TN 1 (10-15)

DI 28095.040 Continuing Disability Review (CDR) Notices for Cessations

A. Introduction to cessation CDR notices

The disability determination service (DDS) will manually prepare and release cessation notices. The DDS will place sample case notices in file for review and release. You will not need a predetermination notice when the cessation notice offers benefit continuation rights. For benefit continuation rights that are not included in cessation notices for whereabouts unknown cases, see DI 28095.050.

B. Initial cessation notice

The DDS prepares and releases initial cessation notices containing the right to have a face-to-face evidentiary hearing on reconsideration and to elect benefit continuation until the disability hearing is over except for cases involving:

  1. cessations for reason of whereabouts unknown;

  2. fraud; and

  3. quality assurance (QA) sample cases (prepare the notice and leave it in file for review and release).

NOTE 1: When a legally competent adult (for example, number holder (HA), disabled widow’s benefits (DWB), childhood disability benefits (CDB), disabled individual (DI), disabled spouse (DS)) beneficiary has a representative payee, the DDS should send the cessation notice to the adult competent beneficiary. Also, send a modified copy of the cessation notice to the representative payee. The representative payee's notice should not contain personal information. Include the decision paragraph (4080-4096) and the sentence “(Beneficiary Name) has been given a more detailed explanation of our decision” on the personalized attachment.

NOTE 2: When using paragraphs on the SSA-L951-U2 (Social Security Notice Letterhead) for notices that are not preprinted, see DI 28095.105 (Title II).When using paragraphs on the SSA-L8052-U2 (Supplemental Security Income Notice of Disapproved Claim) for non-preprinted notices, see DI 28095.110 (Title XVI).

The chart in this section is a list of forms that you can use and reasons for applying each form.

Letter

Reason for use

SSA-L1410-U2 (Notice of Disability Cessation)

Use this form for most Title II medical improvement cessation.

SSA-L951-U2 (Social Security Notice Letterhead)

Use this form for Title II cessation notices that are not preprinted.

SSA-L1411 (Supplemental Security Income Tern Notice of Disability Benefits) NL 00705.358

Use this form for most Title XVI medical improvement cessations.

SSA-L8052-U2 (Supplemental Security Income Notice of Disapproved Claim

Use this form to prepare Title XVI cessation notices that are not preprinted.

Add a third line heading, “Notice of Disability Cessation” to versions of form SSA-L951-U2 (Social Security Notice letterhead) and form SSA-L8052-U2 (Supplemental Security Income Notice of Disapproved Claim). The Office of Earnings and International Operations (OEIO) prepare these notices on the form SSA-L2000-C2 (Universal Notice) and you will not need a third line heading.

NOTE 3: For vocational rehabilitation (VR) “301” cases, see DI 14510.010 and DI 14515.003.

C. Processing a personalized cessation notice

The disability examiner will prepare and release the personalized cessation notice by following the general personalized explanation requirements in DI 26530.010. Use the personalized attachment form SSA-4268 (Explanation of Determination) with the SSA-L1410-U2 (Notice of Disability Cessation) for Title II or a SSA-L1411 (Supplemental Security Income Notice of Disapproved Claim) for Title XVI.

Prepare merged text cessation notices on the SSA-L951-U2 (Social Security Notice Letterhead) for Title II or the SSA-L8052-U2 (Supplemental Security Income Notice of Disapproved Claim) for Title XVI. When you use merged text format, insert and underline the heading, “Explanation of Determination” prior to the personalized portion, and delete it from the Enclosure line.

The personalized attachment form SSA-4268 (Explanation of Determination) or the personalized explanation (merged text) will:

  1. 1. Give the date of the comparison point decision (CPD) and list the evidence sources considered in making that decision.

    NOTE: If the CPD was a continuance instead of an allowance, modify the language in the explanation, for example, “We used the following reports when we decided you were still disabled.”

  2. Include a brief statement describing the basis for the CPD and the reason for the current medical review.

  3. List evidence sources considered for purposes of the continuing disability review.

  4. Provide a brief statement outlining the reasons the beneficiary gave for believing he or she is still disabled and whether or not he or she is engaging in substantial gainful activity (SGA).

