Qualifying For Social Security Disability Benefits

Seeking a Free Consultation with one of Texas’ Houston Social Security Disability Lawyers? Call the Social Security Disability Lawyer Reshard Alexander today at 713.766.3322.

Social Security Disability Lawyer Reshard Alexander helps disabled persons receive the care and compensation they deserve.

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.

Social Security Disability Insurance pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes.

Supplemental Security Income pays benefits based on financial need.

When you apply for either program, I will collect medical and other information from you and help you make a case about why you meet Social Security’s definition of disability.

Use the Benefits Eligibility Screening Tool to find out which programs may be able to pay you benefits.

Definition of Disability

For all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity (SGA) 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.

Disability in Children

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.

What is a “Medically Determinable Impairment”?

A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. The medical evidence must establish that an individual has a physical or mental impairment; a statement about the individual’s symptoms is not enough.

The Disability Determination Process

Most disability claims are initially processed through a network of local Social Security field offices and State agencies (usually called Disability Determination Services, or DDSs). Subsequent appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges in SSA’s Office of Hearing Operations (OHO).

Seeking a Free Consultation with one of Texas’ Houston Social Security Disability Lawyers? Call the Social Security Disability Lawyer Reshard Alexander today at 713.766.3322.

Social Security Field Offices

When an individual applies for disability benefits, whether online, in person, by telephone, or by mail, the application is initially processed at an SSA field office. The completed application and related forms provide information about the claimant’s impairment(s); names, addresses, and telephone numbers of medical sources; and other information that relates to the alleged disability. (The “claimant” is the person who is requesting disability benefits.)

The field office is responsible for verifying nonmedical eligibility requirements, which may include age, employment, marital status, citizenship and residency, and Social Security coverage information. For SSI eligibility, the field office verifies income, resources, and living arrangement information. The field office sends the case to a DDS for disability evaluation.

State Disability Determination Services

The DDSs are State agencies responsible for developing medical evidence and making the initial determination about whether the claimant is or is not disabled or blind under the law. These State agencies are fully funded by the Federal Government.

Usually, the DDS obtains evidence from the claimant’s own medical sources first. When the evidence is unavailable or insufficient to make a determination, the DDS may arrange a consultative examination (CE) to obtain additional evidence. The individual’s own medical source(s) is the preferred source for the CE; however, the DDS may also obtain the CE from an independent source.

After completing its development, the DDS makes the disability determination. An adjudicative team consisting of a medical or psychological consultant and a disability examiner usually makes the determination. If the adjudicative team finds that additional evidence is still needed, the consultant or examiner may recontact a medical source and ask for additional information.

The DDS will refer the case to the State vocational rehabilitation (VR) agency if the claimant is a candidate for VR.

The DDS returns the case to the field office after making a disability determination. The field office takes appropriate action depending on whether the claim is allowed or denied. If the DDS finds the claimant to be disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits. If the claimant is found to be not disabled, the file is retained in the field office in case he or she decides to appeal the determination.

If the claimant appeals an initial determination, the appeal is usually handled much the same as the initial claim with the exception that a different adjudicative team in the DDS than the one that handled the original case makes the reconsideration determination.

Office of Hearing Operations

Claimants who are dissatisfied with the reconsideration determination may request a hearing before an administrative law judge (ALJ) in OHO. The claimant may submit additional information and evidence to the ALJ, and the ALJ will issue a decision based on all the evidence of record, including evidence obtained at the hearing.

When an ALJ needs additional evidence, the hearing office frequently coordinates with the DDS to obtain the evidence. However, hearing offices may also contact medical sources directly. In some circumstances, an ALJ may issue a subpoena requiring the production of evidence or testimony at a hearing.

Seeking a Free Consultation with one of Texas’ Houston Social Security Disability Lawyers? Call the Social Security Disability Lawyer Reshard Alexander today at 713.766.3322.

The Role of the Health Professional

Health professionals play a vital role in the disability determination process and participate in the process in a variety of ways:

As medical sources who provide medical evidence on behalf of their patients;
As CE sources who perform, for a fee, examinations or tests that are needed;
As full-time or part-time medical or psychological consultants reviewing claims in a DDS, in one of SSA’s regional offices, or in SSA’s central office; or
As medical experts who testify at ALJ hearings or respond to written interrogatories from the ALJ.

Claimant’s Own Medical Sources

A medical source who has evaluated, examined, or treated a claimant is usually the best source of medical evidence about the nature and severity of a claimant’s impairment(s).

If an additional examination or testing is needed, SSA usually considers a claimant’s own medical source to be the preferred source for performing a CE.

Consultative Examiners for the DDS

In the absence of sufficient medical evidence from a claimant’s own medical sources, SSA, through the State DDS, may request an additional CE(s) to be performed by licensed medical sources (such as physicians and psychologists). All CE sources must be currently licensed in the State and have the training and experience to perform the type of examination or test SSA requests.

Each State establishes the set fee for CEs, and fees may vary from State to State. Each State agency is responsible for comprehensive oversight of its CE program.

Medical professionals who perform CEs must have a good understanding of SSA’s disability programs and their evidentiary requirements. In addition, these medical professionals are made fully aware of their responsibilities and obligations regarding confidentiality and:

CE scheduling intervals;
CE report content;
Elements of a complete CE;
When a complete CE is not required; and
Signature requirements.

Program Medical Consultants and Psychological Consultants

Medical consultants, who are physicians, and psychological consultants, who are psychiatrists and psychologists, review disability claims at the State, regional, or national levels. During a case review, a medical or psychological consultant usually has no contact with the claimant.

Medical Experts

Administrative law judges may request medical expert testimony on complex medical issues. Each hearing office maintains a roster of medical experts who are called to testify as expert witnesses at hearings or to respond to written interrogatories. The experts are paid a fee for their services.

Confidentiality of Records

Two separate laws, the Freedom of Information Act and the Privacy Act, have special significance for Federal agencies. Under the Freedom of Information Act, Federal agencies are required to provide the public with access to their files and records. This means the public has the right, with certain exceptions, to examine records pertaining to the functions, procedures, final opinions, and policy of these Federal agencies.

The Privacy Act permits an individual or his or her authorized representative to examine records pertaining to him or her in a Federal agency. For disability applicants, this means that an individual may request to see the medical or other evidence used to evaluate his or her application for disability benefits under the Social Security or the SSI programs. (This evidence, however, is not available to the general public.)

SSA screens all requests to see medical evidence in a claim file to determine if release of the evidence directly to the individual might have an adverse effect on that individual. If so, the report will be released only to an authorized representative designated by the individual.