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

2. 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

3. 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

4. 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

5. Income/Asset limits for 2014

6. Concurrent Claims Both SSI and RSDI

7. 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.

8. Sequential Evaluation Process Step 1: Is the claimant engaged in SGA?

9. Substantial Gainful Activity Work done for pay or profit $1,070 gross per month

10. Substantial Gainful Activity

11. Sequential Evaluation Process Step 1: Is the claimant engaged in SGA? Step 2: Does the claimant have a severe impairment?

12. Severe Impairment More than a minimal limitation on one’s ability to work

13. 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?

14. 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

15. Blue Book Listings - Adult

16. Blue Book Listings - Child

17. Step 3.5 – Residual Functional Capacity Maximum ability to do work related activities on a sustained basis

18. 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?

19. Past Relevant work Work performed gainfully within the last 15 years and performed long enough to be learned

20. 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?

21. Other Work Work in the national economy Age affects this step Last step in which someone may be approved

22. Grid Rulings Special rules for older workers Take into account RFC, age, education, and transferable skills

23. Sedentary RFC, Advanced Age

24. 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

25. First Appeal: Reconsideration 60 deadline State agency takes into account new evidence

26. 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

27. Third Appeal: Appeals Council 60 day deadline Not a new determination

28. Fourth Appeal: Federal District Court 60 day deadline Civil suit against Social Security Must be represented by an attorney

29. Potential Claim Issues Chemical Dependency Lack of medical treatment Noncompliance with treatment Criminal background

30. 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

31. Screening Is the individual unable to work full time? Is it due to a medically determinable impairment? Ultimate decision is with Social Security

32. An Overview Kelly Blad, MA, EDPNA