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Social Security's Definition of Disability

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.* "Disability" under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:

•You cannot do work that you did before;

•We decide that you cannot adjust to other work because of your medical condition(s); and

•Your disability has lasted or is expected to last for at least one year or to result in death.

This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments. *

* Statements in red are contradictory and may not be true.  Please do not let them deter you from applying. 

Listing Of Impairments

 The Listing of Impairments describes, for each major body system, impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enought to cause marked and severe functional limitations). Most of the listed impairments are permanent or expected to result in death, or the listing includes a specific statement of duration is made. For all other listings, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the Listing of Impairments are applicable to evaluation of claims for disability benefits under the Social Security disability insurance program or payments under both the SSI program.

 Part A of the Listing of Impairmentscontains medical criteria that apply to the evaluation of impairments in adults age 18 and over. The medical criteria in Part A may also be applied in evaluating impairments in children under age 18 if the disease processes have a similar effect on adults and younger children.

 Part B of the Listing of Impairments contains additional medical criteria that apply only to the evaluation of impairments of persons under age 18. Certain criteria in Part A do not give appropriate consideration to the particular effects of the disease processes in childhood; that is, when the disease process is generally found only in children or when the disease process differs in its effect on children and adults.

 Additional criteria are included in Part B, and the impairment categories are, to the extent possible, numbered to maintain a relationship with their counterparts in Part A. In evaluating disability for child under age 18, part B will be used first. If the medical criteria in part B do not apply, then the medical criteria in part A will be used.

 The criteria in the Listing of Impairments apply only to one step of the multi-step sequential evaluation process. At that step, the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled.

 However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the adjudicator to move on to the next step of the process and apply other rules in order to resolve the issue of disability.

 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 which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings-not only by the individual's statement of symptoms.

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 Disability Adjudication and Review.

 

Evidentiary Requirements

Medical Evidence
Under both the Title II and Title XVIprograms, medical evidence is the cornerstone for the determination of disability.

Each person who files a disability claim is responsible for providing medical evidence showing he or she has an impairment(s) and the severity of the impairment(s). However, the Social Security Administration (SSA), with the claimant's permission, will help the claimant get medical reports from his or her own medical sources. This medical evidence generally comes from sources that have treated or evaluated the claimant for his or her impairment(s).

Acceptable Medical Sources
Documentation of the existence of a claimant's impairment must come from medical professionals defined by SSA regulations as "acceptable medical sources." Once the existence of an impairment is established, all the medical and non-medical evidence is considered in assessing impairment severity.

Acceptable medical sources are:
•licensed physicians (medical or osteopathic doctors);
•licensed or certified psychologists including school psychologists (and other licensed or certified individuals with other titles who perform the same function as school psychologists in a school setting) only for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning ;
•licensed optometrists only for purposes of establishing visual disorders (except in the U.S. Virgin Islands where licensed optometrists are acceptable medical sources only for the measurement of visual acuity and visual fields);
•licensed podiatrists only for purposes of establishing impairments of the foot, or foot and the ankle, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and the ankle; and
•qualified speech-language pathologists only for purposes of establishing speech or language impairments. For this source, "qualified" means that the speech-language pathologist must be licensed by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

 

Medical Evidence from Treating Sources
Currently, many disability claims are decided based on medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant's impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.

 

Medical Evidence From Health Facilities
SSA also requests copies of medical evidence from hospitals, clinics, or other health facilities where a claimant has been treated. All medical reports received are considered during the disability determination process.

 

Other Evidence
Information from other sources may also help show the extent to which an individual's impairment(s) affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments. Other sources include public and private agencies, non?medical sources such as schools, parents and caregivers, social workers and employers, and other practitioners such as naturopaths, chiropractors, and audiologists.

 

Medical Reports

Physicians, psychologists, and other health professionals are frequently asked by SSA to submit reports about an individual's impairment(s). Therefore, it is important to know what evidence SSA needs. Medical reports should include:
•medical history;
•clinical findings (such as the results of physical or mental status examinations);
•laboratory findings (such as blood pressure, x-rays);
•diagnosis;
•treatment prescribed with response and prognosis;
•a statement about what the claimant can still do despite his or her impairment(s), based on the medical source's findings on the above factors.
•if the claimant is an adult age 18 or over, this statement should describe, but is not limited to, the claimant's ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling.
•in adult cases involving mental impairments or mental functional limitations, this statement should describe the claimant's capacity to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting. 

If the claimant is a child under age 18, this statement should describe the child's functional limitations compared to children his or her age who do not have impairments in acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for yourself, and health and physical well-being.

 

Consultative Examinations

If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a consultative examination (CE). The treating source is the preferred source for a CE if he or she is qualified, equipped, and willing to perform the examination for the authorized fee. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. However, SSA's rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if:

•the treating source prefers not to perform the examination;
•the treating source does not have the equipment to provide the specific data needed;
•there are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source;
•the claimant prefers another source and has good reason for doing so; or
•we know from prior experience that the treating source may not be a productive source.

 

Consultative Examination Report Content 

A complete CE report will involve all the elements of a standard examination in the applicable medical specialty and should include the following elements: 

•the claimant's major or chief complaint(s);
•a detailed description, within the area of specialty of the examination, of the history of the major complaint(s);
•a description, and disposition, of pertinent "positive" and "negative" detailed findings based on the history, examination, and laboratory tests related to the major complaint(s), and any other abnormalities or lack thereof reported or found during examination or laboratory testing;
•results of laboratory and other tests (for example, X-rays) performed according to the requirements stated in the Listing of Impairments (see Part III of this guide);
•the diagnosis and prognosis for the claimant's impairment(s);
•a statement about what the claimant can still do despite his or her impairment(s), unless the claim is based on statutory blindness.

if the claimant is an adult age 18 or over, this statement should describe the opinion of the consultant about the claimant's ability, despite his or her impairment(s), to do work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling;
in adult cases involving mental impairment(s) or mental functional limitations, this statement should also describe the opinion of the consultant about the claimant's capacity to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting.

if the claimant is a child under age 18, this statement should describe the opinion of the consultant about the child's functional limitations compared to children his or her age who do not have impairments in acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for yourself, and heath and physical well-being.

•the consultant 's consideration, and some explanation or comment on, the claimant's major complaint(s) and any other abnormalities found during the history and examination or reported from the laboratory tests. The history, examination, evaluation of laboratory test results, and the conclusions will represent the information provided by the consultant who signs the report.

 

Evidence Relating to Symptoms

In developing evidence of the effects of symptoms, such as pain, shortness of breath, or fatigue, on a claimant's ability to function, SSA investigates all avenues presented that relate to the complaints. These include information provided by treating and other sources regarding:

 

•the claimant's daily activities;

 

•the location, duration, frequency, and intensity of the pain or other symptom;

 

•precipitating and aggravating factors;

 

•the type, dosage, effectiveness, and side effects of any medication;

 

•treatments, other than medications, for the relief of pain or other symptoms;

 

•any measures the claimant uses or has used to relieve pain or other symptoms; and

 

•other factors concerning the claimant's functional limitations due to pain or other symptoms.

 

In assessing the claimant's pain or other symptoms, the decision makers must give full consideration to all of the above-mentioned factors. It is important that medical sources address these factors in the reports they provide.

 

Source: www.ssa.gov


 

 

                A disability is any physical or mental difference that affects the way you perform life's daily activities.

 

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