[US] Filing for Social Security Disability Benefits

[David Baxter PhD]

Filing for Social Security Disability Benefits
by Joe Kraynak, Bipolar Blog
November 21, 2008

An intense period of mania or depression can make you feel like you?ve been hit by a truck. You may feel exhausted. You may be unable to concentrate or remember certain details. You may become intolerant of colleagues and others you must deal with on the job. Your family life is also very likely to be chaotic and stressful.

Unfortunately, if you can walk into your local Social Security office, talk to the receptionist, and complete the paperwork, the Social Security Administration is likely to conclude that you don?t qualify for Social Security disability benefits. (In a previous post, Do You Qualify for Social Security Disability Pay?, we reveal just how difficult the Social Security Administration makes it to qualify for disability.)

This doesn?t mean it is impossible to qualify. My wife qualified for several months she was unable to work and received benefit payments for herself and both of our children. (She enlisted the assistance of an attorney who specializes in dealing with the Social Security Administration.) Following are some suggestions that may improve your chances of success:

• Consult your doctor and therapist: Their approval, support, and assistance are critical to helping you establish the fact that bipolar disorder prevents you from working and that any work during this stage of your illness can worsen your condition. If you?re not currently seeing a doctor for treatment, the SSA is very unlikely to approve your claim.
• Keep your doctor appointments: Seeing your doctor regularly provides you with documented proof of your bipolar disorder and keeps your doctor in the loop, ensuring that she will support your appeal. You can?t expect your doctor to cooperate if she hasn?t seen you in three months.
• Have your doctor complete an RFC form for you: Your doctor?s evaluation of your ability to perform work-related tasks often carries more weight than your personal opinion. Usually, the SSA has a form that it sends to your doctor as part of the process of applying for disability, so you may not have to request it from your doctor.
• Document everything: In Bipolar Disorder For Dummies, we include a mood chart that can help you keep a record of how you feel from day to day. The Depression and Bipolar Support Alliance (DBSA) has a Wellness Toolbox that includes an excellent personal calendar to keep track of the ways your disorder affects your moods and life. Documented evidence can help your case.
• File immediately: Disability claims can take several weeks to months to process and often require that you file multiple appeals. Most disability attorneys won?t even talk to you until you?ve filed a claim and been denied, so don?t waste your time consulting an attorney until you have filed and been denied. Of course, there is a chance that you will file and be approved, in which case, you?ve saved yourself the attorney fees!
• Appeal: If the SSA denies your initial claim, which it does 60 to 70 percent of the time, consult an attorney or other legal representative to file an appeal. A judge can override the SSA?s original decision, but you may need to appear at a hearing, in which case you should have a qualified legal representative. Be prepared to appeal several times.
• Keep copies: Copy everything before submitting it. If you talk to someone on the phone, jot down the person?s name and contact information and notes about what the person told you.
• Be nice: Whenever you want something done, you need to treat the people involved with courtesy and respect. Most SSA employees are inundated with paperwork and phone calls?giving them grief can only hurt your case, not help it. Give yourself time to cool off before calling if you?re angry or hurt about needing to appeal or not receiving a response as quickly as you?d like.
• Follow up: Wait a few days after you mail your claim and any pertinent paperwork; then call to make sure that the SSA received the documents. If you can establish a good relationship with an individual at your local SSA office, you have a better chance of keeping everything straight.

Don?t give up! The SSA may seem to be doing all that it can to discourage people from filing for disability benefits, but persistence often pays off, and the SSA is becoming more sensitive to the fact that bipolar disorder and other mental illnesses can be as debilitating as physical disabilities. If you can?t work for a while because of your disorder, you have every right to receive benefits.

 

[Daniel E.]

More info/advice from a comprehensive blog:

The Sleepy Girl Guide to Social Security Disability

 

[Daniel E.]

