In addition to the three possible ending dates for the freeze period shown in DI 10105.035B., amendments to the Social Security Act provide an extended period of eligibility
(EPE) (see DI 13010.210, Extended Period of Eligibility — Overview) which, consequently, extends the ending
date of the freeze. Based on these amendments, if disability ceases December 1, 1980
or later, the freeze may also end with the month preceding the first month the beneficiary
engages in Substantial Gainful Activity (SGA) after the EPE. The EPE begins the month immediately following completion of the 9-month TWP.
EPE was affected by the 1980 and 1987 Amendments as follows:
-
•
1980 Amendments: The EPE provisions in effect from 12/01/1980 through 12/21/1987 provided for a 15-month re-entitlement period. A re-entitlement period cannot begin before 12/1980, even if the TWP ended before
12/1980. Therefore, the earliest 15-month EPE re-entitlement period is from 12/1980
through 02/1982.
-
•
1987 Amendments: The EPE re-entitlement period was extended to 36-months effective 01/1988. The 36-month re-entitlement period applies if a beneficiary is entitled to a disability benefit as of 01/1988 or later
and did not complete a 15-month EPE prior to 01/01/1988.
If there is continuous payment of benefits through the end of the extended (15 or
36-month) period because the beneficiary has not engaged in SGA, disability ceases
the first month of SGA after the EPE (15 or 36-month) period. (DI 13010.210).
If there is not continuous payment of benefits (i.e., benefits are suspended) because of SGA for
any month during the (15 or 36-month) EPE following the 9-month TWP, and benefits are
continually not payable through the close of the (15 or 36-month) EPE period, the period of disability
(i.e., the freeze) ends with the month preceding the first month of continuous nonpayment.
(See DI 13010.210.)
NOTE: If the claimant is not engaging in SGA when the EPE re-entitlement period ends,
the EPE provision allows benefits to continue until SGA is performed or a medical
cessation is determined. (See DI 13010.210A.)
EXAMPLE #1
15-month EPE - No SGA during entire EPE; SGA begins after EPE
9-month TWP: 02/85-10/85
15-month EPE: 11/85-01/87 (no SGA)
First month claimant engaged in SGA: 11/87 and continuing
Disability ceased: 11/87
Grace period: 11/87-01/88 (the month of disability cessation and the two succeeding months - See
DI 13010.210E.2.). The claimant is paid benefits for the grace period.
Period of disability (i.e., the freeze) ends: 01/88 (the last day of the second month after the month in which disability ceases.)
January 1988 is the last month disability benefits are payable.
Benefit termination month (BTM): 02/88
EXAMPLE #2
36-month EPE – SGA begins several months after EPE starts, and SGA continues through
the close of the EPE
9-month TWP: 01/94-09/94
36-month EPE: 10/94-09/97
Claimant does not engage in SGA: 10/94-05/96 (benefits are paid)
Claimant engages in SGA: 06/96-09/97 (see “Grace Period” below for payment months)
Disability ceases: 06/96
Grace Period: 06/96-08/96 (the month of disability cessation and the two succeeding months - See
DI 13010.210E.2.). The claimant is paid benefits for the grace period and benefits are not paid (suspended)
beginning 09/96. Benefits are not payable for any SGA month during the EPE except the disability cessation month and the following 2 months.
Period of disability (i.e., the freeze) ends: 08/96 (the month preceding the first month of continuous nonpayment). August 1996
is the last month for which disability benefits are payable)
Benefit termination month (BTM): 10/97
EXAMPLE #3
36-month EPE – Periodic SGA months during EPE; SGA continues after EPE
02/00 - 10/00 – Claimant’s TWP
-
•
11/00 – (1st month of EPE.) EPE begins the month immediately following completion
of the TWP. In this example, the claimant’s earnings remain below SGA through 04/02.
-
•
05/02 (19th month of EPE) – Claimant’s earnings equal or exceed the SGA limit. Therefore,
this is the month disability ceases (The claimant demonstrates the ability to engage
in SGA. See DI 10105.010.). The claimant is paid benefits for the grace period (i.e., the month of disability
cessation and the two succeeding months. See DI 13010.210E.2.) Benefits are not payable for any SGA month during the EPE except the disability cessation month and the following 2 months.
-
•
06/02-07/02 (20th and 21st months of EPE) – Claimant’s earning continue to equal or
exceed SGA limits. These months complete the grace period. Therefore, benefits are
payable for these months.
-
•
08/02-10/02 (22nd -24th month of EPE) – Claimant’s earning continue to equal or exceed
SGA limits. The claimant’s benefits are not paid (benefits suspended) for these months due to SGA.
-
•
11/02 (25th month of EPE) – Claimant’s earnings are below the SGA limit. Benefits
are paid for this month. (Benefits are payable for any non-SGA month preceding the BTM.)
-
•
12/02-10/03 (26th month through 36th month of EPE) – Claimant’s earnings equal or
exceed SGA limits. Benefits are not paid (benefits suspended) for these months due to SGA.
-
•
37th month (11/03) - Claimant still earning SGA. Claimant’s benefits are terminated.
EXAMPLE #4
36-month EPE - Earnings below SGA during entire EPE and continuing
Same scenario as Example #3, but the claimant’s earnings are below SGA for the entire EPE period (11/00-10/03) and continue to be below SGA 11/03 and continuing. Since
the claimant is not engaging in SGA when the EPE period ends, the EPE provision allows
benefits to continue until SGA is performed or medical cessation is determined. (See DI 13010.210A.) The claimant’s disability will cease effective with the first month earnings equal or exceed the SGA limit.
(The grace period is the month disability ceases and the two succeeding months. The
claimant is paid benefits for the grace period. See DI 13010.210E.2.)
EXAMPLE #5
36-month EPE - SGA during entire EPE and continuing
Same scenario as Example #3, but the claimant’s earnings equal or exceed SGA for all months in the EPE (11/00-10/03) and remain at or above SGA 11/03 and continuing.
Therefore, the claimant’s disability ceases 11/00 (i.e., the first month earnings
equal or exceed the SGA limit). The claimant’s grace period is 11/00-01/01 (the month
of disability cessation and the two succeeding months). Benefits are paid for the
grace period. Benefits are not paid (benefits suspended) for 02/01-10/03 and benefits are terminated 11/03.