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1335.5 General

A. Continuance of entitlement - Entitlement to benefits based on disability continues 

until terminated for one of the following events:

• Beneficiary dies;

• Disabled employee or widow(er) attains full retirement age (FRA);

• Medical recovery of the beneficiary;

• Ability to work is demonstrated.

When benefits are terminated for either of the last two reasons, a new application 

is required to establish entitlement to a disability benefit again or to other 

benefits. Upon the attainment of FRA by a disabled employee or widow(er), the 

disability benefits are converted to regular age benefits automatically without new 

application. Conversion prior to FRA will not occur, even if the beneficiary is 

eligible for benefits based on criteria other than disability, unless medical 

recovery is shown, in which case a new application will be required.

See FOM-I-310.45 regarding termination of benefits.

B. Continuance of benefits - Even while entitlement to disability benefits continues, 

benefits (cash and other) may be suspended for one of the following reasons:

• Work for a railroad employer;

• Excess earnings (see FOM-I-1125).

When the condition causing suspension is removed, benefits may be reinstated if 

the annuitant is still disabled. Any work could cause an investigation to 

determine if the beneficiary has medically recovered or demonstrated an ability to 

work as described later in this chapter. See FOM-I-310.40 regarding suspension 

of benefits and FOM-I-310.80 regarding reinstatement.

C. Medical recovery - The establishment that a beneficiary has medically recovered 

requires a continuance of disability determination by a disability claims examiner 

in the Disability Programs Section. This determination is similar to the initial 

disability determination; the disability claims examiner usually looks at current 

medical evidence and non-medical factors to determine if there has been 

significant medical improvement, which would permit the annuitant to engage in 

substantial gainful activity, since the last rating. Recovery is generally 

determined to have occurred at the time the determination is made. Rarely is 

recovery determined to be retroactive.
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D. Demonstrated ability to work - A beneficiary is considered to have demonstrated 

the ability to work for the purposes of terminating benefits when he has shown 

the ability to work in:

• Substantial gainful activity in total and permanent disability cases, OR

• His/her regular railroad occupation or similar occupation in occupational 

disability cases.

The beneficiary's work activities and earnings are used by disability claims 

examiners to determine if the ability to work has been demonstrated to the extent 

necessary for termination. Consideration is given to circumstances attendant to 

the work activity and earnings such as type of employment, value of services 

rendered, whether a "made" or "subsidized" job, extraordinary expenses 

attributable to the disabling condition, etc.

1335.10 Special Instructions to Disability Applicants

Disability applicants are given special instructions to report certain activities which may 

affect benefits and are cautioned that there are penalties for failure to report.

1335.10.1 Advice to Applicant about Events that Affect Entitlement and Payment 

At the time an application is filed, the contact representative explains to the applicant 

what events will affect entitlement and the payment of disability benefits. He is also told 

how those events affect entitlement and payment. This verbal information is supported

by booklets which also explain what and how events affect benefits.

1335.10.2 Instruction to Report the Occurrence of an Event Affecting Benefits 

At the time of application, the applicant is instructed to report to the Railroad Retirement 

Board the occurrence of any event he has been informed would affect entitlement or 

payment of his benefit. The applicant signs a certification that he understands what the 

events are and that he will report them promptly if they occur. The consequences of 

failure to report are also explained. The applicant also receives an application receipt 

which lists the changes to be reported and explains how to report them.

The "failure to report" concept raises a possible fraud consideration. Refer to 

FOM 1335.40 for handling instructions.

1335.15 Disability Monitoring Programs

Entitlement and receipt of disability benefits are more susceptible to termination or 

suspension than other benefits because the basis for eligibility (disability) is not 

necessarily a permanent condition. Therefore, additional monitoring activities are 

necessary to assure the integrity of the program. Shown below are activities aimed at 

ensuring that disability benefits are properly paid.
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1335.15.1 Disability Reminder Notices

The Railroad Retirement Board (RRB) releases three types of annual disability reminder 

notices to disability annuitants: Forms RL-4, RL-5 and RL-7. 

RL-4 and RL-5 

On an annual basis, the RRB mails Forms RL-4 and RL-5 to retirement and survivor 

disability annuitants. Form RL-4 is issued to employee disability annuitants who are 

under full retirement age. Form RL-5 is issued to survivor disability annuitants who are 

under age 60. These notices remind disability annuitants of events that must be 

reported to the RRB. In addition, these notices provide the monthly earnings limit for 

the current calendar year and prior calendar year. Field offices should handle reports of 

work activity or changes in medical condition that are generated as a result of these 

mailings. If a response is received at headquarters that reports work activity or a 

change in medical condition, the report will be forwarded to the Disability Benefits 

Division (DBD) for handling. See DCM 8.4.3 for how DBD will handle this 

correspondence.

RL-7

The Form RL-7 Disability Reminder Notice – Disabled Annuitant Under Earnings Limits, 

is released to approximately 2,200 employee disabled annuitants who are under full 

retirement age (FRA) and who have earnings under the allowable limits. Annuitants are 

reminded of their responsibility to report any earnings for any month in which they 

exceed the monthly earnings limit or report if their annual earnings exceed the annual 

earnings limit.

The RL-7 is a reminder to these individuals that they must notify the RRB about any 

month their earnings exceed either the monthly earnings limit after deduction of 

disability work expenses during the year and/or if their annual earnings exceed the 

annual earnings limit. In addition, the RL-7 shows the monthly and annual earnings 

limits for three years. Field offices should handle reports of work activity or changes in 

medical condition that are generated as a result of these mailings. If a response is 

received at headquarters that reports work activity or a change in medical condition, the 

report will be forwarded to the Disability Benefits Division (DBD) for handling. See 

DCM 8.4.3 for how DBD will handle this correspondence.

Starting in 2014, individual RL-4, RL-5 and RL-7 notices to annuitants are sent to 

Imaging. This serves as documentation that the annuitant was sent a notice. Blank 

copies of the RL-4, RL-5 and RL-7 are available in RRAILS. 

If you receive an inquiry, assist the annuitant or payee in making any necessary report. 

Forward the report to the Disability Benefits Division (DBD) in an envelope marked: 

"DBD/CDR UNIT-REMINDER-DO NOT OPEN IN MAILROOM." You may include more 

than one report in each envelope. DBD may later request additional development if 

needed.
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1335.15.2 Review of Cases in Current Pay Status

Disability cases are periodically called up for a continuing disability review (CDR). The 

possibility and frequency of review depends on the severity of the case. The Disability 

Benefits Division (DBD) will determine the need for review. That section categorizes 

cases based on the probability of recovery, for instance, medical improvement expected 

(MIE), medical improvement possible (MIP), medical improvement not expected (MINE), 

etc. 

If medical improvement is expected or possible, the disability claims examiner will set a 

future call-up date at the time of the disability freeze determination. On the call-up date, 

the case will be reviewed to determine if entitlement should continue. In MIP cases, 

DBD will go through a screening process and select cases in which a Form G-254a and 

RL-254a are sent to the annuitant. Form G-254a is a screening questionnaire that 

assists in determining whether further medical review is necessary. If DBD does not 

receive a completed G-254a within 30 days, they will send a field assignment to trace 

with the annuitant. If a completed G-254a is not received within 14 days of the tracer, 

DBD will trace again to find out if more time is needed to obtain the completed G-254a. 

If the field indicates that the annuitant cannot be contacted, DBD will release a letter to 

the annuitant informing him that if he does not contact the field office and submit a 

completed G-254a within 30 days, the annuity may be suspended. If the field indicates 

that the annuitant is uncooperative, DBD will request the field to initiate a full CDR by 

requesting a G-254 and current medical evidence.

A full CDR is conducted for all MIE cases and some MIP cases. Generally, the review 

will include acquisition of G-254 and current medical evidence and non-medical 

evidence via an assignment to the field office.

If, however, medical improvement is not expected, the case would not be routinely 

reviewed. While these cases are no longer reviewed on a routine basis, there may be 

situations, (such a disabled child included in O/M becoming eligible for a survivor 

annuity) in which DBD will do a review. If a field assignment is warranted, DBD will 

advise the field office as to the type of information that is needed.

1335.15.3 Report of Work or Recovery by Annuitant

If an annuitant reports work activity or recovery from disability to the field office, the 

report should be sent to DBD promptly. The report to DBD should contain enough 

details to permit the disability claims examiner to determine if a continuing disability 

investigation is required.

A. Report of work - Disability annuitants are required to report all work activity 

regardless of the amount of earnings. See FOM-I-1125.25. 

