What is Considered a Disability?

What is Considered a Disability?

What is considered a disability? Social Security Administration (SSA) defines disability as an individual:

  • having a medical impairment or combination of impairments;
  • the impairment prevents the person from working; and
  • they cannot work for at least twelve months.

Social Security provides a “Listing of Medical Impairments”.  This is also known as the “Blue Book”.  These impairments will automatically qualify you for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

However, you must meet certain conditions.  You can be found disabled if these specific conditions are met. You may still qualify for disability benefits under other guidelines if your medical condition is not on the list.

Listing of Medical Impairments for SSDI include:

The Listing of Impairments is generally broken down by body system or function.  They are the most severe level of disabilities. There are separate disability listings for adults and children under the age of 18.  For adults, the medical conditions that qualify for Social Security Disability:

  • Musculoskeletal system, such as back conditions or dysfunction of the joints and bones;
  • Special Senses and Speech, such as vision and hearing loss;
  • Respiratory Disorders, such as breathing disorders like asthma, cystic fibrosis or lung transplant;
  • Cardiovascular System, such as chronic heart failure, chronic venous insufficiency or peripheral arterial disease;
  • Digestive System, such as chronic liver disease or inflammatory bowel disease;
  • Genitourinary Disorders, such as chronic kidney disease; or
  • Hematological Disorders, such as blood disorders.

Additional examples are:

  • Skin Disorders, such as chronic skin infections, dermatitis or burns
  • Endocrine Disorders, such as diabetes, thyroid gland disorders or pituitary gland disorders
  • Congenital Disorders that Affect Multiple Body Systems, such as Down syndrome
  • Neurological Disorders, such as epilepsy, Parkinsonian syndrome, Multiple Sclerosis, cerebral palsy or peripheral neuropathy
  • Mental Disorders, such as depression, anxiety, post-traumatic stress disorder or schizophrenia
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders, such as systemic lupus erythematosus, mixed connective tissue disease, inflammatory arthritis or HIV/AIDS

The Listings of Impairments for children are almost identical to the adult disability listings.  However, the Childhood Listings also include growth impairments. 

Does Your Condition Meet a Listing?

First, your doctor must diagnosis you with a disability under the Listings.  There are some conditions that will qualify you for disability with a diagnosis alone.  Some examples include:

  • ALS;
  • An organ transplant; or
  • Certain cancers such as esophageal cancer, mucosal melanoma, anaplastic carcinoma of the thyroid gland or small-cell carcinoma (prostate, ovaries, breast, lungs, pleura, intestines or bladder)

Generally, just a diagnosis of a disability is not enough.  The Listings of Impairments set out the requirements for how severe the symptoms are affecting you.  SSA will review clinical findings and laboratory tests to determine if your disability meets the listing.  If you have not had the clinical or laboratory tests required in the listing, you can ask your doctor to perform them. 

Medical Equivalence

Your disability may also medically equal the Listings.

Medical equivalence is found if:

  • Your medical impairment is at least equal in severity and duration; and
  • Does not quite match the requirements under the listing.  

The SSA also recognizes that there are many ways to diagnose and document the same illness.  Your disability may “equal’ a listing if it does not quite meet all of the requirements under the listing.  For example, the listing may require a specific result on a specific lab test.  However, you were given a different test that showed the same results.  SSA may find that your disability equals the listing. 

You can also equal a listing if you have multiple disabilities but none of them meet the listings individually.  SSA will look at listings that are close to your disabilities.  If the combination of your impairments adds up to an impairment that is just as severe as the listing, your disabilities would equal the listings. 

What if your medical condition is not under the Listings?

You can still be found disabled if your disability does not meet or equal the listings.  However, you must show that your medical condition keeps you from working.  

Some examples of other disabilities include:

  • Carpal Tunnel Syndrome
  • Fibromyalgia
  • Chronic Regional Pain Syndrome
  • Reflex sympathetic dystrophy
  • Celiac Disease
  • Degenerative Disc Disease

Your disability must be supported by medical evidence.  Medical evidence may include:

  • Physical examinations
  • Treatment notes
  • MRIs
  • CAT scans
  • X-rays
  • Blood work results
  • Biopsy results
  • Pulmonary function tests
  • Mental health records

What medical evidence is considered relevant?

Your medical evidence must cover the period of time that you became disabled and unable to work.  Your treatment should be continuous and ongoing.   Treatment received prior to becoming unable to work is not necessary.  In fact, it can be harmful in some cases. 

How does SSA evaluate your medical evidence?

