When the medical determination is favorable, determine the appropriate MOE:
If you find that the claimant is under a disability and entitled to EXR in the month
of filing for EXR or the following month, you may reinstate benefits retroactively
for up to 12 months before the EXR request date, provided the claimant meets all factors
Review the “Remarks” section of the SSA-823 for the month and year of the EXR request
and the SGA determination, which will indicate the earliest month of non-SGA in the
retroactive period up to 12-months prior to the date of filing, or from the BTM, whichever
is later. In addition, the FO documents the SSA-823 in remarks, “possible retroactivity
exists prior to the month of filing.” If there is SGA in all months of the 12-month
retroactive period and in the month of filing, the first possible MOE is the month
following the month of filing. The FO documents the SSA-823 with the remarks, “SGA
in month of filing. First possible MOE is MM/YY.”
Establish the MOE to reinstated benefits. Consider the same evidence used to determine
that the claimant is under a disability based on the application of MIRS. The month
of entitlement will be the following:
the month of the EXR request,
the month after the month of the request if there is SGA in the month of filing, or
the first month in the 12-month retroactive period that all factors of entitlement
are met, whichever is earliest.
NOTE: We do not pay retroactive Title II disability benefits in EXR cases for any month
before January 1, 2001.
The MOE can be no later than the month after the month of the EXR request.
The claimant cannot have engaged in SGA in the MOE.
The claimant must meet the MIRS requirements in the MOE.
The MOE cannot be before the BTM of the previous entitlement.
EXAMPLE: Mr. Smith was previously entitled to SSDI for back problems and his earlier entitlement
terminated due to work in November 2013 (BTM). In June 2014, Mr. Smith has an accident
that reinjures his back and he is unable to work. In September 2014, he decides to
file for EXR. When the FO develops the case to send to the DDS, they provide a filing
date of September 2014 and note the following SGA and non-SGA months in the retroactive
SGA Months: 12/13, 1/14, 2/14, 3/14, 5/14
Non-SGA Months: 4/14, 6/14, 7/14, 8/14, 9/14
The DDS decides that Mr. Smith meets the medical requirements of EXR in the month
of filing (September 2014). They then look at the first non-SGA month in the retroactive
period, which is April 2014. They determine that though Mr. Smith did not perform
SGA, he did not meet the MIRS criteria in April 2014. They then look at the next non-SGA
month (June 2014) and determine that Mr. Smith did meet the MIRS criteria in that
month. Therefore, the MOE for EXR is June 2014.