Should I Appeal an Established Onset Date of Disability?

If the Social Security Administration (the SSA) approved you for benefits, but changed the date you said you became disabled, should you appeal? You may think, why not, since the date you became disabled (your "onset date") can affect the amount of back pay you get from Social Security. The earlier the onset date, the better.

But the decision whether to appeal a disability onset date is complicated, and can have dire results if the SSA reverses a disability recipient's award. Any time you appeal a decision made by SSA, a judge (or the Appeals Council) can take a fresh look at the case and deny the claim. But for some people who face the potential for significant back payments or retroactive benefits, the benefit may outweigh the risk.

Here are some good reasons to appeal an established onset date (EOD) and how to go about it to maximize your chances of a win. (For why your established onset date is important, see the first part of this article, challenging a disability EOD.)

Your Onset Date Was Based on Inaccurate Earnings

If your earnings information is inaccurate, the Social Security Administration (SSA) may find that you were performing "substantial gainful activity" (SGA) during certain months and will find you ineligible for benefits in that time period. (For 2023, SGA was defined as earning $1,470 a month.)

Why would cause the SSA to use the wrong numbers? Sometimes earnings show up in quarters when, in fact, an applicant didn't perform work. Inaccurate earnings can happen due to contract jobs, when a person receives payment well after work was completed or when companies (often small or family-owned businesses) continue to pay a disabled worker for a period of time even after he or she can't work. It can also happen to applicants who are part owners of a company but no longer have an active part in the business.

Regardless of the reason, if earnings show up in quarters where you didn't work, the SSA will change your established onset date (EOD) to a period when the earnings record indicates you weren't working at the SGA level. Here, it may be worth it to appeal your EOD if the difference would result in a significant retroactive disability benefit amount.

If you decide to appeal, here are examples of evidence that may be helpful in your appeal:

• if you were an employee, a statement from your employer that states the last day you worked, the reason you continued to receive compensation, and the amount and dates of those payments
• if you are an independent contractor or freelancer, a copy of the contract that states when your work activity ceased and a schedule of your payment dates, or
• if you are an owner or co-owner of a company, evidence that shows you weren't doing SGA for your business during that time.

Example

Kathryn applied for SSDI due to complications from Type 1 diabetes on March 1, 2022. The date she claimed her disability began (her "alleged onset date," or AOD) was August 1, 2020. Although Kathryn in fact stopped working on August 1, 2020, her long-time employer provided her with four additional months of reduced compensation to assist her while she transitioned to not working. The SSA took these payments to mean that she was still "engaged in SGA" during that time and determined that her EOD was December 1, 2020. This resulted in four fewer months of retroactive benefits for Kathryn. Because her retroactive benefit amount would be substantial, Kathryn decided to appeal her EOD. To do this, she provided statements from her human resources director and the company's owner explaining the payments she received for the four months after she stopped work.

Your Onset Date Was Based on an Error in Reading Medical Records

When you receive your decision letter, it will explain in detail why the SSA decided your claim the way it did. If the SSA concluded that your established onset date (EOD) should be different than the disability onset date you claimed on your application (your AOD), it will state specifically why. Make sure you review this section carefully for accuracy.

It's not uncommon for the SSA to make errors about dates. If the SSA is wrong about an important date in your medical records, it can make a huge difference. Or, there could be an actual error in your medical records; for instance, your records could say the date of a biopsy was June 1, 2022, when in fact it was June 1, 2021.

If you do find an error, make sure that you are specific in your appeal and then provide the information necessary to support your allegation that the SSA's information is wrong.

Example

Anthony applied for SSI on May 1, 2021, due to COPD (chronic obstructive pulmonary disease). The date he claimed his disability began (his AOD) was March 1, 2021. In support of his claim, Anthony submitted medical records that contained the results of a breathing test performed on that date. These results should have qualified Anthony for benefits right away. However, when the SSA approved Anthony's claim on August 1, 2022, the agency concluded that his EOD was not until March 1, 2022. The reason for this late EOD was that the SSA had misread the date of Anthony's breathing test—the SSA was off by a year. Due to the SSA's error, Anthony only received four months of back payments rather than 16 months of back payments.

In this case, the SSA's error caused a significant decrease in Anthony's back pay. But on appeal, Anthony was able to show that the SSA had misread the evidence that had been submitted with his claim, and he was successful in his appeal.

Your Onset Date Wasn't Based on All of the Medical Evidence

Sometimes the SSA will issue a decision without all of the applicable medical evidence. This can happen when applicants fail to provide the SSA with all of their medical providers' or medical facilities' contact information. It can also happen if the SSA simply fails to request records, even though the applicant has provided all of the necessary information. Regardless of the reason, if important records are absent from the applicant's file, the SSA might choose the wrong EOD. If this happens to you and you decide to appeal your EOD, you must be proactive and provide the missing evidence with your appeal.

Example

Carolyn filed for SSI on March 1, 2021, due to spinal stenosis. The date she claimed her disability began (her AOD) was February 1, 2021. Carolyn chose this date because this is the date that Carolyn's MRIs indicated she suffered significant narrowing of her spinal column. Unfortunately, Carolyn failed to include the contact information for the medical provider that performed the MRI or to state that the test had even been performed. Carolyn was subsequently approved for benefits in January 2022, with an EOD of June 1, 2021. The SSA based her EOD on a second MRI conducted on June 1, 2021. Had evidence of the earlier MRI been submitted, Carolyn would likely have been entitled to more back pay, based on an onset date of February 1, 2021. But because the potential increase in her back payments was relatively small, Carolyn chose not to risk having her approval for benefits reversed on appeal, and she didn't appeal her EOD.

Should I Talk to an Attorney or Advocate?

If you're considering appealing your EOD, it's a good idea to speak to an experienced disability attorney or advocate who will review your case and discuss with you the pros and cons of an appeal.

_{Updated January 4, 2023}