TN 11 (11-12)

Citations:

20 CFR 404.350(a) and 20 CFR 404.351

A. Policy for the Established Onset Date (EOD) of childhood disability benefit (CDB) claims

1. Earliest possible EOD for CDB claims

For CDB claims, we establish the EOD that is most favorable to the claimant, provided the claimant meets the medical, vocational, and technical factors for disability on that date. In certain situations, an EOD later than the alleged onset date (AOD) may be fully favorable. A fully favorable EOD is one that provides the maximum allowable benefit to the claimant, even if it is after the AOD. A fully favorable EOD never disadvantages a claimant. If an EOD is later than an AOD, but is fully favorable, we may establish the later, fully favorable EOD to expedite claim processing.

2. Determining a claimant’s age

A claimant attains a particular age on the first moment of the day preceding the anniversary of his or her birth.

EXAMPLE: Amy was born on 01/15/2000. She will attain the age of 18 on 01/14/2018.

3. CDB following termination of student benefits

If a CDB claimant alleges onset prior to the termination of student benefits, the Disability Determination Services (DDS) must determine the exact date the claimant met the medical criteria for disability, if that date is on or after the date the claimant attained the age of 18. We need the date the CDB claimant attained age 18 to determine the first day of the claimant’s 24-month Medicare qualifying period.

4. EOD must be before the age of 22 for CDB claims

We must find a CDB claimant disabled before the age of 22 to meet eligibility requirements for initial entitlement. We cannot establish an EOD any later than the day before the date of attainment of age 22 in CDB claims.

EXAMPLE: Steve was born on 07/01/1986 and attains age 22 on 06/30/2008. Therefore, we must establish an EOD on or before 06/29/2008.

5. Onset at age 18 is a fully favorable EOD for CDB claims

The earliest date benefits are payable in CDB claims is the month of attainment of age 18. There is no waiting period for CDB claims. An EOD established on the last day of the month before the month of attainment of age 18 is fully favorable.

EXAMPLE: John was born on 07/01/1990. He attained the age of 18 on 06/30/2008. Therefore, an EOD on or before 05/31/2008 is fully favorable.

A claimant may file a CDB application as early as age 17 and one-half. If the DDS adjudicates the application before the claimant attains the age of 18, any date on or before the last day of the month before the month of attainment of age 18 is fully favorable, as long as the medical evidence of record supports that date.

EXAMPLE: Jodi files a CDB application at the age of 17 and seven months. The DDS reviews the application and the medical evidence and determines Jodi met the medical requirements for disability since 08/15/2008. On that date, she was 16 years old. The DDS establishes a fully favorable EOD of 08/15/2008.

CAUTION: We cannot establish an onset date in the future.

6. Two types of CDB claims-- retroactivity and re-entitlement

There are two types of CDB claims:

CDB-D (based on the earnings record of a disabled number holder) and

CDB-R (based on the earnings record of a retired or deceased number holder). There are a number of factors to consider when establishing the EOD for CDB claims.

• For initial CDB-R claims, retroactivity can be up to six months before the month of application.

• For initial CDB-D claims, retroactivity can be up to 12 months before the month of application.

• For both types of claims, an EOD that allows for full retroactivity, and we established prior to attainment of age 22, is fully favorable.

• For both types of CDB claims, if we cannot establish an exact EOD, an EOD on or prior to the last day of the month before the attainment of age 18 (if filing is prior to age 22) or prior to attainment of age 22 (if filing on or after attainment of age 23), is fully favorable.

• For both types of claims, a claimant may be re-entitled to benefits if we find he or she became disabled again within 84 months (seven years) of the termination of CDB entitlement. For CDB re-entitlement information, see DI 23505.010A.

• For both types of claims, a claimant may be re-entitled to benefits if allowed after the 84th month (seventh year), if disability ceased due to substantial gainful activity (SGA). For information on CDB reentitlement and Trial Work Period (TWP) issues, see DI 10115.040.

7. If CDB terminates

If we terminate a CDB beneficiary because the number holder’s (rather than the claimant’s) disability ceased, the EOD requirement for initial entitlement applies to subsequent CDB claims.

If CDB benefits terminate because the claimant’s disability ceased, the reason disability ceased determines the EOD requirement for re-entitlement.

• If the claimant’s entitlement to CDB benefits terminated for a reason other than the performance of SGA, a new EOD must occur within 84 months after the last entitlement to CDB benefits terminated. We call this the re-entitlement period.

• If the claimant’s disability ceased because he or she engaged in SGA, there is no EOD restriction for re-entitlement to CDB.

If we terminate the claimant’s Title II child benefits because the claimant attained age 18, and the claimant subsequently applies for CDB benefits, the field office (FO) takes a new application. The DDS EOD can be as early as the date of termination, if supported by the medical evidence of record. To determine when the FO does not need to take an application, see DI 11020.012.

