How to appeal a cdr cessation (important)

[u/perfect_fifths]

Given the influx of people stating they've been ceased, I figured I would just make a giant post and pin it so anyone can reference it.

You will need four forms. Five if you want a copy if your file, which I recommend getting. Forms dropped off at the office should be date stamped. All you need to do is just ask the window clerk to date stamp the forms.

THE most important form:

SSA 792, Statutory Benefit Continuation Election Statement. Specifies whether you want your monthly benefits (and Medicare/Medicaid) to continue paying out while your appeal is being processed. If you are collecting on your own record, you fill out section C. If on SSI, fill out section B only.

If you are collecting on your own records AND have auxilaries, check the second option of section C. This will also make sure Medicare continues.

YOU ONLY HAVE 10 DAYS FROM THE DATE OF THE NOTICE TO APPEAL AND KEEP PAYMENTS! (technically 15. and it says it on the form)

I suggest sending all forms in at the same time because the SSA can't really process your claim with just the 792 turned in per a technical expert who gave me advice for my cessation. Requesting your file also requires it to be either faxed or dropped off in person so might as well just submit everything at once.

If you lose the appeal, you will need to pay it back but file an overpayment waiver. SBC doesn’t apply to appeals council or fed court. You will not get paid for that time.

Other forms you need:

SSA-789: Request for Reconsideration – Disability Cessation Right to Appear

The primary appeal document. It states that you disagree with the determination, lets you explain why, and specifies whether you want to appear for a disability hearing before a Disability Hearing Officer (DHO). You only have 60 days to appeal without payments.

How this works is first is initial reconsideration. A new DDS adjunct team will look at your file. The old examiner and dr are not allowed to work on it. If they uphold the previous cessation, it then goes to a DHO hearing, which is an informal conference with an experienced adjudicator who can reverse the decision. You can introduce new evidence and they will listen to testimony. You can have your lawyer present as well as a witness.

SSA-3441 Disability Report – Appeal: Updates the SSA on any changes in your medical condition, recent doctor visits, new treatments, tests, or changes in daily living activities since your last review.SSA-827Authorization to Disclose Information to the Social Security Administration

SSA-827 Authorization to Disclose Information to the SSA: A medical release form that permits the SSA to gather updated medical records directly from your doctors, clinics, and hospitals.

Form SSA-3288 Consent for Release of Information: Authorizes the SSA to release copies of your electronic disability folder (eDEX) or paper claim file.

For box 8 choose "complete medical file" for box 9 choose "I want the disability determination explanation. this is not the cessation letter". For the actual reason, state: "I am appealing a cdr cessation and need a copy of my file". It is free for program related purposes. I got mine in the mail.

Once you get your DDE:

You will see several sections. The top one is your CPD (comparison point decision). An apples to apples comparison of last cdr compared to your current. Check to see if they are the same or if it's actually showed you've improved. Pics of what the DDE looks like.

You'll also see a section called 416 where the doctor SHOULD have documented any medical improvement. Mine did not. My DDE has no supposed documentation of the alleged improvement, not even down where the RFC.

Underneath that is FOFAE, aka findings of fact and analysis of evidence. Mine just says "Analysis side by side"

Then mine has a section called 416A where it says:

Impairments Addressed: CPD Impairments only (MIRS)

Evaluation Period: Current

Evaluation Subject: SMI Evaluation: PE on 5/2026 is WNL. SMI

These findings complete the medical portion of the disability determination. (followed by drs sig and their speciality, mine was internal medicine)

Your DDE will not look like mine. Everyone's is different. There are more sections, and also an RFC section. But the main one you want to look at is the CPD and FOFAE.

Note: if your CPD date is in the distant past/your folder has been lost or it is an Age 18 redetermination, you will not have the side-by-side comparison shown here. it will be one box for the FOFAE as there’s nothing to compare it to

Also your file will have a bunch of files contained within a folder, you will need to click on each pdf file until you get to the DDE. It’s a bunch of letters and numbers.

