Q. How
does the Social Security Administration define “disability”?
The Social Security Administration
(“SSA”) defines disability as “the inability to engage in
any substantial gainful activity by reason of any medically determinable physical
or mental impairment(s) which can be expected to result in death or has lasted
or can be expected to last for a continuous period of not less than 12 months.”
In determining whether you are disabled, SSA considers your age, education,
your past work, and your physical and mental impairments. Virtually any medical
impairment can constitute a disability if it is severe and prevents a person
from the performance of substantial gainful work activity.
Q. What
is the difference between Social Security disability and SSI?
In a nutshell, Social
Security disability (“SSDI”) is funded by the FICA tax that was
withheld from your paychecks while you were employed. SSI is a Federal income
supplement program funded by general tax revenues rather than Social Security
taxes. With Social Security disability, the benefit amount depends upon how
much the claimant contributed during the employment period, whether the claimant
contributed for the required period of time, and whether the impairment meets
the guidelines set by SSA. Under the SSI program, monthly checks are paid
to the disabled, children who are disabled, the elderly and the blind, who
do not have much income and who qualify based on income requirements. The
amount of your benefit depends on where you live.
Q. How
do I begin the disability claim process?
The process is begun with
the initial telephone call to the Social Security Administration at its toll-free
number (1-800-777-1213). They will ask you some basic questions over the telephone
such as your name, address and telephone number. Then they will send a questionnaire
to you to complete and return to them. At a later date you will receive two
or three other questionnaires to complete and return to them. It is important
that on these questionnaires you state all the reasons you believe you are
unable to work, rather than just the main reason.
Q. Do
I have to have an attorney to represent me?
While it is not imperative
that you have an attorney represent you, it is highly recommended that you
have someone who is qualified in Social Security disability law to represent
you, whether it is by an attorney or by a non-attorney representative. The
process for obtaining Social Security disability benefits is a very long process
that can seem complicated and confusing. It is important that you have someone
on your side who understands the process and can guide you every step of the
way. Many cases have been lost by claimants who attempted to represent themselves
and then just simply gave up because they did not understand the administrative
process.
Q. How
long does it take for SSA to decide whether I am disabled?
Please understand first
of all that the process is a lengthy administrative process, and that there
are hundreds of people just like you who are applying for benefits. There
are three main levels through which your claim will be processed: the initial,
the reconsideration, and the hearing before the Administrative Law Judge.
There is a fourth level known as the Appeals Council, which is used for cases
that have been denied at the lower three. Then, if the Appeals Council denies
the case, the case can be appealed to the U.S. court system. The length of
time varies from state to state, but you should expect the duration of the
process to be, at the very least, the better part of two years. Additionally,
you should expect to be turned down twice before your case goes to the Administrative
Law Judge.
Q. Do
I need to wait a certain period of time before filing my case if I believe I
am disabled and no longer able to work?
Q. How
do I know if I am eligible?
Q. What
if I have never worked but am disabled? Can I still get benefits?
Q. Can
I get disability benefits if I have a lot of assets?
Q. I
don’t go to the doctor very often because I can’t afford it. Will
that hurt my case?
Q. If
I am disabled, would my child be eligible for benefits?
Q. How
does a person’s age fit into the disability determination?
Q. My
work history has been sporadic. Will I be eligible for Social Security disability
benefits?
Q. What
does “Substantial Gainful Activity” Mean?
Q. Can
I Work After I Get Social Security Disability Benefits?
Q. I’m
thinking of applying for Social Security disability benefits. What types of
documents will I need?
Q. What
can I expect to happen during my case:
Q. I’m
a stay-at-home mom but now I’m disabled. Would I qualify for Social Security
Disability?
Q. If
I am presently collecting early retirement, can I collect differential disability
benefits or SSI if I’m disabled?
Q. Do
I have to be “permanently disabled” to get Social Security disability
benefits or SSI?
Q. I’ve
heard that there is a list of impairments that Social Security uses in determining
whether a person is disabled. Where do I find that list?
Q. How
will I know if my case has been won?
Q. How
young can a person be to receive Social Security disability benefits?
Q. Why
would SSA’s doctors disagree with a diagnosis made by another doctor?
Q. What can my doctor do
to assist with my case?
Q. I’ve heard the term
“Appeals Council” used. What does it do?
The Appeals Council is the third level of the Social Security disability
appeals process. The Appeals Council is located in Falls Church, Virginia,
and has a satellite office in Baltimore, Maryland. It was created in January
1940 as a three member body to “oversee the hearings and appeals process,
promote national consistency in hearing decisions” made by the Administrative
Law Judge(s) and to ensure that the Commissioner’s records were adequate
for judicial review. As expected, the Appeals Council has grown and is now
made up of approximately 30 ALJs and several hundred support personnel including
appeals officers. When an ALJ gives an unfavorable decision and a claimant
files a request for review is to the Appeals Council, the Appeals Council
looks at all cases, but may grant, deny, or dismiss the request. If it grants
the request for review, it will either decide the case or remand it (return)
to an ALJ for a new decision. As you can imagine, the Appeals Council handles
in excess of 100,000 cases each year. For that reason, the processing time
for an appeal before the Appeals Council is approximately one year.
Q. What is the “Red Book”
used by SSA?
Q. What do the terms “sedentary”,
“light”, “medium”, and “heavy” mean when
referring to work?
Q. What does the term DLI mean?
Q. Someone
told me he is receiving Social Security disability, but he certainly does not
look disabled. Wouldn’t a person have to appear to be disabled in order
to receive benefits?
Q. The
VA says I’m disabled, but Social Security denied my claim. Why would Social
Security not consider me disabled if the VA does?
Q. Can
a person with a 60% disability receive Social Security disability?
Q. I’ve
heard that filing a new claim is better than trying to appeal a claim. Is this
true?
Q. Are
past due benefits paid out with every case that is won?
Q. I
don’t understand the 5 month waiting period for disability cases?
Q. Can
individuals in their 20's and 30's win a disability claim?
Q. Are
children’s cases easier to win than an adult’s case?
In reality, children’s cases are generally more difficult
to win, probably due to the way in which they are evaluated. Many children’s
claims involve impairments such as asthma, epilepsy, ADHD or a learning disorder.
For asthma and seizure disorders, children are evaluated according to the
number of documented attacks they experience during a particular time period
and according to their medication usage. ADHD and learning disorders are evaluated
according to the evidence presented via school records, evaluations and IQ
tests, as well as by psychologists and physicians. Naturally, as time progresses,
children get older, and sometimes, they their condition improves. So by the
time a child has his hearing before the ALJ, sometimes he has improved to
the point that he will be denied benefits.
Q. What
does the term “on the record decision” mean?
Q. What
is a dire need letter?
Unfortunately dire need situations occur to a great number
of families or individuals experiencing the Social Security disability administrative
procedure. This is due in part to the fact that the procedure is quite lengthy
and in part to the fact that the claimant’s financial situation has
changed and not for the better. In many cases, the claimant was the sole breadwinner,
if not the chief breadwinner. That means one income, or the only income, has
disappeared. Unfortunately, the bills usually increase, due to doctor’s
visits, hospitalizations, etc. Many claimants are forced to move in with relatives;
others lose their home. This sort of situation to most individuals would easily
fall into the realm of “dire need”. SSA, however, does not see
it that way. In fact, it is only after a case passes through the initial and
the reconsideration levels, and after an ALJ has set a hearing date, that
a claimant has the opportunity to plead “dire need” and write
a “dire need letter” requesting that the case be expedited. In
reality, the claimant (rather than his attorney or family) should write the
letter explaining the situation, and he should also attach any late notices
from utilities or other creditors. Keep in mind that the actual hearing date
could be a year from the date the hearing was requested, so the financial
situation will only worsen, so any pride on the part of the claimant should
be forgotten. The hearing office will only consider a dire need situation
to be one in which the claimant’s home is about to be foreclosed, or
where the claimant is about to be evicted because he is unable to pay rent,
or where dire medical attention is needed. In some cases, a dire need letter
can reduce the time for the hearing by several months.
