VB 02507.070 SVB Relationship to Title II and Title XVI Benefits
A. POLICY — REOPENING CONCURRENT RSDI/SSI/SVB CLAIMS
1. Administrative Finality Period For RSDI and SSI Determinations/Decisions
Although SSI and SVB initial determinations cannot be reopened after 2 years have elapsed (except in cases of fraud or similar fault or other situations described in VB 02507.010B.1.c.), RSDI (title II) claims can be reopened for up to 4 years if there is good cause. (See GN 04010.001 ff. Also see SI 04070.080 for administrative finality information on concurrent RSDI/SSI claims.)
While SSI and SVB payments generally are not “concurrent” (SSI payments stop when a veteran moves abroad and begins to receive SVB payments), reopening and revision of an SSI determination/decision can give rise to reopening and revision of a determination/decision for SVB. The periods for reopening under administrative finality will usually be different for SSI and SVB benefits because of the differing dates of the respective initial determinations and must be figured independently.
2. When RSDI Revisions Will Affect SSI and/or SVB Payments
The question of revision will arise when issues common to one or more programs are involved. Changes of RSDI determinations regarding eligibility, age and benefit amount could affect SSI and/or SVB determinations.
3. Effect of 4-Year Rule on Reopening SSI and/or SVB Determinations/Decisions
A change in the amount of an RSDI benefit may affect eligibility for or the payment amount of an SSI and/or SVB payment. If a title II determination was made before the administrative finality period for SSI and/or SVB, and that determination is revised, the revision is applicable to SSI and/or SVB determinations made within the 1-year or 2-year period open to correction (see VB 02507.010B.) and/or on a prospective basis.
The change may be used to reopen actual and deemed determinations for SSI and/or SVB determinations as long as all such determinations are made within the applicable SSI or SVB administrative finality period. (See SI 04070.015 thru SI 04070.030 for a discussion of SSI deemed initial determinations. These do not apply in SVB cases.)
Determinations or decisions made before the applicable SSI and/or SVB administrative finality period cannot be reopened and revised retroactively (unless they meet the requirements for reopening at
any time), even if they are incorrect as a result of the revision to the title II benefit. However, a new initial determination (affecting prospective payment) can be made on the basis of a redetermination (see Example 2).
A veteran received concurrent RSDI/SSI benefits from 12/95 through 6/00. On 7/1/00, he became a resident of the Philippines and on 8/4/00 was notified that he was entitled to concurrent RSDI/SVB payments. (His SSI benefits were suspended in 7/00.)
On 11/13/01, SSA discovered that a clerical error had been made when the veteran's RSDI benefit was computed. The initial RSDI determination, dated 12/24/95, was based on a clerical error which was unfavorable to the beneficiary. Under the RSDI rules for administrative finality, the determination could be reopened and revised at any time. The notice of the revised determination (dated 11/19/01) indicated that the veteran's RSDI benefit was increased by $250 per month from the first month of RSDI entitlement and continuing to the present.
As a result of the revised RSDI determination, the veteran's unearned income (for SSI purposes) had to be increased by the additional $250 per month he was receiving in RSDI benefits. As a result, his unearned income was too high to meet the eligibility requirements for SSI benefits at any time from 12/95. However, the initial determination relating to his SSI payments could be reopened and revised from 12/99 through 5/00 only. (Counting back 2 years from 11/13/01, the earliest “deemed” determination that could be reopened and revised was the deemed determination of 12/1/99.) (See SI 04070.030B.1.)
The veteran's ineligibility for SSI in 12/99 made him unable to qualify for SVB payments. Since the initial determination that he qualified for SVB (dated 8/4/00) was within 2 years of the discovery of the RSDI clerical error on 11/13/01, the SVB initial determination could be reopened and revised.
A veteran was entitled to SSI payments in 1/95 at age 78. He became entitled to SVB in 6/00 on the basis of evidence establishing residence in the Philippines 6/1/00. His SSI payments were suspended in the same month.
In a redetermination interview on 6/3/03, new and material evidence came to light showing that the veteran had been living in the Philippines since 5/95. (He never reported his 1995 move abroad and filed for SVB while he was in the United States for a 3-week visit with his son.) Fraud or similar fault was not pursued on account of the veteran's age, ill health and limited ability to understand English (see VB 02507.020B.2., GN 04110.010).
The veteran's determination of SSI eligibility could not be reopened. The last deemed determination of his SSI eligibility was 5/1/00, the month before his benefits were suspended. This was more than two years before 6/03, when SSA discovered his long-time residence abroad.
The initial determination of the veteran's qualification for SVB was made in a letter of 5/11/00. This was an erroneous determination since the veteran was not eligible for SSI in 12/99 or in 5/00, the month he filed for SVB payments. However, over two years had elapsed between the SVB determination and SSA's discovery in 6/03 of the beneficiary's move to the Philippines in 5/95. Thus the SVB determination cannot be reopened retroactively, but benefits can be suspended prospectively on the basis of the redetermination.
Same facts as above except that SSA learned of and documented the beneficiary's 5/95 move to the Philippines on 8/1/01. As a result, the deemed determinations of his SSI eligibility could be reopened and revised from 8/99 through 5/00. The initial determination of his qualification for SVB could also be reopened and revised since the notice of qualification (dated 5/11/00) was within two years of SSA's affirmative action in writing dated 8/2/01.