Social Security Disability – The Medical Decision

Today I am returning to the topic of how a Social Security disability decision is made.   

The Social Security disability application and medical questionnaire (SSA Adult Disability Report – Form SSA-3368) can be completed online.  SSI applications are not online but use the same online SSA-3368.  Whether completing an application online or with an SSA office, first read Information You’ll Need When You Apply for Disability Benefits

For both Social Security and Supplemental Security Income (SSI), local Social Security office representatives make non-medical decisions.  For Social Security, a non-medical decision is if the applicant has enough work at the right time to be insured for disability.  For SSI, a non-medical decision could be if income and resource requirements are met.  

When all non-medical requirements are met, local offices send the application to a state agency called the Disability Determination Services (DDS).  Following very specific SSA requirements, DDS’s make the medical decisions. The process is essentially the same for Social Security and SSI so, for simplicity, I will just refer to Social Security disability. 

Five basic questions are developed when making the medical decision.  These questions always follow the same order.  Development needed to answer any of the five can be significant.  

By legislative design, the Social Security Administration definition of disability is strict, different from other programs, and related to the applicant’s ability to work.  Benefits are paid only for total disability.  No provisions exist for partial or short-term disability. 

In general, a medically determinable physical or mental impairment(s) must have lasted, or be expected to last, at least one year or be expected to result in death.   During this time, you cannot do the work you have done and would not be able to adjust to other work because of your health.  In addition to your health, SSA disability decisions consider your age, past work experience and education.  The five questions refer back to this Social Security definition of disability.  

The first question:   Are you working?   

Most applicants are not working when they apply for disability but some are.  Given that being unable to work is the major component of the disability definition, you can readily see that ongoing employment raises questions that must be addressed.  Local SSA offices evaluate work activity, usually before the claim goes to the state Disability Determination Services (DDS).  

You generally cannot be considered disabled if you are working and your earnings average more than a certain dollar amount per month.  This amount usually changes annually.  In 2012, it is about $1,010 per month.   If ongoing employment earnings exceed this amount, the application is usually denied.  If less, development continues. (Note: very different rules apply when a person already receiving benefits returns to work.)  

Sometimes an applicant returns to work while the claim is at the DDS.  If so, the claim returns to the local SSA office for evaluation of the work.   

Next time:  the second question