You've been diagnosed with an illness that impacts your ability to work, play and thrive.

You're overwhelmed by the prospect of doctors, employment issues, new expenses, loss of income and the mountains of paperwork standing between you and your benefits.

You're not alone.  We know what you're facing and we will show you the best way to navigate these new challenges.

The Disability Key blog and the Disability Key Website are designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with a disability.

Carolyn Magura, noted disability expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her “full salary” while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click on the "download" link to receive Carolyn 's easy-to-read, easy-to-follow guide through this difficult, trying process.

Click Here To Download Now


Wednesday, January 11, 2006

Social Security Disability Insurance (SSDI) APPLICATION PROCESS

Social Security Disability Insurance (SSDI) APPLICATION PROCESS

This document is a checklist provided to walk you through the SSDI application process. As you read, and complete each section, check it off so that you can keep track of where you are in the process.

What and Why SSDI?

You have successful filed for, and have been accepted for, Long Term Disability (LTD) insurance. OR, you do not have access to LTD, or have been declined for LTD. (Note: a denial on behalf of an insurance company for LTD, does not have an impact on your ability to successfully apply for, and be accepted for, Social Security Disability Insurance coverage. The Social Security Administration uses the same and different criteria to determine eligibility..)

If you are a worker who has qualified for SSDI by working a sufficient length of time, (place link to SSA personal statement page here) suffering from a disability, you may be able to receive monetary benefits from the Social Security Administration. Also, in some situations these disability benefits may be awarded to you and your dependents. To determine if your dependents are eligible for benefits, please refer to place SSA link here. This document describes the steps involved in applying for benefits for yourself, as a worker, suffering from a disability.

In general, the Social Security Administration will pay cash benefits to people who are unable to work for a year or more because of a physical or mental disability. In order to receive these benefits, you must prove that you are in fact disabled or suffering from a disability. This document describes the process of “proving disability” in step-by-step detail. As a further assistance, included are forms to help in your proof; both completed documents by someone with the same disease as you have, to serve as examples, and the blank forms available for you to use to describe your own situation.

Disability under Social Security is based on your inability to work. You will be considered disabled if you cannot do the work that you did before (i.e., the job or occupation that you performed at the time when your illness/condition became disabling), and that you cannot adjust to other types of work (given your specific age, level of impairment, past work history, and level of education) because of your medical condition(s). Your disability also must last or be expected to last for at least a year or to result in death.

Why is it so hard to Qualify for SSDI?

There are three primary reasons why it is so difficult to qualify for SSDI:

Ø The applicant thinks that s/he is disabled, but the symptoms have not sufficiently impaired the applicant’s ability to perform “work” as defined by the Social Security Administration.
Ø The applicant has not successfully “proven” that s/he is disabled.
Ø The applicant leaves the “evidence of proof of disability” up to the Social Security Administration, or to another third party, rather than compiling and presenting the evidence to the Adjudicator her/himself.

An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”). This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability. The link to the Social Security “Blue Book” matrix of illnesses and what they consider “proof of impairment” can be found here:

However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the claimant and his/her supporting Medical team.

This requirement on the part of the claimant to “prove” the claim is the primary reason for so many denials. Recent documents indicate that the denial for first time applicants is up to 60%. Denials for second time applicants are up to 80%.
However, applicants who take the time and effort to understand their illness; who take the time to help their doctors, friends and families help them describe in detail how the impairments of the disease have so impacted you that you cannot perform either your job or any job; and, who take the time to compile all of the data for themselves and present the completed file to the Social Security Administration; these are the applicants that have a much higher chance of obtaining approval the first time around. The proof of this statement is that the author, Carolyn Magura, developed this process; developed and used the evidentiary forms and letters; and was approved for SSDI the first time around in under 30 days.

q I understand the why it is so hard to qualify for SSDI.
q I also understand that I must be able to demonstrate that my symptoms impair my normal daily functions in such a way that I meet the Social Security Administration’s definition of “disability”.
q Finally, I understand that I need to document, in great detail, how my symptoms have impaired me.
q I have obtained a copy of my Social Security qualification document.
q If I qualify for SSDI I will be eligible for approximately ____________ amount per month.

Understanding the SSDI Qualification Process

Prior to compiling and completing the documents that will supplement the actual SSDI Application, it is important to consider the following criteria that the Social Security Administration has placed on prospective applicants.

They are:
“1. Are you working?
If you are working in 2002 and your earnings average more than $780 a month, you generally cannot be considered disabled. If you are working in 2003 and your earnings average more than $800 a month, you generally cannot be considered disabled. If you are not working, we go to Step 2.
2. Is your condition "severe"?
Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, we will find that you are not disabled. If your condition does interfere with basic work-related activities, we go to Step #3.
3. Is your condition found in the list of disabling conditions?
For each of the major body systems, we maintain a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to a medical condition that is on the list. If it is, we will find that you are disabled. If it is not, we then go to Step 4.

