Complete the special entries for the SSA-831 as follows:
Item 16: Enter “none established”
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
Route the claim to the Claims Authorizer (CA)/Claims Technical Examiner (CTE) with
an attached Form SSA-559 (Claims Folder/Material Transmittal) instructing the CA/CTE
to process the “X3” denial through the Modernized Claims System (MCS), and process
the award for aged widow(er)’s benefits if it has not already been processed.
In the event that the Disability Determination Services (DDS) has established an onset
later than the AOD, the DDS should have prepared and released the personalized disability
notice (PDN). If they did not do so, the DE/DPS must release the PDN and include paragraph
402 AOD before Age 62 Years 7 Months But Onset Cannot Be Established Before Age 62
Years 7 Months or Later – Less Than 29 Months of Past and/or Future Disability Entitlement
Prior to Age 65
We have determined that you are not entitled to Medicare coverage for the disabled.
However, you may be entitled to Medicare at age 65, whether or not you are disabled.
A person must be disabled for (1) months before his/her Medicare coverage begins. Because your condition was not disabling
on any date through (2) , your Medicare coverage could not begin until you reach age 65.
Show “29” for Disabled Widow(er)’s Claims.
Date claimant is age 62 and 7 months for waiting period cases; age 63 for no waiting
period cases. (MM/DD/YY)