The Partially Favorable Decision

Posted March 31, 2016 by Premier Disability Services, LLC® Every claimant who files for Social Security Disability benefits must allege a date when their medical impairments became disabling. This date is known as the “Alleged Onset Date” or AOD. When the Social Security Administration (SSA) finds a claimant disabled as of their AOD, this is known as a fully favorable decision. At times, SSA may determine that a claimant is disabled on a date subsequent to their AOD. This is known as an “Established Onset Date” or EOD. When this occurs, the decision is known as a partially favorable decision. Below are a few reasons SSA may award a partially favorable decision instead of a fully favorable decision.

Change in Age Categories:
Most claimants must establish that their impairments prevent them from performing any work they performed over the previous 15 years and they are unable to perform other work that exists in the national economy in significant numbers. However, it becomes easier to prove disability when a claimant is 50-54 years of age. The burden lessens even more when a claimant reaches age 55 or older. Special rules known as the “grids” apply to claimants who reach these age categories. Claimants who reach one of these two age categories may only need to prove that the limitations associated with their impairments preclude them from performing their past work. Often, claimants will change age categories while their claims are pending and the application of these grid rules would apply. Under these circumstances, SSA may establish a claimant’s onset date as of their 50th or 55th birthday.

The Medical Evidence Supports a Later Disability Date
Medical evidence is crucial for a claimant to prove disability. Ideally, a claimant will have consistent treatment for their conditions dating back to their AOD. Unfortunately, Social Security Disability claimants often struggle with maintaining treatment due to issues with insurance. As a result, treatment records can often be sporadic and not fully support an AOD. Under these circumstances, SSA may schedule what is referred to as a consultative examination (CE). If supportive, SSA may establish a claimant’s onset date as of the date of the CE if they feel the medical evidence prior to that date is insufficient to determine disability.

A Significant Life Event Justifies Changing the AOD

This is somewhat related to the previous section regarding medical evidence. It is quite common for claimants to experience significant life events that affect their health during the period their claim is pending. For example, a claimant with a severe coronary condition may suffer a heart attack. Also, we have seen claimants with uncontrolled hypertension suffer a stroke a year after they filed for disability benefits. In the eyes of the SSA Adjudicator, these significant life/medical events are often compelling enough to justify disability, just not dating back to the original onset date. We often see DDS offices and Administrative Law Judges establish a claimant’s onset of disability on a date that coincides with this type of significant event.

Should a Claimant Appeal a Partially Favorable Decision?
Each claim is different and it is difficult to provide a blanket answer to that question. Claimants should at least be aware of their right to appeal a partially favorable decision. To be clear, some partially favorable decisions are appropriate and appealing would provide little benefit. On the other hand, some partially favorable decisions fail to properly consider the entire period of disability and justify an appeal. Prior to the hearing level, a claimant will receive very little explanation as to why they received a partially favorable decision. On the contrary, an Administrative Law Judge is required to provide a thorough opinion regarding the reasons they felt a partially favorable decision was more appropriate than a fully favorable. These opinions can be highly technical and difficult to understand. It may be beneficial to hire an Experienced Representative if you are considering appealing a partially favorable decision.

By: Devon Brady of Premier Disability Services, LLC®