Effective Dates: 10/02/2026 - Present

Identification Number:
DI 28075 TN 30
Intended Audience:See Transmittal Sheet
Originating Office:LP DP
Title:Special CDR Issues
Type:POMS Full Transmittals
Program:
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 280 – Continuing Disability Review Cases
Subchapter 75 – Special CDR Issues
Transmittal No. 30, 10/02/2026

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: BET, CR, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

DP

Effective Date

Upon Receipt

Background

NYLAG settlement.

Summary of Changes

DI 28075.200 Special Instructions for Processing Overdue Medical Cessation and Uneffectuated Medical Cessation Cases

Changing sensitivity level from sensitive to non-sensitive per proactive disclosure law.

DI 28075.200 Special Instructions for Processing Overdue Medical Cessation and Uneffectuated Medical Cessation Cases

This section provides Disability Determination Services (DDS) instructions for processing overdue medical cessation (OMC) cases and uneffectuated medical cessation (UMC) cases. The policies and processing procedures apply to all cases (Title II only, Title XVI only, concurrent Title II and Title XVI, and dual Title II entitlement).

A. Policy and background on medical cessation determinations

For various administrative reasons, some medical cessation determinations were not effectuated at the time they were made; as a result, some individuals who should have been terminated, continue to receive benefits. Sometimes the uneffectuated medical cessation determinations remain undetected for a number of years.

Before we may terminate disability benefits, the Social Security Administration (SSA) must send due process cessation notices to the individual. However, due to past practices and systems limitations, SSA cannot confirm with absolute certainty that DDS sent due process cessation notices to some individuals after DDS made medical cessation determinations.

The DDS generates two copies (three copies if there is a representative involved) of a disability cessation notice and places all copies of the notice in the folder. DDS should release the individuals copy of the notice at case closure. However, in some instances, DDS did not send the notices to the individuals, or, SSA lost the notices in transit when DDS transferred the folders to the field office (FO).

In processing the UMC workload, SSA discovered an issue concerning appeals filed on the cessation determinations. In many cases, SSA never sent the appeals to the appropriate component for processing. SSA did not annotate the appeals to the mainframe systems and did not take actions to process the appeals. When SSA discovered the appeals, many of them were very old.

Also, SSA found another issue concerning UMC cases with appeal decisions that were not effectuated (due to administrative error) at the time DDS made the decisions. Therefore, special procedures also apply for UMC cases for which the individual filed an appeal, but SSA never effectuated it.

B. How to identify and process OMC cases for medical cessation determinations DDS made on or after January 01, 2006

Overdue Medical Cessation (OMC) cases are medical cessation determinations made on or after January 01, 2006 , that were not effectuated for more than two months after the month of termination or date of the cessation notice (whichever is later).

SSA considers the administrative actions to terminate benefits on these cases as overdue. The FO will process these OMC cases under the established policies and procedures in DI 13015.265.

NOTE: 

If the FO erroneously sends an OMC case to the DDS for a new CDR, the DDS will process a No Determination and return the case to the FO.

C. How to identify and process UMC cases for medical cessation determinations DDS made before January 1, 2006

Uneffectuated Medical Cessation (UMC) cases are DDS medical cessation determinations made before January 01, 2006 ; however, due to administrative error, SSA did not effectuate the determinations. If normal workflow limitations (backlogs) caused the processing delays, the special UMC procedures do not apply.

SSA cannot determine that the administrative actions were ever properly completed. However, SSA took action to address the effectuation problems from January 2006. DDS will adjudicate new medical CDRs for the UMC determinations made before January 01, 2006. These special procedures apply only to UMC cases; they do not apply to OMC cases.

NOTE: 

The FO will not attempt to verify the mailing of due process cessation notices. The FO will process the cases under the special UMC procedures in subsection DI 13015.265C.

1. Concurrent or dual Title II entitlement cases

It may be possible that at the time of the medical cessation determination, the individual was either concurrently or dually entitled (Title II and Title XVI or more than one Title II case). Mistakenly, we effectuated the termination action on only one title. We consider the termination action on the effectuated title as final (after the appropriate appeals period). For the title on which SSA did not effectuate the medical cessation determination, the appropriate current action depends on the date of the original DDS concurrent medical cessation determination.

