Should I Appeal an Established Onset Date of Disability?

Here are some good reasons to appeal an EOD and how to go about it to maximize your chances of a win.

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 page of this article, challenging a disability EOD.)

Inaccurate Earnings Information

If your earnings information is inaccurate, the 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 2021, SGA was defined as earning $1,310 a month.) How could this happen? Sometimes earnings show up in quarters when, in fact, an applicant didn't perform work. This can happen in contract jobs when a person receives payment well after work was completed or when companies (usually 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 if you are an owner 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 performing SGA. Here, it may be worth it to appeal your EOD if the difference would result in a significant retroactive benefit amount.

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

  • 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
  • if you are an owner or co-owner of a company, evidence that shows you weren't engaged in SGA for your business during that time.

Example

Kathryn applied for SSDI due to complications from Type 1 diabetes on March 1, 2018. The date she claimed her disability began (her "alleged onset date," or AOD) was August 1, 2016. Although Kathryn in fact stopped working on August 1, 2016, 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, 2016. 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.

Error in Explanation of Decision

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) was 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 is not uncommon for the SSA to make errors, and if it is wrong about an important date in your file, it can make a huge difference.

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, 2017, due to COPD (chronic obstructive pulmonary disease). The date he claimed his disability began (his AOD) was March 1, 2017. 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, 2018, it concluded that his EOD was not until March 1, 2018. 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 backpayments rather than 16 months of backpayments.

In this case, the SSA's error caused a significant decrease in his backpayments. However, 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.

New Medical Evidence

Sometimes the SSA will issue a decision without all of the applicable medical evidence. This can happen when an applicant fails to provide the SSA with all of his or her 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 pivotal records are absent from the applicant's file, the EOD can be affected. 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, 2017, due to spinal stenosis. The date she claimed her disability began (her AOD) was February 1, 2017, 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 2018, with an EOD of July 1, 2017. The SSA based her EOD on a second MRI conducted on July 1, 2017. Had evidence of the earlier MRI been submitted, Carolyn would likely have been entitled to a higher backpayment, based on an EOD of March 1, 2017. However, because the potential increase in her backpayment 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?

The decision about whether to appeal an EOD is complicated and can have dire results if a disability recipient's award is reversed. But for some people who face the potential for significant backpayments or retroactive benefits, the benefit may outweigh the risk. If you are considering appealing your EOD, it is a good idea to speak to an experienced disability attorney who will review your case and discuss with you the pros and cons of an appeal.

Updated February 9, 2021

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