SSA has a very clear 5-step approach for assessing disability (see chart). While all of the steps are important, focusing on the following two in particular can help a PWP know what to expect to in the application process.
The SSA Listing
- “Is your condition one that is in the listing of impairments? We maintain a list that describes impairments that are considered severe enough to prevent you from doing any gainful activity.”
- “Gainful work activity is work activity that you do for pay or profit. Work activity is gainful if it is the kind of work usually done for pay or profit, whether or not a profit is made.”
- Your application will be approved “If your condition is listed and it has lasted or is expected to last for at least a year or to result in death…”
- Parkinson’s is included in SSA’s listing of impairments, with the current listing as follows:
“11.06 Parkinsonian syndrome with the following signs: Significant rigidity, bradykinesia, or tremor in two extremities, which, singly or in combination, result in sustained disturbance of gross and dexterous movements, or gait and station.”
- The simplest and most direct way to be approved by SSA is to have your application clearly establish that you meet the criteria set forth in the listing for PD, if in fact you do.
- And that should, if at all possible, be done via credible medical documentation that uses the language of the listing, or at least makes it very easy for SSA to see that you meet those very specific criteria.
- You may want to ask your representative to also frame your application so that it would satisfy one of SSA’s other listed impairments, such as the one for depression, if any would apply in your case.
If you do not have one of the listed impairments, can you work?
- “Can you do any other work? If you cannot do work you did in the past, we determine if you can do other work. We consider your medical condition and your age, education, and past work experience in making this determination.”
- Your application will be approved if SSA determines you cannot do the work you did in the past and “that you cannot do other work for at least a year…”
- An assessment of whether you can work will, of course, typically be a more cumbersome process than gaining approval via the listing approach. It may lead to a more in-depth look at a number of factors, including:
Activities of Daily Living (ADLs):
- What is your day-to-day experience with disability?
- How limited are you in the performance of activities of daily living, and the like? What can you no longer do? What can you do only sporadically, with great difficulty, and/or only in wildly excessive amounts of time?
- Your application should anticipate this and provide such information at the outset (and you can add more if there is need for an appeal). For example, always elaborate on how long it takes you to perform an activity. If you state that you go to the grocery store, provide the adjudicator with how long you shop; if someone else goes along to help carry items or to retrieve items off the shelves; and if you have to use a motorized scooter or some other device to help in ambulation.
- In the case of many PWPs, the variability of the disease process will be important to document; e.g., if you have progressed to the point where things are not just day-to-day, but hour-to-hour or less, and virtually unpredictable at that.
- For an excellent set of Frequently Asked Questions about what SSA considers in assessing whether you can work click the link above.
- Worthy of note is that SSA considers “your chronological age in combination with your residual functional capacity, education, and work experience.”
- In doing so, SSA applies age-based categories of 5 year spans beginning at age 50 and other, and presumes that the older you are, the harder it will be for you to adjust for other work – unfortunate for young onset PWPs.
- Though a younger individual, under age 50, has more stringent criteria to meet, it is not impossible to secure SSA disability benefits. If a younger individual is limited to less than a full range of sedentary work, a finding of disabled is appropriate under SSA’s guidelines.
What If My Application Is Denied?
- With good preparation and documentation, your application will hopefully be approved. In filing for disability benefits under the Social Security Disability program, it is important to know what SSA is looking for in your application. Thus, you are encouraged to find a representative who has an excellent understanding of what Social Security needs in the application and in the evidence submitted.
- The first step in preparing to file for SSA disability would be to speak with your doctor(s) to enlist his/her support. Supportive physicians are vital in filing for SSA disability. Of note, SSA has a “ruling” that states “…treating physicians’ medical opinions are to be given controlling weight in the adjudication of a disability claim as long as the medical evidence supports said medical opinion.”
- However, nearly two thirds of Social Security applications are denied at the initial stage.
- Though denials reported occur less frequently in cases of PD, it might take one or more appeal before you are approved. There are four levels in the SSA review and award system for disability. There is an additional level that takes you out of the SSA system to Federal Court, although only a small percentage of applicants will pass through all five levels.
- If you are denied because you do not yet meet the SSA definition of “disability,” you can reapply if and when your condition worsens.
What If I Am Approved?
- If your application is approved, you will be entitled to benefits (retroactive to the date SSA determines you became disabled). You must wait five full calendar months after your established onset date of disability to begin receiving your monthly cash benefits. You will be eligible for Medicare benefits 24 months after your date of entitlement to cash benefits.
- SSA will also let you know that it reserves the right to revisit your eligibility, and will typically let you know in how many years it expects to revisit your case. SSA normally reviews awarded claims every three, five, or seven years. In rare instances or in conditions that are expected to improve, your claim will be reviewed in less than three years.
What if I want to return to work and have been approved for SSA?
- In the meantime, once Social Security applicants get news of their approval and their lives begin to settle down, it is not uncommon for them to want to both be as active as they can and contribute what they are still able to offer.
- Some may even want to try to return to work in some capacity, perhaps on a part time basis. For PWPs, this may be in a position that allows the flexibility to be productive in small bursts when they are able.
- It is important to know that there are rules about returning to work in any capacity—what and how much you can do without jeopardizing your benefits, how and how much of any income you make will be offset against your benefits, etc.
- These and other important questions deserve careful attention before you step into this arena. Read more information on incentives and programs to return to work.
Content for this section provided by Mark Rubin, J.D.