Advise the annuitant that his work must be reconciled with his disability. Also 

advise an employee of disability work deductions if he earns over the monthly 

disability earnings limit (see FOM1 1125.5.2). 
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B. Report of recovery - If a disability annuitant reports that he has recovered from 

his disability, take a statement from him to that effect. Ask the annuitant to 

submit any recent medical evidence in his possession which substantiates his 

claimed recovery.

Note: Since this workload is handled by the disability Post section, if statements are 

imaged into the Disability mailbox without an email, the Post section does not receive 

the notification. Therefore, in order to ensure all statements are handled accordingly, 

when a report of work (earnings report or recovery from disability report) is received 

from a disabled annuitant, image the statement as file only “Earnings Report” AND send

an email to the DPS mailbox regarding the report of work. 

1335.15.4 Employer Reported Earnings

Both railroad retirement and social security covered earnings are checked each year to 

ascertain if disability annuitants have unreported earnings which may indicate recovery 

or the ability to work.

A. Reported railroad earnings - Since railroad covered earnings are reported directly 

to the Railroad Retirement Board (RRB), checking disabled annuitant records 

against annual compensation reports is a relatively simple process. If earnings 

are reported on an annuitant's record, a referral is generated which initiates an 

investigation.

B. Reported social security earnings - Earnings reported to the Social Security 

Administration (SSA), whether from employment or self-employment, are 

accessible to the RRB. Each year SSA transmits earnings information on 

annuitants who have been earmarked on SSA records as receiving railroad 

benefits. Additionally, requests for earnings information on individual cases can 

be made at any time. Information available is limited to the latest year of earnings 

posted at SSA plus preceding years. If earnings reported at SSA do not match 

earnings reported by the annuitant, an investigation is initiated to resolve the 

discrepancy. An annuitant who disagrees with the earnings reported by SSA 

should be directed to contact SSA to resolve the discrepancy.

C. Reported earnings through the state wage match - A listing of earnings from all 

50 states is obtained by the RRB. DPS reviews referrals from state wage 

matches and often makes assignments to the field for investigation.

1335.15.5 Use of Subpoena in Earnings Investigations

In some earnings investigations of disability annuitants, DBD will request the Office of 

the General Counsel (OGC) to provide a subpoena to be issued to the employer. In 

these cases, DBD will forward the subpoena and return of service document to the field 

office that serves the area in which the employer is located. The field office may deliver 

the subpoena in person, or mail the subpoena by certified mail with a return receipt 

requested. The return of service document is to be completed by the claims 

representative handling the subpoena and is to be filed in the applicant's file. Pend the 
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case for the date the documents are due to be returned as indicated on the subpoena. 

The field office will retain the return of service document until the information sought by 

the subpoena is obtained, at which point the return of service document may be 

discarded. Notify DBD if the employer does not respond to the subpoena, or refuses to 

cooperate with the subpoena, and send the evidence of the receipt of the subpoena to 

DBD, i.e. the return of service document if the subpoena is delivered in person or the 

return receipt furnished by the post office if it was delivered by certified mail.

1335.15.6 SSA Earnings Monitoring

Earnings are requested from SSA for disability annuitants to determine their continuing 

eligibility to receive benefits. This process is referred to as Electronic Data Processing 

(EDP). Once we receive the earnings information, a computer generated Form G-254, 

Continuing Disability Report, and a Form RL-254 cover letter are released to disability 

annuitants having excess earnings. A Form RL-231F letter is also released to the 

annuitant’s non-railroad employer(s) to verify the reported employment and earnings. 

The computer-generated forms include instructions for the completed forms to be 

returned to the annuitants’ local field offices. For tracking purposes, these cases are 

also loaded to Universal STAR (USTAR). Details of the RL-231F forms released, such 

as employers and addresses, can be viewed on the EDP Detail Information screen in 

USTAR. This is accessed through the “Source Detail” button on the Work Detail 

screen.

NOTE: The EDP Detail Information screen in this category of field office work lists only 

the employers and earnings in which Form RL-231F forms were released and require 

monitoring and possible tracing for the return of completed forms. There may be other 

earnings reported (railroad earnings, self-employment earnings, etc.) which are included 

in the total EDP Run Amount at the top of this screen, however these earnings are not 

displayed at the bottom of the EDP Detail Information screen as they do not require field 

office handling. All earnings reports received from SSA are loaded and handled by DPS 

in separate USTAR categories. 