Q. What
does RFC mean?
Q. What
is the disability approval rate?
Q. Can
I call to check on my claim?
Q. Can
a disability case be closed because a claimant has failed to cooperate?
Q. What
does “medication noncompliance” mean?
Q. What
if I was self-employed? Am I still eligible for Social Security disability benefits?
Q. Can a person
receive both Worker’s Compensation benefits and Social Security disability
benefits?
Q. Will SSA pay attention to a
letter from my doctor which says I am disabled?
Q. Will you help me fill out
the forms?
Q. Do you help people who have received
a letter from the Social Security Administration that says that their disability
checks will stop?
Q. I’m unable to leave my house.
Can you still help me?
Q. How
long does each appeal level take?
Q. Who is it that decides whether
or not I’m disabled?
That question is difficult
to answer, because the process through which a case travels is rather like
a checks and balance system. Here is how the case travels through SSA, which
also might explain why the process is lengthy:
At the initial application level, a person called a DDS Examiner makes the
disability determination after first consulting with individuals who are medical
consultants or physicians. However, after the DDS Examiner makes his decision,
the Unit Supervisor can overturn it. At the next level, the Reconsideration
level, a different DDS examiner looks at the file. This person could be in
the same building, in the same room, or right down the hall. That person is
called an Examiner Level II. Again, there are medical consultants and physicians
with which they consult, and again, the decision could be overturned. Additionally,
in government work, as in other technical fields of work, there is a unit
known as Disability Quality Branch or “Quality Control.” The job
of QC is to randomly pull files and examine them for accuracy. Therefore,
if a favorable decision has been made by a DDS or by an Examiner Level II,
QC could pull the file and determine that the finding was not correct, and
then the process would start over again. At both the initial and the reconsideration
levels, the process is basically the same.
The third level of appeal
is the hearing before the Administrative Law Judge. As the title indicates,
there is a lawyer involved. The Administrative Law Judge hears testimony from
the claimant and from a vocational or medical expert then makes his decision.
The vocational and/or medical expert is paid by SSA to be present at the hearing.
Q. Can
SSA require me to have a physical?
Q. If
I have recently had a heart attack, do I have to take a stress test if SSA sends
me to their doctor for an examination?
Q. How
far back does SSA go in paying benefits if I am found to be disabled?
Q. Can
I file for disability benefits if I’m 65 years old?
Q. How
much do you charge to assist me with my disability case?
Q. What
are the most common disabilities?
Although virtually any
medical impairment can constitute a disability if it is severe and thus prevents
a person from the performance of substantial gainful work activity, the following
is a list of impairments most often seen:
lower back
emphysema
asthma
cancer
personality disorders
depression
arthritis
epilepsy
hepatitis
diabetes
Q.
Do I have to be hospitalized before I can get disability benefits?
No, but depending on your
impairment(s), a hospitalization may strengthen your case.
Q. Do
I have to have had surgery before I can get disability benefits?
Even though surgery might
have been recommended by your physician, SSA cannot require anyone to have
surgery.
Q. Does
SSA consider depression a disability?
Depression, as with any
other disease or impairment, is a disability only if it is severe enough to
prevent a person from working. “Depression” comes in different
“packages”, varies from person to person, and can severally impede
a person’s daily activities. In addition, the depression may be compounded
by another impairment, such as a bipolar personality disorder. Medical records
from a physician or psychologist are extremely important and should indicate
the severity of a claimant’s depression. SSA will determine whether
a claimant’s depression prevents him from concentrating, whether he
suffers from short term memory loss, whether there are suicide attempts or
threats, whether the activities of daily living indicate that the claimant
is unable to care for himself, and how the claimant interacts with other people.
Additionally the number of episodes that occur throughout the year play an
important role in determining whether a person is disabled, i.e., is he getting
worse, improving, or staying the same? Hospitalizations for depression or
suicide attempts are an important factor as well. Statements from family members
are very important to a claimant’s case, since many times the claimant
himself is not fully aware of his behavior around other people.
Q. I’ve
been told I have emphysema and that I probably only have a few months to live.
Since the disability process is so long, is it too late to file?
It is not too late to
file for disability. In cases where the impairment is in an advanced stage
or death is imminent, SSA is notified of the severity at the time the application
is filed, and they will expedite the decision. Medical records will indicate
the severity of the impairment.
Q. Will
a person with cancer automatically qualify for disability benefits?
No. As with any disease
or impairment, SSA will look at the severity of the condition. Understand
that there are many types of cancer. Some types of cancer cause death within
a very short time; other types, such as skin cancer, may or may not be considered
disabling.
Q.
If I am presently disabled from injuries incurred in a motorcycle accident,
but am expected to improve, can I still file for disability benefits?
If you believe that you
will be off work for a year, you should file for disability benefits.
Q. My
son has been diagnosed with ADHD. Can he get disability benefits?
A section about ADHD,
or Attention Deficit Hyperactivity Disorder, can be found in SSA’s Listing
of Impairments. In a nutshell, ADHD cases are difficult and SSA almost always
looks at how well the child is doing in school and how the condition affects
his ability to engage in certain specific activities.
SSA’s definition
of Attention Deficit Hyperactivity Disorder is that it is “manifested
by developmentally inappropriate degrees of inattention, impulsiveness, and
hyperactivity. “ The claimant must satisfy the level of severity found
in both A and B of the Listings, which are that he has medically documented
findings which indicate all of the following: marked inattention; and marked
impulsiveness; and marked hyperactivity. They also must have (children ages
3 to 18) at least 2 of the following 3 conditions which are resulting from
ADHD: Marked impairment in age-appropriate cognitive/communication function;
marked impairment in age-appropriate social functioning; or marked impairment
in age-appropriate personal functioning. Needless to say, you must have a
history of well documented medical evidence to support these impairments.
This will be found from the child’s school exams, including achievement
scores and IQ tests, reports, teacher’s notes as well as from mental
health officials and doctors.
Q. Is
degenerative disc disease a disability?
Degenerative disc disease
is a disorder of the spine. This category can be found in SSA’s Listing
of Impairments and includes osteoarthritis, spinal stenosis, herniated nucleus
pulposus, spinal arachnoiditis, as well as degenerative disc disease. Degenerative
disc disease is a common impairment seen on disability applications of claimants
of all ages. The general rule of thumb is, the younger the claimant the more
difficult the case is to win. The problem is that SSA seems to have difficulty
in being able to understand how debilitating back pain can be to an individual,
and, therefore, how difficult it might be for that individual to perform the
requirements of his or her job while at the same time dealing with back pain.
That is why it is extremely important to have medical evidence such as doctor’s
reports indicating a treatment, x-rays, MRIs, CAT scans. SSA generally requests
an examination by one of its physicians when an applicant alleges a disorder
of the spine.
Q. My
doctor says I have Carpal Tunnel Syndrome. Can I get disability benefits?
Carpal tunnel syndrome
cases are one of the more difficult cases to win a favorable decision, if
the case is based solely on the CPS impairment. Carpal tunnel syndrome is
an injury caused by repetitive movements. The individual feels a pinching
of a nerve (the median nerve) that runs from the wrist to the fingers and
base of the thumb. By itself, CPS does not seem to be disabling in the opinion
of SSA. There is no listing for it in the book. For that reason, a claimant’s
work history and overall physical or mental condition is of utmost importance.
A person with severe CPS, whose past work depended on the ability to perform
repetitive hand movements or grip, can be found incapable of returning to
their past work. The next question is, can that person do any other type of
work? If that person has CPS in both hands and the condition is such that
the use of either hand is permanently and severely restricted, a medical vocational
allowance might be given. This means that there is a condition or combination
of conditions that warrant a favorable decision, and in most cases a claimant
will have alleged more than one impairment. It only makes sense that the more
things there are wrong with a person, the more limitations that person has.
Q. I’ve
seen advertisements about Mesothelioma. Can this disease be considered a disability?
