Eligible or Not Eligible (Part I)

My older son is applying for postsecondary programs.  He does not have a lot of patience for administrative processes, so he requires a lot of handholding.  He figures that since he has decent grades and since he will be getting his diploma, he meets the admissions criteria.  My response is yes, but…you still have to fulfill the bureaucratic criteria.  You have to complete the application.  You (or we) have to pay the application fee.  Your school has to provide your transcript.  You have to write the essays, and you have to provide letters of recommendation.  You will only get that letter of acceptance if you have checked all the boxes.  The same is true when a person applies for one of the disability benefits managed by Social Security.

We will start by reviewing the SSA’s definition of “having a disability” for adults, which requires that a person:

• Has a medically determined physical or mental impairment that has lasted or is expected to last at least one year and which…

• Prevents the person from performing Substantial Gainful Activity, which is defined as the capacity to earn more than $1,690/month without special conditions.

  
  

For an initial consideration of disability, both of the above points must be true.  Here is how this can play out in real life:

A.       Consider Ms. Jones, who has been diagnosed with cancer. 

a.        Her medical team predicts that the treatment, including necessary physical rehabilitation, will last 11 and a half months.  Due to the frequency of medical visits, the side effects of the treatment, and the intensity of the expected rehab schedule, Ms. Jones will not be able to work at all over that period.  Will Ms. Jones be adjudicated disabled?  No, because her condition is not expected to last at least one year.

b.       Fast forward to the second half of that twelfth month.  Ms. Jone’s medical team realizes their initial forecasts were a bit too optimistic.  Ms. Jones did not respond to the first type of treatment, so the team had to find and start a new treatment.  As a result, it is going to take Ms. Jones at least 18 months from the date of her initial diagnosis to complete her treatment, after which she will still need rehab.  Now, Ms. Jones will be adjudicated disabled, because she meets the “at least a year” criteria.

B.       Consider Mr. Johnson, who was diagnosed with Lupus in December of 2024.  Mr. Johnson was earning $6,000/month at that time.  As his symptoms progressed, Mr. Rogers had to reduce his level of employment.  By June of 2025, he was working half time for $3,000/month.  By November of 2025, he had shifted to a contract role and was averaging $1,800/month.  By January of 2026, his average monthly earnings had dropped to $1,600/month.  When did Mr. Rogers start to “have a disability” according to Social Security?  In January of 2026, because that was the point at which his impairment prevented him from performing Substantial Gainful Activity.

C.      Consider Alice, who was diagnosed with level 2 autism at age 5.

a.        Alice was in special education for her whole school career.  Alice found a job working at the art supplies store, owned and operated by a family friend.  Alice earns $1,800/month.  Will Alice be adjudicated to “have a disability”?  No, because although she has a medically determinable mental condition, which will last her entire lifetime, Alice is performing Substantial Gainful Activity.

b.       The family friend, who owns the store, attests that Alice is working under “special conditions”.  Whenever Alice feels overwhelmed, she can leave her customer-facing role and work in the stockroom, where she can wear headphones and listen to music.  She only rings up customers who are paying with a credit or debit card, because she is not able to provide correct change to customers who pay in cash.  Since she needs to use the paratransit system to go to and from work, her supervisor excuses any late arrivals or early departures.  The special conditions reduce Alice’s relative productivity to 70% of that of other staff members, which reduces her “countable” income to $1,260/month.  Now, she meets the Social Security’s definition of “disabled”.

D.      Consider George, who was diagnosed with cerebral palsy as a child.  George uses a power wheelchair for mobility, has a service dog, needs regular occupational and physical therapy, and uses adaptive technology to use his computer.  George takes a part-time position at a local advocacy agency.  George earns $2,500/month.  The average monthly costs to maintain George’s wheelchair plus the expenses for his service dog, plus the out-of-pocket costs of his therapies plus the cost of his adaptive technology total $1,100 per month.  George has these expenses approved by the Social Security Administration as Impairment Related Work Expenses.  Since IRWE are deducted before earned income is evaluated, Geroge’s countable earned income is only $1,400/month and he meets the Social Security’s definition of “disabled.”

As frustrating as it is, many processes in life require a person to meet all of a set of criteria.  This is particularly true for government programs, such as SSI and SSDI.