1335.15.6.1 Field Disability Earnings Investigation Work Category

Field offices use USTAR to control and track the case referral, or work item, from when 

it is entered into the system to when it is closed out. The annuitant’s ZIP code is used 

to assign cases to field offices. The cases are loaded under category codes consisting 

of the 3-digit field office number; the letters “DB”; and the last digit in the year of 

earnings, e.g., 296DB7 means the case is assigned to the Chicago field office and the 

earnings were reported for 2007. The same records are also loaded to USTAR for 

DBD-DPS control and tracking under category “DPSDBx” (the last character represents 

the year of earnings). This allows DPS to determine if field offices are in the process of 

investigating work activity, thereby avoiding duplicating work already in progress, and 

for follow-up action upon completion of field office handling.
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1335.15.6.2 Field Office Handling

Field office managers are responsible for assigning USTAR work items. For information 

on how to assign work or other USTAR information, refer to FOM-I-15120.5. Claims 

representatives should take the following actions when handling disability earnings 

investigation cases. 

Form RL-231f or G-254 Received

• Image the form and any documents attached

• Forward the form to DBD-DPS

• Send an e-mail to the DPS mailbox advising receipt and submission of the form. 

• Document in the remarks section of the USTAR work details screen the forms 

received and date received. 

Note that an office can image and submit these forms as they are received, or hold all 

forms, and image and submit them at the same time.

Tracing

Offices should trace for any forms which have not been returned within forty-five days of 

the USTAR entry date. Prepare a tracer (use RRAILS) Form G-254/RL-254 and/or RL231F(s). Detailed information to prepare RL-231F forms, such as employers, 

addresses, and earnings information can be found by clicking on “Source Details” from 

the Work Detail Screen in USTAR. G-254 requires a reporting period date on page one. 

Enter January 1 of the EDP year shown on USTAR source details screen. Pend the file 

for thirty days. Notate in the remarks of the USTAR Work Detail screen the date that 

tracer forms were released and to whom they were sent.

Closing Cases

All forms received – as the last form is imaged and submitted to DPS, include in the 

email notice to DPS that the case is complete. Close the case on USTAR using the 

disposition code “Handled - Case Completed” (HCC).

All Forms Not Returned 

Offices may abandon these cases 30 days after the tracer. Be sure all forms received 

have been imaged and the forms themselves submitted to DBD-DPS. Document in the 

remarks section of the Work Detail Screen on USTAR, the date the case was 

abandoned. Send an e-mail notice to the DPS mailbox notifying them of the case 

abandonment. Be sure to include in your e-mail the forms that were not received as 

well as the date tracer forms were released. Close out the case on USTAR with the 

disposition type - “Case Abandoned” (ABD) and indicate in the remarks of the Work 

Detail Screen that the case is being abandoned. 
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1335.15.6.3 Special Situations

If the annuitant claims:

• not to have worked and the earnings do not belong to them;

• the earnings are incorrect; or,

• any other special situation, take the following actions:

Step Action

1 Advise the annuitant to contact SSA to resolve any discrepancies.

2 Close the case out on USTAR under disposition code “Handled - Case 

Completed” (HCC). Document the remarks section of USTAR with the 

details of the case.

3 Send an e-mail to the DPS Group mailbox detailing circumstances. 

4 Image all documentation as file only.

1335.20 Investigation for Continuing Disability

Investigations to determine if there is continuance of disability under the Railroad 

Retirement Act or the Social Security Act can be initiated by any of the following:

• Voluntary reports - Report by annuitant that his condition improved or he is working;

• Change of address or payee - Address change from hospital to private residence, 

cancellation of representative payee;

• Vocational rehabilitation notice - Report that annuitant has reached his potential for 

return to labor market;

• Earnings report - Earnings should be examined to determine source;

• Medical re-examination required - Diaried cases for automatic review;

• Periodic disability review - Cases called up for routine review.

1335.20.1 Conducting the Investigation

The initial phase of the investigation involves a review of the claim file in light of any 

new information. If the new information cannot be reconciled with the disability rating, 

the disability claims examiner will send an assignment to the field office requesting 

development of certain information and/or evidence.
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Generally, the assignment will request a completed Form G-254, Form G-250 and a 

memorandum giving the contact representative's observations of the annuitant. If the 

investigation was originated by an earnings referral, only a Form Letter RL-231-F will be 

requested.

