagnostic Techniques or Evaluation Shows Impairment(s) Not as Disabling as Considered to Be at Time of the Most Recent Prior Favorable Medical Determination - Able to Engage in SGA

04

53

Medical Condition Not Disabling - Substantial Evidence That Any Prior Favorable Medical Determination of Entitlement to Benefits Was Based Upon Error - Now Able to Engage in SGA

05

54

Drug Addiction is Material to Disability; Otherwise, is Able to Engage in SGA

06

56

Alcoholism is Material to Disability, Otherwise is Able to Engage in SGA

07

57

Both Drug Addiction and Alcoholism are Material to Disability, Otherwise is Able to Engage in SGA

08

58

Failure to Cooperate

13

62

Whereabouts Unknown

14

N/A

Failure to Follow Prescribed Treatment

15

64

Improvement Expected – Work SGA (Clear-Cut)

16

65

NOTE: When completing the SSA-833 use a more specific two-position code. The two-position code is required on all SSA-833s. Enter one of the one-position codes listed in DI 28084.015B.2. in this section between "Reason for Cessation" and "Code". Enter in the "Code" block one of the two-position codes shown in DI 28084.015B.3.a. in this section.

b. Cessation code for expedited reinstatement

Reason Title II Title XVI

Impairment Not the Same or Related to the Impairment That Was the Basis for Previous Disability Entitlement

28

61

NOTE: If the impairment is the same as, or related to, the impairment that was the basis of the previous entitlement, use the codes in DI 28084.015B.3.a. or DI 28084.015B.3.c. in this section, as appropriate.

c. Cessation codes for Title II work CDRs (FO and ODO/PSC use)

Reason Code

Failure to Cooperate

13

TWP Completed - Work SGA - No Medical Issue

17

TWP Completed - Work SGA - Medical Issue

18

Not Entitled to a TWP - Work SGA

19

EPE Reinstatement Denied - Work SGA

20

EPE Suspension After Reinstatement - Work SGA

21

EPE Termination - SGA After Re-entitlement Period

22

d. Cessation codes for Title XVI child CDR

Reason Code

Drug Addiction is Material to Disability; Otherwise Impairment(s) No Longer Results in Marked and Severe Functional Limitations

55

Alcoholism is Material to Disability, Otherwise, Impairment(s) No Longer Results in Marked and Severe Functional Limitations

59

Both Drug Addiction and Alcoholism are Material to Disability, Otherwise, Impairment(s) No Longer Results in Marked and Severe Functional Limitations

60

Failure to Cooperate

62

Failure to Follow Prescribed Treatment

64

Title XVI Child: Medical Improvement; Impairment(s) Does Not Cause Marked and Severe Functional Limitations

90

Title XVI Child: New or Improved Diagnostic Technique or Evaluation Show Impairment(s) Not as Disabling as Considered to be at Time of the Most Recent Prior Favorable Medical Determination; Impairment(s) Does Not Cause Marked and Severe Functional Limitations

91

Title XVI Child: Substantial Evidence Shows That Any Prior Favorable Medical Determination or Entitlement to Benefits Was Based on Error; Impairment(s) Does Not Cause Marked and Severe Functional Limitations

92

e. Cessation codes for Age-18 redeterminations

Reason Code

Failure to Cooperate

62

Age-18 Disability Redetermination, Impairment(s) Does Not Meet Definition of Disability for Adults

97

NOTE: Use cessation code 97 when the cessation determination finds that drug addiction or alcoholism (DAA) is material.

C. References

  • DI 28005.005 The Continuing Disability Review (CDR) Evaluation Process for Title II and Adult Title XVI Individuals

  • DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement

  • DI 28057.020 Effectuating Determinations


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428084015
DI 28084.015 - Reason for Cessation Codes (Item 11) - 10/27/2015
Batch run: 10/27/2015
Rev:10/27/2015