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Columbia MO Social Security Disability Law Blog

Is epilepsy a qualifying disease for disability benefits?

Epilepsy afflicts many people in Missouri. The seizures that typify the disease can interfere with work and with the daily tasks of living. Most people familiar with the disease understand that it has varying degrees of intensity, and the Social Security Administration takes these differences into account in defining the level of disability that qualifies for Social Security disability benefits.

In evaluating SSD claims for benefits based on epilepsy, the SSA looks at the type, duration and frequency of seizures. The applicant must furnish at least one detailed description of a seizure, including the presence or absence of an aura, tongue biting, sphincter control, injuries suffered in the attack and post-seizure symptoms such as drowsiness, confusion, nausea and headaches. The treating physician should submit a statement describing the extent to which the applicant's subjective description of symptoms is consistent with his or her own observations. A very important condition of eligibility for benefits requires that the applicant follow prescribed epileptic treatment. Blood tests are often used to determine the level of anti-epileptic medication in the applicant's blood stream.

Bipolar disorder and SSDI benefits

Some Missouri residents may have experienced bipolar disorder first-hand, either as a patient or as a friend or family of a person with the disorder. The disorder often interferes with a person's ability to work when the depressive features of the disorder are manifest. Sometimes, even the manic aspects of the disorder can cause a person to quit a job when they feel "high" and able carry on without income. In either situation, the disorder has disabling features that can allow an individual to seek Social Security Disability Insurance ("SSDI") benefits.

The Social Security Administration classifies bipolar disorder as an "affective disorder" characterized by a disturbance of the person's mood accompanied by either a manic or depressive syndrome. Bipolar syndrome is a disorder with a history of either or both manic and depressive syndromes. The disorder must result in at least two of the following conditions:

  • Marked restriction of activities of daily living
  • Marked difficulties in maintaining social functioning or
  • Marked difficulties in maintaining concentration, persistence or pace or
  • Repeated episodes of decompensation (lapsing into either a manic or depressive state) for an extended duration.

Comparing SSDI benefits with private disability insurance

Many Missourians purchase private disability insurance to guard against an unforeseen illness or injury that could limit or destroy their ability to work. Most of these persons are also eligible to file claims for Social Security Disability Insurance benefits. In this post, we will provide a summary comparison of the two types of insurance plans and a description of how they may fit together.

The biggest difference between private disability insurance plans and SSDI is the definition of "disability." As we have noted many times in prior posts, a person must be "totally disabled" to be eligible for SSDI benefits. Total disability is defined by the Social Security Administration as the inability to engage in "substantial gainful activity" for a period of at least 12 months. Substantial gainful activity is, in turn, defined as the ability to earn more than a specified amount per month (in 2016, that amount is $1,130 for persons who are not blind and $1,820 for blind persons. Private disability insurance policies contain many different definitions of disability, but most of them are more liberal than the SSDI requirement of total disability. Also, private plans may allow payment for a partial disability, whereas SSDI does not provide any benefits for partial disability. Another difference between the two types of insurance is the larger payments that may be available under private insurance if the insured is willing to pay a large enough premium.

Applicants for SSD benefits often wait years for appeal results

The Social Security Administration (SSA) encourages unsuccessful applicants for disability benefits to avail themselves of the various appellate procedures that it offers. Many persons in Missouri have followed this advice, but they often wait many months or even years to receive a decision after the appeal hearing is concluded. Information emerging from the SSA now shows that this experience is not unique.

Several SSA officials have acknowledged that the situation is a "crisis. The number of people currently waiting for a decision on their SSD appeals is 1.1 million. In 2015, administrative law judges decided about half of the cases that were heard. The average wait is 525 days, almost exactly 1-1/2 years. This average compares unfavorably to an average wait in 2012 of 360 days and to the agency's goal of 270 days.

Are SSD benefits available for mental illness?

As awareness of various types of mental illness spreads in Missouri and elsewhere, persons often wonder whether a mental disorder can be the basis for receiving Social Security Disability benefits. The short answer is "Yes," but making an application and assembling and submitting the necessary evidence can be difficult.

The main difficulty with submitting an SSD claim for a mental disorder is the requirement that evaluation of a mental condition requires "documentation of a medically determinable impairment." In other words, a qualified medical professional must provide a written opinion on the existence and effect of the mental condition. In addition, the Social Security Administration looks at the "degree of limitation such an impairment imposes on a person's ability to work and the expected duration of the condition.

