83 FR 49613 - Social Security Ruling, SSR 18-01p; Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 83, Issue 191 (October 2, 2018)
Federal Register Volume 83, Issue 191 (October 2, 2018)
| Page Range | 49613-49616 | |
| FR Document | 2018-21368 |
[Federal Register Volume 83, Number 191 (Tuesday, October 2, 2018)] [Notices] [Pages 49613-49616] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-21368] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2017-0047] Social Security Ruling, SSR 18-01p; Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims AGENCY: Social Security Administration. ACTION: Notice of Social Security Ruling (SSR). ----------------------------------------------------------------------- SUMMARY: We are providing notice of SSR 18-01p, which rescinds and replaces SSR 83-20, ``Titles II and XVI: Onset of Disability,'' except as noted here. This SSR clarifies how we determine the EOD in disability claims under titles II and XVI of the Social Security Act (Act). Specifically, it addresses how we determine the EOD in claims that involve traumatic, non-traumatic, and exacerbating and remitting impairments. This ruling also addresses special considerations related to the EOD, such as work activity and previously adjudicated periods. Additionally, this SSR clarifies that an administrative law judge may, but is not required to, call upon the services of a medical expert, to assist with inferring the date that the claimant first met the statutory definition of disability. We concurrently published a separate SSR, SSR 18-02p, ``Titles II and XVI: Determining the Established Onset Date (EOD) in Blindness Claims,'' to discuss how we determine the EOD in statutory blindness claims. SSR 18-02p rescinds and replaces two parts of SSR 83-20. Specifically, SSR 18-02p rescinds and replaces the subsection, ``Title II: Blindness Cases,'' under the section, ``Technical Requirements and Onset of Disability''; and the subsection, ``Title XVI--Specific Onset is Necessary,'' which is also under the section ``Technical Requirements and Onset of Disability,'' as it applies to statutory blindness claims. Therefore, SSR 83-20 is completely rescinded and replaced by SSR 18-01p and SSR 18-02p. DATES: We will apply this notice on October 2, 2018. FOR FURTHER INFORMATION CONTACT: Dan O'Brien, 410-597-1632, Dan.OBrien@ssa.gov. For information on eligibility or filing for benefits, call our national toll-free number at 1-800-772-1213, or visit our internet site, Social Security online, at http://www.socialsecurity.gov. SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do not require us to publish this SSR, we are publishing it in accordance with 20 CFR 402.35(b)(1). We use SSRs to make available to the public precedential decisions relating to the Federal old age, survivors, disability, supplemental security income, and special veterans benefits programs. We may base SSRs on determinations or decisions made in our administrative review process, Federal court decisions, decisions of our Commissioner, opinions from our Office of the General Counsel, or other interpretations of law and regulations. Although SSRs do not have the same force and effect as law, they are binding on all components of the Social Security Administration in accordance with 20 CFR 402.35(b)(1). This SSR will remain in effect until we publish a notice in the Federal Register that rescinds it, or until we publish a new SSR in the Federal Register that rescinds and replaces or modifies it. (Catalog of Federal Domestic Assistance, Program Nos. 96.001, Social Security--Disability Insurance; 96.002, Social Security--Retirement Insurance; 96.004, Social Security--Survivors Insurance; 96.006, Supplemental Security Income.) Nancy A. Berryhill, Acting Commissioner of Social Security. Policy Interpretation Ruling Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims We are providing notice of SSR 18-01p, which rescinds and replaces SSR 83-20, ``Titles II and XVI: Onset of Disability,'' except as noted here. Concurrently, we published a separate SSR, SSR 18-02p, ``Titles II and XVI: Determining the Established Onset Date (EOD) in Blindness Claims,'' to discuss how we determine the EOD in statutory blindness claims. SSR 18-02p rescinds and replaces two parts of SSR 83-20. Specifically, SSR 18-02p rescinds and replaces the subsection, ``Title II: Blindness Cases,'' under the section, ``Technical Requirements and Onset of Disability''; and the subsection, ``Title XVI--Specific Onset is Necessary,'' which is also under the section ``Technical Requirements and Onset of Disability,'' as it applies to statutory blindness claims. Therefore, as of October 2, 2018, the date this SSR was published in the Federal Register, SSR 83-20 is completely rescinded and replaced by SSR 18-01p and SSR 18-02p. Purpose: This SSR explains what we mean by EOD and clarifies how we determine the EOD in disability claims under titles II and XVI of the Act. Specifically, it addresses how we determine the EOD in claims that involve traumatic, non-traumatic, and exacerbating and remitting impairments. This ruling also addresses special considerations related to the EOD, such as work activity and previously adjudicated periods. Additionally, this SSR clarifies that an administrative law judge (ALJ) may, but is not required to, call upon the services of a medical expert (ME), to assist with inferring the date that the claimant first met the statutory definition of disability. Citations: Sections 223 and 1614 of the Act, as amended; 20 CFR 404.130, 404.303, 404.315-.316, 404.320-.321, 404.335-.336, 404.350-.351, 404.988-.989, 404.1505, 404.1510, 404.1512-.1513, 404.1520, 404.1574, 416.202, 416.325, 416.905-.906, 416.910, 416.912-.913, 416.920, 416.924, 416.974, and 416.1488-.1489; 20 CFR part 404, subpart P, appendices 1 and 2. Policy Interpretation To be entitled to disability benefits under title II of the Act or to be eligible for Supplemental Security Income (SSI) payments based on disability under title XVI of the Act, a claimant must file an application, meet the statutory definition of disability,\1\ and satisfy the applicable non-medical requirements. If we find that a claimant meets the statutory definition of disability and meets the applicable non-medical requirements during the period covered by his or her application, we then [[Page 49614]] determine the claimant's EOD. Generally, the EOD is the earliest date that the claimant meets both the definition of disability and the non- medical requirements for entitlement to benefits under title II of the Act or eligibility for SSI payments under title XVI of the Act during the period covered by his or her application. Because entitlement and eligibility depend on non-medical requirements, the EOD may be later than the date the claimant first met the definition of disability, and some claimants who meet the definition of disability may not be entitled to benefits under title II or eligible for disability payments under title XVI.