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Disability is something most people do not like to think about. But the chances that you will become disabled probably are greater than you realize. Studies show that a 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching retirement age.
This chapter provides basic information on Social Security disability benefits and is not intended to answer all questions. For specific information about your situation, you should talk with a Social Security representative.
Social Security pays disability benefits through two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program.
This chapter is about the Social Security disability program. For information about the SSI disability program for adults, see Supplemental Security Income (SSI) (Publication No. 05-11000). For information about disability programs for children, refer to Benefits For Children With Disabilities (Publication No. 05-10026). Publications are available online at www.socialsecurity.gov.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security disability insurance program (title II of the Social Security Act (the Act)) and the supplemental security income (SSI) program (title XVI of the Act).
Title II provides for payment of disability benefits to individuals who are “insured” under the Act by virtue of their contributions to the Social Security trust fund through the Social Security tax on their earnings, as well as to certain disabled dependents of insured individuals. Title XVI provides for SSI payments to individuals (including children under age 18) who are disabled and have limited income and resources.
The Act and SSA’s implementing regulations prescribe rules for deciding if an individual is “disabled.” SSA’s criteria for deciding if someone is disabled are not necessarily the same as the criteria applied in other Government and private disability programs.
For all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical 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 not less than 12 months.
Under title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings--not only by the individual’s statement of symptoms.
Most disability claims are initially processed through a network of local Social Security field offices and State agencies (usually called disability determination services, or DDSs). Subsequent appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges in SSA’s Office of Hearings and Appeals.
SSA representatives in the field offices usually obtain applications for disability benefits, either in person, by telephone, or by mail. The application and related forms ask for a description of the claimant’s impairment(s), names, addresses, and telephone numbers of treatment sources, and other information that relates to the alleged disability. (The “claimant” is the person who is requesting disability benefits.)
The field office is responsible for verifying nonmedical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information. The field office sends the case to a DDS for evaluation of disability.
The DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical evidence and rendering the initial determination on whether the claimant is or is not disabled or blind under the law.
Usually, the DDS tries to obtain evidence from the claimant’s own medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for a consultative examination (CE) in order to obtain the additional information needed. The claimant’s treating source is the preferred source for the CE; however, the DDS may also obtain the CE from an independent source.
After completing its initial development, the DDS makes the disability determination. The determination is made by a two-person adjudicative team consisting of a medical or psychological consultant (who is a physician or psychologist) and a disability examiner. If the adjudicative team finds that additional evidence is still needed, the consultant or examiner may recontact a medical source(s) and ask for supplemental information.
The DDS also makes a determination whether the claimant is a candidate for vocational rehabilitation (VR). If so, the DDS makes a referral to the State VR agency.
After the DDS makes the disability determination, it returns the case to the field office for appropriate action depending on whether the claim is allowed or denied. If the DDS finds the claimant disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits.
If the claimant is found not disabled, the file is retained in the field office in case the claimant decides to appeal the determination. If the claimant files an appeal of an initial unfavorable determination, the appeal is usually handled much the same as the initial claim, except that the disability determination is made by a different adjudicative team in the DDS than the one that handled the original case.
Claimants dissatisfied with the first appeal of a determination may file subsequent appeals. The second appeal is processed by a Hearing Office within SSA’s Office of Hearings and Appeals. An administrative law judge makes the second appeal decision, usually after conducting a hearing and receiving any additional evidence from the claimant’s medical sources or other sources.
Medical development by the Office of Hearings and Appeals is frequently conducted through the DDS. However, hearing offices may also contact medical sources directly. In rare circumstances, an administrative law judge may issue a subpoena requiring production of evidence or testimony at a hearing.
Health professionals play a vital role in the disability determination process and participate in the process in a variety of ways:
A treating source is a claimant’s own physician, psychologist, or other acceptable medical source who has provided the claimant with medical treatment or evaluation and has or has had an ongoing treatment relationship with the claimant.
