December 2014

25 new disabilities added to SSA’s Compassionate Allowances list

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Expedited processing available for more conditions

The Social Security Disability evaluation process can be rigorous and lengthy, as any Chicago Social Security attorney can attest. However, for certain severe medical conditions, the Social Security Administration offers expedited claim processing and reduced evidentiary requirements through the Compassionate Allowances (CAL) program. In 2014, the SSA added 25 conditions to the existing list of 200 CAL conditions.

Invariably disabling conditions

The CAL program aims to streamline the application process for people who are clearly disabled. The conditions included on the CAL list are almost always found disabling under SSA criteria. In January 2014, the SSA reported that nearly 200,000 people with severe conditions had qualified for expedited benefits through the program.

CAL conditions are chosen based on opinions from medical professionals, feedback from the public and input from advocacy groups. New conditions are added to the list every year. The updated 2014 list includes several cancers, including prostate cancer. Disorders affecting the digestive, immune and neurological systems are also included on the new list.

People who suffer from conditions on the Compassionate Allowances list still must wait until five months after the onset of the condition to apply for benefits. At that point, the application is fast-tracked, and benefits can be awarded quickly if the applicant meets certain SSA criteria.

Compassionate Allowances applications

People seeking SSD benefits must meet the SSA’s basic medical and non-medical requirements, regardless of whether they suffer from CAL conditions. To qualify for benefits, an individual must have an adequate earnings record. Furthermore, the individual cannot be engaging in substantial gainful activity, which the SSA defines as follows:

  • Work yielding monthly income greater than $1,070 in 2014 or $1,090 in 2015 — this is the standard for most people seeking disability benefits.
  • Work with monthly income over $1,800 in 2014 or $1,820 in 2015 — this limit applies only to individuals with statutory blindness.
  • Work that involves significant activity or should be compensated above the SGA level — the SSA may find that people earning less than the SGA amounts listed above are still engaging in SGA.

The applicant’s disabilities must prevent him or her from performing SGA in any capacity, from a previous job to a new field.

An applicant who suffers from a CAL condition should identify the condition as such in the application. Although medical evidence requirements are minimal for CAL cases, applicants should also provide a diagnosis from an acceptable medical source to establish the legitimacy of the condition.

Applicants with CAL conditions may receive a decision in as little as 10 days. However, issues with medical documentation can slow the decision process. Applicants can reduce this risk by providing all relevant medical records with their applications.

37 million Americans have some form of disability

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An attorney Social Security can help disabled Americans seek benefits

Disability affects millions of people in the U.S., including many Chicago residents, as any attorney Social Security knows. A recent report indicates 37 million Americans suffer from some type of disability. Many of these individuals cannot work and may struggle financially. However, some of these individuals may find relief by seeking Social Security Disability benefits.

Living with disabilities

The 2012 Disability Status Report, which was released in 2014, is based on data from the U.S. Census Bureau’s American Community Survey. The report identifies people as disabled if they suffer from ambulatory, cognitive, auditory or visual impairments. The report also considers people disabled if their conditions impede self-care or independent living.

The report states that 12.1 percent of all Americans suffer from a disability. Ambulatory and self-care disabilities are the most common. The report also indicates the prevalence of disability increases with age. One-quarter of people between ages 65 and 74 suffer from a disability, as do half of people over the age of 75.

The report shows that disability often impacts a person’s income and employment. Just 33.5 percent of disabled individuals between ages 21 and 64 are employed, and just 20.9 percent work full-time. The poverty rate among disabled individuals in this age group is 28.4 percent. Many of these individuals may benefit from financial support, such as SSD benefits.

Claiming SSD benefits

The Social Security Administration employs strict standards to determine whether an individual qualifies for benefits for disability. The individual must demonstrate all of the following:

  • An adequate earnings record — people who have not paid enough in Social Security taxes in recent years or over their lifetimes cannot collect benefits.
  • Inability to work at a gainful level — if an individual earns over $1,070 a month, the SSA considers the work “substantial gainful activity,” and the individual cannot receive benefits. Work with lower income can also be considered SGA, depending on the job duties.
  • A disabling condition — the condition must be expected to last over 12 months or result in death. Additionally, it must prevent the individual from performing past jobs or adapting to new work.