\2\ --------------------------------------------------------------------------- \1\ See 42 U.S.C. 423(d)(1)(A), 1382c(a)(3)(A); 20 CFR 404.1505(a), 416.905(a) (defining disability for adults); 42 U.S.C. 1382c(a)(3)(C); 20 CFR 416.906 (defining disability for children); see also 20 CFR 404.1520(a)(4), 416.920(a)(4) (setting forth the five-step sequential evaluation we use to determine disability for adults); 20 CFR 416.924 (setting forth the three-step sequential evaluation we use to determine disability for children). \2\ Under title II of the Act, a claimant may be entitled to a period of disability even though he or she does not qualify for monthly cash benefits. 20 CFR 404.320(a). --------------------------------------------------------------------------- Outline I. How do we determine the EOD? A. What are the non-medical requirements for entitlement and eligibility under the Act? B. How do we determine whether a claimant meets the statutory definition of disability and, if so, when the claimant first met that definition? 1. How do we determine when a claimant with a traumatic impairment first met the statutory definition of disability? 2. How do we determine when a claimant with a non-traumatic or exacerbating and remitting impairment first met the statutory definition of disability? 3. How do we determine when a claimant with more than one type of impairment first met the statutory definition of disability? II. What are some special considerations related to the EOD? A. How does work activity affect our determination of the EOD? B. May we determine the EOD to be in a previously adjudicated period? III. When is this SSR applicable? Discussion I. How do we determine the EOD? When we need to determine a claimant's EOD, we start by considering whether we can establish the EOD as of the claimant's potential onset date (POD) of disability. The POD is the first date when the claimant met the non-medical requirements during the period covered by his or her application. The POD is the earliest date that we consider for the EOD because it affords the claimant the maximum possible benefits for the period covered by his or her application. The POD may be the same as, earlier than, or later than the claimant's alleged onset date, which is the date that the claimant alleges he or she first met the statutory definition of disability. The period covered by an application refers to the period when a claimant may be entitled to benefits under title II or eligible for SSI payments under title XVI of the Act based on a particular application. The period covered by an application depends on the type of claim. For example, the Act and our regulations explain that if a claimant applies for disability insurance benefits under title II of the Act after the first month that he or she could have been entitled to them, he or she may receive benefits for up to 12 months immediately before the month in which the application was filed.\3\ If a claimant applies for SSI payments based on disability under title XVI of the Act after the first month that he or she meets the other eligibility requirements, we cannot make SSI payments based on disability for the month in which the application was filed or any months before that month.\4\ That is, we cannot make retroactive payments based on disability under title XVI of the Act. --------------------------------------------------------------------------- \3\ 42 U.S.C. 423(b); 20 CFR 404.621(a). \4\ 42 U.S.C. 1382(c)(7); 20 CFR 416.335. --------------------------------------------------------------------------- If the claimant meets the statutory definition of disability on his or her POD, we use the POD as the EOD because it would be the earliest date at which the claimant meets both the statutory definition of disability and the non-medical requirements for entitlement to benefits under title II or eligibility for SSI payments under title XVI during the period covered by his or her application. In contrast, if the claimant first meets the statutory definition of disability after his or her POD, we use the first date that the claimant meets both the statutory definition of disability and the applicable non-medical requirements as his or her EOD. A. What are the non-medical requirements for entitlement and eligibility under the Act? The non-medical requirements vary based on the type(s) of claim(s) the claimant filed. To illustrate, we identify below the most common types of disability claims and some of the regulations that explain the non-medical requirements for that type of claim.Disability insurance benefits: 20 CFR 404.315, 404.316, 404.320, and 404.321; Disabled widow(er)'s benefits: 20 CFR 404.335 and 404.336; Childhood disability benefits: 20 CFR 404.350 and 404.351; and Supplemental Security Income: 20 CFR 416.202 and 416.305. B. How do we determine whether a claimant meets the statutory definition of disability and, if so, when the claimant first met that definition? We need specific medical evidence to determine whether a claimant meets the statutory definition of disability. In general, an individual has a statutory obligation to provide us with the evidence to prove to us that he or she is disabled.\5\ This obligation includes providing us with evidence to prove to us when he or she first met the statutory definition of disability. The Act also precludes us from finding that an individual is disabled unless he or she submits such evidence to us.\6\ The Act further provides that we: --------------------------------------------------------------------------- \5\ To meet the statutory definition of disability, the claimant must show that he or she is unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 42 U.S.C. 423(d)(1)(A), 1382c(a)(3)(A); 20 CFR 404.1505(a), 416.905(a). \6\ 42 U.S.C. 423(d)(5)(A), 1382c(a)(3)(H)(i); 20 CFR 404.1512(a), 416.912(a). [S]hall consider all evidence available in [an] individual's case record, and shall develop a complete medical history of at least the preceding twelve months for any case in which a determination is made that the individual is not under a disability.