BASIC (01-09)

Citations:section 223(d)(6);

20 CFR 404.1506 and Social Security Ruling 83-21

NOTE: Prisoner case restrictions do not apply to title XVI claims.

A. Potential felony-related impairment(s)

When an individual is convicted of a felony committed after October 19, 1980, determine if the individual is disabled considering all impairments. In all cases where it is determined that disability does exist, any impairment(s) arising or aggravated (but only to the extent of the aggravation) in connection with the commission of the felony must be identified. An assessment of disability must be made based on the remaining evidence alone, disregarding the felony-related impairment(s).

It is not necessary that there be a causative connection between the commission of the felony and the disabling condition, but it must be closely related to, or associated with the commission of the offense. In general, the disabling condition (the impairment(s) or the aggravation of a pre-existing impairment(s)) must have occurred at a time and location that is near (i.e., close to the time and place) to the felony. For example, injuries sustained in a motor vehicle accident while fleeing the scene of the criminal offense are closely related to, or associated with, the commission of the offense.

Most impairment(s) identified as arising in connection with a felony are of a traumatic nature, such as an impairment(s) resulting from a gunshot wound. However, since the law does not require that there must be a causative relationship between the commission of the felony and the impairment(s), some non-traumatic impairment(s) may arise in connection with the commission of a felony (e.g., Post Traumatic Stress Disorder).

Vocational factors apply in the regular manner for disability insurance benefit (DIB) and childhood disability benefit (CDB) cases, and for disabled widow(er) benefit (DWB) cases effective with monthly benefits payable for months after December 1990.

B. Not disabled when all impairments considered

When, after considering all impairments, the individual is not disabled, prepare a formal denial determination. Include the following statement in the rationale: “Impairment(s) not disabling; no effort has been made to isolate any felony-related impairment(s).”

C. Disabled when all impairments considered

When the total medical evidence indicates an individual is disabled, the following alternatives must be considered:

1. Impairment(s) not felony-related

When a felony conviction is involved, but there is no evidence that any impairment(s) arose or was aggravated in connection with the commission of this felony, prepare an allowance determination in the usual manner, and include the following statement in the rationale: “Disabling impairment(s) not felony-related.”

2. Impairment(s) felony-related

Exclude from consideration in determining disability any felony-related impairment(s) as follows:

1. Exclude an impairment(s) and resulting functional limitations if the impairment(s) is determined to have arisen “in connection with” the commission of a felony after October 19, 1980, for which the individual has been convicted.

2. Exclude the aggravation of an impairment(s) and the functional limitations attributable solely to the aggravation if a pre-existing impairment is determined to be aggravated “in connection with” the commission of a felony after October 19, 1980, for which the individual has been convicted.

3. When the impairments that are unconnected with the felony are in themselves sufficiently severe to establish disability, an allowance is warranted. This includes establishing disability on the basis of a combination of impairments. The favorable determination or decision must not include any impairment that arose, or any aggravation (of a pre-existing condition) that occurred, in connection with the commission of the felony. When an allowance determination or decision can be prepared, include the following statement in the rationale: “Disabling impairment not felony-related.”

4. When disability cannot be established without including an impairment associated with the commission of the felony, a determination of denial is prepared. Enter “608” (Prisoner Case Denied Due to Felony Related Impairment) in item 26 (List NO.) of the SSA-831 (for listing code descriptions see DI 23501.015B). Include the following statement in the rationale: “Disabling impairment felony-related.”

   NOTE: The exclusion of felony-related impairment(s) applies for the lifetime of the individual.

D. Confinement-related and felony-related impairments

When a claimant is convicted of a felony and confined, all of the medical evidence, including that for any impairment(s) arising or aggravated in connection with confinement for the conviction of the felony (as well as any felony-related impairment), must be evaluated and a determination prepared. For field office (FO) instructions on confinement-related impairments, see DI 10105.105 – Temporary Disregard of Impairments Incurred or Conditions Aggravated in Prison.

1. Not disabled when all impairments considered

When considering all impairments, the individual is not disabled, prepare a formal denial determination. Include the following statement in the rationale: “Impairment(s) not disabling; no effort has been made to isolate any felony-related or confinement-related impairment(s).”

2. Disabled when all impairments considered

First determine if any impairment arose, or if any pre-existing impairment is aggravated, “in connection with” the commission of the felony for which the individual is convicted. If after exclusion of any felony-related impairment an allowance is still warranted by the evidence, the medical evidence must then be further considered to determine the significance of any impairment arising or aggravated (but only to the extent of the aggravation) in connection with confinement in a jail, prison, or other penal institution or correctional facility for the conviction of the felony.

An impairment is considered to arise in connection with confinement, even though the impairment is not attributable to the confinement, when it first occurs during confinement (i.e., the impairment is diagnosed to have begun during confinement and there is no evidence showing that signs and symptoms occurred prior to confinement). Similarly, medical conditions that began prior to confinement and then increase in severity during confinement are considered to be “aggravated” in connection with confinement, regardless of whether the course of the condition was altered by the confinement.

Indicate consideration of any confinement-related impairment(s) as follows:

1. When disability is established based solely on impairment(s) not associated with the commission of the felony or with confinement, include the following statement in the rationale: “Disabling impairment(s) not felony-related or confinement-related.” For example, medical evidence establishes statutory blindness prior to commission of the offense.

2. When disability cannot be established without considering impairment(s) associated with confinement, a disability freeze is established for a DIB claimant (only to protect future benefit rights). For example, medical evidence establishes the diagnosis of Mesothelioma while incarcerated, with no evidence of prior respiratory issues.

3. When a disability freeze is established:

   • Change item 7 (TYPE CLAIM (Title II)) of the SSA-831 (Disability Determination and Transmittal) to indicate it is a freeze only claim. (The Disability Determination Service (DDS) intake and closure unit normally needs to perform this function.)

   • Include the following statement in the rationale: “Determination of allowance justified only when consideration is given to impairment associated with confinement. FREEZE ONLY – Not under a disability for cash benefit purposes during any month confined”.

   • Enter “623” (Prisoner Case - Freeze Only) in item 26 (List No.). For listing code descriptions see DI 23501.015B.

   NOTE: Current system limits require that the DDS convert the Certified Electronic Folder (CEF) to a paper Modular Disability Folder (MDF) prior to closing to allow for the change in case type from “DIB” to “FZ”. For instructions on closing a CEF that was converted to paper in the DDS see, DI 81020.130F.

The possibility of a freeze does not apply to CDB and DWB claimants. If disability cannot be established without consideration of an impairment associated with confinement, prepare a formal denial determination. Include the following statement in the rationale:

“Disabling impairment is confinement-related.”

Although a confinement-related impairment may not be considered in determining disability for benefits payable during confinement, it may be considered for benefit purposes after the individual has been released from prison if the individual files an application for DIB, CDB, or DWB at that time. Entitlement to benefits based on a new application can begin as early as the first full month the individual is no longer confined, provided the individual is determined to be under a disability after release from prison.