1. Social Security Programs
A Look at
Social Security Programs
Presenter: Billie Thomas
Oklahoma Disability Determination Division

2. Program Background

3. Disability Program Mission:
The Mission of the Oklahoma Disability Determination is to provide quality Social Security disability determinations
for the citizens of Oklahoma.
Purpose:
Oklahoma DRS Disability Determination Division provides
High quality, responsive, citizen-centered service that
Meets or exceeds Social Security, State, and
Community expectations and standards.

4. SSA administers two Disability Programs
Social Security Disability Insurance (SSDI) (Title II)
Provides for payment of disability benefits to individuals who are “insured” under the Act by virtue of their contributions to the Social Security trust fund through the Social Security tax on their earnings, as well as to certain disabled dependents of insured individuals.
SSI – Title XVI
Provides for payments to individuals (including children under age 18) who are disabled and have limited income and resources.

5. Who is Eligible for Social Security Disability Benefits?
After 2 years of receiving benefits, people can receive
Social Security Disability Insurance (SSDI)
People under retirement age who have worked long enough and recently enough in covered employment and cannot work because of their impairment(s).

6. What kinds of people get Social Security Disability Benefits?
Disabled workers under retirement age
Disabled adult children
Disabled widows or widowers, age 50 to 60

7. Those who qualify will also be eligible for Medicare Coverage
Hospital Insurance provided - (Part A)
Medical Insurance optional-(Part B)

8. Who is eligible for Supplemental Security Income (SSI)?
Blind or disabled children
Blind or disabled adults with limited income and resources

9. The Disability Application Process begins with a contact.
Visit website at
Call for Appointment at
Visit the local Social Security Office

10. Filing an Application The claimant should: Identify all impairments;
Identify treating doctors with addresses;
Identify dates of hospitalizations with addresses and hospital record numbers.

11. Verification of non-medical Requirements
Local Social Security office verifies:
Earnings and quarters of coverage
income and resource information
Age
Employment
marital status

12. Where Does the Claim Go?
The claim is sent to the Disability Determination Division (DDD), the State agency that:
obtains medical evidence
obtains vocational evidence and
makes the disability determination for the Social Security Administration.

13. Definition of Disability
Social Security’s
Definition of Disability
The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s);
which can be expected to result in death
or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Social Security

14. Substantial Gainful Activity (SGA)
Usually, the best gauge of a person’s ability to work is the amount of pay received.
For calendar year 2016 earnings from work activity averaging more than $1130 per month are considered SGA.
For the blind individual, the SGA level is $1820

15. Impairment Must Be Medically Determinable
Results from
anatomical,
physiological, or
psychological abnormalities
Established by medical evidence consisting of
symptoms,
signs, and
laboratory findings.

16. Disabled Children Under Age 18
Must have a physical or mental condition or conditions that can be
medically proven and which
results in marked and severe functional limitations

17. Disabled Children Under Age 18
Under title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.

18. The Disability
Determination

19. Who Makes the Disability Determination?
Adjudicative team working for the Oklahoma Disability Determination Division (DDD)
Team consists of a
Disability Examiner and a
Licensed Physician or Licensed Psychologist.

20. A step-by-step process
5 Steps of Sequential Evaluation for Adult Claims
A step-by-step process
Engaging in SGA?
Severe impairment(s)
Meets or equals the listings.
Past work
Other work

21. A step-by-step process
Sequential Evaluation for Childhood Claims
A step-by-step process
Severe impairment(s)
Meets or equals the listings.

22. Evaluating the Evidence
All the evidence is evaluated to determine if the severity of the impairment meets or equals the level of severity set out by Social Security in the publication, Disability Evaluation Under Social Security
If the individual does not meet or equal a listing, we evaluate the residual functional capacity.

23. Residual Functional Capacity
The ability to do work-related activities, as evidenced by objective medical findings, is an indicator of what the individual is still capable of doing, despite having a physical or mental impairment.
Social Security Disability is function driven not diagnosis driven.

24. Appealing the Decision Four Levels
Reconsideration
Hearing by Administrative Law Judge
Review by Appeals Council
Federal District Court

25. Continuing Disability Review
AGE 18 Redetermination

26. Continuing Disability Review
Periodic review
nature of impairment
severity of impairment
likelihood of improvement
Additional medical evidence is gathered
Significant Improvement must be demonstrated.