If DDS made the medical cessation determination:

  • •

    on or after January 01, 2006, the FO will process the uneffectuated title under the OMC procedures. That means the FO will take necessary action to terminate benefits retroactively on the uneffectuated title (based on the original cessation determination). The FO will not send OMC cases to the DDS for a new medical CDR determination. However, if the FO mistakenly sends an OMC case to DDS, the DDS will process it as a No Determination and return it to the FO; or

  • •

    before January 01, 2006, DDS should process a new CDR. DDS will adjudicate the new CDR on only the uneffectuated title.

If appropriate, the FO will take a new claim on the title that DDS ceased. The FO will obtain a Form SSA-3368 (Disability Report Adult) and a Form SSA-454 (Continuing Disability Review Report) to capture any information not on the Form SSA-3368, and send the new claim to DDS along with the CDR. If DDS allows the new claim, SSA will base the retroactivity solely on the new application (i.e., 6 or 12 months retroactivity, as appropriate, for a Title II application. Retroactivity does not apply for Title XVI application). The FO will not use either the prior application date or the continued entitlement on the title that we did not cease as a protective filing date for the new application on the properly ceased title. Retroactive benefits are not payable back to the medical cessation date.

2. Special situations for subsequent concurrent cases

Certain situations may arise where the UMC case was not a concurrent or dual entitlement case at the time of the original medical cessation. However, an action subsequent to the original medical cessation (such as the filing of a new claim) involved the other title. Treat these cases as concurrent or dual entitlement filings for UMC purposes. Because of the unique scenarios that the adjudicator may encounter, SSA may need to modify established policy and procedures.

Example 1:

The DDS makes a medical cessation determination in 04/2000 on a Title XVI only case, but SSA never processed the cessation. The NH files for Title II DIB in 11/2002 and the Title XVI allowance is adopted; the medical re-exam diary is set at 11/2005. The eligibility on the Title XVI record terminates in 2004 due to income and resources.

In this example, DDS made the Title XVI medical cessation determination in 2000. Therefore, the case falls under the UMC procedures (i.e., set aside the original medical cessation and process a new CDR). However, because the Title XVI eligibility is already terminated (for non-medical reasons), it would serve no purpose to do a new Title XVI CDR, because, with certain exceptions, a medical cessation is not retroactive.

The other issue DDS must consider is the Title II adoption of the Title XVI allowance. DDS adopted the Title XVI for the Title II in error because SSA should have ceased the Title XVI case in 2000. Because of the special circumstances involved in this case, the FO will initiate a new CDR on the Title II claim to establish a medical basis for future CDRs. The Comparison Point Decision (CPD) folder will be the original Title XVI allowance from which we erroneously adopted the Title II allowance.

Example 2:

The DDS makes a medical cessation determination in 01/2002 on a concurrent Title II and Title XVI case. SSA terminated the Title XVI case, but never processed the cessation on the Title II case. In 05/2003, SSA mailed a Ticket to Work and assigned its use for the individual on 06/28/06. SSA discovers the UMC situation in 11/2007.

Because DDS made a medical cessation determination in 2002, this case falls under the UMC procedures (i.e., set aside the original medical cessation and process a new CDR). However, because the individual is using a Ticket when SSA discovers the UMC issue, the FO will not initiate a new CDR at that time. The FO will initiate a new CDR when the Ticket use terminates.

For unusual situations requiring additional guidance, DDS personnel should contact their regional coordinators. Regional coordinators who need assistance may contact the Office of Disability Policy (ODP).

3. Ticket to work cases

If SSA assigns a Ticket to Work and the individual is using it when SSA discovers and processes the UMC issue, the FO will not initiate a new medical CDR until the Ticket is no longer in use. The FO will document the UMC issue on the DCF and MBR remarks with instructions to pursue the medical CDR if or when the Ticket use terminates.

NOTE: 

If the FO mistakenly sends a case to DDS with an active Ticket, DDS will process it as a No Determination and return it to the FO.

4. FTC cases and WU cases

The FO initiates a new CDR on a UMC case, but the individual fails to comply with the FOs request for needed information or evidence to complete the CDR. After making every effort to obtain the information or evidence, the FO will make a FTC determination per DI 13015.005A.1. FO staff will record the FTC determination on the DCF per the FTC procedures in DI 13015.005A.2.d.