Your medical condition must limit your ability to perform daily activities.  SSA will determine the most that you can do despite your disabilities based on your medical evidence.  An RFC includes both exertional and non-exertional limitations.  Exertional limitations include the:

  • Ability to sit
  • To stand
  • To walk
  • The amount of weight you can lift or carry

Non-exertional limitations include:

  • Your ability to climb stairs or ramps or ladders, or ropes or scaffolds
  • Ability to bend, stoop, kneel, crouch, crawl or balance
  • Your ability to use your hands
  • Environmental restrictions such as your ability to tolerate temperature extremes or dusts, odors, gases or fumes
  • Your ability to follow instructions, get along with other people, stay focused or concentrate, maintain a regular, full-time work schedule

Your doctors may also submit an opinion about your disabilities. The opinion should include specific restrictions about your activities. 

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. If you have already applied for SSI or SSDI, call immediately to make sure your case is still pending and was filed correctly. You may be entitled to significant compensation.  Contact us now for a free consultation.

Related Articles

What is the Appeals Modernization Act?

What is the Appeals Modernization Act?

What is the Appeals Modernization Act?

The Appeals Modernization Act has reduced the average time to receive a VA disability decision. Older claims typically took 3-7 years to receive a decision. In order to address this issue, Congress passed the VA Appeals Modernization Act in 2017.  On February 19, 2019, VA officially implemented this new law.  As a result, VA’s new goal is to complete claims and appeals in an average of 125 days.  This reflects VA’s renewed focus to deliver timely decisions to veterans and their survivors.

The VA Disability Claims Process Applying the Appeals Modernization Act

Filing an Original VA Disability Claim

The Appeals Modernization Act applies if you have already applied for VA Disability Benefits. Therefore, if you are filing an Original Claim it will not apply at the time of filing.  If you never filed a VA claim before, then you’ll need to file an Original claim.  Per VA rules, you can only file an original claim using a VA Form 21-526EZ.  The form asks for your Social Security number, dates of active duty service, branch of service, and other biographical information.  Most importantly, you must briefly explain why your claimed disability is related to your active duty service. 

Filing a VA Disability Supplemental Claim

When VA denies a claim, it must explain why.  VA has always had this duty.  However, the Appeals Modernization Act has enhanced this duty in the veteran’s favor.  As of February 19, 2019, VA must explain to the veteran which elements he successfully proved.  With that knowledge, a veteran should focus on getting evidence for the unproven element(s).  This New and Relevant evidence could change VA’s mind.  A veteran who obtains such evidence should submit it to VA with a Supplemental Claim.

Take the example of Joe Smith

Joe served in the Coast Guard for 3 years.  In 1991, he filed an Original claim for PTSD.  In a 1993 decision, VA denied the claim because there was no current diagnosis of PTSD.  Joe was so discouraged by this decision that he did not file an appeal.  During a 2019 visit to the local VA hospital, doctors diagnosed Joe with PTSD.  Unsure of what to do, Joe contacted DHG for a free consultation.  The experts at DHG agreed to represent him in a Supplemental Claim.  DHG filed a completed VA Form 20-0995 on Joe’s behalf, along with a copy of the current diagnosis.  Four months later, VA granted his PTSD claim at a 70% rating.

Appeals Modernization Act: Filing a Higher Level Review

This path improves on the Decision Review Officer (DRO) lane from the legacy system.  The main difference is that if the claimant requests a telephonic hearing in Higher Level Review, VA must grant it.  In the DRO lane, VA could reject a request for a telephonic hearing for any reason.  Thanks to the Appeals Modernization Act, VA cannot delay your right to a hearing.

Sometimes, VA denies a claim even though it has evidence to satisfy all 3 elements.  Either VA overlooked evidence, or it misunderstood the law it applied to the case.  In either scenario, it’s not that the veteran failed to prove his case.  VA just made a mistake.  If VA’s decision is infected by that kind of mistake, then your best bet is to file a Request for Higher Level Review.  This path involves an experienced VA adjudicator checking a Rating Decision for errors.  This adjudicator may issue a revised Rating Decision that corrects these errors.  And it does not require new evidence.

Appeals Modernization Act, but with slightly different facts 

In this example, assume Joe filed an Original claim for PTSD in 1991.  He filed the claim with a copy of a 1991 PTSD diagnosis and his service treatment records, which showed an in-service diagnosis related to a combat incident.  In a 1993 decision, VA conceded all other elements were met except the diagnosis.  Joe became discouraged and gave up.  Years later, he asked a DHG rep to review his case.  The DHG rep noticed that VA overlooked the 1991 PTSD diagnosis.  DHG immediately filed a Request for Higher Level Review on VA Form 20-0996.  DHG also attached a two-page argument that explained the legal errors.  Five months later, VA issued a revised Rating Decision that granted his PTSD claim effective 1991. This is the benefit of the Appeals Modernization Act.