Mesothelioma means cancer
of the mesothelium, if it is in a malignant stage. This is an impairment commonly
caused by asbestos exposure. The mesothellium is an organ that is essentially
a protective membrane for the body’s internal organs. Without going
into a lot of medical terminology, yes, it can most definitely be a disability.
Q. I
have seizures. Will that be considered a disability?
SSA handles epilepsy cases in a similar way that it handles
respiratory impairments. A claimant needs documented evidence of having had
a specified number of attacks or episodes within a certain period of time,
as well as having had episodes or occurrences even though the claimant was
taking his prescribed medicine. The frequency required depends on the type
of condition. Grand mal seizures must occur more frequently than one per month,
and the claimant must have taken the prescribed treatment for at least 3 months.
Additionally, if they occur during the day they must involve loss of consciousness,
and if they occur at night, they must interfere with the claimant’s
daily activities the following day. Petit mal seizures must occur more than
once a week in spite of the claimant having taken his prescribed medication
for at least 3 months, and must either involve loss of consciousness, confusion
or disorientation, and must interfere with the claimant’s daily activities
during the day. Historical records, including diaries by the claimant and
by close family members, as well as medical records indicating that the claimant
has been into the office after having experienced another episode, can greatly
assist a claimant in winning this type of case. This type of information provides
a history of occurrences for SSA to use in evaluating the severity of the
impairment.
Q. I
did not realize there was more than one kind of arthritis. What are some of
the arthritis types claimed in SSA cases?
There are well over 100
different types of arthritis. Here is some basic information on four common
conditions claimed in SSA cases:
Rheumatoid Arthritis
This type of inflammatory
arthritis not causes joint pain but can cause joint deformity if the condition
is left untreated. It is a systemic disease, which means it can attack all
the body systems. For that reason, it can attack the skin, the heart, the
lungs, the kidneys, the nervous system, the muscles, and the bones. It can
also attack the eyes and the throat.
Gout
Men are mostly affected
by this condition, which for many years was thought of as the “disease
of kings”, meaning a person who ate a “rich” diet was most
prone to the disease. Unfortunately, anyone can be affected by the disease.
Gout is an extremely painful type of arthritis. The attack of pain is sudden,
with swelling, redness and warmth developing in the affected joint. Gout is
caused from deposits of uric acid in the connective tissue or joint spaces
or both. Unfortunately, there is no cure for gout, although most people can
keep it under control and lead normal lives.
Osteoarthritis
This is probably the most
common type of arthritis. If a person is age 75 or over, he probably has at
least one joint affected by osteoarthritis. This condition is a caused by
wear and tear of the cartilage. A person affected will have pain, swelling
and loss of motion in the joint. In addition, the joint may change its shape
or bone spurs may grow on the edges of the joint. Fortunately this condition
is usually easily to diagnose.
Fibromyalgia
Fibromyalgia is a confusing
and controversial condition, and for that reason is a difficult case to win
without other impairments also being present. Fibromyalgia typically affects
women of childbearing age. Its cause is not known. It is a chronic disorder
that is characterized by musculoskeletal pain and fatigue. This is not a true
type of arthritis as it does not cause deformity. Instead, it is a form of
soft tissue rheumatism which causes pain, fatigue and aggravation to the women
it affects. It is difficult to diagnose, as its symptoms are so similar to
other impairments.
Q. Is
insomnia considered a disability?
As a rule, insomnia is
a symptom rather than the problem itself. Sleep deprivation can be an indication
that a larger problem exists, such as a medical or psychiatric disorder. Insomnia
can definitely be long term, and if a medical or psychiatric disorder does
exist, insomnia could play a role in determining whether or not a disability
exists.
Q. What
is Ankylosing Spondylitis and is it considered a disability for Social Security
disability purposes?
As with any other impairment,
the answer is maybe, maybe not. Ankylosing spondylitis (AS) is another form
of arthritis. It mainly involves the spine and joints of extremities, such
as the knees, hips and shoulders. It can cause inflammation of the eyes, lungs
and heart. It is a member of the family of diseases that attack the spine,
which are known as spondylarthropathies, into which Reiter’s syndrome
is also included. Genetics appears to play a role in the cause of ankylosing
spondylitis, and while it can occur in females but mainly occurs in young
men. A diagnosis of AS is made based on medical history, a physical examination,
blood tests and x-rays. The most common symptoms of ankylosis spondylitis
is low back pain, stiffness, with pain and swelling in the shoulders, knees
and hips. While the severity of the impairment would determine whether a disability
exists, combined with other impairments, AS could certainly strengthen a case.
Q. A
friend with Raynaud’s Syndrome was denied Social Security disability benefits.
Is it not considered a disability?
Recent surveys indicate
that as many as 10 percent of the people in the U.S. may be affected by Raynaud’s
phenomenon, and women are more likely than men to have it. Smokers are also
a group who are likely to have it, although the cause of Raynaud’s is
unknown. Unfortunately, it is another impairment that generally needs detailed,
documented medical evidence in combination with another impairment in order
to be successful as a disability. Raynaud’s syndrome is characterized
by episodic attacks that affect the blood vessels of the fingers, toes, ears,
and nose and cause them to narrow, thus causing a reaction such as skin discoloration
and other changes. As the attack diminishes, redness may occur in the fingers
and toes, as well as throbbing and tingling. This attack is usually triggered
by either exposure to cold or by emotional stress and may last from a few
minutes to an hour. Raynaud’s syndrome can either be in a primary or
secondary form, and while it is easy to diagnose, it is more difficult to
determine which form the patient has. Although treatment is not always successful,
Raynaud’s phenomenon generally can be controlled by exercise, not smoking
and generally being able to control stress, as well as with medications.
Q. Is
alcoholism considered a disability?
In and of itself alcoholism
is not a disability. Congress has prohibited SSA from paying disability benefits
because of alcoholism. However, alcoholics who become disabled due to other
conditions can receive Social Security disability benefits.
Q. Is
drug addiction a disability?
The same rule applies
to drug addiction as alcoholism.
Q. Can
children with cerebral palsy receive disability benefits?
If a child is under 18
years of age and the parent’s income is very low, that child possibly
could qualify for children’s disability benefits under the SSI program.
If a child is over 18 years of age, that child could possibly qualify for
SSI benefits regardless of her parent’s income level.
Also, the child might be able to receive disability benefits from a deceased
parent, or if one of the parents is drawing Social Security benefits of some
sort.
Q. How
does SSA evaluate a claim of HIV?
As with other disability
claims, SSA follows the 5 step rule, which is:
1. Is the claimant working?
An individual working and earning more than $700 per month generally cannot
be considered disabled. So if your answer to this step is “no”,
we can go to the next step.
2. Is your condition severe?
If your condition interferes
with your basic work-related activities, SSA will consider your claim. (Go
to step 3) If it does not, your claim will be denied.
3. Can your listing be
found in the List of Disabling Impairments?
SSA maintains a list of
impairments that are severe enough to automatically qualifies an individual
for disability. But if it is not on the list, SSA must determine whether it
equals another impairment on the list. If it is, we can go to Step 4. Following
is a complete list of some of the impairments associated with HIV infections.
Pulmonary tuberculosis
resistant to treatment
Kaposi's sarcoma
Pneumocystis carinii pneumonia (PCP)
Carcinoma of the cervix
Herpes Simplex
Hodgkin's disease and all lymphomas
HIV Wasting Syndrome
Syphilis and Neurosyphilis
Candidiasis
Histoplasmosis
4. Are you able to do
the work you did previously?
If not, we can go to Step 5. However, if you are able to do the work you did
previously, your claim will be denied.
5. Are you able to perform
any other type of work?
SSA will consider the medical conditions, age, education and past work experience
when determining whether a claimant has any transferable skills, in the event
a person cannot do the work they did in the past.