The treating source is usually the best source of medical evidence about the nature and severity of an individual’s impairment(s). If an additional examination or testing is needed, SSA usually considers a treating source to be the preferred source for performing the examination or test for his or her own patient. The treating source is neither asked nor expected to make a decision whether the claimant is disabled. However, a treating source will usually be asked to provide a statement about the claimant’s ability, despite his or her impairments, to do work-related physical or mental activities.
In the absence of sufficient medical evidence from a claimant’s own medical sources, SSA, through the State DDS, may request an additional examination(s). These CEs are performed by physicians (including osteopaths), psychologists or, in certain circumstances, other health professionals. All CE sources must be currently licensed in the State and have the training and experience to perform the type of examination or test SSA requests
Fees for CEs are set by each State and may vary from State to State. Each State agency is responsible for comprehensive oversight management of its CE program.
Medical professionals who perform CEs must have a good understanding of SSA’s disability programs and their evidentiary requirements. In addition, these medical professionals are made fully aware of their responsibilities and obligations regarding confidentiality and:
Physicians of virtually all specialties and psychologists at the State, regional, or national levels review claims for disability benefits. The review work is performed in the State DDSs or SSA’s regional office or headquarters. It is strictly a paper review in which the program physician or psychologist usually has no contact with the claimant.
Because there is no direct involvement of medical professionals in the disability decisions made by administrative law judges in the Office of Hearings and Appeals, administrative law judges sometimes request expert testimony on complex medical issues. Each Hearing Office maintains a roster of medical experts who are called to testify as expert witnesses at hearings. The experts are paid a fee for their services.
Confidentiality of Records
Two separate laws, the Freedom of Information Act and the Privacy Act, have special significance for Federal agencies. Under the Freedom of Information Act, Federal agencies are required to provide the public with access to their files and records. This means the public has the right, with certain exceptions, to examine records pertaining to the functions, procedures, final opinions, and policy of these Federal agencies.
The Privacy Act permits an individual or his or her authorized representative to examine records pertaining to him or her in a Federal agency. For disability applicants, this means that an individual may request to see the medical or other evidence used to evaluate his or her application for disability benefits under the Social Security or the SSI programs. (This evidence, however, is not available to the general public.)
SSA screens all requests to see medical evidence in a claim file to determine if release of the evidence directly to the individual might have an adverse effect on that individual. If so, the report will be released only to an authorized representative designated by the individual.
Under the Social Security disability insurance program (title II of the Act), there are three basic categories of individuals who can qualify for benefits on the basis of disability:
SSA’s regulations provide for disability evaluation under a procedure known as the “sequential evaluation process.” For adults, this process requires sequential review of the claimant’s current work activity, the severity of his or her impairment(s), the claimant’s residual functional capacity, his or her past work, and his or her age, education, and work experience. For children applying for SSI, the process requires sequential review of the child’s current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in marked and severe functional limitations. If an adult or child is found disabled or not disabled at any point in the evaluation, the evaluation does not continue.
In general, to get disability benefits, you must meet two different earnings tests:
The table below, shows the rules for how much work you need for the “recent work” test based on your age when your disability began. The rules in this table are based on the calendar quarter in which you turned or will turn a certain age.
The calendar quarters are:
First Quarter: January 1 through March 31
Second Quarter: April 1 through June 30
Third Quarter: July 1 through September 30
Fourth Quarter: October 1 through December 31
| If you become disabled... | Then you generally need: |
| In or before the quarter you turn age 24 | 1.5 years of work during the three-year period ending with the quarter your disability began. |
| In the quarter after you turn age 24 but before the quarter you turn age 31 | Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled. Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the 6-year period ending with the quarter you became disabled. |
| In the quarter you turn age 31 or later | Work during 5 years out of the 10-year period ending with the quarter your disability began. |
The following table shows examples of how much work you need to meet the “duration of work test” if you become disabled at various selected ages. For the “duration of work” test, your work does not have to fall within a certain period of time.
