Ssdi HELP

bleacherspy

PEB Forum Veteran
Registered Member
#21
This is so wrong and it seems to be a trend. You should not be denied just because you are on active duty! They don't even read their own instructions. Here's what it says:

DI 10505.023 Military Service
A. General
A person in the military service who is being treated for a severe impairment usually continues to receive full pay. Therefore, for substantial gainful activity (SGA) purposes, it is not appropriate to evaluate his or her work activity based on the amount of pay received. Instead, it is generally necessary to use nonmonetary SGA criteria in assessing the work activity of a service member receiving treatment at a military hospital or working in a designated therapy program or on limited duty. That is, the adjudicator must compare the activity with similar work in the civilian work force and determine its reasonable worth. See the “NOTE” for evaluating the work activity of a Title II disability beneficiary if the exemption of work activity provision in DI 10505.020D. applies.

Severely impaired service members may, for example, be placed on limited duty status and put to work in a hospital, office, mailroom, laboratory, or the like. The controlling factor in these cases is an objective evaluation of the work activity itself, and not the service member's duty status, or whether or not a formal therapy program is involved. The fact that a therapy program or limited duty status is involved suggests that special subsidies or conditions may exist (see DI 10505.010). This requires that the adjudicator consider the real value of the work effort within the military setting and then equate its value to similar work in a nonmilitary setting.

NOTE: Under the exemption of work activity provision described in DI 10505.020D., the activities engaged in by a Title II disability beneficiary in work performed after he/she has received Title II disability benefits for 24 months, may not be used as evidence that the individual’s disability has ceased. However, the work activities engaged in by the beneficiary may be used as evidence when determining if disability has ceased if they show that the beneficiary is not engaged in SGA. Therefore, if application of the evaluation criteria in this subsection A. establishes that the work is not SGA, determine that the work does not show that the beneficiary is able to engage in SGA in a case in which the exemption of work activity provision applies. Otherwise, determine the beneficiary’s countable earnings and then apply the guides in DI 10505.020A. or in DI 10505.020B. to determine if the beneficiary is engaged in SGA for disability cessation purposes. Work performed in a therapy program or while on limited duty by a service member receiving treatment for a severe impairment generally suggests that the work is performed under special conditions, therefore pay special attention to considering only that part of the beneficiary’s earnings which are directly related to his or her own productivity when determining countable earnings. Compare the services performed in a military setting with like services performed in the civilian work force to determine the value of the actual services performed by the beneficiary for purposes of determining countable earnings before applying the SGA earnings guidelines.

B. Documentation and evaluation
1. Description of military work activities
The service member is the primary source of information about the work activities he or she performs. Documentation will help to resolve the extent of any subsidy in the military service pay and the actual worth of the limited duties.

If, however, the service member's description of duties is equivocal or apparently inaccurate, or if it shows activities not readily correlated to jobs in the civilian community, corroborative information is necessary. Military personnel having supervisory and administrative knowledge of the details and status of the limited work should be contacted. Examples of such personnel could include commanding officers or senior non-commissioned officers (for enlisted personnel).

NOTE: Army personnel carry a "Company Alert Roster" document that specifies their line of command (Squad Leader to Commander)." This roster may be helpful in identifying a contact for development of work activity.

2. Comparison of military and civilian work activities
a. Comparison based on first-hand knowledge
In some situations the service member's description of job duties may offer reasonable assurance that the work activity can be readily identified and compared to a similar type of civilian occupation, such as clerk-typist, truck mechanic, or the like. The adjudicator may be sufficiently aware of prevailing work and pay scales in the community to be able to equate the service member's job duties with those in the nonmilitary economy and to determine the worth of the services performed. In appropriate situations the file should reflect the details of such knowledge, inasmuch as the SGA determination must be made on the basis of what the service member does and how much such activity would be worth in the civilian community.

