Understanding Social Security Administration’s Rules on Being Disabled

Many people suffer from one or more medical conditions that make it very difficult if not impossible for them to keep their current job. In many cases, even going back to any similar type of work is problematic.  When this occurs, a person will typically go to their treating physician for a letter of opinion to submit along with a written application for Social Security Disability Insurance (SSDI) benefits. The claimant’s doctor may have very little question claimant cannot work and will often have no issue with writing these opinion letters.

SSDI BostonIf the particular doctor is at all familiar with the requirements of the U.S. Social Security Administration (SSA), he or she will often include a series of limitations on claimant’s ability to work including some of the following:

  • Claimant’s ability to stand for any long period of time.
  • Claimant’s ability to sit for any period of time.
  • Claimant’s ability to squat or crouch while at work.
  • Claimant’s inability to lift objects of a certain weight, and if they can lift them all, for how long they can do so over the course of a workday.
  • Claimant’s mental ability to concentrate and perform the tasks necessary for claimant to go back to work.

As our Boston Social Security Disability Insurance benefits attorneys can explain, it is not only physical disabilities, but also mental disabilities which can make a worker unable to work within the context of the SSDI system.  When we say mental disability we may be talking about intelligence, which is still a factor considered by SSA, but it can also include various mental health conditions such as post-traumatic stress disorder (PTSD), major depressive disorder (MDD), bipolar disorder (formally called manic depression in previous editions of the DSM), and sleeping disorders like insomnia.  In many cases, it will not be a single disabling condition, but rather a combination of disabling conditions, which contributes to a disability finding by the SSA.

Engaging in Substantial Gainful Activity in Boston Disability Cases

The first thing to keep in mind is that being unable to work does not only mean you cannot go back to your old job, even if that was the type of job for which you have education and years of training an experience, but any job in which you can engage in substantial gainful activity. This term of art basically means you cannot work at any job, even with reasonable accommodations for you disability, that will allow you to earn a gross income (before taxes) of approximately $1,120 a month. As you can see, this is a very low bar. Even though you may not be able to survive or take care of your family making $12,000 a year, this is the standard, and while that may change from year to year to account for the state of the economy, it does not seem likely there will be a major increase in the substantial gainful activity level anytime soon.

Recent Example of a Social Security Disability Insurance Adjudication

In Coskery v. Berryhill, a Social Security Disability Insurance denial appeal from the U.S. Court of Appeals for the First Circuit, which happens to include cases filed in Boston, a claimant had become disabled after working as a line cook in New England.  He filed his claim for SSDI benefits in 2013 and his application was denied.  This is very common since data shows the clear majority of all applications are initially denied. This is done without any real medical review and it is often done for the reason claimant was not found to be disabled.

At this point, claimant must file a request for reconsideration, which is done online or in person at your local SSA office and then must wait a few months for what will likely be another denial.  We are not saying it is impossible to get approved at this stage in the process, but it is difficult,  so the next step will be to file for a hearing before an Administrative Law Judge (ALJ).  At the hearing before the ALJ, the main issue was whether claimant was disabled as is often the case.

The ALJ cited the standard from 42 U.S.C. Section 432 (a)(1), which states that to be disabled a claimant must be unable to engage in substantial gainful activity by reason of a medical determinable physical or mental condition for a period of at least 12 months. In addition to what we discussed above, it should be noted SSDI is not available for short-term disability, and since it often takes between one and two years to get approved, it wouldn’t help anyway.

The ALJ found even though claimant did have a medical disability that did not allow him to keep his old job, he could perform light work thus meaning he could qualify for substantial gainful activity employment.  At this point, claimant filed for review by the Social Security commission and it was found he was not disabled. This is a discretionary review from the standpoint of SSA, but they will often hear these appeals and usually deny them.

The next step in the process was to appeal to the U.S. District Court in which jurisdiction is proper. This is not a full hearing before a judge in most cases, but rather a review before a magistrate. In this case, the magistrate affirmed ALJ’s finding claimant was not disabled. At this point, claimant appealed to the U.S. District Court for the First Circuit.  While the court of appeals has a right to review the case in a more broad manner than the lower courts, the court concluded ALJ had not erred as a matter of law, and affirmed his finding claimant was not disabled.

While many claimants are ultimately successful, many are not, so the best thing a claimant can do is seek the help of an experienced Boston SSDI lawyer as early in the process as possible. Claimant should not worry about being able to afford an experienced SSDI lawyer because the system is set up in such a way that no fees will be paid unless claimant is successful, and then fees will be paid from the retroactive benefits award so there will never be any out of pocket legal fees paid.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Coskery v. Berryhill, June 4, 2018, U.S. Court of Appeals for the First Circuit

More Blog Entries:

Establishing Medical Disability in Boston SSDI Cases, March 21, 2018, Boston SSDI Lawyer Blog