\7\ --------------------------------------------------------------------------- \7\ 42 U.S.C. 423(d)(5)(B), 1382c(a)(3)(H)(i). --------------------------------------------------------------------------- In addition, when we make any determination, the Act requires us to: [M]ake every reasonable effort to obtain from the individual's treating physician (or other treating health care provider) all medical evidence, including diagnostic tests, necessary in order to properly make such determination, prior to evaluating medical evidence obtained from any other source on a consultative basis.\8\ --------------------------------------------------------------------------- \8\ Id. ``Complete medical history'' means the records from the claimant's medical source(s) covering at least the 12-month period preceding the month in which the claimant applied for disability benefits or SSI payments.\9\ If the claimant says his or her disability began less than 12 months before he or she applied for benefits, we will develop the claimant's complete medical history beginning with the month he or she says his or her disability began, unless we have reason to believe the claimant's disability began earlier.\10\ If applicable, we will develop the claimant's complete medical history for the 12-month period [[Page 49615]] prior to the month he or she was last insured for disability insurance benefits,\11\ the month ending the 7-year period when the claimant must establish his or her disability if he or she applied for widow's or widower's benefits based on disability,\12\ or the month the claimant attained age 22 if he or she applied for child's benefits under title II \13\ based on disability.\14\ --------------------------------------------------------------------------- \9\ 20 CFR 404.1512(b)(1)(ii), 416.912(b)(1)(ii). \10\ Id. \11\ See 20 CFR 404.130. \12\ See 20 CFR 404.335(c)(1). \13\ See 20 CFR 404.350. \14\ 20 CFR 404.1512(b)(1)(ii). --------------------------------------------------------------------------- We consider all of the evidence of record when we determine whether a claimant meets the statutory definition of disability.\15\ The period we consider depends on the type of claim and the facts of the case. For example, a claimant who has applied for disability insurance benefits under title II of the Act must show that: --------------------------------------------------------------------------- \15\ See 20 CFR 404.1513, 416.913 (describing the categories of evidence we consider). --------------------------------------------------------------------------- He or she met the statutory definition of disability before his or her insured status expired, and He or she currently meets the statutory definition of disability,\16\ or his or her disability ended within the 12-month period before the month that he or she applied for benefits.\17\ --------------------------------------------------------------------------- \16\ For a disability insurance benefits claim under title II, an adjudicator may also determine that the claimant had a closed period of disability when the claimant was disabled for at least 12 continuous months and his or her disability ceased after the month of filing, but prior to the date of adjudication. \17\ See 42 U.S.C. 416(i), 423(a)(1); 20 CFR 404.315(a), 404.320. For title II claims, if we find that the claimant did not meet the statutory definition of disability before his or her insured status expired, we will not determine whether the claimant is currently disabled or was disabled within the 12-month period before the month that he or she applied for benefits. If, however, the claimant also filed a different type of claim--for example, a claim for SSI disability payments--we may have to consider whether the claimant is currently disabled to adjudicate the SSI claim. As another example, a claimant who has applied for child's benefits --------------------------------------------------------------------------- under title II must show that: He or she met the statutory definition of disability before he or she attained age 22, and He or she currently meets the statutory definition of disability,\18\ or his or her disability ended within the 12-month period before the month that he or she applied for benefits.\19\ --------------------------------------------------------------------------- \18\ For a child's benefits claim under title II, an adjudicator may also determine that the claimant had a closed period of disability when the claimant was disabled for at least 12 continuous months and his or her disability ceased after the month of filing, but prior to the date of adjudication. \19\ See 42 U.S.C. 402(d)(1)(B), 416(i); 20 CFR 404.320, 404.350(a)(5). For a child's benefits claim under title II, if we find that the claimant did not meet the statutory definition of disability before he or she attained age 22, we will not determine whether the claimant is currently disabled or was disabled within the 12-month period before the month that he or she applied for benefits. If, however, the claimant also filed a different type of claim--for example, a claim for SSI disability payments--we may have to consider whether the claimant is currently disabled to adjudicate the SSI claim. As a final example--because we cannot make SSI payments based on disability for the month in which the application was filed or any months before that month--a claimant who has applied for SSI payments under title XVI must show that he or she currently meets the statutory definition of disability.\20\ If we find that the claimant meets the statutory definition of disability during the period under consideration, then we will determine when the claimant first met that definition. However, we will not consider whether the claimant first met the statutory definition of disability on a date that is beyond the period under consideration. --------------------------------------------------------------------------- \20\ 42 U.S.C. 1382(c)(7); 20 CFR 416.335. For a title XVI claim, an adjudicator may also determine that the claimant had a closed period of disability when the claimant was disabled for at least 12 continuous months and his or her disability ceased after the month of filing, but prior to the date of adjudication. --------------------------------------------------------------------------- 1. How do we determine when a claimant with a traumatic impairment first met the statutory definition of disability? For impairments that result from a traumatic injury or other traumatic event, we begin with the date of the traumatic event, even if the claimant worked on that date. An example of a traumatic event that could result in a traumatic injury is an automobile accident. If the evidence of record supports a finding that the claimant met the statutory definition of disability on the date of the traumatic event or traumatic injury, we will use that date as the date that the claimant first met the statutory definition of disability. 