A Social Security Disability determination is based on What You can still do

A recent discussion in a forum concerned how Social Security Disability benefits are awarded. One participant wrote that eligibility is based on what you paid into the system. Another wrote that eligibility for SSD was based on the type of work that you did in the past. A third person wrote that it depended on what you made and what came out of your paycheck for fica. And a fourth stated that it depended on what your doctor had to say about about your condition. Ok, let's deal with all of these suppositions.

1) Is eligibility for Social Security Disability based on what you paid into the system? It depends on what you mean by "eligibility". If you mean the ability to collect disability disability benefits assuming you have been found to be disabled, then the answer is yes. SSD benefits are accounted for under title II of the social security act and that means to collect such benefits you have to have what is known as insured status. Insured status comes as a result of fica taxes that are taken out of your paycheck or paid directly by you if you are self-employed. So, to even receive SSD benefits, you have to have worked enough quarters and paid enough into the system as a result of your work activity.

2) Is eligibility for SSD based on the type of work that you did in the past? The best way to answer this is to state that some decisions for SSD (and SSI disability as well) are based on a claimant's medical condition (physical or mental) meeting or equaling the requirements of a listing in the blue book, or the Social Security Disability list of impairments. However, while some cases are approved in this fashion, most claimants are awarded benefits on the basis of a medical vocational allowance, a decision that utilizes the social security administration's sequential evaluation process.

This process means that, at the level of a disability application or a request for reconsideration (and, actually, at all levels), a claimant's work history will be considered. In what way? The decision maker for the claim (either a disability examiner or an administrative law judge if the case is at the hearing level) will review the claimant's medical record documentation and then determine what the claimant is still capable of doing.

This is known as residual functional capacity. After determining what the claimant is still capable of doing physically or mentally, or both, the claimant's functional capacity will be compared to the demands of the jobs they've done in the past (the relevant period is the past 15 years). If it is decided that they cannot return to their past work, their functional capacity will be compared to other jobs that they have not actually done, but which they might be considered capable of switching to. Not surprisingly, it is the "other work" step that causes many disability claims to be denied. However, if it is decided that a claimant can neither return to their past work nor perform other work, they will be medically approved on the basis of a medical vocational allowance.

3) To be eligible for SSD, does it depend on what you made and what came out of your paycheck for Fica taxes? We already dealt with this in item number one. The answer, again, is that you have to have insured status for SSD and that comes as a result of your work activity and the taxes you paid into the system which earned you the required quarters of coverage. Assuming you are "insured" for SSD, whether or not you actually get disability benefits will depend on what your medical records have to say about your limitations. What you paid into the system, though, will determine the size of your monthly SSD benefit check.

Note: SSI disability does not work like this. SSI is for disabled children, adults who never worked, adults who were once covered by SSD but due to a long period of not working have lost their SSD coverage, and individuals who are covered by SSD but whose monthly disability check would be very low (lower than what a full SSI monthly benefit would be. The size of an SSI disability benefit check has no relation to whatever a claimant may have previously paid into the system.

4) To be eligible for SSD, does it depend on what your doctor has to say about your condition? Yes. Decisions are based on medical records and medical records are created as a result of your interactions with your treating physicians, i.e. your doctors. Typically, medical records have little to say about your actual limitations, but, nevertheless, even if your records are bare-bones, if they are signed off by a qualified medical professional, they hold the weight of a treating physician's opinion.

Of course, since most doctors only record the information in their notes that they, themselves find useful, it is typically a great idea to obtain a medical source statement on something similar to a residual functional capacity, or RFC, form at some point. RFC forms sometimes often do little to help a claim at the lower levels, but they can absolutely win a case at the hearing level. And in the vast majority of cases, a competent disability lawyer or non-attorney claimant's representative will try to obtain one or more of these to present to a disability 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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