Group I, Category 30
Insufficient Documentation to Show Conformance to Procedural Requirements When A Disability Determination is Based on Unresolved Work Activity That Could Affect the Decision.
ISSUE
Step 1 of Sequential Evaluation is not satisfied. The record does not reasonably document if, and when substantial gainful activity (SGA) ended.
ISSUE
The file contains conflicting dates regarding the claimant’s date last worked at the SGA level. The conflict needs to be resolved to determine the correct onset date.
This 60- year old claimant is filing a DI only claim alleging disability due to a fractured back, sharp numbing pain, limited mobility, restricted range of motion, daily headaches, chest pain, high blood pressure, high cholesterol, dizziness, difficulty balancing, anxiety, and sleep apnea. …show more content…
DI 10510.010.B. lists all three self-employment earning tests and states the FO will consider all three tests before it can be established that the individual’s work activity is not SGA. In this case, the field office completed an SSA-823, but the SSA 823 in file is not policy compliant. The FO stated the claimant is working minimal hours. However, the claimant stated he worked over 45 hours 9/2015. DI 10510.015.B.b indicates if a person renders management services for more than 45 hours a month regardless of the total management time required by the business, the individual would be found to be rendering significant services to business. There are several claim communications in the file regarding attempts to resolve the resolve the issue. However, the FO was unsuccessful in contacting the claimant’s representative regarding the issue. It is unclear whether the claimant is currently engaging in SGA or when this activity ceased. DI 25501.390.A.1 indicates that we will not set the EOD during a period when the claimant engaged in SGA. Therefore, additional development is
Insufficient Documentation to Show Conformance to Procedural Requirements When A Disability Determination is Based on Unresolved Work Activity That Could Affect the Decision.
ISSUE
Step 1 of Sequential Evaluation is not satisfied. The record does not reasonably document if, and when substantial gainful activity (SGA) ended.
ISSUE
The file contains conflicting dates regarding the claimant’s date last worked at the SGA level. The conflict needs to be resolved to determine the correct onset date.
This 60- year old claimant is filing a DI only claim alleging disability due to a fractured back, sharp numbing pain, limited mobility, restricted range of motion, daily headaches, chest pain, high blood pressure, high cholesterol, dizziness, difficulty balancing, anxiety, and sleep apnea. …show more content…
DI 10510.010.B. lists all three self-employment earning tests and states the FO will consider all three tests before it can be established that the individual’s work activity is not SGA. In this case, the field office completed an SSA-823, but the SSA 823 in file is not policy compliant. The FO stated the claimant is working minimal hours. However, the claimant stated he worked over 45 hours 9/2015. DI 10510.015.B.b indicates if a person renders management services for more than 45 hours a month regardless of the total management time required by the business, the individual would be found to be rendering significant services to business. There are several claim communications in the file regarding attempts to resolve the resolve the issue. However, the FO was unsuccessful in contacting the claimant’s representative regarding the issue. It is unclear whether the claimant is currently engaging in SGA or when this activity ceased. DI 25501.390.A.1 indicates that we will not set the EOD during a period when the claimant engaged in SGA. Therefore, additional development is