How to Qualify for Disability

What you need to show and prove to qualify for disability

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by Tim Moore, Disability Representative in North Carolina

How to qualify for Social Security Disability or SSI

“How to qualify for Disability”. This is such a commonly asked question because very few people understand how the Social Security Disability system really works.

(Read if you live in North Carolina)

If you ask someone at a Social Security office, you may be surprised to learn how much they do not know about the disability programs. And that’s because they don’t actually work on the claims. Claims are decided by disability examiners at Disability Determination Services, a related arm of the Social Security Administration.

As a former claims examiner for Social Security , and as a Disability representative, I try to explain how it all works in the most useful way. On this page, we will briefly talk about the listings, how most cases are actually approved, what you need to show Social Security to get approved, and tips that will help you qualify. First of all, what does Social Security mean by “disability”?

What does Social Security consider a Disability?

You will qualify and win your disability case if you can prove that you meet the Social Security Administration definition of disability. The definition requires that you show the following.

A) That you have at least one severe medical impairment.
B) That your medical impairment has lasted, or will last, a full year.
C) That your medical impairment makes it impossible for you to work and earn a substantial, gainful income. This includes being unable to do the work you have done in the past, and also being unable to switch to some type of other work that, if you were not disabled, you could potentially do based on your age, education, functional capacity, and work skills.

How do you show that you qualify?

For the most part, your medical records will provide the information that decides your claim. But know this: even good medical records may not get you disability benefits if it is not clear to the disablity examiner (on an application or reconsideration appeal) or a judge at a hearing what your records actually infer say about your limitations and reduced ability to work. This is why so many cases get denied, and why so many people need to appear at a hearing with a judge where a disability representative can argue their case for them.

Having said all this, your medical records, when interpreted properly, will do the following:

1. Verify what your conditions are.

2. Verify what your symptoms are.

3) Establish how long you’ve had your disabling condition (which is important to calculate the back pay you are owed, and to estabish when your medicare benefits may begin if your claim is for Social Security Disability vs SSI which provides medicaid benefits).

However, there are actually two ways for a disability examiner or a judge (if your case goes to a disability hearing) to award you benefits. And while one of them only involves looking at your medical records, the other takes your work history into consideration.

The first way: Being approved through the list of conditions

If the disability examiner looks at your medical records and finds that you have a condition in the Social Security list of impairments, they may approve you this way. If they do, you won’t have to file an appeal, or go to a disability hearing before an administrative law judge. It is generally the quicker and easier way to be approved.

However, getting a listing approval can be difficult. First of all, not all conditions (such as fibromyalgia and carpal tunnel syndrome) are in the listings, and the listings themselves tend to require a lot of specific information from your medical records. Most cases are simply not approved this way.

The second way: How most disability cases are approved

More cases are approved through something called a medical-vocational allowance. You qualify this way by proving that your condition causes enough problems that you can’t be expected to go back to your past work, and enough problems that you also can’t switch to some type of other work.

Obviously, this type of award involves an examination of not only your medical records, but also your work history information. Therefore, it is vital that you provide the best information possible when you are filing a claim for disability, either SSD or SSI.

What you need to show and prove to qualify for disability

Your work history

When you apply for disability, give detailed information about the jobs you’ve worked for the last 15 years. The examiner will research your jobs and the demands each one had, as well as considering whether you can still do the job. For a disability examiner to properly categorize your jobs, you need to provide:

1. The title of each job;
2. The dates you worked each job;
3. Good descriptions of what you did on each job.

Note: If you drove a truck, don’t simply write “truck driver”. You need to be specific because different types of trucks require different skills and have different physical requirements. Tractor-trailer-truck diver is not the same as driving a small pick up truck.

Tip: Write down your entire work history before you have your disability application interview. It will make the process easier and allow you to provide better information because you won’t have to think about it on the spot.

Your medical conditions

Include all your medical conditions and how they affect you when you apply. Social Security will be looking for signs of how you are limited by your medical condition, which can be physical or mental, or both. The more conditions and symptoms you have, the more likely it will be that you will have greater limitations which might rule out working in any of your past jobs.

If you can’t do your past work, the examiner will still consider whether you can do some type of other work. If you can’t do either, you will qualify for disability. So, it is vital that you point out all your conditions and symptoms.

Your medical treatment sources

Make sure to give Social Security all your treatment sources, new and old. Records from current providers can help prove you are disabled. But older medical records can establish how far back your disability exists which can affect your eligibility for back pay and medicare benefits.

If you do not have current medical records, it will be very difficult to be awarded benefits. If you have not been seen by a doctor in the last 90 days, Social Security will send you to a consultative medical examination performed by an independent physician. However, these exams are short and usually do not provide the information you need to be approved for disability. So, try to have recent treatment when you apply.

Tips to help you qualify for disability

1. Consider looking at your own medical records to see what your doctors have written about your condition and how it affects you. Social Security looks at how your condition limits you, not just that you have a particular condition. If your records lack any mention of your physical or mental functional limitations, you may wish to start mentioning your problems when you see your doctor.

2. If you have a condition, make sure you have been treated specifically for it. Many individuals allege anxiety or depression, or a particular physical issue, without actually having been treated for it. If you receive medication for depression or anxiety from your regular doctor, you may wish to seek more specific treatment from a mental health provider to more fully document your condition.

3. If you have a condition, but have not been treated for it (again, depression is a good example), put it on your disability application anyway. What happens if you haven’t been treated for it? The disability examiner may try to develop that aspect of your case by sending you to a consultative medical examination. In the case of depression, these exams can involve testing that is psychological, or testing for your memory. But, at the very least, they add more evidence to your claim.

Can you qualify for both Social Security Disability and SSI?

Yes you can. Some claims will be for SSD or SSI only. Many claims, however, are concurrent, meaning they are for both. This usually happens when a person’s SSD benefit is low, and so Social Security will allow a concurrent claim so that a person’s monthly benefit will be no less than the full SSI amount. If your claim is for both benefits, it will not affect how the evidence is evaluated or how the decision is made.

How much money do you get if you qualify for disability?

If you get Social Security Disability, your benefit will be based on what you would have gotten at retirement. So, SSD is really you getting your retirement benefit early based on being disabled. To find out what your benefit is, you can simply contact Social Security, directly or online.

SSI is different. The amount you can receive for SSI is capped at a maximum each year. Here is the current amount: SSI full amount.

Additional pages if you live in North Carolina: