Social Security Disability Insurance APDA Education & Support Living with Parkinson’s Disease Disability Social Security Disability Insurance Social Security Disability Insurance Social Security Disability Insurance (SSDI) is a government disability benefit program that is administered by the Social Security Administration (SSA). SSDI benefits are paid on a monthly basis to disabled workers who qualify under the SSA’s rules. SSDI covers total disability, and does not cover partial disability or short-term disability. The SSA publishes a wealth of information about SSDI benefits on the Disability Planner section of its website. Below, we discuss some fundamental concepts relative to SSDI benefits and Parkinson’s disease. Within this discussion, we include links to the SSA’s website (SSA.gov) for further reading so that you can dive deeper into the details as appropriate. Am I covered by SSDI? Not everyone is covered by SSDI. In addition to meeting the SSA’s definition of disability (discussed below), you must have worked in a job that was covered by Social Security and have accrued enough work credits. Click here to visit SSA.gov to read more about SSDI qualification requirements. Eligible workers paid premiums through taxes taken out of their paychecks by their employers, or through self employment, commonly referred to as “FICA taxes” under the Federal Insurance Contributions Act. You must have earned enough in the years before your disability began to qualify for SSDI. Click here to visit SSA.gov to learn more about whether you have enough work credits. Don’t let uncertainty about whether you are covered by SSDI delay you from making your claim, or keep you from filing your application altogether. There is a good chance that you may be covered. According to the SSA’s Fact Sheet, an estimated 173 million workers are covered under Social Security. If you are not covered, the SSA will let you know after you file your application. How does the SSA define disability? “Disability” under the SSA’s rules is defined as “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” See SSA Regulation 20 C.F.R. §404.1505. Click here to read more about the definition of disability on SSA.gov. What is substantial gainful activity (SGA)? You may be surprised to learn that you can earn a certain level of income and still be deemed disabled under the SSA’s rules. SGA is the benchmark that the SSA uses to determine if you have sufficiently impaired earning capacity to qualify for SSDI benefits. If the SSA determines that you are able to engage in SGA (earn more than the allowable monthly SGA), your claim may be denied. The SGA amount changes each year. Click here to view the SSA’s Substantial Gainful Activity table. What is a medically determinable physical or mental impairment? The SSA describes a medically determinable physical or mental impairment as “an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.” SSDI and Parkinson’s disease The SSA may not award SSDI benefits based on your Parkinson’s disease diagnosis alone. In fact, many are able to work for a long time after receiving a diagnosis. Thus, if you are filing a claim, it is important that you provide medical evidence that your Parkinson’s disease symptoms are of a level of severity that prevent you from working. Even if you are still working and not ready to make a claim, be sure that your doctors are documenting your symptoms in your medical records. If your symptoms progress to the point of disability, having the symptom progression documented in the medical records can help you prove your claim and explain what changed over time to render you disabled. The SSA publishes the Blue Book online, which explains the SSA’s disability determination process and the listing of impairments that it will consider when making a disability determination. The SSA’s listing for Parkinson’s disease is found in the Blue Book at 11.06 Parkinsonian syndrome. [NOTE: If you click on this 11.06 link and scroll up in the Blue Book, you will find the 11.00 references and definitions.] To meet listing 11.06, despite adherence to prescribed treatment for at least three consecutive months (see 11.00C), you must have: A. Disorganization of motor function in two extremities (see 11.00D1), resulting in an extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities. OR B. Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following: Understanding, remembering, or applying information (see 11.00G3b(i)); or Interacting with others (see 11.00G3b(ii)); or Concentrating, persisting, or maintaining pace (see 11.00G3b(iii)); or Adapting or managing oneself (see 11.00G3b(iv)). Don’t get overwhelmed with these requirements. When making your initial applicable for SSDI benefits, follow the SSA’s instructions and focus on providing medical evidence of the symptoms that prevent you from working in any job reliably or consistently. The evidence you use can come from many sources such as your medical records, test results, pharmacy records, reports from your doctors, your own personal statement, witness statements from your loved ones who have observed how Parkinson’s disease impacts your life. If your SSDI claim is denied, consider contacting an SSDI lawyer who can help you navigate SSA’s rules and regulations on appeal. How do I file an SSDI Claim? Timing: If you are disabled from Parkinson’s disease and intend to file an SSDI claim, do not delay. Waiting to file your claim could cause you to lose benefits. There are limits on how many months of retroactive benefits the SSA will pay. Read more about retroactive benefits in the SSA’s online handbook. Another reason not to delay is the fact that it could take months to get an initial claim decision from the SSA. Organize your thoughts: When you are ready to apply for SSDI benefits, take a moment to think about your symptoms and how they impact your ability to work in any job reliably and consistently. It can help to write this out so it’s in the front of your mind throughout the process. When completing your application, you will need to describe your symptoms and impairments, list your treatment providers, and including any additional information that relates to your disability. It is a good idea to organize the information that you will need to complete your application in advance. The SSA publishes an Adult Disability Starter Kit to help you get organized to complete your application. Talk to your doctors: When possible, it is a good idea to speak with your doctors about your Parkinson’s disease symptoms and the impact that they have on your ability to work as soon as possible. While your doctors’ opinions that you are disabled are not alone enough to win your claim, their opinions are important evidence that will help you. Your doctors will need to certify your disability to the SSA by demonstrating your symptoms through their examination reports, testing, and when completing claim forms. Ask your doctors to write reports explaining your diagnosis, his or her findings on examination and testing that confirm the severity of symptoms that you suffer, and how your symptoms impact your ability to work in any job. Because Parkinson’s disease can impair you physically and cognitively, it is important that your doctors address both physical and cognitive impairments. For