Defining a Medical Disability for Purposes of Obtaining SSDI Benefits in Maine, Massachusetts and New Hampshire

822347_59633629The Social Security Disability Insurance (SSDI) is a Federal program that pays benefits to individuals with disabilities and certain members of their family if they have worked long enough and paid Social Security taxes as part of that employment.  It is available to qualified residents of any state in the United States, including Maine, Massachusetts, and New Hampshire. Arguably, the most difficult part of qualifying for SSDI benefits is meeting the strict definition of “disability” under federal law. The Social Security Act defines “disability” as the inability to engage in any substantial gainful activity due to a severe medically determinable physical and/or mental impairment(s), which can be expected to result in death, or which has lasted, or can be expected to last, for a continuous period of one year or longer.

Every SSDI benefit applicant has the right to retain legal counsel when applying for SSDI benefits and throughout the appeals process. Your attorney will typically handle the communications with the agency as your representative. Disability Determination Services (DDS) is the federally funded state agency that makes the initial (or, if on an initial appeal in Maine or Massachusetts, reconsideration)  determination of whether an applicant is disabled under the law. DDS will assign the SSDI claim to a disability examiner employed with DDS. The DDS examiner will evaluate all of the medical evidence submitted with the application, including medical records, treatments, medications, test and laboratory results, and other medical reports, questionnaires, narratives your attorney may assist you with obtaining from your treatment providers.  While DDS will also ask your doctors for their treatment documentation, they will not typically request information regarding the severity of your condition and how it limits your ability to work: this is typically left to your attorney to work with you to gather in support of your application for benefits.  If one is not in significant treatment for a condition claimed to be severe and disabling, DDS may determine that additional information is needed and may request that you undergo an examination with one of their doctors (called a consultative examination).

In making their determination, the Social Security Administration remains concerned as to the source of the medical information being provided as part of their determination as to whether the applicant has been disabled. Generally, treatment and diagnosis from licensed doctors, psychiatrists, and psychologists are considered by DDS as acceptable sources in determining a medical disability. However, documentation from unlicensed caregivers, massage therapists, acupuncturists, chiropractors or other various medical sources may not be persuasive or even considered in the DDS examiner’s determination of disability.

DDS takes into account many considerations and factors when deciding whether a claimant is disabled. If an applicant is currently working and earns over a certain amount, DDS will find that the applicant is engaging in substantial gainful activity and therefore does not meet the first step in their evaluation process: that is, that they are not earning gainful wages.   That amount typically increases each year. In 2015, for example, the limit is $1,820 per month for blind applicants and $1,090 per month for applicants with other disabilities. In addition, DDS must address the extent to which the applicant’s medical conditions interfere with their ability to perform basic job functions that are deemed necessary for any manner of gainful employment: that is, sitting, standing, walking, lifting, pushing, pulling, remembering, paying attention, interacting appropriately with coworkers and supervisors and simply attending to basic task functions necessary for simple, unskilled, sedentary type work.  Ultimately, the DDS findings as to one’s functional limitations are evaluated as to how they hinder one’s ability to perform any manner of gainful employment for which one is reasonably suited by age, education and experience for a year or longer.

Assuming the applicant’s medical condition is one that is identified within Social Security’s Medical Listing of Impairments (List of Impairments), one will be found automatically disabled from a medical standpoint if their condition is deemed to meet the criteria for one of these listed impairment.  This determination would be made without the need to consider whether they can perform other jobs (either that they have performed in the past, called their past relevant work or other jobs that are deemed to exist in significant numbers either in the claimant’s region or in significant regions of the national economy).

If not, the evaluation process continues with what are called Steps 4 and 5 of the sequential evaluation process, which is a determination as to whether the applicant is able to perform any of the work they have performed in the 15 years prior to becoming disabled.  Assuming the answer is yes, then a determination would be issued that states the individual is not found disabled under Social Security’s rules.  Assuming, however, the applicant is deemed unable to do the work he or she did before, the agency will look to determine whether other jobs exist in the national economy or in their region, or in significant regions of the country, that they can perform based on the Agency’s consideration of the applicant’s age, education, work experience, and skill set, with consideration as well as to the applicant’s medical condition and how it impacts their functional capacity (both physical and/or mental).  If DDS determines (upon taking into account the above considerations) that the applicant would be capable of performing other manners of manners of gainful work as set forth above, DDS will deny SSDI benefits. It is also important to note that there are special rules regarding people who are blind or have low vision, which can be discussed with a knowledgeable social security disability attorney.

If your application for SSDI benefits is denied because DDS determined that you are not disabled, you will remain entitled to appeal that decision (and through what could be multiple levels of appeal). A knowledgeable SSDI attorney will guide you through the process and ensure that your rights are protected in all stages of the proceedings, from the initial application to the final appeal.  With this in mind, a call to the Law Offices of Russell J. Goldsmith at 1-800-773-8622 will provide you with the additional advice and assistance to make your way through the maze called the Social Security system.