TN 10 (04-09)
DI 26510.010 Completing Item 15 (Claimant Disabled) on the SSA-831
1. Title II - General Disability Insurance Benefits (DIB)
Complete Item 15 as follows:
Check the box in block A., and enter the date of onset of disability in all cases where the claimant is disabled on or before the date the insured status requirement is last met.
When a closed period of disability is established, also check the box in block B, and enter the date (month/day/year) disability ceased.
When both a closed and open period of disability are established based on a single application, prepare two SSA-831s, one for the closed period and one for the open period.
When the month of onset is established but the day is unknown, enter the last day of the month as the date of onset.
2. Disabled Widow(er) Benefits (DWB)
Check the box in block A, and enter the date of onset of disability in all cases where the claimant is disabled on or before the end of the prescribed period.
If the exact date of onset cannot be determined, but the file clearly shows that the claimant was disabled before the end of the prescribed period and a more exact date of onset is not material, show the earliest date which can be established by the evidence of record.
NOTE: The controlling date is the latest date onset can be established without affecting the first month of entitlement.
See DI 26510.010A.1., for closed period.
3. DWB Medicare
If an exact onset date is not established but onset occurred no later than the control date, enter in item 15A, the control date.
If the widow became disabled after the control date and within the prescribed period, enter the exact date of onset.
NOTE: As in regular DWB cases, an exact date of onset of disability is not always material, as long as the established date is within the prescribed period. In Medicare cases, determining controlling dates is the responsibility of the FO. The DDS is responsible for contacting the FO if no controlling date is provided. For a discussion of prescribed period and controlling dates see, DI 25501.360 Established Onset in Deemed Entitlement to Disabled Widow(er)'s Benefits for Medicare Claims.
4. Childhood Disability Benefits (CDB)
Check the box in block A, when disability is established before attainment of age 22 or before the end of the reentitlement period.
When the month of onset is established but the exact date is unknown, enter the last day of the month as the date of onset. NOTE: However, the exact date of the onset must be determined when the onset of disability occurs in the month a disabled child attains age 22.
If the individual's disability was present at birth, show the date of birth as the onset date. When the file clearly shows the individual was disabled before the month age 18 was attained and the exact date of onset cannot be determined without further development, enter the last day of the month before the month of attainment of age 18.
When the file clearly shows the individual was disabled before the month age 22 was attained, the exact date of onset cannot be determined without further development, and the application was filed after attainment of age 23, enter the last day of the month before the month of attainment of age 22. NOTE: In many cases, a precise onset date need not be established. See a “closed period” in DI 26510.010A.
5. Title XVI
Check the box in block A when a disability is established. Leave blank only if statutory blindness is established, and complete item 18 instead. (See DI 26510.025B)
The onset date in a Title XVI only case or a concurrent case involving a Title XVI allowance and a Title II denial for technical reasons (such as being not disabled at date last insured) will ordinarily be established as the date of filing (or protective date of filing, if earlier). However, when date of onset of disability is known and is earlier than the filing date, use date of onset of disability.
Also, show the actual date of onset if the evidence clearly establishes the medical onset subsequent to the date of filing. . (See, DI 25501.370 The Established Onset Date for Title XVI Claims).
In a concurrent Title XVI/Title II dual allowance case, use the Title II EOD as the Title XVI EOD, even if it is earlier than the filing date or protective filing date (see DI 25501.370 The Established Onset Date for Title XVI Claims). If the Title XVI filing date is earlier than the Title II EOD (and the claimant met the medical and technical requirements for disability as of the Title XVI filing date), establish an EOD under each title without regard to the other.
If the date of cessation occurs in or after the month of filing, check block B, and complete in the same manner as for a Title II claim when a closed period of disability is established.
If the date of cessation occurs prior to the month of filing or prior to 1/74, check the box in item 19A. Show the established onset date (not the filing date) in block 15A in accordance with the evaluation principles in “Closed Period” DI 25510.001 – DI 25510.015.
If the FO or DDS entered a date in Item 15A for a PD that needs to be changed and the SSA-831 is paper, draw a line through the date previously entered and enter the date following the same rules.