If applying for SSI/SSDI and you currently earn over the substantial gainful activity (SGA) amount ($1180 a month for the year 2018), a possible way of still qualifying is to deduct Impairment Related Work Expenses (such as therapy not covered by insurance):

SSA's Policy Information Site - POMS

SSA - POMS: DI 10520.000 - Impairment-Related Work Expenses (IRWE) - Table of Contents - 07/24/1996

SSA - POMS: DI 10520.015 - When to Develop IRWE - 06/20/2012

SSA - POMS: DI 10520.025 - Verifying and Documenting Issues of IRWE - 03/28/2017

 

[Daniel E.]

Uses depression as an example:

5 Steps used by SSA to determine disability

 

[Daniel E.]

SSA - POMS: DI 10520.010 - Definitions - 09/14/2017

A. Definition of IRWE [Impairment-Related Work Expense]

An IRWE means an expense for an item or service which is directly related to enabling a person to work and which is necessarily incurred by that person because of a physical or mental impairment. The IRWE must be needed due to an impairment that the DDS established as the medical basis of disability or another impairment that is being treated by a physician or health care provider. Expenses for an impairment-related item or service may include payment for:

purchase,

installation,

maintenance, and/or

repair...

For examples of IRWEs see the Red Book: http://mwww.ba.ssa.gov/redbook/

B. Definition of Health Care Provider

The IRWE must be needed due to an impairment that the DDS established as the medical basis of disability or another impairment that is being treated by a physician or health care provider. A health care provider must be a licensed or registered professional. Health care providers may include, but are not limited to: osteopaths; naturopaths; psychologists; chiropractors; audiologists; nurse practitioners; dentists; physical, occupational, and speech therapists; registered dieticians; clinical nutritionists; and licensed counselors.

C. Definition of Reasonable Limits

The law provides that an amount equal to the cost to the person with a disability of attendant care services, medical devices, equipment, prostheses, and similar items and services will be deductible from earnings in determining SGA and SSI countable earned income. The deductible amount, however, is subject to reasonable limits. Generally, the amount paid for medical services, medical devices (durable medical equipment), prostheses, and similar medically-related items and services will be considered reasonable if it does not exceed the standard or normal cost for the same item or service in the person's community. See DI 10520.025D for development and documentation procedures on the issue of reasonable limits.

Full text:

SSA - POMS: DI 10520.010 - Definitions - 09/14/2017

 

[Daniel E.]

12.00-Mental Disorders-Adult

12.00-Mental Disorders-Adult

www.ssa.gov

12.00 Mental Disorders

C. What evidence do we need to evaluate your mental disorder?

1. General.We need objective medical evidence from an acceptable medical source to establish that you have a medically determinable mental disorder. We also need evidence to assess the severity of your mental disorder and its effects on your ability to function in a work setting. We will determine the extent and kinds of evidence we need from medical and nonmedical sources based on the individual facts about your disorder. For additional evidence requirements for intellectual disorder (12.05), see 12.00H. For our basic rules on evidence, see 404.1512, 404.1513, 404.1520b, 416.912, 416.913, and 416.920b of this chapter. For our rules on evaluating medical opinions, see 404.1520c, 404.1527, 416.920c, and 416.927 of this chapter. For our rules on evidence about your symptoms, see 404.1529 and 416.929 of this chapter.
   
   
2. Evidence from medical sources.We will consider all relevant medical evidence about your disorder from your physician, psychologist, and other medical sources, which include health care providers such as physician assistants, psychiatric nurse practitioners, licensed clinical social workers, and clinical mental health counselors. Evidence from your medical sources may include:
   1. Your reported symptoms.
   2. Your medical, psychiatric, and psychological history.
   3. The results of physical or mental status examinations, structured clinical interviews, psychiatric or psychological rating scales, measures of adaptive functioning, or other clinical findings.
   4. Psychological testing, imaging results, or other laboratory findings.
   5. Your diagnosis.
   6. The type, dosage, and beneficial effects of medications you take.
   7. The type, frequency, duration, and beneficial effects of therapy you receive.
   8. Side effects of medication or other treatment that limit your ability to function.
   9. Your clinical course, including changes in your medication, therapy, or other treatment, and the time required for therapeutic effectiveness.
   10. Observations and descriptions of how you function during examinations or therapy.
   11. Information about sensory, motor, or speech abnormalities, or about your cultural background (for example, language or customs) that may affect an evaluation of your mental disorder.
   12. The expected duration of your symptoms and signs and their effects on your functioning, both currently and in the future.
3. Evidence from you and people who know you. We will consider all relevant evidence about your mental disorder and your daily functioning that we receive from you and from people who know you. We will ask about your symptoms, your daily functioning, and your medical treatment. We will ask for information from third parties who can tell us about your mental disorder, but you must give us permission to do so. This evidence may include information from your family, caregivers, friends, neighbors, clergy, case managers, social workers, shelter staff, or other community support and outreach workers. We will consider whether your statements and the statements from third parties are consistent with the medical and other evidence we have.
   