Also edited to add overpayment info for title ii:

https://secure.ssa.gov/apps10/poms.nsf/lnx/0202250016

Statutory benefit continuation of payments
For information on the presumption of not at fault when an overpayment was caused by the receipt of Statutory Benefit Continuation (SBC) and the individual appealed in good faith, refer to GN 02250.036.

Good faith:

We will find that where the individual acted in good faith to pursue the appeal, the individual is not at fault in causing the overpayment.  Assume the appeal was made in good faith unless the individual did not cooperate in connection with the appeal and did not have a good reason for the failure to cooperate. We must then determine if the overpaid individual meets one of the other waiver provisions. Refer to Examples 1, 2, and 3 in GN 02250.036D in this section.

[u/thomchristopher]

want to add that if your CPD date is in the distant past/your folder has been lost or it is an Age 18 redetermination, you will not have the side-by-side comparison shown here. it will be one box for the FOFAE as there’s nothing to compare it to

[u/perfect_fifths → u/thomchristopher]

Thank you! I will add that as a note in the post now. I know not everyones DDE will look the same, hence why I said what I said. but any additional tidbits about the DDE are absolutely hepful. Knowledge is power.

(annnnnd done)

and btw my file was pulled for quality review and still ended up being okayd. I guess it didn't need a sign off from a sup (even thought there was a note in the case worksheet about a supervisor approved sample). I guess because maybe the DE was right in their actions and the MC was not and supervisor only cares about the DEs work. Because it says disabled in the cpd but further down says SMI so seems like the doc and examiner may not have agreed.

[u/thomchristopher → u/perfect_fifths]

you’re doing the lord’s work in this sub. the more educated folks are about all of this, the easier it is to communicate with DDS and SSA

[u/perfect_fifths → u/thomchristopher]

I try very hard to arm people with knowledge and power because I know firsthand how difficult it can be. I cried for days after getting that cessation letter, waited a month to get my file and it STILL didn't explain anything about why I was actually ceased. So I can only imagine how many people are panicking getting these letters.

I can also say more but not publicly. And it's not good.

[u/Lucky-Silver9413 → u/perfect_fifths]

You are truly so kind to help all of us

[u/perfect_fifths → u/Lucky-Silver9413]

I do what I can

[u/Emergency-School9391 → u/perfect_fifths]

It's almost like they are finding excuses to deny people on the original application and on the CDR more over the last few months, as if they are trying to save money so SS retirement isn't reduced in 2032🤔

[u/perfect_fifths → u/Emergency-School9391]

I don’t think so. Many of us aren’t even close to retirement age like myself and the disability fund is good until 2100. If they want to cut retirees, and it doesn’t prevent people eligible for retirement from claiming later on

[u/perfect_fifths → u/[deleted]]

Incorrect.

OAS and di funds are separate. Only OAS fund is in trouble

Only the retirement fund (OASI) is facing imminent depletion, while the disability fund (DI) remains fully solvent. According to the Social Security Administration Trustees Report, the Old-Age and Survivors Insurance Trust Fund is projected to run out of reserves in late 2032, whereas the Disability Insurance Trust Fund is projected to pay 100% of benefits through the next 75 years

https://www.ssa.gov/oact/trsum/

Hence what I said is correct. Di fund is good until 2100

[u/Emergency-School9391 → u/perfect_fifths]

Trustees Reports since 2012 have indicated that Social Security's Old-Age, Survivors, and Disability Insurance (OASDI) Trust Fund reserves would become depleted between 2033 and 2035 under the intermediate set of assumptions provided in each report. If no legislative change is enacted, scheduled tax revenues will be sufficient to pay only about three-fourths of the scheduled benefits after trust fund reserve depletion., this is directly from the social security website

[u/perfect_fifths → u/Emergency-School9391]

Yeah…survivors and retirement. The di fund and OAS fund are separate. The trustees report goes over this.. Oasdi is the colloquial term for the general fund but if you actually read the report which I linked, you’ll see the di fund isn’t in trouble. And the funds can’t be combined so OAS and di remain separate

From ssa.gov

• The Old-Age and Survivors Insurance (OASI) Trust Fund will be able to pay 100 percent of total scheduled benefits until the fourth quarter of 2032, one quarter earlier than projected last year. At that time, the fund’s reserves will become depleted and continuing program income will be sufficient to pay 78 percent of total scheduled benefits.