NOTE: This table does not cover all situations.
| If you become disabled... | Then you generally need: |
| Before age 28 | 1.5 years of work |
| Age 30 | 2 years |
| Age 34 | 3 years |
| Age 38 | 4 years |
| Age 42 | 5 years |
| Age 44 | 5.5 years |
| Age 46 | 6 years |
| Age 48 | 6.5 years |
| Age 50 | 7 years |
| Age 52 | 7.5 years |
| Age 54 | 8 years |
| Age 56 | 8.5 years |
| Age 58 | 9 years |
| Age 60 | 9.5 years |
There are two ways that you can apply for disability benefits. You can:
You should apply for disability benefits as soon as you become disabled. It can take a long time to process an application for disability benefits (three to five months). We will be able to process your application faster if you provide us with information (see below) when you apply for benefits, and complete the Disability Report. You can complete the Disability Report online at www.socialsecurity.gov/disability/3368. You can also print the Disability Report, complete it and return it to your local Social Security office. We may be able to process your application faster if you help us by getting any other information we need.
The information we need includes:
In addition to the basic application for disability benefits, there are other forms you will need to fill out. One form collects information about your medical condition and how it affects your ability to work. Other forms give doctors, hospitals and other health care professionals who have treated you permission to send us information about your medical condition.
Do not delay applying for benefits if you cannot get all of this information together quickly. We will help you get it.
We will review your application to make sure you meet some basic requirements for disability benefits. We will check whether you worked enough years to qualify. Also, we will evaluate any current work activities. If you meet these requirements, we will send your application to the Disability Determination Services office in your state.
This state agency completes the disability decision for us. Doctors and disability specialists in the state agency ask your doctors for information about your condition. They will consider all the facts in your case. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information. They will ask your doctors:
They also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled.
The state agency staff may need more medical information before they can decide if you are disabled. If more information is not available from your current medical sources, the state agency may ask you to go to a special examination. We prefer to ask your own doctor, but sometimes the exam may have to be done by someone else. Social Security will pay for the exam and for some of the related travel costs.
We use a five-step process to decide if you are disabled.
When the state agency reaches a decision on your case, we will send you a letter. If your application is approved, the letter will show the amount of your benefit and when your payments start. If your application is not approved, the letter will explain why and tell you how to appeal the decision if you do not agree with it.
There are a number of other special rules for people who are blind. For more information, ask for a copy of If You Are Blind Or Have Low Vision—How We Can Help (Publication No. 0510052).
The law provides that, under the Social Security disability program, disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. Therefore, Social Security disability benefits will be paid for the sixth full month after the date the disability began. The 5-month waiting period does not apply to individuals filing as children of workers. Under SSI, disability payments may begin as early as the date the individual files an application.
In addition, under the SSI disability program, an applicant may be found “presumptively disabled,” and receive cash payments for up to 6 months while the formal disability determination is made. The presumptive payment is designed to allow a needy individual to meet his or her basic living expenses during the time it takes to process the application. If it is finally determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for a finding of presumptive disability under the title II program.
The amount of your monthly disability benefit is based on your average lifetime earnings. The Social Security Statement that you receive each year displays your lifetime earnings and provides an estimate of your disability benefit. It also includes estimates of retirement and survivors benefits that you or your family may be eligible to receive in the future. If you do not have your Social Security Statement and would like an estimate of your disability benefit, you can request one from our website at www.socialsecurity.gov or call our toll-free number, 1-800-772-1213.
Certain members of your family may qualify for benefits based on your work. They include:
Note: In some situations, a divorced spouse may qualify for benefits based on your earnings if he or she was married to you for at least 10 years, is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children.
If you are getting other government benefits, the amount of your Social Security disability benefits may be affected. For more information, you should see the following publications:
You can get these publications from our website, or you can contact us to request them.
Medicare helps pay hospital and doctor bills of disabled or retired people who have worked long enough under Social Security to be insured for Social Security benefits. It generally covers people who are 65 and over; people who have been determined to be disabled and have been receiving benefits for at least 24 months; and people who need long-term dialysis treatment for chronic kidney disease or require a kidney transplant. In general, Medicare pays 80 percent of reasonable charges.