Filing a Notice of Disagreement to the Board of Veterans’ Appeals (BVA), using Appeals Modernization Act

What do you do if VA denied your Original Claim, Supplemental Claim, and Request for Higher Level Review?  Your next option is go over their heads to the Board of Veterans Appeals.  VA Form 10182 gives you 3 lanes:

  1. Direct,
  2. Evidence, and
  3. Hearing

The Direct lane is for cases where all evidence and legal argument is already in VA’s records.  The Evidence lane gives you 90 days to provide additional evidence.  The Hearing lane gives you the right to make your case directly to a Veterans Law Judge.  In the Hearing lane, you also have 90 days after the hearing to submit additional evidence.

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Allow us to help you win the most money you can receive in the faster manner possible. You may be entitled to significant compensation that you were not even aware of.  Contact us now for a free consultation, 800-700-0652.

Additional Articles You May Find Helpful

Should I Hire a VA Disability Lawyer?

Should I Hire a VA Disability Lawyer?

Should I Hire a VA Disability Lawyer?

You should hire a VA disability lawyer, especially from https://www.lipconlawfirm.com/truck-accidents/. With a budget over $217 billion, the U.S. Department of Veterans Affairs (VA) is one of the largest federal agencies.  VA’s disability benefit program was intended to be veteran-friendly.  However, for most veterans, applying for VA benefits is a long and frustrating process.  A veteran who represents himself is at a huge disadvantage.  There are hundreds of rules and regulations about the veteran’s rights and VA’s duties.  The process becomes even tougher when VA sends mixed messages, requests information it already has, or issues a decision that completely ignores the evidence.

Do You Have the Expertise?

Most veterans have not studied VA disability law.  Even fewer veterans follow the Federal court cases that change the law every year.  But without that knowledge, many VA claims are doomed to fail.  A VA Disability Attorney’s knowledge and experience can make all the difference.  Specifically, an attorney, especially the professionals from https://www.denvercocriminaldefenselawyer.com/, can determine exactly how to turn a loss into a win. 

Who Needs a VA Disability Lawyer?

Beeman Heifner Benge – Personal Injury Lawyers says that in this fight, a veteran needs someone who is aiming for the same target.  That’s why many of our clients left previous arrangements. Before hiring DHG, many of our veteran clients did not have a VA disability attorney.  Some represented themselves.  They learned very quickly that VA didn’t share the same urgency and had a different result in mind.  Others were represented by a Veteran Service Organization (VSO) such as DAV or American Legion.  Because they work out of VA facilities, there is a perceived conflict of interest.  Does a VSO work for VA or the veteran? 

What is a VA Disability Lawyer’s Role?

Your VA disability claim is too important to risk.  When you hire a VA Disability Attorney, you’re hiring your own specialist to get the job done.  Most of them work for a contingency fee.  They don’t get paid unless they win past-due benefits for the veteran.  And because the contingency fee is usually a fixed 20%, the attorney has every incentive to win the largest possible award.  Plus, the attorney-client relationship ensures he/she is on your side.  Both you and the attorney would be aiming at the same target.

An experienced VA Disability Attorney knows VA’s written and unwritten rules has the knowledge to prepare a game plan to best achieve your objective.  Working together with your attorney, you have a better chance to hit your target.

When Should I Hire a VA Disability Lawyer?

Immediately!  The earlier you can prove your case the faster you can receive your VA disability benefits. In addition, the VA Disability Lawyer will be able to analyze your disability onset date and make sure you receive the maximum back benefits, according to an experience elder abuse law firm Chicago. Generally, a veteran must prove the following to win a VA disability claim:

  1. Current diagnosis,
  2. In-service event, disease or injury, and
  3. Medical nexus between the first 2 elements.

If you don’t have a medical diagnosis, then you need to see your doctor.  Only licensed medical professionals can diagnose medical conditions.  Attorneys cannot do so.  However, if VA denies your claim for any of these reasons, you should probably hire a VA Disability Lawyer:

  • Negative medical nexus (“less likely than not”),
  • No documented proof of in-service event, disease or injury, , or
  • VA ignored evidence proving all 3 elements.

Which VA Disability Lawyer Should I Hire?

VA Accreditation

Only attorneys who have been accredited by VA can represent veterans in disability cases, as a result, VA holds Disability Lawyers to a high ethical standard.  Accreditation reflects VA’s standard for responsible, qualified representation of this nation’s veterans.  A searchable database of VA accredited attorneys, claims agents and VSOs is available here.

