SSR 78-24: DISABILITY -- REFUSAL TO ACCEPT VOCATIONAL REHABILITATION SERVICES

PURPOSE: To revise current policy concerning good cause in title II and title XVI disability/blindness cases where the beneficiary-recipient refuses to accept vocational rehabilitation (VR) services.

CITATIONS: Social Security Act, as amended, sections 222(a), 222(b), and 1615; Regulations No. 4, section 404.422, Regulations No. 16, section 416.1707.

PERTINENT HISTORY: Title II regulations permit an individual to refuse VR services without having benefits withheld (deductions) where there is good cause for such refusal. The only example currently listed in the title II regulations under which good cause may be found to exist is where the individual is a member or adherent of a recognized church or religious sect which teaches its members or adherents to rely solely on prayer or spiritual means in the treatment and care of any physical or mental impairment. Title XVI regulations provide for good cause to be found under a number of additional examples. Although the title XVI examples are applicable to title II case situations, a need exists to consolidate and update the examples applicable to both titles.

POLICY DIRECTIVE STATEMENT: For purposes of both title II and title XVI, an individual may refuse VR services and continue to be eligible for benefits if such refusal is based on good cause. For example, an individual has good cause for refusing VR services where:

: a. The individual is physically incapable of accepting the rehabilitation services offered (e.g., terminally ill or bed confined).
: b. The services offered would conflict with the individual's prescribed medical regimen.
: c. The individual's mental or emotional impairment prevents him or her from making a prudent judgment.
: d. The individual (1) is engaged in substantial gainful activity or (2) will return to substantial gainful work activity within 3 months.
: e. The individual has been offered services which require him or her to be away from home for such a period of time that such absence will adversely affect the health or welfare of the individual's family (e.g., absence will prevent individual from caring for children or disabled relative).
: f. The individual is receiving rehabilitation services under another governmental or private plan which may be expected to restore his or her ability to engage in substantial gainful work activity; or is a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare him or her for gainful employment.
: g. The individual is a member or adherent of any recognized church or religious sect which teaches its members or adherents to rely solely on prayer or spiritual means in the treatment and care of any physical or mental impairment, and the individual's refusal to accept rehabilitation services was due solely to his or her adherence to the teachings and tenets of the church or sect. Although such membership or adherence constitutes good cause for refusing VR services in the form of medical care and/or treatment, it is not a valid basis for refusing diagnostic and evaluation services (including medical examinations) or vocational training and education.
: h. The training or other services for which the individual has been found eligible following evaluation is not designed to restore him or her to substantial gainful work activity (e.g., training would be for work likely to result in less than substantial gainful activity level earnings).

DOCUMENTATION: The following evidence requirements relate to the corresponding good cause criteria cited above:

: a. Either medical evidence in file establishing that the individual is physically incapable of accepting VR services, or verification of such incapability obtained from the treating source.
: b. Either medical evidence in file or verification from the treating source that the individual's medical regimen conflicts with the acceptance of VR services.
: c. Either medical evidence in file establishing that the individual is mentally incapable of making a prudent judgment, or verification of such incapability obtained from the treating source.
: d. (1) Current Substantial Gainful Activity (SGA) -- The individual's statement as to current SGA including, in employment cases, the employer's name and the monthly wags); and, if necessary, supporting evidence from another source.
: Future SGA -- The individual's statement as to intent to return to SGA (including, in employment cases, the future employer's name and the anticipated monthly wages); and, at the time of the intended return to work, the current SGA documentation described in (1) above.
: e. Verification through the VR agency as to the time required away from home together with testimony from a reliable person having personal knowledge of the individual's family situation.
: f. Verification from the school or agency providing the training.
: g. Evidence identifying the church or sect and substantiating the individual's affiliation, and where a group other than the Church of Christ, Scientist, is involved, documentation that medical treatment is prohibited by the tenets and teachings of the church or sect.
: h. Verification from the VR agency.

CROSS-REFERENCES: Claims Manual Sections 6609-6612 and T6602-T6603; Disability Insurance State Manual Sections 290- 296; Disability Operating Manual Sections 860-880; and Disability Operating Manual Circular 51.

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