8. Chart for establishing a CDB-D (disabled number holder) onset date

In the rare instance that the claimant files CDB following the termination of student benefits, do not use this chart, but refer to the instructions in footnote #1.¹

Footnotes:

¹ After the attainment of age 18, some claimants file CDB claims following termination of their Student Benefits. In this type of case, to ensure completion of the 24-month Medicare qualifying period at the earliest possible point, always establish the exact EOD if it is in or after the month of attainment of age 18, or establish the onset date as the last day of the month before the month of attainment of age 18, if the evidence establishes the EOD before the month of attainment but the exact date is unknown. For more detailed information, see DI 81010.020B.

² Either of these dates or any date before these dates is fully favorable.

³ Exact EOD may be after alleged onset date (AOD) and require a personalized disability explanation (PDE) notifying the claimant of a partially favorable allowance. See DI 25501.280 Notifying Claimants of Partially Favorable Allowances.)

9. Chart for establishing CDB-R onset (retired or deceased number holder) claims

In the rare instance that the claimant files CDB following the termination of student benefits, do not use this chart, but refer to the instructions in footnote #1.¹

Footnotes:

¹ When the claimant attains age 18, some claimants file CDB claims after we terminate his or her Student Benefits. To ensure completion of the 24-month Medicare qualifying period at the earliest possible point, we always establish the exact onset if it is in or after the month of attainment of age 18, or we establish the onset date as the last day of the month before the month of attainment of age 18, if the evidence establishes onset before the month of attainment of age 18, but the exact date is unknown. For more detailed information, see DI 81010.020B.

² Either of these dates, or any date before these dates, is fully favorable.

³ If EOD is after AOD, a personalized disability explanation (PDE) is required notifying the claimant of a partially favorable allowance. (See DI 25501.280 Notifying Claimants of Partially Favorable Allowances.)

B. Component roles and responsibilities in establishing the EOD for CDB claims

1. Field office (FO)

• The FO conducts a disability interview.

• The FO completes Form SSA-3367 (Disability Report—Field Office), providing the DDS with the claimant’s alleged onset date (AOD), potential onset date (POD), and the claimant’s protective filing date.

• The FO considers the claimant’s work history (if any), the claimant’s age at the time of the AOD, the claimant’s protective filing date, prior filings, and other technical entitlement factors when determining the POD.

• The FO alerts the DDS of the need to establish an EOD on or after the date the claimant attained the age of 18, if a CDB claimant alleges onset prior to the termination of student benefits.

2. Disability Determination Services (DDS)

If the DDS determines the claimant is disabled, the DDS establishes the earliest possible EOD the medical, vocational, and other evidence supports, based on the technical factors governing the EOD for CDB claims provided by the FO.

C. Component instructions for establishing the EOD for CDB claims

1. Field office (FO)

Take the following actions.

• For instructions concerning taking CDB applications, see DI 11020.010.

• For technical requirements and EOD development for CDB claims, information concerning when a precise onset date is not needed, and information concerning re-entitlement to CDB benefits, see DI 11020.015.

• For instructions concerning when CDB claim development is not required, see DI 11020.020.

• For forms used in CDB claims and instructions concerning development of a CDB claim, see DI 11020.025.

• If a CDB claimant alleges onset prior to the termination of student benefits, alert the DDS using EDCS, or on the SSA-3367, if the claim is an EDCS exclusion, so DDS can establish a precise onset date to determine the first day of the claimant’s 24-month Medicare qualifying period.

2. Disability Determination Services (DDS)

1. Establish onset the first day the claimant meets the requirements for disability for a CDB claim. For an initial filing, CDB benefits are only payable to claimants who are disabled prior to the attainment of age 22.

2. You do not need a precise EOD if the EOD provides for full retroactivity of benefit payment. For CDB, an EOD is fully favorable if:

   • it is on or before the last day of the month prior to the month the claimant attained age 18, or

   • the protective filing is on or after the date the claimant attained age 23, and disability began prior to the date the claimant attained age 22.

3. An EOD is fully favorable for CDB re-entitlement as of:

   • the first day of the sixth month before the month of the protective filing date for CDB-R claims.

   • the first day of the twelfth month before the month of the protective filing date for CDB-D claims.

     REMINDER: The EOD must be in the 84-month (seven-year) re-entitlement period unless previous CDB entitlement terminated because the claimant performed SGA.

4. When establishing an EOD after the date the claimant attained age 18, but prior to the date the claimant attained age 22, determine if the EOD is fully favorable. An EOD on or before the claimant’s alleged onset date (AOD) is always favorable. When the EOD is after the claimant’s AOD, consider retroactivity (see GN 00204.030) and requirements for the first month of entitlement (see DI 10115.025).

For CDB-R claims

• If the number holder is living, EOD is fully favorable on or before the first day of the sixth month before the month of protective filing.

• If the number holder is deceased, EOD is fully favorable on or before the last day of the sixth month before the month of protective filing.

For CDB-D claims

if the number holder is living, EOD is fully favorable on or before the first day of the 12^th month before the month of protective filing.

D. References

• DI 10115.001 Requirements for Entitlement to CDB

• DI 11020.010 CDB Applications

• DI 11020.015 Technical Requirements and Onset Development for CDB

• DI 11020.020 When Childhood Disability Development is Not Required

• DI 11020.025 Forms Used in CDB Claims

• DI 23505.010 CDB Re-entitlement

• GN 00302.400 Point at Which a Particular Age is Attained