BASIC (03-12)

DI 25505.025 Duration Requirement for Disability

Citations:

Social Security Act — Sections 216(i), 223(d), and 1614(a)

Regulations — 20 CFR 404.1505, 404.1509, 404.1522, 404.1523, 404.1581, 404.1582, 404.1583, 404.1598, 416.905, 416.906, 416.909, 416.922, 416.923, 416.981, 416.983, and 416.998

Social Security Rulings — 82-52, 82-53

A. Introduction

For all individuals under title II and adults under title XVI, the Act defines disability as:

“The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

In title XVI child cases, the Act defines disability for an individual under the age of 18 as:

"a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."

NOTE: To find a person disabled, his or her medically determinable impairment(s) must meet the duration requirement.

B. Definition of duration requirement for disability

The duration requirement for all claimants under title II and title XVI begins at the time that a person is continuously unable to engage in substantial gainful activity (SGA) because of a medically determinable impairment(s).

In title XVI child cases, the duration requirement begins at the time that a child’s impairment(s) is so severe that it results in marked and severe functional limitations.

In all title II and title XVI cases, the impairment(s) must be expected to result in death or have lasted or be expected to last for a continuous period of not less than 12 months.

REMINDER: A claimant who was previously entitled to a period of disability and who files a new claim must meet the duration requirement again for any subsequent period of disability.

C. Expected to result in death

The phrase “expected to result in death” refers to imminent death that is expected within 12 months of onset of disability. An impairment(s) is “expected to result in death” if the impairment is found to be terminal based on established medical knowledge and the specific facts of the case.

NOTE: For title II claims (Disability Insurance Benefits (DIB) and Disabled Widow(er)’s Benefits (DWB)) that require a waiting period, if a claimant’s death follows so quickly after the onset of disability, and an onset earlier than alleged is not possible, return the claim to the field office (FO) for a technical denial. For further discussion on cases involving death, see DI 23510.000.

D. 12 continuous months

Unless the impairment(s) is expected to result in death, to meet the 12-month duration requirement, the impairment(s) must prevent the claimant from engaging in any substantial gainful activity (SGA) for 12 months and must have lasted or be expected to last for a continuous period of not less than 12 months.

REMINDER: The duration period can begin before the date first insured (DFI) in title II DIB claims, before the date of a spouse’s death in title II DWB claims, and prior to the filing date in title XVI claims.

E. Exceptions to duration requirement

The 12-month duration requirement does not apply to the following types of cases:

  • Statutory blindness under title XVI (see DI 26005.005A);

  • Title II DIB, DWB, and CDB claims when the claimant is statutorily blind, age 55 or older, and work comparability provisions apply (see DI 26005.001E);

  • Title II statutory blindness for a period of disability (i.e., disability freeze), a claimant of any age must be disabled for a continuous period of 5 full calendar months (see Disability freeze DI 26001.010D.2. and Duration Requirement for Freeze DI 10105.030); and

  • Continuing disability review (CDR) cases, unless a claimant has a new disabling impairment(s) that begins after the cessation month (see DI 25505.030A.3.).


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DI 25505.025 - Duration Requirement for Disability - 03/05/2012
Batch run: 08/11/2016
Rev:08/11/2016