Why some Social Security Disability claims succeed more easily

When one works with people, it is hard to turn off work-related thoughts after hours.  Being as much a Dolly Parton fan as anyone else, I can say that helping people apply for Social Security Disability benefits requires more than “working 9 to 5”.  This might explain why I had a dream recently in which a person asked me whether some applications are “easier” to get through than others.  Variations on this question come up frequently in my waking interactions with prospects and clients.  Before elaborating on an answer, I want to remind readers briefly of the four difference types of disability benefits:

• Supplemental Security Income (SSI).  This is a benefit for people who meet the Social Security Administration’s definition of “having a disability” and have low income and few financial resources.  Neither the applicant nor her/his parents need any amount of work history to be eligible for SSI.

• Social Security Disability Insurance (SSDI).  This is a benefit for people who meet the Social Security Administration’s definition of “having a disability” and have a sufficient number of work credits for their age.  Unearned income and financial resources are irrelevant.

• Childhood Disability Benefits/Disabled Adult Child benefits.  This is a benefit for people who meet the Social Security Administration’s definition of “having a disability” and have done so since before they turned 22 until the date when their parent(s) file for Social Security.

• Survivor’s benefits.  This is a benefit for people who meet the Social Security Administration’s definition of “having a disability” and have done so since before they turned 22 until the date that a parent passes away.

I also want to remind readers of the Social Security Administration’s definition of “having a disability”, which is that the applicant has:

A medically determinable physical or mental condition that has lasted or is expected to last more than a year or end in death and which causes a significant developmental deficit in comparison to peers (for child applicants) prevents the applicant from performing “Substantial Gainful Activity” (“SGA”) for adult applicants. Fulfilling these last two requirements means that the impairments are severe and the applicant needs the benefits.

Since I work mostly with adults of age 18 or older, I will continue from that perspective.  The disability-application cases that get through the process the most easily are those where the disabling impairment is on the Administration’s Compassionate Allowance List.  These are conditions that the SSA has predetermined to be so severe that they preclude the performance of SGA with no further evidence required.  One example is Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).  Others are Glioblastoma Multiforme, Malignant Multiple Sclerosis, Trisomy 9, and Zellweger Syndrome.  The full A-Z list can be found here: https://www.ssa.gov/compassionateallowances/conditions.htm.  Such cases are approved within a month, provided that financial or work credit requirements are met because the medical community and Social Security agree immediately that the impairments are severe.

The next easiest are cases where the disabling impairment appears on the SSA’s Adult Listing of Impairments and the defining criteria include measurable data. The Adult Listing of Impairments is a catalogue of many mental and physical conditions that includes the criteria under which the medical community is certain of the diagnosis and by which the medical community concludes a certain severity of impact.  Non-mosaic Down Syndrome is a good example.  Because Down Syndrome is a genetic condition, it can be identified or “proved” definitively on a claimant’s karyotype.  Note that mosaic Down Syndrome, in which not every cell carries the extra chromosome, requires supporting evidence beyond a karyotype.  Another example of a clear cut case is Intellectual Disability.  I have known many people with this diagnosis.  Their abilities and aptitudes range widely.  However, for the purposes of an SSA disability application, if the applicant has an IQ of 70 or below as measured by an industry standard IQ test, no further evidence is required. 

The next easiest cases to process are those where the applicant has a diagnosis that is catalogued on the SSA’s Adult Listing of Impairments, and a medical practitioner has written notes or a report that clearly covers all the symptoms listed in the SSA’s definition using language that is the same as or very similar to the language used in the definition.  This means identifying 3 out of 5 or 5 or more out of 10 of the presenting diagnostic characteristics as a particular definition might require, as well as stating clearly that the characteristics cause an “extreme” or “marked” limitation on specific areas of mental or physical functioning as required by the definition of that impairment. When at least one limitation is “extreme” or at least two limitations are “marked,” the impairment is deemed to have significant impact on the applicant’s capacity to work.

Looking at it from the opposite perspective, certain types of cases are going to be more difficult to get through.  Some people have co-morbid diagnoses where each appears on the adult listing of Impairments.  No diagnosis meets all the listing requirements, but taking the diagnoses together, they significantly limit the ability of the person to perform SGA.  If a person has a rare condition that, though serious, has not made it to the SSA’s Listing of Adult Impairments, we then need to find a listed condition that is similar such that the rare diagnosis “equals” that listing by manifesting with the same symptoms and having the same impact on mental or physical functioning.  We take the same approach with people who have severe symptoms but do not have any specific diagnosis.  We determine whether the presenting symptoms might equal one or more listed impairments.  If we cannot do this, we must then go into granular detail about the applicant’s residual functioning capacity.  This requires a lot of medical evidence and may require an independent vocational evaluation. 

Beyond the nature of the impairments is the nature of the evidence.  It is very difficult to get a case through where all the evidence is old, sparse, or incomplete.  If an 18-year-old is applying for disability under the category of intellectual disability but the last time their IQ was measured was at age 11 and the score was borderline that time, the person will need to be retested.  If a person has any kind of mental or physical impairment but has not seen a doctor or therapist for years, they will likely need to re-establish that medical relationship before proceeding.  If a person is applying under the category of autism or any condition that exists on a spectrum, but they have an average or above average IQ and few to no stereotypical manifestations of that condition, they are likely to require further evidence. 

Finally, it is worth mentioning that cases where the applicant does not meet non-medical criteria will be impossible to get through.  If the applicant is performing Substantial Gainful Activity or if the impairment is not expected to last for at least a year, the applicant will not be approved.  Additionally, a person with a diagnosis that clearly meets a listing will not be approved for SSI if s/he has financial resources that exceed the SSA’s limit.  A person will not be approved for SSDI if s/he does not have enough work credits for her/his age.  A person will not be approved for CDB/DAC survivors’ benefits unless at least one SSA-covered parent has filed for disability or retirement benefit or died AND the adult-child applicant has sufficient evidence that her/his disability started before age 22 and that s/he did not perform SGA at any time from before age 22 until the parent’s filing date. 

When I work with a claimant on a disability application, it sometimes seems that to paraphrase Dolly again, the SSA “won’t seem to let [you]”.  It might even feel like the Administration is “out to get [you]” but the reality is that in order to be approved, a claimant’s impairments must be such that a reputable medical source has deemed that they impact significantly the claimant’s ability to work.  Very often, for this reason, a difficult case can be made much stronger by more thorough, recent and specific medical documentation.