“He ain’t disabled…”

The popular misconception.

The popular misconception.

Perhaps one of the most frequent complaints a disability advocate will hear starts out with, “I know somebody collecting disability…” Then there is some description of the person which paints them as the picture of health. The complaint ends with something like, “he ain’t disabled… And if he is, then I should be found disabled too.” While we have touched on how our hypothetical complainer can prove his or her disabilities and begin receiving benefits, we have not talked about people that are already receiving benefits. Specifically, what benefit recipients must do continue receiving benefits.

For the most part, life on disability is the same as life without it. However, there are some requirements that disability beneficiaries must keep to as long as they are collecting benefits.

First off, an applicant for disability must remain disabled. This seems like common sense. However, some disabilities go away: cancer can go into remission, back surgeries are successful more often than not, a psychiatrist can finally find the right medication to control symptoms, etc. If a claimant experiences a significant improvement in medical symptoms he or she must report this improvement. The cynical reader would say this is how so much of the tremendous disability fraud is allowed to happen as the typical claimant is sure to not report these changes.

The Social Security Administration, though, is not content to take claimants’ words for it. Another major requirement for claimants is that they comply with Continuing Disability Reviews (CDR). CDRs take two primary forms and which form it takes is currently chosen by a computer. According to the Deputy Commissioner of SSA, the agency uses statistical modeling to determine which cases are most likely to need a continuing review. While the deputy commissioner did not specify how this modeling works, it is a reasonable assumption that the more a determination of disability depends upon subjective evidence at the outset, the more likely it is to receive a more intensive review.

CDRs can be done in paper or in a doctor’s office. Many disability claimants will have been required to visit a doctor as part of developing their claim. The examination they receive after they have been approved is essentially the same examination. The most major difference is that the doctor might assume at the outset that the claimant’s conditions were, in fact, disabling when the claimant was awarded benefits and is now looking to see if they still are. The rest of the CDR may involve an interview with the claimant, running earnings reports, and querying bank databases to ensure compliance with earning and asset rules.

A paper CDR is what is assigned to cases that are less likely to see an improvement in symptoms or that were awarded based on very solid objective evidence. In these reviews, the Administration sends claimants function reports, disability questionnaires, and work activity reports, among others, to record statements from the claimants about how they live their lives and what treatment they are getting. Any suspected medical improvement or unreported work will trigger the more intensive CDR.

Beyond the CDRs, claimants are responsible for notifying the agency of any material changes in their lives. This could be a simple change of address or, in some circumstances, things that seem less relevant such as the marriage or death of a dependent. Generally, these requirements are much more stringent for claimants receiving SSI than they are for those only receiving SSDI as these individuals can only exceed the original qualifying criteria under certain circumstances.

For instance, an SSI claimant that is single with no children is required to have $2,000 or less in the bank at all times. If the claimant does not report to SSA even a single time when their bank account may be over the allowable limit (a lump sum child support payment for instance) they can be deemed overpaid and required to repay all of the benefits that they have received after the overpayment occurred. So, in order to maintain benefits, a claimant will need to educate themselves as to the requirements applicable to his or her situation.

While these requirements may not seem to be particularly taxing, the ramifications for an individual who is relying upon these benefits to make ends meet are enormous. So, while it may appear that that neighbor, friend, or relative is not disabled, SSA has reviewed their case and will continue to do so to ensure that they are, in fact, disabled.

If you have questions about maintaining your benefits or applying for disability contact us today!

Social Security Disability: Qualifying Conditions

Are there specific conditions that qualify a claimant for Social Security Disability benefits?

The short answer is no. The long answer is a slightly more nuanced no.

On some disability websites, potential claimants may come across lists of conditions like these. Many providers assemble these lists as examples of conditions that could be the basis of an SSDI or SSI claim. This can generally be somewhat misleading in that it can create the false impression that there are specific conditions that one must have in order to qualify for disability. However, this is simply not the case.

Social Security does have the Listing of Impairments. These Listings were created to streamline the disability process a bit by providing a list of common conditions that can lead to a finding of disability. However, what must be understood about the Listings in that they can be somewhat generic. This means that instead of identifying depression as a condition they identify “Affective Disorders,” which is a category of psychological conditions. This is the same for numerous other conditions. In fact, the listings only get specific where they need to be.

In some cases, the Listings will not only identify a specific condition, but also specific testing or test results that a claimant would need to have completed in order to meet the requirements of the Listing. For instance, with chronic heart failure, one would need to experience systolic failure, an ejection fraction of 30% or less, and inability to perform an exercise tolerance test at a workload of 5 METs or less due to a decrease of 10 mmHg in systolic blood pressure below their baseline systolic blood pressure in order to meet Listing 4.02 Chronic Heart Failure. So, in this example, a claimant would need to fail a cardiac stress test due to a drop in blood pressure, have an ejection fraction (which can be measured or estimated through a few different tests) that is approximately half of normal, and, though it is not mentioned, a poorly functioning left ventricle.

