Social Security Benefits

by Dorsett Bennett
Attorney at Law

INTRODUCTION

The United States has Social Security. This is a government attempt to provide individuals who are either of retirement age or are disabled with some income and medical benefits. There are two main portions or parts of the program. First of all, you have Title II for people who have earned enough employment quarters to qualify for benefits. As a general rule, an individual will need to have worked at least 5 years in the preceding 10 years to have 'insured' status for Title II benefits. You can go to your local Social Security Office to determine your insured status, or complete and mail in a form that you can get at that office to find out. Doing the form will also tell you approximately what benefit amount you and your dependents would receive. Children who are under the age of 18 are qualified dependents.

TitleXVI, or SSI, Supplemental Security Income, is for individuals who have not earned enough employment quarters to have insured status. There is a maximum amount payable depending on the state that you live in. Part of SSI is budgeted by the federal government and part by the individual states. The state portion is what causes the variance from state to state. The program is also income dependent, which means that if you have other income or qualified assets, that it can affect the amount that you receive, or even eligibility under the program.

I would encourage all of you to obtain information on your eligibility so that you can properly plan for the future. For example, it is possible that your condition is progressing to the point that you will not be able to work in a couple of years, but that you lack only 3 quarters of employment to qualify for SSDI (Social Security Disability Insurance). You may want to find employment suitable to your current condition so that you will have insured status.

PROCEDURE

There is a four step administrative process in applying for Social Security Benefits. The first step is application. You will go down to a local office and file an application.* The claims representative will review your employment history to see if you qualify for Title II benefits and will ask you about your disability. This claims representative will print out a form, stating a numbers of items, which you will sign. Be aware that this person will also be doing a subjective report on you, assessing whether or not you seem impaired. You will need to provide the names and address of all your medical care providers. The application will be sent to the Disability Determination Services of the state in which you live. This is an office which determines the first two steps of the administrative process. These offices are staffed by state employees, not employees of the federal government. These employees usually make the disability determinations for both Social Security Benefits and medicaid. Be advised that the DDS does not have to get your medical records. All they have to do is ask for them. If your medical provider does not send them, the DDS will make the decision on the records they do have. It is a good idea to check with all your medical care providers about a week after your initial visit to the Social Security Office and twice a week thereafter to be sure that they have sent the DDS your medical records. DDS has physician advisors and they can send you to a consulting physician. The consulting physician may not be a specialist in your disease. You can ask your personal specialist to do a narrative report which lists the information needed to show you "meet the listing" for your medical condition. But even if you do not "meet the listing" entirely, you may be disabled for Social Security purposes depending upon your age, education and past work experience. There is a multiple step analysis that Social Security is supposed to look at to determine disability.

If you are denied at step one, you can apply for a Reconsideration of the initial denial. This will be done in the same DDS office but by a different evaluator. Most initial decisions will not be overturned. It is important to file for steps two and three within the required deadlines. When you receive a denial letter, call Social Security immediately for the papers to be sent to you. This may be difficult because you may be upset when you receive the denial letter but it is important.*

If your are denied on the reconsideration, you go to step three, or the Administrative Hearing. At this point you will be before employees of the SSA. In most offices, an attorney advisory will review the file. It is possible that you will get a favorable decision at that point. If not, the matter will be scheduled before an Administrative Law Judge.

If you are denied by the Administrative Law Judge, you appeal to the Appeals council. If you lose there, you can file in US District Court for a review of the decision.

MULTIPLE SCLEROSIS CRITERIA

LISTING 11.09

Multiple sclerosis. With:

A. Disorganization of motor function as described in listing 11.04B;

B. Visual or mental impairment as described under criteria in Listings 2.02, 2.03,or 2.04, or 12.02;

C. Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathological involved by the multiple sclerosis process.

I. General Considerations

A. This listing deals with "multiple sclerosis".

B. Multiple sclerosis is a disease of the nervous system, the cause of which is not known.

C. What multiple sclerosis does to the person concerned depends on what part of their nervous system is involved at any particular time. It is an unpredictable disease, which tends to "flare-up", and then quiet down, leaving more damage each time. Sometimes it takes years to cause any severe impairment, and in other cases, it affects the claimant much more quickly and severely.

D. Part A, B, or C must be fulfilled, but not all.

II.Specific Requirements

A. Part A

1. Part A deals with "disorganization of motor function", which means impairment of the claimants ability to walk, or use their arms and hands effectively.

2. The actual evaluation is not done under Part A. The requirements are the same as those for Listing 11.04B. (Listing 11.04B is as follows" Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, gait, and station. Under this listing SSA is mainly interested in the ability to walk and to use the arms and hands. Two extremities must be involved.}

B. Part B

1. Part B deals with visual or mental impairments caused by multiple sclerosis.

2. Multiple sclerosis tends to damage the optic nerves to the eyes. If this is the problem, the impairment would be evaluated under Listings 2.03, 2.04 or 2.02, all of which deal with visual impairment. Their specific requirements must be filled. (If you are making your claim on this basis, contact the local Multiple Sclerosis Society for more specific information.)

3. If the multiple sclerosis has caused some type of mental impairment, the case would be evaluated under Listing 12.02. (Listing 12.02 is as follows: Chronic brain syndromes with

A. Demonstrated deterioration in intellectual functioning, manifested by persistence of one or more of the following clinical signs:

1. Marked memory defect for recent events; OR

2. Impoverished, slowed, preservative thinking, with confusion or disorientation; OR

3. Labile, shallow, or coarse affect:

B. Resulting persistence of marked restrictions of daily activities and constriction of interests and deterioration in personal habits and seriously impaired ability to relate to other people.)

C. Part C

1. Part c of Listing 11.09 is new and is added to take into account motor abnormalities that develop with exercise, especially fatigue. There must be evidence that the diagnosis of multiple sclerosis is valid, reason to believe that the part of the body fatigues is involved with the multiple sclerosis disease process. a description of the fatigue and type and amount of activity causing it.

As yet, there is not S.S. Disability policy statement standardizing the amount or type of exercise to be performed with upper or lower extremities.

*Webmaster comments:

It is no longer necessary to go down to the Social Security Office to obtain the paperwork or have the initial interview. This can be done over the phone. Look up the 800 number for Social Security in the Federal listings in the white pages of your phone book to get the process started.

If your application is denied at any level, call the number on the denial letter for the appeal paperwork to be sent to you. The appeal must be filed within a certain number of days from the date of the letter. Whether you are sobbing with disappointment and fear or calmly angry, call immediately! You will be ready to do the paperwork by the time it gets to you through the mail.

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