Tuesday, September 25, 2012

Does depression qualify you for Social Security Disability benefits?

Depression is one of the most common mental disorders affecting people in the United States. One recent study estimated that nearly 15 million Americans suffer from Major Depressive Disorder or clinical depression. That means that nearly 7% of Americans aged 18 and older are affected by depression during any given year. While most people can overcome the condition through therapy and/or medical treatment, many Americans are disabled by depression. In fact, according to the World Health Organization, depression is the leading cause of disability for Americans aged 15-44. So what can you do if depression had disabled you to the point that you are no longer able to work? For many, the answer is Social Security Disability benefits (SSD) – either Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income (SSI). Social Security Disability benefits can provide a financial lifeline for those disabled by depression. However, not all people suffering from depression qualify for SSD benefits. In this post, I will review the criteria necessary to meet a medical listing for depression and, thus, qualify for SSDI benefits. It is important to note that you can still qualify for SSD benefits even if your depression does not meet the level of the medical listing. In that case you will have to demonstrate that your depression (and any other medical conditions) would prevent you from sustaining full time work – 8 hours a day, 5 days a week.
Medical Listing
As I mentioned in the post, a medical listing is a collection of medical criteria created by SSA. If your condition meets the criteria in the medical listing, you will meet the medical requirements necessary for receiving Social Security Disability benefits. In the case of depression, meeting a medical listing requires fulfilling two conditions. Lets look at these two requirements separately.
Condition 1: Does your condition meet the criteria for Depressive Syndrome?
When you apply for SSD benefits because of depression, the first step the SSA will take to determine if you meet the medical listing is to determine if your condition actually qualifies as a true Depressive Syndrome. After all, there is a big difference between just being depressed and having clinical Depression. The SSA provides very specific criteria to determine whether your condition qualifies. According to the SSA, a Depressive Syndrome is a medically documented condition (which is either constantly present or is intermittent) with at least four of the following characteristics:
  1. Anhedonia: a persistent loss of interest in nearly all activities.
  2. Loss of appetite with change in weight
  3. Sleep disturbances: either lack of sleep or too much sleep
  4. Psychomotor agitation or retardation:
    1. Psychomotor agitation is characterized by repeated purposeless and unintentional activities that seem to stem from some sort of mental tension or disturbance. Examples of these include wringing hands repeatedly or pacing. 
    2. Psychomotor retardation is the noticeable slowdown of physical or mental activity also due to some mental disturbance.
  5. Decreased energy 
  6. Feelings of guilt or worthlessness
  7. Difficulty with concentration or thinking
  8. Thoughts of suicide
  9. Hallucination, delusions, or paranoid thinking: seeing visions, hearing voices, thinking that people are plotting against you, etc.
 Condition 2: Does your condition cause severe functional limitations?
 The second consideration is whether your condition is severe enough to limit you from working. You can satisfy this guideline in one of two ways:
1. Demonstrate that the condition is significantly limiting your ability to function by meeting two of the following criteria:
a. Marked restriction of activities of daily living: these are the activities that people do on a daily basis that allow them to independently live their lives. These activities include grooming and hygiene, using a telephone, cleaning your home, paying bills, and using public transportation. In evaluating your ability to perform activities of daily living, the SSA will also determine the extent to which you can perform them. In other words, the SSA will determine if you can perform these activities independently, appropriately, effectively, and for extended periods of time. Through this evaluation, the SSA will determine the extent to which your condition limits your ability to function on a daily basis.
b. Marked difficulties in maintaining social functioning: this describes your ability to interact effectively with other people. To determine this, the SSA will look for any history of altercations, evictions, termination of employment, avoidance of relationships and other signs that your condition prevents you from establishing and maintaining social interactions and relationships necessary for a functional role in both the workplace and society.
c. Marked difficulties in maintaining concentration, persistence, or pace: this describes the ability to maintain enough concentration to successfully complete tasks commonly performed in the workplace. Such limitations are usually demonstrated through psychological testing (mental status examination), prior work evaluations or both.
d. Repeated episodes of decompensation, each of extended duration: this describes periods of exacerbation in which your depression becomes so severe that you experience the marked functional limitations described above. These periods of decompensation are usually identified in the medical record as times when medications or treatments need to be significantly altered and/or documentation is present expressing the need for a more structured psychological support system (hospitalization, for example). The SSA defines the “repeated episodes of decompensation, each of extended duration” as three periods within 1 year (or an average of once every 4 months) , each lasting for at least 2 weeks.
2. Demonstrate a medically documented history of depression that has lasted at least 2 years and caused more than a minimal limitation of ability to do basic work and that is currently controlled with medication or therapy but demonstrates 1 of the following:
a. Repeated episodes of decompensation, each of extended duration: see 1d, above.
b. The condition is so unstable that even a minimal increase in mental demand or a change in environment would predictably lead to a decompensation.
c. A history of 1 year or more in which the condition leads to an inability to function outside a “highly supportive living arrangement”: the condition only allows you to be functional in very select living environments such as a psychiatric hospital, halfway house, or a highly structured household.
The Importance of Documentation
In previous posts, I have mentioned the importance of documentation in submitting a claim for SSD benefits. While documentation is important for SSD claims for physical disabilities, it is even more vital for claims based on mental disabilities like depression. For physical disabilities, most documentation needs to come from the notes of a treating physician, imaging studies, and labs. For SSD claims based on mental disability due to conditions such as depression, however, the medical record is only part of the documentation necessary. While results of psychological testing and the impression of a medical professional are important, information from non-medical sources are also critical to a successful claim. For example, information from the claimant himself, family members, friends, and coworkers can substantially supplement the record and verify the findings of the medical record. Equally important is to present this evidence from various sources over as long a period of time as possible. Such longitudinal evidence will better establish the severity and extent of your functional impairment. Much of this information needs to be properly and effectively presented in the initial application. Many of my clients have come to me after being rejected for an SSD claim despite actually meeting a medical listing for depression solely because they did not include all the appropriate evidence in their applications. As I mentioned before, including all the appropriate evidence from the beginning can mean the difference between receiving SSD benefits and dealing with a frustrating rejection from the SSA. If you are not sure what to include in your application, seek the assistance of a knowledgeable, experienced attorney in your area.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.

