TN 60 (08-96)
DI 32586.035 Stieberger Development Period
A. Policy -- development period
DEVELOPMENT PERIODS are calculated (see B.) on a case-by-case basis including special considerations in DWB and CDB claims (see DI 12586.035F). It will often overlap with, but not be identical to, the PAYMENT PERIOD.
In most cases, the Stieberger DEVELOPMENT PERIOD will begin the 48th month immediately preceding the date of SSA's receipt of the request for review and end at the point of readjudication. In some cases, however, the DEVELOPMENT PERIOD may begin earlier or later, or may even be two (or more) non-consecutive periods in all. (See B., which contains FO rules for computing the DEVELOPMENT PERIOD.)
There are some instances in which the DDS may have to develop for the entire retroactive period. (See C. below.)
The FO will enter the basic DEVELOPMENT PERIOD on the DEVELOPMENT/PAYMENT PERIOD WORKSHEET (See DI 32586.095 Exhibit 3). The worksheet will be prong filed on the right side of the DIB jacket, just beneath the SSA-831 (if there is one).
B. Policy -- computing the development period
To compute the basic DEVELOPMENT PERIOD, FOs will (for CDB and DWB claims, see DI 12586.035F.):
Find the date SSA received the request for review in the RESPONSE DATE field on the Stieberger Court Case Alert (Exhibit 9, DI 12586.095). They may also use the 48-month chart which appears in DI 12586.095, Exhibit 12.
If the class member is deceased, FOs will follow DI 12586.035C.2.
In counting back 48 months, FOs DO NOT include:
periods the class member was already entitled (even if in suspense) to title II unreduced `A', `HA', `DWB' or CDB;
periods of entitlement (even if in suspense) for title XVI;
periods of potential entitlement to any benefit above, based on a claim pending at any administrative level or in court, regardless of whether or not consolidation is possible or has occurred;
periods covered by a medical denial/cessation decision issued while the class member was not a New York State resident; or,
years that the computer earnings query shows annual earnings levels in the SGA guidelines were exceeded. (See DI 12586.040 for a complete discussion as to how work activity may affect the DEVELOPMENT PERIOD.)
C. Policy -- developing the entire period
The DDS will have to develop all the way back to the alleged onset (or cessation month) in the earliest title II Stieberger claim, or the date claim filed (or cessation month) in the earliest title XVI Stieberger claim if the following (see 2., below) Section 10(e)(5) exception (taken from the Settlement Agreement) applies. Also, if it is necessary to develop back to the earliest retroactive date, it will be necessary to obtain the prior file(s). If an exception cannot be made under the Section 10(e)(5) criteria, a determination is prepared based on the period developed.
2. Section 10(e)(5) exception
The DDS must develop all the way back to the earliest retroactive date (see 1., above) if it is determined at any step of the sequential evaluation process that the individual was not disabled during all or part of the basic DEVELOPMENT PERIOD, i.e., the basic 48-month period, plus the period from the date of receipt of the request for review to the present, and one of the following conditions is corroborated:
The individual had a chronic impairment during the period developed; AND, she/he alleged it was more severe in the past, AND, more information is needed about any earlier acute phase (e.g., rheumatoid arthritis in major joints that was not active during the period developed, previously uncontrolled epilepsy or diabetes that was under control during the DEVELOPMENT PERIOD); OR,
His/her treating source(s) during the DEVELOPMENT PERIOD differed from his/her treating source(s) prior to the DEVELOPMENT PERIOD, or s/he had no treating source during the DEVELOPMENT PERIOD; AND, it is learned that other evidence may be available; e.g., from an earlier treating source, that may attest to a more serious impairment in the past.
NOTE: Before developing the additional period of disability, the DDS must determine whether one of the conditions above has been corroborated by the combination of a statement from the claimant, a medical report submitted by the claimant, and/or information in SSA's records (see D.1.). Exception: If the reopened case was a cessation, 10(e)(5) is deemed to be met.
The DDS will use the CORROBORATION OF STIEBERGER 10(e) (5) (i) (ii) CONDITIONS checklist (Exhibit 4, DI 32586.095) to determine whether the 10(e)(5) exception applies (see D.1.).
1. Deciding whether Section 10(e)(5) applies
To decide if Section 10(e)(5) applies:
Complete the CORROBORATION OF STIEBERGER 10(e)(5)(i)(ii) CONDITIONS checklist (Exhibit 4, DI 32586.095), record your decision as to whether to develop back to the beginning of the retroactive period, sign the checklist and place it in the Stieberger file.
Review the current evidence together with the class member's responses to the questions on the SSA-3368 (SSA-454-BK) and Stieberger supplement (Exhibit 5, DI 32586.095).
If necessary per the checklist (item B.2.), request that the claimant submit a medical report to substantiate earlier severity. Allow 30 days for a response.
IF the 10(e)(5)(i)(ii) conditions are not met, there will be no need for further development. Prepare a determination based on the basic DEVELOPMENT PERIOD.
IF the 10(e)(5)(i)(ii) conditions are met, develop back to the AOD (title II) and/or the date of application (title XVI), and request and review the prior file(s) - see 2.
2. Prior folder requests
Where the DDS determines that development of the entire retroactive period is necessary, take the following actions:
Return the green jacket to the FO citing DI 12586.035E.
Ask the FO to:
obtain the prior folder(s) and, if the prior folder(s) is UTL, reconstruct it with disability report information covering the period from AOD through the beginning of the basic DEVELOPMENT PERIOD;
obtain additional SSA-821s, as necessary;
determine the date last insured (DLI); and,
return the green jacket with the above material attached (enclosed).
3. Action upon receipt of Stieberger claims folder
Review the evidence in the prior file, per the following:
Review the Stieberger claims folder(s) and adjudicate the earlier period in accordance with the Stieberger instructions (DI 32586.001).
If the Stieberger claims folder(s) is not available, reconstruct the record to the extent feasible.
Attempt to develop gaps or conflicts in the evidence. Request any necessary additional information related to relevant gaps or conflicts from sources mentioned in the Stieberger claims folder(s) (e.g., sources identified by the claimant).
Adjudicate the earlier period (the entire DEVELOPMENT PERIOD) based on the evidence that you have.