TN 10 (05-04)
DI 11005.050 Prescribed Period and Controlling Date
Information used to establish the prescribed period for DWB (DI 10110.001) must be accurate. Incorrect information could affect the claimant's entitlement to benefits because disability must begin before the end of the prescribed period.
1. Prescribed Period
a. Usual Case
The prescribed period fields appear on the EDCS 3367 (or complete question 6 on the SSA-3367 in EDCS exclusion claims).
NOTE: If an “E” beneficiary is filing for DWB because the “E” benefits are in suspense due to not having the number holder’s entitled child in care, the prescribed period has not yet begun.
b. Medicare-Only Claim Filed by a Mother/Father (E) Beneficiary
In this claim situation, the prescribed period has not yet begun.
NOTE: Remember that in Medicare-only cases, the prescribed period ends with the month before the month in which the claimant attains age 65, or 84 months (7 years) following the month in which the period began, whichever is earlier.
c. Verify Information
Verify information, when there is any doubt of its accuracy, through SSA records (e.g., master beneficiary records, microfiche, claims folders) or other records of probative value (e.g., death certificate, birth certificate).
2. Controlling Date
The controlling date appears on the EDCS 3367 (or enter the controlling date in question 6 on the SSA-3367 in EDCS exclusion claims). Generally, the controlling date is the latest date that onset can be established without affecting the first month of potential entitlement. However, if the alleged onset date (AOD) is after the controlling date, an established onset date that is the same as the AOD is a fully favorable established onset date.
NOTE: Remember that the controlling date for development of medical evidence may be the AOD, the potential onset date (POD), - see the chart in DI 25501.220C.1.b for POD instructions, the first day of the fifth month prior to the earliest entitlement month, the end of the prescribed period, or the date of remarriage.
C. Exhibit - Guide for Determining Prescribed Period and Controlling Date
Prescribed period begins with the latest of:
_______ Month of number holder’s (NH’s) death
_______ Last month of previous entitlement to DWB that terminated because disability ceased
_______ Last month of entitlement to E (Mother's) benefits
Prescribed period ends with the earliest of:
_______ Month before the month widow(er) attains age 60. (In Medicare - only cases, leave blank.)
_______ If filing for Medicare only, the month before the month widow(er) attains age 65
_______ Last day of 84th month following the month the prescribed period began
Select the latest of:
_______ 12 months retroactive from filing date1
_______ NH's month of death
_______ Month widow attains age 50
_______ Month after the last month of entitlement to E or DWB
_________ Indicate 1st day of 5th month before date selected in 1. above
_________ Indicate the alleged onset date or the potential onset date, (see the chart in DI 25501.220C.1.b. for POD instructions)
_________ Indicate the later date of 2. and 3. above
_________ Indicate the date the prescribed period ends
_________ Indicate the earlier of 4 and 5 above
_________ In a remarried widow(er)’s claim, indicate the date of
remarriage; otherwise, leave blank.
_________ Indicate the earlier of 6 and 7 above.
This date is the CONTROLLING DATE
1 For DWB Medicare-only claims in which the widow(er) alleges amyotrophic lateral sclerosis, enter the month of entitlement to “D” or “E” benefits.
In a remarried widow(er)'s claim, the controlling date will be established as of the date of remarriage (line 7), if the remarriage occurred after the attainment of age 50, and the date of remarriage is earlier than the controlling date that would otherwise be derived from calculations in the guide (line 6). This is because one of the requirements for entitlement as a remarried widow(er) is that the widow(er) was disabled at the time of remarriage. In such situations, the remarriage is deemed not to exist. See RS 00207.003.
Remarriage may also be deemed not to exist in a subsequent DWB claim if the disabled widow(er) was previously entitled to DWB at the time of remarriage and then subsequently had entitlement terminated due to, for example, SGA. In this situation, leave item 7 in the guide blank.
Situations that occur frequently in DWB claims:
1. Example 1
Jane Doe, age 53, filed an application on 7/7/03 stating that she became disabled on 2/15/03 because of a heart attack. The prescribed period began in 4/96 when Jane Doe was last entitled to mother's benefits and ended 4/30/03, the 84th month following the month it began. The controlling date for the development of medical evidence is 2/15/03, which is the AOD. The controlling date for the development of medical evidence is 2/15/03, which is the AOD and the POD.
2. Example 2
Anna Cervides, age 56, filed an application on 8/15/03 alleging a disability that began on 6/15/00, due to a lung condition. The prescribed period began in 6/96 when Ms. Cervides’ spouse died and ended on 6/30/03, the 84th month following the month it began. Based on the filing date, the first possible month of entitlement is 8/02. The controlling date for medical development purposes is 3/1/02. (This is the first day of the fifth month before the first possible month of entitlement.)
3. Example 3
Mary Roe, age 58, filed an application on 6/3/03 stating she has been disabled since 1/95 because of a bad back condition. The prescribed period began in 12/90 when her spouse died and ended 12/31/97, the 84th month following the month it began. Based on the filing date, the first possible month of entitlement is 6/02. However, since the claimant must establish disability before the end of the prescribed period, the controlling date for medical development purposes is 12/31/97, the last day of the prescribed period.
4. Example 4
Bertha Witwer, age 55, has been receiving E benefits since 9/96 (when her husband died) based on an entitled child in her care. At that time she had been disabled due to a heart condition but did not wish to file for DWB because of her eligibility to E benefits. On 9/25/03 she filed for entitlement to Medicare. Since she is still entitled to E benefits, her prescribed period has not yet begun. Based on the filing date, the first possible month of deemed entitlement is 9/02. The controlling date for medical development purposes is 4/1/02. (This is the first day of the fifth month prior to the first month of deemed entitlement.)
5. Example 5
Donna Viudez, born 8/15/40, has been receiving aged widow's (D) benefits since 8/00 when she attained age 60. Her husband died in 6/99. She was not previously entitled to E or DWB benefits. On 3/16/03 she filed for entitlement to Medicare alleging disability beginning 12/25/02. The prescribed period began in 6/99 and ends 7/05, the month before the month of attainment of age 65. The controlling date for medical development purposes is 12/25/02, the AOD and the POD.
6. Example 6
Jeanette Veuve, born 8/15/35, has been receiving D benefits since 8/8/95 when she attained age 60. Her spouse died in 3/95. On 3/15/03, she filed for entitlement to Medicare alleging disability as of 8/15/91. If onset is established as of 3/1/95 (5 months before the first month of entitlement to D benefits in 8/95), then she will be deemed entitled to Medicare effective 8/97—24 months after her first entitlement to D benefits. Therefore, the controlling date would be 3/1/95. (This is the first month of the prescribed period.)
7. Example 7
Mrs. Smith, age 54, files an application for DWB in 6/03. She tells us that her first husband died in 12/98 and that she remarried in 1/00. Her AOD is 3/99. If this were not a remarried widow's claim, the controlling date would be 1/02, 17 months before the month of filing. However, because disability at the time of remarriage is a factor of entitlement, her controlling date is 1/00, the date of remarriage.