TN 47 (08-96)
DI 42586.055 Special Characteristics of Stieberger Reopenings
The Stieberger settlement agreement provides special development and payment rules for use in reopenings. How these special rules affect title II cases is discussed below. A complete discussion of the special Stieberger rules may be found in DI 12586.020 - DI 12586.090.
It is not usually necessary for the DDS to develop disability for the entire period. Rather, the settlement agreement permits the DDS, subject to certain exceptions explained below, to develop for a limited period, usually beginning 48 months prior to SSA's receipt of the request for review. (See B. for instructions on computing the Stieberger DEVELOPMENT PERIOD).
The Stieberger PAYMENT PERIOD may also be limited, but usually begins earlier than the DEVELOPMENT PERIOD. (See DI 42586.065 for instructions on computing the title II PAYMENT PERIOD).
The FO computes the DEVELOPMENT PERIOD and PAYMENT PERIOD prior to sending a case to the DDS.
B. Background -- Stieberger development period
The basic period of STIEBERGER medical development (`DEVELOPMENT PERIOD') generally will be the period that begins 48 months immediately preceding the date of SSA's receipt of the request for review and runs through the present. In some cases, however, the DEVELOPMENT PERIOD may begin earlier, may be less than 48 months or may even be two (or more) non-consecutive periods of up to 48 months in all. (C.1., below, contains rules for computing the DEVELOPMENT PERIOD.) The FO computes the DEVELOPMENT PERIOD.
Finally, there are some instances in which the DDS may have to develop for the entire retroactive period. The DDS decides when this must be done (see D., below).
The FO computes the DEVELOPMENT PERIOD and prong files the DEVELOPMENT/ PAYMENT PERIOD worksheet (Exhibit 9, DI 42586.095) on the right side of the DIB jacket.
The process the FOs will use to compute the DEVELOPMENT PERIOD follows the procedures below:
1. Computing the DEVELOPMENT PERIOD
Find the date SSA received the request for review in the RESPONSE DATE field on the Stieberger Court Case Flag/alert.
NOTE: The DEVELOPMENT PERIOD begins 48 months prior to the date in the RESPONSE DATE field. (A 48-month chart appears in DI 42586.095, Exhibit 10.)
However, in counting the 48 months, 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 decision issued while the class member was not a New York State resident; or,
calendar years (except the year of onset) during which posted earnings exceed SGA levels for the year. (See DI 42586.055 below for a complete discussion as to how work activity may affect the DEVELOPMENT PERIOD.)
2. Stieberger class member deceased
Where the Stieberger class member died before the Response Date, the FO's substitute the date of death for the Response Date and compute the DEVELOPMENT PERIOD in accordance with 1., above.
D. Process -- developing the entire period
The DDS develops the entire retroactive period in two situations: (1) the basic 48-month DEVELOPMENT PERIOD extends back to the AOD on the earliest title II claim or month of filing of the earliest title XVI claim, or (2) a Section 10(e)(5) exception applies (see 2., below).
2. Section 10(e)(5) exceptions
The DDS will determine whether the 10 (e) (5) exception applies based on the medical evidence on hand and that submitted by the claimant, and on the class member's responses to the disability questions on the Stieberger Supplement (DI 42586.095, Exhibit 11). The DDS must develop all the way back to the earliest retroactive date if it is determined at any step of the sequential evaluation process that the individual was not disabled during all or part of the 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 10 (e) (5) conditions is corroborated:
The individual had a chronic impairment during the DEVELOPMENT PERIOD; 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 DEVELOPMENT PERIOD, previously uncontrolled epilepsy or diabetes that was under control during the DEVELOPMENT PERIOD); OR,
His/her treating source during the 48-month DEVELOPMENT PERIOD differs from his/her treating source prior to the 48-month 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 more serious impairment in the past.
NOTE: Before developing the additional period of disability, the DDS must determine whether one of the conditions in a. or b. above has been corroborated by a combination of statements from the claimant, and a medical report submitted by the claimant or information in SSA's records.
The DDS will use a CORROBORATION OF STIEBERGER 10(e) (5) (i) (ii) CONDITIONS CHECKLIST (Exhibit 13, DI 42586.095) to determine whether the 10(e)(5) exception applies. If the 10 (e) (5) conditions are not met, the DDS will prepare a denial (or partial allowance, if appropriate) based on the basic DEVELOPMENT PERIOD. If the 10 (e) (5) conditions are met the DDS will develop back to the AOD (title II) and/or the date of application (title XVI), and prepare a determination covering the entire period.
E. Policy -- readjudicating Stieberger cessations
Readjudicating Stieberger cessations requires the following special handling because of the limitations on development and payment (see DI 12586.020):
Adjudication of the DEVELOPMENT PERIOD (DI 12586.035) generally is completed without the prior file using initial disability standards. However, if the DEVELOPMENT PERIOD extends back to the date of cessation in the Stieberger claim, special processing is needed (the prior file is obtained, the medical improvement standard (MIRS) is used, and a decision whether to use an SSA-831 or SSA-833 is made).
If all or part of the DEVELOPMENT PERIOD cannot be allowed, the claimant is deemed to meet 10(e)(5) criteria (DI 12586.035D.2.), and the case is developed back to the date of cessation using the prior folder and applying the MIRS standard.
If the case is developed back to the date of cessation and claimant is found to have a continuing disability, either a continuance or a new allowance determination is prepared, depending on whether the start of the PAYMENT PERIOD is during or after the termination month in the Stieberger claim or is later.
If a claim is not continued or allowed based on MIRS, the possibility of a later allowance sometime during the reopened period is considered.
Whether the DDS uses the MIRS will depend on whether the DDS is required to develop all the way back to the month of cessation.
Whether an SSA-831 or an SSA-832/833 (which means having offered a face-to-face hearing) is prepared by the DDS depends on whether the determination is based on MIRS, and also on whether the 48-month limit on payments prior to 12/1/91 (DI 12586.001, item 8.) prevents resumption of benefits in the month benefits were terminated by the Stieberger cessation.