27. Age 18 Redetermination
EVALUATING AS IF IT WAS THE FIRST TIME THEY APPLIED AND LOOKING AT THE 4 STEP EVALUATION PROCESS (WE SKIP SGA ANALYIS)
NO NEED FOR MEDICAL IMPROVEMENT TO BE DENIED.

28. Age 18 Disability Redetermination
We must redetermine your eligibility if you are eligible for SSI disability benefits and:
(i) You are at least 18 years old; and
(ii) You became eligible for SSI disability benefits as a child (i.e., before you attained age 18); and
(iii) You were eligible for such benefits for the month before the month in which you attained age 18.

29. Age 18 Disability Redetermination
WHEN IS ELIGIBILITY REDETERMINED?
DURING THE ONE YEAR PERIOD BEGINNING ON THE CLAIMANT’S 18th BIRTHDAY
AGE 18 REDETERMINATION PROCESS
INITIAL INTERVIEW, DDS REVIEWS MEDICAL RECORDS, POSSIBLE CONSULTATIVE EXAM, APPEALS.

30. Rules for Age 18 Redetermination
We will use the rules for adults (individuals age 18 or older).
We will not use the rule for people who are doing substantial gainful activity, and we will not use the rules for determining whether disability continues.

31. Age 18 Redetermination and SGA
An individual who works despite a disabling impairment may qualify for special SSI cash benefits and in most cases for Medicaid benefits when his or her gross earned income exceeds the applicable dollar amount which ordinarily represents SGA. The calculation of this gross earned income amount, however, is not to be considered an actual SGA determination. Also, for purposes of determining eligibility or continuing eligibility for Medicaid benefits, a blind or disabled individual who, except for earnings, would otherwise be eligible for SSI cash benefits may be eligible for a special SSI eligibility status under which he or she is considered to be a blind or disabled individual receiving SSI benefits.

32. Age 18 Redetermination and SGA
The adult standards for initial claims will apply to disability redeterminations for individuals who have attained age 18, except that the SGA step of the sequential evaluation process will not apply.
DDS will consider all current impairments, including any new impairments even if they do not meet the duration requirement.

33. Age 18 Redetermination and School Records
Evidence Regarding Functioning From Educational Programs
may indicate how well a young adult can use his or her physical or mental abilities to perform work activities. The following examples of school-reported difficulties might indicate difficulty with work activities:
Difficulty in understanding, remembering, and carrying out simple instructions and work procedures during a school-sponsored work experience;
Difficulty communicating spontaneously and appropriately in the classroom;
Difficulty with maintaining attention for extended periods in a classroom;
Difficulty relating to authority figures and responding appropriately to correction or criticism during school or a work-study experience;
Difficulty using motor skills to move from one classroom to another.

34. DENIAL OF AGE 18 REDETERMINATION
SSA FINDS DISABILITY ENDED THE EARLIEST OF:
(1) The month the evidence shows that you are not disabled under the rules in this section, but not earlier than the month in which we mail you a notice saying that you are not disabled.
(2) The first month in which you failed without good cause to follow prescribed treatment.
(3) The first month in which you failed without good cause to do what we asked.
The factors that could generally be good cause are for failure to cooperate and for failing to attend a consultative examination.

35. DENIAL OF AGE 18 REDETERMINATION
Disability ceases as of the date of the disability redetermination decision.
Eligibility ends the last day of the second month following the month of cessation.
Benefits are paid for two months following the month of cessation if all other eligibility criteria are met.

36. MET LISTING LEVEL AS A CHILD
DENIAL OF AGE 18 REDETERMINATION
MET LISTING LEVEL AS A CHILD
SINCE “LISTING-LEVEL SEVERITY” IS GENERALLY THE SAME IN BOTH PART A AND B OF THE LISTINGS; AND MOST PART B LISTINGS HAVE AN EQUIVALENT LISTING IN PART A, IF A CHILD’S IMPAIRMENT MET/EQUALED A LISTING IN PART B OF THE LISTINGS, THEY WILL OFTEN MEET/EQUAL A LISTING IN PART A.
EXCEPTION: UNLESS THERE WAS MEDICAL IMPROVEMENT.
EVEN IF THERE WAS IMPROVEMENT, WE DO NOT USE THE REVIEW STANDARD FOR A CDR IN AN AGE 18 REDETERMINATION

