TN 12 (06-14)

DI 25501.220 Potential Onset Date (POD)

A. Introduction to the POD

1. What is the POD?

The POD is the earliest possible date that the adjudicator should consider to establish the established onset date (EOD) based on non-medical factors. This date may be the same as, earlier, or later than the alleged onset date (AOD).

2. The POD is an alert

The POD guides disability case development. With the POD, the claims representative “alerts” the disability determination services (DDS) disability examiner to:

  • work issues that suggest possible disability entitlement before or after the AOD (e.g., work after onset, a reduction of work hours that may reduce work activities below the level of substantial gainful activity, and possible unsuccessful work attempts [UWA]), see DI 25501.220C.1.b. in this section, or

  • other non-medical factors (e.g., date first or last insured and prescribed period) limiting the DDS consideration of disability entitlement to a period before or after the AOD.

3. The POD is claim-specific

At the initial and reconsideration levels (including escalated claims), the field office (FO):

  • completes form SSA-3367 (or EDCS), and

  • considers the POD for each disability claim type where all non-medical requirements are met.

IMPORTANT: If there is more than one claim type, the FO considers the POD for each disability claim type separately.

4. The POD does not provide information about blind onset

The POD considers potential non-blind disability entitlement factors only. The POD does not take into account special development completed in cases involving alleged visual impairments. Therefore, the DDS may only use the POD to determine an onset based on disability rather than statutory blindness. The POD does not guide development for statutory blindness.

IMPORTANT: The POD does not apply in new title II claims filed subsequent to a prior period of statutory blind entitlement ceased due to substantial gainful activity (SGA) or a disability freeze based on statutory blindness only (no cash benefits). In this situation, forward new claims to PC for disability insurance benefits (DIB) attainment processing per DI 13010.135G.

For detailed information on statutory blindness development, evaluation, and processing, see DI 26000.000 Statutory Blindness Cases – Development, Evaluation and Processing Issues – Table of Contents.

B. Component roles regarding the POD

1. FO roles

IMPORTANT: Do not deny a DIB claim based on insured status for a claimant alleging a visual impairment before determining the statutory blind insured status.

The FO:

  1. determines when SGA ceased and completes work activity on the SSA-821-BK or SSA-820-BK and the SSA-823 (unless clearly not SGA policy applies), and

  2. considers the POD for each disability claim type and provides the POD when required:

    • for Title XVI claims complete the EDCS 3367 POD screen or SSA-3367 POD field if the POD is different from the protective filing date or the filing date if there is no protective filing, and

    • for Title II claims see the chart in DI 25501.220C.1.b for determining the POD.

REMINDER: For concurrent cases, consider the POD separately for each disability claim type.

NOTE:Never assign a POD on a technical denial, for example, due to SGA, because there is no possibility of disability entitlement on the claim.

For related instructions, see:

2. DDS roles

The DDS:

  1. focuses initial disability case development on the POD,

  2. considers the POD when determining the disability established onset date (EOD), and

  3. makes a final UWA determination.

IMPORTANT: If the FO did not provide the POD when required or the POD is clearly incorrect, you must get the correct POD from the FO.  You may do so by telephone, assistance request, or if there is an unresolved SGA issue, by returning the claim to the FO. For more information on exchanging information between the FO and DDS, see DI 10005.010 Field Office (FO) and Disability Determination Services (DDS) Exchange of Information and Coordination of Actions and DI 10005.015 Case File Movement.

C. Component instructions regarding the POD

1. FO instructions

Consider a POD for each claim type as follows:

a. POD for Title XVI claims

The POD is generally the protective filing date or the filing date if there is no protective filing.

IMPORTANT: If the POD is the same as the protective filing date or the filing date, you do not need to enter the POD on the SSA-3367; refer to DI 11005.045A.1.c.

EXCEPTION: If SGA ceased after the protective filing (or filing) date, the POD is the last date the claimant performed SGA.

NOTE: SGA limits apply in title XVI initial claims with the exception of those medically determined to meet statutory blindness. Because the POD considers disability entitlement factors only, consider SGA in title XVI POD determinations.

b. POD for Title II claims

In most title II claim types, the POD is the AOD unless non-medical factors, such as case-specific work issues, result in a different POD. See the chart below.