   
4. Evidence from school, vocational training, work, and work-related programs.
   1. School. You may have recently attended or may still be attending school, and you may have received or may still be receiving special education services. If so, we will try to obtain information from your school sources when we need it to assess how your mental disorder affects your ability to function. Examples of this information include your Individualized Education Programs (IEPs), your Section 504 plans, comprehensive evaluation reports, school-related therapy progress notes, information from your teachers about how you function in a classroom setting, and information about any special services or accommodations you receive at school.
      
      
   2. Vocational training, work, and work-related programs. You may have recently participated in or may still be participating in vocational training, work-related programs, or work activity. If so, we will try to obtain information from your training program or your employer when we need it to assess how your mental disorder affects your ability to function. Examples of this information include training or work evaluations, modifications to your work duties or work schedule, and any special supports or accommodations you have required or now require in order to work. If you have worked or are working through a community mental health program, sheltered or supported work program, rehabilitation program, or transitional employment program, we will consider the type and degree of support you have received or are receiving in order to work (see 12.00D).
      
5. Need for longitudinal evidence.
   1. General. Longitudinal medical evidence can help us learn how you function over time, and help us evaluate any variations in the level of your functioning. We will request longitudinal evidence of your mental disorder when your medical providers have records concerning you and your mental disorder over a period of months or perhaps years (see 404.1512(d) and 416.912(d) of this chapter).
   2. Non-medical sources of longitudinal evidence. Certain situations, such as chronic homelessness, may make it difficult for you to provide longitudinal medical evidence. If you have a severe mental disorder, you will probably have evidence of its effects on your functioning over time, even if you have not had an ongoing relationship with the medical community or are not currently receiving treatment. For example, family members, friends, neighbors, former employers, social workers, case managers, community support staff, outreach workers, or government agencies may be familiar with your mental health history. We will ask for information from third parties who can tell us about your mental disorder, but you must give us permission to do so.
   3. Absence of longitudinal evidence. In the absence of longitudinal evidence, we will use current objective medical evidence and all other relevant evidence available to us in your case record to evaluate your mental disorder. If we purchase a consultative examination to document your disorder, the record will include the results of that examination (see 404.1514 and 416.914 of this chapter). We will take into consideration your medical history, symptoms, clinical and laboratory findings, and medical source opinions. If you do not have longitudinal evidence, the current evidence alone may not be sufficient or appropriate to show that you have a disorder that meets the criteria of one of the mental disorders listings. In that case, we will follow the rules in 12.00J.
      
6. Evidence of functioning in unfamiliar situations or supportive situations.
   1. Unfamiliar situations. We recognize that evidence about your functioning in unfamiliar situations does not necessarily show how you would function on a sustained basis in a work setting. In one-time, time-limited, or other unfamiliar situations, you may function differently than you do in familiar situations. In unfamiliar situations, you may appear more, or less, limited than you do on a daily basis and over time.
   2. Supportive situations. Your ability to complete tasks in settings that are highly structured, or that are less demanding or more supportive than typical work settings does not necessarily demonstrate your ability to complete tasks in the context of regular employment during a normal workday or work week.
   3. Our assessment. We must assess your ability to complete tasks by evaluating all the evidence, such as reports about your functioning from you and third parties who are familiar with you, with an emphasis on how independently, appropriately, and effectively you are able to complete tasks on a sustained basis.