TN 2 (05-10)
DI 27025.015 Personalized Explanations in Closed Period and Unfavorable Onset Date Allowances
The Disability Determination Services (DDS) prepares a personalized determination notice for:
reconsideration Title II and Title XVI closed period; and
reconsideration Title II and Title XVI unfavorable onset date allowances
For notice instructions, see DI 27030.005B Title II - Allowances and DI 27030.015B Title XVI Allowances.
In reconsideration concurrent Title II/Title XVI closed period and unfavorable onset date allowances, the DDS prepares a separate notice and personalized explanation for each claim. However, when the basis for the decision is the same for both claims (e.g., medical/vocational allowance) and the contents of the personalized explanation are the same, attach a copy of the personalized explanation to each notice showing the correct social security number. Medical and non-medical reports listed on the initial personalized explanation do not need to be repeated.
B. Personalized notice for closed period and unfavorable onset allowances
The personalized explanation must include the following elements:
1. Medical and non-medical reports
List the medical (and if appropriate), non-medical reports (by name and date) evaluated as shown in DI 26530.055 Personalized Explanation Preparation Guide Form. Reports may be listed in paragraph form if saving space is a consideration or more than three reports are used.
2. Unresponsive medical sources
Do not mention unresponsive medical sources. List reports in paragraph form if saving space becomes a consideration, or if more than three reports are used. An optional disclaimer statement in DI 26530.055 Personalized Explanation Preparation Guide Form may be used to indicate that additional reports were not obtainable, but we had adequate information to evaluate the claimant’s condition, such as; “Additional reports were not obtainable; however, we had enough information to evaluate your condition.”
3. List of Impairments
Include a narrative list of the impairments evaluated. Do not use technical terms unless the claimant uses them and appears to understand them. When information in file suggests that the claimant has a mental impairment or is unaware of the exact nature of his or her condition, the examiner must exercise care not to offend or upset the claimant. If the claimant is unaware of the impairment, use general terms such as:
“The evidence does not show any other conditions which would significantly limit your ability to work.”
4. Medical severity
Provide a brief description of medical severity; however, use care when discussing medical evidence.
5. Medical duration
When a claim is denied because medical duration is not met, the medical, and if applicable, vocational information provided must cover this issue.
6. Vocational factors
a. Closed period allowance
When vocational factors are considered in a closed period allowance, prepare a brief description of the job the claimant can perform, or a statement that the claimant is unable to perform any of the work he or she did during the period evaluated. Considering age, education, and past work experience, does he or she still have the capacity to perform other work which is less demanding? Refer to exertion, mental capacity, skill level, or requirements for less physical effort (specify in general terms, e.g., lighter work). Do not cite other jobs.
b. Unfavorable onset date
When vocational factors are considered in an unfavorable onset date allowance, list the job the claimant was capable of performing up to the date of onset, indicating whether the claimant is unable to do any of the work he or she did during the period evaluated and whether he or she has the capacity to do other work which is less demanding.
7. Work activity
When the claimant's work activity is the reason for the closed period or unfavorable onset determination, the information provided in the explanation must cover this issue.
For examples of closed period and unfavorable onset personalized explanations, see DI 26530.015C Personalized Explanation in Initial Closed Period, Unfavorable Onset Date, and DWB Allowances Where the Month of Entitlement is Restricted to January 1991 Under P.L. 101-508.
D. Procedures for special situations
1. Unfavorable allowance — freeze claimant
In cases of an unfavorable allowance for a freeze claim, the DDS prepares only the personalized explanation and the component with jurisdiction of the folder is responsible for preparation and release of the notice. If the claimant is age 54 or older, send to the appropriate Program Service Center (PSC), otherwise send to the Office of Disability Operations.
For additional information about disability freeze provisions, see DI 26001.005.
2. Unfavorable onset date allowance — Disabled Widow(er) Benefit (DWB) for Medicare only
When the DDS prepares an unfavorable allowance for a DWB claim filed for Medicare coverage only, the DDS:
3. Unfavorable onset date allowance — Alleged Onset Date (AOD) within 5 months of full retirement age (FRA) Disability Insurance Benefit (DIB))
When the DDS establishes DIB onset later than the AOD (for medical reasons), but within 5 months of FRA, the DDS:
prepares only the personalized explanation;
forwards it to the PSC through the field office (FO); and
adds a message to the certified electronic folder immediately prior to case closure, instructing the FO to release the notice; or
attaches an SSA-408 (Route Slip) to the modular disability folder, indicating that a personalized explanation should be released with the retirement insurance benefit notice.
For additional instructions on notifying the FO of special notice instructions see, DI 81020.130 Electronic Case Closure.