b. Comparison based on military occupation manuals
If no obvious comparison can be made between the service member’s military work duties and a civilian occupation, it may be necessary to consult the military occupation manuals. These manuals are published by each branch of military service and provide a classification system for all military service occupations for enlisted personnel, commissioned officers, and warrant officers. They describe the duties and personnel qualifications for each listed military occupation. For those occupations with a “direct, or reasonably related, civilian counterpart,” one or more “civilian source jobs” are listed according to the job code or title in the Department of Labor's Dictionary of Occupational Titles (DOT). This correlation of military service occupations with civilian jobs classified in the DOT makes the military occupation manuals an indispensable reference source for comparing military and civilian work activities. The military occupational manuals are available through the officer in charge of personnel matters at military hospitals and installations and online at http://www.careersinthemilitary.com/ . Click on “career exploration” then “alphabetical job list” for a specific job title that is cross-referenced by branch of service as well. Civilian counterpart jobs are listed here also.

Military reference materials should be used only when necessary for equating the job duties of service members with those performed in the civilian sector.

C. Comparison based on contact with other sources
Other steps may be indicated if reasonable doubt remains as to what represents an equivalent civilian job or as to how the value of the service member's work activities compares with the pay for similar civilian work. Contact may be made with employers, the U.S. Employment Service, or other informed sources of employment and vocational data, including a vocational specialist. These contacts are expected to be for advice and information gathering only, to aid judgments in the case. In some instances the military occupation manuals will not list, in conjunction with a military job, any related civilian job, or they may list only one civilian job which happens not to exist in the community in which the comparison is conducted. The title of the disabled service member's military service occupation and/or listed civilian job may, however, lead the vocational specialist to identify closely related civilian occupations discussed in the DOT with which the adjudicator may satisfactorily compare the military service occupation.

DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases
A. Claims development
Contacting military personnel can be difficult due to frequent residence changes. To ensure expeditious handling of MC/WW cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary re-contact:
  • obtain a permanent mailing address and phone number, and
  • obtain the claimant’s residence address.
The claimant’s residence address, not mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

1. Modernized Claims System/Modernized Supplemental Security Income Claims System (MCS/MSSICS)
  • Enter all claims using MCS or MSSICS, or both.
  • Take full (not deferred) Title XVI applications.
2. Electronic Disability Collection System (EDCS)
Follow the normal interviewing guidelines in DI 11005.000 Disability Interviews, which includes recording the information into EDCS.

For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases.

3. Curtailing completion of the disability report
If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary re-contact.

If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:

  • DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
  • DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820
  • The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.
4. DD Form 214 (Certificate of Release or Discharge from Active Duty)
Department of Defense issues a DD Form 214 for each period of active duty service. It contains important information for claims development.

If the claimant submits a DD Form 214(s), place a copy into the Shared Evidence Screen (EVID) or the Non-Disability Repository for Evidence (NDRed), or both.

IMPORTANT: To expedite handling of MC/WW claims, do not delay forwarding these claims to the DDS, even when the DD Form 214 is not readily available. Accept the claimant’s allegation that the disability occurred during military service without the DD Form 214 or other documentation.
For additional information, see GN 00301.310 The Non-Disability Repository for Evidentiary Documents (NDRed) Application—Overview and MSOM EVID 001.002 Shared Processes Menu (SPMN).

B. Military pay and substantial gainful activity (SGA)
Do not evaluate the claimant’s work activity based solely on military wages, without making an SGA determination, since active duty service members usually continue to receive full military pay while receiving medical treatment (for more information on evaluation and development of employment, see DI 10505.001). For example, the claimant may be working in a designated therapy program or on limited duty while receiving treatment. Instead, determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force. Always take into consideration any applicable work incentives (e.g., impairment-related work expenses [IRWE], subsidies or special conditions).

For additional information, see DI 10505.020 Evaluation Guides and DI 10505.023 Military Service.

C. Additional MC/WW considerations
1. Disability insurance benefit (DIB) offset
Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits see DI 52130.015.

2. Closed period of disability
Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant was disabled for a continuous period of at least 12 months, but at the time of adjudication the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability.
For additional information on closed period of disability, see DI 25510.010 Closed Period Under Title II and DI 25510.015 Closed Period Under Title XVI.

Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of SGA alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110 Return to Work.

3. Potential Onset Date (POD)
When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., IRWEs, subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).

Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.

For more information on completing work activity reports and claims development, see:

  • DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only),
  • DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),
  • DI 10005.005 Field Office (FO) Disability Development, and
  • DI 11005.045 Completing the Paper Form SSA–3367–F5 (Disability Report-Field Office)
D. Claims documentation
1. Development worksheet (DW01) screen in MCS/MSSICS
  • Establish a UNIT code of “___XRQ” on the DW01 screen for claimants who meet the MC/WW definition in DI 11005.003A.1.
    Use the first three characters of the unit code per local instructions (e.g., unit number, initials).
  • Establish an ISSUE of “MC/WW Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.
    Although MC/WWs are expedited following the same procedures as TERI cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence of a terminal illness.
2. Decision input (DECI) screen in MCS
Establish a listing code of 108 (for a list of the codes see GN 01040.100).

3. MC/WW flag
a. Certified electronic folder
If the MC/WW flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) to create an MC/WW flag in EDCS. The flag will alert the DDS to expedite processing of the claim.

b. Paper modular disability folder (i.e., EDCS exclusion)
Attach an MC/WW flag to the front of the folder before sending to the DDS. (See an exhibit of the MC/WW flag in DI 11005.006I in this section.)

E. Sending an MC/WW to the DDS and tracking status
MC/WW claimants may be hospitalized when you are ready to transfer the claim to the DDS. To ensure that you send the claim to the correct DDS office, verify the claimant’s actual or last known physical residence address. DDS jurisdiction is not based on the claimant’s mailing address.
For information on determining the DDS with jurisdiction of the claim, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

1. Sending an MC/WW claim to the DDS
When sending an MC/WW claim to the DDS, take the following steps:

  1. EDCS claims: Annotate the EDCS remarks section with the words “Military Casualty/Wounded Warrior Case.” For instructions on transferring a EDCS case, see DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
  2. EDCS exclusions: Send the paper case in a priority mail envelope with a “Military Casualty/Wounded Warrior Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations.
2. Verifying DDS receipt and tracking status of the claim
  • Obtain a DDS Query (DDSQ) two days after the claim is transmitted to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim is transmitted. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.
  • Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d. The Disability Interview-- Identifying Terminal Illness (TERI) Cases.
F. DDS makes a determination
For favorable DDS determinations, expedite payment action for Title II and Title XVI claims. If a Title II allowance is an earnings computation processing exclusion, take the following actions:

  1. Complete an A101/EF101 and route to the appropriate processing center (PC).
  2. Annotate the A101/EF101 in remarks indicating that it is an MC/WW case.
  3. Monitor the claim(s) through all stages of development and adjudication.
NOTE: PCs follow the special handling procedures for TERI cases. For identifying TERI cases, see DI 11005.601E. The PC Inquiry and Expediting staff is responsible for payment processing.

G. MC/WW appeals process
All MC/WW appeals receive priority handling and should be coded as instructed in DI 11005.006D.1. through DI 11005.006D.3. in this section.

1. EDCS claims process
a. Reconsideration request process
Follow these steps for processing reconsideration requests:

  • Non-prototype states: process the request using the same instructions for initial claims.
  • Prototype states (i.e., where the first level of appeal is the hearing): do not complete the reconsideration. Follow hearing request procedure in DI 11005.006G.1.b. in this section.
b. Hearing request process
Follow these steps for processing hearing requests:

  • Send the request directly to the Office of Disability Adjudication and Review (ODAR) as indicated in DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
  • If the MC/WW flag is not automatically attached to the case in EDCS, attach the flag to alert ODAR to expedite appeal processing (See DI 11005.006D.3. in this section).
c. Request for Appeals Council (AC) review process
To process requests for AC review, send the request directly to the AC as indicated in DI 81010.150 Processing Claims Appeals of Medical Decision in Electronic Disability Collect System (EDCS) and DI 12020.001 Appeals Council (AC) Review.

  • If the MC/WW flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on MC/WW flagging, see DI 11005.006D.3. in this section).
2. EDCS exclusions process
Complete and add the MC/WW flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.006I in this section.)

