What makes you eligible for Social Security Disability or SSI?

The decision on your disability case--either a disability award or a denial of your claim--will be made on the basis of three types of evidence which may make an applicant eligible for Social Security Disability (SSD) or Supplemental Security income (SSI) benefits: medical evidence, work history or academic performance information (for child applicants), and information about a person's normal daily activities.

1. Medical evidence - This includes all the records that are obtained by the Social security administration from your treatment providers, including admission and discharge summaries, reports of bloodwork, imaging (CT scans, xrays, PET scans, and MRI scans), and the notes made by your specific doctors, particularly the doctor who would be considered your treating physician.

If your claim is based on a mental disorder, of course, your psychiatrist would be considered your treating physician.

Medical evidence, at the disability application and reconsideration appeal levels, is generally confined to just medical records. However, at the social security hearing level, it usually includes (assuming the claimant's disability attorney or disability representative is competent and experienced) a statement from the treating physician on something known as an residual functional capacity form or medical source statement.

2. Work history or Academic performance information - For adults who are attempting to qualify for disability and become eligible for benefits, the second area of information that will come under consideration will be related to their work history. What this essentially means is that a disability examiner will review the claimant's relevant work history (jobs worked in the prior fifteen years) and try to determine if the claimant has the ability to go back to one of those jobs, or perform some type of other work based on their various skills and training.

For children whose parents are filing for SSI disability for them, work history, obviously, is not an issue. But the child's ability to engage in age-appropriate activities is. And, therefore, social security will evaluate how the child is performing in school. This will mean that a disability examiner will try to obtain school records, reports of academic achievement testing and IQ testing, and sometimes questionaires completed by the child's teachers.

3. Information about the claimant's ADLs, or activities of daily living - Normal daily activities are considered by SSA (the social security administration) to provide insight into whether or not a person can engage in work activity (or, for children, age-appropriate activities).

For example, if a person has degenerative disc disease, it would be normal to expect that they might have difficulty remaining in one type of standing or sitting position for very long, or difficult bending or crouching, or lifting objects above a certain weight. If their prior employment required them to engage in these types of physical activities, they may no longer have the ability to return to that type of job, or do any other type of job that utilizes such activities.

The question becomes, how will the social security administration know if an individual has a certain type of limitation, or set of limitations? Simply being diagnosed with a certain impairment is generally not proof, in and of itself. And while medical records provide the bulk of the evidence used on a case, very often the records recorded by physicians do not make mention of specific physical limitations or mental limitations.

For this reason, then, disability examiners will usually contact a claimant and ask them about their normal daily activities. They may do this by sending out a questionaire for the claimant to complete and return, or they may call the claimant directly. They may also (and often do) contact an individual who knows the claimant-called a third-party contact person-and this person is usually supplied at the time the claimant files for disability.

Continued at: Part II: What makes a person eligible to receive 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.

Most popular topics on SSDRC.com

Social Security Disability in North Carolina

Common Mistakes to avoid after being denied for Disability

Tips to Prepare for Filing for Social Security Disability or SSI

Advice to Win SSD and SSI Benefit Claims

Social Security Disability SSI Questions

What is the difference between Social Security Disability and SSI?

How to get disability for depression

Getting disability for fibromyalgia

SSI disability for children with ADHD

What is the Application Process for Social Security Disability and SSI?

Social Security Disability SSI Exam tips

More Social Security Disability SSI Questions

What makes you eligible for Social Security Disability or SSI?

Related pages:

Applying for Disability with COPD in North Carolina
When does social security consider you eligible for disability benefits?
Who is eligible for SSI Disability?
Disability Criteria - Eligibility For Social Security and SSI Disability
Can I Be Eligible For SSI And Social Security Disability At The Same Time?
Social Security Disability and SSI Mental Claims and Criteria
Can you apply for disability on the basis of multiple health problems?
What makes a person eligible to receive disability benefits?
Inability to Work and Eligibility for Social Security Disability and SSI Benefits
What makes you eligible for Social Security Disability or SSI?
If You Are Currently Working Are You Eligible To Receive Social Security Disability Benefits?
Will Being A Veteran Affect Your Eligibility And Chances For Social Security Disability?
Are SSD and SSI disability cases decided the same way in terms of Eligibility?
Is the Medical Criteria to Get Social Security Disability or SSI Benefits hard?
Criteria for how Social Security Disability is Awarded
Social Security Disability SSI Criteria and the Evaluation Process