If the claimant is disabled and entitled to EXR, we may reinstate benefits retroactively
for up to 12 months before the EXR request date, but no earlier than January 1, 2001
provided the claimant meets all factors of entitlement. The MOE is the earliest month
that the claimant did not perform SGA and met all of the EXR eligibility requirements.
If there is SGA in all months of the 12-month retro period and in the month of filing,
the first possible MOE is the month following the month of filing. The month of entitlement
cannot be before the benefit termination month (BTM) of the previous entitlement.
The MOE must be a non-SGA month. If the claimant performed SGA in the month of filing
and the following month, the FO must issue a technical denial. Normal suspension and
terminating events apply to all reinstated benefits.
MOE example: Mr. Smith was previously entitled to Social Security disability insurance (SSDI)
for back problems and his entitlement terminated due to work in January 2015. In June
2017, Mr. Smith has an accident that re-injures his back and he is unable to work.
In September 17, he requests EXR. When the FO develops the case to send to the DDS,
they document the request date of September 2017 and note the following SGA and non-SGA
months in the 12-month retroactive period:
SGA Months: September 2016, October 2016, November 2016, December 2016, January 2017,
February 2017, March 2017, and May 2017
Non-SGA Months: April 2017, June 2017, July 2017, August 2017, and September 2017
The DDS decides that Mr. Smith meets the medical requirements of EXR in the month
of filing (September 2017). They then look at the first non-SGA month in the retroactive
period, which is April 20017. They determine that although Mr. Smith did not perform
SGA, he did not meet the Medical Improvement Review Standard (MIRS) criteria in April
2017. They then look at the next non-SGA month (June 2017) and determine that Mr.
Smith did meet the MIRS criteria in that month. Therefore, the MOE for EXR is June
2017, which is the first month of the initial reinstatement period (IRP).