Determining SSDI Eligibility

Determining SSDI Eligibility

The Boston Social Security Disability lawyers at Bellotti Law Group, P.C. understand that for most SSDI cases, there is not a clear-cut path to getting your disability application approved. Instead, success most often hinges on experienced and persuasive presentation of your situation to the Social Security review board. Our Boston disability attorneys know the factors the Social Security Administration focuses on and presents your case with an emphasis on what really counts. Our Boston disability lawyers have obtained countless favorable SSDI decisions for our clients over many years. The Social Security regulations are complex and are frequently poorly applied to real-world situations. In order to best assist our clients, the Social Security Disability attorneys at Bellotti Law carefully explain the relevant factors considered and how we can present their case in the most thorough and persuasive manner to the Social Security decision review board. The SSDI lawyers at Bellotti Law Group, P.C. will make a world of difference in getting your claim approved in the shortest amount of time possible.

Call our Boston disability lawyers at Bellotti Law Group, P.C. today for a free consultation at 617-225-2100. Our SSDI lawyers have the experience and past success to help your claim get approved.

In the most simple terms possible, eligibility for SSDI is determined based on whether you are "disabled" according to the definition in the Social Security regulations. In order to qualify as "disabled" pursuant to the guidelines, you must show that you have a physical or mental impairment that precludes you from completing any type of work. The Social Security review board generally undertakes a "five-step" sequential evaluation process in determining if you are disabled pursuant to the guidelines. If you do not meet all five prongs of the test, your application will be denied. Of course, there is room to persuasively present your case to show you do indeed meet the requirements of each step.

Social Security Administration 'Five-Step' Sequential Evaluation Process

1. You Are Not Engaging In 'Substantial Gainful Activity'

To be eligible for Social Security disability benefits, you must be unable to earn more than a set monthly amount, which varies from year to year based on the assessed "cost of living" and national average wage index. A person earning over this amount is generally considered to be engaging in "substantial gainful activity" and does not meet the first prong of the test. The SSA sets the SGA at two different rates, one for statutorily blind individuals and one for non-blind disabled individuals. For 2012, the SGA was set at $1010/month for non-blind individuals and $1690/month for blind individuals.

2. You Must Have A "Severe" Impairment For At Least 12 Continuous Months

Prong two of the five-step disability evaluation process conducted by the Social Security review board requires that you have a "severe impairment." According to case law precedent from the First Circuit, pursuant to Social Security Ruling 85-28, a claim may be denied for lack of a "severe impairment" only "where the medical evidence establishes only a slight abnormality or combination of slight abnormalities that would have no more than a minimal effect on an individual's ability to work even if the individual's age, education, or work experience were specifically considered." Barrientos v. Secretary of Health and Human Servs., 820 F.2d 1, 2 (1st Cir. 1987). Basically, any reduction in your "Residual Functional Capacity" (RFC is defined by the SSA as what you can still complete, even with your impairments) qualifies as a "severe" medically determinable impairment and meets step two of the process.

Additionally, there is a duration requirement. The duration requirement states that unless your impairment is expected to result in death, it must have actually lasted, or be expected to last, for a continuous period of 1 year (12 months). Short periods of remission will not usually break the chain of continuation. However, unrelated ailments cannot be "tacked" together to meet the durational requirement.

3. Your Medical Condition Must Meet Or "Medically Equal" A Sign, Finding Or Symptom Found In The "Listing Of Impairments"

The "Listing of Medical Impairments" is a set of medical criteria for disability found in the Social Security disability regulations. The list is extensive and varies for children and adults. The complete list can be accessed here:

http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

The list is vast and your condition is likely included. However, it is possible that your impairment is not included, but can still successfully be argued that it is "medically equivalent" to an impairment on the list. Our Boston SSDI lawyers have helped numerous clients meet this threshold, even though their condition was not specifically noted.

4. You Must Be Unable To Perform "Past Relevant Work" As "Ordinarily Done"

In short, prong four requires that you are incapable of performing any work you have done in the last 15 years, as it is "ordinarily done," provided that work was done at the "substantial gainful activity" (SGA) level. Basically, you must recall your easiest work and show why you can no longer perform that job. If you have held an "easy" (non-demanding) job in the last 15 years and you can still perform those duties, you will be deemed "not disabled" and will not qualify for SSDI.

If you can still perform your "past relevant work" duties as "ordinarily done," then you will be determined not disabled. This hold true even though your actual past job may have required greater effort and exertion and you cannot do that particular job. The job "ordinarily done" requirement will not be applied for your benefit, however, if your past work was easier than the way the job is "ordinarily done." Instead, the board will review the actual job requirements in the manner you performed them when deciding whether you are capable of performing "past relevant work."

5. You Must be Unable To Perform Any "Other Type of Work"

This is the final, and most complex, step in the entire sequential social security disability eligibility process. Basically, the SSA wants to determine if there is any job you can feasibly do. This is often the most difficult hurdle to overcome in being determined "disabled" for SSDI benefits.

Here, the Social Security Administration will use the "medical-vocational guidelines" to consider your ability to do "other work," taking into account factors such as your age, work experience, and education. These factors will be placed into a grid and will be weighed with your capacity to work to decided if you can be expected to "adjust" to "other work" that exists in the national economy. In general, individuals who are older, less educated, and have fewer work experiences will be less likely to be expected to adapt to "other work" and meet this final SSDI prong.

Medical-Vocational Exceptions to the "Five-Step" SSDI Evaluation Process

There exists three, very specific "medical-vocational" exceptions, which allows a person to avoid "step-five" evaluation. These exact profiles must be met to avoid the above scrutiny.

Profile #1:

A individual will be considered "disabled" if he:

  • Has a severe, medically determinable impairment;
  • Is age 55 or older;
  • Has an 11th grade education or less; and
  • Has no past relevant work experience.

Profile #2 (the "worn-out worker"):

A individual will be considered "disabled" if he:

  • Has no more than a sixth grade education;
  • Worked 35 years at arduous unskilled labor; and
  • Is unable to do the arduous unskilled labor done in the past.

Profile #3:

A individual will be considered "disabled" if he:

  • Isn't working at SGA level
  • Has a lifetime commitment (30 years or more) to a field of work but with no transferable skills
  • Can't perform past work because of severe impairment
  • Is closely approaching retirement age (age 60 or older)
  • Has no more than a limited education
Factors That Are NOT Considered By The Social Security Review Board

Despite their undeniable effect on your ability to obtain or maintain gainful employment, there are many factors the SSA will not consider in reviewing your SSDI application. These include, but are not limited to:

  • A lack of jobs in your geographical area or line of work
  • Employers not hiring you because of your perceived disability
  • You are unqualified for jobs in your location
  • The economy is bad and finding a job is difficult
  • You do not like a particular job or want to work in a particular field
  • You cannot find a job that will pay enough to support you or your family

Again, as legitimate as these "real-world" concerns are, they will not be factors in determining your SSDI eligibility.

The Boston social security disability lawyers at Bellotti Law Group, P.C. will persuasively help you get your disability claim approved. Call one of our skilled and experienced SSDI attorneys today at 617-225-2100 for a free consultation. We have offices in Boston, Cambridge, and Quincy and serve all of Massachusetts, Rhode Island, and Connecticut. You can also use our secure contact form and an SSDI lawyer will contact you quickly.

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