4. Can you do the work you did previously?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then we must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, we proceed to Step 5.

5. Can you do any other type of work?
If you cannot do the work you did in the past, we see if you are able to adjust to other work. We consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.” Note: copied directly from the SSA Online website at this link:

In addition, to these general rules, there are specific rules for what the SSA calls “special conditions”. Check here to see if you qualify for one of these special conditions.

Compiling and documenting the evidence of your Disability

The following process will walk you, step-by-step through the documents to focus your evidence to show:

Ø That you have an illness (Multiple Sclerosis) and are suffering from documented symptoms, over time.
Ø That these symptoms meet the SSA definition of “disability”.
Ø That these symptoms impair your normal daily living activities.
Ø That this impairment will last for at least 12 months.
Ø That this impairment will keep you from performing “any occupation”.
Note: this process only will work if, in fact, you do have the illness; you do have the symptoms; the symptoms can be documented and proven by supporting information by Doctors, friends, family, and co-workers; and, that you actually are impaired from performing work of any occupation. This is NOT a process for use in attempting to defraud the Social Security Administration.

 Having read the SSA definitions above, I believe that I am disabled; and that this disability does impair me from working.
 My Doctors, family, friends, and co-workers also agree, and are willing to support me in this process.


Step #1: Complete the Symptom Matrix in great detail. Use attachment # 333, and use attachment #444 as an example. Remember, this is your best opportunity to describe how you feel; how your illness, MS, impacts you. This is NOT the time to portray a “stiff upper lip”; it is the time to “complain all that you want”!

 I have completed the first draft of my Symptom Matrix.

Step #2: Review your current job description. Hopefully, your job description will contain what is called “physical capacity criteria” that indicate what specific physical, mental, and social “levels of interaction” are required when performing your job. (See attachment ----, an example of a job description that includes the physical capacity criteria.)

If your job description does not include such criteria, you will need to develop them. For example, in your job:
1. If you need to use a computer, this activity could require you to be able to carry out small motor skills proficiently for 2-4 hours per day, or longer.
2. In using this computer, you would be required to sit for 2-4, and up to 6 hours per day.
3. In using this computer, you would be required to have visual skills capable of viewing a computer screen for 2-6 hours per day.
4. If your job requires you to inspect a warehouse, this activity requires you to walk for 2-4 hours at a time; for distances up to 2 miles; to conduct activities in a non-office work environment that could reflect temperature differences between heat and cold.
5. This warehouse inspection could require you to climb the equivalent of 5 flights of stairs at least 4 times per day.
6. As a Welder of iron plating, you could be required to stand, sit, bend, for 4-7 hours per day.

These are just a few examples of how activities of a job correlate to the physical activities of normal daily living. What you need to do is to develop the physical requirements of your job. Please see appendix___________ as an example.

q I have developed the physical requirements of my job.

Step #3: Your next step is to complete the “Before and After” activity matrix found at attachment _______. It is important to keep in mind what your end result needs to be. You are documenting YOUR LIFE, to communicate to someone who does not know you what you did before your disease/accident had an impact on your life.

As you review the MS-specific example of Before and After, you will see that the Before section describes Ms. Magura’s physical activities associated with her job as Vice President of Human Resources for Cascade General, the Portland Ship Repair Yard. Please read Ms. Magura’s example carefully. Note that she discusses the job activities in great detail:
1. When the workday began.
2. What type of activities needed to be performed.
3. What type, frequency, duration, and intensity of interpersonal actions with others needed to be performed.
4. The diversity of activities being performed; the length of each workday; the volume of activities; the requirement for multi-tasking, etc.
5. The number of hours being worked each day;
6. What activities were accomplished after work each day; during the weekend.
7. Please see that she “described”, in the “Before” the job activities. By comparing the before and after, one can see that the symptoms, as described in the Symptom Matrix, are, in the after, not able to be performed.

In summary, what you are doing is “painting a picture” of your life BEFORE your illness/accident forced you to change your activities. You need to be as specific and as detailed as you can be. What you are doing is explain what your “Normal Daily Living” looked like!

Next, you need to complete the “After” side. Again, read Ms. Magura’s example to see how detailed she is in explaining the impact that MS symptoms have had on her ability to perform her normal daily living activities and the physical, mental, and interpersonal actions of her job.

Review the Symptom Matrix (Attachment ____________) that you have already completed to document your symptoms when documenting your “After” side of this matrix. Again, be as specific and as detailed as you possibly can.

