Identification Number:
CJB 13-01 REV
Intended Audience:All ODAR Hearing Level Personnel
Originating Office:ODAR Office of the Chief Administrative Law Judge
Title:Modifications to Unfavorable Title II Medical Cessation Decisions
Type:Chief Judge Bulletins
Program:Disability
Link To Reference:Social Security Ruling 13-3p; Acquiescence Ruling 92-2(6); 20 C.F.R. § 404.1594
 
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.

      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)).

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:
    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.
    ISSUES

    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