The Importance Of The “Disability Onset Date” In Social Security Disability Decisions
The “Disability Onset Date” (DOD) is the date that the Claimant has met the evidentiary requirements to prove “disability” as defined by the Social Security law. This date is extremely important in evaluating disability cases. For instance, if the DOD is after the Claimant has turned 50 years old, the Medical Vocational Guidelines might mandate a finding of disability. (See Age: A Crucial Factor in Your Social Security Disability Case). Conversely, if the DOD is after the “date last insured” then it doesn’t matter how disabled the Claimant is, because the Claimant is not insured, the Claimant is not entitled to Social Security Disability Benefits. (See Have I Worked Long Enough to Qualify for Social Security Disability Benefits?).
How is the Disability Onset Date Established?
In the initial application for disability benefits, the Claimant is asked for the date that they became unable to work. The response to this question will be referred to by SSA as the “alleged” DOD. The SSA will evaluate your case to determine if the Claimant meets the criteria for disability as of the date alleged. When considering how to answer this question, the Claimant should provide the date that their condition prevented them from working, not the date that the disabling condition started or was diagnosed. Thus, the alleged DOD should not be the date the Claimant was diagnosed with multiple sclerosis but the date the condition finally stopped them working.
Amending the Disability Onset Date
The Claimant can always amend their alleged DOD. Often this is done at the request of counsel after reviewing the medical records and discussing the case with the Claimant. Situations in which the Claimant may need to amend the alleged DOD are:
the Claimant worked after the alleged DOD,
a later onset date after the age of 50 will allow for the application of the Medical Vocational Guidelines (typically making it easier to establish disability), or
to conform to subsequent medical conditions which occurred after the alleged DOD (i.e., a new traumatic injury occurred after the original condition which combined with the original condition may make it easier to establish disability).
Frequently, the issue of amending the DOD is raised by the Administrative Law Judge (ALJ) at the hearing. The ALJ may have reviewed the evidence and may believe that a different (usually later) DOD may allow for a favorable decision in the case. Choosing to amend the DOD, especially at the hearing, needs to be considered carefully. On the positive side, if the ALJ has raised the issue, it most likely means that the ALJ believes that the Claimant will have met the evidentiary requirements to prove disability as of that date. Thus, amending the DOD to this new date may result in a favorable decision.
However, changing the DOD may result in a decrease in benefits. First, there may be a loss of past due benefits. For example, if the original DOD was 1/1/2010 and the Claimant amend to 1/1/2011, the Claimant may have lost out on 12 months of past due benefits. (See How do I Calculate My Past Due Benefits for Social Security Disability?). Second, by changing the DOD the Claimant may delay Medicare eligibility. Medicare benefits begin 24 months after the Claimant is first entitled to monthly disability benefits. Using the original DOD in the previous example, 1/1/2010, monthly benefits would begin in June 2010 because of the 5 month waiting period. This means that the Claimant would be entitled to Medicare in June of 2012 because of the 24 month waiting period for Medicare benefits. But if the Claimant amended the DOD to 1/1/2011, the Claimant would have to wait until June 2013 for Medicare eligibility.
Partially Favorable Decisions
The SSA sometimes unilaterally amends the DOD through a “partially favorable decision.” In these cases, the Claimant receives a partially favorable decision indicating that the SSA has decided that the Claimant is disabled but that the disability is not established until a later date — not the alleged DOD from the initial application. Typically this occurs for one of two reasons. First, the new date reflects an actual change in the Claimant’s condition as reflected in the medical records. This could be the date of a new injury, the date of a surgery, or simply a date in the medical records when the doctors indicate a definite worsening of condition. Second, the SSA may have amended the DOD to take advantage of the Medical Vocational Guidelines which make it easier to establish disability after the age of 50. In these circumstances the new DOD may just be the Claimant’s 50th birthday.
A partially favorable decision can be appealed. However, upon appeal the SSA will re-examine the entire case and consider all the issues again. The next decision could actually take away the benefits the Claimant was just awarded in the partially favorable decision. Any decision to appeal a partially favorable determination should be handled with extreme caution. The risk of losing a guaranteed source of monthly income and medical insurance benefits may outweigh the chance for some additional money in past due benefits.
By David Galinis