SSD Disability Determination Process

If you have an injury or illness that prevents you from working, you may qualify for Social Security Disability benefits. Once you apply for payments, the Social Security Administration (SSA) will use a disability determination process to decide if you have an eligible medical condition.  

The application process can be complex, and the first attempt at seeking benefits often results in a denial. A Social Security disability lawyer with Berger and Green can review your initial application or assist with an appeal. We have helped thousands of clients receive disability benefits. Our team is here and ready to serve you, too. 

Which Disabilities and Illnesses Qualify?

When making a disability determination, the SSA uses the Blue Book, which lists conditions and illnesses that are disabling and the medical criteria used to evaluate them. Qualifying conditions include but are not limited to:

• Musculoskeletal disorders
• Vision impairment and blindness
• Loss of hearing or speech
• Cystic fibrosis
• Chronic asthma
• Chronic heart failure
• Ischemic heart disease
• Chronic liver disease
• Inflammatory bowel disease
• Chronic kidney disease
• Hematological disorders
• Skin disorders
• Burns
• Endocrine disorders
• Congenital disorders 
• Epilepsy 
• Cerebral palsy
• Mental disorders
• Cancer
• Immune system disorders

Does the SAA Consider Factors Other Than Your Medical Condition?

The SSA administers two distinct disability programs: Social Security Disability Insurance (SSDI) and Social Security Income (SSI). SSDI benefits disabled workers who have paid into the SSDI program through Social Security contributions drawn from their income. Therefore, in addition to making a disability determination, the SSA will also review your work credits to decide on SSDI eligibility.

According to the SSA, the amount of wages or self-employment income needed to earn one work credit in 2022 is $1,510. You can earn up to four credits maximum per year. Workers can usually receive SSDI benefits with a minimum of 20 credits or about five years of work.  

SSI is a needs-based program for disabled individuals with limited income and resources. You do not need work credits to qualify for SSI. However, to receive either SSDI or SSI, your injury or illness must prevent you from engaging in substantial gainful activity (SGA). The SGA amount for 2022 is $1,350 per month ($2,260 for blind individuals). 

Who Oversees the Disability Determination Process?

The initial disability determination is made at the state level through local SSA field offices and state Disability Determination Services (DDS) agencies. You can find your local Pennsylvania or Ohio office here. 

Once your local field office receives your application (you can file in person, by phone, by mail, or online), it will start by verifying non-medical information, such as your age, marital status, and employment. The field office will then turn your application over to the DDS to decide if your injury or illness qualifies. 

The DDS looks at the medical information you submitted with your application. If your medical documentation is insufficient, the DDS may ask you to submit to a consultative examination (CE). If the DDS decides your condition is disabling, the SSA will determine the amount of your benefits and begin payments. If the DDS decides you do not qualify, the SSA will deny your claim. 

Fast Track Conditions

The SSA may fast-track the disability determination process for certain medical conditions it deems severe enough to automatically prevent an individual from doing SGA. Some conditions considered for Compassionate Allowance by the SSA include:

• Amyotrophic lateral sclerosis (ALS)
• Esophageal cancer
• Gallbladder cancer
• Hydranencephaly
• Inflammatory breast cancer (IBC)
• Mesothelioma
• Small cell lung cancer
• Thyroid cancer

Why Would the SSA Deny Your Claim?

There are several reasons why the SSA may deny your application, including:

• You did not submit sufficient medical evidence
• You do not comply with a CE request 
• The SSA determines your injury or condition is not disabling
• The SSA does not believe your disability will last at least 12 months
• You fail to comply with your prescribed treatment plan
• Drug addiction or alcoholism contributed to your condition
• The SSA does not know how to contact you
• You have not earned enough work credits

Our Social Security Disability Lawyers Can Help With An Appeal

If the SSA denies your disability claim, our lawyers can assist with appealing their determination. We can:

• Review your initial application and uncover the reason for the denial
• Obtain missing documentation or medical evidence
• Correct any clerical errors or technical problems with your application
• File your appeal request and represent you throughout the appeals process

Steps of an Appeal

The four stages of an appeal are:

• Reconsideration – You have 60 days from receiving notice of the SSA’s initial determination to ask for reconsideration for medical or non-medical reasons. During reconsideration, a claims examiner not involved with your original denial will review your application.
• Administrative Law Judge (ALJ) hearing – If reconsideration results in another denial, you can request a hearing before a Judge. During the hearing, you will present evidence, and witnesses may testify. We can represent you during the hearing and question witnesses. 
• Appeals Council – If the ALJ does not decide in your favor, you have 60 days from receiving notice of the decision to ask the Appeals Council to review your case. At this stage, you can submit new evidence. The council may send your claim back to the ALJ.
• Federal court – If you are not satisfied with the outcome of the Appeal Council’s decision, you can file an action with your local United States District Court. 

How Much Is the Average Disability Payment?

According to the SSA, the average monthly disability benefit paid to all disabled workers was $1,234 in 2019. While this is a modest sum, it can make a huge difference for those unable to work due to an injury or illness.  

We understand that for many, SSA payments are vital to make ends meet and pay for basic needs. We want to help you get the disability benefits you deserve. Let us fight for you and your family. 

Call Berger and Green Today

For help reviewing your Social Security disability application or assistance with an appeal, reach out to Berger and Green today.