Social Security Disability:
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Transcript Social Security Disability:
Traumatic Brain Injury and the Social Security Disability Process
An Overview
Kelly Blad, MA, EDPNA
Social Security Disability Programs
Retirement, Survivors, and Disability Insurance (RSDI,
Title II)
Work based disability program
Must prove disability prior to Date Last Insured
Supplemental Security Income (SSI, Title XVI)
Federal welfare program for the disabled, blind, and
elderly
Must meet income and asset requirements
Retirement, Survivors, and
Disability Insurance
Monthly benefit amount based on earnings record
Must be disabled and insured
5 month waiting period for eligibility
Auxiliary benefits available
Medicare coverage after 24 months of eligibility
Not reduced by income or assets
Supplemental Security Income
$721 for an individual and $1,081 for a couple and may
be reduced depending on
Living situation
Income
Medical assistance coverage
Income/Asset limits for 2014
Concurrent Claims
Both SSI and RSDI
Disability
Inability to engage in substantial gainful activity by
reason of a medically determinable impairment that
has lasted or is expected to last at least 12 months or
result in death.
Sequential Evaluation Process
Step 1: Is the claimant engaged in SGA?
Substantial Gainful Activity
Work done for pay or profit
$1,070 gross per month
Substantial Gainful Activity
Sequential Evaluation Process
Step 1: Is the claimant engaged in SGA?
Step 2: Does the claimant have a severe
impairment?
Severe Impairment
More than a minimal limitation on one’s
ability to work
Sequential Evaluation Process
Step 1: Is the claimant engaged in SGA?
Step 2: Does the claimant have a severe impairment?
work?
Step 3: Does the impairment meet or
equal a medical listing?
Medical Listings
Social Security Website, “Blue Book”
Organized by body system
Separate listings for children and adults
First step in which someone may be approved
Blue Book Listings - Adult
Blue Book Listings - Child
Step 3.5 – Residual Functional
Capacity
Maximum ability to do work related
activities on a sustained basis
Sequential Evaluation Process
Step 1: Is the claimant engaged in SGA?
Step 2: Does the claimant have a severe impairment?
work?
Step 3: Does the impairment meet or equal a medical
listing?
Step 4: Can the claimant perform his or
her past relevant work?
Past Relevant work
Work performed gainfully within the last 15
years and performed long enough to be
learned
Sequential Evaluation Process
Step 1: Is the claimant engaged in SGA?
Step 2: Does the claimant have a severe impairment?
work?
Step 3: Does the impairment meet or equal a medical
listing?
Step 4: Can the claimant perform his or her past
relevant work?
Step 5: Can the claimant perform any
other work?
Other Work
Work in the national economy
Age affects this step
Last step in which someone may be approved
Grid Rulings
Special rules for older workers
Take into account RFC, age, education, and
transferable skills
Sedentary RFC, Advanced Age
Application Process
Initial Application
Online or in person application taken by district office
State agency collects medical records and makes
determination
Clear medical records, no red flags
First Appeal: Reconsideration
60 deadline
State agency takes into account new evidence
Second Appeal: Request for
Hearing
60 day deadline
Claimant/claimant’s representative is responsible for
providing medical records
Testimony and medical records are used to make
determination
Third Appeal: Appeals Council
60 day deadline
Not a new determination
Fourth Appeal: Federal District
Court
60 day deadline
Civil suit against Social Security
Must be represented by an attorney
Potential Claim Issues
Chemical Dependency
Lack of medical treatment
Noncompliance with treatment
Criminal background
Provider’s Role in SSA’s
Determination
SSA uses medical, education, and rehabilitation
records in the determination
Providers record diagnoses and symptoms
Providers can provide medial opinions
Screening
Is the individual unable to work full time?
Is it due to a medically determinable impairment?
Ultimate decision is with Social Security
An Overview
Kelly Blad, MA, EDPNA