TN 1 (07-16)

DI 11020.050 Field Office (FO) Technical Denials of Childhood Disability Benefits (CDB) Including Substantial Gainful Activity (SGA) and other Technical Denials

A. Technical denials of CDB claims due to SGA

CDB claims that do not meet the non-medical requirements do not require a disability determination, and are adjudicated in the FO.

The FO:

  • prepares and releases the denial notice to the claimant; and

  • retains the non-Electronic Disability Collect System (EDCS) paper folder in the FO per Field Offices (FO) Retaining and Shipping Paper Modular Disability Folders (MDF) in DI 11010.370.

References:

B. Examples of CDB denials

The FO issues technical denials in the following situations:

  • The claimant did not meet a nonmedical factor of entitlement (for example, relationship or dependency). (For additional information on entitlement factors, see Child’s Benefits for Entitlement and Non-Entitlement and Non-Entitlement Provisions in RS 00203.001.

  • The claimant’s alleged onset date (AOD) is after attainment of age 22. You cannot establish the potential onset date (POD) prior to attainment of age 22, and there is no prior entitlement to CDB. (For additional instructions on establishing the POD, see number two per DI 25501.220C.1.b. The claims specialist (CS) (formerly claims representative) should prepare and release the appropriate denial notice with an explanation that Social Security Administration cannot pay benefits because the AOD is after age 22. (For additional Disallowance Notices instructions, see in NL 00601.020. Include paragraph 301(A) per Numbered Paragraphs in NL 00708.100.)

  • The claimant has never been entitled to CDB and the FO cannot establish the onset date prior to age 22 because of SGA after age 22. (When processing an SGA denial through EDCS, see DI 81010.020 and DI 81010.140D. For the appropriate SSA-831-U3 entries, see DI 11010.205).

  • SSA made a prior determination (on or after January 6, 1986) that the claimant was not disabled prior to age 22, there is no potential for reopening. For example: claimant does not submit new and material evidence, and the 1972 amendments do not apply.
    When uncertain about whether newly submitted evidence is ‘new and material’, send the case to the DDS. If a court issued a decision after January 6, 1986, see the fifth bullet in, DI 11020.070.

  • The claimant was previously medically denied after age 22 (i.e., for DIB or CDB), there is no potential for reopening, there are no changes in the disability evaluation criteria), and no changes to the Listing of Impairments. (For additional information on Res Judicata, see Guides for Determining Applicability of Res Judicata in DI 27516.010.

  • The claimant alleges that he or she is again under a disability that began after the 84th month since the last (non-SGA) termination of CDB and his or her parent is receiving Disability Insurance Benefits (DIB), Retirement Insurance Benefits (RIB), or is deceased. Prepare and release model letter “V” per instructions in NL 00705.065.

  • Claimant files a CDB claim on the record of a grandparent and the parent was alive or previously found not to be disabled in or after the month the grandparent-child relationship must be established.


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DI 11020.050 - Field Office (FO) Technical Denials of Childhood Disability Benefits (CDB) Including Substantial Gainful Activity (SGA) and other Technical Denials - 07/20/2016
Batch run: 07/20/2016
Rev:07/20/2016