Documentation of this
impairment is critical and must include laboratory test results and x-ray
results. The HIV infection itself as well as any HIV-related manifestations
must be documented. Signs and symptoms are very important and may include
repeated infections; fever or night sweats; enlarged lymph nodes, liver, or
spleen; generalized weakness; pain on exertion; persistent cough; headache;
anorexia; nausea and vomiting, as well as the side effects of the medication,
and, of course, depression
Q. Are
there separate guidelines for women and children with HIV?
Yes. SSA recognizes that
HIV infection can run its course differently in women and children than in
men. SSA’s list of impairments describes the level of severity necessary
for these impairments to be determined disabling. In order for a child to
be found disabled, he or she must have a condition which matches or is equal
in severity to either the adult or childhood HIV listing or another impairment
found in the list of impairments.
Q. I
know of a child who is receiving disability benefits from SSA and I do not believe
he is disabled. How could this happen?
There are three ways that
a child could receive benefits from the Social Security Administration through
either the Social Security disability insurance program or the Supplemental
Security Income program. They are:
• Supplemental Security Income - these benefits are paid to disabled
children under 18 years of age who have limited income or resources, or who
are children of parents or homes with limited income and resources;
• Social Security Dependents Benefits - these benefits are paid to children
under 18 years of age who have a parent who is collecting retirement or disability
benefits from SSA.
• Social Security Survivors Benefits - These benefits are also paid
to children under 18 years of age who has a parent who has died.
A child does not have to be disabled to receive these benefits, and the child
can continue to receive these benefits until age 19 or if he or she is a full-time
student in elementary or high school.
Q. My
child is disabled. Will his case ever be reviewed?
Yes. The law requires
SSA to review a child’s disability to verify that he or she is still
disabled at least every 3 years for a child under the age of 18 whose conditions
are expected to improve, and not later than 12 months after birth for a baby
whose disability is based on low birth weight unless SSA determines that the
condition is not expected to improve by the child’s first birthday and
SSA schedules the CDR for a later date. At the time that SSA does the CDR,
the child’s parent or guardian to present proof that the child has been
receiving treatment that is considered medically necessary and available for
the child’s disabling condition.
In addition, children
who are eligible for SSI benefits in the month that they turn 18 years of
age must have their eligibility redetermined. The redetermination will be
done during the one-year period before the child’s 18th birthday. SSA
uses the rules for adults filing new claims when making this determination.
Q. When are Social Security disability benefits paid?
Social Security benefits
are paid each month, but for the prior month. For instance, a check received
in June is for the month of May.
Your benefit award notice will have this information on it. Generally, the
day in the month on which you receive your benefit will depend on the birth
date of the person on whose record you receive benefits. For example, if you
receive benefits as a disabled worker, your benefit will be determined by
your birth date, but if you receive benefits as a spouse, your benefit payment
date will be determined by your spouse's birth date.
An example follows::
Birth date on
Benefits paid on
1st - 10th
Second Wednesday
11th - 20th
Third Wednesday
21st - 31st
Fourth Wednesday
For example, your date
of birth is June 16. Your monthly retirement check will be paid on the third
Wednesday of every month. The date you receive your benefits will have no
effect on the way your benefits are figured.
Q.
I have some major health issues and would like to apply for disability benefits.
However, I have a wife who does not work and 2 children who will need to go
to college. Are there any benefits available to them, and if so, would they
continue to receive them if I died?
Yes. Once you start receiving
disability benefits, certain members of your family may also qualify for benefits
on your record. While each family member may be eligible for a monthly benefit
that is up to 50 percent of your disability rate, there is a limit to the
total amount of money that can be paid to a family on your Social Security
record. Although the limit varies, it is around 150 to 180 percent of your
disability benefit. Should the sum of the benefits payable on your account
be greater than this family limit, the benefits to the family members will
be reduced proportionately. Your benefit will not be affected.
Q.
I have applied for disability benefits. Someone told me I might be able to give
some of my benefits to my granddaughter who lives with me. How does that work?
A dependent grandchild
might qualify under the following conditions:
• the child must
be unmarried; and
• be under age 18; or
• be 18-19 years old and a full-time student (no higher than grade 12);
or
• be 18 or older and have a disability that started before age 22.
Usually, benefits cease when a child reaches 18 years of age. However, if
that child is still a full-time student at a secondary (or elementary) school
at age 18, the benefits will continue until that child graduates, or until
two months after that child reaches 19 years of age, whichever is first. The
child’s benefit amount would be approximately 150 to 180 percent of
your disability benefit, if she were the only person receiving benefits on
your record.
Q.
I had polio as a child and believe some of my symptoms are returning. Would
these symptoms be considered a disability by SSA?
SSA refers to returning
polio symptoms as ``Postpolio sequelae'' . Although a person may have had
previously undetected motor residuals following an earlier infection, they
may report symptoms later in life.
SSA reports that most polio survivors in the United States are now in their
forties or older. SSA’s rules require that “an individual establish
disability based on the existence of a medically determinable impairment;
i.e., one that can be shown by medical evidence, consisting of symptoms, signs,
and laboratory findings. Disability may not be established on the basis of
an individual's statement of symptoms alone.” SSA does consider postpolio
sequelae to be a medically determinable impairment when documented by appropriate
medical signs, symptoms and laboratory findings, and it may be the basis for
the finding of a disability. The claimants functional limitations will be
considered.
Q.
My ex-wife told me she was going to try to get part of my benefits if I win
my Social Security disability case. Wouldn’t that affect how much I receive?
Your ex-wife may qualify
for benefits on your record under certain conditions. To qualify, she would
need to:
• have been married
to you for at least 10 years;
• be at least 62 years old;
• be unmarried; and
• not be eligible for an equal or higher benefit on his or her own Social
Security record, or on someone else's Social Security record.
The amount of benefits payable to her would have no effect on the amount of
benefits you or your current spouse may receive.
Q.
My niece told me that her Social Security disability benefits were being “offset”
by her Worker’s Compensation benefits. What does that mean?
The term “offset”
means that the amount a person would ordinarily receive for Social Security
disability benefits is being reduced because of another disability payment
that person is receiving. Normally, Social Security disability payments would
not be affected by a disability payment from another source, but if the additional
source is a worker’s compensation payment or a payment by another public
disability program, then the Social Security disability payment is affected.
The payment is reduced so that the combined amount of the two does not exceed
80% of the recipient’s average current earnings.
Q.
My husband received a noticed from SSA telling us that they had overpaid him.
Do we have to return the money since it was SSA’s error?
It is possible to apply
for and receive what is known as a Waiver of Overpayment. You would be able
to apply for the Waiver if you appeal their decision and win the appeal, or
if the overpayment was their mistake and it would be a hardship for you to
repay the amount.
Q.
My exwife told me that I have no excuse for not paying child support because
it can be taken from my Social Security disability benefits. Is that correct?
Indeed it is. However,
your dependent children may be entitled to a child’s benefit based on
your benefit. If you have not already given SSA your children’s names,
ages, addresses and Social Security numbers, you may add it to your record.
Q.
I am receiving Social Security disability benefits, but my health is rapidly
deteriorating. Can my monthly benefit amount be increased so that I can pay
for my medicine?
Unfortunately, the benefit
is a set amount that is based on your earnings record.
Q.
If I am awarded disability benefits, will I receive them until I die?
You will receive the benefits
until you reach retirement age or until your condition improves to the point
that you are able to return to work on a full time basis for more than 9 months.
SSA periodically can and does re-evaluate disability cases to determine whether
an individual’s condition has improved.
Q. My doctors have diagnosed me with emphysema,
arthritis and have said I am bipolar. My employment has been off and on because
I cannot deal with the pain. I’m not sure exactly when any of my diseases
started, but I have heard that the Date Last Insured is important. How important
is it?
The Date Last Insured, or DLI, is the last day that a person
had coverage for Social Security disability purposes. Sometimes, persons with
multiple impairments find it difficult to actually pinpoint when a new impairment
began, especially if the impairment is a mental impairment. Also, persons
with multiple impairments often find it difficult to remain employed for a
lengthy period of time, due to their overall health and the problems related
thereto. However, knowing the date last insured is very important, because
SSA goes back 10 years. For example, if a person’s DLI was 12/31/2002,
he would need to be able to prove he was disabled on or before that date.