Due to the unsettling effect continuing disability reviews may have on some annuitants, 

development of all continuing disability review (CDR) cases must be initiated by 

telephone. In rare situations where telephone contact is not possible, release a Custom 

Field Service Letter on RRAILS asking the annuitant to contact a field office by 

telephone. Begin the review process when the annuitant calls. Following this initial 

contact, the field office development of a continuing disability investigation assignment 

should be conducted in the same manner as initial development of disability (excluding 

medical improvement not expected [MINE] cases). Document all actual and attempted 

contacts on Contact Log.

Please note that field personnel should exercise caution during any questioning of 

annuitants that involves personal contact (either in person or by phone). For example, if 

earnings are under investigation and clarification is needed, ask appropriate questions 

to obtain the factual information needed. Do not interrogate the annuitant about 

inconsistencies. 

If the annuitant refuses to cooperate, follow the procedures in FOM-I-1325.15.3. 

If the case is one which involves MINE, the Disability Benefits Division (DBD) will 

identify it as such in the field office assignment. You will probably only need to develop 

a Form G-254 and a statement from a medical source since additional medical evidence 

is usually not required. If no medical source is available, you will need to secure a 

statement from a non-medical third party source. Refer to FOM-I-1335.20.2 for 

instructions on developing MINE reviews.

1335.20.2 Special Handling of MINE Cases 

Cases selected for continuing disability review categorized as MINE will be identified as 

such by the Disability Benefits Division (DBD) in the field office assignment.

Investigation of these cases will not be as intensive and may be handled differently than 

the other cases selected for review. Because of the sensitive nature of these cases, 

particular care should be taken in gathering information. Development of these cases 

should be initiated by phone.

A. DBD assignment - DBD will provide information as to the nature of the disability 

and the last phone number on record for the annuitant. If the phone number 

provided is not current or if DBD indicates that no phone number is available 

from the file, attempt to secure the number from a local phone directory or 

directory assistance. DBD will also provide the date to enter in Section 1 of the 

Form G-254 and information for you to use to prepare a letter to the medical 

source provided by the annuitant. Also follow any additional instructions DBD 

provides. In the course of the investigation you may discover something that 
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could cause DBD to request additional medical evidence (e.g., annuitant working, 

signs of improvement in condition, etc.). Complete the original assignment and 

return it. Allow DBD to determine what additional action is necessary.

B. Annuitant Contact - Contact the annuitant by telephone and identify yourself and 

the reason for your call. Advise the annuitant that you would like to ask a few 

questions which will constitute the continuing disability report and estimate the 

amount of time needed to complete the questioning. Ask the annuitant if you've 

reached him/her at a convenient time; if not, schedule a time to call back and 

conduct the phone interview. If you are unable to make phone contact with the 

annuitant, release a Custom Field Service Letter on RRAILS asking the annuitant 

to contact your office by phone, and begin the review process when the annuitant 

calls. 

Upon completion of the questions on the Form G-254, advise the annuitant that 

you will be sending the form by mail for the annuitant's review and signature. 

Also explain that a Form G-197 will be sent for signature which allows us to 

contact the annuitant's doctor for a statement. If the annuitant is not currently 

under doctor's care, do not secure a Form G-197. However, you will need to 

secure the name, address and phone number of a non-medical third party who 

can verify the annuitant's statements. Also determine the third party's 

relationship to the annuitant. Signed permission to contact a non-medical third 

party is not necessary.

It is preferred that the Form G-254 be completed over the telephone, however, if 

that is not feasible or the annuitant prefers to complete the form personally, you 

may send it in the mail after the initial phone contact explaining the purpose of 

the review. You will also need to secure a signature on Form G-197 or the 

information to contact a non-medical third party as explained above.

Send the Form G-254 and Form G-197 (if necessary) to the annuitant; include a 

return envelope. Pend the case for 15 work days. If the form(s) have not been 

returned within that time frame, contact the annuitant and check on status. If the 

annuitant personally completed the Form G-254, review the form for completion. 

If necessary, contact the annuitant for clarification or missing information. 

Proceed to C. or D. of this section as appropriate.

If the telephone contact discloses that the annuitant is incapable of completing 

the review, advise DBD and determine if representative payee development is 

necessary. Do not pursue the disability review unless instructed to do so by 

DBD.

If the annuitant refuses to cooperate, advise DBD and take no further action 

unless instructed to do so by DBD.

C. Securing statement from medical source - Prepare a letter to the annuitant's 

current medical provider. DBD will furnish specific information to be used in 
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preparing the letter. For example, an assignment involving a statutorily blind 

individual may state that you should ask the physician if visual acuity remains at 

20/200 or less in the better eye. If multiple conditions exist, you may need to 

pose more than one question. 