A POD determination is not needed when a subsequent title II DIB claim is filed after a prior period of statutory blind entitlement ceased due to SGA, or a disability freeze based on statutory blindness, as noted in DI 25501.220A.4., in this section.

To determine the POD:

  1. Consider whether a technical factor(s) such as date first insured (DFI), date last insured (DLI), controlling date, and SGA are material.

  2. If no technical factor limits the POD to a date later than the AOD, consider whether the POD could be earlier than the AOD.

    Evaluate these situations on a case-by-case basis. An earlier POD might be appropriate when allegations indicate impairment(s) prior to the AOD, and the claimant was working after the AOD, but you determine the work was not SGA. For example, prior to the AOD the claimant may have:

    • had subsidized employment,

    • had income below SGA,

    • had a UWA, as recommended to the DDS by the FO, or

    • been in pay status, but out on sick leave or other type of non-countable income after the date last worked (for information on military pay and SGA, see DI 11005.006B).

    EXAMPLE of an earlier POD: A claimant had a heart attack on 04/26/2010. From 04/27/2010 through 06/26/2010, he did not work but received sick pay. On his application, he alleged disability because of the heart attack and stated his disability began on 06/27/2010, when his sick pay ended. His POD would be 04/26/2010, the date of his heart attack, even though his AOD is 06/27/2010.

    EXAMPLE of a later POD: A claimant alleges disability since 11/02/2009. On his application, he indicated he performed SGA until 10/30/2009 and from 12/17/2009 until 03/15/2010, after the AOD. The POD may be 03/15/10, the day the claimant last performed SGA, although it may be 10/30/2009 if the FO believes a UWA is likely.

  3. Document the POD determination on the EDCS 3367 or the SSA-3367.

    NOTE: Document all work issues on an SSA-820-BK or SSA-821-BK and SSA-823 (see DI 10510.025 and DI 10505.035).

Consider the factors listed on this chart when determining the POD:

Claim Type

The POD is generally:

Disability Insurance Benefits (DIB)

the latest of:

  • AOD,

  • DFI, or

  • the date the claimant last performed SGA.

Disabled Widow(er) Benefits

(DWB)

the latest of:

  • AOD,

  • the date the claimant last performed SGA, or

  • the controlling date.

REMINDER: If the claimant performed SGA through the end of the prescribed period, there is no POD and no DWB entitlement. For related policy, see DI 10110.001D and DI 11005.050A.

Childhood Disability Beneficiary-Retired or Deceased

(CDB-R) (not re-entitlement)

the earliest date that provides the claimant with a fully favorable EOD, and also:

  • Precedes the month of attainment of age 22

  • Is no earlier than the date the claimant last performed SGA

  • Affords maximum retroactivity based on the filing date and the NH’s entitlement month or date of death

For more information refer to the chart in DI 25501.330A.9.

Childhood Disability Beneficiary-Disabled

(CDB-D) (not re-entitlement)

the earliest date that provides the claimant with a fully favorable EOD, and also:

  • Precedes the month of attainment of age 22

  • Is no earlier than the date the claimant last performed SGA

  • Affords maximum retroactivity based on the filing date and the NH’s entitlement month

For more information refer to the chart in DI 25501.330A.8.

REMINDER: If the applicant has never been entitled to CDB benefits and you cannot establish the onset date prior to age 22 because of SGA performed after age 22, deny the claim for SGA. See DI 10115.022B.

CDB Re-entitlement

the latest of:

  • AOD, or

  • the date the claimant last performed SGA.

REMINDER: CDB benefits may be reinstated after the usual 84-month period (7 years) if the beneficiary’s previous disability entitlement terminated because of the performance of SGA. See DI 23505.010A.

Disabled Minor Child

(DMC)

the latest of:

  • AOD,

  • the date the child last performed SGA,

  • the youngest child-in-care attained age 16, or

  • the controlling date (the first date the parent can be entitled to benefits).

For related information about DMC claims, refer to DI 11025.010 and DI 23505.001.

Medicare for Qualified Government Employment (MQGE)

the latest of:

  • AOD,

  • DFI,

  • the date the claimant no longer performed SGA, or

  • 17 months prior to the protective filing date (or filing date if there is no protective filing date).

For related information about MQGE claims, refer to DI 11035.000.

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