Therefore, a person with sporadic employment would need to ask himself which
was more important: more sporadic employment IF he is able to get it, or disability
benefits.
Q. I’m between
a rock and a hard place. In order to get disability benefits, a person’s
disability must last 12 months. I’ve been told it may take 2 years for
the Social Security Administration to decide whether or not I’m disabled.
I don’t have a lot of money but I do have a lot of debts. Can I file for
disability benefits and still work?
The Social Security Administration does not consider anyone
who is working to be disabled. However, once a person has been found disabled,
he can work under certain conditions.
Q. We
have a 44 year old son with severe arthritis who is, in our opinion, disabled.
Can he draw disability under our Social Security?
He could draw disability benefits only if his parent is retired
or disabled, and the adult child became disabled before reaching the age of
21.
Q. I filed
for disability benefits and won. I have multiple impairments and thought I would
win because of my severe arthritis, but I won because of my severe depression.
Should I appeal this decision? I’m almost crippled because of the arthritis.
Your situation is not uncommon, and it may be that the combination
of your impairments resulted in the allowance which, in turn, resulted in
your favorable decision. Your monthly benefit would not be affected regardless
of which impairment was a result of the allowance, and the benefit was what
you set out to gain, correct? But to answer your question: no, you cannot
appeal the decision.
Q. My
husband is basically blind in one eye. Can he get disability benefits?
SSA’s guidelines for evaluating claims due to a loss
of vision is the best corrected vision. In other words, how well can that
person see out of the other eye. If the person has adequate vision in the
other eye, then the person would not be considered disabled by SSA.
Q. My
son was in a bad car accident several years ago and has lived for several years
with severe pain from the injuries although he has worked. He now has arthritis
in his back and takes medication, which makes him groggy. That isn’t good
at work, of course, but if he doesn’t take it, he can’t stand the
pain. Can SSA understand how pain can keep a person from working?
SSA will try to evaluate your son’s level of pain by
using several methods. One is by evaluating how the pain affects your son’s
ability to function in his normal daily routine. This is called the Activities
of Daily Living (or ADL). Another evaluation is called a Pain Questionnaire.
They will ask the location of the pain, how often the pain exists, how severe
it is, and how the pain limits the person. Another evaluation would be a review
of the medication used to relieve the pain and any side effects the medications
cause. Of course, pain for one person is not the same as pain for another
person, and for that reason SSA must determine how all of these factors together
limit a person’s ability to work.
Q. I have had
severe asthma since childhood. Could I get disability benefits?
Not knowing all the details, we would be unable to determine
what SSA would grant. However, SSA will look at several factors. The criteria
is whether you have had asthma attacks that required hospitalization for at
least 24 hours that were not considered emergency room visits, whether you
had these attacks every 2 months, and whether this frequency persisted for
at least the last 12 months in a row.
Q. I have been
diagnosed with COPD which has caused me to really “slow down”. Other
than that, I think I’m pretty healthy. However, my friends think I should
apply for Social Security disability benefits. Could I get disability benefits
because of COPD?
A person with emphysema without other impairments would normally
need to be in very serious condition in order to get benefits. However, other
factors would need to be considered, such as your age and the results of pulmonary
function studies. Cases with a claimant age 50 and over are more likely to
be given an allowance than a case with a claimant age 40.
Q. My
50 year old husband suffers from severe depression. He has multiple impairments.
He rarely leaves the house, and does none of the household chores. He has not
worked in a year. His claim was denied but we appealed. Is there anything our
family can do to help his case?
Yes. SSA will consider information submitted by friends and
family members. Many spouse’s keep a diary for a certain period of time
of their loved one’s activities (or lack thereof). This might also include
information about any mood swings, such as how often the mood swings occur.
Then the diary could be transferred to letter form and submitted to the Administrative
Law Judge who has been assigned the case.
Q. Can
sickle cell anemia be considered a disability?
Sickle cell anemia is a disorder which affects the shape
of red blood cells and causes it to be less efficient at carrying blood to
the muscle and organ systems. This impairment can cause severe pain to the
affected areas. It often manifests itself in crisis episodes which incapacitate
the person completely. SSA will look at how many episodes a person has experienced
in a certain period of time and whether the crisis episode required hospitalization.
A person who has suffered two crises in a one-year period of time would have
a good case.
Q. Is
an insurance policy part of the Social Security disability benefits package?
Fortunately, a person found disabled by the Social Security
Administration is eligible for federal health benefits, which is either Medicare
or Medicaid. The criteria is this: A person qualifying for Social Security
disability would automatically qualify for Medicare after having received
Social Security disability insurance payments for two years. Normally, the
Social Security Administration notifies a recipient and gives them the necessary
information needed to enroll in Medicare. A disabled person qualifying for
Supplemental Security Income is eligible for Medicaid, which is free to eligible
recipients. Some states require recipients to apply for the Medicaid benefits,
while other states automatically enroll the recipients when they qualify.
Q. How
are Social Security disability benefits calculated?
The monthly benefit amounts that a person receives for Social
Security disability is based on his or her lifetime average earnings. Annual
adjustments are made to account for the cost of living increases or modifications.
Q. If
I move from one state to another, will I lose my disability benefits?
No. All you need to do is notify SSA of your address change.
However, some states supplement disability benefits with additional benefits,
and these do not “transfer”.
Q. Will
I lose my Social Security disability benefits if I get married?
Social Security disability benefits are not based on an income
need. Therefore, if you are receiving Social Security disability benefits,
you would not lose them. If, however, you are receiving Supplemental Security
Income because you are disabled, your husband’s income and resources
would be included for your eligibility purposes. The combination of the two
incomes may result in your benefits being terminated, or a reduction in benefits.
Q. I applied for disability benefits over a year
ago and was turned down. If I want to apply again, will this hurt my case?
Our answer would depend
on a number of individual circumstances. However, if you were denied benefits
and did nothing, at some point your case ended when the appeal time ended.
If at a later date you re-apply, the determination of non-disability from
your former case would be considered res judicata, which is a legal term meaning
that the non-disability from your former case could not be questioned. If
your insured period has run out and you are later determined disabled, you
would not be able to draw Social Security benefits, but you might be able
to draw SSI. Of course, if your insured period has not ended, then you might
be able to draw Social Security disability benefits.
Q. What
do I do if SSA tries to cut off my disability benefits?
You
should immediately appeal your case and seriously consider talking with an attorney
about representing you. If you appeal within 10 days after being notified by
SSA that your disability benefits are ending, you have the right to request
that your disability benefits continue during the appeal.
Q. What
is the difference between Medicare and Medicaid?
An easy way to remember
the difference is that Medicaid is a poverty program while Medicare is not.
Disabled individuals who receive Medicaid do so because they are on the SSI
(Supplemental Security Income) program. That means that their income level
is low and they are poor enough to qualify. It also means that these people
may have a hard time finding a doctor to treat them, because Medicaid pays
doctors at a low rate.
Medicare, on the other hand, does not have income eligibility criteria. If
you have been determined disabled by SSA, you qualify for Medicare after 24
months. Medicare pays doctors at a higher rate than Medicaid, and most doctors
are willing to accept a Medicare patient. Medicare does not, however, generally
pay for prescription benefits.
Q. I
had a pension plan at my last job. Can I receive benefits from it as well as
from Social Security disability?
Social Security disability
benefits are not affected by any private insurance you may have, such as a
company pension or by a 401k plan.
Q. In
your opinion, what is the biggest mistake a person could make when trying to
get Social Security disability benefits?
We would have to say that
the biggest mistake we see is claimants failing to appeal their claim. More
than half of the people who receive a denial fail to appeal. Many people simple
do not understand that the process to determine a person disabled is a very
long one, so they simply give up.
