Social Security Disability and SSI the Basics 

On this webpage I will explain Social Security disability and supplemental security income. If you are attempting to get disability under both or one of these programs the definition of disability is the same. The Social Security Administration defines disability as:

"The inability to engage in any substantial gainful activity by reason of the medically determinable impairment, physical or mental (or combination of impairments), which can be expected to result in death, or which has lasted or can be expected to last for continuous period of not less than 12 months."

I will now discuss the two programs. I will start with Social Security disability insurance. 

Social Security disability also called Title II, SSD I, SSD and DIB.

To be eligible for Social Security Disability Benefits you must have paid into the social security system by way of Social Security tax that you pay the government from your work earnings. You must have sufficient work credits to be considered fully insured. This means you must of worked and paid taxes long enough to have enough credits to be eligible. You must also have recent work credits. Although this can depend on the claimants age in most situations a claimant must of worked five out of the last 10 years to be fully insured and eligible for SSD. To be eligible to receive benefits you must be found disable while you are insured. If you have worked consistently than you would normally have five years from the date you last worked before your insured status runs out. The date your insured status runs out is called your date last insured or DLI. If you are found disabled your benefits start on the six month after the month in which SSA found you to be disabled or one-year prior to the date of your application whichever is less. If you are found disabled you are also entitled to Medicare benefits two years and six months from the date SSA found disabled or after you have been receiving benefits for a period of two years. 

Supplemental security income benefits also called Title 16 and most commonly SSI.

SSI is a federal welfare program for the disabled and elderly and it is based on financial need. Unlike SSD, where the benefits are paid from social security trust fund, the payments for SSI come from general tax revenues. Therefore, eligibility for SSI is not based on work credits, instead to be eligible for SSI one must have limited income and resources. To be eligible for SSI one must both be financially eligible and 65 or older or blind or disabled. How SSA determines if you are disabled is the same for both SSD and SSI and will be explained later in this page. I will now discuss the financial eligibility for SSI. To be eligible for supplemental security income one must have resources that are less than $2000 for an individual and $3000 for a married couple. The home is excluded from the calculation of resources. The cash value of other assets which include things like life insurance and investments are counted as resources. One car per household is excluded from the calculation of resources. What SSA considers to be resources can start to get a little complex. Earned and unearned income in the household in which the claimant lives will be calculated in determining eligibility. I should also note here that if you have a claim for SSD and SSI the SSD payments will be counted as income and can reduce or eliminate SSI benefits. In most situations, one must be a citizen to be eligible for SSI. There are exceptions to this rule that are too numerous to discuss here but the information exceptions to this rule can be found on my website at http://www.ultimatedisabilityguide.com/ssi.html and the SSA website.

There is also child's SSI but since this is a website for veterans I will not discuss this program on this page. 

The Social Security Disability and SSI five step process that determines if you are disabled.

Now that I have discussed the Social Security Administration's definition of disability and the two main programs for the disabled I will now explain how the decision-makers at SSA determines if you are disabled. They use a five step process to determine disability.

At step 1 of the process, SSA will determine whether you are considered working under their rules. This means you are working to an extent that they call substantial gainful activity or SGA. When SSA considers whether or not you are considered working at SGA level how they determine this will depend on whether you are an employee or self-employed. If you are an employee than substantial gainful activity will be found if you earn more than $980 gross a month for the year 2009. If you make less than $980 per month and then your work will probably be considered not SGA. Each year has a different SGA threshold so every year prior to 2009 the amount you can make is a little bit less each year you go back. If you are self-employed the rules can be quite complicated on what is and what is not SGA so you may need to seek legal advice if this pertains to you. If social security determines that you are working at SGA level then you will be found not disabled. If they find you are not working at SGA level then you proceed to the next step.

At step two, SSA will determine if you have a severe impairment. Social Security defines a severe impairment as: "an impairment, or combination of impairments, is considered severe if this significantly limits your physical and mental abilities to do basic work activities." An impairment will be considered severe if that impairment imposes more than mild limitation on one's ability to perform work related activities. The severe impairment must last for 12 consecutive months or be expected to result in death. If you are found to have a severe impairment you then move to the next step. If your impairment is found to be not severe then you are found not disabled.

At step three, SSA will determine if you have an impairment that meets or equals a listed impairment. The medical listing of impairments is grouped into categories. A copy of the medical listing of impairments can be found on the SSA website at http://www.socialsecurity.gov/disability/professionals/bluebook/listing-impairments.htm . The medical listings are set up to find someone disabled where their condition is considered so severe that it would prevent the individual from doing any gainful activity without consideration to their age, education or work experience. If one doesn't exactly meet a particular medical listing they can also be found disabled at this stage if they are found to equal a listed impairment. This means their condition is at least equal in severity and duration of the criteria of any listed impairment. To be found disabled at this stage of the process it takes a medical opinion that you meet or equal one of the listing impairments. If you are found to meet or equal listed impairment you are found disabled. If you are found not to meet or equal listed impairment you then move to step for the process.

At step four, SSA will determine if your impairment prevents you from performing your past relevant work. In other words, if the limitations caused by your medical condition both exertional and non-exertional would prevent you from performing the requirements of your past relevant work. SSA considers the work you did in the prior 15 years as past relevant work. To make this determination and a determination at the next step the decision-maker will decide what your residual functional capacity is. This is defined as "the most a claimant can physically or mentally do despite his or her limitations". So in a nutshell, SSA will look at the requirements of your past work and compare it to your residual functional capacity to determine if you can perform any of your past work. When determining someone's residual functional capacity there exertional limitations are classified as sedentary, light, medium, heavy, or very heavy. There are also non-exertional limitations which are considered which include but are not limited to environmental limitations and mental limitations. If it is found that you cannot perform your past relevant work then you proceed to step five. If you it is found that you can perform your past work than you are found not disabled.

At step five, SSA will determine whether or not you can do other work existing in significant numbers in the regional and national economy based on your residual functional capacity. Your age education and past relevant work experience are all very important at this stage in the process. To determine whether or not there is significant number of jobs SSA will refer to the medical vocational guidelines also commonly called the GRIDS. For a full explanation of the GRIDS and how they are used you can visit my webpage at http://www.ultimatedisabilityguide.com/grid_rules.html . The GRID rules will look at your age, education and past work experience and your residual functional capacity and compare it to a chart that will direct the finding of disabled or not disabled. However, often times especially when one has non-exertional impairments they will not fit neatly into this chart. A vocational expert is often used as an expert witness to help determine what if any jobs and the number of those jobs an individual with your residual functional capacity could perform. So if after this evaluation the decision-maker decides there is a significant number of other jobs you could perform then you will be found not disabled. If SSA finds there is not a significant number of jobs you could perform or the GRID chart shows you are disabled then he will be found disabled.

The above is a quick summary of the five step process but if you want to give yourself the best chance to win your case you should research not only how SSA determines if you are disabled but what you can do to make your case stronger. I have authored a comprehensive website on Social Security disability and SSI which includes many helpful tips and strategies to win your case depending on your particular medical conditions. To continue your research feel free to read my comprehensive website at http://www.ultimatedisabilityguide.com/index.html . I will also in the future write from time to time addressing specific subjects on Social Security disability and VA compensation here on Jim Strickland's website.