WHAT DOES SOCIAL SECURITY MEAN BY DISABILITY, I.E. WHAT IS THE DEFINITION?

What does social security mean by disability, i.e. what is the definition?

The definition of disability used by the Social Security Administration is different from what many applicants and potential applicants might expect. Many individuals mistakenly assume the following:

1. That Social Security Disability and SSI disability provide for temporary disability benefits.

2. That Social Security Disability and SSI disability provide for partial disability benefits.

3. That Social Security Disability and SSI disability are based on a complete inability to work at the individual's last job.

4. That Social Security Disability and SSI disability are based on recommendations from a claimant's physician.

Let's discuss these in order. First of all, the SSD and SSI disability programs do not provide for temporary disability benefits. When a person is approved for disability, the award is granted based on a presumption that the claimant may be permanently disabled. Social Security does have a process for periodically reviewing claims to see if a person remains disabled and, thus, eligible to receive benefits. And this process involves having the claimant go through a CDR, or continuing disability review, every few years.

If the review finds that no medical improvement has taken place, the claimant's benefits will be continued. However, even though a review process exists, claims are nonetheless decided on the assumption that a person's state of disability will be long-standing or permanent, and not at all temporary.

Secondly, SSA (the social security administration) does not award claims on the basis of partial disability. That is, if a person loses the use of a limb or an eye, they cannot be approved for benefits on the basis of this alone. They also cannot be approved for a percentage loss of use of a limb, or an eye, or an ear, etc.

Thirdly, SSA does not make decisions on the basis of whether or not a claimant is unable to do their past job. Past work does play a role. However, individuals who are found to be unable to go back to a past job may still be denied on the basis that they can can do something else.

Fourth and finally, SSA does not make decisions based solely on what a person's treating physician has to say about their condition. A medical source statement from a doctor that has a history of providing treatment (i.e. a treating physician) can provide a basis for the approval of a claim.

However, this statement must refer to the claimant's remaining level of function (their residual functional capacity, or RFC) and it must also be supported by the physician's own record of treatment.

If a doctor supplies a statement that their patient is totally disabled, but the statement does not provide any information regarding their patient's limitations, then the statement will be practically useless. By the same token, if a doctor provides a detailed statement that supports their patient's claim for disability but this statement is in contradiction to the physician's own treatment notes, then the statement may not be regarded as valid and may be rejected.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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