What makes a person eligible to receive disability benefits?

Continued from: Part I: What makes you eligible for Social Security Disability or SSI?

After all the various types of evidence have been gathered on a Social Security Disability or SSI disability case by a disability examiner, how is the decision made? Or, perhaps a better way to put it is to ask "How does a person qualify for disability benefits and what makes them eligible?" We can answer the question in two parts.

How does a person qualify for disability

There are two ways in which an individual will qualify for disability benefits in either the SSD or SSI disability program. The first method is by having a condition that is listed in the social security administration blue book (the social security list of impairments) and also meeting the severity requirements of the listing for that condition. Satisfying a listing can be difficult and most conditions are not listed in the blue book.

An example of a condition that is listed in the blue book is asthma. Qualifying for disability under the asthma listing requires being able to show documented medical evidence that the condition has, first of all, been diagnosed, but, further, that the individual has chronic asthmatic bronchitis of a certain severity level, or that the individual has suffered a certain number of asthma attacks within a designated time frame.

One difficulty of satisfying the asthma listing is that for an attack to be countable it needs to have been documented by a physician. However, most people do not rush off to the hospital each time an asthma attack occurs. This can make satisfying the asthma listing difficult. But asthma is, by far, not the only listing in the blue book that is difficult to satisfy for whatever reasons. Many of the conditions in the Social Security impairments list will be very difficult to meet due to the documentation requirements.

Added to that difficulty, though is the fact that most medical conditions are not listed. Conditions like fibromylagia and carpal tunnel syndrome, while being fairly common, are not given listings.

Being approved on the basis of both your medical and work history

Fortunately, there is another means of receiving a disability award. This is by being given what is called a medical vocational allowance. This is a type of approval that requires a disability examiner to review a claimant's medical records and determine how they are functionally limited by giving them a rating. For example, for physical functional capacity, are they capable of heavy, medium, light, or sedentary work? For mental functional capacity, are they capable of performing what social security refers to as SSRTs, which are simple, routine, repetitive tasks?

This rating of a person's limitations is compared to the type of work they have done and this allows the disability examiner to decide whether or not they are capable of engaging in work activity.

The great majority of all approved cases are approved on the basis of a medical vocational allowance being made. And since this allowance (approval) is both medical and vocational in nature, claimants should try to provide as much information, at time of filing for disability, with regard to where they have been treated and where they have worked.

Giving Social Security details about your work history

The work history, in particular, should be well documented. It is generally unwise to simply list one's past places of employment. Instead, a claimant should also supply an accurate job title along with a detailed description of the duties involved for each job. This is because the disability examiner will rely on a resource published by the department of labor known as the DOT, or dictionary of occupational titles.

Jobs that are identified in the DOT supply information about the mental and physical requirements of jobs, as well as the skills that are held by individuals who have performed these jobs. Properly identifying the claimant's jobs in the DOT can determine whether or not the disability examiner will consider the claimant as capable of returning to their past work, or even being able to do some new type of work based on their training.

So, obviously, it is clearly in the claimant's best interests to provide enough detailed information about their work history so that their jobs can be properly identified. Because it can make a difference as to the outcome of a case.

What makes a person eligible for disability benefits?

Simply put, a person is eligible to receive disability benefits if they satisfy the definition of disability used by the social security administration. The way that SSA views disability is different from private disability insurance companies and very different from the military in the sense that it is not enough for a person to be disabled to the extent that they can no longer do their last job.

Their condition must be severe enough that the limitations that are imposed by their condition, or conditions, rule out the ability to do any kind of work while earning a substantial and gainful income.

The catch phrase in the last sentence, of course, is substantial and gainful income. What that basically means is that a person may be still work and be considered disabled by SSA if they are not able to work and earn a certain amount of gross income each month. That amount is the SGA limit (see the definition of: SGA, or substantial gainful activity ).

Here is a condensed form of the definition of disability. If a person's case satisfies this standard of disability, they may be approved for benefits.

1. The individual's condition must be severe, versus a simple non-severe impairment that has no substantial impact in terms of reducing their ability to engage in normal daily activities.

2. The condition cannot be temporary. Instead, it must last a minimum of 12 months (additional information: Can you get temporary Social Security Disability or SSI benefits? ).

3. The condition must result in functional limitations, of a physical or mental nature, or both, that make it impossible for the individual to work and earn a substantial and gainful income. And this inability to work at this earnings level must persist for at least one full year.

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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