2. How do we determine when a claimant with a non-traumatic or exacerbating and remitting impairment first met the statutory definition of disability? Non-traumatic impairments may be static impairments that we do not expect to change in severity over an extended period, such as intellectual disability; impairments that we expect to improve over time, such as pathologic bone fractures caused by osteoporosis; or progressive impairments that we expect to gradually worsen over time, such as muscular dystrophy. Exacerbating and remitting impairments are impairments that diminish and intensify in severity over time, such as multiple sclerosis. When a claimant has a non-traumatic or exacerbating and remitting impairment(s), and we determine the evidence of record supports a finding that the claimant met the statutory definition of disability, we will determine the first date that the claimant met that definition. The date that the claimant first met the statutory definition of disability must be supported by the medical and other evidence \21\ and be consistent with the nature of the impairment(s). --------------------------------------------------------------------------- \21\ See 20 CFR 404.1513, 416.913 (describing the categories of evidence we consider). --------------------------------------------------------------------------- We consider whether we can find that the claimant first met the statutory definition of disability at the earliest date within the period under consideration, taking into account the date the claimant alleged that his or her disability began. We review the relevant evidence and consider, for example, the nature of the claimant's impairment; the severity of the signs, symptoms, and laboratory findings; the longitudinal history and treatment course (or lack thereof); the length of the impairment's exacerbations and remissions, if applicable; and any statement by the claimant about new or worsening signs, symptoms, and laboratory findings. The date we find that the claimant first met the statutory definition of disability may predate the claimant's earliest recorded medical examination or the date of the claimant's earliest medical records, but we will not consider whether the claimant first met the statutory definition of disability on a date that is beyond the period under consideration. If there is information in the claim(s) file that suggests that additional medical evidence relevant to the period at issue is available, we will assist with developing the record and may request existing evidence directly from a medical source or entity that maintains the evidence. We may consider evidence from other non-medical sources such as the claimant's family, friends, or former employers, if we cannot obtain additional medical evidence or it does not exist (e.g., the evidence was never created or was destroyed), and we cannot reasonably infer the date that the claimant first met the statutory definition of disability based on the medical evidence in the file. At the hearing level of our administrative review process, if the ALJ needs to infer the date that the claimant first met the statutory definition of disability, he or she may call on the services of an ME by soliciting testimony or requesting responses to written interrogatories (i.e., [[Page 49616]] written questions to be answered under oath or penalty of perjury). The decision to call on the services of an ME is always at the ALJ's discretion. Neither the claimant nor his or her representative can require an ALJ to call on the services of an ME to assist in inferring the date that the claimant first met the statutory definition of disability. The Appeals Council may review the ALJ's finding regarding when the claimant first met the statutory definition of disability, or any other finding of the ALJ, by granting a claimant's request for review or on its own motion authority.\22\ The Appeals Council may also exercise its removal authority and assume responsibility of the request for hearing. The Appeals Council will review a case if there is an error of law; the actions, findings, or conclusions of the ALJ are not supported by substantial evidence; there appears to be an abuse of discretion by the ALJ; or there is a broad policy or procedural issue that may affect the general public interest.\23\ The Appeals Council will also review a case if it receives additional evidence that meets certain requirements.\24\ If the Appeals Council grants review, it will issue its own decision or return the case to the ALJ for further proceedings, which may include obtaining evidence regarding when the claimant first met the statutory definition of disability. If the Appeals Council issues a decision, it will consider the totality of the evidence (subject to the limitations on Appeals Council consideration of additional evidence in 20 CFR 404.970 and 416.1470) and establish the date that the claimant first met the statutory definition of disability, which is both supported by the evidence and consistent with the nature of the impairment(s). --------------------------------------------------------------------------- \22\ 20 CFR 404.969, 416.1469. \23\ 20 CFR 404.970, 416.1470. \24\ 20 CFR 404.970(a)(5), (b) and 416.1470(a)(5), (b). --------------------------------------------------------------------------- 3. How do we determine when a claimant with more than one type of impairment first met the statutory definition of disability? If a claimant has a traumatic impairment and a non-traumatic or exacerbating and remitting impairment, we will consider all of the impairments in combination when determining when the claimant first met the statutory definition of disability. We will consider the date of the traumatic event as well as the evidence pertaining to the non- traumatic or exacerbating and remitting impairment and will determine the date on which the combined impairments first caused the claimant to meet the statutory definition of disability. II. What are some special considerations related to the EOD? A. How does work activity affect our determination of the EOD? We consider the date the claimant stopped performing substantial gainful activity (SGA) when we establish the EOD. SGA is work that involves doing significant and productive physical or mental duties and is done (or intended) for pay or profit.