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SSA's Definition of Disabilty

What does it mean when a friend, family member, client, patient or other acquaintance says they are disabled? In any case, they may or may not be speaking the same language that the Social Security Administration speaks when defining disability.

The Social Security Administration (SSA) has a rather specific legal definition to classify an individual as disabled, and therefore medically eligible to receive Social Security disability benefits. The term as the SSA defines it has a much narrower scope than that perceived by a layperson. When people normally describe themselves or others as having a “disability,” they may mean that they have a physical or mental impairment that creates occupational limitations, but does not preclude all work. For example, an individual who is injured on the job is generally assessed with a percentage of partial “disability” of the injured body part. This is basically a number rating the loss of that person’s use of a particular body part. However, if the person’s injury allows him or her to return to some other occupation despite that loss of use, he or she would not be disabled under the SSA’s regulations.

In other words, there is no partial disability under the SSA’s regulations. Unlike the Department of Veteran’s Affairs, which pays different amounts of benefits based on a person’s percentage disability rating, SSA pays either 100% or nothing. You either are disabled or you are not disabled. There is no in between.

Essentially, a person is disabled under SSA’s regulations if he or she:

1) Is currently not working at a level of substantial gainful activity;
2) Has one or more medically determinable impairments that significantly limits the person’s ability to do basic work activities and;
3) Has been unable to engage in (or is expected to be unable to engage in) any competitive employment on a sustained and full-time basis for 12 months or more as a result of the impairment(s).

Substantial gainful activity is fairly straight-forward. This encompasses work activity in which a person earns more than $980 per months (for the year 2009; cost-of-living raises this amount every year).

Medically determinable impairments encompass physical and mental injuries, diseases and disorders that cause exertional and/or non-exertional limitations. These limitations must affect a person’s ability to do basic work activities such a standing, sitting, lifting, seeing, hearing, handling, communicating, etc.

A person’s impairment or combination of impairments must prevent him or her from engaging in competitive employment on a sustained and full-time basis. In other words if a person with chronic back pain is unable to complete a normal workday without having to take unscheduled extended breaks due to the severity of his or her pain, then full-time employment will likely be out of the question. Likewise, a person with a mental illness may have periods during which he or she functions normally. However if there are intermittent periods of decompensation in which the individual is unable to leave his or her house, sustained and full-time employment would not be possible. Even if a person is able to work regularly on no more than a part-time basis, then he or she would meet the medical requirements of disability under SSA’s regulations.

The SSA has specific medical criteria listed in their regulations. If a claimant meets or equals the severity described in these criteria, he or she is deemed disabled. If the claimant does not meet these criteria, then SSA determines whether he or she is able to work based on a finding of residual functional capacity. SSA has special regulations that may make it easier for older claimants to be approved, depending on education and past work experience.

Doctors and other medical professionals should take care to specify a patients limitations caused by a medical condition. If the limitations caused by a condition would prevent sustained, full-time employment, then the patient may be rightfully entitled to disability benefits under the law until the point that he or she is able to return to full-time work.

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