October 2014

Seeking SSD for blindness

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A Chicago Disability attorney can offer guidance

More than 3.6 million Americans over age 40 are visually impaired, according to the American Academy of Ophthalmology. Over 1 million people in the same age group are legally blind. These individuals may face significant expenses and difficulty working, as any Chicago disability attorney knows. Fortunately, Social Security Disability benefits may be available to people with statutory blindness or even low vision.

Disability evaluation

People with visual impairments can medically qualify for SSD benefits automatically if they meet one of three criteria provided in the “Blue Book” of impairment listings. The criteria apply to the stronger eye after best correction and are as follows:

  • Vision is 20/200 or worse. This level of visual impairment constitutes statutory or legal blindness.
  • Visual field is contracted to an angle of less than 20 degrees. This degree of impairment also qualifies as statutory blindness.
  • Visual efficiency is less than 20 percent, or the visual impairment value is greater than 1.00.

The Blue Book specifies appropriate medical tests applicants can use to prove they meet one criterion.

People who do not meet any of these criteria may still receive SSD benefits for vision problems. The Social Security Administration grants medical-vocational allowances to people who cannot reasonably perform gainful work due to their disabling conditions. The SSA may consider factors besides medical condition, such as transferrable job skills, to determine whether an individual qualifies for a medical-vocational allowance.

Special rules

People who are considered legally blind qualify for various special work incentive programs. The SSA allows blind individuals to earn up to $1,800 in monthly income without losing eligibility for benefits. Self-employed blind individuals can work an unlimited number of hours for their businesses without losing benefit eligibility.

Blind individuals who are currently working can also request a disability “freeze.”  When calculating future benefits, the SSA will not factor in the income the individual earns while working in a limited capacity due to his or her disability. This exclusion allows the individual to collect a higher benefit amount.

Blind individuals who are older than 55 and attempt to return to work are protected against benefit termination. If these individuals exceed the monthly income limit of $1,800, the SSA only suspends benefits. If an individual’s income later falls below the same threshold, his or her SSD benefits resume.

These specialized programs are only available to people with statutory blindness. Therefore, it is essential for legally blind individuals seeking SSD benefits to provide proper documentation and establish that the condition qualifies as statutory blindness.

Certain changes can cause benefit loss

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Under the Social Security Administration’s strict standards, conditions that qualify for Social Security Disability benefits are often long-term or permanent. Many beneficiaries in Illinois may think this makes the loss of benefits unlikely. However, as any disability lawyers in Chicago can attest, various factors can result in the loss of SSD benefits.

Medical improvements

Changes in the disabling condition can lead to benefit loss. The SSA conducts continuing disability reviews every three or seven years to determine whether a condition still qualifies as disabling. If medical evidence or self-reporting suggests improvements in the condition, the SSA reevaluates the beneficiary’s ability to work. Benefits stop if the SSA determines the individual can work gainfully.

Medical improvements and other developments can trigger unscheduled continuing disability reviews. If a beneficiary stops pursuing recommended treatment, the SSA may review the case and stop benefits. If medical advances produce a new treatment protocol for the condition, the individual is also at risk for benefit loss.

Beneficiaries who appeal the disability review decision within 15 days may continue receiving benefits while the SSA reconsiders the decision. Applicants who receive a second denial and appeal within 10 days may receive benefits while waiting for the hearing. However, the SSA does not let beneficiaries continue collecting benefits during higher appeals.

Non-medical developments

Even if a person’s medical condition has not changed significantly, the person may still lose benefits. The following circumstances can result in the loss of benefits or overall eligibility:

  • Reaching retirement age. Beneficiaries start receiving Social Security Disability retirement benefits at this point.
  • Incarceration. If a beneficiary is convicted of a crime and confined to a penal institution, benefits stop for the duration of the incarceration. In certain circumstances, a felony conviction can affect permanent eligibility for benefits.
  • Resuming substantial work. A beneficiary loses eligibility if he or she engages in substantial gainful activity. The SSA often uses income as a measure of SGA. For individuals who aren’t blind, monthly earnings over $1,070 constitute SGA. However, the SSA can also consider the nature of the work. A job generating income below the SGA threshold could still be considered SGA.

People who return to work while receiving benefits may keep their benefits for a set period, known as a trial work period. After the 9-month trial period ends, individuals who are engaging in SGA lose their benefits. However, they qualify for special programs, including a three-year extended eligibility period and a five-year period of expedited benefit reinstatement. These measures can help people receive benefits quickly if they need them again in the future.