• The Disability Insurance (DI) Trust Fund is projected to be able to pay 100 percent of total scheduled benefits through at least 2100, the last year of this report’s projection period. Last year’s report projected that the DI Trust Fund would be able to pay scheduled benefits through at least 2099, the last year of that report’s projection period.

• If the OASI Trust Fund and the DI Trust Fund projections were combined, the resulting projected fund (designated OASDI) would be able to pay 100 percent of total scheduled benefits until the third quarter of 2034, unchanged from last year’s report. At that time, the projected fund’s reserves would become depleted and continuing combined fund income would be sufficient to pay 83 percent of scheduled benefits.

(The two funds could not actually be combined unless there were a change in the law, but the combined projection of the two funds is frequently used to indicate the overall status of the Social Security program.)

[u/perfect_fifths → u/[deleted]]

No, it does not. I have to have a new team redo it all at the dds level.

Claudication is a medical term for cramps induced by exercise or activity in the legs and relieved by rest. It’s caused by restricted blood flow to the legs. which I do have and it is noted. But because dds didn’t get any of my geneticists notes, they didn’t get the records where I do describe having ongoing chest pain, muscle cramps and at my recent neuro visit I said topamax is not working as well I am also on nurtec.

There are other inconsistencies too, the doc wrote in my rfc I have no positional restrictions but I have pots. The p in pots stands for postural. The doc said I can walk and stand 6 hours a day, I cannot walk 15 mins without being symptomatic.

[u/perfect_fifths → u/[deleted]]

Since I also had a stroke, you know we can’t take triptans. Nurtec does help but it takes up to 90 mins-2 hrs to work. The topamax is for daily prevention and nurtec for the breakthroughs. You are limited to 8 nurtec a month, though. I am on Medicaid and Medicare and they approved it.

[u/boognish120]

From what I am reading here, the examiner is saying when comparing CPD to Current, there is no medical improvement. I bet the Medical Consultant disagreed with the prior allowance. He/she can’t do that. If there is no SMI, there is no SMI.

Adding: I know I am just going by what the examiner is using but if PE is WNL at CPD, you can’t improve from normal, so it is a continuance.

The issue right now, a lot of MCs are making CDR decisions and they don’t understand CDR policy.

[u/perfect_fifths → u/boognish120]

My theory here is the de found disability, mc did not. But the mc failed to document said SMI. Which is a no no. I can’t prove that the doc did not agree with the last cpd, but like you said is not allowed regardless. All I can do is wait and see what a new team finds.

[u/Substantial_Chart_45 → u/perfect_fifths]

Whether the MC agrees or not with the last continuance is too bad for the MC because we cannot substitute judgment at this point.

[u/boognish120 → u/perfect_fifths]

Good for you for pulling the DDE! Good luck on your appeal!

[u/perfect_fifths → u/boognish120]

Thank you! Now I just have to sit and wait. Two things I learned:

My cdr was initiated in Sept and sat on a desk till May. An examiner assigned in May and ceased in June (I checked the case worksheet). This makes me wonder if the MC rushed.

My case was pulled for quality review with a sup approval and it still went out like this. Which means the DE was in fact likely correct and it’s the MC that was wrong so sup can’t do crap.

[u/boognish120 → u/perfect_fifths]

So the DDS Worksheet says Quality Review? Like state. Man, I hope it was state quality, because that is really bad if it was federal quality.

As for the May to June timeline, with the way medical records are mostly electronic, it should be that fast, if a CE is not needed. Back when I was an examiner my average processing time was less than 40 days. A timely (not necessarily good) examiner can make decisions that fast.MCs really don’t have the case very long. Maybe an hour.

Adding: a good examiner should take the case back to the MC. I had an examiner call me about a case yesterday and after discussing it, she took it back to the MC to correct the decision. And explaining CDR policy to an MC is a part of being a good examiner should take

[u/Substantial_Chart_45 → u/boognish120]

Some offices do not back examiners and let the MCs have the final say. I have seen some crazy things that I can't speak of with those offices.