In most States, individuals who qualify for SSI disability payments also qualify for Medicaid. (The name varies in some States-the term “Medicaid” is not used everywhere.) The program covers all of the approved charges of the Medicaid patient. Medicaid is financed by Federal and State matching funds, but eligibility rules may vary from State to State.
Social Security rules make it possible for people to test their ability to work without losing their rights to cash benefits and Medicare or Medicaid. These rules are called “work incentives.” The rules are different for title II and title XVI, but under both programs, they may provide:
If an individual disagrees with the initial determination in the case, he or she may appeal it. The first administrative appeal is reconsideration, which is generally a case review at the State level by an adjudicative team that was not involved in the original determination. If dissatisfied with the reconsideration determination, the individual may request a hearing before an administrative law judge. If he or she is dissatisfied with the hearing decision, the final administrative appeal is for review by the Appeals Council. In general, a claimant has 60 days to appeal an unfavorable determination or decision. Appeals must be filed in writing and may be submitted by mail or in person to any Social Security office. If the individual exhausts all administrative appeals, but wishes to continue pursuing the case, he or she may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.
Under this program, Social Security and Supplemental Security Income disability beneficiaries can get help with training and other services they need to go to work at no cost to them. Most beneficiaries will receive a “ticket” that they can take to a provider of their choice who can offer the kind of services they need. To learn more about this program, ask for a copy of Your Ticket To Work (Publication No. 05-10061).
Under both the title II and title XVI programs, medical evidence is the cornerstone for the determination of disability. Each person who files a disability claim is responsible for providing medical evidence showing that he or she has an impairment(s) and how severe the impairment(s) is. However, SSA will help claimants get medical reports from their own medical sources when the claimants give SSA permission to do so. This medical evidence generally comes from sources who have treated or evaluated the claimant for his or her impairment(s).
Documentation of the existence of a claimant’s impairment must come from medical professionals defined by SSA regulations as “acceptable medical sources.” Once the existence of an impairment is established, all the medical and nonmedical evidence is considered in assessing impairment severity.
“Acceptable medical sources” generally include licensed physicians (medical or osteopathic doctors); licensed or certified psychologists (includes school psychologists or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities and borderline intellectual functioning); licensed optometrists (for the measurement of visual acuity and visual fields); licensed podiatrists (for purposes of establishing impairments of the foot, or foot and ankle, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot, or foot and ankle); and qualified speech-language pathologists (for purposes of establishing speech or language impairments only).
Social Security also requests copies of medical evidence from hospitals, clinics, or other health facilities where a claimant has been treated. All medical reports received are considered during the disability determination process.
Currently, many disability claims are decided on the basis of medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant’s impairments and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.
Information from other sources may also help show the extent to which a person’s impairment(s) affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments. Other sources include public and private agencies, non-medical sources such as schools, parents and caregivers, social workers and employers, and other practitioners such as naturopaths, chiropractors, audiologists.
Physicians, psychologists, and other health professionals are frequently asked by SSA to submit reports about an individual’s impairment. Therefore, it is important to know what evidence SSA needs. Medical reports should include:
If the evidence provided by the claimant’s own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE. The treating source is the preferred source for a CE if he or she is qualified, equipped, and willing to perform the examination for the authorized fee. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. However, SSA’s rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if:
A complete CE is one that involves all the elements of a standard examination in the applicable medical specialty. A complete consultative examination report should include the following elements:
In developing evidence of the effects of symptoms, such as pain, shortness of breath, or fatigue, on a claimant’s ability to function, SSA investigates all avenues presented that relate to the complaints. These include information provided by treating and other sources regarding:
The Listing of Impairments describes, for each major body system, impairments that are considered severe enough to prevent a person from doing any gainful activity (or in the case of children under age 18 applying for SSI, cause marked and severe functional limitations). Most of the listed impairments are permanent or expected to result in death, or a specific statement of duration is made. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the Listing of Impairments are applicable to evaluation of claims for disability benefits or payments under both the Social Security disability insurance and SSI programs.
Part A of the Listing of Impairments contains medical criteria that apply to adults age 18 and over. The medical criteria in part A may also be applied in evaluating impairments in persons under age 18 if the disease processes have a similar effect on adults and younger persons.
