Qualifications for Disability Benefits and the Types of Evidence Social Security Looks at
If your case is at the initial level, which simply means an application for disability benefits, then the claim will be handled by a disability examiner at an agency known as DDS, or disability determination services. The examiner will render a decision that is based primarily on the medical evidence that is obtained, but which can also be determined by other types of evidence. Those other types of evidence that are gathered and used to determine a claimant's qualifications for disability benefits will depend on whether or not the claimant is a child or an adult.
Filing for children
For a child filing for disability, the evidence will very often also involve school records. This is not just confined to grade reports but IEPs and the results of whatever specialized testing the child has been given, such as weschler intelligence tests or academic achievement tests.
In addition to this, a disability examiner will sometimes try to obtain a completed questionaire from a child's teacher or teachers. Working as a disability examiner myself, it was commonly a part of my case development process to send out a questionaire to each of a child's teacher's simply because A) not all of them would respond and B) as with every disability case, the more information in hand the better the odds of making a good decision which would, hopefully, lead to a disability case being approved (and with as much back pay as possible for the claimant).
Filing for adults
For an adult who is filing for disability, medical records will really constitute the bulk of the evidence. And this would include admission and discharge summaries from hospitals, as well as reports of testing (blood work, diagnostic tests, specialized exams such as neurological examinations, and imaging reports for CT, PET, and MRI scans), and progress notes from individual doctors.
Note: Though hospitals will often send additional medical records such as nurse's notes, these are typically of no use since, as far as the social security administration is concerned, evidence is only valid when it bears the authority of a licensed physician (meaning the signature).
Having said this, though, an adult claim will also require a disability examiner to review the claimant's work history. This is because a decision for a Social Security Disability claim or an SSI disability claim for an adult will ordinarily be what is known as a medical vocational decision.
In short, this means that whether or not a person will be awarded disability benefits as an adult will depend on whether or not they can still, in light of their condition and the mental and/or physical limitations that exist as a result of their condition, engage in work activity. This includes, as most people would guess, their last job. But it also includes potentially any job they have worked in what SSA refers to as the relevant period. And the relevant period goes back 15 years from the time that a person alleges that they became disabled. In addition to this, whether or not a person will be awarded disability benefits will be determined by whether or not they have the ability to do some type of other work
Who qualifies for disability as an adult? These are individuals who are found to no longer have the ability to engage in work activity, either at a job they have done in the last 15 years, or at some new type of work that they might be able to logically switch to (assuming they were not disabled).
At this point, it might seem that the qualifications for disability benefits are extraordinarily hard. However, the process is made easier by the fact that a person's available job opportunities will be taken into consideration when their claim is processed. And what jobs are available to a person will be viewed in light of their education, skills, age, and, especially, the level of physical or mental restrictions (i.e. functional limitations) that they have as a result of their various impairments.
This, of course, is why it is so important for social security to be made aware of all the medical treatment sources that a person has gone to in recent months--as well as several years back--because the more evidence that a disability examiner has the more accurately they can rate a claimant's functional limitations. Which might then lead to the conclusion that they cannot engage in work activity.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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