Friday, April 28, 2006

Qualifying for Disability - How difficult are the Qualifications ?

If you talk to enough people who have been through the ringer of qualifying for social security disability or ssi disability, you'll find many commonalities and shared opinions. For example, a great many claimants will remark on how long it took for their inital claim to be processed (which, more often than not, ended up as a denial for benefits). Others who found it necessary to file a request for a hearing before an administrative law will probably comment on how terribly long it took to get a hearing date and then how long it took to actually receive a decision from the judge after the hearing was held and the qualifications were met. Last, but not least, claimants will comment on how hard qualifying and being awarded benefits is when you have condition x, condition, Y, condition Z, or all three.

Without a doubt, it can be difficult to be approved for disability benefits with many, if not most medical conditions. For example, back pain, a degenerative disc condition, ms, bipolar disorder, depression, a heart condition, copd, asthma...and the list goes on.

By the same token, however, it is likewise possible to be approved for social security disability or ssi on the basis of nearly any medical condition as well. Why is this so? Because the way the social security administration makes approvals (and denials) on claims has little to do with what particular condition a person has been diagnosed with. Instead, the focus is on other qualifications, i.e. what a person is still capable of doing, despite their illness.

So, for example, if person A has emphysema, yet is able to persist at a job, that individual will not qualify to receive disability benefits (in the SSA system, you can still work and file for or even receive disability benefits, but your earnings must be under a certain threshold amount called SGA which is subject to change on an annual basis). On the other hand, if person B has emphysema and the condition imposes sufficient restrictions such that the individual cannot perform the requirements of his current or past work, or any other work, that individual will be eligible to receive disability benefits.

The concept that is employed by the social security administration is something called "residual functional capacity". And, in fact, when a disability claimant's case is reviewed by a disability examiner, an RFC writeup will be done by both the examiner and the unit doctor he or she works with to determine what the disability applicant is still capable of doing despite the effects of their illness.

Now, if you do some research into disability adjudication, you'll hear about things like the blue book. The blue book, or impairment listing manual, is a book that lists the approval criteria for a number of selected impairments (many conditions are not listed in the manual). You may also come across the term, "medical vocational allowance". These types of allowances account for most of the approvals made by social security and they work, for the most part, like this:

1. Does the claimant have a medical impairment?

2. Is the impairment considered severe?

3. Has the impairment prevented (or will it prevent) the claimant from working and earning SGA for at least 12 months at a job they have done in the past, or at any other form of work?

Simply put, if a claimant does not meet or equal the disability specifications of the listing book (the blue book) for a particular illness, but yet also cannot work and earn at least the SGA amount, they can be approved for disability benefits on the basis of a medical vocational allowance.

Undoubtedly, qualifying for disability is difficult for many, if not most, claimants. However, this is as much a function of the shortcomings of the disability system as it is anything else. What do I mean by this? Consider this fact: approximately 70 percent of those who file for disability get denied at the initial claim level. But, for those who pursue their claim to the point where their case can be presented before an administrative law judge, more than half of these individuals will be approved. What does this mean? There's only one conclusion you can draw, really, which is that half of the disability claims that get denied by disability examiners should, instead, have been approvals.

And, of course, there are other conclusions you can draw as well, which are:

1. If you get denied, don't give up and don't be too surprised that you were denied.

2. If you get denied, make sure you take advantage of the appeals process, because, ultimately, you may be a better chance of winning disability benefits.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Disability Appeal Deadline
How long does it take to get a disability hearing scheduled ?
File for disability
Disability attorneys


Blogger Stacey Adams said...

Thank you for such valuable information. Been through the ringer trying to health insurance coverage for my son that cover bipolar disorder, treatment and meds and the only way to get it was through social security disability. Thanks for posting the appeal process.

7:59 AM  
Blogger Disability Blogger said...

Thanks Stacy. And thanks for your own blog, by the way. My step-son has bipolar.

9:19 AM  
Anonymous Anonymous said...

Sad, but true. It's a shame that so many of us have had to get a lawyer (which wound up costing us $5300) to get what we should have received in the first place. It is a messed up system. I had to sell my home to survive, after borrowing from friends and family for 3 years. My SSDI was approved three months later, by an ALJ in an OTR decision that said I shouldn't have been denied in the first place.

3:04 PM  
Anonymous Anonymous said...

Excellent site. Having been a rescue worker at the WTC on 9/11 and being denied ssdi with the WTC cough this site gives great info into the process.

8:30 PM  
Blogger Linda said...

I am currently seeing an orthopedist and going to physical therapy twice a week which costs me $80 co-pay. I can walk and stand but after a while, for example, shopping for groceries and then having to cook, I'm in a lot of pain. I don't know if that qualifies for SS disability but I am in constant pain and can't stand for more than an hour without pain and sitting, I need to move around and change positions and that isn't just back but neck pain also. How do I find out if I qualify and what measures to take? For instance, do I ask my doctor for a note, recommendation or what should I do?

11:46 AM  

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