The letter should also state that we will accept photocopies of the doctor's reports 

or notes in lieu of a statement. Include the signed Form G-197 signed by the 

annuitant and a return envelope.

If the annuitant provided more than one medical source, release a letter to the 

primary source only.

If the annuitant is not currently under doctor's care, make a third party contact as 

described in D. below.

D. Non-medical third party contact - This contact only needs to be made if a medical 

source is not available. The third party contact is the person provided by the 

annuitant as stated in A of this section. Third party contacts include family 

members or friends, if they have knowledge of the annuitant's condition and can 

provide an objective assessment. However, it is preferred third party contacts be 

custodial institutions, sheltered workshop administrators, social service or other 

organizations that provide some sort of assistance or a member of the clergy.

Contact the third party by phone. If phone contact is not possible, prepare a 

letter. Ask the contact how recently he or she saw the individual, and whether, 

so far as he/she can tell, the individual remains impaired and unable to work. 

(Where no medical issue exists, the non-medical contact is primarily to verify that 

the individual is alive and not working.) Explain that we are conducting a 

continuing disability review on the individual as required by law.

Assure the person that we have permission from the individual to contact them. 

Do not tell such third parties any information about the individual other than that 

we are conducting a disability review. Prepare a summary of the statement, and 

forward it for the contact's review and signature; include a return envelope. In the 

rare situation that there is no third party available who can confirm the annuitant's 

statements, a representative of the field office will serve as the third party 

contact. You should first contact DBD in this situation. They will provide specific 

questions and observations based on the annuitant's impairment.

1335.25 Continuance of Disability Under the Railroad Retirement Act

The end result of the continuing disability investigation will be a determination by the 

disability claims examiner regarding the continuance of disability benefits under the 

Railroad Retirement Act (RR Act).
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1335.25.1 Annuitant Still Meets Disability Requirements

In order to determine continued entitlement to disability benefits, the disability claims 

examiner must:

• Determine that the disability requirements of the RR Act, whether for occupational or 

total and permanent disability, are still met; AND

• Reconcile any work activity with the disability. If entitlement continues, any known 

earnings must be considered.

For Employees

A. Earnings or expected earnings over the monthly disability earnings limit after 

deduction of disability related work expenses - The annuity will be suspended 

and pended to the end of the year for final work deduction determination.

B. Earnings or expected earnings are less than the monthly disability earnings limit

after deduction of disability related work expenses – No action will be taken.

1335.25.2 Annuitant No Longer Meets Disability Requirements of RR Act

Benefits will be terminated if the disability claims examiner determines that:

• The disability requirements of the RR Act are no longer met; OR

• Work activity cannot be reconciled with the disability (e.g., annuitant receiving 

benefits on the basis of being occupationally disabled as a track laborer works for a 

private contractor and performs the same duties of a track laborer).

The annuity will be payable (subject to work deductions) through the end of the second 

month following the month in which the annuitant no longer meets the disability 

requirements of the RR Act.

1335.30 Continuance of Disability Under the Social Security Act

If the annuitant is receiving benefits attributable to the Social Security Act (SS Act) 

(O/M, Medicare, etc.), the continuing disability investigation will also be a determination 

regarding the continuance of those benefits.

NOTE: Even though benefits attributable to the SS Act may be terminated, benefits 

under the Railroad Retirement Act (RR Act) may be continued if the requirements of the 

RR Act are still met (e.g., an annuitant may have recovered to the point that he is no 

longer entitled to a disability freeze, yet still be entitled to an annuity on the basis of 

occupational disability).
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1335.30.1 Annuitant Meets Disability Requirements of SS Act 

In order to determine continued entitlement to SS Act based on disability benefits, the 

disability claims examiner must:

• Determine that the disability requirements of the SS Act are still met; AND

• Reconcile any work activity with the disability according to SS Act rules. If 

entitlement continues, earnings still must be considered under RR Act work 

deduction rules.

1335.30.2 Annuitant Does Not Meet Disability Requirements of SS Act

A. Annuitant does not meet SS Act requirements but does meet RR Act 

requirements - If the annuitant no longer meets the SS Act requirements for 

disability but does meet the requirements for disability under the RR Act, then SS 

Act-based benefits must be terminated while RR Act benefits will continue (see 

FOM-I-1335.25.1).