Experience

Experience makes a world of difference. Since 1993, the National Organization of Veterans’ Advocates (NOVA) has been the leading organization for training and support of VA Accredited representatives. At Disability Help Group, our representatives are long-standing NOVA members. You know what you are looking for, the https://www.sweetesq.com/car-accidents/ has all details you need and you can choose your lawyer easily.

Speak to The Lawyer

There are many firms out there that you never get to speak with the attorney. At Disability Help Group our representative will talk to you and be your main contact during your entire case. When you hire an attorney you should ask: 

  1. When will I get to speak with my lawyer?
  2. Who will be my main point of contact?
  3. How many cases has my lawyer won?

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Has VA ever denied your case?  You may be entitled to significant compensation.  Contact us now for a free consultation.

Additional Articles You May Find Helpful

What is the Difference Between SSI and SSDI?

The difference between SSI and SSDI. Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are both federal disability programs under the Social Security Administration (SSA).  Both programs provide cash payments for individuals who meet the definition of “disabled.”  However, there are distinct differences between them.

What is SSI?

Supplemental Security Income (SSI) is a financial need-based program that considers your income, assets and resources.  Supplemental Security Income, SSI is funded by general tax funds, not the Social Security trust fund.  It has a very strict set of financial requirements. To meet the SSI financial requirements, you must:

  • Own less than $2,000 in assets (or $3,000 for a couple),
  • Have a very limited income, and
  • Be a US citizen (there are very few exceptions to this).

Both disabled children and adults may qualify for SSI benefits.  You can file for SSI without  a work history.  Supplemental Security Income (SSI) payments have a maximum monthly rate.  The federal SSI payment standard for 2020 is $783 per month.  Most states will provide an additional small supplemental payment.  Dependent children or spouses do not receive payments under SSI.

What is SSDI?

Social Security Disability Insurance (SSDI) is available to individuals who have worked a certain number of years and paid into the Social Security system.   Unlike SSI, there are no limitations for income or assets.  Social Security Disability Insurance (SSDI) requirements are that:

  • You must be between the ages of 18 and 65 years old, and
  • You have earned a certain amount of “work credits.” 

To file for SSDI you do not have to be a US citizen.  Any worker with a valid social security number who paid into Social Security may file.  Under SSDI, a disabled individual’s spouse and dependent children are eligible to receive partial dependent benefits.  Spouses and dependent children are also called auxiliary benefits.  There is a waiting period of five months after being found disabled before payments will begin.  The amount of an individual’s benefits is determined by your earnings record.

Medical Coverage for SSI and SSDI

Individuals who receive payments under the SSI program receive Medicaid. Medicaid benefits start right away.  Individuals receiving SSDI will receive Medicare benefits.  However, these benefits will not begin right away.  Medicare benefits start two years after a person is found eligible for SSDI.  However, Medicare does not cover all primary medical care.  You may need to purchase an additional policy to supplement Medicare benefits.   

What do SSI and SSDI Have in Common?

SSA will ask five questions to determine your eligibility for both SSI and SSDI.

  • Are you working?
  • Is your condition “severe” (limiting your ability to work for at least 12 months)?
  • Does your condition meet or equal the medical listing (the condition is causing the most severe limitations and impact on your functioning)?
  • Can you do any of your past work (only work done in the past 15 years)?
  • If not, is there any other type of work you can do?

In addition, Social Security will ask you to complete forms.   These will ask you to describe your daily activities.  You will need to provide a description of your work history.  Social Security will also contact your doctors to review your medical records. 

Can you collect SSI and SSDI at the same time? 

You can file for both SSDI and SSI (“Concurrent Benefits”) if:

  • If you have earned enough credits for SSDI and
  • Meet the financial requirements for SSI.

Example of Concurrent Benefits

You have worked consistently in the past.  However, you had to stop working due to your medical conditions.  Now that you are no longer working, you may not have any income.  You may have to apply for state assistance or rely on others for financial help.  You would be able to file for SSDI because of your work history.  In addition, you would be able to file for SSI because you now have a limited income. 

In some cases, a person may collect SSI and SSDI benefits at the same time. 

Your SSDI benefit may low because of several factors, including:

  • earning lower wages throughout the course of your work  history
  • having very little or not at all in the last 10 years
  • becoming disabled at a young age

If your monthly payments from SSDI are below $783 per month, you can also receive an SSI payment up to that amount.  If you receive payments from both SSDI and SSI, you will also receive Medicare and Medicaid benefits. 

There are some cases where an individual may not qualify for either SSDI or SSI.

  • You did not earn enough credits for SSDI, 
  • You may have other income, assets or resources that are too high to file for SSI, or 
  • Your spouse’s income is too high.

