DI 26530.005 Cases Requiring a Personalized Disability Explanation
The following notices require a personalized disability explanation:
Initial title II and title XVI medical and medical/vocational denials;
Initial title II and title XVI Substantial Gainful Activity (SGA) denials;
Initial title II and title XVI closed period allowances; and
Unfavorable onset date allowances except:
Closed period allowances in which the onset and cessation dates are the same as those
Title XVI cases in which onset is alleged prior to the protective filing month, but established during the protective filing month, or during the month of filing if there is no protective filing. DWB or Childhood Disability
Beneficiary (CDB) claims in which the onset is set later than alleged but which allows
payment or entitlement to Medicare for the disabled at the earliest date based on
the retroactivity of the application, number holder's date of death or first month
DIB claims when the Alleged Onset Date (AOD) is earlier than the date insured status
is first met (for MQGE claims, see DI
DIB claims in which the period of disability ends due to attainment of full retirement
age (FRA). In these cases, the disability benefits are converted to retirement benefits.
Any adverse title II reopening determination in which a written, personalized disability
explanation of the adverse action is not provided under due process (see DI 27536.000);
Title II or XVI reopenings which are less than fully favorable.
Title XVI multicategory cases: If a currently entitled SSI beneficiary files to establish
entitlement under a second category and the subsequent claim is denied, the DDS will
prepare and release the personalized notice outlined in DI 26535.021.
NOTE: A personalized notice is not necessary when an individual files a disability claim
alleging a visual impairment and the DDS makes a fully favorable determination based
on another impairment since the determination is not totally or partially unfavorable.