 

SSA offers Social Security Disability work programs

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Incentives for beneficiaries to return to work

Many Social Security Disability benefit recipients believe they will immediately lose their benefits if they return to work. However, as most Social Security lawyers in Chicago know, the Social Security Administration offers beneficiaries various work programs. These programs encourage beneficiaries to resume work by giving them access to special assistance and exemptions from certain SSA policies.

Special work rules

Beneficiaries may engage in work that does not qualify as substantial gainful activity without risking benefit loss. In 2014, the SSA defines substantial gainful activity as work yielding monthly income greater than $1,070. For blind individuals, the earnings limit is $1,800.

Even if an individual resumes SGA, the individual may continue collecting SSD benefits during a trial work period. Whenever monthly earnings exceed $770, the SSA counts that month as part of the trial period. Beneficiaries can still receive benefits for 9 months, even if they earn income above the SGA threshold.

After 9 months that qualify as part of the trial work period, beneficiaries working above the SGA level lose eligibility for benefits. However, they qualify for a 36-month extended eligibility period. During this time, if monthly earnings fall below the SGA threshold, the beneficiary receives his or her usual benefit.

During the five-year period after the trial work period ends, beneficiaries also qualify for expedited reinstatement of benefits. If a beneficiary requests reinstatement, the SSA automatically pays six months of benefits while evaluating the case. Even if the application is denied, the beneficiary may keep the benefits already awarded.

Other work incentives

The SSA also offers beneficiaries other special programs and rules to support them in working while disabled. These include:

  • Recognition of disability-related work expenses. These could include special accommodations the individual needs to work, such as receiving counseling or commuting via taxi. When considering whether a beneficiary is working above the SGA level, the SSA deducts these expenses from the individual’s income.
  • Medicare eligibility regardless of earnings. After the trial work period ends, beneficiaries may continue receiving Medicare Part A coverage for 93 months. Beneficiaries can also continue paying a premium for Medicare Part B coverage.
  • Vocational rehabilitation services. The SSA’s Ticket to Work program allows beneficiaries to take advantage of free services from an Employment Network or a state Vocational Rehabilitation agency. Available services include vocational training and classes on writing resumes.

Beneficiaries who opt into Ticket to Work can continue collecting benefits during the program. During that time, the SSA cannot conduct a continuing disability review, unless the individual fails to meet the program’s timely progress requirements. This helps individuals prepare for gainful work while still receiving needed support.

 

 

The Social Security Disability hearing: Preparing for it

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A Social Security lawyer can assist

Many people seeking Social Security Disability benefits in Illinois will not receive approval during the initial application. Instead, they may have to appeal the decision multiple times. After the second denial and appeal, SSD applicants must appear before a judge during a disability hearing. As any Social Security lawyer can attest, people who are prepared for this hearing are more likely to see a favorable outcome.

Gathering evidence

After a claim has been denied, the Social Security Administration stops collecting medical records. By the time the disability hearing takes place, the medical records the SSA possesses may be outdated. Applicants should obtain current records before the hearing. Applicants can keep one copy and submit another to the hearing office.

Before obtaining the records, applicants should review their case files and see which records they need. Applicants can also look for missing documentation or mistakes made during the initial decision process. This can help applicants present a stronger case at the hearing.

Each applicant should also obtain a detailed statement about his or her functional capacity from a doctor. The statement should describe the condition and its specific disabling effects. A treating physician can write a letter or complete a Residual Functional Capacity form, which is the form the SSA uses when evaluating an individual’s functional abilities.

Answering questions

During the disability hearing, applicants may need to answer questions from a judge and a vocational expert. Applicants should be prepared to give concise accounts of the following:

  • Symptoms of the condition. Applicants should avoid exaggeration or vagueness. Rather than saying a condition causes terrible pain, the applicant should describe the location, duration and severity of the pain.
  • Daily limitations. Illustrative examples are preferable to broad statements. For example, to show the cognitive impacts of a condition, an applicant could talk about difficulty completing or focusing on specific activities, such as paying the bills.
  • Work history. This information helps the judge determine whether a person can perform work he or she performed in the past. If so, the claim will be denied. Applicants should provide accurate information about the duties and physical or mental requirements of each job.

Applicants should also be ready to explain potentially harmful facts in their case files. These could include failure to seek treatment, deviations from treatment protocol or struggles with the overuse of medication. Applicants should note the reasons for their actions or the steps they have taken to remedy the issue.

People who are represented should work with their attorneys to understand the hearing process and prepare for potential questions. An attorney can also acquire necessary medical records, leaving the applicant more time to focus on getting ready for the disability hearing.

 

What is the SSA’s Blue Book?

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Guidelines for disability claim evaluations

The Social Security Administration’s book Disability Evaluation Under Social Security can play a decisive role in disability claims, as any Social Security attorney in Illinois knows. This book, commonly called the “Blue Book,” establishes medical criteria for Social Security Disability determinations. People seeking SSD benefits can use the book to understand how their claims will be evaluated.

Book structure and contents

The Blue Book is divided into several sections. The first section provides an overview of the SSA’s benefit programs. It explains the SSA’s definition of disability and the disability determination process. The second section establishes standards for acceptable evidence. The third section contains the list of impairments that the SSA recognizes as disabling.

The impairment listings are divided into two sections, for adults and children. The adult listings are divided into 14 categories or disease groups. These categories are typically based on the nature of the condition or the bodily system the condition affects.

Specific disabling conditions are listed under each disease group. A description of symptoms or functional limitations accompanies each listing. Objective tests or observations needed to document the condition and its effects may also be specified. The SSA automatically considers a condition disabling if it meets the severity and evidentiary requirements established in the applicable Blue Book listing.

Qualifying under a listing

If a person suffers from a listed condition and meets the relevant criteria, the person qualifies for disability benefits from a medical standpoint. However, this does not guarantee that the person will receive benefits. As the Blue Book explains, individuals also must meet other Social Security Disability requirements:

  • A person must have an adequate earnings record. People who have not paid enough money into the Social Security system cannot collect benefits, regardless of how disabling their conditions are.
  • The condition must be expected to result in death or last longer than a year. The SSA will not award benefits for short-term disabilities.
  • The condition must prevent the individual from doing work he or she performed in the past. The condition must also preclude the individual from adjusting to any new type of work.

People who do not meet the terms of a Blue Book listing can still qualify for benefits. However, they may have to provide additional medical evidence and personal information, including work history and educational background.

A person may “equal” a Blue Book impairment listing if his or her symptoms and limitations are equal in severity to those outlined in the listing. Otherwise, a person may qualify for a medical-vocational allowance. The SSA grants this allowance if a person’s remaining functional capacity is deemed too limited to support gainful employment.

Skin ailments and Social Security Disability

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A Chicago Social Security attorney can help

Skin is the body’s largest organ, in terms of both surface area and weight. Although some skin conditions are merely cosmetic nuisances, a Chicago Social Security attorney may see people with serious ailments that result in pain, limited mobility or other conditions that prevent them from working. Fortunately, Social Security Disability benefits may be available to help people who suffer from these types of conditions.

General criteria

The Social Security Administration has a general set of criteria when it comes to disabling skin conditions. To determine whether a skin condition meets this criteria, a claims examiner may take several factors into account. These include:

  • The location, size and severity of lesions. Generally, lesions must interfere with joint motion, restricting the movement of at least two extremities, impeding fine and gross hand movements or limiting ability to walk.
  • The frequency of flare-ups. The examiner will also weigh the severity of flare-ups, the duration between flare-ups and the individual’s ability to work during remissions.
  • The other symptoms. Pain and physical limitations are the primary symptoms considered.
  • The effects of treatment. The examiner may consider the type and duration of treatment, its efficacy and any side effects.

An examiner may consider whether a skin condition is inherited, stress-based or due to past exposure to irritants, which could range from allergens to toxins. The examiner will also weigh whether the victim requires a carefully protected environment to maintain health and safety.

The SSA requires a professional diagnosis of the skin condition. This diagnosis should be supported with laboratory findings, such as blood tests or biopsy results, or other objective medical evidence.

Qualifying conditions

The SSA directly recognizes several skin disorders as disabling. The SSA establishes severity criteria for several specific conditions, including ichthyosis, bullous disease, dermatitis and hidradenitis suppurativa. The SSA also establishes criteria for more general conditions, such as photosensitivity disorders and persistent skin or mucus membrane infections. People who meet these criteria may qualify for SSD benefits without direct evaluations of their ability to work.

The SSA evaluates numerous skin conditions based on their effects on other body systems. These conditions include burns, tuberous sclerosis, autoimmune disorders and conditions that affect ability to see, hear, speak or eat. Additionally, malignant skin tumors are evaluated as neoplastic diseases rather than skin conditions.

If the SSA does not directly recognize a skin condition as disabling, the victim may still qualify for benefits. The SSA claims examiner must consider the specific limitations the condition imposes, along with the applicant’s education, work history and transferrable skills.

SSD Application: Tips on gathering your work history

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Professional assistance

Many people seeking Social Security Disability benefits in Illinois know they must support their claims with ample medical documentation. However, many of these people overlook the importance of providing a detailed work history.

