Eligibility

Am I disabled and eligible for benefits? The term disabled has a particular definition for short term disability, for long term disability, for work comp, for a sports team, as well as for the SSA. For now, it only matters what the SSA says. Essentially the SSA says that if you cannot engage in substantial gainful activity (work) by reason of any medically determinable physical or mental impairment which can be expected to result in death or has/will last twelve consecutive months, then you are disabled. Getting benefits depends on how long you have worked and how much you have paid into the program.

It is important that you understand some basic points about how the SSA goes about determining whether someone is disabled. This process doesn’t always make sense. For example, most people think that if they cannot get a job because of their medical problems, this must prove that they are disabled. Or, if their doctor says they are disabled, then that proves they are disabled. But, for the SSA, an inability to get a job proves that you cannot get a job but not that you are disabled.

Disability determination is a “hypothetical” or theoretical determination. The Social Security Administration looks only at whether you are hypothetically able to work, not whether you’d be hired. Work is a term of art. So, forget about what you think work means. For the SSA program, it only matters what the SSA says work means.

Sometimes, the medical findings about your condition alone will cause the judge to find you disabled based on the listings. You can find the listings at ssa.gov/disability/professionals/bluebook/AdultListings.htm. Usually, if you are going to win at a listing level, you will win at the first two steps which are called the initial and the reconsideration.

Generally, we need to prove two things. First thing, your medical impairments prevent you from performing any work you’ve done in the past fifteen years as you performed it or as it is usually performed in the national economy from the time the disability began. Second thing, that there isn’t really any work you are capable of doing considering your age, education and work experience.

The older you are, the better your situation for winning a case. If you are under age 50, the general rule is that you’ve got to prove that you can’t do a sit down job. The SSA comes up with some pretty easy jobs they say people can perform.

Generally, if you are between the ages of 50 and 54, the general rule is that you have to prove that you cannot do work involving being on your feet six hours of the day and lifting up to about 20 pounds. But, even if you could do a sit down job you would win.

Generally, if you 55 or older you have to prove that you cannot be on your feet for most of the day, frequently lifting 25 pounds, occasionally up to 50 pounds.

The SSA asks questions that typically relate to frequency and duration at every level of their process. For example, how often do you have pain and how long does it last. Then, the SSA will ask what you do and compare the answers. So, if you say you have pain every day and it is so severe that there are hours you are in bed every day but your main hobby mountain climbing for weeks at a time, the SSA will question your case. The SSA is also a careful student of your doctor’s records, especially as it relates to vacations, travel, and other activities.

The SSA really likes objective medical evidence. Typically that means they like to look at what tests say. For example, an MRI is a test they like to see. What you want to do is have the testimony of three witness groups in agreement. Those groups are test results or objective medical evidence, your doctor’s opinion including the notes in the medical records, and lay testimony which consists of you, family and friends.