HOW SOCIAL SECURITY DECIDES ELIGIBILITY

H~ow disabled do you have to be to get Social Security benefits? And how does Social Security determine if you are disabled enough to get payments?

The Social Security Act defines disability as: "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or to last for a continuous period of not less than twelve months."

That means that Social Security does not pay partial disability payments. You won't be considered disabled if you are able to do any type of work not just your customary job.

It also means there are no benefits for short-term disabilities. You do not have to be permanently disabled, as many people erroneously believe, but your application will be denied if you are expected to be able to return to work within a year.

Social Security contracts with state governments to collect medical evidence and make disability decisions. Each state has a Disability Determinations Section (DDS) which is funded by federal money and closely monitored by federal authorities.

The state DDS system is sometimes confusing to the public. It was established because the states had been operating vocational rehabilitation (VR) agencies prior to 1956 and their experience in working with disabled people was expected to lend expertise to the new disability program. That kinship with VR is why Missouri's DDS is part of their Department of Elementary and Secondary Education.

~Should you become disabled, your local Social Security office will take your application for benefits. A lengthy medical questionnaire, including the names and addresses of doctors, hospitals and clinics that have treated you, will be completed and forwarded to the DDS in your state.

After they receive your medical questionnaire, DDS will contact your doctors, hospitals and clinics and collect a history of your impairment and results of recent tests and examinations. Collection of this data is the main reason it takes an average of three months to process a claim for disability benefits.

Your doctors will be asked for objective data: signs, symptoms and lab findings. DDS will not ask your doctors whether you are disabled. Since Social Security has a unique definition of disability that your doctor may not be familiar with-or agree with-disability decisions are made by teams of specially trained DDS personnel including physicians.

Usually, evidence obtained from your doctors and other treatment sources is enough to justify an allowance or denial of your claim. When it is not, DDS arranges an additional examination, at government expense, called a consultative exam (CE). CEs are necessary in about one of four claims.

There are two common misconceptions about CEs. CEs are not done by "Social Security doctors" but by private physicians. In fact, the applicant's family doctor can do the CE. Also, CEs are not necessarily complete examinations of the patient. Most people have at least some medical records. Sometimes one additional test or observation that takes just a few minutes is all that is needed to complete the necessary evidence.

DDS makes decisions in a step-by-step process involving five questions:

Are you working? If you're working in substantial gainful activity you do not meet Social Security's definition of disability and you will not be considered disabled regardless of how severely impaired you are. Substantial gainful activity is defined as performance of significant and productive physical or mental work for pay or profit. Work worth at least $500 per month is generally considered substantial.

Is your condition severe? Your impairments must interfere with work related activities or your application won't be considered further.

Is your condition found on Social Security's list of disabling impairments? Federal regulations include a list of impairments so severe that they automatically qualify as disabling. If your condition is on the list, or equally severe to one on the list, you will be found disabled.

Can you do the work you did previously? If you don't "meet or equal the listing" DDS decides whether your condition prevents you from doing your customary wo~rk-the work you've been doing the last fifteen years. If you can still do your customary work, your application is denied.

Is there any other job that you can do? If you can't do your customary work DDS does an individual assessment of your residual functional capacity: Considering your condition, age, education and past work experience, what can you still do? The Department of Labor's Dictionary of Occupational Titles is consulted for information on the physical demands of occupations. Finally, your application is all~owed if there is no job that you can do.

Only about forty percent of disability applications are allowed by DDS.