The second biggest mistake
would be lack of medical care. Many people do not understand that medical
treatment records provide the most important evidence to prove a disability
case. Some people with long-term, chronic conditions may feel that the doctors
are not really helping them, so they stop going to their doctor, not realizing
that it is a mistake, not only for their health, but also for their case.
Q. I
have many health problems, but I cannot decide which one in particular it is
that has caused me to stop working. Can a combination of health problems allow
a person to win a disability case?
SSA should consider all
of your impairments and the combined effects they present. Many claimants
have more than one health problem and the combined effects must be considered.
Q. What
is a hearing before the Administrative Judge like?
While hearings may vary
from state to state, the hearings are all fairly informal and not at all like
a trial in a court room. The hearing is generally in a small room, and the
only people present usually are the judge, a secretary operating a tape recorder,
the claimant, the claimant’s attorney, and anyone the claimant has brought
as a witness. In some cases, the judge may have a doctor or a vocational expert
to testify. SSA does not have a lawyer present, though, to represent it.
Q. Can
I appeal a case beyond the Appeals Council?
If you are denied by the
Appeals Council, your next step would be to appeal to the Federal Courts.
In fact, a Social Security disability claim can be appealed all the way to
the U.S. Supreme Court, and the Supreme Court does hear an appeal about a
Social Security disability case about once every two years..
Q. With
all the information available on the internet about Social Security disability,
I do not understand why a person could not easily handle his own case. How hard
could it be?
There is not a requirement
anywhere that a person has to have an attorney represent them. In fact, we
have heard of people who have been successful at handling their own cases.
However, we have also seen people lose benefits or be denied altogether because
they handled their case themselves. We have also seen cases that had been
started by a claimant that were not “fixable” by an attorney.
In our opinion, It is important to get an experienced attorney to guide you
through the process right away.
Q. Are
there a lot of people who take advantage of the system and get disability benefits
when they really are not disabled?
We would have to say
that most claimants are really disabled. The process for determining whether
or not a person is disabled is very long and complex, and there is a checks
and balances system in place at SSA whereby it seems that cases are meant
to be denied rather than allowed. For that reason, it would be difficult,
at least, to fake a disability.
Q.
Isn’t the Social Security Administration supposed to help me get disability
benefits?
Sorry. It doesn’t
work that way. In fact, SSA makes it very difficult for people to get disability
benefits. In a nutshell, it is SSA’s job to deny a claim for disability
benefits.
Q. Everyone
knows attorneys are very expensive. If I can’t work, how am I supposed
to be able to pay an attorney to help me get disability benefits?
In most disability cases,
an attorney will accept your case on a “contingency basis”. This
means that the attorney gets paid only if he or she wins your case.
Q. It
would seem to me that if I am too sick to return to my previous employment that
I would be entitled to disability benefits. Is this not correct?
The Social Security Administration
is not concerned about the fact that you cannot return to your previous employment.
You must prove that you cannot return to any employment, no matter what it
might be.
Q.
Rather than call long distance, can I call the 800 number to SSA to get an answer
to any question I might have?
If you have a question,
we would recommend that you first call your attorney, then if you are still
not satisfy that you call the district office where you initially filed your
claim. The 800 number for SSA has been proven unreliable time and time again.
You must understand that because of the many levels and departments involved,
the right hand at SSA does not always know what the left hand is doing. The
district office generally can give you reliable information, though.
Q. I
know of a child who is receiving disability benefits from SSA and I do not believe
he is disabled. How could this happen?
There are three ways that
a child could receive benefits from the Social Security Administration through
either the Social Security disability insurance program or the Supplemental
Security Income program. They are:
• Supplemental Security Income - these benefits are paid to disabled
children under 18 years of age who have limited income or resources, or who
are children of parents or homes with limited income and resources;
• Social Security Dependents Benefits - these benefits are paid to children
under 18 years of age who have a parent who is collecting retirement or disability
benefits from SSA.
• Social Security Survivors Benefits - These benefits are also paid
to children under 18 years of age who has a parent who has died.
A child does not have to be disabled to receive these benefits, and the child
can continue to receive these benefits until age 19 or if he or she is a full-time
student in elementary or high school.
Q. My
child is disabled. Will his case ever be reviewed?
Yes. The law requires
SSA to review a child’s disability to verify that he or she is still
disabled at least every 3 years for a child under the age of 18 whose conditions
are expected to improve, and not later than 12 months after birth for a baby
whose disability is based on low birth weight unless SSA determines that the
condition is not expected to improve by the child’s first birthday and
SSA schedules the CDR for a later date. At the time that SSA does the CDR,
the child’s parent or guardian to present proof that the child has been
receiving treatment that is considered medically necessary and available for
the child’s disabling condition.
In addition, children
who are eligible for SSI benefits in the month that they turn 18 years of
age must have their eligibility redetermined. The redetermination will be
done during the one-year period before the child’s 18th birthday. SSA
uses the rules for adults filing new claims when making this determination.
Q. When
are Social Security disability benefits paid?
Social Security benefits
are paid each month, but for the prior month. For instance, a check received
in June is for the month of May.
Your benefit award notice will have this information on it. Generally, the
day in the month on which you receive your benefit will depend on the birth
date of the person on whose record you receive benefits. For example, if you
receive benefits as a disabled worker, your benefit will be determined by
your birth date, but if you receive benefits as a spouse, your benefit payment
date will be determined by your spouse's birth date.
An example follows::
Birth date on 1st - 10th
Benefits paid on Second Wednesday
Birth date on 11th - 20th
Benefits paid on Third Wednesday
Birth date on 21st - 31st
Benefits paid on Fourth Wednesday
For example, your date
of birth is June 16. Your monthly retirement check will be paid on the third
Wednesday of every month. The date you receive your benefits will have no
effect on the way your benefits are figured.
Q.
I have some major health issues and would like to apply for disability benefits.
However, I have a wife who does not work and 2 children who will need to go
to college. Are there any benefits available to them, and if so, would they
continue to receive them if I died?
Yes. Once you start receiving
disability benefits, certain members of your family may also qualify for benefits
on your record. While each family member may be eligible for a monthly benefit
that is up to 50 percent of your disability rate, there is a limit to the
total amount of money that can be paid to a family on your Social Security
record. Although the limit varies, it is around 150 to 180 percent of your
disability benefit. Should the sum of the benefits payable on your account
be greater than this family limit, the benefits to the family members will
be reduced proportionately. Your benefit will not be affected.
Q.
I have applied for disability benefits. Someone told me I might be able to give
some of my benefits to my granddaughter who lives with me. How does that work?
A dependent grandchild
might qualify under the following conditions:
• the child must
be unmarried; and
• be under age 18; or
• be 18-19 years old and a full-time student (no higher than grade 12);
or
• be 18 or older and have a disability that started before age 22.
Usually, benefits cease when a child reaches 18 years of age. However, if
that child is still a full-time student at a secondary (or elementary) school
at age 18, the benefits will continue until that child graduates, or until
two months after that child reaches 19 years of age, whichever is first. The
child’s benefit amount would be approximately 150 to 180 percent of
your disability benefit, if she were the only person receiving benefits on
your record.
Q.
I had polio as a child and believe some of my symptoms are returning. Would
these symptoms be considered a disability by SSA?
SSA refers to returning
polio symptoms as ``Postpolio sequelae'' . Although a person may have had
previously undetected motor residuals following an earlier infection, they
may report symptoms later in life.
SSA reports that most polio survivors in the United States are now in their
forties or older. SSA’s rules require that “an individual establish
disability based on the existence of a medically determinable impairment;
i.e., one that can be shown by medical evidence, consisting of symptoms, signs,
and laboratory findings. Disability may not be established on the basis of
an individual's statement of symptoms alone.” SSA does consider postpolio
sequelae to be a medically determinable impairment when documented by appropriate
medical signs, symptoms and laboratory findings, and it may be the basis for
the finding of a disability. The claimants functional limitations will be
considered.
Q.