  1. Reconsideration request process: Refer to DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim, and DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial.
  2. Hearing request process: Follow assembly and routing instructions in DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing.
  3. Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 Appeals Council (AC) Review.
H. References
DI 10005.005 Field Office (FO) Disability Development

DI 10505.001 General – Evaluation and Development of Employment

DI 10505.020 Evaluation Guides

DI 10505.023 Military Service

DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only)

DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)

DI 11005.000 Disability Interviews

DI 11005.003 Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases

DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms

DI 11005.045 Completing the Paper Form SSA-3367–F5 (Disability Report-Field Office)

DI 11005.601 The Disability Interview – Identifying Terminal Illness (TERI) Cases

DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determinations Services (DDS)

DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim

DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

DI 12020.001 Appeals Council (AC) Review

DI 13010.110 Return to Work

DI 25510.010 Closed Period Under Title II

DI 25510.015 Closed Period Under Title XVI

DI 52130.015 Military Disability Benefits

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

DI 81010.020 Curtailing Completion of the EDCS 3368 or EDCS 3820

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)

DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)

DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

MSOM EVID 001.002 Shared Processes Menu

GN 00301.310 The Non-Disability Repository for Evidentiary Document (NDRed) Application—Overview

GN 01040.100 Listing Codes

DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing

I. Exhibit of MC/WW flag
To flag MC/WW cases, use the following printable flag.
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#22
This is so wrong and it seems to be a trend. You should not be denied just because you are on active duty! They don't even read their own instructions. Here's what it says:

DI 10505.023 Military Service
A. General
A person in the military service who is being treated for a severe impairment usually continues to receive full pay. Therefore, for substantial gainful activity (SGA) purposes, it is not appropriate to evaluate his or her work activity based on the amount of pay received. Instead, it is generally necessary to use nonmonetary SGA criteria in assessing the work activity of a service member receiving treatment at a military hospital or working in a designated therapy program or on limited duty. That is, the adjudicator must compare the activity with similar work in the civilian work force and determine its reasonable worth. See the “NOTE” for evaluating the work activity of a Title II disability beneficiary if the exemption of work activity provision in DI 10505.020D. applies.

Severely impaired service members may, for example, be placed on limited duty status and put to work in a hospital, office, mailroom, laboratory, or the like. The controlling factor in these cases is an objective evaluation of the work activity itself, and not the service member's duty status, or whether or not a formal therapy program is involved. The fact that a therapy program or limited duty status is involved suggests that special subsidies or conditions may exist (see DI 10505.010). This requires that the adjudicator consider the real value of the work effort within the military setting and then equate its value to similar work in a nonmilitary setting.

NOTE: Under the exemption of work activity provision described in DI 10505.020D., the activities engaged in by a Title II disability beneficiary in work performed after he/she has received Title II disability benefits for 24 months, may not be used as evidence that the individual’s disability has ceased. However, the work activities engaged in by the beneficiary may be used as evidence when determining if disability has ceased if they show that the beneficiary is not engaged in SGA. Therefore, if application of the evaluation criteria in this subsection A. establishes that the work is not SGA, determine that the work does not show that the beneficiary is able to engage in SGA in a case in which the exemption of work activity provision applies. Otherwise, determine the beneficiary’s countable earnings and then apply the guides in DI 10505.020A. or in DI 10505.020B. to determine if the beneficiary is engaged in SGA for disability cessation purposes. Work performed in a therapy program or while on limited duty by a service member receiving treatment for a severe impairment generally suggests that the work is performed under special conditions, therefore pay special attention to considering only that part of the beneficiary’s earnings which are directly related to his or her own productivity when determining countable earnings. Compare the services performed in a military setting with like services performed in the civilian work force to determine the value of the actual services performed by the beneficiary for purposes of determining countable earnings before applying the SGA earnings guidelines.

B. Documentation and evaluation
1. Description of military work activities
The service member is the primary source of information about the work activities he or she performs. Documentation will help to resolve the extent of any subsidy in the military service pay and the actual worth of the limited duties.