B. Annuitant does not meet SS Act or RR Act requirements - If it is determined that 

the annuitant no longer meets the requirements of either the SS Act or RR Act, 

all benefits must be terminated.

1335.30.3 Cessation of Disability Under the SS Act

Cessation of disability under the SS Act will be found effective with the earliest month in 

which one of the following applies:

A. If medical recovery is not an issue, as of the first month after 9 months of trial 

work in which the evidence establishes the individual is able to engage in 

substantial gainful activity (SGA). It is not necessary for the beneficiary to be 

engaging in SGA or still working in the month of cessation. For example, if an 

individual stopped working in the 9th month of his trial work period, cessation 

may still be found in the 10th month if his work activity during the completed trial 

work period clearly demonstrated the ability to engage in SGA. If the trial work 

period extension applies to the overall minimum (O/M) or a disabled child 

included in the O/M, see FOM-I-325.95. 

B. If the trial work period does not apply (e.g., freeze only), as of the first month in 

which individual engages in SGA, or if he has worked in 9 months of his trial work 

period, as of the month he returns to work which is SGA.

C. As of the month the evidence establishes that medical recovery has occurred.

D. As of the month in which it is determined that, despite reasonable effort, the 

claimant cannot be located and that there is a reasonable possibility that 

disability has ceased.
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E. As of the month it is determined that a beneficiary will not cooperate and there is 

a question of continuing disability. For an explanation of trial work period and 

SGA, see FOM-I-310.65.1 and FOM-1-310.65.2. 

1335.30.4 Coordination of Cessation Decisions with Social Security 

Administration

When the RRB determines that an annuitant no longer meets the disability requirements 

of the SS Act, the Social Security Administration is notified if a joint freeze decision case 

is involved (see FOM-I-1305.20.3.A).

1335.35 Written Notice of Termination

When it has been determined that an annuitant has recovered from disability or has 

demonstrated the ability to work, he is entitled to a written notice 30 days in advance of 

termination. The notice will provide him with:

• Date of recovery or demonstrated ability to work;

• Description of the evidence used as a basis for the determination;

• Termination dates of the annuity, freeze and Medicare, if applicable;

• An opportunity to submit any evidence within 30 days which will be considered in a 

review of the decision to terminate;

• Notice that any payments received after entitlement has ended are erroneous and 

will be subject to recovery;

• Notice that in the absence of new evidence, the decision to terminate will become 

final, and he will have the right to reconsideration/appeal at that time.

If new evidence is submitted within the allotted time and causes a reversal of the 

decision, payments will continue and a written notice will be sent reversing the decision 

to terminate. If the new evidence does not alter the decision, the annuitant will be so 

informed and termination will proceed. Regular reconsideration and subsequent appeal 

procedures will still apply.

1335.40 Handling Possible Fraud in Disability Cases

Under certain circumstances, fraud under the "failure to report" and "false claims and/or 

false statements" concepts may apply to disability cases. The elements of fraud are 

discussed in FOM 1235.25.

Situations meeting the guidelines under the failure to report and false claims and/or 

false statements concepts should be reported to the appropriate Headquarters 

operational section, i.e., the retirement post section or survivor post section. The 

operational unit will take necessary actions, i.e., prepare field assignments, release 
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overpayment letters, establish the debt on the PAR system, and, if an overpayment 

exceeding the threshold amount (see RCM 6.6.191) exists, prepare a referral to the 

Office of the Inspector General. Cases referred to and returned from OIG should be 

logged into the Referral Tracking System application (see FOMI 15165 – RTS 

Instructions). Please see your supervisor for instructions on who enters cases for your 

Section. 

When an assignment is sent to a field office to obtain earnings, medical or other 

entitlement information from an annuitant, field office personnel should obtain 

information by questionnaire when possible. Field personnel should exercise caution 

during any questioning of annuitants that involves personal contact (either in person or 

by phone). For example, if earnings are under investigation and clarification is needed, 

ask appropriate questions to obtain the factual information needed. See DCM 8.8.2, 

FOM 1310, and FOM 1 Article 13, Appendix E, for more information. Do not 

interrogate the annuitant about inconsistencies. Helping the individual complete a 

questionnaire or asking for information or for a clarification is different from interrogation 

to obtain incriminating evidence. The latter is the OIG's responsibility. The reason for 

this focus on questioning technique is to avoid compromising effective prosecution if 

fraud becomes an issue in a case.