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Columbia MO Social Security Disability Law Blog

What is a residual functional capacity assessment?

Residents in Missouri who apply for Social Security Disability Insurance or SSDI benefits will ikely be required to submit to a "residual functional capacity assessment." In this post, we will explain the nature of a functional capacity assessment and show how it affects a person's chances of receiving SSDI benefits.

The medical evidence that accompanies an initial SSD claim for benefits may not completely answer certain questions concerning the nature and extent of the applicant's qualifying illness or injury. A residual functional capacity assessment is then used to obtain more information about how the illness or injury affects the applicant's ability to work.

How does the Social Security Act define "disability"?

Many Missourians who are contemplating filing a claim for disability benefits under the Social Security Act will want to know and understand how the statute defines "disability." In this post, we will review the statutory language and explain how the Social Security Administration or SSA uses the language in evaluating SSD claims.

In order to receive SSD benefits, a person must be permanently and totally unable to work. No benefits are payable for a partial or temporary disability. The term "totally disabled" means that the applicant must be unable to engage in "substantial gainful activity" for a period of at least one year. Substantial gainful activity is measured by a person's annual wages from work. In 2016, a person who earns less than $1,130 per month is considered to be totally disabled.

What is Supplemental Security Income?

The Social Security Administration or SSA administers a number of programs intended to assist Missourians who are disabled or financially impoverished. One of the most used programs is called Supplemental Security Income or SSI, but few people understand how the program works.

A person making a claim for SSI benefits must provide information about the qualifying condition, such as age, blindness or disability and their income and assets. The following groups of persons are eligible for SSI benefits if they have income less than the maximum prescribed by SSA regulations: age 65 or older, blind or disabled.

Understanding the Social Security disability appeals process

Understanding the Social Security disability appeals process is important for disabled individuals and their families who rely on resources made available to those suffering with a disability that results in an inability to work. In general, Social Security disability (SSD) benefits are available to individuals suffering from a medical condition that lasts longer than 12 months, or is expected to result in death, which renders them unable to work or perform gainful activity. In addition, to qualify for SSD benefits, the disabled individual must meet the work history requirement, however, additional options, such as Supplemental Security Income, may be available to disabled individuals who do not meet the work history requirement.

A large number of applications for Social Security disability benefits are initially denied. Following a denial, the applicant has 60 days to make an appeal so it is important to promptly respond to a denial of a claim for benefits. There are generally 4 steps in the appeals process. The first step is the reconsideration process. During the reconsideration process, a party not involved in the initial review of the claim for benefits reviews the entire application again. New evidence may also be submitted at this time so it is important to have complete medical records to provide.

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.

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