DI 25501.240: Disability Freeze and Established Onset

changes
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~~Effective Dates: 11/19/2012 - Present~~
Effective Dates: 07/30/2018 - Present
TN 11 (11-12)
DI 25501.240 Disability Freeze and Established Onset
A. Policy regarding disability freeze and established onset
1. What is a Disability Freeze?
We refer to a period of disability for a worker as a “disability freeze.” For entitlement to Disability Insurance Benefits (DIB), a beneficiary needs a minimum number of years of covered employment. In addition, we compute a beneficiary’s averaged indexed earnings to derive benefit amounts for retirement and disability insurance benefits, based on his or her lifetime earnings. A beneficiary generally has little or no earnings during a period of disability. The period of disability, if used to compute the beneficiary’s retirement or disability insurance benefits, would reduce or eliminate future benefits.
To prevent the reduction or loss of future benefits, a disability freeze eliminates the years of low earnings due to disability when computing benefit amounts for certain Social Security benefits. We also freeze insured status during a disability freeze period. To qualify for a disability freeze, we must find the beneficiary met our medical and non-medical criteria for disability or blindness during the disability freeze period.
2. Earliest possible established onset date (EOD)
We establish the EOD of a period of disability on the earliest possible date based on the medical and other evidence in the file. Establishing the earliest possible EOD is important because of the following reasons.
* For DIB claims, the EOD affects the claimant’s entitlement to DIB, the amount of the monthly benefit, and the benefit payment period.
* If we subsequently terminate the claimant’s disability benefits, the EOD of a period of disability for DIB, or a disability freeze, affects later entitlement to title II benefits for the claimant or his or her family.
* The period of disability established for the current DIB, or a disability freeze, affects insured status for a subsequent period of disability, retirement or survivor’s benefits, as well as the amount of monthly disability, retirement, or survivors benefits.
EXAMPLE: Jill filed an application for DIB benefits on October 19, 2011. Her alleged onset date (AOD)/potential onset date (POD) is February 2, 2007. Disability Determination Services reviewed the claimant’s medical evidence and found she had a central nervous system vascular accident (CVA) on February 2, 2007. Because of the CVA, DDS found the severity of Jill’s condition met listing 11.04.A. as of February 2, 2007. The DDS establishes a February 2, 2007 onset date for a period of disability. Jill will not receive cash benefits retroactive to February 2, 2007, as our regulations (20 CFR 404.621) direct that a claimant can only receive benefits for up to 12-months immediately before the month in which a claimant files an application. Since Jill’s application date is more than 12 months after the onset of the period of disability, she cannot receive benefits retroactive to February 2, 2007. However, the February 2, 2007 onset date of a period of disability enhances Jill’s monthly benefit amount for both disability and retirement benefits and may preserve potential future entitlements to title II benefits for Jill and her family.
3. Expedient for the EOD in the same year and calendar quarter
In DIB cases, where the earliest possible EOD is unclear, you do not need to perform additional development to establish an exact EOD if:
* the evidence is sufficient to establish an EOD on the last day of the calendar quarter (that is, 03/31, 06/30, 09/30, or 12/31) in which the AOD, or POD if applicable, occurs and
* the EOD is more than 17 full calendar months prior to the filing date, and
* the claimant meets insured status at the EOD.
Do not apply this expedient unless all of the conditions listed above are met.
EXAMPLE: If the filing date is 02/02/2011 and the AOD is 04/07/2001, the expedient allows establishing an EOD of 06/30/2001, the last day of the same calendar quarter and year as the AOD. You do not need further development of the exact onset date if the evidence is sufficient to establish that disability began no later than 06/30/2001.
B. Component roles for disability freeze and onset
The field office and Disability Determination Services roles for establishing disability freeze and onset are as follows.
1. Field office (FO)
The FO establishes the POD at the earliest possible date to establish a “freeze” that is most beneficial to the claimant.
2. Disability Determination Services (DDS)
The DDS determines the earliest possible EOD based on medical and other factors.
C. Component instructions for disability freeze and onset
The FO and DDS take the following actions for establishing disability freeze and onset.
1. Field office (FO)
* Alert the DDS of the claimant’s earliest POD based on the AOD and other factors.
* Document the findings on the SSA-3367 (Disability Report – Field Office) and SSA-820 or SSA-821 (Work Activity Report – Self-Employed Person or Work Activity Report-- Employee), as necessary.
2. Disability Determination Services (DDS)
* Develop evidence according to procedures in DI 22505.000.
* Consider evidence that addresses the AOD or the POD annotated on the SSA-3367, SSA-820, SSA-821, and SSA-823 forms.
* Consider evidence that addresses the AOD or the annotated on the SSA-3367, SSA-820, SSA-821, and SSA-823 forms.
* Establish the earliest possible EOD that is supported by the medical evidence, the non-medical evidence, and technical factors provided by the FO.
D. References
* DI 26001.005 Title II Disability Freeze
* DI 10105.005 Eligibility for Disability Insurance benefits (DIB) or the Disability “Freeze”
* DI 26001.010 Title II Disability Freeze
* DI 10105.005 Eligibility for Disability Insurance Benefits (DIB) or the Disability “Freeze”

POMS Reference

DI 25501.240: Disability Freeze and Established Onset