EDPNA COMMON QUESTIONS

Question 1

A final determination, either Title II or Title XVI, may be reopened within how many year(s) “for any reason”

Answer 1

1 Year

Question 2

7 Exertional Strength Demands for Jobs

Answer 2

1. Sitting
2. Standing
3. Walking
4. Lifting
5. Carrying
6. Pushing
7. Pulling

Question 3

Formal Schooling 6th Grade Level or Less:

Answer 3

Marginal Education

Question 4

Formal Schooling 7th Grade to 11th Grade:

Answer 4

Limited Education

Question 5

Waiting Period for T2

Answer 5

If you do not become disabled on the first of the month, you cannot count this month in the full 5 calendar months.

Question 6

Medicare Waiting Period (SSDI Only)

Answer 6

Starts 29 months from established onset date. (this includes 5 month waiting period)

Question 7

Earned Income (SSI Only)

Answer 7

You get to disregard the first $20 no matter what & an additional $65 if EARNED income.

Question 8

One Third Reduction Rule

Answer 8

If claimant is not receiving both food and shelter, the 1/3 reduction rule does NOT count.
- Presumed Value would come into play

Question 9

Res Judicata

Answer 9

Latin phrase meaning “matter already judged”.
- for SSDI Cases both of the following have to occur:
1. A subsequent claim has been filed.
2. The last determination has become final and the claimant has DLI in the past.

Question 10

Collateral Estoppel

Answer 10

Latin Term “Issue already decided”
- Issue preclusion: Once an issue of fact or law has been decided by one court, the parties to that action are barred from relitigating that issue in another action.
- Can be used in allowance or denial.

Question 11

Appropriate Use of Benefits are: (404.2040)

Answer 11

1. Current Maintenance: includes cost incurred in obtaining food, shelter, clothing, medical care, and personal comfort items.
2. Institutional Care: If a beneficiary is receiving care in a Federal, State, or private institution because of mental or physical incapacity, current maintenance includes the customary charges made by the institution, as well as expenditures for those items which will aid in the beneficiary’s recovery or release from the institution or expenses for personal needs which will improve the beneficiary’s conditions while in the institution.
3. Support of legal dependents: If the current maintenance needs of the beneficiary are met, the payee may use part of the payments for the support of the beneficiary’s legally dependent spouse, child, and/or parent.
4. Claims of Creditors: A payee may not be required to use benefit payments to satisfy a debt of the beneficiary if the debt arose prior to the first month for which payments are certified to a payee. If the debt arose prior to this time, a payee may satisfy it only if the current and reasonably foreseeable needs of the beneficiary are met.

Question 12

Step 4 - Sequential Evaluation

Answer 12

we consider our assessment of your residual functional capacity and your past relevant work.

YOU CANNOT BE APPROVED AT THIS STEP

Question 13

Art’s Equation for Special Insured Status

Answer 13

(age of client) - 21 x 4 / 2.
Ages 21 to 23 need 6 credits to be insured.
Example:
25-21=4x4=16/2=8

Example 2:
30-21=9x4=36/2=18

Question 14

SSDI Conditions for Reopening

Answer 14

A case may be reopened with a determination within FOUR years of the initial determination if good cause or other circumstances are established.
- 12 months for any reason

Question 15

SSI Conditions for Reopening

Answer 15

A case may be reopened with a determination within TWO years of the initial determination if good cause or other circumstances are established.
- 12 months for any reason