That seems pretty specific. But, most people do not realize that it is possible to “equal” a Listing. So, with the heart failure example, if a claimant had an ejection fraction of 40% and also had a knee problem limiting his ability to perform a stress test, he or she might be considered to have equaled the listing because, while they did not have exactly what the listing was looking for, they had conditions that combined to equal the severity that the Listing was looking for.

The equals argument can even be applied to conditions that have nothing to do with what the Listing is asking for, but demonstrate a similar level of severity. For instance, the asthma Listing is applicable to a number of different conditions including migraines. So, while you may not have ever had asthma, as long as you are taking a prescribed treatment and still have six migraines within a twelve-month period you would be able to argue that you equal the asthma listing.

The fact is that there are no specific conditions that one must have in order to medically qualify for disability. We have even seen claimants approved who did not have a firm diagnosis, but only confirmation by a doctor that they were experiencing severe symptoms of an unknown origin. In fact, all that is required to medically qualify is to have a severe, medically determinable impairment, that prevents a claimant from maintaining substantial gainful employment in their prior or other work, that is expected to last at least 12 months. If these basics are met, a claimant likely will have a good medical argument for disability.

If you would like further information on how your conditions could qualify you for disability or would like to speak with someone in the office about your claim please contact us!

Social Security Tips: The Mail

One of SSA's most common issues is one that is very basic.

One of SSA’s most common issues is one that is also very basic.

At Omega, we try to make ourselves available to people through various types of media. One of these is Avvo.com. Resources like these are great for asking quick questions or figuring out if you need an attorney to answer a more complex one. These sites also allow us as practitioners to reach people by answering questions. I recently answered a question on Avvo from an individual who had not received a key piece of mail from the Social Security Administration which subsequently caused him serious issues with his benefits.

This raised an issue that attorney advocates and claimants encounter on a frequent basis: the mail.

As individuals, people have almost certainly heard of one thing or another being lost in the mail. However, because they are sending less and less mail through the Post Office these days, losing things in the mail is an occurrence that rarely, if ever, happens. Generally, if we mail something it gets to where it is going reminding us that there is a minimal chance that anything could ever be lost in the mail.

But, if you happen to be sending thousands of pieces of mail per month and millions of pieces of mail per year like the Social Security Administration things will be lost on a regular basis. The question, then, becomes what can a claimant do about lost mail from SSA?

Fortunately, the answer is not the usual lawyerly “it depends.”

The answer is to be diligent and to stay involved with your claim, or if you have already been awarded benefits, to stay in contact with the Administration. For example, the question I answered on Avvo was from an individual already awarded benefits. Aside from receiving his monthly checks this person went about his business like normal with no contact to or from the agency until he received a letter in the mail stating that his benefits were going to be suspended since he was “not cooperating” with SSA. Of course, he would have cooperated if he knew he had to. The lesson to be learned here is that checking in with a field office at least quarterly can help prevent these circumstances.

There are simple reasons why that is. First off, a claimant can tell the field office staff that they have not received any mail from the Administration in a while and ask the office if any has been sent. If some has, since you are entitled to a copy of everything in your file, you can request that SSA re-send anything you missed. Moreover, checking in quarterly puts you in relatively good stead as far as collecting any mail you missed as many SSA deadlines for submitting documents or performing other activities are going to be 30, 60, or 90 days from the date of mailing. So, as long as you are checking in regularly you should be able to collect any missed documents prior to the deadline running out. You also may be able to correct any issues before anyone at SSA realizes that there is an issue.

This also solves the problem of good cause should you happen to miss one of these deadlines. Generally, SSA will keep a log of every time you call into them. If you have a pattern of checking on your claim to show them, if you miss a deadline because something was lost in the mail you will be far more credible and are much more likely to be granted good cause for a missed deadline than simply saying, “I didn’t get it.”

There are other ways to be diligent in ensuring that mail is received as well. Remember, that the loss of mail goes both ways, so things you send to SSA can also be lost. Here are a few more tips that should help no matter which way the mail is going:

  • Never send SSA originals of any of your own documents if you can at all possibly avoid it
  • Only send Social Security’s own forms back to them as originals(they require “wet” signatures on some documents), but keep a copy for yourself
  • If you are going to provide an address to Social Security because you only have a temporary living situation, provide one where a friend, relative, or other responsible person lives that can contact you if you receive mail
  • If you are sending something very important send it with a return receipt even though that costs a little bit more
  • If you have the ability to, and even if SSA only wants a wet signature, fax a copy of the document you are mailing to the office that requested the mailing
  • If you feel like you are regularly missing mail from SSA, call them and change your address
  • If you move, forward the mail from your old address via the Post Office and call the Administration to change your address
  • If the agency asks you for something, try to send it back within the time period they gave you
  • Even if you would leave a form mostly blank send it back to SSA
  • Do not expect that your attorney will complete documents asking for information from the claimant, you, without any input from you
  • Do not ever rely on SSA to do anything to ensure that you received mail they sent you
  • Do not ever assume that they will tell you that they did not receive something you sent before it that is causing a problem. If you mail something, wait a week, and then call them.

Ultimately, the mail might be the biggest cause of unnecessary problems for Social Security Disability claimants. Staying involved in your claim is the best way to do this. Of course, it also helps to have a good attorney, so contact us today!