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. If you have already applied for SSI or SSDI, call immediately to make sure your case is still pending and was filed correctly. You may be entitled to significant compensation.  Contact us now for a free consultation.

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Related Articles

VA Disability Compensation Rates 2020

VA Disability Compensation Rates 2020

VA Disability Compensation Rates 2020 increased about 1.6% from 2019 rates. If the VA decides that a veteran’s disability is related to service, it must then assign a rating percentage.  By law, VA may assign rating of 0%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% and 100%.  These percentages guide the precise dollar amount VA must pay to a disabled veteran. 

Individual v. Combined Ratings, VA Disability Compensation Rates 2020

Combined VA Disability Compensation Rates 2020

A 100% disability compensation rating is the maximum permitted by law. However, what if you have one disability at 70% (such as PTSD) and another disability at 50% (such as sleep apnea)?  Does that mean you have a total rating of 120%?  Unfortunately, no.  To avoid going over the 100% cap, VA uses a Combined Ratings table.  Instead of adding your individual ratings, VA combines them using a formula.  This is known as “VA math.”

Combined Ratings Table

2020 VA Disability Compensation Rates. In fact, the Combined Ratings table provides that after your conditions are rated, they are all combined using a specific formula. First, the VA considers the most disabling condition – that is, the one with the highest rating – then less disabling conditions in order of severity.  Consequently, this method captures the residual efficiency of a veteran with more than one service-connected condition.  Because the maximum percentage reflects total impairment, the formula will never result in a rating higher than 100%.

If the combined value ends in a number from 5 through 9, VA rounds up to the next highest multiple of 10.  Values that ends in 1 through 4, VA rounds down to the lower multiple of 10.  If the combined value ends in 0, then rounding is unnecessary. 

Combined Rating Example

For example, a veteran with 70% for PTSD and 50% rating for sleep apnea has a combined value of 85%.  An 85% value rounds up to a 90% combined rating.  Similarly, for a veteran with a combined value of 84%, rounds down to 80%.  A veteran with two separate disabilities rated at 10% each has a combined value of 19%, which rounds up to a 20% combined rating.

A veteran’s combined rating determines his monthly compensation payment.  For all combined rating percentages above 0%, VA will make specific monthly payments to the veteran. The higher the disability rating, the higher the monthly compensation VA will pay to the veteran. 

How Much are 2020 VA Disability Compensation Rates per Month?

VA disability compensation rates depend on your combined rating and how many dependents rely on you for support.  All things considered, if you have a 0% rating, then VA will not pay any monthly benefits.   As long as you have at least a 30% combined rating percentage, VA will pay a bit extra for every dependent.  Altogether, the following 2020 rates break down the monthly benefit VA must pay based on your overall rating percentage:

Veteran with No Dependents

10%$142.29
20%$281.27
30%$435.69
40%$627.61
50%$893.43
60%$1,131.68
70%$1,426.17
80%$1,657.80
90%$1,862.96
100%$3,106.04

Veteran with Spouse Only (No Children)

10%$142.29
20%$281.27
30%$486.69
40%$696.61
50%$979.43
60%$1,234.68
70%$1,547.17
80%$1,795.80
90%$2,017.96
100%$3,279.22

Veteran with 1 Child Only

10%$142.29
20%$281.27
30%$469.69
40%$673.61
50%$950.43
60%$1,200.68
70%$1,507.17
80%$1,749.80
90%$1,966.96
100%$3,221.85

Veteran with Spouse and 1 Child

10%$142.29
20%$281.27
30%$525.69
40%$747.61
50%$1,043.43
60%$1,311.68
70%$1,636.17
80%$1,897.80
90%$2,132.96
100%$3,406.04

Veteran with Spouse, 1 Child, and 1 Dependent Parent

10%$142.29
20%$281.27
30%$566.69
40%$802.61
50%$1,112.43
60%$1,394.68
70%$1,733.17
80%$2,008.80
90%$2,257.96
100%$3,545.02

Living Adjustments

Periodically, VA will re-assess the precise dollar amounts to keep pace with increases in the cost of living.  This usually happens at the same time that the Social Security Administration issues a Cost of Living Adjustment (COLA).

Make Sure VA is Paying You Correctly, VA Disability Compensation Rates 2020

If you already have a VA rating percentage, then don’t assume that VA is paying you based on the 2020 rates.  Periodically, veterans should check their compensation status to ensure the payment is correct.  If you are unsure of your combined rating, then ask VA to send you a Summary of Benefits.  This letter will include your rating and the monthly dollar amount.  Compare VA’s records to the tables listed above.

Additional Articles You May Find Helpful