Social Security Ruling, SSR 18-01p; Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims, 49613-49616 [2018-21368]
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Federal Register / Vol. 83, No. 191 / Tuesday, October 2, 2018 / Notices
removal of one or more directors; or (3)
any other matter under either the Act or
applicable State laws affecting the
Board’s composition, size or manner of
election.
15. Each Regulated Fund’s chief
compliance officer, as defined in rule
38a–1(a)(4), will prepare an annual
report for the Board of such Regulated
Fund that evaluates (and documents the
basis of that evaluation) the Regulated
Fund’s compliance with the terms and
conditions of the application and the
procedures established to achieve such
compliance.
For the Commission, by the Division of
Investment Management, under delegated
authority.
Eduardo A. Aleman,
Assistant Secretary.
[FR Doc. 2018–21375 Filed 10–1–18; 8:45 am]
BILLING CODE 8011–01–P
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
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
(SSR).
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, nontraumatic, 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
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SUMMARY:
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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 tollfree number at 1–800–772–1213, or visit
our internet site, Social Security online,
at https://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.
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.
(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.)
Policy Interpretation
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
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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
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 fivestep 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).
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determine the claimant’s EOD.
Generally, the EOD is the earliest date
that the claimant meets both the
definition of disability and the nonmedical 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
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
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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 nonmedical 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
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).
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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.
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;
3 42
4 42
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U.S.C. 423(b); 20 CFR 404.621(a).
U.S.C. 1382(c)(7); 20 CFR 416.335.
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• 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:
[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
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
‘‘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
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).
7 42 U.S.C. 423(d)(5)(B), 1382c(a)(3)(H)(i).
8 Id.
9 20 CFR 404.1512(b)(1)(ii), 416.912(b)(1)(ii).
10 Id.
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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
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:
• 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 12month period before the month that he
or she applied for benefits.17
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 12month period before the month that he
or she applied for benefits.19
11 See
20 CFR 404.130.
20 CFR 404.335(c)(1).
13 See 20 CFR 404.350.
14 20 CFR 404.1512(b)(1)(ii).
15 See 20 CFR 404.1513, 416.913 (describing the
categories of evidence we consider).
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.
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
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12 See
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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.
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
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.
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.
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49615
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).
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.,
21 See 20 CFR 404.1513, 416.913 (describing the
categories of evidence we consider).
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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).
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
22 20
CFR 404.969, 416.1469.
CFR 404.970, 416.1470.
24 20 CFR 404.970(a)(5), (b) and 416.1470(a)(5),
(b).
23 20
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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.
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
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
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
25 20
26 20
CFR 404.1510, 416.910.
CFR 404.1574(a)(1), (c) and 416.974(a)(1),
(c).
27 20
CFR 404.988, 404.989, 416.1488, 416.1489.
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).
28 See
PO 00000
Frm 00087
Fmt 4703
Sfmt 4703
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
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2016–0034]
Social Security Ruling, SSR 18–3p;
Titles II and XVI: Failure To Follow
Prescribed Treatment
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
(SSR).
We are providing notice of
SSR 18–3p. This Ruling provides
guidance about how we apply our
failure to follow prescribed treatment
policy in disability and blindness
claims under Titles II and XVI of the
Social Security Act (Act).
DATES: We will apply this notice on
October 29, 2018.
FOR FURTHER INFORMATION CONTACT: Dan
O’Brien, Office of Vocational,
Evaluation, and Process Policy in the
Office of Disability Policy, Social
Security Administration, 6401 Security
Boulevard, Baltimore, MD 21235–6401,
410–597–1632. 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 https://
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
SUMMARY:
E:\FR\FM\02OCN1.SGM
02OCN1
Agencies
[Federal Register Volume 83, Number 191 (Tuesday, October 2, 2018)]
[Notices]
[Pages 49613-49616]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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,
[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 https://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