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Social Securtiy Disability The Long Road to Approval

5/22/06
Marilyn Caldwell, PA-S
1218 Memorial Ave, Apt 4
Williamsport, PA 17701
336-575-7027
calmar23@email.pct.edu
Pennsylvania College of Technology PA Program

Introduction

When most people think of the word disabled they tend to think of people who are born mentally or physically
challenged. They don't think of the other population of people who have become disabled over time from other
causes. These are people that have functioned normally and usually worked a blue-collar job all their life
until they just unable to continue. Usually, they have been disabled by trauma, experience deterioration of
their body or in most cases, both. Most of these people tend to also have a lower amount of education than
the general United States population1. The Survey of Income and Program Participation (SIPP) conducted by
the U.S. Census Bureau in 2001, showed that 38% of disability recipients had a high school diploma, 15%
percent had a 9th - 11th grade education, and 10% only had 8 years of education or less1. The number of
people receiving disability benefits has risen dramatically after the last decade. In 1996, 7,689,664 people were receiving disability benefits and in 2004 the number had risen to 9,773,201, this included all types of disability benefits1. As the data shows, disabled workers are becoming more common and a growing problem in the US. They need help from all aspects of the process to assist them in receiving the benefits they deserve. As PC-A, we need
to educate all medical professionals, friends, and families of these people to try to help them along the long and frustrating process of applying for and eventually receiving Social Security Disability (SSD). This guide will be geared towards helping your disabled adult patient apply for SSD or SSI.

Before you start to help, there are a few definitions that you should know. To simplify, SSD is only for people who have worked at a job that has deducted social security tax from their paycheck for the last 10 to 15 years. For someone who has not worked in the recent past or has a significantly low income; Supplemental Security Income (SSI) is available, which comes from everyone's US tax dollars2. SSD and SSI are not based on private disability insurance company decisions and is a completely separate process. The Social Security Administration (SSA) defines disability as the "inability to engage in any substantial gainful activity (SGA) 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."3 Disability is awarded to people based on strict guidelines; so that the people that are not truly disabled do not get through the system and take away the SSA's resources that are rapidly being depleted.

Eligibility
The following people are eligible for SSD:
" disabled workers under 65 and their families,
" individuals who become disabled before 22, if a parent (or in certain cases, a grandparent) who is covered
" under Social Security retires, becomes disabled, or dies,
" disabled widows or widowers, age 50 or over, if the deceased spouse worked long enough under Social Security.
" This also applies to certain disabled surviving divorced spouses over 50
" blind workers3
The following people are eligible for SSI:
" Disabled persons under 65 who have very limited income and resources
" Disabled children under 18
" Blind adults or children3
In addition to the above criteria, as the definition states, your patient must be unable to work at any type
of job, not just the one they have worked at most of their life, and also be physically or mentally disabled
so that their disability will last for at least 12 months and therefore will be unable to be gainfully employed.
If your patient wants to try to work while applying for disability, inform them that it is ok as long as they
earn no more than $860.00 a month. Take note that this number changes every year4. Remember if you feel someone
is unable to work, you can write them out of work for the amount of time you feel is necessary. This can be a
helpful part in your patient's application for disability.

The Process and How You Can Help

The first step for your disabled patient who wants to apply for disability is to call the SSA or stop by their
local SSA office to set up a telephone interview. The first forms to be filled out are Adult Disability and Work
History. These forms are also available online at www.ssa.gov or picked up at their local office. When the telephone
interview occurs, please inform your patient that they need all of their medical and work history information
gathered and available during this interview because they will be asked many questions about these two aspects of
their life. After the interview is completed and the forms are received at the local SSA office, it takes about
six months to get a decision. This is the stage where the most people are denied5, so you need to convince your
patients to not give up. The next stage is called the reconsideration stage and now your patient needs to fill
out a new form called a Request for Reconsideration where they will be asked to update their medical and work
history since the last time they filled their initial application form with the SSA. Again, many people are denied at this stage5, but try not to let your patient lose hope of receiving their well deserved benefits. If their reconsideration is denied, your patient can request a hearing and they will again be asked to update their medical and work history based on the time since the reconsideration forms were completed. After the Request for Hearing is submitted, the SSA will begin to collect medical records from every place that the patient has listed in all of the forms previously submitted. This is also a time when the SSA will request that your patient receive a Consultative Examination (CE) from a physician working for Disability Determination Services (DDS). Many patients do not want to attend these appointments because they know that the physician works for SSA and therefore are usually working against the patient. You must inform your patient that these appointments are necessary if they want to continue the process. Sometimes more than one CE may be ordered for more than one doctor. If your patient also has an attorney helping with their case then their attorney may submit a Physical Capacities Examination (PCE) form to you to be filled out and signed by you or your physician. If you receive a PCE, fill out the form and have your supervising physician sign the form. The SSA is just recently beginning to consider physician assistants and their opinions. Currently, their decisions are ultimately swayed by a physician as opposed to a PA-C5. Hopefully in the future that will change and they will weigh your opinion and the physician's opinion equally. Until then, you need to fill out these forms for your patients and have your physicians sign them. Another piece of evidence that can be helpful and be submitted to the SSA is a short letter from you or your physician stating that you feel your patient is permanently and totally disabled and that they are no longer able to be gainfully employed5. Next SSA will set a hearing date usually after a year or two of waiting. It is important to inform your patient that it is extremely important that they attend their hearing because the judge will base his or her opinion on your patient's past medical and work history and your patient's appearance on that day. You should inform your patient to dress as they usually would, there is no need make themselves "pretty" for the hearing, it can actually be detrimental to their case.

Conclusion
Remember that this process can take a few years to complete and therefore your patient will be going through a rough time financially, physically, and mentally. If your patient loses their health insurance because they can no longer work, try to provide them with free medical clinic information in your area and also be aware that your patient, if not already, may begin to feel depressed and that these feelings should not be overlooked. Besides possible treatment, you can simply take time to listen and help comfort your disabled patient and encourage them to continue with the process even though it may feel like nothing is happening and that the process will never end. For most people who are truly disabled and make it to the hearing, they have a good chance of being approved and you should continue to remind them of that when they come in for their appointments. Remind them that you are there to help and are willing to fill out any paperwork that can help their case or any other care that they need.
References

1. Social Security Association. The Annual Statistical Report on the Social Security Disability Insurance Program,
2004. Available at: http://www.ssa.gov/policy/docs/statcomps/di_asr/2004/di_asr04.pdf. Accessed March 25, 2006.
2. Social Security Association. Difference between Social Security disability and SSI disability. Available at:
http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_faqid=245&p_
3. Social Security Association. The Answers for Doctors & Other Health Professionals Page.
Available at: http://www.ssa.gov/disability/professionals/answers-pub042.htm. Accessed March 25, 2006.
4. Social Security Association. Working While Disabled - How We Can Help. Available at:
http://www.ssa.gov/pubs/10095.html#part3. Accessed March 25, 2006.
5. A. Caldwell, Esq., Personal interview, March 21, 2006.

© 2006 Marilyn E. Caldwell