Part B contains additional medical criteria that apply only to the evaluation of impairments of persons under age 18. Certain criteria in part A do not give appropriate consideration to the particular effects of the disease processes in childhood, i.e., when the disease process is generally found only in children or when the disease process differs in its effect on children and adults. Additional criteria are included in part B, and the impairment categories are, to the extent possible, numbered to maintain a relationship with their counterparts in part A. In evaluating disability for a person under age 18, part B will be used first. If the medicalcriteria in part B do not apply, then the medical criteria in part A will be used.
The criteria in the Listing of Impairments apply only to one step of the multi-step sequential evaluation process. At that step, the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled. However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the adjudicator to move on to the next step of the process and apply other rules in order to resolve the issue of disability.
Several terms included in the various definitions of disability and blindness (under titles II and XVI) and other terms closely related to the concept of disability are subject to more than one possible interpretation. This policy statement explains the various definitions of disability and blindness and describes in detail how pertinent terms are to be interpreted and applied.
Under title II, the term “disability” means -
Under title XVI, the term “disability” means -
Under title II and title XVI -
Under title XVI only
“Substantial gainful activity” means the performance of significant physical or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit. “Significant activities” implies not only that the activities are useful in the accomplishment of a job or the operation of a business, but also that they are the kind normally done for pay or profit. Work may be substantial even if it is performed on a part-time basis, or even if the individual does less, is paid less, or has less responsibility than in previous work. Work activity is gainful if it is the kind of work usually done for pay, whether in-cash or in-kind, or for profit, whether or not a profit is realized. Activities involving self-care, household tasks, nonremunerative training, hobbies, therapy, school attendance, clubs, social programs, etc., are not generally considered to be SGA.
Title II workers or CDB applicants, or title XVI claimants age 18 or older, are unable to engage in any SGA if by reason of their impairment(s), they are not only unable to do past relevant work, but cannot, considering their age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy regardless of whether such work exists in the immediate area in which the individuals live, or whether a specific job vacancy exists, or whether the individuals would be hired if they applied for work.
The statute specifies that “work which exists in the national economy” means work which exists in significant numbers either in the region where the individuals live or in several regions of the country. The purpose of so defining the phrase is not only to make it clear that jobs need not be available in the region in which the individuals live, but also to emphasize that, conversely, a type(s) of job which exists only in very limited numbers or in relatively few geographic locations may not be said to “exist in the national economy.” This distinction will assure that individuals are not awarded benefits simply on the basis of lack of jobs in the region in which they live, nor denied benefits on the basis of the presence in the economy of isolated jobs in which the individuals could engage.
In the Listing of Impairments, the regulations describe impairments of a level of severity deemed to preclude an individual from engaging in any gainful activity. An applicant for title II disabled widow’s, widower’s, or surviving divorced spouse’s benefits or title XVI child’s benefits must have an impairment(s) that meets or equals an impairment in the Listing.
As in the case of a title II worker or CDB applicant or a title XVI claimant age 18 or older, a title II widow(er), or title XVI child whose work demonstrates ability to engage in SGA is not under a disability. The level of severity of an impairment which a title II widow(er) or a title XVI child must meet or equal to be determined to be under a disability is that which is considered under the regulations to be sufficient to preclude engaging in any gainful activity (i.e., must meet or equal the Listing), as distinguished from SGA. The concept of “gainful activity,” however, is used only in setting the requisite level of severity of the impairment in the Listing of Impairments and not otherwise.
The 1967 amendments provided benefits for widows, widowers, or surviving divorced spouses at age 50 or older whose physical or mental impairment(s) is of a level of severity deemed sufficient to preclude an individual from engaging in any gainful activity. Such a level of severity is described in the Listing. In order to qualify for benefits, a widowed person or surviving divorced spouse must, therefore, have an impairment(s) which meets or equals the level of impairment severity in the Listing, and not be engaging in SGA.