  5. State the basis for the disability decision, using a decision paragraph (4080-4096) from NL 00708.100.

  6. Discuss the findings of the CDR process. Rewrite the appropriate parts of the supplemental rationale in plain language to discuss the findings, DI 28091.010.

1. Disability insurance benefits (DIB), childhood disabled beneficiary (CDB), disabled individual (DI), blind individual (BI)

  • Describe current medical severity and address each allegation (including pain).

  • Discuss medical improvement (MI) and functional capacity (MI related to the ability to work), or exceptions to the MI standard.

  • If appropriate, provide a brief job description the beneficiary can perform. Also provide a statement that since the person cannot do any of the work he or she did during the period evaluated ( considering age, education and past work experience) he or she still has the capacity to do other work that is less demanding or requires less physical effort (specify in general terms, e.g., lighter work.) Do not cite other jobs.

2. Disabled widow benefits (DWB), surviving divorced spouse (SDS), disabled child (DC)

  • Discuss medical improvement or exceptions.

  • Discuss why the person no longer meets special medical rules.

D. Examples of personalized explanations

This section contains samples of personalized explanations. Every personalized explanation must include the factors listed in DI 28095.040C.1 and DI 28095.040C.2 in this section.

NOTE: These samples intend to show the proper format and the sequence of the elements. Do not use these samples as policy statements nor as examples of how to evaluate medical findings.

1. Medical improvement occurred - not severe

On February 15, 2015, we used the following reports to decide that you were disabled:

Hudson Memorial Hospital, report covering 08/10/14 to 09/6/14 and outpatient records of 10/03/13 to 01/17/14

John Masters, M.D., report of 02/05/13

This information showed that you broke your left leg. You could not walk without crutches and your leg was slow to heal. Since your leg was expected to get better, we are looking at your case again.

We used the following reports to decide if you continue to be disabled under our rules:

Daniel Jones, M.D., report dated 02/24/14

Thomas Doucette, M.D., report dated 03/27/13

Albert Cohen, M.D., Orthopedic Surgeon, consultative examination of 03/30/13

You said that you have not worked since your injury and you still cannot work because of the problem with your left leg.

(Insert decision paragraph.)

This new medical evidence shows that your broken leg has now healed and you can walk normally. You could not walk without help at the time we made our disability decision. Now you can stand and walk normally. Therefore, your impairment has medically improved and you are able to work. You are no longer disabled as of (cessation month/year).

2. Medical improvement occurred - DWB

On July 15, 2015, we used the following reports to decide that you were disabled:

Oak Ridge Hospital, report of admissions of 08/24/14- 09/15/14 and 05/30/14 - 06/17/14

Marvin Henry, M.D., report of 07/10/13

Keven R. Connally, O.D., report of 07/12/13

This information showed that you had a severe back condition. You had pain, muscle spasms and limited movement of your spine. This condition lasted more than three months and did not improve when you were hospitalized two times. We are reviewing your case because your impairment was expected to improve.

We used the following reports to decide if you continue to be disabled under our rules:

University Hospital, reports of admission of 10/07/13 - 10/20/13

Michael Wilson, M.D., report of 02/28/14

Marvin Henry, M.D., report of 03/04/14

Keven R. Connally, O.D., report of 03/10/14

You said that you are still disabled because of back and right leg pain and that you have not worked since your injury.

(Insert decision paragraph.)

This new medical evidence shows that you had back surgery in October 1984, which improved your condition. You now have good movement of your spine, no muscle spasms and normal reflexes. The evidence shows you still have occasional pain if you lift heavy objects. The pain you experience infrequently is not so severe that you cannot do any work at all. Your back condition has medically improved and you are no longer disabled as of (cessation month/year).

3. Medical improvement occurred - can do past work

On December 10, 2014, we used the following reports to decide that you were disabled:

Concord Hospital, inpatient records 08/17/14 - 08/31/14

Cliff Adams, M.D., report dated 11/1/13

Frederick Thompson, M.D., Cardiologist, consultative examination 11/13/14

The information showed that you had a severe heart condition. You had chest pain and shortness of breath. We are reviewing your case now because it was possible your impairment could improve.

