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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.








Return to:  Social Security Disability Resource Center, or read answers to Questions








Related pages:

Qualifications for Disability Benefits
SSI disability qualifications for Adults and Children
Permanent Disability Qualifications for SSD and SSI
Social Security Disability And SSI Qualifications - What is the examiner looking for?
Social Security Disability Attorney Qualifications and Expenses
What are the disability qualifications in North Carolina?
Getting SSDI but making too much money
Would I eligible for SSD since I was disabled at the time I stopped working?



Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria