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Social Security Disability Secrets
"The Ultimate
Consumer's Guide To Understanding Social Security Disability"
Dallas Morning News & Ft. Worth Star Telegram Review !
The following was reported in the Dallas Morning News & Ft. Worth Star Telegram October 1997:
"Hints For the Disabled By Patricia Galbreaith
Dear Readers: Continuing last week's column on Social Security disability (SSD), we find that to be disabled and entitled to SSD benefits, claimants must show themselves unable to earn $500 a month. The question is not whether claimants are able to do the same work they had done before they became disabled, but whether they can perform ANY work that will earn them about $500 a month. Claimants who had worked and earned $2,500 a month for the past 20 years are not considered disabled as long as they can earn $500 a month.There are several factors that must be considered in evaluating and making a determination about whether a claimant is capable of any substantial work. Considerations for the decision are set out by Social Security Disability in the "Listings and Grid Tables" used to determine whether a claimant can receive disability benefits. The listings are basically a set of the "most often" encountered disabling conditions.
The claimant's impairment must meet the medical requirements of the listing and result in functional limitations. The claimant must be determined not to have the skills or education to transfer existing skills to another type of work.Age plays perhaps the largest role in determining whether a claimant meets all the criteria of the listing. If a claimant is found not to meet even one of the standards set out in the listing, that claimant cannot be found to be disabled, according to Social Security Disability.
Social Security Disability listings are based on four levels of ability to work, and these four levels of ability are the basis for the Social Security Disability "Grid Tables and Listings".
- Sedentary Refers to work that requires mainly sitting and no physical labor
- Lightrefers to work that requires slightly more effort than sedentary
- Medium refers to work that requires average physical ability, i.e., sitting, standing, moderate lifting
- Heavy to very heavy refers to work that requires what realistically amounts to any and all types of physical work.
The first thing decided in a claim is what level of work the claimant is capable of performing. This determination is based on medical reports. Other factors considered are age, education and transferable skills. The entire picture is put together, and a determination is made on the claimant's potential for performing work.
All factors about the claimant and the impairment are then compared against the grid tables and the standards of the listings. Only then is a determination made on whether a claimant is entitled to benefits under Social Security Disability.
The information in "The Ultimate Consumer's Guide to Understanding Social Security Disability" provided the information claimants must have to evaluate whether their impairments should lead to benefits.
Contact: Pro Se Publications, Attn. National Divorce & Bankruptcy Center, 3707 Herring Lane, Wichita Falls, Texas 76302. Phone: (940) 322-7543. Or fax (940) 691-5389."
INTRODUCTION
By better understanding the processes and procedures, as well as the criteria (standards) used to evaluate a claim for disability benefits, a claimant can greatly improve the likelihood that their claim will be approved and benefits will actually be received. It is very difficult, if not darn near impossible, to win at a game where you don't know the rules and requirements. If only the person making the decision about your very survival knows what the rules are, you have no way of knowing if they are in fact fairly applying the rules to your claim. Those that make the decisions that affect your very livelihood are only human - they do make mistakes. Unless you educate yourself and know what the rules and standards are that should be applied to your claim, you will never know if the criteria were properly applied to your situation.
If you have already filed for Social Security Disability, this introduction will probably only confirm, in large part, what you yourself have already learned first hand. If you have not yet filed, this introduction is not intended to discourage you from filing, but rather to prepare you for the reality of filing a social security disability claim and the obstacles that you will have to overcome to actually receive a disability benefit check.
Most citizens work the majority of their adult lives. They pay social security taxes which are directly withheld from their earnings each pay period. Although they may complain occasionally about the ever escalating burden of social security taxes; in the back of their minds they rationalize the cost as an investment - something that they will have put away to provide for their golden years, or as a safety net in the unlikely event that they are ever disabled and unable to continue to provide for themselves and their families.
Like most people, you probably thought you would never need the provision for disability benefits under social security and in all honesty, you actually know very little about the program you have relied on to be your safety net. Unfortunately, all too often, claimants quickly come to realize the sad truth - their safety net has a very large hole in it.
Once you have made the decision that you should apply for social security disability benefits or that you should at least get more information about the benefits and procedures (just in case) - you take the obvious first step - you call your local social security office and explain your situation. You are told that social security has a pamphlet that explains the benefits and rights of claimants that they will be glad to send you. Feeling better that you have taken the first step, you wait for the information to arrive.
After reading the information pamphlet, you are left with the distinct impression that social security disability is available to all those workers who have worked the required number of quarters and are disabled. You are given information about the procedures to follow when applying for social security disability. As you would expect, you are required to fill out some forms, send them in for verification of your disability, and wait for your money to be mailed to you. Seems pretty simple so far right? Wrong! For purposes of this discussion, we will assume that you have in deed worked the required number of quarters to meet the qualification for social security disability benefits and will confine ourselves to the issue of meeting the second part of the two prong test - disability.
The first problem every applicant for social security disability faces is the sudden realization that what is disability to you, to your doctor, to any one with common sense, may not be disability as defined by social security.
Social security disability has a very fact specific set of rules, regulations, tables, and agency policies that are used to determine whether a claimant for disability meets the definition and criteria of disability under the social security system- for the purposes of entitlement to benefits. What seems to you like a fairly simple determination - are you or are you not disabled - becomes something subject to determination according to a set of criteria that often defies common sense and logic.
After completing the initial claim for benefits and being told that you will receive a written determination about your claim in 90-120 days, you go home and you wait. While you are waiting, you probably still believe that the process of filling out forms and getting official recognition of your disability is just part of the process required before you receive a benefit check. After all, you know you are disabled, your doctor knows you are disabled - he said so in all of his medical reports about your medical condition. Social security disability must surly base their determination of your disability on your doctor's reports right? Wrong! Remember the set of criteria mentioned earlier? Regardless of what the doctor who has actually been treating you writes in medical reports; the determination of whether or not you are disabled depends, not on your doctor's assessment of your medical condition, but whether or not you, as a claimant, fall within the scope and criteria used by to determine disability for the purposes of collecting benefits.
To be found to be disabled and therefore entitled to Social Security Disability benefits a claimant must be determined to be unable to perform any substantial gainful employment. Substantial gainful employment is generally based on whether or not the claimant is capable of earning $500.00 per month. The question is not whether or not the claimant is able to do the same work they had done before they became impaired (disabled), but whether or not they can perform any work that will earn them approximately $500.00 per month. A claimant who had worked and earned $2,500.00 per month for the past 20 years is not disabled as long as they can do some type of work to earn $500.00 per month.
There are several factors that must be considered in evaluating and making a determination about whether or not a claimant is capable of any substantial gainful employment. The factors to be considered in the decision are basically set out by Social Security Disability in the Listings and Grid Tables used to determine whether or not a claimant is disabled for purposes of receiving disability benefits.
The factors and criteria to be met are set out in what Social Security calls the "Listings" and "Grid Tables". The listings are basically a set of the most often encountered disabling condition that lead to an impairment severe enough to be determined - disabled. The listings not only identify the impairment, i.e.; asthma, spinal disorders, psychological disorders etc. but also set out the criteria that must be met by a claimant whose claim is based on that particular listing. Each listing has the functional limitations for that listing detailed that specify what a claimant must be unable to do or limited to doing to meet the standards of the Listing. For example, to determined to be disabled, if the claim and impairment is based on a 'bad back', the claimant must have medical evidence to prove that their condition is severe enough to meet or exceed the specific criteria of the listing. Each listing also has what is called the "theory" of the case. The theory is simply the logical reason that allows a claim to be approved when the claimant meets the required criteria of the listing; or reasons not to allow the claim for disability.
Each standard or criteria must be met by a claimant to found to be disabled. The claimant's impairment must meet the medical requirements of the listing, result in the functional limitations set out, and the claimant must be determined not to have the skills or education to transfer existing skills to another type of work that they are able to do. Age plays perhaps the largest role in determining whether or not a claimant meets all of the criteria of the listing. If a claimant is found not to meet even one of the standards set out in the listing - that claimant can not be found to be disabled according to Social Security Disability.
Social Security Disability listings are based on 4 levels of ability to work and these four levels of ability are the basis for the Social Security Disability "Grid Tables and Listings:
The first thing to be decided in a claim is what level of work the claimant is capable of performing (if any) with their impairment - sedentary - light - medium - heavy to very heavy. This determination is based on the functional limits of the claimant as detailed in their medical reports.
Secondly, the other factors are considered; age, education, and transferable skills.
Finally, the entire picture is put together as a whole and a determination is made based on all of the factors about whether or not a claimant is capable of performing substantial gainful employment. This is where the Grid Tables and Listings criteria come into play.
All of the factors about the claimant and their impairment are then compared against the Grid Tables and the standards of the Listings. Only then is a determination made on whether or not a claimant is entitled to benefits under social security disability.
The information in this book provides the information a claimant must have to realistically evaluate whether or not their impairment should lead to a finding of entitlement to benefits. Listings for the most frequently allowed claims including - the listings symptoms of the impairment, medical evidence to document their claim a subjective "Reality Check" where appropriate to allow the claimant to make informed, educated decisions about their claim for disability benefits under Social Security.
It bears repeating that:
By better understanding the processes and procedures, as well as the criteria (standards) used to evaluate a claim for disability benefits, a claimant can greatly improve the likelihood that their claim will be approved and benefits will actually be received. It is very difficult, if not darn near impossible, to win at a game where you don't know the rules and requirements. If only the person making the decision about your very survival knows what the rules are, you have no way of knowing if they are in fact fairly applying the rules to your claim. Those that make the decisions that affect your very livelihood are only human - they do make mistakes. Unless you educate yourself and know what the rules and standards are that should be applied to your claim, you will never know if the criteria were properly applied to your situation.
No one can say with absolute certainty whether or not a social security disability claim will be allowed. There are certain factors that can be predicted, with reasonable certainty, to increase the likelihood of a favorable decision and the actual payment of disability benefits. It is to those factors that the body of this chapter is addressed. As previously mentioned, disability for purposes of receiving social security benefits is determined by whether or not the claimant's disability and other factors fit neatly into the scheme of one of the GRID TABLES". The overwhelming majority of disability claims that are approved, are based on one of the Grid Tables. The following factors directly impact on which table's standards the claimant's disability will be determined.
A. AGE OF CLAIMANT
The age of the claimant is the single most important determining factor in whether or not the claim for disability benefits will or will not be approved.
B. Education Of The Claimant
Education has very little to do with whether or not a claimant is allowed disability benefits unless the claimant is functionally illiterate ie: unable to read and write well enough to function in a modern society at the same level as the majority of the citizens. This is possibly the greatest injustice done to those applying for social security disability. There are countless hard working people in the construction or other labor intensive areas that are not illiterate, but do not have a high school education and are unable to compete and qualify for jobs with those who do have a high school education.
C. Work Experience
The claimant's prior work history has a major impact on the determination of the their disability. You are only required to prove that you are unable to perform the same type of work that you have done in the past fifteen (15) years. This can have a dramatic impact on your chances of winning your disability claim. It is essential that the evidence show that you cannot perform the same type of work you have done in the past. Putting together the necessary information to ensure that your evidence will show to the Administrative Law Judge that you are unable to perform the same type of work you have previously done is one of the many things that you can do to increase your chances of winning your disability case. (more will be said later about how to gather the necessary evidence)
D. Physical Limitations
It is not the disease or injury that makes a person disabled as it applies to social security disability. It is rather the physical limits the disease or injury causes in the claimant that determines disability. A claimant may have a disease such as cancer that has a horrible name and sends shivers up your spine, but it is not the fact that the claimant has cancer that qualifies them for disability benefits. Disability is determined based on how the cancer has placed physical limitations on the claimant. Many people have cancer. Not all people with cancer are disabled.
E. Mental Illness
By the date of the hearing before an Administrative Law Judge there are probably very few social security claimants that stick with the process through the hearing before an Administrative Law Judge that do not have some degree of psychiatric problems. You will have endured months if not years of physical pain, financial devastation, and the day to day difficulties that are part and parcel of having a serious condition that disables you and no doubt has turned your life upside down. It is virtually inconceivable that anyone could survive the process up to the hearing level without at least having some degree of depression as a reaction to their circumstances. In cases where the Administrative Law Judge could go either way in his decision, reactive depression brought on by your circumstances may well be the extra disabling factor that convinces the Administrative Law Judge to rule in your favor.
