What is Social Security Disability?

B. Defining Disabled

For adults and children applying for SSDI and for adults applying for SSI , being disabled means that you are unable to engage in any substantial gainful activity because of a medically determinable physical or mental impairment. The disability must have lasted or be expected to last for a continuous period of at least 12 months, or be expected to result in death.

For children applying for SSI , being disabled means the child has a medically determinable physical or mental impairment that causes marked and severe functional limitations. The limitations must have lasted or be expected to last for a continuous period of at least 12 months, or be expected to result in death.

Let’s break these concepts down further.

1. Inability to Engage in Substantial Gainful Activity

Inability to engage in substantial gainful activity (referred to as the SGA requirement) means that if you work, you do not earn more than a certain amount of money. For nonblind people, the 2008 amount is $940 per month. For blind people, the amount is $1,570 per month in 2008 and is adjusted annually. If you ever need to find out the SG A income limit for a given year, simply call a local SSA office. (See Section C, below.)

Even if you have an impairment that meets the requirements for disability, you won’t qualify for SSDI or SSI if you earn more than the SGA level. In this situation, if you stop working and apply for disability payments, you must be able to show that your medical condition became worse or that special help you required to do your job was no longer available. The SSA is very lenient in this regard, if you make it clear that you had to stop working because of your medical problems. If you say you stopped working without a medical reason, you might not qualify to receive benefits.

SGA refers only to money you obtain from working, not money you obtain from other sources, such as investments or gifts.

2. Medically Determinable Impairment

A medically determinable physical or mental impairment is a disorder (abnormal condition) that results from anatomical (body structure), physiological (body function), or psychological (mental) abnormalities that can be proved by medically acceptable clinical and laboratory diagnostic techniques. The Social Security Act requires that a physical or mental impairment be established by medical evidence consisting of signs (objective findings by a medical provider), symptoms (subjective complaints by you), and laboratory findings.

In other words, the SSA must be able to determine that you have something wrong with you, either physically or mentally. To make such a decision, the government can ask to examine your treating doctor’s records and your hospital records, order x-rays or other tests as needed, or have you examined by a doctor of its choosing if your records are incomplete or too old. Symptoms such as pain are important, but alone cannot get you benefits. They must be linked to some physical or mental problem. In addition, your statement alone that you have symptoms is not sufficient. A doctor must show that you have a physical or mental condition that could cause the symptoms you say you have.

Remember: The medical listings are on the CD-ROM. CD Parts 1 through 14 contain the Listing of Impairments, which is the medical information the SSA uses to determine whether your impairment meets the requirements to obtain disability benefits.

3. Duration of Disability

Your impairment must be severe enough to disable you (according to the SSA’s medical criteria) for at least 12 continuous months or to result in your death. The 12-month duration requirement does not mean that you must have been severely ill for a year before applying for benefits. The SSA often presumes that an impairment will last a year when it has not improved after three months. If an impairment is obviously long-lasting and very severe, the SSA can make an immediate determination. For example, if your spinal cord was cut in half in an automobile accident, you will, at the very least, be unable to walk for the rest of your life. There would no reason for the SSA to wait before approving your claim, assuming you otherwise qualify.

The SSA includes the possibility of death in the definition of disability because death is the most extreme disability possible. Nothing in the Social Security Act specifies how to measure the possibility of death. But the SSA does provide some guidance. If you meet the criteria of any of the cancer listings, the SSA presumes you cannot work, based more on a poor prognosis than on an inability to do work. These cancer prognoses include a median life expectancy of 36 months. (See CD Part 13 on the CD-ROM for more on cancer listings and the definition of median life expectancy.) Sometimes, the SSA uses the same survival probabilities in deciding noncancer disabilities that might result in death. These estimates can be difficult to make and require medical knowledge.

Many people apply for disability after acute injuries or impairments that won’t produce any long-term effect severe enough to qualify for benefits. If you have any question in your mind about how long your impairment will last, apply for benefits. This is especially true if you are over 50 years old. Older people do not need as severe an impairment as people under 50 to be allowed benefits. You can also ask your doctor’s opinion about how long your illness will last. But it will be up to the SSA to decide whether you meet the minimum duration requirement of 12 months. In some cases, the SSA might think your impairment will last long enough, even if your doctor does not.

There is one exception to the duration of disability requirement: SSI claims based on blindness have no duration requirement.

Next: C. Contacting the Social Security Administration

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