Disability in children under age 18 will be determined solely by consideration of medical factors (i.e., vocational factors do not apply). A finding of disability may be made only when the child’s impairment or combination of impairments is as severe as the examples contained in the Listing of Impairments (Part A or Part B). When the specified criteria are met or equalled, disability may be established on the basis of the medical facts in the absence of evidence to the contrary (e.g., the actual performance of SGA).
By Reason of ... Impairment
The physical or mental impairment(s) must be the primary reason for the individual’s inability to engage in any SGA (or gainful activity). When, for instance, an individual remains unemployed for a reason(s) not due to a physical or mental impairment(s), such individual may not be considered disabled. Unemployment may be attributable to a number of reasons other than disability: individuals may be unsuccessful in obtaining work they could do; or work they could do may not exist in the local area; or the hiring practices of certain employers, technological changes in the industry, or cyclical economic conditions may preclude their employment; or there may be no job openings; or they would not actually be hired to do work they could otherwise perform.
“Medically Determinable”
The law requires that the physical or mental impairment(s) which results in inability to engage in any SGA (or inability to engage in any gainful activity in the case of a title II DWB applicant or title XVI child) must be a SGA impairment(s). This means that the impairment(s) must result from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
An individual’s description of his or her impairment(s) (symptoms) is, in itself, insufficient to establish the presence of a physical or mental impairment(s). For the purposes of determining a “SGA impairment,” the following definitions apply:
Symptoms are the claimant’s own description of the physical or mental impairment(s).
Signs are anatomical, physiological, or psychological abnormalities which can be shown through the use of medically acceptable clinical techniques. Psychiatric signs are medically demonstrable phenomena (apart from the claimant’s symptoms), indicating specific abnormalities of behavior, affect, thought, memory, orientation, and contact with reality. They must also be shown by observable facts that can be medically described and evaluated.
Laboratory findings are manifestations of anatomical, physiological, or psychological phenomena demonstrable by the use of medically acceptable laboratory diagnostic techniques. They include chemical, electrophysiological, roentgenological, or psychological tests.
Those aspects of the disability determination that relate to the nature, extent and duration of the impairment must be based on medical facts (i.e., symptoms, signs, and laboratory findings).
Residual Functional Capacity
Residual functional capacity (RFC) is the remaining capacity to perform work-related physical and mental activities despite certain functional limitations resulting from SGA impairments. The assessment of RFC must be documented to support the adjudicative conclusion of just what the individual can still do in a work setting, and must be fully responsive to the claimant’s statements, including those about symptoms (especially pain) which concern the nature and extent of the impairments.
The RFC assessment is based primarily on the medical findings which must be complete enough to permit and support the necessary judgments concerning the individual’s physical, mental, and sensory capacities and any environmental restrictions. Descriptions and observations of the claimant’s restrictions by medical and nonmedical sources in addition to those made during formal medical examinations must also be considered in the determination of RFC. When multiple impairments are involved, the RFC is derived from an assessment of the remaining functional capacity after consideration of all impairments.
Duration of Impairment
Duration of impairment under title II and title XVI refers to that period of time during which an individual is continuously unable to engage in SGA (or any gainful activity) because of a SGA physical or mental impairment(s). It extends from the date of onset of “disability” to the time the impairment(s) no longer prevents the individual from engaging in SGA. Since the Social Security Amendments of 1965, the disabling impairment(s) preventing an individual from engaging in any SGA (or any gainful activity) must be expected to result in death, or must have lasted or be expected to last for at least 12 continuous months from the date of onset (e.g., from January 17, 1981, through January 16, 1982). However, there is no “duration” requirement for “blindness” under title XVI.
Impairment Which Ended Prior to Decision or Determination
Where the evidence establishes that the claimant was unable to engage in any SGA (or gainful activity) for a continuous period of at least 12 months, but by the time the decision or determination is made, the claimant is able to engage in SGA (or gainful activity), he or she may be entitled to disability benefits for all or some of the time he or she was unable to engage in SGA (or gainful activity).
Impairment Which Can Be Expected to Result in Death
An impairment will be considered likely to result in death if, on the basis of established medical knowledge, it is found to be in a terminal state under the particular circumstances in the case. A disabling condition which actually does result in death will be considered one that was “expected to result in death.”