When you are finished, provide the Before and After matrix, your job description, and your Symptom matrix to someone who knows you and ask them to critique the matrixes as they compare both to your job description, and to how they have observed your change over time. Ask them the following question: “If you were an Insurance Adjuster, do these matrixes provide enough information for you to get a clear picture of the impact that my illness has had on me; of the level of impairment that the illness has had on my normal daily living?” If the answer is yes, then you are ready to continue. If no, revise the matrixes until the answer is yes.

After your friends, family, and co-worker(s) have reviewed the documents, select no less than 2, and preferably 3, to write a letter on your behalf to the Social Security Administration. As an example, see attachments 99999 and 8888.

q I have completed my Before and After matrix.
q I have provided copies of my matrixes and my job description to friends and families. They critiqued them.
q My matrixes adequately describes the impact that my illness has on me, and of the level of impairment that the illness has had on my normal daily living.
q I have copies of letters from friends and co-workers describing how they have witnessed my symptoms’ impact my daily normal living over time.

Working with your Doctor

Step #4: is to review the information about what your Doctor needs to know to help you by completing the Physical Capacity Evaluation or Residual Capacity Assessment Form. (See Appendix ------ for the instructions for your doctor. See Appendix ------ for a copy of a letter that you can copy to explain to your doctor what you need for him/her to do to assist you with your SSDI application. See Appendix ----- for a copy of a Physical Capacity Evaluation (PCE) Form for your Doctor to use. )

Make sure that you have 2 copies of the PCE form. Complete one yourself, as you see yourself impaired by your illness. Your previously completed matrixes will help you here. After filling out your copy, as you see yourself, review your job description once again.

Provide a copy of your matrixes, a copy of the instructions to your doctor along with the cover letter, a copy of your letters from friends and co-workers, along with the blank PCE form, to your doctor.

REMEMBER: If your doctor has any differences of opinion about your symptoms and limitations; make sure that the two of you resolve the differences before the doctor completes the Insurance forms for you.

When you get the letter(s), the PCE form and the chart notes from your doctor(s), be sure that you read them carefully. You will need to be sure that whatever symptoms, conditions, and issues noted by the doctor(s) are adequately addressed in your matrices.

One more key step in the “proof” arena. If you have had any “tests” performed to determine the presence of MS (i.e., MRI, spinal tap, eye tests, etc.) make sure that the test results also are included in the chart note information received from your doctor(s). Also, print from this website, to include in your documentation, how to interpret the test results when MS is the diagnosis:

 You have resolved any differences of opinion about your symptoms and your limitations with your Doctor(s).
q You have received back from your Doctor(s), the completed PCE form, the letter(s), and the chart notes.
q You have read the chart notes, and have made sure that anything noted is reflected in your matrixes.
q If you have had tests conducted, you have printed out the information that shows how to interpret the test results when MS is the diagnosis.

Completing the SSDI Application

It is recommended that you now make an appointment with your local Social Security Administration. Your local SSA office can be located through the following link.

After you have made the appointment (probably for some time in the future, because they are usually backed-up) please see the link below and download the actual application.

Complete as much of it as you can. This is another document to take with you to your appointment.

Next, the SSA recommends that you also include the following:
· A copy of your social security card, showing your number;
· Names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment;
· Names of all medications you are taking;
· Medical records from your doctors, therapists, hospitals, clinics and caseworkers;
· Laboratory and test results;
· A summary of where you worked and the kind of work you did;
· A copy of your W-2 Form (Wage and Tax Statement), or, if you are self-employed, your federal tax return for the past year;
· A certified copy of your divorce decree if you are divorced; and,
· An original of your birth certificate.

In addition to these documents, you also will be taking copies of the documents that you have just finished compiling:
· Your Symptom Matrix;
· Your Before and After Matrix;
· Your Doctor Completed PCE
· Your letters from your doctor(s); your friend(s); from your co-worker(s);
· Your doctor chart notes; and,
· If tests were performed, an explanation of how to read the test results when MS is the diagnosis.

You might want to compile all of the information into a binder. The SSA will have you take the documents out of the binder, and place them in a file folder.

q You have compiled all of the documentation that proves that you have a disability; that the symptoms of that disability impair your normal daily living; and, that you cannot return to work.
q You have made sure that you have kept an entire set of documentation for yourself.

CONGRATULATIONS! You are now ready for your appointment with the Social Security Administration!

Good Luck

A Message to Your Doctor (Social Security Disability)

A Message to Your Doctor

Your patient is in the process of attempting to qualify for disability benefits from either an insurance carrier or the Social Security Administration and will need specific details when documenting their symptom’s impact on a Functional Capacity Evaluation (PCE) form. (Note: this process also can be called a Residual Functional Capacity [RFC] assessment”. It is used extensively by the Social Security Administration; it is form SSA-4734.)