If, however, the service member's description of duties is equivocal or apparently inaccurate, or if it shows activities not readily correlated to jobs in the civilian community, corroborative information is necessary. Military personnel having supervisory and administrative knowledge of the details and status of the limited work should be contacted. Examples of such personnel could include commanding officers or senior non-commissioned officers (for enlisted personnel).

NOTE: Army personnel carry a "Company Alert Roster" document that specifies their line of command (Squad Leader to Commander)." This roster may be helpful in identifying a contact for development of work activity.

2. Comparison of military and civilian work activities
a. Comparison based on first-hand knowledge
In some situations the service member's description of job duties may offer reasonable assurance that the work activity can be readily identified and compared to a similar type of civilian occupation, such as clerk-typist, truck mechanic, or the like. The adjudicator may be sufficiently aware of prevailing work and pay scales in the community to be able to equate the service member's job duties with those in the nonmilitary economy and to determine the worth of the services performed. In appropriate situations the file should reflect the details of such knowledge, inasmuch as the SGA determination must be made on the basis of what the service member does and how much such activity would be worth in the civilian community.

b. Comparison based on military occupation manuals
If no obvious comparison can be made between the service member’s military work duties and a civilian occupation, it may be necessary to consult the military occupation manuals. These manuals are published by each branch of military service and provide a classification system for all military service occupations for enlisted personnel, commissioned officers, and warrant officers. They describe the duties and personnel qualifications for each listed military occupation. For those occupations with a “direct, or reasonably related, civilian counterpart,” one or more “civilian source jobs” are listed according to the job code or title in the Department of Labor's Dictionary of Occupational Titles (DOT). This correlation of military service occupations with civilian jobs classified in the DOT makes the military occupation manuals an indispensable reference source for comparing military and civilian work activities. The military occupational manuals are available through the officer in charge of personnel matters at military hospitals and installations and online at http://www.careersinthemilitary.com/ . Click on “career exploration” then “alphabetical job list” for a specific job title that is cross-referenced by branch of service as well. Civilian counterpart jobs are listed here also.

Military reference materials should be used only when necessary for equating the job duties of service members with those performed in the civilian sector.

C. Comparison based on contact with other sources
Other steps may be indicated if reasonable doubt remains as to what represents an equivalent civilian job or as to how the value of the service member's work activities compares with the pay for similar civilian work. Contact may be made with employers, the U.S. Employment Service, or other informed sources of employment and vocational data, including a vocational specialist. These contacts are expected to be for advice and information gathering only, to aid judgments in the case. In some instances the military occupation manuals will not list, in conjunction with a military job, any related civilian job, or they may list only one civilian job which happens not to exist in the community in which the comparison is conducted. The title of the disabled service member's military service occupation and/or listed civilian job may, however, lead the vocational specialist to identify closely related civilian occupations discussed in the DOT with which the adjudicator may satisfactorily compare the military service occupation.

DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases
A. Claims development
Contacting military personnel can be difficult due to frequent residence changes. To ensure expeditious handling of MC/WW cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary re-contact:
  • obtain a permanent mailing address and phone number, and
  • obtain the claimant’s residence address.
The claimant’s residence address, not mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

1. Modernized Claims System/Modernized Supplemental Security Income Claims System (MCS/MSSICS)
  • Enter all claims using MCS or MSSICS, or both.
  • Take full (not deferred) Title XVI applications.
2. Electronic Disability Collection System (EDCS)
Follow the normal interviewing guidelines in DI 11005.000 Disability Interviews, which includes recording the information into EDCS.

For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases.

3. Curtailing completion of the disability report
If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary re-contact.

If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:

  • DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
  • DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820
  • The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.
4. DD Form 214 (Certificate of Release or Discharge from Active Duty)
Department of Defense issues a DD Form 214 for each period of active duty service. It contains important information for claims development.

If the claimant submits a DD Form 214(s), place a copy into the Shared Evidence Screen (EVID) or the Non-Disability Repository for Evidence (NDRed), or both.