One purpose of this concept is to assure that disability may be established for the individual who has an incapacitating impairment which is expected to cause death before it lasts 12 months. However, if in a title II case, death follows so quickly after the alleged onset date of the impairment that a period of disability cannot be granted (i.e., a waiting period applies and the alleged onset is less than 5 full calendar months before the month of death) and an earlier onset cannot be established, the claim will be denied.
You should have as much of the following information as possible for your interview. Use this checklist to keep track of the information you gather. You can use this list to keep your information together.
Keep your appointment. Do not delay filing even if you do not have all of the information. We will help you get any missing information.
Children from birth up to age 18 may get Supplemental Security Income (SSI) benefits. They must be disabled and they must have low income and few resources. Here are answers to some questions people ask about applying for SSI for children.
Social Security has a strict definition of disability for children. A child is disabled if:
An agency in your state makes the disability decision for us. They review the information you give us. They will also ask for information from medical and school sources and other people who know about your child. If the state agency needs more information, they will arrange an examination or test for your child, which we will pay for.
Besides being disabled, your child must have little income and resources to be eligible. We also consider the family’s household income, resources and other personal information.
Keep your appointment even if you do not have all the information listed on the checklist. We will help you get the information we need.
It can take 3 to 5 months to decide a child’s SSI disability claim. We will send you a letter telling you what we decided.
If we approve your child’s claim, the letter will show the payment amount and start date.
If we do not approve your child’s claim, the letter will explain why. The letter will also tell you how you can appeal our decision if you do not agree. It is easy to appeal. If you decide to appeal, contact us.
If you want more information, check out our website, www.socialsecurity.gov/disability, or call us at 1-800-772-1213 between 7 a.m. and 7 p.m. on business days with specific questions and any time for general information. People who are deaf or hard of hearing may call our toll-free TTY number, 1-800-325-0778.
If you are more comfortable speaking in a language other than English we provide free interpreter service on request to conduct your Social Security business. This service is available when you talk to us by phone or in a Social Security office.
State and Local Medical Assistance
SSI is not a medical assistance program. Your state Medicaid agency, local health department, social services office or hospital can help you find your nearest health care agencies. Your Social Security office can also help you find health care agencies.
Medicaid is a health care program for people with low incomes and limited assets. In most states, children who get SSI benefits can also get Medicaid. Even if your child cannot get SSI, he or she may be able to get Medicaid. Your state Medicaid agency, your local Social Security office or your state or county social services office can give you more information.
State Children’s Health Insurance Program (SCHIP)
Your child may be able to get health insurance from the State Children’s Health Insurance Program, even if he or she does not get SSI. SCHIP provides health insurance to children from working families with incomes too high to get Medicaid, but who cannot afford private health insurance. SCHIP provides insurance for prescription drugs and for vision, hearing and mental health services in all 50 states and the District of Columbia. Your state Medicaid agency can provide more information about SCHIP. You can also go to www.cms.hhs.gov/schip or make a free phone call to 1-877-KIDS-NOW (1-877-543-7669) for more information on your state’s program.
If your child is under age 16 and we decide he or she is disabled and can get SSI, we will refer him or her to your state children’s agencies for social, developmental, educational and medical services. Even if your child cannot get SSI, these state agencies may be able to help him or her.
As children approach the age to work, we have many ways to encourage those who get SSI disability benefits to go to work:
Your local Social Security office can provide more information about these work incentives. You can also find answers to many questions on our Work website, www.socialsecurity.gov/ work.
The Social Security Administration protects the privacy of those we serve. Our first regulation was written to ensure your privacy. As a federal agency, we are required by the Privacy Act of 1974 (5 U.S.C. 522a) to protect the information we get from you.
If you are an Advocate, Attorney or Third Party Representative and you are helping someone prepare an Internet Social Security Benefit Application and/or an Internet Disability Report, you must:
“A form SSA-1696, Appointment of Representative, is being forwarded to SSA on (date).”