Why Is It Hard to be Found Disabled for Social Security Disability or SSI for Seizures?

I have read this question, or ones very similar to it in forums, and really there is no pat answer to the question. Here are some types of responses that I have come across for this question.

1. "I have been trying to figure that out myself. My doctor days I cannot work because of seizures, but SSI says they do not happen often enough. I have been denied twice and I am thinking I am done with it. I am going back to work. This new medication the doctor put me on is helping but it costs $540.00 per month, I cannot get Medicaid, so I have to work. Good luck if you are trying."

2. 'There are a lot of people who think they are disabled, but just because you feel you do not want to work anymore does not make you disabled. The test for SSI is actually tougher than SSDI. SSD denies about 50% of the people that comes in and applies for money. Collect all your papers and evidence of your problem and go back there. Do not hire one of those SSD lawyers to help you; they will only take a large chunk of your money if you do end up getting any. If you get denied, keep applying.

Lets address the first response.

This individual obviously has some type of seizure disorder and Social Security has determined that their seizures are controlled to the point that they do not occur often enough. Social Security's neurological epilepsy impairment listing states that an individual who suffers from epilepsy (seizures), no matter the cause, will have their degree of impairment determined by the type, frequency, duration, and secondary effects of the seizures.

Per the listing book, i.e the social security "blue book", individuals applying for Social Security Disability must have been having seizures more than once a month in spite of three months of prescribed treatment if the epilepsy is convulsive in nature.

If an individual suffers from a non-convulsive type of epilepsy, they must be having seizures weekly in spite of three months of prescribed treatment. In this case, it appears that the individual's medication is working and that their seizures are controlled to the point that their seizures are not occurring often. I would definitely say that this individual does not meet or equal a Social Security impairment listing. However, nonetheless, there might be a chance of winning disability if the individual pursued their disability claim through the appeal process to the level of an administrative law judge hearing.

There are times where an individual simply does not have the residual functional capacity (what an individual is able to do in spite of the disabling condition) to engage in sustained substantial gainful work activity and they could potentially be approved through a medical vocational determination. It is hard to say in this individual's case. Why? Because they obviously feel that they can work at a job because they state they are going back to work. Which leads me to the second individual's response (third paragraph above).

This individual stated that there are many people who think they are disabled...but just because they think they do not want to work does not make them disabled. In my experience as a disability claims examiner, I have not observed that individuals simply all of a sudden conclude that they do not want to work anymore and, therefore, apply for disability. Generally, a health problem arises that makes an individual feel that it is impossible for them to work.

However, when they apply for disability with Social Security, they are told that they are able to A) work at a past job or B) do some other type of work that is performed in the economy.

Social Security Disability, by its very definition, means that an individual is unable to perform substantial work activity due to their disabling condition. Social Security establishes a monthly gross earning amount that it considers to be substantial gainful activity (SGA). If an individual is able to earn more than that, it does not matter what their condition is, or really even how severe the impairment is; they will be denied for the performance of SGA. Social Security is not about specific conditions; rather it is about an individual's ability to work with the limitations imposed upon them by their disabling condition or conditions. So many people who think they are disabled are, unfortunately, not disabled by Social Security Disability guidelines.

It is not medically harder to be approved for disability if you are applying for SSI or SSD. Medical approval rates for initial SSI or SSD claims are about 40 percent. Another 10-15 percent of those that file reconsideration appeals will be approved. And finally if an individual appeals their SSD or SSI claim to an administrative law judge hearing, about 66 percent will win their disability benefits.

These statistics are the same no matter which disability program an individual is eligible for. The medical disability determination process is exactly the same for both disability programs. Many individuals apply for both disability programs at the same time and some receive SSI benefits for the first five months that they could not receive SSD due to a five-month waiting period that is involved in SSD, or they are concurrently entitled to both programs.

Lastly, this second responder does not think an SSD attorney or representative is helpful to winning disability claims. I would have to strongly disagree with this person since the statistics published by the social security administration clearly point in the opposite direction. But, having said that, disability claims are as varied as the individuals who file them. So what might have resulted in an approval of benefits for one person may not work for another.

In the final analysis, there are many reasons to obtain the services of a Social Security Disability attorney or non-attorney representative, however one of the most important reasons is that they know the guidelines of the Social Security Disability program and are familiar with concepts such as sequential evalution, dire need, trial work months, DLI (date last insured), substantial gainful activity, res judicatta, unsuccessful work attempts, transferrability of skills, medical source statements, the medical-vocational framework of rules a.k.a. the grid, duration, the definition of disability used by SSA, what constitutes past relevant work, what constitutes an acceptable medical treatment source, etc, etc.

Currently, at the hearing level, represented disability claims are more than fifty percent more likely to be approvals than disability claims without representation (forty percent of claimants who represent themselves at hearings are awarded benefits, while sixty-two percent of claimants with representation are awarded benefits).

Additionally, this individual believes if you are denied, just keep applying. Well, you should not keep applying again and again; you should appeal your denied claim. You will win your disability case a lot sooner if you use the Social Security Disability appeal process. On the other hand, if you keep filing new applications, you will keep receiving denials.

The appeal process is simply the preferred option, and most individuals who are denied on their disability applications will eventually be approved for benefits if they appeal and get their case heard by an administrative law judge at a disability hearing.

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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