What Determines if a Person is Disabled?

When a disability leaves you unable to work at all or in the capacity you did prior to becoming disabled, the income loss can put you and your family into a financial crisis. Collecting financial resources from the government’s Social Security Administration can mitigate that crisis. However, applying for and receiving these resources is not easy. 

Applying on your own is a mistake that could cost you benefits. Instead, have an experienced Social Security Disability lawyer from Pilzer and Klein handle your case and give you the best chance of securing financial relief.

How Does the Social Security Administration (SSA) Define “Disabled?”

To meet the SSA’s definition of “disabled,” you must meet these criteria:

• Because of a medical condition, you are unable to work or perform “substantial gainful activity” (SGA).
• Your medical condition prevents you from performing work you did previously or from adjusting to other types of work.
• You have experienced or are expected to experience the medical condition for at least one year, or your condition may lead to death.

How Severe Does My Condition Need to Be to Qualify as a Disability?

Your medical condition must be severe enough to substantially impede your ability to perform basic work-related tasks. These basic tasks can include sitting, standing, walking, lifting, or remembering.

Does “Disability” Only Apply to Physical Conditions?

A disability can be a physical or mental condition or a condition that includes both physical and mental effects. Common examples of conditions that potentially qualify for Social Security Disability (SSD) include, but are not limited to:

• Heart Conditions
• Cancer
• Rheumatoid Arthritis
• Multiple Sclerosis
• Autoimmune Diseases
• Spinal Cord Injuries
• Bipolar Disorder
• Depression
• Schizophrenia
• Autism Spectrum Disorder

How Do I Know if My Specific Condition Qualifies?

The SSA has two extensive lists of conditions that qualify as a disability. The list titled “Part A” applies to applicants 18 years and older, though, for some conditions, the list also applies to children under 18. The list titled “Part B” includes criteria applicable to children under 18.

What if My Condition Is Not Included on the SSA List?

If your condition does not appear on the list, the SSA will investigate to determine if your situation is severe enough to prevent you from performing SGA and is as serious as the conditions included on their list. If your condition does not meet those criteria, but you can not perform the tasks you could previously, the SSA will consider your medical situation, age, education, prior work experience, and transferable skills to see what employment opportunities are suitable for you.

What Evidence Do I Need to Prove My Disability?

You need medical evidence that meets SSA regulations. This evidence includes reports from doctors who have evaluated and treated you and documentation from facilities where you have undergone testing and/or treatment. Ultimately, the SSA requires “objective medical evidence” from an “acceptable medical source” to prove your disability exists. 

You may also provide evidence from non-medical sources to verify you cannot complete the task necessary for SGA. These sources may include relatives and friends, caregivers, neighbors, employers, clergy, or social welfare agency representatives, among others.

How Specific Does My Evidence Need to Be?

You need to submit very specific evidence to prove your medical condition prevents you from completing tasks related to SGA. 

For example, if you claim pain, fatigue, or shortness of breath makes it impossible for you to work, the SSA will require an explanation of your daily activities and how your condition affects your ability to carry out those activities. They want to know:

• When, for how long, how often, and how intensely do your symptoms occur
• Factors that cause or worsen your symptoms
• The kind, amount, and efficacy of medication on your symptoms
• Other treatments implemented to mitigate your symptoms

Do I Have to Be Evaluated by SSA Doctors?

You may be required to see an independent, SSA-approved doctor in some situations, including:

• Your doctor does not want to perform the examinations required.
• Your doctor or medical facility is not equipped to provide the required evidence
• Information provided by your doctor or other medical sources contains inconsistencies
• You have reason to prefer an independent doctor over your own
• The SSA has had prior unproductive experiences with your doctor
• Your doctor does not fulfill SSAs qualifications for an “acceptable medical source”

How Long Does the Approval Process Take?

Gathering evidence and completing your application can take weeks or months, though, with the help of an SSD lawyer, that process will move more efficiently. 

If your application is approved, you will usually have to wait five months before receiving the first payment. Your payments begin in the sixth month after the date your disability started. For example, if your condition started on March 10th of a given year and you filed your application on April 1st of that year, you would see your first payment in September of that year.

Does the Process Ever Move Faster?

The SSA has established two initiatives to expedite the approval process for some cases.

Under “Compassionate Allowances,” for cases involving diagnosis of pancreatic cancer, leukemia, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), payments are active upon the first full month of disability. For example, if you are diagnosed in April of a given year but do not apply for SSD until June of that year, you will receive payment retroactively for May of that year. There are also many more compassionate allowance conditions.

The Burden of Proof Is on You

The SSA does not give money away easily, even when those requesting it show significant need. Gathering thorough evidence from the right sources, keeping up with doctor’s visits, and maintaining organized, detailed reports of your symptoms and treatments are essential to building a strong case. When stressed, afraid, and in pain from a disability, these tasks can seem insurmountable, and you may feel hopeless and isolated. 

You are not alone. You do not have to, and should not attempt to, build your case by yourself. Contact Pilzer and Klein for a free consultation with an expert SSD attorney who will take on the burden of proving your case with great skill and compassion.