Facts about Developmental Delay and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. Developmental delays are usually caused by a variety of life-long conditions categorized as developmental disabilities (DD). Developmental disabilities include Down syndrome, autism spectrum disorders and cerebral palsy, all conditions also referred to as special needs.
2. Developmental delay refers to mental and physical characteristics below the level of other individuals at the same age. These impairments affect daily functioning in a variety of ways, including learning, language, mobility and coordination. Those with developmental disabilities are often less equipped to care for and economically support themselves in adulthood.
3. In 1970 the United States Congress created a law for those with developmental disabilities who were often confined to institutions, to protect the individuals and improve conditions. The current version of law requires acceptance and inclusion of those with developmental disabilities into the community and ensures better care and treatment.
4. Developmental disabilities are classified into severe, profound, moderate, and mild. Treatment and care are based around these classifications. The goal of treatment is typically to increase independence in daily activities, and to help the individual reach their full capacity in all areas of development.
5. Individuals with developmental disabilities often require some level of care for their entire lives, although this varies from person to person and is based on each individual's unique abilities and impairments.
6. Individualized care and treatment plans may include a variety of therapy techniques. Respite services are available for families who care for individuals with developmental disabilities at home. Transportation services including free bus passes or shuttles are available in many places.
7. Advocacy for developmental disabilities continues to grow. Advocates help individuals and families navigate 'the system' (including schools and social welfare programs). They also work for changes in policy and legislation, often directly with those who have developmental disabilities in an attempt to increase self-advocacy and independence for those with DD.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
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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