A claimant, including a child, applying for Supplemental Security Income (SSI) based on disability or blindness, may receive up to 6 months of payments prior to the final determination of disability or blindness if he/she is found to be presumptively disabled or blind and meets all other eligibility requirements.

In order to make a PD or PB finding, the available evidence must reflect a high degree of probability that the claimant’s impairment or combination of impairments meets the Social Security Administration (SSA) definition of disability or blindness. In the case of readily observable impairments (e.g., amputation of a leg at the hip), a PD/PB finding is possible without medical or other evidence.

In other situations, a PD/PB finding must be based on medical or non-medical evidence, which, although not sufficient for a formal determination of disability or blindness, are sufficient to establish a high degree of probability that the claimant is disabled or blind.

It is possible that a case meets more than one category of expedited cases, e.g., Compassionate Allowance (CAL), PD/PB, Terminal Illness (TERI), Quick Disability Decision (QDD), and Military Casualty/Wounded Warrior (MC/WW) cases.

For information regarding processing see:

• •

  DI 23022.000 CAL cases

• •

  DI 23020.045 TERI cases

• •

  DI 23022.000 QDD cases

• •

  DI 11005.006 MC/WW cases

PD/PB provisions do not apply in the following situations:

• •

  Reconsideration or other administrative appeals;

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  Prerelease cases; or

• •

  Cases where the individual has a history of sustained work while severely impaired (but not at listing level severity), which terminated for reasons that were not obviously impairment related.

  NOTE: Title XVI claims escalated to the reconsideration level (see DI 27010.005) and prior technical denials for excess income that have been reversed on appeal are eligible for PD/PB. These types of claims are considered initial claims for the DDS because there was no previous medical determination.

1. 1. 

   SSA field offices (FOs) are authorized to make a PD/PB finding for only those categories listed in DI 11055.231.

2. 2. 

   The DDS is authorized to make a PD/PB finding in any case in which there is a high degree of probability that the case will be allowed on formal determination, see DI 23535.010A.1.

3. 3. 

   If an individual's prior claim has been denied based on medical factors, the FO or DDS may make a PD/PB finding on a new initial claim only when the individual presents:

   1. a. 

      Sufficient evidence of a worsening in his or her physical or mental condition; or

   2. b. 

      New impairment(s) not previously assessed, which demonstrate(s) a strong likelihood that the subsequent claim will be allowed.

1. 1. 

   Prior to the final determination of disability or blindness, an individual may receive up to six months of payments based on a PD/PB finding, if he or she meets all other eligibility requirements.

2. 2. 

   Payments based on a PD/PB finding are not considered overpayments if it is later determined that the claimant is not disabled or blind unless:

   • •

     The claim is disallowed due to ineligibility based on factors other than disability or blindness; or

   • •

     It is subsequently determined that the claimant had excess resources or that the amount of payment was computed in error. In such cases, only the incorrect payment amount is considered an overpayment.

3. 3. 

   If a claimant eligible for PD/PB benefits does not receive the payment(s), or it/they were returned, and the claimant subsequently receives a denial decision from the DDS, SSA may re-issue the PD/PB benefit(s) via one-time payment (OTP).