My ex-wife told me she was going to try to get part of my benefits if I win
my Social Security disability case. Wouldn’t that affect how much I receive?
Your ex-wife may qualify
for benefits on your record under certain conditions. To qualify, she would
need to:
• have been married
to you for at least 10 years;
• be at least 62 years old;
• be unmarried; and
• not be eligible for an equal or higher benefit on his or her own Social
Security record, or on someone else's Social Security record.
The amount of benefits payable to her would have no effect on the amount of
benefits you or your current spouse may receive.
Q.
My niece told me that her Social Security disability benefits were being “offset”
by her Worker’s Compensation benefits. What does that mean?
The term “offset”
means that the amount a person would ordinarily receive for Social Security
disability benefits is being reduced because of another disability payment
that person is receiving. Normally, Social Security disability payments would
not be affected by a disability payment from another source, but if the additional
source is a worker’s compensation payment or a payment by another public
disability program, then the Social Security disability payment is affected.
The payment is reduced so that the combined amount of the two does not exceed
80% of the recipient’s average current earnings.
Q.
My husband received a noticed from SSA telling us that they had overpaid him.
Do we have to return the money since it was SSA’s error?
It is possible to apply
for and receive what is known as a Waiver of Overpayment. You would be able
to apply for the Waiver if you appeal their decision and win the appeal, or
if the overpayment was their mistake and it would be a hardship for you to
repay the amount.
Q.
My exwife told me that I have no excuse for not paying child support because
it can be taken from my Social Security disability benefits. Is that correct?
Indeed it is. However,
your dependent children may be entitled to a child’s benefit based on
your benefit. If you have not already given SSA your children’s names,
ages, addresses and Social Security numbers, you may add it to your record.
Q.
I am receiving Social Security disability benefits, but my health is rapidly
deteriorating. Can my monthly benefit amount be increased so that I can pay
for my medicine?
Unfortunately, the benefit
is a set amount that is based on your earnings record.
Q.
If I am awarded disability benefits, will I receive them until I die?
You will receive the benefits
until you reach retirement age or until your condition improves to the point
that you are able to return to work on a full time basis for more than 9 months.
SSA periodically can and does re-evaluate disability cases to determine whether
an individual’s condition has improved.
Q. I got injured while I was working and started
receiving worker’s comp benefits. I thought I would be able to return to
work, but my injuries are worse than anticipated. Can I file for Social Security
disability benefits now, or do I have to wait until my worker’s comp ends?
You do not have to wait until your worker’s compensation
benefits end. In fact, you should not wait. The process for being determined
disabled is a very lengthy process which can take at least two years. If you
waited before filing, there could be a gap between the worker’s compensation
benefits and the Social Security disability benefits.
Q. Can a person receive Social
Security disability benefits for leukemia?
Each and every disability case is different, but it would
depend on how severely the person was affected by the condition. In reality,
that is true no matter what the disease might be. For example, cancer is a
disease which, although frightening, can be treated and cured quickly in many
cases. Other cancer conditions are extremely painful and devastating in patients
and can even result in death. So the mere fact that a person has a particular
disease does not necessitate a finding of disability for that person.
Q. I
have heard that it takes a long time to get Social Security disability benefits.
Why can’t a person skip the middle or reconsideration level, since everyone
get denied at that level anyway?
The answer to your question is twofold. First, not everyone
gets denied at the reconsideration level. True, the percentage of favorable
decision is very low compared to the ALJ level, but some claimants do win.
And second, the process for determining whether a person is disabled is an
administrative process, which means that each level must be completed before
going to the next.
Q. I
really would rather work than sit and home and draw Social Security disability
benefits. If I get better, can I go back to work?
Yes, you can. In fact, SSA encourages individuals who are
receiving Social Security disability benefits to do just that. If you return
to work, your benefits may continue in full for one year. If you have to stop
working again in the following three years, you can receive your benefits
again without having to re-file your claim.
Q. I
am disabled and receive SSI. My exwife says she is going to have my disability
benefits seized for child support. Can she do this?
Since Supplemental Security Income (SSI) is essentially a
public welfare benefit, it has nothing to do with a claimant’s earnings
record. Therefore, SSI benefits cannot be seized for another purpose. Social
Security disability benefits can, however, be seized for child support, because
they are derived from a claimant’s earnings record.
Q. Can
anyone call SSA to verify that I have filed for Social Security disability benefits?
The information you have provided to SSA is confidential and
will be discussed only with you with a few exceptions: if you want someone
else to help you with your Social Security business, SSA needs your permission
to provide your information to and/or discuss your case with that person.
In fact, if you call SSA yourself, you might notice that they ask you questions
to verify your identify. There are occasions when SSA can share your information
with others, such as other government agencies that administer health or welfare
programs, such as Medicaid or food stamps. Those agencies are not allowed
to share your information with anyone else.
Q. I
received some information from SSA with a “ticket” to work. What
is the Ticket to Work program?
It is a program to assist disabled persons who wish to return
to work. It is strictly voluntary. If you are interested and feel you might
be able to work, you can take the “ticket” to your state vocational
rehabilitation agency or to an agency that has agreed to assist SSA in providing
employment services to disability beneficiaries. SSA also has a publication
called “Your Ticket To Work”, if you would like further information.
Q.
We have a young man in our church who is mentally impaired and who is trying
to get Social Security disability benefits. He does not seem to have anyone
to help him in the way of a family member. I’m afraid he will not be able
to handle his financial affairs when he gets all that money from Social Security.
Can SSA appoint someone to help him with his money?
In the event a recipient of Social Security disability benefits
might be unable to manage his or monies, SSA can arrange for the funds to
be sent to a relative or other person who agrees to use the money to take
care of the person for whom the benefits are paid. That person is called a
“Representative Payee”.
Occasionally someone believes that a power of attorney and representative
payee are one and the same. The terms are not the same.
Q. Does SSA
recognize a power of attorney for purposes of managing money for a Social Security
disability recipient?
No. SSA does not recognize power of attorney for purposes
of managing benefit payments. A power of attorney is legal process where one
individual grants a third party the authority to transact certain business
for that individual. However, it does not diminish the rights of the individual,
nor does it usually grant the third party the right to manage the individual's
assets.
Q.
What happens to my benefits if I have to go to jail?
If you have been convicted
of a crime and have to go to jail. Benefits are generally not paid for the
time a person is incarcerated, but any family members eligible to receive
benefits based on your work may continue to receive benefits.
Q. What
can I expect when my Social Security disability benefits are up for review?
When SSA elects to review
your case, it will send you a letter notifying you. The letter will be followed
by a telephone call from your local SSA office to explain the review process
as well as your appeal rights. The SSA representative will ask you to provide
information regarding your medical treatments and any work that you may have
performed. Then a disability examiner and a doctor will review your file and
request your medical records. If they feel you need a special examination
by another doctor, SSA will arrange it, pay for the examination and some of
your transportation costs. When a decision has been made, SSA will send you
a letter notifying you that you are still disabled and will continue to receive
benefits, or that SSA has determined that you are no longer disabled. If you
disagree with SSA’s decision, you can appeal. If you do not file an
appeal, your benefits will cease 3 months after SSA determines your disability
ended.
Q.
My Social Security disability earnings are too high for SSI but too low for
me to pay all my bills. Is there another source that might help me?
Each community has a social
services department in the hospital or clinic. There are also private nonprofit
health groups who assist individuals. Each state has a vocational rehabilitation
agency as well as state and local social service agencies who have information
available to people with disabilities.
Q.
I have a brother who is applying for citizenship in the United States and I
believe he might be disabled. Would he be eligible for any type of Social Security
disability benefits?
SSA’s rule for eligibility
for SSI is as follows:
Generally, if you are a noncitizen, you may be eligible for SSI if:
• You were lawfully living in the U.S. on August 22, 1996 and you were
blind or disabled on that date, or you were receiving SSI on August 22, 1996;
• You were lawfully
admitted for permanent residence under the Immigration and Nationality Act
(INA) and have a total of 40 credits of work in the U.S. Your spouse’s
or parent’s work also may count.
