Enter the allowance or denial RBC in Item 22 of the SSA-831
1. Closed Period Cases
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•
RBC reflects the period of disability at the time of adjudication.
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•
Establish a closed period of disability under Title II, per DI 25510.010
2. Collateral Estoppel
When disability is established before the prior EOD, enter the RBC that reflects the nature of the favorable determination
for the earlier period under adjudication. When disability is
not established earlier than the EOD for the prior favorable determination or decision, enter RBC
“CE” (collateral estoppel - Title II). per DI 27515.001D3.a.
3. Res Judicata
When you deny a claim on the basis of res judicata enter “S1” in Item 22 per DI 27516.005B.3.
4. Childhood Disability Beneficiary (CDB) Re-entitlement Claims
When adjudicating CDB re-entitlement claims, enter the pertinent RBC for the CDB allowance
or denial. The RBC should reflect the nature of the allowance or denial on the date
of adjudication. Refer to the allowance or denial chart in DI 23505.010B.3. For additional guidance see the following:
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•
DI 23505.010A Childhood Disability Beneficiary (CDB) Re-entitlement
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•
DI 10115.035A Requirements for Re-entitlement for a change in the re-entitlement period
5. Denials at the time of adjudication
The RBC reflects the nature of the allowance or denial at the time of adjudication.
However, in denials, when a technical requirement is no longer met,
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•
Use the RBC at the time the technical requirement was last met;
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•
Select the appropriate code from the reference charts in DI 26510.045C, in this section.
DIB/DWB Claim—Denial
Basis for Decision
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Enter in Item 22 Reg-Basis Code
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ER1 or PP1 Last met on or after date of current decision
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ER1 or PP1 last met prior to date of current decision
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Impairment Not Severe—Medical Consideration Alone
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F12
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F2
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Capacity for SGA—Any Relevant Past Work
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H1
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H2
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Capacity for SGA—Other Than Relevant Past Work
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J1
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J2
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Engaging in SGA—(DIB claims only)
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N13
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N23
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Impairment Prevented SGA for a Period of Less Than 12 Months
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E1
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E2
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Impairment Prevents SGA at Time of Adjudication but is not Expected to Prevent SGA
for a Period of 12 Months
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E3
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E4
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Insufficient Evidence Furnished
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M54
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M65
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DAA Is Material to the Determination of Disability
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Z1
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Z2
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NH Does Not Want to Continue Development of Claim—Wants Decision Made on Evidence
in File
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M3
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M4
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NH Does Not Want to Continue Development of Claim—Does Not Indicate Decision to be
Made on Evidence in File
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M7
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M8
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NH Willfully Fails to Follow Prescribed Treatment
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K1
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K2
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DWB Medicare Only Case—EOD at or after Age 62 Years and 7 Months—No Prior Disability
Benefit Entitlement or Not Disabled, Whereabouts Unknown
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X3
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X3
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1 ER (earnings requirement); PP (prescribed period).
2 Also use this RBC in situations where the claimant only meets the fully insured requirement
at AOD or later, has alleged a visual impairment, and the claimant does not meet the
definition of statutory blindness.
3 Use this code if the FO has determined that the claimant is engaging in SGA, the
claimant alleges a visual impairment and the DDS determines that the claimant is not
statutorily blind.(See Item 22 (Regulation Basis Code – Procedure – Title II – DIB-SGA
Alleged, DI 26010.040C. )
4 Do not use M5 when the claimant cooperated but there is insufficient evidence of
disability. In these situations, use F1.
5 Do not use M6 when the claimant cooperated but there is insufficient evidence of
disability relating to the period before the insured status requirement was last met.
In these situations, use F2.
DIB/DWB Claim – Allowance
Basis for Decision
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Enter in Item 22 Reg-Basis Code
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Impairment Meets Level of Severity of Listings
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A11
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Impairment Equals Level of Severity of Listings
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B1
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Medical and Vocational Considerations
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C1
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Medical and Vocational considerations
(35-40 Years of Arduous Unskilled Work, Marginal Education, and Significant Impairment)
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D1
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1 When the date of onset (in item 15A) is based on statutory blindness, but the claimant
is found not disabled for cash benefit purposes (item 18A), enter RBC "A1."
CDB Claim—Denial
Basis for Decision
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Enter in Item 22
Reg-Basis Code
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CDB Claim, or reentitlement CDB claim and re-entitlement period (RP) last met on or
after date of current decision
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Reentitlement CDB claim and RP last met prior to date of current decision
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Impairment Not Severe—Medical Consideration Alone or Condition Disabling but did not
Exist Before Age 22
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F1
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F2
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Capacity for SGA—Vocational Considerations
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G1
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G2
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Impairment Prevented SGA for a Period of Less Than 12 Months
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E1
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E2
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Impairment Prevents SGA at Time of Adjudication but is Not Expected to Prevent SGA
for a Period of 12 Months
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E3
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E4
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Insufficient Evidence Provided
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M51
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M62
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Claimant Does not Want to Continue Development of Claim
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M3
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M4
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Claimant Willfully Fails to Follow Prescribed Treatment
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K1
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K2
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Drug Addiction and/or Alcoholism is Material to the Determination of Disability
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Z1
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Z2
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1 M5 is not used when the claimant has cooperated but there is insufficient evidence
before age 22 to establish disability - use F1 instead.
2 M6 is not used when the claimant has cooperated but there is insufficient evidence
before the end of the reentitlement period to establish disability - use F2 instead.
CDB Claim—Allowance
Basis for Decision
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Enter in Item 22 Reg-Basis Code
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Impairment Meets Level of Severity of Listings
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A1
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Impairment Equals Level of Severity of Listings
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B1
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Medical and Vocational Considerations
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C1
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Parent Determination—Denial
Basis for Decision
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Enter in Item 22 Reg-Basis Code
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Impairment Not Severe—Medical Considerations Alone or Condition Disabling but did
not Exist Before Dependency Date
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F1
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Capacity for SGA—Any Relevant Past Work
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H1
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Capacity for SGA—Other Than Relevant Past Work
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J1
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Impairment Prevented SGA for a Period of Less Than 12 Months
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E1
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Impairment Prevents SGA at Time of Adjudication but Is Not Expected to Prevent SGA
for a Period of 12 Months
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E3
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Insufficient Evidence Furnished
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M5
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NH Does Not Want to Continue Development of Claim
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M3
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NH Willfully Fails to Follow Prescribed Treatment
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K1
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Parent
Determination—Allowance
Basis for Decision
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Enter in Item 22 Reg-Basis Code
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Impairment Meets Level of Severity of Listings
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A1
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Impairment Equals Level of Severity of Listings
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B1
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Medical and Vocational Considerations
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C1
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Medical and Vocational Considerations (35-40 Years of Arduous Unskilled Work, Marginal
Education, and Significant Impairment)
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D1
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