IMPORTANT: To expedite handling of MC/WW claims, do not delay forwarding these claims to the DDS, even when the DD Form 214 is not readily available. Accept the claimant’s allegation that the disability occurred during military service without the DD Form 214 or other documentation.
For additional information, see GN 00301.310 The Non-Disability Repository for Evidentiary Documents (NDRed) Application—Overview and MSOM EVID 001.002 Shared Processes Menu (SPMN).

B. Military pay and substantial gainful activity (SGA)
Do not evaluate the claimant’s work activity based solely on military wages, without making an SGA determination, since active duty service members usually continue to receive full military pay while receiving medical treatment (for more information on evaluation and development of employment, see DI 10505.001). For example, the claimant may be working in a designated therapy program or on limited duty while receiving treatment. Instead, determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force. Always take into consideration any applicable work incentives (e.g., impairment-related work expenses [IRWE], subsidies or special conditions).

For additional information, see DI 10505.020 Evaluation Guides and DI 10505.023 Military Service.

C. Additional MC/WW considerations
1. Disability insurance benefit (DIB) offset
Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits see DI 52130.015.

2. Closed period of disability
Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant was disabled for a continuous period of at least 12 months, but at the time of adjudication the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability.
For additional information on closed period of disability, see DI 25510.010 Closed Period Under Title II and DI 25510.015 Closed Period Under Title XVI.

Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of SGA alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110 Return to Work.

3. Potential Onset Date (POD)
When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., IRWEs, subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).

Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.

For more information on completing work activity reports and claims development, see:

  • DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only),
  • DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),
  • DI 10005.005 Field Office (FO) Disability Development, and
  • DI 11005.045 Completing the Paper Form SSA–3367–F5 (Disability Report-Field Office)
D. Claims documentation
1. Development worksheet (DW01) screen in MCS/MSSICS
  • Establish a UNIT code of “___XRQ” on the DW01 screen for claimants who meet the MC/WW definition in DI 11005.003A.1.
    Use the first three characters of the unit code per local instructions (e.g., unit number, initials).
  • Establish an ISSUE of “MC/WW Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.
    Although MC/WWs are expedited following the same procedures as TERI cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence of a terminal illness.
2. Decision input (DECI) screen in MCS
Establish a listing code of 108 (for a list of the codes see GN 01040.100).

3. MC/WW flag
a. Certified electronic folder
If the MC/WW flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) to create an MC/WW flag in EDCS. The flag will alert the DDS to expedite processing of the claim.

b. Paper modular disability folder (i.e., EDCS exclusion)
Attach an MC/WW flag to the front of the folder before sending to the DDS. (See an exhibit of the MC/WW flag in DI 11005.006I in this section.)

E. Sending an MC/WW to the DDS and tracking status
MC/WW claimants may be hospitalized when you are ready to transfer the claim to the DDS. To ensure that you send the claim to the correct DDS office, verify the claimant’s actual or last known physical residence address. DDS jurisdiction is not based on the claimant’s mailing address.
For information on determining the DDS with jurisdiction of the claim, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

1. Sending an MC/WW claim to the DDS
When sending an MC/WW claim to the DDS, take the following steps:

  1. EDCS claims: Annotate the EDCS remarks section with the words “Military Casualty/Wounded Warrior Case.” For instructions on transferring a EDCS case, see DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
  2. EDCS exclusions: Send the paper case in a priority mail envelope with a “Military Casualty/Wounded Warrior Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations.
2. Verifying DDS receipt and tracking status of the claim
  • Obtain a DDS Query (DDSQ) two days after the claim is transmitted to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim is transmitted. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.
  • Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d. The Disability Interview-- Identifying Terminal Illness (TERI) Cases.
F. DDS makes a determination
For favorable DDS determinations, expedite payment action for Title II and Title XVI claims. If a Title II allowance is an earnings computation processing exclusion, take the following actions:

  1. Complete an A101/EF101 and route to the appropriate processing center (PC).
  2. Annotate the A101/EF101 in remarks indicating that it is an MC/WW case.
  3. Monitor the claim(s) through all stages of development and adjudication.
NOTE: PCs follow the special handling procedures for TERI cases. For identifying TERI cases, see DI 11005.601E. The PC Inquiry and Expediting staff is responsible for payment processing.