The SSA recognizes various conditions as disabling if they meet certain requirements. These conditions and criteria are published in the SSA’s “Blue Book” of impairments. The SSA directly evaluates the functional impacts of conditions that do not appear in the Blue Book.

To prove a condition is disabling, people seeking SSD benefits should provide extensive medical documentation. These individuals should also supply information about their education, past work and relevant skills. The SSA may use all of this information to determine whether a disabled individual qualifies for disability benefits.

 

4 conditions that may automatically qualify for Social Security Disability

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Benefit approval likely for certain severe conditions

Any Chicago disability attorney knows that qualifying for Social Security Disability benefits is rarely certain, no matter how disabling a condition is. However, the Social Security Administration identifies certain medical conditions that are almost always debilitating enough to merit benefits. People who suffer from these conditions usually qualify “automatically” for benefits, provided they meet the SSA’s non-medical criteria.

Automatic medical approval

The SSA recognizes 225 Compassionate Allowances conditions, which qualify for benefits if they meet set medical criteria. The following four conditions are included in the list and commonly found disabling:

  • Early onset Alzheimer’s disease. Alzheimer’s disease causes irreversible changes to the brain, affecting memory, language and personality. In people younger than 65, the condition may significantly limit ability to work. The SSA accepts family history, onset history and cognitive examinations as evidence to support the diagnosis.
  • Muscular dystrophy. Muscular dystrophy causes irreversible muscle damage and can affect the eyes, lungs, heart or brain. Some victims experience muscle contractions or must use wheelchairs. The SSA recognizes three types of disabling muscular dystrophy and specifies acceptable medical evidence for each. Genetic testing, biopsies and immunostaining of tissue are potentially admissible tests.
  • Certain cancers. The SSA recognizes various cancers as disabling, including breast, bladder and liver cancer. Some cancers, such as head, neck and ovarian cancer, must spread or prove inoperable to qualify for benefits. Others, such as acute leukemia, qualify for benefits under any circumstances.
  • Heart transplant graft failure. Organ rejection after a heart transplant can cause heart failure, while the use of immunosuppressive medications to prevent organ failure can introduce adverse side effects. These include heightened risks of infection, cancer or kidney damage. The SSA requires MRIs and professional evaluation to diagnosis heart transplant graft failure.

These four conditions frequently qualify for SSD benefits; however, people claiming benefits for these conditions still must meet other SSA criteria.

Financial considerations

To collect SSD benefits, applicants must have sufficient earnings records. Typically, applicants need 40 credits, with 20 credits accrued over the last decade. However, the requirements vary based on age. Younger applicants need fewer credits. The amount of income that equals one credit changes annually. In 2014, $1,200 of income represents one credit. In 2015, $1,220 of income is worth one credit. Workers can only earn four credits per year.

Social Security benefits are not available to people who are engaging in substantial gainful activity. This is work with income exceeding $1,070 per month in 2014 and $1,090 per month in 2015. Work yielding lesser income may also be considered SGA, depending on the nature of the work. People engaging in SGA are ineligible for benefits, regardless of how serious their medical conditions are.

What is physical residual functional capacity?

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Assessing functional limitations with disability lawyers in Chicago

Many people suffer from debilitating conditions that the Social Security Administration does not directly consider disabling, as most disability lawyers in Chicago know. These individuals may still qualify for Social Security Disability benefits if the SSA determines they cannot work. To evaluate whether gainful employment is feasible, the SSA analyzes a person’s functional capabilities. Physical residual functional capacity, which is a measure of physical ability, is often a central aspect of this evaluation.

Measuring physical limitations

An analysis of physical residual functional capacity describes the limitations an individual experiences as a result of any impairments he or she suffers from. These impairments could include disabilities, minor conditions and adverse side effects of medical treatments.

RFC accounts for two types of limitations. Exertional limitations are strength-based and affect a person’s ability to sit, stand, walk, carry, lift, pull or push. The SSA evaluates exertional limitations to determine what level of work an individual can perform. The five levels range from sedentary to very heavy. Non-exertional limitations are other limitations, such as difficulty handling or manipulating objects; issues with speech, vision or hearing; problems with concentration or memory; and inability to work in certain environments.