\25\ If medical and other evidence indicates the claimant's disability began on the last day he or she performed SGA, we can establish an EOD on that date, even if the claimant worked a full day. Generally, we may not determine a claimant's EOD to be before the last day that he or she performed SGA. --------------------------------------------------------------------------- \25\ 20 CFR 404.1510, 416.910. --------------------------------------------------------------------------- We may, however, determine a claimant's EOD to be before or during a period that we determine to be an unsuccessful work attempt (UWA). A UWA is an effort to do work that discontinues or reduces to the non-SGA level after a short time (no more than six months) because of the impairment or the removal of special conditions related to the impairment that are essential for the further performance of work.\26\ --------------------------------------------------------------------------- \26\ 20 CFR 404.1574(a)(1), (c) and 416.974(a)(1), (c). --------------------------------------------------------------------------- B. May we determine the EOD to be in a previously adjudicated period? Yes, if our rules for reopening are met \27\ and the claimant meets the statutory definition of disability and the applicable non-medical requirements during the previously adjudicated period.\28\ Reopening, however, is at the discretion of the adjudicator.\29\ --------------------------------------------------------------------------- \27\ 20 CFR 404.988, 404.989, 416.1488, 416.1489. \28\ See also Program Operations Manual System (POMS) DI 25501.250.A.5 (explaining when a period of disability may begin during a previously adjudicated period). \29\ 20 CFR 404.988, 416.1488 (stating that ``[a] determination, revised determination, decision, or revised decision may be reopened . . .'') (emphasis added). --------------------------------------------------------------------------- III. When is this SSR applicable? This SSR is applicable on October 2, 2018. We will use this SSR beginning on its applicable date. We will apply this SSR to new applications filed on or after the applicable date of the SSR and to claims that are pending on and after the applicable date. This means that we will use this SSR on and after its applicable date, in any case in which we make a determination or decision. We expect that Federal courts will review our final decisions using the rules that were in effect at the time we issued the decisions. If a court reverses our final decision and remands a case for further administrative proceedings after the applicable date of this SSR, we will apply this SSR to the entire period at issue in appropriate cases when we make a decision after the court's remand. [FR Doc. 2018-21368 Filed 10-1-18; 8:45 am] BILLING CODE 4191-02-P
![Federal Register / Vol. 83, No. 191 / Tuesday, October 2, 2018 / Notices 49613
removal of one or more directors; or (3) Disability’’; and the subsection, ‘‘Title blindness claims. SSR 18–02p rescinds
any other matter under either the Act or XVI—Specific Onset is Necessary,’’ and replaces two parts of SSR 83–20.
applicable State laws affecting the which is also under the section Specifically, SSR 18–02p rescinds and
Board’s composition, size or manner of ‘‘Technical Requirements and Onset of replaces the subsection, ‘‘Title II:
election. Disability,’’ as it applies to statutory Blindness Cases,’’ under the section,
15. Each Regulated Fund’s chief blindness claims. Therefore, SSR 83–20 ‘‘Technical Requirements and Onset of
compliance officer, as defined in rule is completely rescinded and replaced by Disability’’; and the subsection, ‘‘Title
38a–1(a)(4), will prepare an annual SSR 18–01p and SSR 18–02p. XVI—Specific Onset is Necessary,’’
report for the Board of such Regulated DATES: We will apply this notice on which is also under the section
Fund that evaluates (and documents the October 2, 2018. ‘‘Technical Requirements and Onset of
basis of that evaluation) the Regulated FOR FURTHER INFORMATION CONTACT: Dan Disability,’’ as it applies to statutory
Fund’s compliance with the terms and O’Brien, 410–597–1632, Dan.OBrien@ blindness claims. Therefore, as of
conditions of the application and the ssa.gov. For information on eligibility or October 2, 2018, the date this SSR was
procedures established to achieve such filing for benefits, call our national toll- published in the Federal Register, SSR
compliance. free number at 1–800–772–1213, or visit 83–20 is completely rescinded and
For the Commission, by the Division of our internet site, Social Security online, replaced by SSR 18–01p and SSR 18–
Investment Management, under delegated at http://www.socialsecurity.gov. 02p.
authority. SUPPLEMENTARY INFORMATION: Although
Purpose: This SSR explains what we
Eduardo A. Aleman, 5 U.S.C. 552(a)(1) and (a)(2) do not mean by EOD and clarifies how we
Assistant Secretary. require us to publish this SSR, we are determine the EOD in disability claims
[FR Doc. 2018–21375 Filed 10–1–18; 8:45 am] publishing it in accordance with 20 CFR under titles II and XVI of the Act.
402.35(b)(1). Specifically, it addresses how we
BILLING CODE 8011–01–P
We use SSRs to make available to the determine the EOD in claims that
public precedential decisions relating to involve traumatic, non-traumatic, and
the Federal old age, survivors, exacerbating and remitting impairments.
SOCIAL SECURITY ADMINISTRATION This ruling also addresses special
disability, supplemental security
[Docket No. SSA–2017–0047] income, and special veterans benefits considerations related to the EOD, such
programs. We may base SSRs on as work activity and previously
Social Security Ruling, SSR 18–01p; adjudicated periods. Additionally, this
determinations or decisions made in our
Titles II and XVI: Determining the SSR clarifies that an administrative law
administrative review process, Federal
Established Onset Date (EOD) in judge (ALJ) may, but is not required to,
court decisions, decisions of our
Disability Claims call upon the services of a medical
Commissioner, opinions from our Office
AGENCY: Social Security Administration. of the General Counsel, or other expert (ME), to assist with inferring the
interpretations of law and regulations. date that the claimant first met the
ACTION: Notice of Social Security Ruling
Although SSRs do not have the same statutory definition of disability.