G. MC/WW appeals process
All MC/WW appeals receive priority handling and should be coded as instructed in DI 11005.006D.1. through DI 11005.006D.3. in this section.

1. EDCS claims process
a. Reconsideration request process
Follow these steps for processing reconsideration requests:

  • Non-prototype states: process the request using the same instructions for initial claims.
  • Prototype states (i.e., where the first level of appeal is the hearing): do not complete the reconsideration. Follow hearing request procedure in DI 11005.006G.1.b. in this section.
b. Hearing request process
Follow these steps for processing hearing requests:

  • Send the request directly to the Office of Disability Adjudication and Review (ODAR) as indicated in DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
  • If the MC/WW flag is not automatically attached to the case in EDCS, attach the flag to alert ODAR to expedite appeal processing (See DI 11005.006D.3. in this section).
c. Request for Appeals Council (AC) review process
To process requests for AC review, send the request directly to the AC as indicated in DI 81010.150 Processing Claims Appeals of Medical Decision in Electronic Disability Collect System (EDCS) and DI 12020.001 Appeals Council (AC) Review.

  • If the MC/WW flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on MC/WW flagging, see DI 11005.006D.3. in this section).
2. EDCS exclusions process
Complete and add the MC/WW flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.006I in this section.)

  1. Reconsideration request process: Refer to DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim, and DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial.
  2. Hearing request process: Follow assembly and routing instructions in DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing.
  3. Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 Appeals Council (AC) Review.
H. References
DI 10005.005 Field Office (FO) Disability Development

DI 10505.001 General – Evaluation and Development of Employment

DI 10505.020 Evaluation Guides

DI 10505.023 Military Service

DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only)

DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)

DI 11005.000 Disability Interviews

DI 11005.003 Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases

DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms

DI 11005.045 Completing the Paper Form SSA-3367–F5 (Disability Report-Field Office)

DI 11005.601 The Disability Interview – Identifying Terminal Illness (TERI) Cases

DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determinations Services (DDS)

DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim

DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

DI 12020.001 Appeals Council (AC) Review

DI 13010.110 Return to Work

DI 25510.010 Closed Period Under Title II

DI 25510.015 Closed Period Under Title XVI

DI 52130.015 Military Disability Benefits

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

DI 81010.020 Curtailing Completion of the EDCS 3368 or EDCS 3820

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)

DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)

DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

MSOM EVID 001.002 Shared Processes Menu

GN 00301.310 The Non-Disability Repository for Evidentiary Document (NDRed) Application—Overview

GN 01040.100 Listing Codes

DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing

I. Exhibit of MC/WW flag
To flag MC/WW cases, use the following printable flag.
Yep, i told the clerk that and gave her a copy of my physical therapy treatment of when i first started getting PT. Gave her a copy of my MEB evaluation from the provider which stated that I was unfit and deemed for the MEb. Gave her a copy as well of my VA rating as well. And any other medical documents they will be able to obtain themselves. Also gave her a copy of my orders and she still said just brace yourself for the denial..i mean at this point there’s really nothing else to do but to wait for it to come back and then appeal it pretty much..it sucks but after reading so many others post I’ve simply braced myself for it and won’t be surprised by the denial letter
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#23
Hopefully I’ll be able to find a good ssdi lawyer like others have and can be approved on the second go. I see the turn around rate after having a lawyer from what others have posted is pretty high compared to the first time.
 

Odiemus

Registered Member
#24
Peter: I was told that it only mattered if you had been working. I have been on convelescent leave since September and not working. So my contracted pay (sympathy pay) does not count as gainful employment as I have not been working. Were you placed on leave, or did you have some sort of statement submitted from your leadership that said you were unable to work?

From what I understand if you WORK and get PAID... then you are not eligible. You have to be able to prove that you are too disabled to find/keep work.
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#25
Peter: I was told that it only mattered if you had been working. I have been on convelescent leave since September and not working. So my contracted pay (sympathy pay) does not count as gainful employment as I have not been working. Were you placed on leave, or did you have some sort of statement submitted from your leadership that said you were unable to work?