F. Theory Of The Case
The theory of the case is the reason or logic that supports your claim for disability. For each theory that supports the claimant's disability, there is also probably a theory that will deny them their disability determination. It is important to recognize those theories that would be against your case and be prepared to show how they do not apply in your case.
Note: The listing numbers (if provided) for each impairment correspond to the listing numbers designated by the Social Security Administration department of disability for the impairment.
The following is provided as only 1 of the 40 impairments detailed in the book and is intended to give you a "feel" for the way information is presented.
I. Hip Disorders (1.03)
Arthritis of a major weight bearing joint (due to any cause): With a history of persistent joint pain and stiffness with signs of marked limitation of motion or abnormal motion of the affected joint on current physical examination . With:
Functional Limits: Claimants with hip impairments often report being unable to sit or stand for any length of time and severe pain.
Medical Evidence: If the impairment is caused by
congenital hip problems it may be advisable to gather all medical
records covering the hip problem going back to birth if necessary
and documenting all surgeries.
Hip impairment due to aseptic necrosis of the femoral head
may be caused for no known reason or as the result of one of the
following:
If the impairment is due to aseptic necrosis of the femoral head due to one of the above causes, that cause should be documented as well as the impairment of the hip resulting from the cause.
Theories: Claimants age 50 or over that due to education and skills are unsuited for sedentary work, often win for that reason. Those who have a history of sedentary work and are below age 50 have a far more difficult time in obtaining a favorable ruling unless they can show that they are unable to sit due to the weight placed on the hip. The hip is the largest joint in the body and hip pain can be disabling if it is severe.
Social Security Ruling 83-12 states the following:
There are some jobs in the national economy-typically
professional and managerial ones-in which a person can sit or
stand with a degree of choice. If an individual had such a job
and is still capable of performing it, or is capable of
transferring work skills to such jobs, he or she would not be
found disabled. However, most jobs have ongoing work processes
which demand that a worker be in a certain place or posture for
at least a certain length of time to accomplish a certain task.
Unskilled types of jobs are particularly structured so that a
person cannot ordinarily sit or stand at will.
Appearance: Claimants suffering from severe hip impairments will display a seriously altered and or labored gait. Administrative Law Judges will observe the claimant's walk, limp and any devices such as canes, walkers etc. necessary to walk or stand.
Reality Check: A claimant suffering such a severe
impairment as that in number 1 of the listing have often undergone
hip replacement or are candidates for such a replacement. Often,
the claimant is told that the replacement cannot be done (no
matter how badly needed) until the claimant looses a substantial
amount of weight and frequently, a claimant is unable to sit for
extended periods because of the weight placed on the hip joint
while sitting.
This 180 + page book provides the information essential to
understanding the criteria used by Social Security Disability to
determine your disability and guides you through every step of
the process from evaluating your impairment - (according to
social security Disability 'grid' tables), to filing the initial
paperwork, gathering medical information, attending a hearing,
and receiving a check.
I. "DISABILITY" DEFINED
II. TYPES OF DISABILITY PROTECTION UNDER SOCIAL SECURITY
III. DISABILITY DETERMINATION
IV. DETERMINATIONS AND THE ADMINISTRATIVE REVIEW
V. DISABILITY ACCORDING TO SOCIAL SECURITY
VI. GATHERING INFORMATION
VII. FILING THE CLAIM FOR DISABILITY BENEFITS
VIII. PREPARING FOR:HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE.
IX. MEDICAL EVIDENCE FOR THE HEARING
X. ATTENDING THE HEARING BEFORE AN Administrative Law Judge
XI. APPEALING AN Administrative Law Judge DECISION
XII. BENEFITS WHEN CLAIM IS APPROVED
IMPORTANT DEFINITIONS AND TERMS FOR UNDERSTANDING THE LISTINGS OF IMPAIRMENTS
XIII. 40 OF THE MOST COMMON IMPAIRMENTS APPROVED FOR SOCIAL SECURITY DISABILITY (LISTINGS)
APPENDIX A "THE GRIDS" Medical-Vocational Guidelines (20 C.F.R., Part 404, Subpart P, Appendix 2 )
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