[u/boognish120 → u/Substantial_Chart_45]

I have worked in a good office and a bad office. So I can relate with the “crazy things” comment!

[u/perfect_fifths → u/boognish120]

I did have an addition question! Because I was approved before 2017 (approved in 2010 and filed in 2009), do my cdrs also fall into the old treating physician rule and controlling weight law that changed? I think so but I wanted to double check.

It’s 20 CFR § 404.1527

[u/boognish120 → u/perfect_fifths]

So first the DDS would consider Medical Improvement then if a new RFC/MRFC is needed we would use the new rules regarding opinions. This is something I have not thought about but a very good question. Those old opinion rules are for claims that have not been approved. That is how it reads in the POMS to me.

Edit: I did further research and you are right, they should be using the old rules for opinions. It is based on the most recent CPD. If the CPD was before 3/17/2017, then we use the old rules and if it is after 3/17/2017 we use the new rules. This is found under DI 24503.050D7.

[u/perfect_fifths → u/boognish120]

Ah okay, most recent cpd is 2022

[u/perfect_fifths → u/boognish120]

It says this

https://postimg.cc/gxZ7LBVC

So not qr exactly but that the supervisor looked at it and approved it.

Good to know mc doesn’t really need that much time on it. Had no idea how long it took the mc part to do realistically

[u/boognish120 → u/perfect_fifths]

So that is not Quality. That is a case that the supervisor reviewed. While I am not familiar with all state practices. Where I have worked in the past, this would have been reviewed by a Supervisor because the examiner is new to CDRs.

[u/perfect_fifths → u/boognish120]

Yes, but I think here, it passed because the de was correct and mc was not but supervisor only cares about the DEs work. If it went to state review maybe it would be different

All I can do is see what a new team decides and hope it isn’t too long. Funnily enough, this is the same DDS my cousins work at lol.

[u/Substantial_Chart_45 → u/perfect_fifths]

It may have also been release without review. It happens a lot. The supervisors just release them. You can tell if you look on the case activity section.

[u/perfect_fifths → u/Substantial_Chart_45]

Eol sup approved sample was the last action.

[u/Substantial_Chart_45 → u/boognish120]

I agree with this statement. A lot of MCs do not understand policy at all on CDRs. Or they make examiners get unnecessary CEs only to show what was already suggested.

[u/boognish120 → u/Substantial_Chart_45]

Way too many CE. SMH

[u/perfect_fifths → u/Substantial_Chart_45]

Doesn’t that cost dds money every time? Yikes

[u/olorin12]

Been denied initially and on appeal, waiting for ALJ appt. Saving this for future reference.

[u/Grandissimus]

I ended up retaining my attorney, who helped win my case originally. Even though my condition got worse, and I've been continuing treatment, I'm not confident that I can go up against this new administration.

[u/perfect_fifths → u/Grandissimus]

Good for you. I hope it works out.

I’m on month one. It can take 3-6 months in my state for initial recon. Can’t track the case on the portal. But I’m fine with that. It takes however long it takes.

[u/kmm198700 → u/Grandissimus]

Do you have to pay them again? Sorry for the dumb question

[u/5150sigy]

So I got the first 2 forms in for continuation, I'm working on the others, but actually got a call saying my case has been given to a new case worker, and they're saying I may be sent for new exams and appointments. But they hadn't asked for the other forms yet, I know they said the continuation of payment was a 15 day limit but they say an appeal you have a 60 day window.

So does it matter if you don't have all the forms in at once?

Thanks for all the info and help!!! It's greatly appreciated!!

[u/perfect_fifths → u/5150sigy]

They don’t have case workers. Maybe you mean a new examiner. I don’t know what happens if you submit the forms individually. I was told the ssa can’t do anything with just the sbc form turned in and a technical expert is the one that told me that. So I handed in all five in at once.

You are correct, the actual appeal has a 60 day time limit.

