Childhood Disability

CHILDHOOD DISABILITY

The requirements for childhood disability claims are different from that of an adult and have been the subject of relatively recent Supreme Court action. As any practitioner will tell you – winning a child disability claim is not easy. This struggle for benefits is based largely in part to the strict definitional requirements for childhood disability.

Where an adult will be evaluated under a 5 step sequential evaluation process, a child will only go through 3 steps.

1.    Is the child working at a gainful level? (If yes, the claim is denied at the first step)

2.    Does the child have a severe impairment? (If no, the claim is denied at step two)

3.    Does the child equal or meet the functional limitations of a listed impairment?

It is often at the 3rd step where the difficulty begins. After all, how do you determine a child’s “functional limitations”??

In determining a child’s functional limitations, SSA will look at the child “as a whole” under 6 domains. These domains are:

1.    Acquiring and using information

2.    Attending and completing class

3.    Interacting and relating with others

4.    Moving about and manipulating objects

5.    Caring for oneself

6.    Health and physical well being

A child must be found to be at least markedly impaired in two of the six domains to be considered disabled.  What is markedly limited? SSA defines that as “less than extreme but more than moderate”.  See how clear that is? There will be more blogs in the near future on childhood disability claims. Stay tuned!

Burton McKinnish: Social Security Disability

SSA Lingo

When I first became a cop I had a terrible time memorizing the “10” codes (10-4, 10-6, 10-32, etc,etc). But pretty soon I had 90% of em down pat. To this day I bet I could still get 50% right.  Then I started my job with the Social Security Administration. On my first day I was bombarded with initials and lingo that I had no clue about. What’s worse is that one sentence could contain several words in lingo!! But alas, just like being a cop I had 90% of em down pat within a few weeks. As a claimant for social security benefits, knowing the lingo will help you better understand SSA staff when discussing your claim. If you are an attorney, you better KNOW these following terms or face looking like a fool in front of your client when the Judge asks you a question using the SSA lingo. Heres the basics...

Lingo	Translation	Meaning
AOD	Alleged Onset Date	The date you are claiming you became disabled
CDR	Continuing Disability Review	A follow up determination to see if you have remained disabled
DAC	Disabled Adult Child	A person who is now an adult but became disabled while a child
DEQY	Detailed Earnings Query	List of your income and places you worked
DIB	Disability Insurance Benefits	Social Security’s Insurance benefits for the disabled
DLI	Date last insured	The last time you are eligible for insurance benefits
DOT	Dictionary of Occupational TItles	A book of Job descriptions
DSM-IV	Diagnostic and Statistical Manual - 4th edition	The mental health “go to” book.
PIA	Primary Insurance Amount	How much $$ you get if disabled
POMS	Program Operational Manual	SSA’s instruction book
QC	Quarter of Coverage	Earn 4 per year working at a gainful level
RFC	Residual Function Capacity	What you can do despite your disability
SGA	Substantial Gainful Activity	Sufficient work
SSA	Social Security Administration
SSI	Supplemental Security Income	Insurance for those who do not have sufficient quarters of coverage
SSR	Social Security Rulings	Policy on SSA decisions
TWP	Trial Work Period	An attempt to work after being disabled

These are the most used ones but there are several others. Remember the “meanings” section is just my own layman’s definitions. A true SSA scholar would have a conniption with some of my definitions but these should give you a working knowledge of the system. 

SSA HEARINGS - WHAT TO EXPECT

During my initial interviews I have to explain to my potential clients that most cases will end up in front of a Judge. I often sense an immediate apprehension when I use the word “Judge” or “Courtroom”.  Most people only know about Court from what they see on Law & Order. However, Social Security hearings are about the furthest thing from what is seen on Law & Order that you can imagine. But there are a few similarities that you will need to be familiar with. 

Social Security hearings are not adversarial. This means that Social Security will not have an attorney present to cross examine you. In many cases it will be just you, your representative, the Judge, and a court reporter. The Judge is neutral and while he is a part of the Social Security Administration he is not bound by any prior agency determinations on pending claim. Most hearings have the feel that you are just having a conversation with the Judge. 

Strict rules of evidence rarely apply in Social Security hearings. Hearsay is allowed and documents are do not require a foundation as you typically see in civil and criminal court. But, like we see in Law & Order, all witness must be sworn under oath with penalty of perjury.  You will be asked to raise your right hand when you swear under oath but don’t make a big deal if you raise your left one – ive seen it happen a hundred times.

When the Judge asks you a question you should answer the question. Do not tell your life story. The Judge most likely has another hearing scheduled within 45 minutes of yours so be mindful of the time. If a Judge asks you about your arm and there is nothing wrong with your arm – say so and stop. Don’t immediately jump to what your disabling condition is. He will get to that soon enough.  If the Judge asks you how long or how far you can do something don’t say “not long” or “not far”. The Judge knows you don’t have a stop watch with you all the time but he will need some sort of idea as to the answer. If the Judge asks a question about distance be sure to use a distance that is common. Don’t say “from my front porch to my neighbor’s house”. The Judge will have no idea how far that is. Perhaps you could use a city block or a football field as a guide. 

