TN 7 (11-23)

DI 28003.010 Deferrals of Continuing Disability Review (CDR) Process

A. Agency responsibility

The agency's policy is to complete a CDR on every case. A CDR may be deferred if it falls into one of the following categories:

 

  1. 1. 

    Reasons unrelated to the disability, for example, weather, travel, hospitalization (short duration); or

  2. 2. 

    Suicidal or homicidal situations (with regional office (RO) approval), see DI 13005.070 and DI 28040.100D.

If the case meets one of these categories to defer the CDR, the Disability Determination Services (DDS) must follow the procedures in DI 28003.010C in this section.

NOTE: 

If the case involves a Title II prisoner, see DI 28065.000.

B. Contact with the medical source prior to the field office (FO) CDR interview

Generally, the CDR begins with the FO contacting the disabled individual or representative payee via mail to complete all the necessary CDR forms.

An optional CDR procedure is applicable only in potential suicide or homicide cases. In those cases, the FO may decide that contact should be made with the medical source before the FO interview. This contact determines if the source can furnish information on how the individual may react to the CDR. The RO will establish whether this contact is made by the FO or the DDS .

The FO forwards the folder to the DDS if:

  • The name of the last known medical source is in the folder;

  • After a review of the evidence, the FO decides to follow the optional procedure; and

  • Regional policy requires the contact made by the DDS .

The DDS's inquiry to the medical source should be clear and concise, similar to the example below, and released with the form SSA-1994 (Cover Sheet Confidential Medical Info).

EXAMPLE:

“Our records show that you were the medical source for (Beneficiary’s Name) in (date). (Beneficiary’s Name) case is scheduled for a continuing disability review. Because of the individual's past medical history, if you continue to treat the individual, we need your assessment. This assessment should include any impact the initial interview and subsequent contacts by SSA or State agency employees might have on (Beneficiary’s Name) mental status; including suicidal and homicidal potential. Please respond as soon as possible.”

The DDS checks the second block on Form SSA-1994 (Cover Sheet Confident Medical Info) and follow up with the medical source if there is no response within 10 days. During any telephone contact with the medical source, the DDS must emphasize that the inquiry is due to our concern for the individual's health and well- being.

If the source states the individual cannot make this judgment, the DDS returns the folder to the FO to proceed with the CDR in the usual manner. If the source says the individual is no longer the medical source for the identified individual, the DDS should make one attempt to contact a family member or community representative identified in the folder as having close contact with the individual. The DDS should limit the second effort to an attempt to identify the individual's current medical source. If identified, the DDS writes to this physician. Otherwise, no further attempts are made and the folder is returned to the FO to schedule the face-to-face interview.

If the medical source indicates that the face-to-face interview would have negative effects on the individual's mental health increasing suicide and homicide potential, the DDS documents the folder, and contacts the regional office for guidance. In life threatening situations, consideration should be given to deferring the CDR.

The face-to-face interview will be scheduled by the FO and the case processed as usual under the following circumstances:

  1. 1. 

    The medical source states that there is no current threat of suicide/homicide potential,

  2. 2. 

    The medical source refuses to provide an opinion on the individual's suicide/homicide potential; or

  3. 3. 

    The medical source states that the individual is no longer a patient and is not aware of a current treating source.

NOTE: 

In all circumstances, the DDS will accurately document the case before returning the case to the FO.

See DI 55025.010 for medical CDR processing instructions for beneficiaries with Tickets to Work.

C. DDS responsibility

The DDS must defer the CDR when the case meets one of the deferral categories in DI 28003.010A in this section. Prior to deferral a case for hospitalization for a new impairment, see DI 28005.210. The DDS must contact the regional office for guidance on other situations that may require deferral.

NOTE: 

In cases that are deferred for a life-threatening situation, the DDS should add a flag in the electronic case folder that will be displayed in eView back to the field office (FO) with the following remark: “Deferral for life-threatening situation. Regional Office approval received on (date).”, see DI 81020.085. Also add an SSA-5002 (Report of Contact) as mentioned in DI 23030.005 to the folder.

The DDS will process the deferred CDR as a continuance in the electronic case processing system and complete the following actions:

  1. 1. 

    Item 12 using the:

    • SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI ) using continuance code 81; or

    • SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal –Title II) using continuance code 41, see DI 28084.020.

  2. 2. 

    Item 23 using the SSA-832 or SSA-833,with a diary date not exceeding six months.

  3. 3. 

    In Item 24 add a remark on the SSA-832 or SSA-833:

    • “Deferral for reasons unrelated to the disability on (date); not to exceed 6 months. This determination is not the CPD, due to deferral.”; or

    • “Deferral for life-threatening situation regional office approval received on (date); not to exceed 6 months. This determination is not the CPD, due to deferral.”.

      NOTE: 

      An MC/PC signature is not required for these cases.

  4. 4. 

    Prepare and send an SSA-L1013 (Social Security Notice of Continued Disability) for Title II cases, or an SSA-L1014 (Supplemental Security Income Disability Information) for Title XVI cases.

  5. 5. 

    Send the case back to the FO as mentioned in DI 81020.250B1.

NOTE: The DDS should retain the folder if development can be complete within two months. After completing the determination, the DDS must send the case back to the FO as mentioned in DI 81020.250B2. For additional procedures on closing and routing the electronic folder, see DI 81020.250.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428003010
DI 28003.010 - Deferrals of Continuing Disability Review (CDR) Process - 11/17/2023
Batch run: 01/04/2024
Rev:11/17/2023