TN 5 (04-24)

DI 23010.009 Necessary Conditions to Make a Failure to Follow Prescribed Treatment Determination

A. Three conditions necessary before making a failure to follow prescribed treatment (FTFPT) determination

Only make an FTFPT determination when all three of the following conditions are met:

  • The individual is found to be entitled to benefits based on disability or eligible for blindness benefits;

  • The individual's own medical source prescribed treatment for the impairment(s) upon which the disability finding was based; and

  • The individual did not follow the prescribed treatment.

B. Condition 1: Otherwise disabled or blind

The individual has been found entitled to disability or statutory blindness benefits under titles II and XVI of the Social Security Act (Act).

C. Condition 2: Own medical source prescribed treatment

The individual's own medical source prescribed treatment for the medically determinable impairment(s) (MDI(s)) upon which the disability finding is based. If the individual’s residual functional capacity (RFC) includes a limiting effect from an impairment or impairments, then the impairment(s) is one upon which the disability finding is based.

1. What is prescribed treatment

Prescribed treatment includes medication, surgery, therapy, durable medical equipment, or an assistive device. Prescribed treatment does not include lifestyle modifications, such as dieting, exercise, or smoking cessation.

EXAMPLE: A claimant with a Body Mass Index of 70 and severe degenerative arthritis of the knees is told by their medical source that if they reduced their weight, the arthritis in their knees would improve. We will not make an FTFPT determination for this treatment, even if there is evidence that the claimant refused to exercise or diet to reduce their weight.

2. Who prescribed treatment

Consider treatment prescribed by the individual’s own medical source(s). For a definition of medical source, see DI 22505.001A.4.

Do not make an FTFPT determination if the treatment was prescribed only by a consultative examiner (CE), medical consultant (MC), psychological consultant (PC), medical advisor (MA), medical expert (ME), or by any medical source during an evaluation conducted solely to determine eligibility for any State or Federal benefit, including workers compensation.

3. Evidence of prescribed treatment

Consider any evidence of prescribed treatment, including:

  • statements offered on prescription forms;

  • indications within a medical source’s records that they prescribed a specific treatment; and

  • information provided by the individual or third parties that corroborates evidence on record.

4. When treatment was prescribed

The medical source may have prescribed treatment at any time, even in the distant past. However, you evaluate whether the individual failed to follow the prescribed treatment only during the relevant claim period from the earliest of the alleged onset date, potential onset date, or established onset date. If the prescribed treatment is not relevant to the adjudicative period in the claim, do not make an FTFPT determination. Do not consider whether the individual failed to follow prescribed treatment prior to the first possible date of entitlement.

EXAMPLE: On August 2, 2018, an individual files for disability benefits based on an impairment related to a lower-extremity amputation. The individual is no longer wearing prostheses that their medical source prescribed in 2016. You determine that the individual meets all of the other criteria for disability. Even though the individual’s own medical source prescribed the treatment in the past, and the individual may no longer see the medical source who prescribed the prosthesis, it meets condition 2.

D. Condition 3: Individual did not follow the prescribed treatment

This condition is met if you have any evidence that the individual did not follow the prescribed treatment during the time(s) which the individual may be entitled to disability or blindness benefits.

EXAMPLE: A medical source’s treatment note includes a statement that the patient has not been compliant with a prescribed medication regimen.


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http://policy.ssa.gov/poms.nsf/lnx/0423010009
DI 23010.009 - Necessary Conditions to Make a Failure to Follow Prescribed Treatment Determination - 04/24/2024
Batch run: 04/24/2024
Rev:04/24/2024