Dress normally but cleanly. There is no reason for you to wear a suit but there is also no reason for you to wear a t-shirt with holes in it that has profanity on the front. In the majority of cases the Judge will not tell you his decision from the bench. He will close the hearing and issue his decision in writing.  

2010 Disability Statistics

SSA has released the 2010 Disability Statistics. In 2010, 1,026,988 disabled workers were awarded benefits. This statistic does NOT include only those individuals who qualified for SSI (Supplemental Security Income) only. This statistic represents only those persons who were "insured" to receive benefits by working five out of the last ten years. Here is the breakdown by impairments:


32.5% Musculoskeletal and connective tissue


21.4% Mental Disorders (more on that statistic in a bit)


10.2% Circulatory


9% Neoplasms


8.2% Nervous system and sense organs


18.7% Other


The Mental Disorders category was further analyzed by SSA which concluded the following:


11.2% Mood disorders


2.9% Organic Mental disorders


2.1% Schizophrenic and other psychotic disorders


1.8% Intellectual disabilities


.1% Developmental disorders


.2% Autistic disorders


3% Other

5 STEP SEQUENTIAL EVALUATION

The Social Security Administration has developed a five (5) step sequential process to determine if a claimant is eligible to receive disability benefits. This test is only for adults as children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

Is the claimant working? If so, how much? There is a presumption that certain amounts of income constitute substantial gainful activity (SGA). In 2011 the limit is $1000.00 per month. (Blind claimants have a higher limit). This amount changes almost yearly. Of course a person can still be found to be performing SGA even if the monthly income is less than $1000.  So if you are working at a substantial gainful level your disability process ends here. You do not continue to the other steps.

Step 2: Severe impairment

The claimant must have a severe impairment or a combination of impairments which significantly limit his physical or mental ability to do basic work activities without regard to age, work history, or education.  The level of proof at this level is considerably low and the majority of claimants proceed on past this level. 

Step 3: Listing of Impairments

SSA has established a list of impairments that qualify for disability benefits. At this stage a claimant must show that he meets or equals at least one of the listed impairments. This determination is made without regard to a persons age, education, or work history. Most claimants do not meet or equal a listing level impairment. The Social Security definitions and requirements contained in the listings are designed for the most severe cases. Even if a claimant does meet or equal a listed impairment the claimant must also meet the durational requirements that the impairment is expected to last 12 months or longer or end in death.  If a claimant equals or meets a listed impairment and meets the durational requirement benefits are awarded at this step. If the claimant does not meet or equal the listings then the case will proceed on to the fourth step.

Step 4: Past Relevant Work

If a claimant has a severe impairment (step 2) but does not meet or equal a listed impairment (step 3) then SSA will look at past relevant work. Past relevant work is work performed 15 years prior to the onset of disability. Given a residual function capacity does the claimant have the ability to return to their past relevant work? A residual function capacity is basically a determination of what a person can do despite their impairment. For example a person with COPD may no longer be able to lift 50lbs but can still lift 10lbs on a sustained basis. The constraints of the residual function capacity will determine if the claimant can perform their past relevant work. For example, if your past relevant work required you to lift 50lbs and walk 8 hours a day and your residual function capacity due to a back injury limited you to only lifting 25lbs and walking 4 hours a day then you would be found unable to return to your past relevant work. If you are determined that you can return to your past relevant work you will be denied disability at this step.

Step 5: Ability to perform other work

So SSA says that you cant go back to your past relevant work but now asks are there other jobs you can go do. The determination at this step factors in your residual function capacity, age, education, and prior work. The majority of SSA disability claims are decided at step 5. If it is determined that you cannot perform other work the a claim for benefits would be awarded. If you are over 50 don’t be alarmed by the requirements under step 5. SSA has a table called “GRIDS” that factor in age. If you are 55 and your past relevant work is Heavy concrete layer then SSA will require you to go be retrained to perform sedentary jobs.

SSA expands compassionate allowance list

Beginning this month the SSA will add 13 additional new conditions to its list of compassionate allowances. When a claimant for disability benefits alleges  one of the conditions listed on the compassionate allowance list the claimant will begin receiving benefits while the claim is being processed through the agency. This could save the claimant months of waiting for benefits to begin.  Unfortunately, many attorneys and representatives are not aware of this list and often allow a claim of benefits under this provision of SSA policy to go unused. The 13 new additional conditions are:


Malignant Multiple Sclerosis
Paraneoplastic Pemphigus
Multicentric Castleman Disease
Pulmonary Kaposi Sarcoma
Primary Central Nervous System Lymphoma
Primary Effusion Lymphoma
Angelman Syndrome
Lewy Body Dementia
Lowe Syndrome
Corticobasal Degenreration
Multiple System Atrophy
Progressive Supranuclear Palsy
ALS/Parkinsonism Dementia Complex