From what I understand if you WORK and get PAID... then you are not eligible. You have to be able to prove that you are too disabled to find/keep work.
No i was not placed on leave but i was removed from my primary mos and moved into the shops because i could not perform my initial job tasks, and although i worked, my hours were either limited or most of the time i was doing nothing, because i could not perform most duties. The clerk also wrote up a memo because of my shortened working hours, and also attached that with my packet. She still said it may come back disapproved because she has seen people with even 100 percent disabilities still get denied. She could have just been a negative Nancy but I’ll be hoping for the best, but also ready for the worst.
 

Frenchy1212

Registered Member
#26
I too like the online application.

You can answer what you know. then look up what you don;t know or can;t remember; then go back and add info to your claim.

Be sure in the remarks you indicate you are a "wounded warrior" You do not have to be in a wounded warrior battalion to be considered a wounded warrior.

Best wishes
Mike
1513773849647.png
 

Primary Alternate

PEB Forum Veteran
Registered Member
#31
I finally received the denial letter, and it stated I was denied for work activity and my income/earnings. I appealed it and reiterated that I have been on the military payroll during the IDES process, but have not actively worked since early 2016. I also restated that all income/earnings will cease in 9 days. I hope the new reviewer of my case approves it. Now that I think about it, I think I really should have included the MEB letter of my Commander stating that haven't been able to work for over a year.
I did just this and my claim was yet denied again for the second time. Have to go before an ALJ.
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#33
So I check the SS site and it currently says

“The disability determination service for your state is processing the medical portion of your benefit application. If they need any additional information they will contact me”

Not sure if this is a good sign or not. It’s on the step 2 of 3 in the process.
 

GSWarrior2017

PEB Forum Veteran
Registered Member
#34
So I check the SS site and it currently says

“The disability determination service for your state is processing the medical portion of your benefit application. If they need any additional information they will contact me”

Not sure if this is a good sign or not. It’s on the step 2 of 3 in the process.
I would say it is good. That at least means that you did not get a "technical denial", and you have moved on to stage 2 of the review. Technical denials for "income/employment/earnings/missing financial documents" are extremely common and shut cases down at stage 1. You cleared that hurdle at this point.
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#35
I would say it is good. That at least means that you did not get a "technical denial", and you have moved on to stage 2 of the review. Technical denials for "income/employment/earnings/missing financial documents" are extremely common and shut cases down at stage 1. You cleared that hurdle at this point.

Thank you. This entire process i feel like is a hit or miss from everything i have read, but at least I’m passed the hurdles of step one. Is that the step where the majority of people are usually denied at first?
 

GSWarrior2017

PEB Forum Veteran
Registered Member
#36
Thank you. This entire process i feel like is a hit or miss from everything i have read, but at least I’m passed the hurdles of step one. Is that the step where the majority of people are usually denied at first?
According to the SSA's statistics, it appears that most applicants for Social Security disability benefits are denied for medical reasons -- that is, the Social Security Administration (SSA) didn't find that their medical conditions were so severe that they couldn't work. However, some disability applicants instead receive what’s referred to as a “technical denial.” When a disability applicant receives a technical denial, this means that the applicant was found ineligible for benefits for non-medical reasons (and the SSA didn’t review even the medical evidence). You made it passed the technical denial hurdle, but the largest percentage of denials are at the medical level (or step 2). Keep your head up, and stay hopeful though!
 

Peter.parker.gonzalez

PEB Forum Veteran
Registered Member
#37
According to the SSA's statistics, it appears that most applicants for Social Security disability benefits are denied for medical reasons -- that is, the Social Security Administration (SSA) didn't find that their medical conditions were so severe that they couldn't work. However, some disability applicants instead receive what’s referred to as a “technical denial.” When a disability applicant receives a technical denial, this means that the applicant was found ineligible for benefits for non-medical reasons (and the SSA didn’t review even the medical evidence). You made it passed the technical denial hurdle, but the largest percentage of denials are at the medical level (or step 2). Keep your head up, and stay hopeful though!

Oh okay i understand now, thank you very much for your responses!
 
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