What makes you disabled for SSD, Social Security Disability Benefits, OR SSI?

How much can you work and earn before becoming ineligible for SSD or SSI?)

In other words, if you retain the ability to work but only at a level that is below the SGA earnings limit that is in effect for a given year, then you may be considered disabled by Social security.

The actual definition of disability states that, to qualify for disability, the following must be true:

1. The person filing for disability must have a medically determinable basis for the impairment that they claim to be disabling. What does SSA mean by "medically determinable"? This simply means that the claimant's diagnosis, and the limitations and restrictions that result from their diagnosed condition, must be documented, i.e. proven by medical evidence. This will typically mean medical records obtained from the various doctors who have treated a claimant (but also including hospitals and specialized clinics).

2. The person applying for disability must have a condition that is severe enough to prevent them from being able to work and earn a substantial and gainful income.

3. This level of severity must persist for at least one full year in order for an individual to be awarded disability benefits.

Whether or not a person can engage in substantial and gainful work activity will determine whether or not they meet the qualifications for disability under either the SSD (Social Security Disability) or SSI (supplemental security income) program.

How is it proven that a case actually meets the definition of disability used by the social security administration? If the medical evidence shows that the claimant's current physical and/or mental abilities are not up to the task of doing any of the jobs that they might have done in the past 15 year period (this is what SSA considers to be the relevant work period), then it is possible that they may be approved for disability.

However, the inability to return to a past job is only part of the equation. Once a return to past work is eliminated as an option, a claimant's file (which includes their medical records, statements from a treating physician--referred to as a residual functional capacity statement or medical source statement--work history reports, and questionaires regarding their activities of daily living) must also demonstrate that the claimant lacks the ability to use their education and job training, given full consideration of their age and functional limitations, to do some type of other work.

The inability to work, of course, at a level that allows the individual to earn a substantial and gainful income, must last for at least one full year. If the individual's state of disability does not last for a full year, the claim will be turned down as durational denial.

What happens if a disability claim is denied on the basis of duration, i.e. that the condition was not disabling for long enough a period of time? The claimant may elect to further pursue the claim by following the appeal process. Filing appeals is always preferable to filing a new claim since the filing of appeals will advance the case further along in the system.

The first appeal, the request for reconsideration, is handled in an identical fashion to the disability application and is simply processed by a different disability examiner. And, not surprisingly, the rate of denial on reconsiderations is very high. In fact, the percentage of denials at the recon level typically exceeds 80 percent.

Getting through the recon level, though, allows a claimant to file the second appeal in the SSD and SSI system. That appeal is known as a request for hearing before an administrative law judge. At a hearing, a claimant will, statistically, stand a much higher chance of being awarded benefits, particularly when the case is A) properly prepared and B) properly presented to the presiding judge.

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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