Examples of Who Is and Is Not Disabled
Social Security disability law defines “disability” as an inability “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
An individual is not “disabled” if drug addiction or alcoholism would “be a contributing factor material to the Commissioner’s determination that the individual is disabled.”
However, you cannot always rely on common sense to tell you who is and who is not disabled under Social Security law. Here are some examples:
- He is 35 years old with 10 years of trial experience.
- He is not working, but he is looking for a job.
- He lost his left foot in a car accident a year ago.
Because of stump complications, he is unable to use a prosthetic device to walk one block at a reasonable pace, though he uses it to walk shorter distances, e.g., around an office or around his apartment. When he goes longer distances, he rides a motorized scooter.
He is disabled based on Step 3 of the Sequential Evaluation Process.
- He has a college education.
- He is a quadriplegic with only limited use of his right hand and arm and no use whatsoever of his legs and left arm.
- He uses an arm brace to write.
- He works a few hours per day as a bookkeeper and earns, after deductions for expenses related to his impairment, about $1,050 per month on average.
Because of his earnings he is not disabled.
Example: Construction worker
- He is 48 years old.
- He has done heavy unskilled construction work since age 16.
- He has a fourth grade education and is capable of reading only rudimentary things like inventory lists and simple instructions.
- He has a “low normal” I.Q.
- He is limited to sedentary work because of a heart condition.
He is not disabled unless he has some additional limitations.
Example: Machine operator
- He is 38 years old.
- He has done medium exertion level unskilled factory work, operating a machine since he graduated from high school.
- A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to such work not requiring bimanual dexterity.
He is probably disabled.
Example: Truck driver
- He is 61 years old.
- He worked as a truck driver all his life except that 10 years ago during a downturn in the trucking industry, he worked for 1-1/2 years at a sedentary office job which he got with the help of his brother-in-law.
- He is limited to sedentary work because of a pulmonary impairment.
He is not disabled because he is still capable of doing the office job.
- He is 50 years old.
- He has a high school education.
- He has done unskilled light exertion factory work as a packer for the past 30 years.
- He had a heart attack on January 1 and, after being off work for eight months, he recovered after an angioplasty. His cardiologist gave him a clean bill of health and was ready to send him back to work when he broke his leg in a fall unrelated to his heart condition. In a cast and unable to stand and walk as required by his job, he could not return to work until February. He was off work a total of 13 months.
He is not disabled for the time he was off work based on Step 3 of the Sequential Evaluation Process. A regulation provides that unrelated impairments may not be combined to meet the requirement that a claimant be unable to work for 12 months.
- She is 55 years old.
- She has an eleventh grade education.
- She has not worked in the past 15 years. Before that she was a secretary.
- She has a back problem diagnosed as status post laminectomy.
- She is limited to maximum lifting of 50 lbs. with frequent lifting of 25 lbs., is capable of frequent bending, stooping, etc., and has no limitation for standing or walking.
She is disabled for the SSI program as long as she meets the income and asset limitations for that program. She is not eligible for Social Security disability benefits because she has not worked for so long.
9 Tips for Applying for Social Security Disability Benefits
1. Likelihood of success. If (a) your physical or mental disability is severe, (b) your condition limits your activities of daily living, (c) your medical impairment will last or has lasted longer than 12 months, and (d) your doctor agrees with this assessment, you should apply for Social Security disability.
2. Irrelevant evaluation factors. SSA has a strict definition of disability that ignores many real-life aspects of the job market. Difficulty finding a job, thinking that no one will hire you with your condition, believing you could not pass a job-required physical, or even knowing that the pay you would receive for the work you can do is too little to live on … all of these important real-world considerations do not matter to the Social Security Administration (SSA) when evaluating your claim for benefits.
Proof from doctors
3. Medical evidence. As is the case with most legal claims, what counts in disability evaluations is what you can prove. If no medical records exist to support your claim of disability, you are unlikely to be successful. SSA figures that if your medical condition is severe enough to keep you from working, then it should justify doctor visits, tests, diagnosis, and treatment.
4. Failure to follow treatment. SSA expects you to try to get better. That means doing what your doctor prescribes. If you do not believe that your doctor’s recommended treatment will help, then be sure your doctor documents the treatment’s odds of success or failure.
5. Keep good records. Conversely, if you do follow your doctor’s prescribed treatment, document your efforts. Without records, you are unlikely to remember the date of every doctor visit, lab test, medicine taken, and therapy received. Obtain the business cards of every doctor you see and file them. Save your pill bottles. Keep notes of your pain and other medical events.
Evidence from you
6. Symptoms vs. diagnosis. SSA does not expect you to be an expert on medical conditions. Even if you are, SSA would rather learn about your impairment from your doctor and your medical records. What SSA wants to receive from you are details about your symptoms. For example, how severe is your pain? Is it constant or intermittent? What aggravates your pain? What reduces it? Do you suffer from shortness of breath or fatigue? No one knows your symptoms better than you. Do your best to explain them in detail without exaggerating or minimizing. Do not omit or gloss over any lesser conditions just because you have one severe condition and several minor ones.
7. Physical restrictions. What can’t you do? Sit for lengthy periods? Stand and walk? Lift and carry? Bend, twist, kneel, and stoop? Manipulate objects with your hands? Social Security disability is a functional program. SSA will focus on your limitations rather than your diagnosis.
8. Effect of symptoms and restrictions. How does your medical condition affect your daily activities? Tell SSA about the impact on your personal care (hygiene, dressing, bathing), errands and housework (driving, shopping, cleaning), and social functioning (hobbies, sports, interaction with friends and family).
9. Consistency, accuracy, and honesty. Contradictions, errors, memory lapses, and discrepancies all work to erode your credibility, and nothing will sink your claim faster than questions about your truthfulness.