(SSR).
force and effect as law, they are binding Citations: Sections 223 and 1614 of
SUMMARY: We are providing notice of on all components of the Social Security the Act, as amended; 20 CFR 404.130,
SSR 18–01p, which rescinds and Administration in accordance with 20 404.303, 404.315–.316, 404.320–.321,
replaces SSR 83–20, ‘‘Titles II and XVI: CFR 402.35(b)(1). 404.335–.336, 404.350–.351, 404.988–
Onset of Disability,’’ except as noted This SSR will remain in effect until .989, 404.1505, 404.1510, 404.1512–
here. This SSR clarifies how we we publish a notice in the Federal .1513, 404.1520, 404.1574, 416.202,
determine the EOD in disability claims Register that rescinds it, or until we 416.325, 416.905–.906, 416.910,
under titles II and XVI of the Social publish a new SSR in the Federal 416.912–.913, 416.920, 416.924,
Security Act (Act). Specifically, it Register that rescinds and replaces or 416.974, and 416.1488–.1489; 20 CFR
addresses how we determine the EOD in modifies it. part 404, subpart P, appendices 1 and 2.
claims that involve traumatic, non- (Catalog of Federal Domestic Assistance, Policy Interpretation
traumatic, and exacerbating and Program Nos. 96.001, Social Security—
remitting impairments. This ruling also Disability Insurance; 96.002, Social To be entitled to disability benefits
addresses special considerations related Security—Retirement Insurance; 96.004, under title II of the Act or to be eligible
to the EOD, such as work activity and Social Security—Survivors Insurance; for Supplemental Security Income (SSI)
previously adjudicated periods. 96.006, Supplemental Security Income.) payments based on disability under title
Additionally, this SSR clarifies that an XVI of the Act, a claimant must file an
administrative law judge may, but is not Nancy A. Berryhill, application, meet the statutory
required to, call upon the services of a Acting Commissioner of Social Security. definition of disability,1 and satisfy the
medical expert, to assist with inferring applicable non-medical requirements. If
Policy Interpretation Ruling we find that a claimant meets the
the date that the claimant first met the
statutory definition of disability. We Titles II and XVI: Determining the statutory definition of disability and
concurrently published a separate SSR, Established Onset Date (EOD) in meets the applicable non-medical
SSR 18–02p, ‘‘Titles II and XVI: Disability Claims requirements during the period covered
Determining the Established Onset Date We are providing notice of SSR 18– by his or her application, we then
(EOD) in Blindness Claims,’’ to discuss 01p, which rescinds and replaces SSR
amozie on DSK3GDR082PROD with NOTICES1
1 See 42 U.S.C. 423(d)(1)(A), 1382c(a)(3)(A); 20
how we determine the EOD in statutory 83–20, ‘‘Titles II and XVI: Onset of CFR 404.1505(a), 416.905(a) (defining disability for
blindness claims. SSR 18–02p rescinds Disability,’’ except as noted here. adults); 42 U.S.C. 1382c(a)(3)(C); 20 CFR 416.906
and replaces two parts of SSR 83–20. Concurrently, we published a separate (defining disability for children); see also 20 CFR
Specifically, SSR 18–02p rescinds and SSR, SSR 18–02p, ‘‘Titles II and XVI: 404.1520(a)(4), 416.920(a)(4) (setting forth the five-
step sequential evaluation we use to determine
replaces the subsection, ‘‘Title II: Determining the Established Onset Date disability for adults); 20 CFR 416.924 (setting forth
Blindness Cases,’’ under the section, (EOD) in Blindness Claims,’’ to discuss the three-step sequential evaluation we use to
‘‘Technical Requirements and Onset of how we determine the EOD in statutory determine disability for children).
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![49614 Federal Register / Vol. 83, No. 191 / Tuesday, October 2, 2018 / Notices
determine the claimant’s EOD. application. The POD may be the same • Childhood disability benefits: 20
Generally, the EOD is the earliest date as, earlier than, or later than the CFR 404.350 and 404.351; and
that the claimant meets both the claimant’s alleged onset date, which is • Supplemental Security Income: 20
definition of disability and the non- the date that the claimant alleges he or CFR 416.202 and 416.305.
medical requirements for entitlement to she first met the statutory definition of
B. How do we determine whether a
benefits under title II of the Act or disability.
The period covered by an application claimant meets the statutory definition
eligibility for SSI payments under title
refers to the period when a claimant of disability and, if so, when the
XVI of the Act during the period
may be entitled to benefits under title II claimant first met that definition?
covered by his or her application.
