An Overview Kelly Blad, MA, EDPNA Traumatic Brain Injury and the Social Security Disability Process

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