More information about TBI & Social Security Disability

• General Statistics for SSD
• Examples of TBI-Symptoms Affecting Employability
• Comparing SSD and SSI
• SSA Definitions of Disability
• Factors Evaluated in SSD Determinations
• SSD Application Procedures
• Other Key Points

General Statistics for SSD

• Disability benefits first became available to persons under age 50 in 1960.
• The average age of disabled worker beneficiaries has declined over time.
• The most recent data (from 2008) indicates the average age is 52.6.

• The average age of retired worker Social Security beneficiaries is 73.9 (data from 2008).
• Social Security benefits of $672 billion were paid to nearly 51 million Americans in 2009.
• Monies awarded to disabled workers and their dependents accounted for 18% of this sum.
• It is estimated that nearly 3 out of every 10 20-year-olds will become disabled prior to age 67.
• 69% of the private sector workforce does not possess long-term disability insurance.

Source: socialsecurity.gov

Examples of TBI Symptoms Affecting Employability

TBI-related impairments that may prompt the disability application process include, but are not limited to, the following:

• Significant cognitive deficits
• Problems with communication and/or comprehension, Memory deficits, Attention limitations, Inability to organize, Slowed processing speed

• Limited insight into deficits and/or poor judgment, such that it would be unsafe to work
• Significantly impaired physical functioning (e.g., right-sided paralysis in a right-handed individual whose primary skills are in labor-related positions)
• Uncontrolled epilepsy (seizures)
• Significantly impaired social skills that would preclude employment (e.g., disinhibition)
• Serious psychological disturbances as a result of the TBI (e.g., severe depression, significantly increased emotionality)

Comparing Social Security Disability (SSD) and Social Security Income (SSI)

There are two options for Social Security disabilty benefits.

Social Security Disability (SSD) benefits are designated for individuals under the age of 65 and their families. SSD benefits can be obtained:

• If an individual is determined to be disabled and has earned enough credits to be considered "insured."
• If an individual is determined to be disabled widow/widower between ages 50 and 60, and his/her deceased spouse earned enough credits to be "insured."
• If an individual was determined to be disabled prior to age 22 and one/both of his/her parent(s) is disabled or deceased, and earned enough credits to be "insured."
• If an individual is blind.

Supplemental Security Income (SSI) payments can be obtained:

• If an individual is under age 18 and is determined to be disabled.
• If an individual is under age 65, is determined to be disabled, and meets specific financial requirements (SSI benefits are need based). No prior work history or "insured" status is required.
• If an individual is a blind adult or child.

Depending on the specifics of an applicant's individual situation and needs (e.g., length of time receiving SSD, impending need for medical care), Medicare and/or Medicaid benefits may also be awarded.

SSA Definitions of Disability

The Social Security Administration applies the following relatively strict definitions of disability:

• For Adults
  "(Disability is) the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment 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."
• For Children
  "A child considered to be disabled under Social Security law if the child has any 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."

Factors Evaluated in SSD Determinations

A set of 5 questions are used to determine if a given applicant is disabled.

1. Is the person working?
2. Is his/her medical condition "severe"?
3. Is his/her medical condition on the "List of Impairments"? (see below)
4. Can he/she do the work he/she did in the past?
5. Can he/she do any other type of work?

All states use the same medical criteria for determining disability. A copy of the medical evaluation criteria (the "List of Impairments") is available online through the U.S. Social Security Administration.

The decision to award or not award disability benefits is made by a team of professionals.

• The team may include a physician/psychologist and a disability examiner working for disability determination services (DDS) in the state where the claimant resides.
• The team will consider many factors, such as the applicant's current medical/psychiatric status and limitation, education and training, work history, and age.
• The team will consider the individual's potential to do his/her past line of work and/or to adjust to a new type of employment.

Evaluation by the team takes into account the person's ability to:

• physically exert him/herself;
• complete "manipulative and postural activities" (e.g., reaching, climbing);
• tolerate various environmental conditions (e.g., heat and cold, humidity, noise);
• see, hear, and speak;
• initiate attention and maintain concentration;
• comprehend, recall, and execute directions;
• interact and respond to co-workers, supervisors, and typical work scenarios;
• and deal with changes in the work setting.

In addition to the information provided by an applicant, the SSA may seek additional information.

• For example, to better understand a child applicant's day-to-day functioning, supplemental observations and opinions from school professionals (e.g., teachers, school nurses, counselors, administrators) may be sought.

Examples of information that is not taken into account include:

• Whether or not an individual actually will be hired
• Whether or not job openings are available for the applicant
• Whether or not a job availability would require the individual to relocate
• The interest of the individual in a particular line of work
• Whether or not the applicant has the necessary certificate or license to re-engage in a previous line of work

SSD Application Procedures

The Social Security Administration has made the majority of disability application forms available online, and has provided a great deal of reference materials for applicants and providers. These forms and references can be found at socialsecurity.gov.

• Application for SSD benefits can be made as soon as a person becomes disabled.
• However, there is a 5 month waiting period such that benefits can be paid for the sixth full month following the onset of the disability.
• This waiting period is not required for persons filing as children; SSI payments can start in the first full month following application for benefits or onset of eligibility.

• An individual can check his/her application status online at any time, as well as begin the appeals process if his/her claim is denied.
• When a decision is made, the applicant will receive a letter detailing the determination.

The Social Security Administration estimates that it will take between 3 and 5 months from the time of application for a decision on the disability claim to be made, although delays in obtaining paperwork from the applicant and/or providers may delay this process.

An opinion by a physician/psychologist that an applicant cannot work does NOT guarantee that disability benefits will be awarded.

Individuals are frequently denied and may choose to go through an appeals process and/or seek legal representation.

Other Key Points

• There is not an option to apply for short-term or partial disability through the SSA.
• Following award of benefits, periodic Continuing Disability Reviews (CDR) are scheduled to determine if improvement has occurred such that the awardee now has the ability to work.
• The SSA has provisions to incentivize individuals receiving disability benefits to try to return to work as possible.
• For example, a "trial work period" (TWP) of 9 months (not necessarily consecutive) may be allowed, during which an individual can continue to receive benefit monies.
• Additionally, if a person becomes disabled again within 5 years of previously receiving disability, the 5 month waiting period is not required.