We used the following reports to decide if you continue to be disabled under our rules:

Concord Hospital, inpatient records 06/05/13 - 06/28/13

Cliff Adams, M.D., report dated 02/09/13

Elise Friehold, M.D., Cardiologist, report of 03/15/13

You said that you still have a severe heart condition which limits your activities and you have not worked since you became disabled.

(Insert decision paragraph.)

This new evidence shows that you had two bypass operations. As a result, the circulation to your heart is better and special tests show your shortness of breath has decreased. Although you have occasional chest pain when you do heavy work, it is relieved by medication or rest.

Your heart condition has medically improved. You are able to do work which requires little physical exertion and no stress, such as your past job as a laundry marker. You are no longer disabled as of (cessation month/year).

4. Medical improvement occurred - can do other work

On April 12, 2015, we used the following reports to decide that you were disabled:

St. John's Hospital, inpatient 02/06/13 - 03/01/13

Lakeside Rehabilitation Center, outpatient 03/01/13 - 03/27/13

Claude Arkari, M.D., report of 04/01/13

This information showed that you were injured in a motorcycle accident. X-rays showed that your right knee did not heal and you could only walk short distances. We are reviewing your case now because your impairment was expected to improve.

We used the following reports to decide if you continue to be disabled under our rules:

Lakeside Rehabilitation Center, outpatient 04/05/13 - 04/21/13

Robert Franklin, M.D., report of 02/08/14

Samuel Glassner, M.D., Orthopedist, consultative examination of 03/01/14

You said that you still cannot return to work because of knee pain. You have not worked since your accident.

(Insert decision paragraph.)

This new medical evidence shows that your right knee has healed, although you have slightly limited movement of your knee. Your knee impairment has medically improved.

Although you cannot do your past job, you can do other jobs that require less physical effort. Based on your age (53), your limited education, and past work experience, you can do other work. You are no longer disabled as of (cessation month/year).

5. Medical improvement occurred - Group I exception - vocational therapy can do other work

On August 13, 2014, we used the following reports to decide that you were disabled:

General Hospital, report of admission of 01/03/13 - 02/06/13

T. Weston, M.D., report of 01/28/13

L. Lehman, M.D., report of 02/28/13

The information showed that your left leg was amputated above the knee as a result of a motorcycle accident. You had continued problems with the stump and because of pain and tenderness; you could not use a prosthetic leg. You also had a right shoulder dislocation. Your case is being reviewed now because your impairment was expected to improve.

We used the following reports to decide if you continue to be disabled under our rules:

T. Weston, M.D., report dated 09/19/13

L. Lehman, M.D., report dated 09/21/13

G. Robertson, M.D., report dated 10/01/13

You said that you have not worked since the accident. You are still disabled because of the left leg amputation and difficulty walking with an artificial leg.

(Insert decision paragraph.)

Current reports show that you had several operations to relieve the problems with your amputated leg. As a result, x-rays now show no complications and you can wear an artificial leg with little discomfort. Also, you are having no problems with your right shoulder and you have full movement of it with no pain. Your condition improved medically and your ability to do work-related activities increased.

Information shows you received counseling at the Department of Vocational Rehabilitation and received an associate degree in computer science.

Although your leg impairment keeps you from doing your past job, it does not keep you from doing other jobs that require less physical effort. The vocational therapy you received made you more able to do other work. Based on your age (30), your education (16 years), and your past work experience, you can do other work. Therefore, you are no longer disabled as of (cessation month/year).

E. Notice to auxiliaries

Prepare and release the notice to any auxiliary for whom the number holder is not the payee, using DI 28095.105 Title II Medical Cessation Notices Chart. Use the auxiliary (or payee for auxiliary) name and address.

F. Concurrent Title II and Title XVI cessations

Follow the notice instructions in this section for Title II and Title XVI and add disclaimer paragraph 842 on Title II notices and paragraph 841 on Title XVI notices.

NOTE: If you use form notices, add paragraphs (841 and 842) to the personalized explanations of the determination.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428095040
DI 28095.040 - Continuing Disability Review (CDR) Notices for Cessations - 10/13/2015
Batch run: 10/13/2015
Rev:10/13/2015