TN 1 (02-16)

DI 23505.010 Childhood Disability Beneficiary (CDB) Reentitlement

A. CDB reentitlement provisions

The 1972 amendments allow a beneficiary to become reentitled to CDB on the same record:

  • At any time when the previous entitlement terminated due to substantial gainful activity (SGA) (not time limit); or

  • Within 7 years when the previous entitlement ended due to any other reason, including medical recovery.

NOTE: A CDB claim on a different record requires an initial entitlement determination with a finding of disability prior to age 22.

See also:

  • RS 00203.015 Re-entitlement Requirements for Child’s Benefits, DI 25501.330 Establishing an Established Onset Date (EOD) for Childhood Disability Benefits (CDB) Claims, and

  • DI 10115.001 Requirements for Entitlement to Childhood Disability Benefits (CDB).

  • DI 10115.001 Requirements for Entitlement to Childhood Disability Benefits (CDB)

Under the CDB reentitlement provision:

  • CDBs have protection comparable to that of disabled widows and widowers who become entitled again to benefits if they recover from an earlier disability and then become disabled again.

  • The reentitlement period (RP) begins with the month following the last month of previous entitlement to CDB and ends with the close of the 84th month (7 years) following the month the most recent entitlement to CDB terminated due to disability cessation.

  • A child may again be entitled as a CDB case if disability onset is within the 84-month reentitlement period and the child:

    1. Is statutorily blind;

    2. Is age 55 or over; and

    3. Was engaging in SGA not comparable to relevant past work performed either before the later of date of attainment of age 55 or date the child became statutorily blind. (For details, see DI 26005.001D).

Effective October 1, 2004, section 420A of P.L. 108-203 allows reentitlement to childhood disability benefits after the usual 84 months (7 years) period if the beneficiary's previous disability entitlement terminated because of the performance of SGA.

Examples of CDB reentitlement:

  • A 35-year-old individual’s disability entitlement ceased 6 years ago due to medical recovery. The individual stopped working 2 months ago due to a disability. We may consider this individual for CDB reentitlement.

  • We ceased a 51-year-old individual’s disability entitlement 16 years ago due to SGA without medical recovery. The sheltered workshop lost funding last month and no longer employs the individual. We may consider this individual for CDB reentitlement.

  • A 63-year-old individual worked as an able-bodied seaman prior to going blind at age 55. Since that time, he has worked as a host. Although this work is SGA, he may be eligible for reentitlement because he can no longer engage in SGA requiring skill or ability comparable to the work he performed before age 55. However, SSA would withhold benefits while he engaged in SGA at his current job.

B. Form SSA-831 (Disability Determination and Transmittal) completion

Complete the SSA-831 in the usual manner for a CDB case with the following exceptions:

1. Item 15 – Onset

In reentitlement cases where the evidence clearly establishes an exact onset date, show that date.

In reentitlement cases where the evidence does not establish an exact onset date, but establishes disability before the end of the RP, and a more precise date is not material, show the first day of the earliest month and year that the evidence of record can establish the individual as disabled.

Where the medical findings are inconclusive as to an exact onset date but clearly show disability commenced at least:

  1. Twelve months for a CDB-D case (based upon NH disability entitlement) prior to the month in the filing date; or

  2. Six months for a CDB-R case (based upon NH retirement entitlement) prior to the month in the filing date; and

  3. Within the RP; then

    • Establish onset on the first day of the 12th month before the month in the filing date (for a CDB-D case) or

    • Establish onset on the first day of the 6th month (for a CDB-R case) before the month in the filing date, to permit full retroactivity of benefits.

2. Item 19 – Claimant Not Disabled

a. Block A

Check this block in a CDB reentitlement case where the individual's impairment is not disabling and the reentitlement period has not expired.

b. Block B

Check this block in a CDB reentitlement case where the evidence established the individual was not under a disability before the end of the RP, and the RP has expired. Enter the last day of the RP.

c. Block C

Do not check this block in a CDB reentitlement claim.

3. Item 22 – Regulation Basis Code (RBC)

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. For a description of the basis for determination refer to “Completing Item 22 (Regulation Basis Code) on the SSA-831” (DI 26510.045A).

a. Not Disabled Chart

Use this chart for determinations of “not disabled”: Enter in Item 22 Reg-Basis Code

Basis for Determination

Reentitlement CDB claim and RP last met on or after date of current decision

Reentitlement CDB claim and RP last met prior to date of current decision

Impairment Not Severe – Medical Consideration Alone or Condition Disabling But Did Not Exist Before Age 22

F1

F2

Capacity for Substantial Gainful Activity (SGA) – Vocational Considerations

G1

G2

Impairment Prevented SGA for a Period of Less Than 12 Months

E1

E2

Impairment Prevents SGA at Time of Adjudication but is Not Expected to Prevent SGA for a Period of 12 Months

E3

E4

Insufficient Evidence Furnished

M5

M6

Failure or Refusal to Submit to Consultative Examination (CE)

L1

L2

Claimant Does not Want to Continue Development of Claim

M3

M4

Claimant Willfully Fails to Follow Prescribed Treatment

K1

K2

b. Disabled Chart

Use this chart for determinations of “disabled”:

Basis for Decision

Enter in Item 22 “Reg. Basis Code”

Impairment Meets Level of Severity of Listings

A1

Impairment Equals Level of Severity of Listings

B1

Medical And Vocational Consideration

C1

4. Item 29 – LTR. PAR. NO.

Leave item 29 of the SSA-831 blank when a computer generates the notice.

