If the claimant is disabled and entitled to EXR, we may reinstate benefits retroactively
for up to 12 months before the EXR request date provided the claimant meets all factors
of entitlement. The MOE is the earliest month that the claimant did not perform SGA
and met all of the EXR eligibility requirements. If there is SGA in all months of
the retroactive period and in the month of filing, the first possible MOE is the month
following the month of filing. The month of entitlement cannot be before the benefit
termination month (BTM) of the previous entitlement. The MOE must be a non-SGA month.
If the claimant performed SGA in the month of filing and the following month, the
FO must issue a technical denial. Normal suspension and terminating events apply to
all reinstated benefits.
Example: A claimant was previously entitled to Social Security disability insurance (SSDI)
for back problems and their entitlement terminated due to work in January 2021. In
June 2023, they re-injure their back and they are unable to work. In September 2023,
they request EXR. The FO develops the case and sends it to the DDS, they document
the request date of September 2023 and note the following SGA and non-SGA months in
the 12-month retroactive period as follows:
SGA Months: September 2022, October 2022, November 2022, December 2022, January 2023,
February 2023, March 2023, and May 2023
Non-SGA Months: April 2023, June 2023, July 2023, August 2023, and September 2023
The DDS decides that the claimant meets the medical requirements of EXR in the month
of filing (September 2023). They then look at the first non-SGA month in the retroactive
period, which is April 2023. The DDS determines that although the claimant did not
perform SGA, they did not meet the Medical Improvement Review Standard (MIRS) criteria
in April 2023. They then look at the next non-SGA month (June 2023) and determine
that the claimant did meet the MIRS criteria in that month. Therefore, the MOE for
EXR is June 2023, which is the first month of the initial reinstatement period (IRP).