Because entitlement and eligibility or eligible for SSI payments under title We need specific medical evidence to
depend on non-medical requirements, XVI of the Act based on a particular determine whether a claimant meets the
the EOD may be later than the date the application. The period covered by an statutory definition of disability. In
claimant first met the definition of application depends on the type of general, an individual has a statutory
disability, and some claimants who claim. For example, the Act and our obligation to provide us with the
meet the definition of disability may not regulations explain that if a claimant evidence to prove to us that he or she
be entitled to benefits under title II or applies for disability insurance benefits is disabled.5 This obligation includes
eligible for disability payments under under title II of the Act after the first providing us with evidence to prove to
title XVI.2 month that he or she could have been us when he or she first met the statutory
entitled to them, he or she may receive definition of disability. The Act also
Outline benefits for up to 12 months precludes us from finding that an
I. How do we determine the EOD? immediately before the month in which individual is disabled unless he or she
A. What are the non-medical the application was filed.3 If a claimant submits such evidence to us.6 The Act
requirements for entitlement and applies for SSI payments based on further provides that we:
eligibility under the Act? disability under title XVI of the Act after [S]hall consider all evidence available in
B. How do we determine whether a the first month that he or she meets the [an] individual’s case record, and shall
claimant meets the statutory other eligibility requirements, we develop a complete medical history of at
definition of disability and, if so, cannot make SSI payments based on least the preceding twelve months for any
when the claimant first met that disability for the month in which the case in which a determination is made that
definition? application was filed or any months the individual is not under a disability.7
1. How do we determine when a before that month.4 That is, we cannot In addition, when we make any
claimant with a traumatic make retroactive payments based on determination, the Act requires us to:
impairment first met the statutory disability under title XVI of the Act. [M]ake every reasonable effort to obtain
definition of disability? If the claimant meets the statutory from the individual’s treating physician (or
2. How do we determine when a definition of disability on his or her other treating health care provider) all
claimant with a non-traumatic or POD, we use the POD as the EOD medical evidence, including diagnostic tests,
exacerbating and remitting because it would be the earliest date at necessary in order to properly make such
impairment first met the statutory which the claimant meets both the determination, prior to evaluating medical
evidence obtained from any other source on
definition of disability? statutory definition of disability and the
a consultative basis.8
3. How do we determine when a non-medical requirements for
claimant with more than one type entitlement to benefits under title II or ‘‘Complete medical history’’ means
of impairment first met the eligibility for SSI payments under title the records from the claimant’s medical
statutory definition of disability? XVI during the period covered by his or source(s) covering at least the 12-month
II. What are some special considerations her application. In contrast, if the period preceding the month in which
related to the EOD? claimant first meets the statutory the claimant applied for disability
A. How does work activity affect our definition of disability after his or her benefits or SSI payments.9 If the
determination of the EOD? POD, we use the first date that the claimant says his or her disability began
B. May we determine the EOD to be claimant meets both the statutory less than 12 months before he or she
in a previously adjudicated period? definition of disability and the applied for benefits, we will develop the
III. When is this SSR applicable? applicable non-medical requirements as claimant’s complete medical history
his or her EOD. beginning with the month he or she says
Discussion
his or her disability began, unless we
I. How do we determine the EOD? A. What are the non-medical have reason to believe the claimant’s
requirements for entitlement and disability began earlier.10 If applicable,
When we need to determine a eligibility under the Act?
claimant’s EOD, we start by considering we will develop the claimant’s complete
whether we can establish the EOD as of The non-medical requirements vary medical history for the 12-month period
the claimant’s potential onset date based on the type(s) of claim(s) the
(POD) of disability. The POD is the first claimant filed. To illustrate, we identify 5 To meet the statutory definition of disability, the
below the most common types of claimant must show that he or she is unable to
date when the claimant met the non- engage in any substantial gainful activity by reason
medical requirements during the period disability claims and some of the of a medically determinable physical or mental
covered by his or her application. The regulations that explain the non-medical impairment which can be expected to result in
POD is the earliest date that we consider requirements for that type of claim. death or which has lasted or can be expected to last
• Disability insurance benefits: 20 for a continuous period of not less than 12 months.
amozie on DSK3GDR082PROD with NOTICES1
for the EOD because it affords the 42 U.S.C. 423(d)(1)(A), 1382c(a)(3)(A); 20 CFR
claimant the maximum possible benefits CFR 404.315, 404.316, 404.320, and
404.1505(a), 416.905(a).
for the period covered by his or her 404.321; 6 42 U.S.C. 423(d)(5)(A), 1382c(a)(3)(H)(i); 20 CFR
• Disabled widow(er)’s benefits: 20 404.1512(a), 416.912(a).
2 Under title II of the Act, a claimant may be
CFR 404.335 and 404.336; 7 42 U.S.C. 423(d)(5)(B), 1382c(a)(3)(H)(i).
8 Id.
entitled to a period of disability even though he or
3 42 U.S.C. 423(b); 20 CFR 404.621(a). 9 20 CFR 404.1512(b)(1)(ii), 416.912(b)(1)(ii).
she does not qualify for monthly cash benefits. 20
CFR 404.320(a). 4 42 U.S.C. 1382(c)(7); 20 CFR 416.335. 10 Id.
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![49616 Federal Register / Vol. 83, No. 191 / Tuesday, October 2, 2018 / Notices
written questions to be answered under combined impairments first caused the that Federal courts will review our final
oath or penalty of perjury). The decision claimant to meet the statutory definition decisions using the rules that were in
to call on the services of an ME is of disability. effect at the time we issued the
always at the ALJ’s discretion. Neither decisions. If a court reverses our final
II. What are some special
the claimant nor his or her decision and remands a case for further
considerations related to the EOD?
representative can require an ALJ to call administrative proceedings after the
on the services of an ME to assist in A. How does work activity affect our applicable date of this SSR, we will
inferring the date that the claimant first determination of the EOD? apply this SSR to the entire period at
met the statutory definition of disability. We consider the date the claimant issue in appropriate cases when we
The Appeals Council may review the make a decision after the court’s
stopped performing substantial gainful
ALJ’s finding regarding when the remand.