If the system is unable to generate the proper disability determination notice and a manual notice must be prepared, item 29 of the SSA-831 may require special notice and coding instructions. See “Completing Item 29 (Letter/Paragraph Number) on the SSA-831” per DI 26510.085.

For denials, complete item 29 as follows:

Type of Claim

Initial

Reconsideration

Suffix1  2  3  4

Title II

L4437

L928 5  6

“A” “Z” “C25”

1 In item 29 of the SSA-831, enter “C25” if the claimant requests the return of an original document he or she has submitted.

2 Combination of suffixes. Where more than one suffix is applicable in a case, (e.g., an attorney or other party represents the claimant and has authorized disclosure), enter all the appropriate suffixes in item 29; for example, L443-A-Z.

3 The authorization is in the form of a statement in file.

4 If the claim escalated to the reconsideration level, add closeout paragraph 314 and paragraph 585 per NL 00708.100.

5 In concurrent reconsideration affirmation of denials, use one SSA-L-928 and check off each claim type. Place an electronic image of the letter in the certified electronic file and the multiple claim numbers shown at the top of the letter. For paper modular disability folders, place copies of the letter in each claim folder.

C. CDB Personalized Disability Notices

DDS must prepare and release a personalized disability explanation (PDE) to a CDB claimant on all less than fully favorable disability determinations. The personalized notice consists of a form notice (SSA-L443) and a PDE containing the required information. For complete instructions on completing notices, refer to “How to Prepare the Notice” per NL 00603.000 and “Electronic Case Closure” per DI 81020.130. For complete instructions for PDEs, refer to “Personalized Disability Explanations” DI 26530.000.

The PDE must contain the “determination” and “miscellaneous” paragraphs as indicated in the charts provided in this section.

1. Reentitlement denial 7-year period not expired or previous SGA cessation

PDE paragraphs for initial denials

Write PDE paragraphs in the third person when an individual files on behalf of the child. For explanation paragraph content, see “Numbered Paragraphs” per NL 00708.100.

Use this chart to determine the appropriate paragraph:

Basis for
Decision is

Reg. Basis Code
Shown in Item 22

Decision
Paragraph 1

Miscellaneous
Paragraph 2

Impairment Not severe – Medical Consideration

F1
(Under Age 22)

330.5

522.7 (last day of specified period)

Condition Disabling but Did Not Exist Before Age 22

F2
(Age 22 or Older)

330.8

522.7 (last day of specified period)

Capacity for SGA – Vocational Considerations

G1
(Age 22 or Older)
G1
(Under Age 22)

301
 
302

522.7 (last day of specified period)

Impairment Prevented SGA For a Period of Less Than 12 Months

E1
(Age 22 or Older)
E1
(Under Age 22)

331.1

522.7 (last day of specified period)

Impairment Prevents SGA at Time of Adjudication But is Not Expected to Prevent SGA For a Period of 12 Months

E3
(Age 22 or Older)
E3
(Under Age 22)

331

522.7 (last day of specified period)

Insufficient Evidence Furnished

M5-
(Age 22 or Older)
M5
(Under Age 22)

341

522.7 (last day of specified period)

Failure or Refusal to Submit To a Consultative Examination

L1
(Age 22 or Older)
L1
(Under Age 22)

342

522.7 (last day of specified period)

Claimant Does Not Want To Continue Development of Claim

M3-
(Age 22 or Older)
M3
(Under Age 22)

343

522.7 (last day of specified period)

Claimant Willfully Fails To Follow Prescribed Treatment

K1-
(Age 22 or Older)
K1
(Under Age 22)

381

522.7 (last day of specified period)

1Element 3 of personalized disability explanation.

2The last paragraph of personalized disability explanation if a concluding paragraph is not necessary.

2. Reentitlement denial not disabled within 7 years of prior medical cessation

PDE paragraphs for initial denials

Write PDE paragraphs in the third person when an individual files on behalf of the child. For explanation paragraph content, see “Numbered Paragraphs” per NL 00708.100.

Use this chart to determine the appropriate paragraph:

Basis for Decision is

Reg. Basis Code
Shown in Item 22

Decision
Paragraph 1

Miscellaneous
Paragraph 2

Reentitlement Denial

Not Disabled Within 7 Years of Prior Medical Cessation

  • F2

  • G2

  • E2

  • L2

  • M4

  • K2 (Age 22 or older)

  • K2 (Under Age 22)

522.5 (Last Day of Specified Period)

522.6

1 Element 3 of personalized disability explanation.

2 The last paragraph of personalized disability explanation if a concluding paragraph is not necessary.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423505010
DI 23505.010 - Childhood Disability Beneficiary (CDB) Reentitlement - 02/04/2016
Batch run: 02/04/2016
Rev:02/04/2016