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After a stroke, it may take time to assess the extent of your disability. Keep a record of symptoms and disabilities, and track them to prepare a social security disability claim. You may qualify for Social Security Disability Income if you’ll be out of work for at least a year.
According to the Social Security Administration (SSA), a stroke is a medical condition that could qualify a person for a disability benefit depending on the severity of the event, type of post-stroke limitations you have, and how long limitations are expected to last.
If you have suffered a stroke and the after-effects are expected to prevent you from working substantially for at least a year or it is not known when you may be able to return to work, you should file an application for Social Security Disability benefits. Medical care, diagnostic tests such as brain scans, lab tests, medication, and physician examinations will be needed to help prove your claim. A monthly benefit check could help with your daily living costs, as well as, health-related expenses.
Qualifying for a Disability Benefit
The first step in your claim evaluation is a determination of whether you are continuing to work at a substantial gainful activity (SGA) level. In 2020, substantial gainful activity generally is defined as the ability to earn at least $1,260 gross wages per month or if you are self-employed the ability to earn $1,260 net profit and/or work eighty hours per month. If you are performing SGA and were not off work or working below SGA for twelve months prior to your return to SGA employment, your claim will be denied.However, before determining whether you are performing SGA, SSA will reduce your earnings by any Impairment-Related Work Expenses (IRWE’s). Also, if you are working for a friend or relative or anyone else who is giving you a lot special accommodations at work, even keeping you on the job to help you out, your work might not be SGA. If you tried to go back to work and had to stop because of the same or related health condition in less than three months and in some cases less than six months, your return to work may be treated as an unsuccessful work attempt so that twelve months of disability can be accrued counting months off work on each side of the unsuccessful work attempt.
Your Medical History
If you are not performing SGA, the Examiner will inspect your medical history file. It s advisable to check with the examiner to be sure that key medical reports and test results and clinic appointments are in your claim file and available for consideration. Within this file, should be all the medically relevant information concerning your stroke. It should include:
- Diagnostic tests
- Imaging test results
- Laboratory test results
- Out-patient records
- In-patient records
- Surgeries and the related notes
- Prescription drug records, dosage, effectiveness, along with side effects
- Your treatment plan and how successful it is
- Your physician’s and specialist’s records, including descriptions of your limitations
- Physical, speech, occupational, and psychological therapist’s records
Included in this file should be detailed descriptions of your stroke symptoms, how long they lasted, and how serious they have been. If your condition has improved, one question will be whether it is still improving or improvement has plateaued.
A Daily Journal
It is also helpful to keep a daily journal to document all the medically relevant events that occur and how they relate to your activities each day. Because the person who is displaying the symptoms cannot always observe himself, the documentation job may fall to the spouse, a nurse, or even another person who is present when an episode occurs.
It can take two to five months to get a decision, so it could be a good idea to file the claim and then gather key documentation together as quickly as possible to be sure it is all considered. Another option is to assemble records and then file the application. Your Social Security Disability Income (SSDI) application can be completed at the local office, online, or maybe even by telephone. Once your initial application has been submitted, SSA will review your claim. The SSA knows that during the time after a stroke, severe and disabling symptoms may slowly improve. Because of this, they often want to wait, possibly for three months or more, to see how much you might improve over a year’s time and what your condition is after it stabilizes. If they do defer the claim, they will send you a letter notifying you of when they will get updated medical records and resume review of your claim.
Don’t stop accumulating your records though. This is an ongoing process. Keep your daily log going and keep track of medical procedures. Submit any major repeat testing that is done. When notified that a Disability Examiner has been assigned to your case, any new records can go directly to him or her. Up to that point, your local Social Security office will accept them.
The Blue Book
A Social Security has a manual that lists medical conditions and accompanying findings or symptoms that automatically qualify a person for benefit approval. This manual is called the Blue Book.
For a stroke to be the basis for an automatic approval, the Blue Book lists the following limitations that must be present:
- Serious difficulties in controlling movements or coordination with at least two limbs. It can be arms or legs.
- The ability to write or speak is lost completely or it is severely limited.
Marked limitation in physical functioning and in one of the following areas of mental functioning, both lasting for at least three consecutive months after the stroke:
- Understanding, remembering, or applying information; or
- Interacting with others; or
- Concentrating, persisting, or maintaining pace; or
- Adapting or managing oneself.
