How are Decisions on SSDI and SSI Disability Claims made by SSA?

Most decisions on SSDI (Social Security Disability insurance) and SSI (supplemental security income) disability claims are made on the basis of a medical vocational allowance. This is the "other type of award decision" that is made by the social security administration. The first is the meeting, or equaling, of the requirements of a listing in the social security administration's impairment listing manual, otherwise known as the blue book.

But satisfying a listing requirement can be fairly tough since the listing criteria is often very specific. And in the case of mental impairments, it can be difficult to actually glean the information necessary to satisfy the various levels of criteria needed to grant disability benefits for (to use an example) an affective or cognitive impairment disorder.

Which is why it can be helpful when mental health treatment professionals, such as psychiatrists, provide a detailed synopsis and summary of their patient's treatment history: some will even try to submit this type of information in lieu of the actual records.

Most approval decisions that are made by disability examiners (the individuals who work to process disability claims at the initial disability application and reconsideration appeal levels) are vocational allowances because there really isn't enough information in the medical records that "jumps out at them" for a certain physical or mental condition that definitively states "yes, I satisfy this listing" (keep in mind, also, of course, that many conditions are simply not included in the social security list of impairments as well).

However, what is a medical vocational allowance? There are several components to this type of decision. This type of approval is made when the social security administration determines that the applicant cannot do their last job, or any of their past work that was performed within the last fifteen years, while earning a substantial and gainful income.

It also made when the social security administration determines that the applicant cannot do any other type of work for which their age, skills, education, and residual functional capabilities might make them suited.

Finally, this type of decision is made when the social security administration (through a disability examiner, or a judge if the case is at the hearing level) has reviewed all the medical evidence that has been gathered and it has been determined that the applicant's condition has been disabling for a period of not less than one full year.

Why does the social security administration use one year as the benchmark? It may be somewhat arbitrary, but SSA takes the position that if a person's condition has prevented them from being able to work at one of their former jobs, and has prevented (or will prevent) them from working at some form of other work for a full year, it is reliably predictive of their future situation.

Even so, SSA will still require individuals who have been approved to receive disability benefits to undergo periodic reviews. These are known as CDRs, or continuing disability reviews, and they occur every few years.

Fortunately, for those who receive disability benefits, the protocol for taking someone off benefits requires that the social security administration prove that "medical improvement" has taken place. And this is is difficult to prove--meaning that most individuals who are put on disability benefits can count on them to be there in the future without interruption.

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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