If a new CDR is initiated on a UMC case, but a WU issue arises in the FO, the FO will process according to DI 13015.005B.

If a FTC or WU issue arises in the DDS, process according to DI 28075.005 or DI 28075.007.

5. Section 301 cases

Section 301 of the Social Security Disability Amendments of 1980 (P.L. 96-265) provides for continuation of disability benefits to certain individuals whose disability medically ceases while the individual is engaged in a program of vocational rehabilitation or similar program (see DI 14500.000 through DI 14515.000). If benefits continue after a DDS cessation determination made prior to January 01, 2006, because of a favorable Section 301 allowance determination, the case is not a UMC case and the special UMC procedures do not apply.

D. Appeals of uneffectuated medical cessation determinations

In processing the UMC workload, SSA discovered an issue concerning appeals filed on the cessation determinations. In many cases, SSA never sent the appeals to the appropriate component for processing. SSA did not annotate the appeals to the mainframe systems and SSA did not take actions to process the appeals. When SSA discovered the UMC cases, many of the appeals were very old. Therefore, special procedures apply for this category of UMC cases, but only if the processing delays were caused by administrative error.

If normal workflow limitations (e.g., backlogs) caused processing delays, the special procedures do not apply. To determine what caused the delays, review the folders, and obtain pertinent queries (MBR, SSID, DDSQ, CPMS, etc.) to determine the particular circumstances involved in each case.

Possible situations:

  1. 1. 

    If the FO discovers an unprocessed appeal on the uneffectuated cessation determination in the file during the FO review of the UMC issue, the FO will document the folder with the Special Determination attachment (Exh #2) and will initiate a new CDR per DI 28075.200E in this section.

  2. 2. 

    If the FO receives a current appeal on a UMC case, the FO will document the folder with the Special Determination attachment (Exh #2) and will initiate a new CDR per DI 28075.200E in this section.

  3. 3. 

    If DDS receives a current appeal on a UMC case, document the folder with the Special Determination attachment (Exh #2) and return the case to the FO with the flag shown in Exh #3. For electronic procedures, see Certified Electronic Folder (CEF) Flags in section DI 81020.085.

  4. 4. 

    An individual files an appeal on a UMC case. DDS reversed the cessation to a continuance. Process the continuance as usual, according to established procedures.

  5. 5. 

    An individual files an appeal on a UMC case. The appeal decision upheld the medical cessation determination. The FO will not terminate benefits at this time; however, they will document the folder with the Special Determination attachment (Exh #2) and initiate a new CDR. See DI 28075.200E in this section.

  6. 6. 

    If an individual files an appeal on a UMC case and the appeal decision upheld the medical cessation determination and the FO has already terminated benefits; however, the FO did not effectuate the appeal decision at that time due to administrative error, then:

    1. a. 

      If the FO receives any type of protest (e.g., request for waiver of overpayment, or new claim filed), the FO will reinstate benefits, pay any benefits withheld, document the folder with the Special Determination attachment (Exh #2), and initiate a new CDR.

    2. b. 

      If the FO does not receive a protest, the FO will not take any further action; FO staff will not attempt to identify cases already terminated unless they receive a protest.

    3. c. 

      If the FO terminated benefits after an appeal decision and an individual filed a new application, the FO will reinstate benefits, pay any benefits withheld and document the folder with the Special Determination attachment (Exh #2). The FO will initiate a new CDR and treat the new application as a duplicate filing.

  7. 7. 

    If the DDS receives a pipeline UMC appeal case that SSA previously sent for appeal processing, document the folder with the Special Determination attachment (Exh #2), and return the case to the FO for initiation of a new CDR. Use the flag shown in Exh # 3.

NOTE: 

These special UMC procedures do not apply after DDS makes the new determination. For example, if the new CDR determination (made after January 1, 2006) again results in a cessation determination, the FO will terminate benefits based on the new CDR cessation date and process any subsequent appeal.

E. How to adjudicate uneffectuated medical cessation determinations made before January 01, 2006

NOTE: 

UMC cases are eCDR exclusions.

