Who is disabled?

While the SSA looks at disability in an absolute sense - an individual is either totally and permanently disabled or is not disabled at all - the definition of disability is obviously somewhat nebulous. It is not uncommon to know or hear stories of persons who have been declared disabled and yet seem to navigate through life's activities much more easily than persons who have been denied disability benefits.

In order to prove oneself disabled under the official Social Security definition, the claimant must demonstrate that (1) he or she meets the prior work requirement, (2) the impairment is "medically" determinable, and (3) he or she is totally disabled for at least the next twelve months or is expected to die from the condition.

The typical disability claimant must show that he or she was gainfully employed for 20 of the last 40 quarters before becoming allegedly disabled. This prior work requirement demonstrates the claimant has significantly contributed to the fund from which he or she now wishes to draw. Therefore, disability benefits become one's entitlement. It is assumed that the claimant, because of past demonstration of willingness to work, would be much happier working than collecting benefits. A disabled person who has never been able to work is not eligible, but neither does that individual have the expectation of benefits engendered by contributing to the fund during working years.

ALJ Hearing

The ALJ will begin the hearing with a statement concerning his or her role in the disability process. The ALJ will state that this is a de novo hearing, meaning that previous decisions are not binding upon the ALJ's judgment in the case. ALJ allowances are not "reversals" of State denials because the ALJ will be looking at the application and medical records with a fresh perspective and often additional written evidence. The ALJ will then make a statement as to what the issues in the hearing are. 

The claimant may be represented at the hearing by an attorney or lay counsel although the SSA will not provide one for a claimant. The claimant's attorney will be shown the list of exhibits already in the case file and be asked if there are any objections to them. 

The ALJ will administer an oath to the claimant and witnesses as each gives testimony. The ALJ will ask questions as will the attorney, if present. The burden of exploring all pertinent facts and issues of the case rests with the ALJ. The ALJ may include medical or vocational expert witnesses in the hearing to help present a fair picture of the claimant's capacities. 

The hearing process should include coverage of these areas--the claimant's full work history, the claimant's personal and medical history, and a description of the claimant's daily activities. Through testimony and additional written evidence, the ALJ must determine if the claimant can perform any previously held job, based on his or her individual case history or jobs theoretically available in the national economy.

First Stage of the Disability Claim Process

To apply for disability benefits, the individual must go to the local SSA district office and complete application and medical release forms. The application will include employment history, identification of alleged impairment(s), names and addresses of treating physicians and hospitals, and a description of how the alleged condition keeps the claimant from working. 

After completion of forms, the district office will make a determination as to whether the claimant has paid enough into the trust fund. A computer search will answer this inquiry. Next, the district office sends the claim to the State Disability Determination Service (DDS). The DDS obtains the medical records and then passes them, along with the application, to a physician and an adjudicator. 

The physician will review the medical records and determine how the alleged impairments would affect the performance of mental and physical tasks such as oral and written communication, bending, lifting, walking, etc. The physician's report of findings is submitted to an adjudicator who uses it to determine if any of the claimant's impairments equal or meet the severity of conditions in the Listings. The Listings include thirteen sections of impairments, ranging from ailments of the musculoskeletal system to malignancies. A claimant meeting one or more of the conditions in the Listings is automatically considered to be disabled since medical science has concluded that substantial gainful activity is highly unlikely with these conditions, and the impairments are expected to result in death or last for a continuous period of not less than twelve months. 

If the claimant's condition is not clearly identified in the Listings, the State adjudicator should measure the residual functional capacity of the claimant, ranging from "Very Heavy" to "Less than the Full Range of Sedentary." This determination assumes that disability can be ascertained by establishing an applicant's ability to function despite an impairment.

Definition of Disability

Disability has different meanings depending upon the eligibility requirements or purpose of the programs. Defining disability is difficult since it is a multidimensional concept.

Disability if a medical model used to characterize disability policy, is used as a chronic pathology or impairment associated with an incapacity to perform physical functions or activities of daily living. Policy definitions of disability even though general and unique to individual programs are very important because they often have the impact of law. Legal and governmental definitions tend to be formal and specific depending on legislative, regulatory or judicial interpretation.

To qualify for payments under the Social Security Disability Insurance and Supplemental Security Income, an individual’s disabling condition must meet certain medical, psychological or vocational criteria. Laws are made by elected officials who are influenced by lobbyists and the changing public mood. Judges who respond to evidence presented by attorneys and heath experts and the personal condition of the applicant may not interpret these laws in accord with the intention of the lawmakers.

In order to establish the presence of a disability, diagnostic testing and assessment are necessary. Social security disability benefits are available to previously earning individuals under the age of 65 who are unable to work due to disability. Supplemental security income provides a minimum monthly income to people over 65 years of age, disabled or blind and who have limited assets and income.  

Social Security Administration and SSI

Supplemental Security Income (SSI) is a federal public assistance program that provides a minimum cash income to people who are below a designated poverty level who are old, blind, or otherwise disabled. Those who are blind or disabled must have medical verification that they are unable to engage in any substantial gainful activity.

The state-administered welfare programs for the aged, blind, and disabled that existed before SSI are widely recognized to have been enmeshed in a bewildering patchwork of rules, regulations, policies, and procedures. Costly delays, mistakes, intergovernmental strife, recipient frustration, and taxpayer complaints were common occurrences. 

A major argument in favor of SSI was that the federal government would do a better administrative job than the states. The Social Security Administration was made responsible for administering the new program because many SSI recipients would also be drawing social security benefits. In addition, the Congress hoped that the widespread favorable public image of the social security system would reduce the stigma often associated with being on welfare and would also encourage eligible persons to enroll in the program.

The Social Security Administration has a quality assurance program to test the administrative efficiency of SSI. This program employs sampling techniques to gauge administrative performance and to determine how efficiently the program is operating. Each month a random sample of cases is selected to determine the causes, extent, and cost of payment errors. SSI recipients are interviewed at home to determine if they are receiving the proper SSI payment.