The patient has provided this explanation to you, so that you can better assist them in completing the necessary forms. The patient also has taken the first step of completing the form as s/he sees symptoms impacting his/her normal daily functions. If you have a difference in opinion about your patient’s perception, please resolve the differences with the patient before completing the form.
Doctors with patients who have been injured or have Social Security disability claims are usually asked to provide evidence. But what do the Social Security people mean by "disability"? And what kind of evidence do they need from doctors?
There is no universal definition of "disability." It depends on who is defining it - Veterans administration, Worker's Compensation, ADA.
A functional capacity evaluation can be an essential tool in determining whether a patient is disabled for purposes of Social Security disability benefits. It is one of the primary reasons for SPECIFICALLY documenting the impairment a disease or illness has on a patient’s normal daily living (NDL).
An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”. This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability.
However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the patient and his/her supporting Medical team.
An individual's "residual functional capacity" (RFC) means what an individual can do despite the limitations of the individual's impairment. The tool used to determine a patient's RFC is the functional capacity evaluation, which assesses a patient's capacity to do work-related physical and mental tasks on a regular and continuing basis--which means eight hours a day, five days a week.
A useful functional capacity evaluation needs to assess three important areas: physical abilities, mental limitations, and other non-exertional impairments and restrictions. All of a patient's impairments that are supported by medical records, even those that are not sever, should be addressed in the functional capacity evaluation since the combination of impairments may adversely affect the patient's ability to work.
1. Physical Abilities. This section of the functional capacity evaluation should describe the patient's limitations regarding physical activities. All potential activities that might be required for a work situation should be addressed: sitting, standing, walking, lifting, carrying, bending, squatting, crawling, climbing, reaching, stooping, kneeling, and so on. The patient's ability to do particular types of repetitive motions should also be considered. Please bee sure to note any necessary restrictions on the patient's physical activities. For example, can the patient lift up to 10 pounds? Over 50 pounds? And how often can the patient engage in such activity? Never? Occasionally? Frequently?
2. Mental Limitations. This part of the functional capacity evaluation should fully describe any of the patient's limitations in understanding, remembering, and following through on instructions. Also, be sure to note any limitations the patient has with respect to responding appropriately to common work situations, such as the ability to handle work pressures, receive supervision, or relate to co-workers.
3. Non-Exertional Impairments. This part of the evaluation should include information on other factors such as a patient's pain, environmental restrictions, the need for rest breaks, and any side effects of medication. When describing pain, be sure to note any objective signs of pain, the degree of pain, and the frequency of pain experienced by the patient. The evaluation should also explain whether the patient will need unscheduled breaks because of pain.
Any applicable environmental restrictions should be included in the functional capacity evaluation, as well. Must the patient avoid exposure to dust, fumes, or smoke? Can the patient tolerate heights?
The evaluation should address the patient's need for rest breaks, time off, and effects of the patient's medication. Is it likely that the patient will miss days of work because of pain or the side effects of medication? All such limitations should be fully described as they will affect the patient's ability to do work.
It is very important that the patient’s Doctors are very specific about the occupational limitations (including additional information not requested on the forms, if necessary). Also, it is important that NO ONE assume that a symptom or illness will automatically equate to functional impairment. You cannot depend on common sense to tell you who is disabled under the Social Security law. For example: with Multiple Sclerosis patients, an MRI that shows lesions does not necessarily equate to physical impairment, without the Doctor providing the actual “link” examples for that specific patient. SSA evaluators do not necessarily assume an MRI, which shows demyelinating disease, equals vocationally limiting fatigue, for example, unless a medical professional makes and explains the connection.
Here are some more examples:
1. A 48 year-old construction worker has done heavy, unskilled labor since age 16. He has a 4th grade education and a "low/normal" I.Q. He can read only basic things, like inventory lists and simple instructions. His heart condition limits him to sedentary work. He is not disabled under Social Security law unless he has an additional limitation.
2. A 38 year-old machine operator has done unskilled, medium exertion factory work since graduating from high school. A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to work not requiring bi-manual dexterity. He is disabled under Social Security law.
3. A 61 year-old truck driver has been driving trucks all his life. But during a downturn in the trucking industry ten yeas ago he worked 18 months at a sedentary office job for his brother-in-law. Now a pulmonary impairment limits him to sedentary work. He is not disabled under Social Security law because he is still capable of doing the office job.
The Social Security Administration (SSA) defines disability as:
"Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual's age, education and work history."

The ultimate decision regarding a patient's residual functional capacity rests with the SSA, which may request a functional capacity evaluation to be performed by its own medical consultants. However, the importance of a functional capacity evaluation done by the treating physician or other health care professional cannot be underestimated. After all, it is that person who is most knowledgeable about the patient's condition and any resulting occupational limitations. The treating health care professional's functional capacity evaluation can greatly assist a patient in obtaining much-needed disability benefits.

Thank you very much for taking the time to assist your patient in this difficult process.