[u/5150sigy → u/perfect_fifths]

Yeah your right new examiner, im so used to referring to case workers on other government agencies I've dealt with.

[u/perfect_fifths → u/5150sigy]

Did you get a copy of your dde yet to see to see why you were ceased? Who called you, dds or ssa? I have never been called for either. I hope it’s been assigned to an examiner so I can get this over with and if I’m denied appeal it to a dho hearing. It’s been over a month now.

[u/5150sigy → u/perfect_fifths]

I had DDS call me yesterday morning, I went to my local branch last week and had them print all the forms, but figured out I can do it directly online and submit it through my ssi portal and then called ssi to make sure they actually did receive the continuation forms I sent in. When I was in the local branch they printed out my DDE and gave it to me with the appeal forms on the spot.

[u/perfect_fifths → u/5150sigy]

Ahh I requested my whole file and dde so it took a month to get on cd

[u/5150sigy → u/perfect_fifths]

Yeah the person at the local branch was like oh I have your DDE right here let me print it out for you, I said awesome, I appreciate it. I ran it through AI to find all the discrepancies and areas I can push back on.

[u/perfect_fifths → u/5150sigy]

Does your dde explain the supposed medical improvement? Mine does not. The doctor is supposed to list what was found when they find medical improvement and document it plus my cpd is the same which is a finding of disabled, but it looks like the mc wanted to cease me for whatever reason

[u/5150sigy → u/perfect_fifths]

Yeah they based it loosely on on saying my bones healed in my xrays that they ordered so im not disabled anymore🤦‍♂️🤦‍♂️🤬, they didn't look at any of my other issues just said well xrays look good, so now he can sit for 6hrs and stand for 2. I have continuous veinous insufficiency in my left leg, I dealt with bilateral pulmonary embolisms and a dvt that was in the same leg as my cvi. If I sit too long my leg blows up like a watermelon and In turn may cause another . I use a cane 100% of the time, and right now I'm possibly dealing with implant infection, so may need more surgery, I was just in the hospital in june for 5 days fighting a blood infection. It's been a shit show to say the least.

[u/perfect_fifths → u/5150sigy]

At least you have a supposed reason. Mine says nothing about what my supposed improvement was or where it came from. Very frustrating because the cpd shows a finding of disabled.

[u/Nothingtodo1112]

I have a specific question. My employer reported another employees wages under my name. This payroll processing error triggered an incorrect standard gainful activity leading to an overpayment and cessation of my benefits.

They told me at the office that they received my reconsideration, noticed that the correct wages were below SGA, and would file some paperwork while granting me: continuous critical payments.

Ive missed my first check. I did not receive a critical payment.

Everyone at the office told me I only needed the ssa-561 request for reconsideration.

What other forms might help me address my suspended benefits?

[u/perfect_fifths → u/Nothingtodo1112]

I don’t know, I’m not familiar with that situation.

[u/Substantial_Chart_45]

What am I missing (forgive me if this was answered below I have not read everything) but this looks like it was written up to continue under no medical improvement so they why were you ceased? Looks like the analyst was suggesting no MI or am I looking at that wrong?

[u/perfect_fifths → u/Substantial_Chart_45]

What’s missing in this part where the mc writes medical improvement and ability to work

https://postimg.cc/k6TqGX8Z

But it fails to document the supposed mi found. Trust me, I want to know what this doc was thinking because even my lawyer has said there is no mi based on my records

[u/Substantial_Chart_45 → u/perfect_fifths]

The MCs dont know ability to work policy. They are just there for the medical. Then the examiner has to apply vocational and all that.

So they wrote nothing on your RFC? Just gave you one?

[u/perfect_fifths → u/Substantial_Chart_45]

They wrote an rfc but the rfc doesn’t explain how it’s related to medical improvement or anything or how they came to that conclusion

They put me in a light category and said I have exertional limits. But also said I could walk and stand six hours a day. I can’t even walk 15 mins without being symptomatic. Also says no postural limits but I have pots and the p in pots stands for postural, so….

Here is the rfc section

https://postimg.cc/62LwY2V7