Medical Vocational Allowance
Often the symptoms displayed by the patient do not exactly match the limitations written in the Blue Book. If that happens, the examiner goes on to the next step, to see if a medical-vocational allowance (MVA is possible.). This is another method to determine if you would qualify for disability benefits. The disability examiner will look to other problem areas, such as, hearing loss, vision problems, loss of dexterity, or personality changes to determine whether considering your medical condition and your work and educational history, you would be able to return to the duties of jobs you have performed in the past or meet the demands of learning and performing a new occupation.
The disability examiner and a staff physician will review your medical records and any statements from your physicians to determine what your limitations are. If it is not clear, you may be asked to attend a consultative examination or your physician or therapist may be asked to provide more information.Unless you have extremely obvious and visible limitations, it isn’t a good idea to rely on a consultative examination (if one is even ordered) because an SSA-approved doctor seeing you just once may not result in an accurate assessment of your limitations. It is better to do your best to submit information from your test results attending physicians and specialists.
It is also important to provide thorough and detailed information about the mental and physical demands of jobs you have held in the past. If there are any you think you cannot do now, point those out and explain why you cannot perform those duties. If you are unable to complete claim forms and are able to communicate, try to convey the information to a relative or friend or care provider so that person can do a good job of describing the demands of your past work
If you are helping someone who cannot communicate effectively, try to contact former employers for a written job description or information about the job title, duties, and physical and mental requirements. A co-worker or relative might also have some information.
Residual Functional Capacity
You may be asked to have an examination for an assessment of your cognitive ability and/or your physical ability to determine such things as how much weight you can lift and carry, how long you can stand or sit, your capabilities of pushing, pulling, and bending. With all this information, a Residual Functional Capacity (RFC) assessment form may be completed to arrive at your physical ability to work in Sedentary, Light, Medium or Heavy work and/or what mental functions you can still perform. This information will be used to determine whether or not you can go back to a prior occupation. If not, the medical information in file, including the RFC, will be considered with your vocational background, transferable skills, training, and education to determine whether you can work in a new occupation. If you are age fifty or over, your age will also be considered.
An example would be if you were a warehouse worker, and you are now incapable of standing for more than fifteen minutes at a time because of balance problems but can sit at a desk for an entire shift and work a full five days. In this example, if you can work at a light-duty assignment, your disability benefit would not be approved if that light duty work was an occupation that exists in the general economy and was not a special- accommodation job to which a regular employee would not be assigned.
Another illustration would be if because of your stroke you lost your ability to focus on a task and understand and retain instructions. In this case, finding a job with those limitations might not be feasible, so a disability benefit would probably be approved.
If you are found to be disabled, you might be eligible for one or more of the following federal benefit programs.
- SSDI – Social Security Disability Income
This SSA program provides a disability benefit if you are unable to perform SGA for a year or more and you are insured for benefits because you have worked enough in the past with a certain amount of recent work and have paid Social Security taxes on those earnings.
- SSI – Supplemental Security Income
This SSA needs-based, public-assistance program allows monthly benefits for disabled persons and individuals age sixty-five and over who have low household income and assets.
This federal insurance program provides health insurance for those age sixty-five or over and for individuals who have received SSDI or other types of Social Security Disability benefits for twenty-four months.
Medicaid health insurance is funded by federal and state funds. It is typically available to people who qualify for SSI. States administer Medicaid and determine eligibility. Accordingly, eligibility criteria (other than being an SSI recipient) varies a great deal from state to state in terms of who can qualify and what the income and asset limits are for eligibility.
If Denied, You can Appeal
The disability claims examiner is not the final word on your claim application. If you are turned down for the benefit, it is still possible to be approved. You can appeal and if the reconsideration appeal is denied, you can appeal again for a hearing with an administrative law judge. You do not need an attorney, but an experienced attorney or other knowledgeable representation is recommended. The law involved in these types of cases can be complex and bringing in an expert attorney who specializes in SSDI and SSI cases is probably the wisest course of action.
An attorney who has experience and training in these types of matters will be able to assemble your case to present it to the judge in the strongest possible terms. In addition, the lawyer would understand if additional evidence was needed or other witnesses, such as expert witnesses, should be called. This litigator would also be adept at conducting effective cross-examinations of witnesses presented by the SSA in order to find discrepancies, missing or misinterpreted data, or weaknesses in their conclusions. Social Security has rules about legal fees that can be charged and you will have to pay attorney fees only if you are awarded benefits.
Since this is such a serious legal matter and the financial stakes are so high, you should only have the best representation to protect your interests. When this is completed and your claim has been approved, you can truly appreciate the monthly benefit check that arrives to relieve some stress from your life.