DI 12586: Stieberger Case
TN 55 (08-96)
A. Policy
For title II initial and continuing entitlement and for title XVI initial entitlement, tolerances apply to the development of work activity issues and to what constitutes sufficient evidence on which to base work activity determinations.
Work activity prior to 12/01/91 will be considered in making determinations of initial disability but will not be used for assessing trial work months or for determining an SGA cesssation, termination, or suspension -- See DI 12586.001, item 11, and DI 12586.040B.5.
During the tolerance period, trial work month (TWM), trial work period (TWP), impairment-related work expense (IRWE), subsidy, unsuccessful work attempt (UWA), and substantial gainful activity (SGA) determinations may be based on readily available evidence and the class member's reasonable allegations unless there is evidence to the contrary.
(For definitions of and criteria for:
subsidy, IRWE, and SGA, see DI 10501.001ff;
UWA, see DI 11010.145;
TWP, see DI 13010.001ff.)
B. Definitions
1. Current Eligibility Period
The Stieberger CURRENT ELIGIBILITY PERIOD is the period beginning January 1st of the calendar year prior to the year in which a favorable medical decision is made under Stieberger . Full development and verification applies in this period.
2. Tolerance Period
The Stieberger TOLERANCE PERIOD is the period prior to January 1st of the year before the year in which a favorable medical decision is made under Stieberger .
3. Readily Available Evidence
Readily Available Evidence - information available to the FO at the time of interview (e.g., SEQY, DEQY, MEF, MBR, SSR, any folder(s) or development already in the FO, any documentation the individual brings to the interview, etc.).
4. Reasonable Allegations
Reasonable Allegations - allegations which a reasonable person would accept and which are not discrepant or inconsistent with readily available evidence.
C. Procedure - General
1. Tolerance Process
Follow the procedure below in developing work issues and making work determinations.
Obtain the individual's statements regarding the period(s) of work. Use the SSA-820/821, as appropriate (see DI 10510.001 ff. and DI 10505.001ff.).
Obtain readily available evidence about work (see B.3, above).
Reconcile any discrepancies between the individual's initial allegations and readily available evidence. Obtain an SSA-795, SSA-5002, etc., as appropriate. Also see GN 00301.040; GN 00301.285, and GN 00301.305 for guidance on resolving inconsistencies in an individual's statements. See g. and 2., below.
Accept reasonable allegations concerning work activity, including allegations of work months, nonwork months, sick/vacation or disability pay, subsidy, IRWE, UWA (duration, special conditions), etc., without further verification or employer contact.
Average any posted earnings among the approximate months worked when exact dates of work are unknown. (See DI 10505.015 and DI 10510.015 B.2. for additional guidance on averaging earnings and income, respectively).
Make the work issue determination (e.g., subsidy, IRWE, SGA, UWA, TWP, etc.) using the readily available evidence and the individual's allegations, unless there is evidence to the contrary. See c., above, and g. and 2., below.
See 2., below, if discrepancies cannot be reconciled or there is other evidence to the contrary (GN 00301.000ff.).
2. Exclusion to Work Issue Tolerance Process
Follow regular work issue development requirements if the individual's allegations are not reasonable or there is other evidence to the contrary (see DI 10501.00ff., DI 11010.00ff., and DI 13010.000ff.).
D. Procedure - Documentation
Document the file, including summary reports of contact (SSA-5002), SSA-820/ 821s, SSA-832/833s, etc. Annotate the Master Beneficiary Record (MBR) and/ or the SSR, as shown below, if these tolerances were used in making a work activity decision.
1. Master Beneficiary Record
Input “Special Stieberger rules used.” in the Special Message field via the CIPM screen.
2. Supplemental Security Record (SSR)
Annotate the Remarks (RMKS) segment of the SSR with “Stieberger Class Member” .