Social Security Disability benefits for back pain

Many people in Missouri who suffer from back pain may wonder if they are eligible for Social Security Disability benefits for their injury. The answer depends upon whether the person’s work history and medical condition satisfy the many eligibility requirements for disability benefits. There are certain medical requirements for obtaining disability benefits based on a spine injury.

Disability benefits are available for a number of conditions called “disorders of the spine”: herniated pulposus, arachnoiditis, which is the inflammation of a membrane that surrounds the spinal cord, stenosis, which is the narrowing of the spinal canal, osteoarthritis, degenerative disc disease, facet arthritis and a vertebral fracture. The condition must be accompanied by evidence of nerve root compression demonstrated by pain, limitation of spinal motion, muscle weakness and sensory or reflex loss. Any such condition must be verified by an accepted imaging technique, such as X-ray or MRI, or an operative report or pathology note. In other words, the pain must be associated with a medically determinative condition that could reasonably be expected to produce pain or other symptoms.

Proving a claim for Social Security Disability benefits

Most people in Missouri who have suffered a serious illness or injury that interferes with their ability to work have considered applying for Social Security Disability benefits. To a first-time claimant, the application process can seem confusing and intimidating. In this post we want to provide an overview of the information used by the Social Security Administration in evaluating SSD claims.

In order to obtain SSD benefits, a person must prove that he or she is totally disabled according to SSA's definition of the term. While a number of medical or mental conditions may cause disability, the claimant must prove that a specific injury or illness prevents him or her from working. The SSA federal regulations defines "disability" as the inability to engage in substantial gainful activity. This criterion is expressed in monetary terms: if a claimant is able to work and to earn more than $1,130 per month, he or she cannot be considered to be totally disabled. That criterion is explicit, but the others are not always so clear.

Understanding SSD work credits

Most people in Missouri understand that a person must be completely disabled to become eligible for Social Security Disability ("SSD") benefits, but the extent of a person's disability is not the only criterion that determines eligibility. A person must also have worked for a minimum number of weeks or years to become eligible. The Social Security Administration uses a system of "work credits" to determine if a person has worked long enough when it evaluates an SSD claim.

Prior to 1978, work credits were determined based upon work performed in a calendar quarter, or every three months. After 1978, the SSA switched to the entire calendar year to determine credits. Work credits are now based upon work performed and wages earned during the entire year, regardless of when the work was performed. For example, a person might do enough work and earn enough money to earn the annual maximum of four credits in the first six months of the year and fail to earn any credits during the remaining six months. Nevertheless, the person's total for the year is still four credits. Under current law, a person receives one credit for every $1,260 in earnings, up to a maximum of four credits per year.

Understanding Social Security disability appeals rights

Every year, many Missourians apply for Social Security disability benefits, and their applications are approved. Unfortunately, a great number of Missourians are denied Social Security disability benefits. In this post, we will provide a summary of various rights to request and pursue an SSD appeal.

"Appeal" is a broad term that includes four separate and different processes. Generally speaking, a claimant must have his or her claim rejected before an appeal to the next level can be taken. The four levels are:

  • Reconsideration
  • Hearing by an administrative law judge
  • Review by the SSA appeals council, and
  • Federal court review.

Anxiety disorders and social security disability benefits

Social security disability benefits are available for a wide variety of illnesses, but perhaps the most difficult type of disability to establish is one resulting from a type of mental illness called anxiety disorder. An SSD claim based on an anxiety order is difficult to prove because most, if not all, of the medical evidence is based upon subjective evaluation of the patient by a psychologist or other therapist. Nevertheless, such claims are often approved, and an understanding of the various categories of anxiety disorder can be helpful in gathering supporting evidence.

A generalized anxiety disorder is a more or less constant state of tension and worry not related to a specific event or situation. A state of generalized anxiety disorder must last for six months to qualify for disability benefits. Obsessive compulsive disorder (OCD) is repetitive or ritualistic behavior that used used to control other symptoms of anxiety. Panic Disorder or panic attacks are repeated states of acute anxiety or fear that have no identifiable cause. Phobias are overwhelming and irrational fears of otherwise unthreatening situations, things, places, or events. Post-traumatic stress disorder is severe stress caused by experiencing or witnessing an especially traumatic event. (We will deal with each of these conditions in greater detail in subsequent posts.)

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