An attorney Social Security professional can explain that the Social Security Administration examines the disability and the way it affects the applicant’s ability to work. Specifically, the SSA evaluates whether the applicant could return to a past job or use skills from a prior job in a new context. Thus, documenting work history poorly can greatly increase the risk of claim denial.

Past relevant work

Before gathering work history, people applying for SSD should understand what information the SSA needs. The SSA does not weigh every job an individual has held. Instead, a claims examiner considers all work performed in the last 15 years, including seasonal and part-time employment. Jobs that were too short-term to produce relevant skills are not counted as past relevant work.

Non-work activity, such as volunteer work, is not considered past relevant work. Similarly, jobs yielding income below the substantial gainful activity level are not taken into account. This threshold changes annually; in 2014, monthly income over $1,070 constituted SGA. Finally, work trial periods or other work attempts are not viewed as past relevant work.

The claims examiner will review all past relevant work and consider how it compares to the applicant’s current capabilities. The examiner may deny the claim if the applicant appears to have skills or experience relevant to the work he or she is currently deemed capable of.

Preparing the application

When documenting employment history, disability applicants should not simply provide the company name, position held, dates worked and contact information. This may give the claims examiner a poor idea of the responsibilities and skills associated with each job. Applicants should provide all of the following information:

  • Hours and income. This indicates whether the job qualifies as past relevant work.
  • Duration of job training. Specialized training should also be recorded.
  • Physical and mental requirements. Unique job duties that employees in similar positions did not perform should be noted.
  • Physical constraints. Applicants should specify whether employers provided accommodations or allowed employees to stand, walk or sit as needed.
  • Special aspects of the job. These could include using advanced equipment, overseeing others, handling money or working with the public.

SSD applicants should never exaggerate job responsibilities. This can make an applicant seem well-suited to various other types of employment. At the same time, applicants should not downplay job duties. Dishonesty can also lead to claim denial. Many applicants may benefit from working with an attorney to create an accurate, detailed employment history before submitting the application.

 

Can you collect Social Security Disability if you receive other assistance?

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Using additional support programs

Social Security Disability benefits often provide a crucial form of support to people who cannot work due to disabling conditions. Still, a Chicago disability attorney knows that residents who receive lower benefit amount may still need additional assistance. Fortunately, the Social Security Administration permits benefit recipients to collect other forms of support. However, some types of assistance can change SSD benefit amounts or eligibility.

Permitted concurrent benefits

Social Security Disability benefit recipients can receive small amounts of income from work. However, the work cannot qualify as “substantial gainful activity.” SGA is defined as follows:

  • Employment with monthly income exceeding $1,800 for blind individuals.
  • Employment yielding monthly income over $1,070 for people with other disabling conditions.
  • Employment involving substantial work duties and hours for self-employed individuals and veterans.

People who qualify for lower SSD benefit amounts may also be entitled to Supplemental Security Income payments. These benefits are awarded based on financial need. The recipient can qualify if his or her SSD benefit falls below $721. The recipient’s total SSD and SSI payments are not added. Instead, the SSD benefit is subtracted from the total available SSI payment. The most the individual can receive collectively is $721.

The Social Security Administration also allows individuals to receive certain other disability benefits while receiving SSD. Private disability benefits, from either an insurance policy or an employer, are acceptable. Veterans may also collect Department of Veterans Affairs disability benefits without any impact on their SSD benefits.

Benefits affecting SSD

Some public disability benefits can reduce the SSD benefit amount awarded. If an employee collects workers’ compensation, for instance, total benefits from both programs are capped at 80 percent of the person’s prior average wages. If the workers’ compensation benefits cease and the individual still qualifies for SSD benefits, those benefits will increase accordingly.

Though the SSA permits concurrent SSD and SSI payments, other Social Security benefits are not awarded simultaneously. For example, people cannot collect retirement, disability or spousal benefits at the same time. Instead, the SSA awards whichever benefit amount is highest.

Collecting unemployment benefits does not technically prevent people from receiving SSD benefits. However, people typically cannot qualify for both benefits. Unemployment benefits support people who can work but cannot find employment. SSD benefits assist people who are unable to work for at least 12 months due to medical conditions. Thus, collecting or applying for unemployment benefits can significantly undermine a person’s SSD claim.

Overcoming the barriers in receiving Social Security Disability for fibromyalgia

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Disability Lawyers in Chicago help fibromyalgia victims

One form of disability that disability lawyers in Chicago often see in clients is fibromyalgia. Fibromyalgia is a chronic illness that causes various adverse symptoms, including pain, exhaustion, dizziness, depression and memory problems. The efficacy of treatments varies, and the condition prevents some victims from performing work or activities of daily living. Social Security Disability benefits may be available to help these victims.