Tuesday, September 18, 2012

How long do I have to wait for a hearing before an Administrative Law Judge?

One of the most often asked questions I receive in my practice is: “How long do I have to wait until I get my hearing date with the ALJ?”  The answer I have for my clients isn’t one they usually like: “it may be a long time.”  In truth, the amount of time you have to wait for a hearing depends on the hearing office handling your Social Security Disability claim.  This links provides information regarding the average wait time per each hearing office. http://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html   It is important to note that these time frames apply to the amount of time from the filing of a Request for Hearing until you go before an ALJ.  This timeframe does not include the time in which it takes the Social Security Administration to decide your initial claim and your request for reconsideration.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.

Friday, September 14, 2012

What happens if my medical condition does not meet a medical listing?

A few weeks ago, I posted a blog article about the medical listings for back impairments. As I mentioned in the post, a medical listing is a collection of medical criteria that need to be met and documented in order for the Social Security Administration (SSA) to deem you disabled from a medical standpoint and grant you Social Security Disability (SSD) benefits (either Social Security Disability Insurance Benefits or Supplemental Security Income benefits). But what if your medical condition does not meet all of the criteria necessary for a medical listing but still prevents you from performing your existing job or finding new employment? Don’t worry, all is not lost. In this post I will explain how you can still qualify for SSDI benefits even if your condition does not qualify for a medical listing.

Meeting a medical listing is not the only way to prove that you are disabled per SSA regulations. Many people applying and obtaining SSD benefits do not meet a medical listing. As I discussed in a previous article, if your condition does not meet a medical listing, you can still prove that you are disabled by demonstrating that you are both unable to work at your previous job(s) or at any other jobs on a full time sustained basis.

If you do not meet a medical listing, the SSA will assess your Residual Functional Capacity (RFC). Simply put, an RFC is a determination of what you can still do despite your medical condition. In basic terms, the SSA will determine if you are still capable of performing heavy, medium, light, or sedentary work. This determination will be based on a medical opinion about your physical restrictions. At this point, your treating physician’s opinion is crucial because you want to present the most compelling evidence possible demonstrating your ability (or inability) to perform certain work functions. As such, documentation by your physician can be the difference between getting approved or denied SSD benefits.

As I mentioned, the RFC will determine the extent of physical and mental exertion that you can still take on in the context of your medical condition and/or disability. However, a given RFC may prevent you from doing one type of job but not another. For example, an RFC that restricts you to sedentary work may qualify you for SSD if you were a trained lumberjack but may not qualify you for benefits if you were a data entry clerk. As such, once the SSA determines your RFC, they will then look at your past relevant work. Employing the expertise of vocational experts, the SSA will then determine if your RFC will allow you to continue performing your usual job activities. If the SSA determines that your RFC does not preclude you from performing this past relevant work, then your application for SSDI benefits will be denied.

