TN 4 (12-09)

NOTE: For instructions on jurisdiction based on residency, see DI 20101.030A.

A. DDS jurisdiction for Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), Child Disability Benefits (CDB), and Medicare-Qualified Government Employee (MQGE) applications

1. Disability claims filed prior to date first insured

A claimant may file a disability claim many months before attaining insured status when wages are earned within the calendar year, but not yet posted as quarters of coverage (lag earnings). The field office (FO) may determine insured status up to 9 months prior to the actual accrual of the insuring quarters within that calendar year. If a claimant files a disability claim prior to meeting insured status, the FO:

• annotates the SSA-3367 (Disability Report – Field Office) with the future date of insured status, “Date first insured”, and the mm/dd/yy listed; and

• forwards the claim to the DDS for a disability determination.

NOTE: The FO cannot technically deny these claims for lack of insured status since insured status is met at some future date.

If the DDS allows the claim, the DDS:

• establishes an onset date based on the medical and other evidence in file; and

• forwards the claim to the FO.

The FO corrects the onset date to the first day of the quarter the claimant meets insured status. This date is the established onset date (EOD) and the waiting period is counted from the EOD.

The FO sends the case back to the DDS for an amended EOD and the DDS adjudicates the case accordingly if the FO later determines that it needs to amend the date first insured due to:

• insured status;

• an earlier onset date can be established; or

• other technical reasons.

REFERENCES:

• GN 00204.007B – Application Filing Date

• DI 25501.300A – Established Onset Dates (EOD) for Disability Insurance Benefit (DIB) Claims

2. New disability claim filed and a reopening, collateral estoppel, or exception to res judicata is possible

The FO may refer a case to the DDS for a new disability determination if:

• There is a possibility of a reopening;

• There is a possibility of collateral estoppel;

• A claimant was denied using medical listings that were correct when the determination was made, but have since been revised due to new policy considerations.

REFERENCES:

• DI 27505.020 – Change of Ruling or Legal Precedent (Change of Position).

• DI 27516.010 – Guides for Determining Applicability of Res Judicata.

• DI 27501.005 – Reopening and Revising a Determination or Decision.

• DI 27515.000 – Collateral Estoppel.

3. DDS receives a non-medical technical denial

The FO may request the return of a case when it discovers that it is a non-medical technical denial and a DDS determination is not warranted.

The DDS returns the case to the FO:

• For certified electronic folders (CEF), route according to the instructions in Processing “No Determination” (ND) Claims (DI 81020.127) and Electronic Case Routing Before Final Determination (DI 81020.125).

• For modular disability folders (MDF), route according to the instructions in No Determination Routing DI 32005.020.

REFERENCE:

DI 81020.115 - Processing Reopenings

4. New disability application for an unadjudicated period following a prior denial

A subsequent Title II claim filed after a disability denial is the jurisdiction of the DDS if the insured status requirement is still met after the date of the prior denial. The DDS must determine if disability is met in the unadjudicated period.

B. SSA jurisdiction for a DIB/DWB/CDB application

1. DIB freeze or DWB claim when the disability insured status or prescribed period requirement is not met on or after the alleged onset date (AOD), or potential onset date (POD), if different from the AOD

Use the chart below to determine SSA jurisdiction based on claim type, and the AOD or POD. The SSA has jurisdiction when a disability application is:

2. Subsequent DIB, Freeze, or DWB application when the disability insured status or prescribed period requirement is not met after the period adjudicated by prior determination that the claimant is not disabled

The SSA has jurisdiction when a disability application is filed and:

• The claimant's disability insured status or applicable prescribed period expired within the period adjudicated by the previous determination that he or she was not disabled; or

• The claimant’s insured status or prescribed period has expired and, although the exact date of the prior denial is unknown, it is clear that it was after the end of the date last insured or prescribed period.

NOTE: If, in either of the above situations, a claim is inadvertently sent to the DDS, the FO alerts the DDS to transfer the case back to the FO.

For exceptions, see Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions – Initial and Subsequent Cases DI 20101.001A.2.

REFERENCES:

• DI 81020.125 – Electronic Case Routing Before Final Determination

• DI 10115.040 – CDB Reentitlement Issues

• DI 11020.060 – DDS Jurisdiction and Routing

• DI 81020.075 – Field Office (FO) Determinations.

3. Childhood disability benefit (CDB) claim

a. Alleged onset date (AOD) after age 22 with no prior CDB entitlement; or prior determination that child was not disabled through age 22

The SSA has jurisdiction when:

• a child alleges traumatic onset of disability after attainment of age 22 and was not previously entitled to CDB;

• a child was previously found not disabled through age 22;

• a claimant has an impairment of a non-traumatic origin and alleges onset after age 23; or

• a claimant engaged in SGA after age 22 and a period of CDB entitlement cannot be established prior to age 22.

b. Subsequent CDB claim with AOD more than 7 years after CDB termination

The SSA has jurisdiction when:

• A subsequent disability claim has been filed by, or on behalf of, a disabled child for whom a disability determination of denial or cessation was previously made; and

• The AOD on the current claim is more than 7 years after the previous CDB terminated.

EXCEPTION: Section 420A of P.L. 108-203 allows re-entitlement to childhood disability benefits after the 7-year period if the beneficiary’s previous entitlement to disability terminated because of substantial gainful activity.

NOTE: The FO or the Program Service Center (PSC) may request DDS action if the subsequent claim is filed under one of the applicable circumstances described in DI 20101.001B.4.

REFERENCE:

DI 23505.010 — Childhood Disability Beneficiary (CDB) Reentitlement.

4. New disability application when disability was previously established and not terminated

The FO, Office of Central Operations (OCO), or the PSC has jurisdiction when a DIB, DWB, or CDB claim is filed for a claimant whose disability has been established in connection with a previous Title II claim and is not terminated (e.g., a current CDB or DWB claim is received for a claimant with a prior DIB claim). Supplemental Security Income (SSI) claims filed are the jurisdiction of the FO.

With the exception of Railroad (RR) annuitant cases, OCO or the PSC transfer claims to the DDS for any additional development relating to onset for disability benefits or continuance of disability. In DIB cases only, the SSA has jurisdiction if the case requires a determination that the established period of disability has continued up to, and including, the date of adjudication.

C. DDS jurisdiction for Title XVI-only claims

1. New disability application when disability was previously established and not terminated

Although most subsequent Title XVI claims are FO jurisdiction, there are exceptions that fall under the jurisdiction of the DDS:

• A subsequent Title XVI claim is filed by a Title II disability claimant who alleges blindness, but was not previously determined to be statutorily blind.

• A continuing disability issue pending on the Title II record at the time the subsequent Title XVI claim is filed.

• A subsequent Title XVI claim with a protective filing date earlier than the EOD for the Title II claim.

• A subsequent Title XVI claim is filed by a Black Lung miner.

2. Reversal of field office technical denial

When an FO technical denial is reversed and reactivated, the FO sends the claim to the DDS for an initial medical determination instead of a reconsideration determination. The DDS processes the claim according to the instructions in Processing Field Office (FO) Determinations DI 81020.075.

3. Aged individuals

The DDS has jurisdiction for disability or blindness determinations needed for qualified non-citizens, age 65 or older, who:

• Were lawful residents in the United States on 08/22/96;

• Are qualified non-citizens;

• Are disabled or blind as defined in the Social Security Act, regardless of age or date of onset; and

• Meet all other eligibility requirements for SSI.

a. 1619(b) eligibility for aged individual

Section 5032 of P.L. 101-508 provides that, effective 05/01/91, individuals age 65 or over may establish eligibility under Section 1619(b) provided they are found disabled or blind under SSA rules. Annotate: ”Aged Individual -1619(b) eligibility determination” on the Electronic Disability Collect System (EDCS) Routing Form, in Item 11 of the SSA-831, or in the “Remarks” field of the DI16 (Disability Transmittal) for modular disability folders (MDF).

For additional instructions, see SI 02302.030C.7.

b. Multi-category claim

A claimant may elect to change his or her claim category (e.g., from disabled to blind, or from disabled to aged) when seeking a higher state supplemental payment. Further, claimants may initially apply as disabled or blind after attaining age 65. Process these claims according to the instructions in DI 26005.005–Title XVI.

c. Non-citizens subject to sponsor deeming

A non-citizen is deemed with the income and resources of his or her immigration sponsor(s) and the sponsor’s spouse for a period of 3 years after admission into the U.S., unless, regardless of age, he or she becomes blind or disabled after admission into the U.S. for permanent residence. You can identify these cases by checking the remarks section of the 3367 in the Electronic Disability Collect System for the remark “Non-Citizen Case-Date of Admission (date). The DDS processes these cases according to the instructions in Aliens Subject to Sponsor-to-Alien Income Deeming SI 01320.900C.

NOTE: This deeming exception does not apply to individuals who are admitted to the country under “new” affidavits of support described in Sponsor-to-Alien Deeming (1996-1997 Legislation) SI 00502.200A.2.

d. Aged non-citizen

Under the Balanced Budget Act of 1997, enacted on 08/05/97, a blind or disabled non-citizen can be SSI-eligible regardless of the non-citizen’s age and date of onset of disability or blindness if he or she meets:

BOTH the following criteria:

• He or she was lawfully residing in the U.S. on 08/22/96; and

• At the time of application, is a qualified non-citizen (see Basis SSI Alien Eligibility Requirements SI 00502.100A.2.);

AND either:

• Meets an exception condition for qualified non-citizens (see Basic SSI Alien Eligibility Requirements SI 00502.100A.3.); or

• Is in one of five designated non-citizen status classifications, and the status was granted within 7 years of the date he or she filed for SSI (see Time-Limited Eligibility for Certain Aliens SI 00502.106).

D. SSA jurisdiction for Title XVI

1. SSI non-disability technical denial

If the FO forwards a claim to the DDS and later finds that the claimant is not eligible due to non-disability eligibility criteria; e.g., income or resources are not met, the FO notifies DDS to stop development and return the case immediately via an “FO determination alert” in eView.

2. Procedure for returning a claim to the FO

Upon receipt of the FO alert, the DDS:

• Stops all medical development;

• Prepares a “No Determination;”

• Transfers the claim to the FO that made the determination; and

• Sends the claim to case closure.

If the folder has already been returned to the FO as the result of a phone call or electronic notification, disregard the alert message.

NOTE: Return MDFs according to the instructions in Field Office Determinations DI 81020.075. If concurrent Title II and Title XVI paper claims are involved, the DDS stops all actions on the Title XVI claim and continues to process the Title II claim, following the routing procedures in Special Routing Principles DI 32005.005A.

REFERENCES:

• DI 81020.075 – Field Office (FO) Determinations

• DI 81020.080 – Certified Electronic Folder (CEF) Alerts

• DI 81020.127 – Processing “No Determination” (ND) Claims

• DI 81010.140 – Processing FO Determinations