TN 1 (01-11)

DI 40105.015 Onset for DIB Less Than 5 Full Months before Full Retirement Age (FRA)

A. Waiting period applies – onset less than 5 months before FRA

When a waiting period applies and the number holder’s (NH)’s alleged onset date (AOD) is less than 5 full months before full retirement age (FRA) and no earlier onset is possible (e.g., the claimant worked at or above substantial gainful activity levels up to AOD), the Claims Authorizer (CA) will process the “X1” denial. Form SSA-831 (Disability Determination and Transmittal) is not required.

B. Waiting period applies – alleged onset is more than 5 months before FRA

In situations where the waiting period applies and the NH’s AOD is more than five full months before FRA and the Disability Determination Services (DDS) establishes an onset less than five full months before FRA, a substantive determination of onset will have been made.

The other six Program Service Centers – Disability Processing Branch, Disability Processing Specialist (DPS) must prepare an amended or revised SSA-831 using reg-basis code “X2”.

ODO will not be involved in processing these cases because the NH is over age 54.

This type of denial is limited to those cases in which the field office has established the claimant’s date of birth (see DI 11010.055).

Preparing the SSA-831 – Waiting Period Applies – Onset is More Than 5 Months before FRA

Complete the special entries for the SSA-831 as follows:

  • Item 19: Check block A

  • Item 22: Enter “X1” if onset has not been established (allegation is used). Enter “X2” if DDS has established an onset.

  • Item 27: Fully rationalize the basis for the determination. If additional space is necessary, check the second block and continue the rationale on an SSA-4268.

Prepare an SSA-567 in paperless and route the claim to the CA through the paperless process with an attached Form SSA-559 (Claims Folder/Material Transmittal), instructing the CA to process the “X2” denial through the Modernized Claims System (MCS). In addition, add necessary dictated language in the SSA-573 (Special Typing Instructions) for the CA to add to the notice.

NOTE: If the DDS has established an onset later than the AOD, the DDS should have prepared and released the personalized disability notice (PDN). If the DDS did not do so, the (DE/DPS) must prepare and release the PDN.

C. Sample standard paragraphs

The following are sample standard paragraphs that the DE/DPS can add to the SSA-573 as the situation applies.

1. NH demonstrated ability to engage in SGA despite impairment within 5 months before attaining FRA

We have determined that you are not entitled to disability benefits. A person who has been disabled for at least five full calendar months before reaching full retirement age may be eligible for disability benefits. We find the work that you did despite your disability before you reached your full retirement age, showed that you were not disabled under the law. Although a person's condition may have required reducing the hours of work or giving up the regular line of work, the person may not be entitled to disability benefits unless the disability prevents substantial gainful work in any occupation.

2. NH attained FRA in waiting period or earlier – onset established

We have determined that you are not entitled to disability benefits. To receive disability benefits, a person must be disabled at least five full calendar months before reaching full retirement age. Based upon the evidence you submitted it has been determined that your disability did not begin until (1) . According to our records, your full retirement age is (2) . You attained your full retirement age in (3) .

Fill-ins:

  1. Established onset (MM/DD/YY)

  2. Full Retirement Age

  3. Date Full Retirement Age attained (MM/YY)

3. NH attained FRA in waiting period or earlier based on alleged onset – no earlier onset possible

We have determined that you are not entitled to disability benefits. To receive disability benefits, a person must be disabled at least five full calendar months before reaching full retirement age. Since you gave (1) as the date you became disabled and you reached full retirement age in (2) you are not entitled to disability benefits.

Fill-ins:

  1. AOD (MM/DD/YY)

  2. Date Full Retirement Age attained (MM/DD/YY)