How severe must your condition be to be awarded Social Security Disability or SSI?
To be awarded Social Security Disability or Supplemental Security Income (SSI) disability, you must have a condition, or combination of conditions, that have prevented you from working for twelve continous months, or that you expect to prevent you from performing any kind of substantial and gainful work activity for twelve continuous months.
Why twelve months?
Duration is an integral aspect of the Social Security Administration's definition of disability. Conditions that are otherwise disabling but which fail to meet this minimum length requirement will be denied on the basis of duration by a disability examiner if the claim is being decided at the disability application level (initial claim), or during the reconsideration appeal phase.
Note: The request for reconsideration is the first appeal in the SSA disability system.
At the second appeal level, the disability hearing level, an Administrative Law Judge, or ALJ, may be able to award what is known as a closed period. This is a lump sum benefit payout for a defined period less than one year's length, during which a claimant otherwise met the qualifications for disability under Social Security guidelines.
However, this is the only level of the system at which this type of award occurs and, typically, the opportunity for receiving a closed period award is heightened when a claimant is able to provide additional medical record documentation that was not present during the application and reconsideration phases, or when the claimant's disability attorney is able to satisfactorily demonstrate that the disability examiner erred in one of the prior determinations.
Social Security does not award partial or temporary disability benefits
Social Security Disability is a total disability program, as is SSI. Neither program will award temporary disability benefits, meaning benefits that are paid out monthly for a temporary and defined time period. When a person is awarded disability benefits, the award is made under the assumption that the claimant will receive the benefits indefinitely, until such time as a future review (known as a CDR, or continuing disability review) determines that the individual has achieved medical improvement of their condition.
Nor will either program award benefits for "partial disability", meaning the partial loss of use of an sensory ability (vision, hearing, for example), or the partial loss of an extremity.
For a condition to be considered disabling for an adult, it must result in the loss of the ability to engage in work activity while earning a substantial and gainful income. For a condition to be considered disabling for a child, it must result in the loss of the ability to engage in what SSA refers to as "age-appropriate activities". For school-age children, this will ordinarily translate into an impairment of the ability to keep up with their peers in a school setting, which is why children filing for disability will have not only their medical records reviewed, but will often have their school records reviewed as well.
Measuring the severity of your condition
To be approved for SSD or SSI benefits, you must have a severe impairment that causes significant functional limitations. If your medical and/or mental conditions have been so severe as to prevent activities of daily living including work activity (substitute age-appropriate activities for a child), then you need to contact Social Security and file a disability claim.
How does the Social Security Administration measure how severe your condition is? As stated, severity begins with duration. However, assuming a disabling condition exists for the minimum one-year time period (note: you do not have to wait until you have had your condition for one full year: disability examiners and administrative law judges can review the evidence and make a determination as to whether or not your condition will eventually last one full year), SSA will look for evidence of severity by obtaining your medical records and your work history (school records for a child), along with daily activity questionnaires completed by you and a person who knows you--this individual is referred to as a "third-party contact person".
Activities of daily living
What are ADLs, or activities of daily living? Daily activities can include household cleaning, personal hygiene, hobbies, driving, getting groceries, counting change, managing money, etc. For physical impairment cases, this is measured in terms of your ability to stand, sit, walk, stoop, crouch, reach, and carry certain weights (just to name a few). For mental impairment cases, this may be measured in terms of the ability to remember and retain knowledge, comprehend instructions, interact with family, friends or strangers, complete tasks, or the ability to maintain attention and concentration (again, just to name a few).
ADL information is typically gathered by a disability examiner in one of two ways. The examiner will either send you a questionaire to complete and return, or the examiner will call you and interview you on the phone, completing the questionaire form as the interview proceeds. As mentioned before, sometimes the examiner will also contact your third-party contact person (usually a friend, relative, or neighbor) to gather ADL information.
SSA takes the position that by learning more about your daily activities, a clearer picture may emerge regarding your functional capabilities and limitations. In actuality, though, ADL information does not play a significant role in determining whether or not a person qualifies for disability. This is because ADL information is entirely subjective and does not contain "objective data", such as what can be obtained from medical evidence (lab reports, imaging studies, and assessments made by a physician or psychologist).
Why, then, does SSA gather ADL information? Because, in some cases, more information about a person's activities can shed light on how a condition affects them. In the majority of cases, though, disability examiners give scant consideration to the ADL information that they gather. Judges at hearings, however, are often known to give greater attention to them, just as judges routinely give greater attention to the opinion of a claimant's treating physician than a disability examiner will.
Qualifying for disability
Qualifying for disability occurs in one of two ways. The first is by meeting or equaling the requirements of a condition, mental or physical, that is included in the Social Security Disability List of Impairments, or simply the listings.
What do we mean by "the listings?" Social Security uses a guidebook that contains impairment listings to address most medical and mental conditions. If your condition is so severe that your symptoms satisfy the criteria of a Social Security impairment listing, you are awarded disability benefits. However, most disability applicants have significant impairments that may not satisfy the severity requirements of an impairment listing. Or they may have a condition that is not even listed in the manual (for example, carpal tunnel syndrome and fibromyalgia are not listed).
If your condition does not fulfill the criteria of an impairment listing, but you still have a condition that causes limitations significant enough to prevent you from engaging in work activity (or age-appropriate activities for a child), you may be awarded disability benefits through a medical vocational allowance.
What is a medical vocational allowance? Simply this: If you do not meet an impairment listing, the disability examiner will continue the evaluation process. Meaning that after your medical records have been evaluated, the disability examiner will determine your functional limitations (for example, inability to sit or stand or walk more than a certain length of time, or inability to retain newly learned information).
These limitations will be noted in an RFC, or residual functional capacity, assessment that may be physical or mental. The RFC rating, or assessment, will be compared to your past work to see if you can return to any of the jobs you have performed in the last fifteen years.
If you cannot do any of these former jobs, the examiner will look to your education and work skills, giving consideration to your age and functional limitations, to see if it is possible for you to switch to a new type of work, or other work. If it is decided that you cannot be expected, based on the severity of your condition, to be able to do some type of other work, you are likely to be awarded disability benefits.
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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