An Overview Kelly Blad, MA, EDPNA Traumatic Brain Injury and
the Social Security Disability Process
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Social Security Disability Programs Retirement, Survivors, and
Disability Insurance (RSDI, Title II) Work based disability program
Must prove disability prior to Date Last Insured Supplemental
Security Income (SSI, Title XVI) Federal welfare program for the
disabled, blind, and elderly Must meet income and asset
requirements
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Retirement, Survivors, and Disability Insurance Monthly benefit
amount based on earnings record Must be disabled and insured 5
month waiting period for eligibility Auxiliary benefits available
Medicare coverage after 24 months of eligibility Not reduced by
income or assets
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Supplemental Security Income $721 for an individual and $1,081
for a couple and may be reduced depending on Living situation
Income Medical assistance coverage
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Income/Asset limits for 2014
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Concurrent Claims Both SSI and RSDI
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Disability Inability to engage in substantial gainful activity
by reason of a medically determinable impairment that has lasted or
is expected to last at least 12 months or result in death.
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Sequential Evaluation Process Step 1: Is the claimant engaged
in SGA?
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Substantial Gainful Activity Work done for pay or profit $1,070
gross per month
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Substantial Gainful Activity
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Sequential Evaluation Process Step 1: Is the claimant engaged
in SGA? Step 2: Does the claimant have a severe impairment?
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Severe Impairment More than a minimal limitation on ones
ability to work
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Sequential Evaluation Process Step 1: Is the claimant engaged
in SGA? Step 2: Does the claimant have a severe impairment? work?
Step 3: Does the impairment meet or equal a medical listing?
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Medical Listings Social Security Website, Blue Book Organized
by body system Separate listings for children and adults First step
in which someone may be approved
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Blue Book Listings - Adult
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Blue Book Listings - Child
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Step 3.5 Residual Functional Capacity Maximum ability to do
work related activities on a sustained basis
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Sequential Evaluation Process Step 1: Is the claimant engaged
in SGA? Step 2: Does the claimant have a severe impairment? work?
Step 3: Does the impairment meet or equal a medical listing? Step
4: Can the claimant perform his or her past relevant work?
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Past Relevant work Work performed gainfully within the last 15
years and performed long enough to be learned
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Sequential Evaluation Process Step 1: Is the claimant engaged
in SGA? Step 2: Does the claimant have a severe impairment? work?
Step 3: Does the impairment meet or equal a medical listing? Step
4: Can the claimant perform his or her past relevant work? Step 5:
Can the claimant perform any other work?
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Other Work Work in the national economy Age affects this step
Last step in which someone may be approved
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Grid Rulings Special rules for older workers Take into account
RFC, age, education, and transferable skills
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Sedentary RFC, Advanced Age
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Application Process Initial Application Online or in person
application taken by district office State agency collects medical
records and makes determination Clear medical records, no red
flags
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First Appeal: Reconsideration 60 deadline State agency takes
into account new evidence
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Second Appeal: Request for Hearing 60 day deadline
Claimant/claimants representative is responsible for providing
medical records Testimony and medical records are used to make
determination
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Third Appeal: Appeals Council 60 day deadline Not a new
determination
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Fourth Appeal: Federal District Court 60 day deadline Civil
suit against Social Security Must be represented by an
attorney
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Potential Claim Issues Chemical Dependency Lack of medical
treatment Noncompliance with treatment Criminal background
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Providers Role in SSAs Determination SSA uses medical,
education, and rehabilitation records in the determination
Providers record diagnoses and symptoms Providers can provide
medial opinions
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Screening Is the individual unable to work full time? Is it due
to a medically determinable impairment? Ultimate decision is with
Social Security
