Eligibility and qualifying for disability in Texas

Continued from: Social Security Disability and SSI requirements in Texas

To qualify for disability benefits in Texas through the Social Security Disability or SSI program, a person must prove the following:

1. Their medical evidence (which usually consists of their medical records, but can also consist of one or more statements from their treating physcian) must show that they have at least one severe mental or physical medical impairment.

2. The impairment, or impairments, should be severe enough that it lasts at least a full year while also making it impossible for the claimant to:

a) Work and earn a substantial and gainful income at one of their past jobs (done in the 15 year relevant work period that existed prior to the point at which their condition became disabling according to Social Security).

and also:

b) work and earn a substantial and gainful income at some type of other work. What does Social Security mean by other work?

How does it actually get proven that a person's case meets this criteria, thus qualifying for disability benefits? We should approach this in two separate ways. First, how decisions are made at the disability application level and reconsideration appeal level and, secondly, how decisions are made at disability hearings.

Common questions about filing for disability in Texas
How disability examiners begin to work on cases

After a person files a claim for disability, either in person at a local Social Security office, over the phone with a local Social Security office, or online, their claim is sent to DDS, or disability disability determination services.

Practically as soon as the case arrives at a Texas DDS, it is assigned to a disability examiner. The examiner's first job will be to start requesting MER, or medical evidence of record. The letters requesting medical records that are sent to the various doctors and hospitals that have provided treatment to a claimant will be determined by the information provided at the time of application.

Therefore, it is very important to list all treatment sources, dates of treatment, names of doctors, contact information. The difficulty invovled with getting all of a claimant's medical records constitutes the single largest contributor to how long disability applications take.

Amazingly, some people only give very sketchy information about their treatment sources on their disability report form, almost as if they think the disability examiner can magically make this information appear. But doing this can cause one's own case to move a lot slower than it might otherwise.

After the medical records have arrived, however, the examiner will begin to comb through the medical records to look for A) what the disagnosed conditions are, B) what the response to treatment has been, C) what the prognnosis is, and D) evidence of functional limitations that affect the ability to do normal daily activities and engage in work activity.

How you qualify for disability in Texas?

Essentially, the disability examiner who is working on the SSDI or SSI claim is looking to see if a person has a medical condition (which can be physical or mental) that satisfies the approval criteria of a listing in the blue book. The listings, or blue book, or impairment listing manual, contains dozens of conditions and the criteria for what makes a person disabled if they have the condition. The criteria is very detailed and based on specific, objective findings such as reports of imaging (MRI, XRAY, CT scan), blood work, spirometry, and other types of medical testing.

Most claims that qualify for disability in Texas are not approved by meeting or equaling the requirements of a listing. The listing requirements for most conditions are fairly difficult to meet.

If the disability examiner does not see that an approval can be made through a listing, then the examiner will use the information in the medical records to assess what the claimant's level of functioning is, otherwise known as their residual functional capacity. A person's RFC rating, for physical conditions, ranges from sedentary, to light, to medium. An RFC rating will indicate how much weight a person can lift, how long they can sit, stand, or walk, and may also reference a person's ability to reach, grasp, bend, crouch, see, hear, and tolerate certain environmental conditions.

If an individual's condition is mental, the RFC rating will address the ability to remember, concentrate, and interact with co-workers and supervisors.

How are these residual functional capacity ratings used? The examiner will look at the person's work history to see if they still have the physical and/or mental ability to go back to one of their former past jobs. To make this determination, the examiner will look at the information provided by the claimant to try to identify each job in something known as the DOT, or dictionary of occupational titles (sort of like using a phone book or doing a Google search).

For example, if someone states that their last job was "truck driver", the examiner will attempt to find out what kind of truck driver. Dump truck driver? Tractor-trailer-truck driver? Delivery truck driver? The one that is identified is important because each job will have different duties and requirements, and require different things from the individual.

And for this reason, again, it is very important the person filing for disability provide very detailed information about their work history in addition to their medical history.

If it appears to the examiner that the claimant cannot go back to their past work, then the examiner will consider their limitations, age, education, and the level of skills they have attained in their work to see if they can actually do some type of other work. If they are so severely limited that this is not possible, they will be approved for disability under either SSDI or SSI. And this type of approval, as opposed to being approved via a listing, will be something known as a medical vocational allowance because it involved reviewing both the medical history and the work history too.

More at Qualifying for disability in Texas at a hearing

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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