Conversely, if you are not capable of performing your past relevant work with this RFC, the SSA will move on to the next step of determining whether, given your age, education, and past work experience you would be capable of performing other work. For example, if you are a lumber jack but your RFC limits you to sedentary work, the SSA will determine if you can perform a sedentary job like that of a data entry clerk. This determination, as I previously mentioned, is made based on how old you are, what level of schooling or training you completed, your education background, and your past work. If the evaluation then determines that this combination of factors prevents you from performing another type of job, you will be granted SSD benefits.

This is a very general description of the process for determining whether you are disabled despite not having met a medical listing. As you can imagine, in reality, the decision making process is more complex and labor intensive. Multiple factors contribute to the determination of whether you are able to return to past relevant work and/or to perform a new type of job. Nonetheless, the main take home message remains the same: if your medical condition prevents you from being able to perform your job, you still may be able to qualify for SSD benefits despite not meeting a medical listing.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.

Wednesday, September 5, 2012

What is the process for determining whether you qualify for Social Security Disability (SSDI or SSI) benefits?

Many people applying for Social Security Disability benefits are confused about the process the Social Security Administration (SSA) goes through in order to determine whether someone is eligible for Social Security Disability (SSD) benefits. The Social Security Administration has actually laid out specific steps that they follow to determine if someone is disabled and therefore qualifies for SSD benefits. In this post, I provide a simplified description of the sequence of steps the SSA takes to evaluate whether you are disabled per Social Security’s regulations. 
       1.    Did you earn more than a specific amount of money since your alleged onset date of disability (the date that you claimed you became disabled)?
In this first step, the SSA will obtain a report of your earnings to determine if you have earned money since the day you claimed you became disabled. If you have earned money since the day you claim you became disabled, the SSA will look to see if the average monthly amount you earned is more than the SGA or the Substantial Gainful Activity amount for that year. This is the maximum monthly amount of money you can earn while still being eligible for SSD benefits during that period of time. This amount changes from year to year. For 2012, for example, the SGA amount is $1010 per month if you are not blind and $1690 per month if you are blind. As I mentioned, the SGA amount differs each year and you can determine the SGA amount for each year by going to the SSA.GOV website (http://www.ssa.gov/oact/cola/sga.html).
In general, if your average monthly earnings exceed the SGA amount for that particular year, then the SSA will determine that you are not eligible for SSD benefits. There are certain exceptions that apply to this rule and if you have been denied on this basis, you should contact an attorney experienced in handling Social Security Disability claims. If you have not earned more than the SGA amount, then SSA will move your claim to Step 2.
       2.    Is the claimant’s condition “severe”?
· The second step is to determine if your condition is “severe.” SSA defines a condition as “severe” if it has more than a minimal effect on your ability to do basic work activities. This is a very low threshold to meet as most impairments will have some effect on a person’s ability to perform basic work-related activities, even if the condition does not completely prevent work activities. If your condition is considered “severe”, then the SSA will progress your claim to Step 3.
      3.    Does your condition meet a medical listing?
The third step in the process is to determine if your medical condition meets a medical listing. In order to meet a medical listing, specific criteria must be met which deem the condition (in and of itself) severe enough to automatically warrant SSD benefits. The SSA maintains a list of such medical conditions for each major body system, all of which can be found on the SSA website. If your condition meets a medical listing then you are considered disabled for purposes of SSD benefits. In some cases, people applying for SSD may not see their condition(s) specifically acknowledged by the SSA as a potential medical listing. In such a situation, the SSA will determine if your condition is equivalent in severity to a related medical condition that is actually on the list.
Even if their condition is listed, however, most people applying for SSD do not have a condition(s) severe enough to automatically qualify for benefits via a medical listing. If your condition does not meet a medical listing all is not lost. If your condition does not meet or equal a medical listing, the SSA will move to Step 4.
      4.    Can you perform past relevant work?
If your condition does not meet or equal a medical listing, the SSA will then determine whether you are capable of performing “past relevant work.” “Past relevant work” is work performed within the previous 15 year period, assuming that it lasted long enough to be learned and was substantial gainful activity (SGA). If the answer is no (you cannot return to any past relevant work) the SSA will proceed to Step 5.
      5.    Can you perform other work?
If it is determined that you cannot perform your past relevant work, the SSA will try to determine whether there is any other work you could reasonably do based on your age, education, and transferability of job skills. This decision will also be based on your residual functional capacity. This term refers to what tasks and skills an individual can still perform despite the functional limitations and restrictions caused by the physical and/or mental impairments stemming from a documented medical condition. The types of jobs that SSA can determine you are capable of performing diminishes with older age, less education and less previous work experience. That means that the older you are, the less education you have and the less previous work experience you have, the more difficult it is for the SSA to determine that there is other work that you can do. If you are unable to perform any past relevant work or any other work (based on your age, education and work experience), then you should be approved for Social Security Disability benefits.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.