guidance on how the SSA evaluates a disability claim based on Parkinson’s disease see the SSA’s listing for Parkinson’s disease discussed above. To help quantify your impairments, your doctors might send you for a functional capacity examination (also known as an FCE). During an FCE exam, a physiatrist or physical therapist will put you through a battery of tests designed to measure your ability to perform work-related physical tasks. If you are suffering from cognitive impairment such as impaired concentration or forgetfulness, your doctor might refer you for a neuropsychiatric examination, which is intended to measure your cognitive impairment. Your application: An SSDI claim begins with an application that can be completed online, by phone, or in person at your local SSDI office. Here is a link to the SSA’s website with more information on how to apply online. If you prefer to apply in person, click here to locate your local SSA office and find a phone number that you can call to apply for benefits or schedule an appointment. If you are overwhelmed, or just want some help understanding the application process, you can make an appointment at your local SSA office to meet with an SSA employee in person. You can call to make an appointment by dialing 1-800-772-1213 (TTY 1-800-325-0778). To find the location of your local SSA office, visit https://secure.ssa.gov/ICON/main.jsp Gathering and submitting your evidence of disability: Do not rely on the SSA to prove your claim for you. While the SSA will offer to assist you in collecting medical records, it is a good idea to collect them yourself from your doctors to ensure that nothing is overlooked. Providing the SSA with your medical records might also help you get a decision faster and possibly avoid a denial based on insufficient evidence. Save a copy of what you send to the SSA, and proof that you sent it such as fax confirmation or a certified mail receipt. After you file your application, your non-medical information, such as age and employment history, will be reviewed at the SSA’s field office where non-medical eligibility is determined. If you are deemed eligible by the field office, they will send your medical information to Disability Determination Services (DDS) for an “evaluation of disability.” The DDS is responsible for initially determining whether a claimant’s condition qualifies them as disabled under the law. What happens if my claim is approved? If your SSDI claim is approved, the earliest that you will be paid benefits is five months after your date of disability. This five month period is called the “waiting period.” Benefits will be paid for the sixth full month following the date of disability. Your benefit amount will depend on your earnings history prior to disability. You can access your Social Security statement online by clicking here. The SSA also provides benefit calculators. Appealing a denied SSDI claim Do not wait to appeal to consult with an attorney for assistance with your appeal. Your denial letter will advise you of the limited amount of time that you have to file your appeal. If you miss your appeal deadline, you may lose rights to your benefits. SSDI claims can be denied for many reasons. The SSA should explain the reasons in the denial letter. There are several sequential levels of appeal available to you including request for reconsideration, administrative law judge hearing, appeals council review, and federal court review. Click here to read the SSA bulletin on the Appeals Process. The law does not require you to have a lawyer to help you appeal, but it may be a good idea for you to have one. Each case is different. An experienced SSDI attorney may be able to identify errors made by the SSA, write your appeal, collect the evidence you need and advocate for you at the hearing. A few tips for the appeal process: Meet your appeal deadline. Most appeals must be filed within 60 days of receiving the denial notice. If you miss your deadline, you may lose your rights to your benefits. Read your denial letter carefully to understand your appeal deadlines. The SSA allows you to file your Appeal online. File a “Request for Reconsideration,” not a new claim. Although you are not filing a new claim, be sure to update your claim. Submit a new RFC and any new information on your condition, limitations, treatment, etc. Send all documents via fax or certified mail and save proof that you sent them. Consider hiring an attorney to represent you, especially if you have been denied benefits previously. In summary, learn as much as you can about this process before you apply. Doing so may allow you to reduce your wait time and make the transition from work to disability quicker and easier for everyone involved. Having trouble meeting the SSA’s listing for Parkinson’s disease? Consider relying on Residual Functional Capacity (RFC) instead. As explained above, the SSA has specific medical guidelines for evaluating disability from Parkinson’s. Parkinson’s manifests in different ways. What if you don’t meet the SSA’s Parkinson’s criteria? You might still qualify for disability benefits through what’s known as a Residual Functional Capacity (RFC) evaluation. Through an RFC, you will need to work with your doctor to prove that your symptoms prevent you from performing work that you are qualified to do, reliably and consistently. Let’s say you’re 60 years old and your Parkinson’s severely affects one of your legs, but you can still walk. You may not walk quite as well as most people, but you’re not restricted to a wheelchair. This would likely not qualify medically via the Blue Book, but you could still qualify if you can prove that you cannot work at your current job. This would be possible if you were on your feet all day, such as working construction or retail. Older applicants also have a much easier time getting approved for Social Security benefits through an RFC because the SSA believes older adults are harder to retrain and thus unable to take an easier desk job. If you have been diagnosed with young-onset Parkinson’s disease, however, you may have a more challenging time getting approved. This is especially true if you hold a college degree and you work at a desk job. If you experience a similar situation to the example above where you cannot walk, the SSA will argue that you do not need to walk to earn income at your desk job. You can download an RFC for your doctor to fill out on your behalf online. Be sure to submit as much medical evidence as possible when applying for disability benefits, especially when you are unable to meet the SSA’s listing for Parkinson’s disease. With strong medical evidence, you could still qualify for disability benefits. nbsp; APDA makes this information available solely for the purpose of general education. It is not intended as specific advice for your specific circumstance or as legal, insurance or medical advice. APDA encourages those who find this information useful to contact a legal advisor for answers to specific questions and assistance. The following information was graciously provided by the disability law firm of Chisholm Chisholm & Kilpatrick LTD, with support from Douglas L. DuMond of Simian Advisors LLC. APDA does not endorse any disability law firm or have a formal affiliation with CCK or Simian Advisors LLC.