Unfortunately, receiving SSD benefits for fibromyalgia can be challenging. Fibromyalgia has no known cause. Various factors are thought to contribute to its development. Many symptoms are self-reported and cannot be objectively measured. Individuals with fibromyalgia must provide thorough documentation and meet special requirements to qualify for benefits.

Medically determinable impairments

Before fibromyalgia can be evaluated as a disabling condition, the victim must prove it is a medically determinable impairment. The condition must meet the following criteria:

  • Associated pain must last over three months and affect all four quadrants of the body.
  • Objective medical tests must prove other conditions are not responsible for the observed symptoms.
  • The victim must have 11 positive tender points in a medical exam of 18 established tender points. Alternately, the victim must experience at least 6 recognized fibromyalgia symptoms.

If these criteria are met, the condition qualifies as a medically determinable impairment. However, it is not yet considered disabling. Victims still must provide extensive documentation to prove the fibromyalgia prevents gainful employment.

Documenting adverse effects

People seeking benefits should obtain a diagnosis from a rheumatologist, rather than a general practitioner. A rheumatologist will be more familiar with acceptable means of diagnosing fibromyalgia and ruling out other conditions. Applicants should supplement the diagnosis with medical records spanning the full duration of treatment.

To establish the extent of the disability and fibromyalgia, applicants should ask a physician to complete a Residual Functional Capacity evaluation. This is a detailed assessment of how fibromyalgia affects a victim’s physical or mental abilities. The Social Security Administration uses this information to determine whether a person can work despite suffering from fibromyalgia. Often, a treating physician’s analysis is more accurate than the SSA analysis. The SSA’s conclusions are based only on provided medical evidence.

Applicants should consider keeping journals of symptoms. The nature, duration and intensity of the symptoms should be recorded. Victims should also note any impacts the symptoms have on basic daily activities. Applicants can additionally collect statements from family, friends, co-workers and others who can attest to the effects of the condition. These statements are not conclusive evidence, but they can bolster a claim.

Fibromyalgia can be difficult to document, and many initial claims are denied. An attorney can help an applicant ensure that all relevant medical evidence and other documentation is provided.

Wounded warriors and Social Security Disability

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Social Security lawyers in Chicago and veterans

Military service can have devastating and permanent physical or mental consequences. Social Security lawyers in Chicago understand that disabled veterans in Illinois often face many challenges, including working to support themselves. Social Security Disability benefits may be available to help these wounded warriors. However, the Social Security Administration requires veterans to meet the same strict standards as other applicants.

Evaluating disability

The SSA employs different standards than the Department of Veterans Affairs. Thus, disabled veterans with VA compensation ratings of 100% Permanent & Total are not guaranteed disability benefits.

When evaluating disablement, the SSA considers whether the applicant can perform substantial work. A condition is only considered disabling if it prevents all gainful employment. The SSA also requires the condition to be expected to last over one year or result in death.

The SSA identifies numerous disabling conditions in its book Disability Evaluation Under Social Security, also known as the “Blue Book.” The book details criteria each condition must meet to be considered disabling. Veterans who establish that they suffer from listed conditions and meet relevant criteria can receive benefits without submitting further evidence.

For other veterans, the SSA weighs various factors to decide whether to award benefits for disability. These include the extent and severity of the condition, its response to treatment and associated functional limitations. The veteran’s work history and education are also considered.

Veterans are mostly evaluated like other SSD applicants. However, the SSA makes a few special provisions for wounded warriors.

Exceptions for veterans

If a veteran’s injury or condition occurred during active duty, the application is marked as “Military Casualty/Wounded Warrior” (MC/WW). The file is treated as a “critical case,” with every stage of the application process expedited, if the incident happened on or after October 1, 2001. The SSA defines active duty as follows:

  • Full-time duty or active duty training for service members in the Army, Air Force, Navy, Marine Corps or Coast Guard
  • Presence at military academies or pre-deployment centers for students
  • Active full-time duty during war or national emergency for members of the Army or Air Force National Guard
  • Active duty, full-time training, yearly training or attendance at a Military Service School for reservists

Civilian applicants cannot receive SSD benefits if they perform work with monthly income over $1,070. However, the SSA recognizes that service members may receive full pay while they are incapable of working. Therefore, the SSA only considers the type of work a veteran performs.

The SSA may reach a different decision regarding a veteran’s disability than the VA. However, the SSA is encouraged to weigh the VA’s assessment and decision. Veterans who face claim denial despite a 100% VA disability rating may want to meet with an experienced attorney to discuss appealing the decision.