activity (SGA) when we establish the
claimant first met the statutory [FR Doc. 2018–21368 Filed 10–1–18; 8:45 am]
EOD. SGA is work that involves doing
definition of disability, or any other
significant and productive physical or BILLING CODE 4191–02–P
finding of the ALJ, by granting a
mental duties and is done (or intended)
claimant’s request for review or on its
for pay or profit.25 If medical and other
own motion authority.22 The Appeals SOCIAL SECURITY ADMINISTRATION
evidence indicates the claimant’s
Council may also exercise its removal
disability began on the last day he or [Docket No. SSA–2016–0034]
authority and assume responsibility of
she performed SGA, we can establish an
the request for hearing. The Appeals
EOD on that date, even if the claimant Social Security Ruling, SSR 18–3p;
Council will review a case if there is an
worked a full day. Generally, we may Titles II and XVI: Failure To Follow
error of law; the actions, findings, or
not determine a claimant’s EOD to be Prescribed Treatment
conclusions of the ALJ are not
before the last day that he or she
supported by substantial evidence; there AGENCY: Social Security Administration.
performed SGA.
appears to be an abuse of discretion by ACTION: Notice of Social Security Ruling
We may, however, determine a
the ALJ; or there is a broad policy or (SSR).
claimant’s EOD to be before or during a
procedural issue that may affect the
period that we determine to be an SUMMARY: We are providing notice of
general public interest.23 The Appeals
unsuccessful work attempt (UWA). A SSR 18–3p. This Ruling provides
Council will also review a case if it
UWA is an effort to do work that guidance about how we apply our
receives additional evidence that meets
discontinues or reduces to the non-SGA failure to follow prescribed treatment
certain requirements.24 If the Appeals
level after a short time (no more than six policy in disability and blindness
Council grants review, it will issue its
months) because of the impairment or claims under Titles II and XVI of the
own decision or return the case to the
the removal of special conditions Social Security Act (Act).
ALJ for further proceedings, which may
related to the impairment that are
include obtaining evidence regarding DATES: We will apply this notice on
essential for the further performance of
when the claimant first met the October 29, 2018.
work.26
statutory definition of disability. If the FOR FURTHER INFORMATION CONTACT: Dan
Appeals Council issues a decision, it B. May we determine the EOD to be in O’Brien, Office of Vocational,
will consider the totality of the evidence a previously adjudicated period? Evaluation, and Process Policy in the
(subject to the limitations on Appeals Yes, if our rules for reopening are Office of Disability Policy, Social
Council consideration of additional met 27 and the claimant meets the Security Administration, 6401 Security
evidence in 20 CFR 404.970 and statutory definition of disability and the Boulevard, Baltimore, MD 21235–6401,
416.1470) and establish the date that the applicable non-medical requirements 410–597–1632. For information on
claimant first met the statutory during the previously adjudicated eligibility or filing for benefits, call our
definition of disability, which is both period.28 Reopening, however, is at the national toll-free number at 1–800–772–
supported by the evidence and discretion of the adjudicator.29 1213, or visit our internet site, Social
consistent with the nature of the Security online, at http://
impairment(s). III. When is this SSR applicable? www.socialsecurity.gov.
3. How do we determine when a This SSR is applicable on October 2, SUPPLEMENTARY INFORMATION: Although
claimant with more than one type of 2018. We will use this SSR beginning on 5 U.S.C. 552(a)(1) and (a)(2) do not
impairment first met the statutory its applicable date. We will apply this require us to publish this SSR, we are
definition of disability? SSR to new applications filed on or after publishing it in accordance with 20 CFR
the applicable date of the SSR and to 402.35(b)(1).
If a claimant has a traumatic claims that are pending on and after the
impairment and a non-traumatic or We use SSRs to make available to the
applicable date. This means that we will public precedential decisions relating to
exacerbating and remitting impairment, use this SSR on and after its applicable
we will consider all of the impairments the Federal old age, survivors,
date, in any case in which we make a disability, supplemental security
in combination when determining when determination or decision. We expect
the claimant first met the statutory income, and special veterans benefits
definition of disability. We will programs. We may base SSRs on
25 20 CFR 404.1510, 416.910.
consider the date of the traumatic event 26 20
determinations or decisions made in our
CFR 404.1574(a)(1), (c) and 416.974(a)(1),
as well as the evidence pertaining to the (c).
administrative review process, Federal
court decisions, decisions of our
amozie on DSK3GDR082PROD with NOTICES1
non-traumatic or exacerbating and 27 20 CFR 404.988, 404.989, 416.1488, 416.1489.
remitting impairment and will 28 See also Program Operations Manual System Commissioner, opinions from our Office
determine the date on which the (POMS) DI 25501.250.A.5 (explaining when a of the General Counsel, or other
period of disability may begin during a previously interpretations of law and regulations.
adjudicated period). Although SSRs do not have the same
22 20 CFR 404.969, 416.1469. 29 20 CFR 404.988, 416.1488 (stating that ‘‘[a]
23 20 CFR 404.970, 416.1470. determination, revised determination, decision, or
force and effect as law, they are binding
24 20 CFR 404.970(a)(5), (b) and 416.1470(a)(5), revised decision may be reopened . . .’’) (emphasis on all components of the Social Security
(b). added). Administration in accordance with 20
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Document Created: 2018-10-02 01:19:33
Document Modified: 2018-10-02 01:19:33
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice of Social Security Ruling (SSR). | |
| Dates | We will apply this notice on October 2, 2018. | |
| Contact | Dan O'Brien, 410-597-1632, [email protected] For information on eligibility or filing for benefits, call our national toll-free number at 1-800-772-1213, or visit our internet site, Social Security online, at http:// www.socialsecurity.gov. | |
| FR Citation | 83 FR 49613 |
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