Social Security Disability Eligibility

I worked for several years as a disability claims examiner for the social security adminstration's DDS (disability determination services). In that capacity, I rendered decisions on both social security disability and SSI disability claims, involving nearly every medical impairment, of a physical or mental nature, that one could imagine.

One thing I noticed working as a disability examiner and also working in the area of claimant representation was this: most people have no idea whatsoever what social security disability and SSI are. That is, unless they begin to have significant health problems that truly interfere with their ability to work and earn enough to support themselvse. It's at that point that people begin to find out about the disability programs operated by the federal government through SSA (social security administration)---in all candor, before I began working as a disability examiner, I knew practically nothing about SSD or SSI, I'm not even sure if I knew the programs existed.

Something else I noticed was that most individuals who are forced to file for disability have no idea how disability claims are decided. In other words, what are the eligibility rules? What makes one person disabled and entitled to receive benefits versus another individual whose case is deemed to lack eligibility?

Make no mistake. The process for winning disability benefits can be complex and burdensome (i.e. it can take a long time to finally be approved for disability benefits). And it is not unusual for individuals who have lost the ability to adequately support themselves through their work activity to end up in bankruptcy or foreclosure while they wait out the process. However, having said that, the disability eligibility program is still very simple in some ways. How is it simple? It's simple in the sense that eligibility for social security disability and SSI disability benefits really boils down to just two considerations.

What your medical records have to say about you

Eligibility for disability benefits really begins with medical documentation. Many attempt to say that proving one's eligibility is simply a matter of getting a doctor to state that one is disabled. However, this is not exactly the case (though many doctors labor under the illusion that this is true). For example, if a doctor supplies a statement to social security stating that their patient is unable to work, this statement, even though it was supplied by a physician who has a history of treatment with the applicant, will be rejected if the statement deviates significantly from what the doctor's own medical records have to say. In other words, the doctor's statement is not the final word on whether someone will be approved for disability.

In can be the final word...but only if the doctor's statement is corrobated by the doctor's own records.

In general, however, medical records will decide the outcome of a case. That's because medical records will indicate to the decision-maker (who, depending on what level the claim is at, will be either a disability examiner or a disability judge) what it is that the claimant is--

A) capable of doing and

B) no longer capable of doing.

What a person is able to do is referred to as functional capacity. What a person is able to do after taking into account their illness is referred to as residual functional capacity, or RFC for short. RFC assessements are written up on every single social security disability and SSI disability case and they dicate the final decision on a case when they are looked at in conjunction with the second of our two considerations.

The kind of work you've done in the past and the skills you've acquired

A person's RFC or residual functional capacity assessement might be relatively useless for determining whether or not a person should receive disability were it not for the fact that social security also looks at an individual's work history.

In evaluating cases, the social security administration will consider the jobs performed by a person within the last 15 years. This is done to get an idea of what a person has done in the past and what the requirements of those jobs have been.

In other words, did those jobs require certain capabilities that, perhaps, no longer exist now as a result of either an illness or an injury. Social security also looks at a claimant's past work to determine what their acquired work skills might be. This is to determine whether or not they may be able to switch to some new form of work, even if their medical records indicate that they do not have the ability to go back to one of their former jobs.

Social Security Disability Eligibility really boils down to these two considerations: 1) work history and other vocational factors (such as age, education, and skills) and 2) what the person's medical records have to say about them and the limitations they possess.

Additional Information
Social Security Disability Eligibility
Social Security Disability Eligibility FAQ

Resource Links

How Do You Get Approved for Disability with Social Security?

Amount of time it takes to get approved for disability