TN 2 (06-08)

DI 27510.001 Period Covered by a Final Determination or Decision: “Period Adjudicated”

A. Operating Policy

Where there has been a prior final determination or decision on the issue of disability, the following apply when adjudicating post-entitlement issues or a subsequent claim of the same individual:

  • The “period adjudicated” refers to that period covered by a determination or decision which has become administratively final and binding upon both the claimant and SSA unless a new determination or decision is made on appeal or reopening. See Final Determination or Decision (DI 27501.001A.3.) and Reopening and Revising a Determination or Decision (DI 27501.005).

  • On subsequent claims, adjudicators will limit their consideration to the period after the prior period adjudicated, except in certain circumstances (see Subsequent Applications – Adjudicators Will Limit Consideration on Subsequent Claims (DI 27510.005A.).

B. Determining Last Day of the “Period Adjudicated”

Use the charts below to determine the last day of the “period adjudicated” when adjudicating a subsequent claim or post-entitlement issues.

Exhibit 1

Determining Last Day of “Period Adjudicated”
Below Administrative Law Judge (ALJ) Hearing Level1
 

Denial

Allowance

Closed Period7

DIB or Freeze

Date DDS (or SSA) 2 approved last determination of Denial or, if earlier, the DLI3.

Date SSA approved determination of award4 or last day of waiting period5.

Date DDS (or SSA) 2 approved closed period determination or if earlier, the DLI3.

CDB

Date DDS (or SSA) 2 approved last determination of denial or, if earlier, the day before attainment of age 223.

Date SSA approved determination of award4.

Date DDS (or SSA) approved closed period determination.

DWB or CDB Reentitlement

Date DDS (or SSA) approved last determination of denial or, if earlier, the last day of the prescribed period (PP) 3.

Date SSA approved determination of award or (for DWB only) last day of waiting period5.

Date DDS or SSA approved closed period determination or if earlier, the last day of the PP3.

 

Cessation

Continuance

CDR

Date disability ceased.

Date DDS or SSA approved determination of continuance or date SSA approved determination of Resumption of Award (SSA-39256 series).

     

Footnotes:

  1. Refer to SSA mainframe system queries, Master Beneficiary Record (MBR), Supplemental Security Record (SSR), as well as the SSA-3367 and the Case Processing and Management System (CPMS), and APRS systems, to obtain the appropriate exhibit dates.

  2. When SSA approval is required, i.e., SSA has jurisdiction.

  3. When alternative dates are given, the earlier one is the last day of “period adjudicated” unless otherwise indicated in these notes.

  4. Look for the Benefit Payment Section in eView, the MBR or SSA 831, as appropriate. You may also contact the FO to have them review the A101 and the EF101 (SSA determination of award) in the Online Retrieval System (ORS) if you are unable to determine the appropriate date.

  5. Governing date when notice was sent before expiration of waiting period.

  6. Governing date where benefits had been terminated or interrupted.

  7. Since a period of disability extends the DLI, contact the FO so they can review an updated earnings record for the current DLI.

  

Exhibit 2

Determining Last Date of “Period Adjudicated”
ALJ or Appeals Council (AC) Decision1
 

Denial

Allowance

Closed Period6

DIB or Freeze

Date of ALJ decision or, if earlier, the DLI2.

Date of ALJ or AC decision.

Date of decision affirming or establishing a closed period or if earlier, the DLI2.

CDB

Date of the ALJ decision or, if earlier, the day before attainment of age 22.

Same as above.

Date of decision.

DWB or CDB Reentitle-ment

Date of ALJ decision or, if earlier, the last day of PP.

Same as above.

Date of decision or if earlier, the last day of PP.

  

 

Cessation

Continuance

CDR

Affirmation only: date disability ceased.4 Affirmation with change of cessation date: date disability ceased as decided by ALJ or AC5. (Unless the claimant is in the 6th circuit (Kentucky, Michigan, Ohio, and Tennessee) 7.

Date of ALJ or AC decision.3

   

Footnotes

  1. Refer to SSA mainframe system queries MBR, SSR, etc., as well as the SSA-3367 to obtain the appropriate exhibit dates.

  2. When alternative dates are given, the earlier one is the last day of “period adjudicated.”

  3. If the ALJ or AC decision is a continuance, there is no need to adjudicate the new application. Consider the subsequent claim a duplicate claim.

  4. If the ALJ dismissed a request for hearing, treat any new application as if no hearing request was ever filed.

  5. If the AC (without issuing decision) denies or dismisses a request for review of the ALJ's decision, the period adjudicated reverts to the ALJ decision.

  6. Since a period of disability extends the DLI, contact the FO so they can review an updated earnings record for the current DLI.

  7. In cessation cases from the Sixth Judicial Circuit, i.e., Kentucky, Michigan, Ohio, and Tennessee, the date of the final decision is the actual decision date and not the date disability ceased (see AR 92-2(6)). Also see Policy – Prior Claim at AC Level and New Application/Reconsideration Filed (DI 20101.025C).

Exhibit 3

Determining Last Date of “Period Adjudicated”
Court Decision1
 

Court Affirmed2

Court Allowance3

Initial Denial

Date of the ALJ decision or, if earlier, the DLI for a denied DIB or freeze claim, the day before attainment of age 22 for a denied CDB claim, or the last day of the prescribed period for a denied DWB claim.

Date of ALJ or AC last administrative decision.

CDR

Date ALJ or AC determined disability ceased.

Date ALJ or AC determined disability ceased.

NOTE: The period adjudicated by the court's decision is determined by the agency decision under review.

Footnotes:

  1. Refer to SSA mainframe system queries MBR, SSR, etc., as well as the SSA-3367 to obtain the appropriate exhibit dates.

  2. When a case is remanded to SSA, the period adjudicated reverts to the last SSA decision (ALJ) appealed to the court.

  3. The court rules only on evidence presented through the date of an ALJ decision.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427510001
DI 27510.001 - Period Covered by a Final Determination or Decision: "Period Adjudicated" - 09/21/2011
Batch run: 09/21/2011
Rev:09/21/2011