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SSI and SSDI Claims

By Stacy M. Sadove, Esq.

The Social Security Administration (“SSA”) put forth a listing of disabling conditions that are considered severe enough to qualify an individual for a medical determination of disability for purposes of social security disability benefits (either Social Security Income “SSI” or Social Security Disability Income “SSDI”).  These conditions interfere with an individual’s ability to achieve substantial gainful employment.

In order to determine if a condition meets the definition required by SSA to obtain benefits, the SSA publishes an impairment listing manual, or “Blue Book,” used by state-run Disability Determination Services (“DDS”) to determine whether or not a person meets the SSA’s criteria for a qualifying disability. Officially titled “Disability Evaluation Under Social Security”, the Blue Book is the product of administrative rule-making by the SSA. The complete list is codified in Title 20 of the Code of Federal Regulations, as Appendix 1 to Subpart P of Part 404 of the SSA’s regulations. It is also published in book form and on the SSA’s website (see link below).  Examiners use the Blue Book to determine if an applicant meets the SSA’s definition of “disabled.” The Blue Book offers an important guide to SSA examiners’ methods for evaluating disability applications. On January 17, 2017, the SSA published the most recent version of the Blue Book on its website.

In addition to the Blue Book conditions, individuals may qualify for disability benefits under one of the SSA’s 200+ Compassionate Allowance listings (see link below). Through the Compassionate Allowance initiative, claimants suffering from extremely severe medical conditions may qualify for expedited consideration of their Social Security Disability claim, thereby drastically reducing the waiting period before approval.

Included in the new listings are:

  • Updates to Section 12.00 regarding Mental Disorders and Section 14.00 regarding Immune System Disorders. With particular relevance to many of our clients, Section 12.00 includes the listing for Autistic disorder and other pervasive developmental disorders (12.10).

The new listings characterize Autism spectrum disorder (12.10) by qualitative deficits in the development of reciprocal social interaction, verbal and nonverbal communication skills, and symbolic or imaginative activity; restricted repetitive and stereotyped patterns of behavior, interests, and activities; and stagnation of development or loss of acquired skills early in life.  Symptoms and signs may include, but are not limited to, abnormalities and unevenness in the development of cognitive skills; unusual responses to sensory stimuli; and behavioral difficulties, including hyperactivity, short attention span, impulsivity, aggressiveness, or self-injurious actions. Examples of disorders that the SSA will evaluate in this category include Autism spectrum disorder with or without accompanying intellectual impairment, and Autism spectrum disorder with or without accompanying language impairment.  The category specifically does not include the mental disorders evaluated under neuro-cognitive disorders (12.02), intellectual disorder (12.05), and neuro-developmental disorders (12.11).

With regard to a finding of Autism, the definition requires medical documentation of both of the following:

  • Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and significantly restricted, repetitive patterns of behavior, interests, or activities, AND Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F): Understand, remember, or apply information (see 12.00E1); Interact with others (see 12.00E2); Concentrate, persist, or maintain pace (see 12.00E3); Adapt or manage oneself (see 12.00E4).

littman krooks elder lawThese listings differ from previous year listings, as they redefine the definition of Autism, as well as require additional information on behalf of the claimant in order to prove that the claimant meets the definition.

Oftentimes a person will apply for disability benefits and receive a denial notice with regard to the application. More often than not, this is because the medical documentation that the claimant provides fails to detail with enough specificity to meet the Blue Book requirements, their entitlement to benefits. Having a doctor write an affirmation on your behalf attesting to your condition using the language of the Blue Book goes a long way toward establishing eligibility for benefits. Working with an attorney to assist you in understanding your rights, as well as the intricacies of the benefits system can be helpful in making a better case to the SSA establishing why the claimant requires benefits. Moreover, should your application be denied, you may want to seek legal help with regard to an appeal for benefits. Remember that your appeal is time sensitive so be sure to appeal within the time listed on your denial notice.

For more information regarding the Blue Book listings and Compassionate Allowances please see the following links:

 

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