Harvard Case
Group I, Category 23 Incorrect Decision Regarding Onset Relative to Title II Eligibility Period
ISSUE
The DDS proposes allowance for this claimant with an EOD of 6/30/16. The evidence in file shows a later onset date is warranted and the claimant was not insured for title II benefits at the time the disability began.
CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES)
The claimant is a 31-year old filing a concurrent claim with an AOD of 07/25/2012 due to Psoriatic arthritis, cataracts, hepatitis C, s sesamoiditis, depression, anxiety, iritis, pilonidal cysts, ankylosing spondylitis arthritis, and plantar fasciitis.
The medical evidence in file shows the claimant was admitted 12/15/16 in cardio-pulmonary arrest from an acute heroin accidental encounter, with acute and subacute hepatic failure, acute kidney failure, tubular necrosis, acute respiratory failure with hypercapnia and hypoxia, metabolic encephalopathy, and anoxic brain damage. He was apneic and pulseless in asystole and was resuscitated. The physical exam on 01/30/17 he still had an unsteady gait and was non-verbal. On 4/7/17, three month status post the incident he still could not speak. Records from 11/15/16 show the claimant complained of pain in the right toe and chronic back pain. …show more content…
The evidence in file supports this determination; however, a later onset date is warranted.
The claimant’s date last insured is 6/30/16. From 6/30/16 through 12/15/16 the claimant was capable of lifting/carrying 20/10 pounds occasionally/frequently, standing/walking 4 hours, and sitting 6 hours. Due to the claimant’s age, RFC and education, this RFC results in a denial. As of 12/15/16, listing 11.04 is met. DI 25501.320.C.2 instructs the DDS to establish the EOD at the earliest possible date based on medical, vocational, and technical factors, and deny the claim if onset cannot be established prior to the
ISSUE
The DDS proposes allowance for this claimant with an EOD of 6/30/16. The evidence in file shows a later onset date is warranted and the claimant was not insured for title II benefits at the time the disability began.
CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES)
The claimant is a 31-year old filing a concurrent claim with an AOD of 07/25/2012 due to Psoriatic arthritis, cataracts, hepatitis C, s sesamoiditis, depression, anxiety, iritis, pilonidal cysts, ankylosing spondylitis arthritis, and plantar fasciitis.
The medical evidence in file shows the claimant was admitted 12/15/16 in cardio-pulmonary arrest from an acute heroin accidental encounter, with acute and subacute hepatic failure, acute kidney failure, tubular necrosis, acute respiratory failure with hypercapnia and hypoxia, metabolic encephalopathy, and anoxic brain damage. He was apneic and pulseless in asystole and was resuscitated. The physical exam on 01/30/17 he still had an unsteady gait and was non-verbal. On 4/7/17, three month status post the incident he still could not speak. Records from 11/15/16 show the claimant complained of pain in the right toe and chronic back pain. …show more content…
The evidence in file supports this determination; however, a later onset date is warranted.
The claimant’s date last insured is 6/30/16. From 6/30/16 through 12/15/16 the claimant was capable of lifting/carrying 20/10 pounds occasionally/frequently, standing/walking 4 hours, and sitting 6 hours. Due to the claimant’s age, RFC and education, this RFC results in a denial. As of 12/15/16, listing 11.04 is met. DI 25501.320.C.2 instructs the DDS to establish the EOD at the earliest possible date based on medical, vocational, and technical factors, and deny the claim if onset cannot be established prior to the