In Title II SSDI disability claims and title XVI SSI adult disability claims, the alleged onset date (AOD) is always the date the claimant alleges he or she became unable to work because of his or her medical condition, whether or not that date appears to be appropriate or in line with the evidence.
With Social Security Disability Insurance (SSDI), you can receive retroactive pay as far back as 12 months prior to the date you apply for benefits. Of course, to receive retroactive benefits prior to the application date, you must be found disabled prior to the application date. In order to receive a full 12 months in backpay benefits, you must establish that you became disabled at least 17 months before the date you applied. That’s because there is a five-month waiting period after the onset of disability during which benefits are not paid or owed.[Note: There is no such thing as retroactive pay for Supplemental Security Income benefits, or SSI. If you are approved for SSI, you receive benefits as of the first month after your application.]
Why Is the Onset Date, or AOD, Important?
Your disability onset date determines how much you will receive in past due benefits, also called “backpay” or “past due” benefits. For example, let’s say that you applied for SSDI on December 1, 2012, and you alleged in your application that your disability began on September 1, 2012. The Social Security Administration (SSA) reviews your claim and issues a decision on December 1, 2013, approving you for benefits. If the Social Security Adminitration agreed with your onset date of September 1, 2012, you would qualify for backpay benefits from February 1, 2013 to the present (five months after your AOD of September 1, 2012).
On the other hand, let’s assume that the Social Security Administration disagreed with your onset date and sets February 1, 2013 as your “established onset date” of disability. You would qualify for less backpay, and receive benefits only from July 1, 2013 (five months after your established onset date of February 1, 2013). This move by the SSA cut out several thousand dollars of your past due benefits.
The onset date can also determine whether your claim is approved or not, since you must be disabled for 12 months (or be expected to be disabled for 12 months) to qualify for disability benefits. The onset date is when the clock starts ticking for this 12-month durational requirement.
When Can Social Security Change Your Alleged Onset Date?
If Social Security reviews all of the evidence in your claim and disagrees with the date you say you became disabled, it can establish an onset date later than you think is appropriate. To determine your established onset date (EOD), the SSA will look at your alleged onset date (AOD), when you last worked, and what the medical evidence shows. If the SSA changes the onset date from your AOD, it sets what is called the EOD. However, the SSA must explain why your alleged date is not appropriate under the circumstances and why its EOD is correct.
What Can You Do If the SSA Changes Your AOD?
If the SSA changes your AOD to a later EOD, you will lose some backpay and your eligibility for Medicare and/or Medicaid will be delayed. However, you can appeal the established onset date by asking Disability Determination Services (DDS) to do a reconsideration of the EOD. Or, if your EOD was set at the reconsideration level, you can ask an administrative law judge to review the EOD at a hearing. If an ALJ set the EOD at a hearing, you can appeal to the Appeals Council.[Note: when you appeal the onset date, the scope of review is not limited to the dates. Your entire claim is up for review. The DDS or SSA can review the disability determination itself on appeal, and – in a “worst case scenario”- an adjudicator could reverse your approval and say you are not disabled at all.]
If you’ve been approved for benefits, you should speak to an experienced disability lawyer for a case evaluation to determine whether you should appeal an EOD.
Sometimes when the SSA changes your AOD to a later EOD, the EOD is still more than 17 months prior to the date you applied for disability benefits. In such a scenario, the change in the onset date really will not matter because you cannot receive retroactive backpay benefits for more than 12 months before your application date (plus the five-month waiting period) anyways.
When Are the AOD and EOD the Same?
If you are approved for disability benefits and Social Security or DDS (either an administrative law judge or a disability claims examiner) determines that your disability began on the same date you alleged in your application, the AOD is effectively the same as the EOD.
AOD is Just the Starting Point
The claimant’s AOD is just the starting point in deciding the established onset date (EOD). The EOD is the date Social Security establishes the claimant first meets the medical, vocational, and other entitlement or eligibility requirements for disability benefits. If the medical and other evidence in the claim file are consistent with the AOD, the AOD will become the EOD. If there are other non-medical factors in evidence that prohibit the disability examiner (DE) from establishing an EOD as of the AOD, the field office (FO) proposes a potential onset date (POD). One example of this would be evidence of work activity after the AOD.
The AOD May Be The Last Day of Substantial Gainful Activity (SGA)
Social Security considers the date the claimant stopped performing “substantial gainful activity” (SGA) when establishing the EOD. The Social Security Administration will not establish the onset date before the last day SGA was performed.