An individual’s RFC is used in various ways to determine whether the individual can work. These include:

  • Supporting a grid determination — the SSA uses medical-vocational guidelines or “grids” to identify individuals who should be considered disabled. The grids take RFC and other factors into account.
  • Evaluating ability to do past work — the SSA does not award benefits to individuals who can return to previous jobs. If a prior job has an RFC level the applicant can work at, and if the applicant is not found disabled under the grid rules, the SSA may deny benefits.
  • Evaluating ability to adapt to new work — if an individual cannot perform any past work, the SSA considers whether the individual is capable of other jobs at the appropriate RFC level.

An accurate analysis of RFC is essential, since it can directly affect whether an applicant receives benefits.

Documenting RFC

The SSA uses various forms of evidence to analyze RFC. In addition to direct medical evidence, the SSA considers statements from a treating physician about the effects of the disabling condition. The SSA also weighs descriptions of functional limitations from the applicant and other personal sources, such as family, friends and co-workers.

People seeking SSD benefits often benefit from asking a treating physician to complete a physical RFC form. Often, a physician who is familiar with the patient and his or her condition can analyze RFC more accurately than an SSA claims examiner. This more precise analysis can improve the likelihood of claim approval.

 

Strong documentation can strengthen your application for disability

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Social Security lawyers in Chicago provide application assistance

Most Social Security lawyers in Chicago know that people seeking Social Security Disability benefits face a high risk of claim denial. The Social Security Administration uses strict standards to determine whether a condition meets the definition of disability. Claim denial due to poor supporting evidence is not uncommon. Applicants can reduce this risk by providing as much documentation as possible when filing their SSD claims.

Medical evidence

Applicants should provide the SSA with any medical records relating to the disabling condition, including treatment records, test results and notes from physicians. Since the SSA requires evidence showing an applicant is presently disabled, some of these records should be less than 90 days old. However, applicants should also supply older records, which can indicate the onset date and enduring nature of the condition.

Applicants also can benefit from giving the SSA contact information for all treating sources and facilities, including names, phone numbers and addresses. The SSA is responsible for contacting these sources for any additional information needed, but in some cases, it may be difficult for a claims examiner to find the correct source. By including contact information, applicants can prevent delays in the claim evaluation and decision process.

Applicants should supplement their medical records with a statement from a treating physician. The statement can encompass aspects of the disability that are not apparent based on medical records alone, including:

  • Details about the condition and its prognosis
  • Debilitating symptoms associated with the condition
  • Related limitations that prevent the applicant from working gainfully or performing activities of daily living

Statements from non-medical professionals can further support medical evidence. For example, an applicant’s family members could describe the functional limitations the applicant experiences and the ways those limitations interfere with daily life.

Other documentation

In addition to including medical evidence with the application for disability, applicants should provide detailed information over their work history. When the SSA evaluates whether a condition prevents an applicant from working, the SSA must consider whether the individual can return to any prior jobs or adjust to new work. Detailed descriptions of job duties and training help the SSA accurately understand an individual’s work experience and job-related skills.

Applicants should also note whether their impairments affected their performance at past jobs. If this was the case, an applicant may want to ask managers or co-workers to provide statements about the applicant’s functional capabilities and ability to handle necessary job duties. These statements can support an applicant’s assertion that working despite the disability is not feasible.

 

Brain tumors may be eligible for SSD benefits

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A brain tumor can cause countless debilitating effects, whether it is malignant or benign, as any Social Security lawyer understands. Tumors press on the brain, producing symptoms such as headaches, confusion, speech problems, ambulatory issues, personality changes or memory loss. Chicago residents who struggle to work or handle daily tasks because of these symptoms may qualify for Social Security Disability benefits. People who rely on brain tumor treatments associated with severe side effects, such as radiation therapy, may also be eligible for benefits.