Other noncitizens who
may be eligible for SSI payments include active duty members of the U.S. armed
forces; American Indians born outside the U.S; certain noncitizens admitted
as Amerasian immigrants; and Cuban or Haitian entrants, as well as others.
Q.
My husband was receiving disability benefits when he died unexpectedly this
month. I gave birth to our daughter this week. Would she qualify for any type
of benefits from his record?
If a parent receiving
Social Security benefits is deceased, a newborn may qualify for survivors
benefits.
Your local SSA will help you apply for these benefits. You, too, may qualify
for benefits as your husband’s widow.
Q. My
family has determined that my 23 year old sister is schizophrenic. What are
the requirements for schizophrenia to be a disability?
Schizophrenia is characterized
by the onset of psychotic features with the deterioration from a previous
level of functioning. SSA’s required level of severity is met when the
requirements in both A and B are satisfied, or when the requirements in C
are satisfied. They are as follows:
A. Medically documented persistence, either continuous or intermittent, of
one or more of the following:
1. Delusions or hallucinations; or
2. Catatonic or other grossly disorganized behavior; or
3. Incoherence, loosening of associations, illogical thinking, or poverty
of content of speech if associated with one of the following:
a. Blunt affect; or
b. Flat affect; or
c. Inappropriate affect;
OR
4. Emotional withdrawal and/or isolation;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace;
or
4. Repeated episodes of decompensation, each of extended duration;
OR
C. Medically documented history of a chronic schizophrenic, paranoid, or other
psychotic disorder of at least 2 years' duration that has caused more than
a minimal limitation of ability to do basic work activities, with symptoms
or signs currently attenuated by medication or psychosocial support, and one
of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment
that even a minimal increase in mental demands or change in the environment
would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years’ inability to function outside
a highly supportive living arrangement, with an indication of continued need
for such an arrangement.
Q. If
I am collecting early retirement, could I also collect Social Security disability
benefits or SSI?
Yes, but you must first prove that your disability began before
you elected to retire.
Q. I was in
a very serious accident this year that caused burns to 60 % of my body and need
to file for Social Security disability benefits. How does SSA evaluate burns?
SSA’s guidelines state that since electrical, chemical,
or thermal burns can affect other body systems (musculoskeletal, special senses
and speech, respiratory, cardiovascular, renal, neurological, or mental),
it will evaluate burns the same way it evaluates other disorders that can
affect the skin and other body systems, which is, to use the listing for the
predominant feature of the claimant’s impairment. If the soft tissue
injuries require continuing surgical management, SSA will evaluate the impairment
under section 1.08 of the Blue Book; if the burns do not meet the requirements
of 1.08 and the claimant has extension skin lesions that result in a very
serious limitation that has lasted or can be expected to last for a continuous
period of at least 12 months, SSA will evaluate them under 8.08 of the Blue
Book.
Q. I
have been diagnosed with hidradenitis suppurativa. How can I meet the listing
for this condition?
To meet the requirements for this condition, a claimant must
have extensive skin lesions involving both axillae, both inguinal areas of
the perineum that persist for at least 3 months despite continuing treatment
as prescribed. Additionally, if you do not have continuing treatment as prescribed,
if your treatment has not lasted for at least 3 months, or if you do not have
extensive skin lesions that have persisted for at least 3 months, your impairment
cannot meet the requirements of the listing. However, SSA may still find a
claimant disabled because the impairment meets the requirements of a listing
in another body system or medically equals the severity of a listing.
Q. My
nephew was born with Down Syndrome. Would he meet SSA’s listings as a
baby?
According to SSA, Down syndrome “established by clinical
findings, including the characteristic physical features, and laboratory evidence
is considered to meet the requirement of listing 10.06, commencing at birth.”
Medical records must show confirmation of a positive diagnosis by a clinical
description of the usual abnormal physical findings associated with the condition,
as well as definitive laboratory tests, including chromosomal analysis. Medical
evidence that shows that a positive diagnosis has been confirmed by appropriate
laboratory testing, at some time prior to evaluation, is acceptable in lieu
of a copy of the actual laboratory report.
Q. My
son is autistic. Can an autistic disorder be a disability?
This condition is described by SSA as being “characterized
by qualitative deficits in the development of reciprocal social interaction,
in the development of verbal and nonverbal communication skills, and in imaginative
activity. Often, there is a markedly restricted repertoire of activities and
interests, which frequently are stereotyped and repetitive.” The severity
level is met when all of the following are satisfied:
A. Medically documented findings of all of the following:
a. Qualitative deficits in reciprocal social interaction; and
b. Qualitative deficits in verbal and nonverbal communication and in imaginative
activity; and
c. Markedly restricted repertoire of activities and interests;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace;
or
4. Repeated episodes of decompensation, each of extended duration.
Q.
What is SSA’s definition of “disability” for a child?
SSA’s definition of disability for children is as follows:
“Under title XVI, a child under age 18 will be considered disabled if
he or she has a medically determinable physical or mental impairment or combination
of impairments that causes marked and severe functional limitations, and that
can be expected to cause death or that has lasted or can be expected to last
for a continuous period of not less than 12 months.”
Q.
What medical sources does SSA consider acceptable for Social Security disability
purposes?
SSA’s acceptable
medical sources include the following:
• licensed physicians
(medical or osteopathic doctors);
• licensed or certified psychologists;
• licensed optometrists (measurement of visual acuity and visual fields);
• licensed podiatrists (for purposes of establishing impairments of
the foot, or foot and ankle only, depending on the State in which the podiatrist
practices);
• qualified speech-language pathologists (for purposes of establishing
speech or language impairments only);
as well as the medical evidence SSA requests from hospitals, clinics, or other
health facilities where the claimant has been treated.
Q. Our
grandson is 8 years old but he looks like he is much younger because he is so
small. Is there any disability pertaining to a child’s lack of growth?
SSA considers growth impairment
as possibly being disabling in itself or as an indicator of the severity of
the impairment due to a specific disease process. Growth impairment determinations
must be based on a child’s current height with at least 3 previous determinations,
including the child’s height and length at birth, and these should be
plotted on a standard growth chart. The child’s body weight corresponding
to the ages represented by the heights should also be included, as well as
the adult heights of the child’s natural parents and heights and ages
of the child’s siblings. These findings provide SSA with a basis upon
which to identify children whose short stature represents a familial characteristic
rather than a result of disease.
Q. My
husband has had numerous ear infections, among other impairments, and now he
cannot hear a normal conversation. His doctor says a hearing aid would not help.
Can loss of hearing be considered a disability?
In order to meet the listing,
a hearing impairment not restorable by a hearing aid would be one manifested
by one of the following: (a) the average hearing threshold sensitivity for
air conduction of 90 decibels or greater, and for bone conduction to corresponding
maximal levels, in the better ear, determined by the simple average of hearing
threshold levels at 500, 1000, and 2000 hz.; or (b) by speech discrimination
scores of 40 percent or less in the better ear.
Q. What
does SSA consider “loss of speech”?
In evaluating the loss
of speech, SSA considers the ability to produce speech to include the use
of mechanical or electronic devices that improve voice or articulation. Additionally,
however, an impairment of speech may also be evaluated under the body system
for the underlying disorder, such as neurological disorders.
Q. I
am presently getting worker’s compensation but am also applying for Social
Security disability benefits. Will SSA consider my medical records from my worker’s
comp doctors?
In evaluating an individual’s
claim for either Social Security disability benefits or SSI, SSA considers
medical records, including examinations and medical tests, from worker’s
compensation and other programs. However, SSA will make it’s own determination
as to whether the individual is disabled.
Q. A
friend told me that he had contacted his state representative to speed his case
along. Would that really do any good?
If a case seems to be
taking an unusually long time to process, sometimes a congressional inquiry
will help your case be processed a little faster. That does not mean that
special consideration will be given with any and all cases, however. Your
attorney should be taking care of this for you.