Adjudicate UMC determinations made before January 01, 2006 as if SSA never completed the medical cessation determination. The FO will follow established policy and procedures for initiating a new medical CDR and obtain a new Form SSA-454 (Continuing Disability Review Report) and Form SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)). Using the flag shown in Exh #1 (Uneffectuated Medical Cessation), the FO will send the new CDR case to the DDS for adjudication.

The DDS will follow established policies and procedures for adjudicating a new medical CDR. The comparison point decision (CPD) will be the most recent favorable medical decision. The previous cessation determination will have no bearing on the CPD. However, consider any medical and/or other evidence in the file from the uneffectuated CDR for the current evaluation. In all of these cases, the DDS has already found the individual not disabled at some point in the past. If the individual is found not disabled for more than 12 months, but is currently disabled, provide an explanation in the decisional rationale. The reason for the explanation is so a future reviewer understands why the individual was never ceased when they should have been, and benefits were never stopped. Upon completion, return all UMC cases (including CONTINUANCE cases) to the FO. Use the flag shown in Exh # 1, but reverse the To and From annotations.

 

Uneffectuated Medical Cessation

 

TO:DDSFROM: FODATE:

 

Disabled Individual: ____________________________

 

SSN: BIC:

 

 

This case is an uneffectuated medical cessation (UMC). The DDS made the cessation prior to 01/01/2006. Per DI 13015.265 and DI 28075.200, SSA/DDS should set aside the cessation determination and process a new CDR determination. Upon completion, return ALL completed CDRs to the FO (including T2 and T16 continuance cases). Place this flag on top of the folder. Reverse the To and From annotations.

 

 

FO Contact:

 

CR Name:

 

CR Phone Number:

 

Exhibit 1 Uneffectuated Medical Cessation

View In PDF

 

 

Uneffectuated Medical Cessation --- Appeal

 

Disabled Individual:____________________________________

 

SSN: _______________________________________________

 

The DDS issued a medical cessation determination in this case prior to January 01, 2006. Subsequently, the disabled individual filed an appeal at the DDS (reconsideration), Office of Disability Administrative Review (ODAR), or Appeals Council (AC). However, due to administrative error(s), the FO did not send the appeal request/decision:

  • •

    To the appropriate office for processing, or

  • •

    Did not send it when received, or

  • •

    Did not effectuate the decision at the time it was made.

Special processing instructions in DI 13015.265 and DI 28075.200 provide that the FO will initiate a new initial continuing disability review (CDR) for the cessation determination DDS made prior to January 01, 2006 and the disabled individual did not file an appeal.

 

[]Appeal Filed but not processed.

 

The individual filed an appeal but too much time has passed to process the appeal without more recent medical and other relevant evidence. Accordingly, we will consolidate the appeal with a new CDR. After the agency completes the new CDR and issues a new or revised determination, we will give the individual the opportunity to continue with an appeal.

By consolidating the appeal with a new CDR, we will handle all cases where we made the cessation determination before January 01, 2006. We will handle these cases in the same manner. We will suspend all actions relating to the pending appeal and make a new or revised CDR determination.

 

[]Appeal Filed and processed.

 

We made an appeal decision, but due to administrative error(s), did not effectuate it at the time. If we had effectuated the decision, the individual would be subject to a retroactive termination. This retroactive termination could result in a large overpayment assessment due to the agency delay in processing the appeal.

 

In the interest of preventing any adverse effect to all individuals in the UMC appeal group and handling all UMC cases in the same manner, we will not process the unfavorable appeal decision. We will make new CDR decision which we will give the individual the opportunity to appeal.

 

Exhibit 2 - Appeal Decisions

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Uneffectuated Medical Cessation Appeal Case

 

TO:FOFROM: DDS:

 

Disabled Individual: ____________________________

 

SSN: _______________________________________

 

This case is an uneffectuated medical cessation. The DDS made a cessation determination prior to 01/01/2006. Per DI 28075.200D, DDS is returning this case to the FO for initiation of a new CDR. Place this flag on top of the folder.

 

Comment:

 

 

 

 

 

DDS Contact:

 

Date:

 

 

Exhibit 3 - Uneffectuated Medical Cessation Appeal Case

View In PDF

NOTE: 

Delete Explanation of Determination if the personalized information is included in the body of the notice.)


DI 28075 TN 30 - Special CDR Issues - 10/02/2026