37. MET LISTING LEVEL AS A CHILD
DENIAL OF AGE 18 REDETERMINATION
MET LISTING LEVEL AS A CHILD
SINCE “LISTING-LEVEL SEVERITY” IS GENERALLY THE SAME IN BOTH PART A AND B OF THE LISTINGS; AND MOST PART B LISTINGS HAVE AN EQUIVALENT LISTING IN PART A, IF A CHILD’S IMPAIRMENT MET/EQUALED A LISTING IN PART B OF THE LISTINGS, THEY WILL OFTEN MEET/EQUAL A LISTING IN PART A.
EXCEPTION: UNLESS THERE WAS MEDICAL IMPROVEMENT.
EVEN IF THERE WAS IMPROVEMENT, WE DO NOT USE THE REVIEW STANDARD FOR A CDR IN AN AGE 18 REDETERMINATION

38. FUNCTIONAL EQUALS AS A CHILD
DENIAL OF AGE 18 REDETERMINATION
FUNCTIONAL EQUALS AS A CHILD
A MARKED LIMITATION IN A FUNCTIONAL DOMAIN, MAY RESULT IN AN EXTREME LIMITATION IN PART A OF THE LISTINGS
FOR EXAMPLE, ABSENT MEDICAL IMPROVEMENT OR SHOWING THAT A PRIOR FINDING WAS IN ERROR: A MARKED LIMITATION IN INTERACTING AND RELATING WELL WITH OTHERS, MIGHT RESULT IN AN EXTREME LIMITATION SOCIAL FUNCTIONING AS AN ADULT.

39. SECTION 301
IF THE YOUNG ADULT IS FOUND NOT TO BE DISABLED BECAUSE OF MEDICAL IMPROVEMENT, PAYMENTS MAY CONTINUE IF:
1) They are participating in the Ticket to Work and Self-Sufficiency program or another appropriate program of vocational rehabilitation and (2) Completion of the program or continued participation for a specified period will increase the likelihood that they will not return to the disability or blindness benefit rolls.

40. SECTION 301
If a young adult is a student age 18 through 21 participating in an individualized education program (IEP), and we find that completion/continuation in the IEP increases the likelihood that claimant will not return to the benefit rolls, payments may continue until the IEP is completed or the person stops participating in the IEP for any reason.
Payments may continue if a young adult is participating in another appropriate program, where completion/continuation in that program increases the likelihood that the person will not return to the disability benefit rolls because the program provides the person with:
Work experience that will increase the likelihood of doing PRW; OR
Education, skilled or semi-skilled work experience that will increase the likelihood of adjusting to other work.
For example, the young adult is in a VR-sponsored training program to become a certified computer technician. He/She is acquiring computer skills that will permit direct entry into semiskilled or skilled occupations, thus increasing his/her overall ability to adjust to other work. We would determine that the training program would increase the likelihood that he/she will not return to the disability or blindness benefit rolls.

41. Medical Evidence

42. Sources of Medical Evidence
Acceptable medical sources
Other sources

43. Acceptable Medical Sources
Licensed physicians
Licensed osteopaths
Licensed or certified psychologists
independent general practice
school psychologists
Licensed optometrists
Licensed podiatrists
Hospital, clinic, or other health facilities.

44. Other Types of Acceptable Sources of Evidence
Social workers
Social Service agencies
VR Counselors
Audiologists
Speech & language pathologists
Chiropractors
Nurses
Physiotherapists
Parents/relatives,
neighbors, friends, clergy
School professionals
Teacher Questionnaires are very important!

45. Treating Source Evidence
The claimant’s treating source is often in the best possible position to provide detailed longitudinal information about the claimant.

46. Why We Obtain A Consultative Examination (CE)
More detailed findings
Technical / specialized tests
Resolve conflicts

47. Sending in Medical Evidence
Electronic Records Express
Call PR to get set up
Fax ( )
Mail

48. Contact Information
(statewide) (locally)
Bruce Smith (405)
Billy Drew (405)
Billie Thomas (405)
Amanda Fox (405)
PO Box Oklahoma City, OK