Means of qualifying

A brain tumor can be evaluated under one of several listings in the Social Security Administration’s “Blue Book” of disabling conditions. The relevant listing depends on the nature of the tumor and the side effects it causes. These listings include:

  • Neoplastic diseases — highly malignant and recurrent brain tumors may qualify under this listing.
  • Petit or grand mal epilepsy — brain tumors that cause epilepsy can be evaluated under these listings.
  • Central nervous system vascular accident — tumors resulting in stroke can be considered under this listing.

If a brain tumor causes hearing loss, speech impairments or mental disorders, it may be evaluated under those listings.

If a brain tumor does not meet any listing requirements, the Social Security Administration may determine that the tumor “equals” a listing. The applicant must show the symptoms associated with the tumor are equal in severity to those implied in the listing. If an applicant does not meet or equal a listing, the applicant may qualify for a medical-vocational allowance. The applicant must prove gainful employment is not reasonable by documenting the impairments associated with the tumor, its treatment or other personal medical conditions.

Supporting the claim

Applicants should support their claims with as much medical evidence as possible. The existence and nature of the tumor should be established through biopsy reports, radiology reports and notes from treating physicians.

People who intend to qualify for benefits by meeting a Blue Book listing should consult the book to ensure they have shown they meet every listing requirement. People who do not meet the Blue Book criteria should document any symptoms that impede gainful employment. For instance, symptoms such as dizziness, partial paralysis or memory problems could prevent a person from working in a physical or sedentary job.

Certain types of brain tumor, such as glioblastoma multiforme, may qualify for expedited processing through the Compassionate Allowances program. The SSA requires minimal objective evidence to support claims involving Compassionate Allowances conditions, which typically qualify for SSD benefits. Applicants must specify in their claims if they are seeking benefits for a Compassionate Allowances condition. Thus, applicants should read through the Compassionate Allowances list before applying for benefits.

Can I collect disability if I live in a nursing home?

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Plan for new living situations with a Social Security attorney

Many people who collect Social Security Disability benefits will require nursing home care at some point. As any Social Security attorney can explain, nursing home stays do not affect eligibility for SSD benefits. However, people who collect disability benefits through the Supplemental Security Income program may lose their benefits during nursing home stays, depending on the nature of the facility and duration of the stay.

Differences between facilities

People who stay at nursing homes that accept Medicaid payments may lose all or part of their disability benefits. The Social Security Administration distinguishes between the following types of care facilities:

  • Facilities accepting Medicaid — beneficiaries lose their eligibility if Medicaid pays for more than half the cost of living and care at one of these facilities.
  • Private facilities declining Medicaid — beneficiaries can theoretically keep their benefits while staying at one of these facilities. However, people who can pay for private care independently may not be eligible for SSI based on personal income.
  • Public facilities — even if Medicaid addresses less than half the cost of care at one of these facilities, beneficiaries lose SSI eligibility.

The SSA makes exceptions for children staying in facilities that accept Medicaid and children with private insurance to cover half the cost of nursing home care. These SSI beneficiaries may still collect a reduced benefit of $30 per month.

If two spouses collect Social Security benefits and one spouse enters a nursing home, the other spouse’s eligibility for SSI or SSD benefits is not affected. However, the spouse living outside the nursing home will start receiving individual payments, rather than couple’s payments.

Shorter-duration stays

The SSA makes an exception to the above rules when a beneficiary’s nursing home stay is not expected to exceed 90 days. Beneficiaries may continue collecting full benefits during a period of “temporary institutionalization.” However, beneficiaries must inform the SSA in writing that they need ongoing benefits to maintain a permanent place of living during the stay. Beneficiaries also must document the expected length of the stay with a statement from a doctor.

If temporary institutionalization unexpectedly extends beyond 90 days, beneficiaries should inform the SSA immediately. The SSA will stop benefits at this point. However, beneficiaries may be eligible for quick reinstatement of disability benefits upon leaving the nursing home, if they use the SSA’s prerelease procedure.

The prerelease procedure is available to beneficiaries who apply for reinstated benefits months prior to leaving the nursing home. These individuals must prove their medical conditions are likely to qualify for benefits.  Beneficiaries who use the prerelease procedure may receive their regular disability payments as early as 30 days after release from the nursing home.