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Traumatic Brain Injury and the Social Security Disability Process. An Overview. Kelly Blad, MA, EDPNA. Social Security Disability Programs. Retirement, Survivors, and Disability Insurance (RSDI, Title II) Work based disability program Must prove disability prior to Date Last Insured

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an overview

Traumatic Brain Injury and the Social Security Disability Process

An Overview

Kelly Blad, MA, EDPNA

social security disability programs
Social Security Disability Programs
  • Retirement, Survivors, and Disability Insurance (RSDI, Title II)
    • Work based disability program
    • Must prove disability prior to Date Last Insured
  • Supplemental Security Income (SSI, Title XVI)
    • Federal welfare program for the disabled, blind, and elderly
    • Must meet income and asset requirements
retirement survivors and disability insurance
Retirement, Survivors, and Disability Insurance
  • Monthly benefit amount based on earnings record
  • Must be disabled and insured
  • 5 month waiting period for eligibility
  • Auxiliary benefits available
  • Medicare coverage after 24 months of eligibility
  • Not reduced by income or assets
supplemental security income
Supplemental Security Income
  • $721 for an individual and $1,081 for a couple and may be reduced depending on
    • Living situation
    • Income
  • Medical assistance coverage
concurrent claims
Concurrent Claims
  • Both SSI and RSDI
disability
Disability
  • Inability to engage in substantial gainful activity by reason of a medically determinable impairment that has lasted or is expected to last at least 12 months or result in death.
sequential evaluation process
Sequential Evaluation Process
  • Step 1: Is the claimant engaged in SGA?
substantial gainful activity
Substantial Gainful Activity
  • Work done for pay or profit
  • $1,070 gross per month
sequential evaluation process1
Sequential Evaluation Process
  • Step 1: Is the claimant engaged in SGA?
  • Step 2: Does the claimant have a severe impairment?
severe impairment
Severe Impairment

More than a minimal limitation on one’s ability to work

sequential evaluation process2
Sequential Evaluation Process
  • Step 1: Is the claimant engaged in SGA?
  • Step 2: Does the claimant have a severe impairment? work?
  • Step 3: Does the impairment meet or equal a medical listing?
medical listings
Medical Listings
  • Social Security Website, “Blue Book”
  • Organized by body system
  • Separate listings for children and adults
  • First step in which someone may be approved
step 3 5 residual functional capacity
Step 3.5 – Residual Functional Capacity

Maximum ability to do work related activities on a sustained basis

sequential evaluation process3
Sequential Evaluation Process
  • Step 1: Is the claimant engaged in SGA?
  • Step 2: Does the claimant have a severe impairment? work?
  • Step 3: Does the impairment meet or equal a medical listing?
  • Step 4: Can the claimant perform his or her past relevant work?
past relevant work
Past Relevant work

Work performed gainfully within the last 15 years and performed long enough to be learned

sequential evaluation process4
Sequential Evaluation Process
  • Step 1: Is the claimant engaged in SGA?
  • Step 2: Does the claimant have a severe impairment? work?
  • Step 3: Does the impairment meet or equal a medical listing?
  • Step 4: Can the claimant perform his or her past relevant work?
  • Step 5: Can the claimant perform any other work?
other work
Other Work
  • Work in the national economy
  • Age affects this step
  • Last step in which someone may be approved
grid rulings
Grid Rulings
  • Special rules for older workers
  • Take into account RFC, age, education, and transferable skills
application process
Application Process
  • Initial Application
    • Online or in person application taken by district office
    • State agency collects medical records and makes determination
    • Clear medical records, no red flags
first appeal reconsideration
First Appeal: Reconsideration
  • 60 deadline
  • State agency takes into account new evidence
second appeal request for hearing
Second Appeal: Request for Hearing
  • 60 day deadline
  • Claimant/claimant’s representative is responsible for providing medical records
  • Testimony and medical records are used to make determination
third appeal appeals council
Third Appeal: Appeals Council
  • 60 day deadline
  • Not a new determination
fourth appeal federal district court
Fourth Appeal: Federal District Court
  • 60 day deadline
  • Civil suit against Social Security
  • Must be represented by an attorney
potential claim issues
Potential Claim Issues
  • Chemical Dependency
  • Lack of medical treatment
  • Noncompliance with treatment
  • Criminal background
provider s role in ssa s determination
Provider’s Role in SSA’s Determination
  • SSA uses medical, education, and rehabilitation records in the determination
  • Providers record diagnoses and symptoms
  • Providers can provide medial opinions
screening
Screening
  • Is the individual unable to work full time?
  • Is it due to a medically determinable impairment?
  • Ultimate decision is with Social Security
social security disability

Social Security Disability:

An Overview

Kelly Blad, MA, EDPNA