Retention Date: Indefinite
Revised: 07/06/2017 - This revises CJB 13-01 to identify another error discovered in the continuing disability template.
We are revising this CJB to address an error found in the template for unfavorable title II medical cessation decisions. In June 2017, we discovered an error in the "Applicable Law" section, which says "[a]lthough the claimant generally continues to have the burden of proving disability at this step, a limited burden of going forward with the evidence shifts to the Social Security Administration." This sentence should be removed.
On February 21, 2013, the Social Security Administration (SSA) issued Social Security Ruling (SSR) 13-3p, which requires an adjudicator reviewing a medical disability cessation to determine disability through the date of the adjudicator’s decision.
Due to the policy change, the current title II unfavorable FIT CDR Adult Decision template refers to obsolete policy, requiring adjudication only through the cessation date.
Until the necessary changes to title II FIT templates are made, decision writers must make the necessary changes when drafting an unfavorable medical cessation decision involving a title II claim. Most importantly, unless the case involves an expired date last insured (DLI), decisions must reflect adjudication through the date of the Administrative Law Judge’s (ALJ) decision.
This guidance does not apply to favorable medical disability cessation decisions because the favorable CDR Adult Decision templates already comport with SSR 13-3p. This bulletin is also inapplicable to Supplemental Security Income (SSI) only claims, and to substantial gainful activity (SGA) cessations.
Modifying the FIT CDR Template
To locate the template, the user selects the Unfavorable decisional outcome, a “DIB” or “SSDC” claim type, and the outcome category of “Medical Improvement – Related to Ability to Work.” To modify a FIT CDR Adult Decision, in the “Findings of Fact and Conclusions of Law” section, the decision writer (DW) must:
NOTE: No change is necessary in title XVI claims, as adjudicators were already required to review medical cessation through the date of the decision. While the FIT CDR Adult Decision template for SSI-only claims can serve as a guide, it cannot be used verbatim as it lacks an SGA analysis step, required in title II claims (20 C.F.R. § 404.1594(f)(1)).
1. Specifically address whether the initial cessation determination was correct.
2. Determine whether the beneficiary is eligible for a new period of disability any time through the date of the decision (or DLI, if earlier).
3. Make present-tense findings to reflect the 8-step analysis for Title II claims through the ALJ decision date, or the DLI if earlier. Decisional analyses, findings, and conclusions must be case-specific. To illustrate when present-tense finding changes may be necessary, please note the following examples.
Example #1: The initial cessation determination was correct and the beneficiary has not again become disabled.
The issue is whether the claimant’s disability has ended under section 223(f) of the Social Security Act.
After reviewing all of the evidence of record, the undersigned Administrative Law Judge finds that the claimant’s disability ended as of [the cessation date], and that the claimant has not become disabled again since that date.
Example #2: The beneficiary has not engaged in SGA since the date of the comparison point decision (CPD).
FINDINGS OF FACT AND CONCLUSIONS OF LAW
The claimant has not engaged in substantial gainful activity since [CPD date] (20 CFR 404.1594(f)(1)).
Direct all program–related and technical questions to your RO support staff. RO support staff may refer questions or unresolved issues to the appropriate Headquarters’ contact.
CJB 13-01 REV - Modifications to Unfavorable Title II Medical Cessation Decisions - 07/06/2017