Many people are confused about what Social Security benefits might be available to them. Here are answers to frequently asked questions. What is the difference between SSI and SSDI? SSDI or Social Security Disability Insurance is available to disabled individuals who have paid enough FICA taxes to be insured. SSI or Supplemental Security Income is available to disabled individuals who have income and resources which are under the designated limit. In order to be eligible for either benefit you need to show that you are disabled as defined by Social Security. What does it mean to be disabled according to Social Security? To be disabled according to Social Security: you must be unable to do work you did before and you cannot adjust to other work because of a medical condition. your disability must last or be expected to last for at least one year or to result in death. You can be disabled for many different kinds of illnesses, including psychological illness. How long does it take to get on Social Security benefits? Obtaining Social Security benefits can be a long and frustrating process. In Pennsylvania it takes approximately 4-5 months to receive a decision on your initial application. If you are denied and request a hearing you will probably wait 12-18 months before a hearing is scheduled. How much money will I receive? How much money you receive on SSDI depends on how much you earned while you were working. Social Security averages your past earnings and uses a special calculation formula. For most people, they average the best 35 years of earnings to figure the benefit amount. For SSI recipients, the base amount is $721 per month for an individual and $1,082 per month for an eligible couple. What medical benefits are available if I am on disability benefits? Medicare is available to SSDI recipients after a 24 month waiting period. Medicaid is available to SSI recipients. Do you have more questions? Contact Portnoy Disability Practice for answers to all of your Social Security questions.
12.01 Category of Impairments, Mental -Adult 12.04 Affective disorders: Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation. The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied. A. Medically documented persistence, either continuous or intermittent, of one of the following: 1. Depressive syndrome characterized by at least four of the following: a. Anhedonia or pervasive loss of interest in almost all activities; or b. Appetite disturbance with change in weight; or c. Sleep disturbance; or d. Psychomotor agitation or retardation; or e. Decreased energy; or f. Feelings of guilt or worthlessness; or g. Difficulty concentrating or thinking; or h. Thoughts of suicide; or i. Hallucinations, delusions, or paranoid thinking; or 2. Manic syndrome characterized by at least three of the following: a. Hyperactivity; or b. Pressure of speech; or c. Flight of ideas; or d. Inflated self-esteem; or e. Decreased need for sleep; or f. Easy distractibility; or g. Involvement in activities that have a high probability of painful consequences which are not recognized; or h. Hallucinations, delusions or paranoid thinking; or 3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes); AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration; OR C. Medically documented history of a chronic affective disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following: 1. Repeated episodes of decompensation, each of extended duration; or 2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or 3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement. http://www.socialsecurity.gov/disability/professionals/bluebook/12.00-mentaldisorders-adult.htm
Childhood Listings 112.04 Mood Disorders: Characterized by a disturbance of mood (referring to a prolonged emotion that colors the whole psychic life, generally involving either depression or elation), accompanied by a full or partial manic or depressive syndrome. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Medically documented persistence, either continuous or intermittent, of one of the following: 1. Major depressive syndrome, characterized by at least five of the following, which must include either depressed or irritable mood or markedly diminished interest or pleasure: a. Depressed or irritable mood; or b. Markedly diminished interest or pleasure in almost all activities; or c. Appetite or weight increase or decrease, or failure to make expected weight gains; or d. Sleep disturbance; or e. Psychomotor agitation or retardation; or f. Fatigue or loss of energy; or g. Feelings of worthlessness or guilt; or h. Difficulty thinking or concentrating; or i. Suicidal thoughts or acts; or j. Hallucinations, delusions, or paranoid thinking; or 2. Manic syndrome, characterized by elevated, expansive, or irritable mood, and at least three of the following: a. Increased activity or psychomotor agitation; or b. Increased talkativeness or pressure of speech; or c. Flight of ideas or subjectively experienced racing thoughts; or d. Inflated self-esteem or grandiosity; or e. Decreased need for sleep; or f. Easy distractibility; or g. Involvement in activities that have a high potential of painful consequences which are not recognized; or h. Hallucinations, delusions, or paranoid thinking; or 3. Bipolar or cyclothymic syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently or most recently characterized by the full or partial symptomatic picture of either or both syndromes); and B. For older infants and toddlers (age 1 to attainment of age 3), resulting in at least one of the appropriate age-group criteria in paragraph B1 of 112.02; or, for children (age 3 to attainment of age 18), resulting in at least two of the appropriate age-group criteria in paragraph B2 of 112.02. 1. For older infants and toddlers (age 1 to attainment of age 3), resulting in at least one of the following: a. Gross or fine motor development at a level generally acquired by children no more than one-half the child's chronological age, documented by: (1) An appropriate standardized test; or (2) Other medical findings (see 112.00C); or b. Cognitive/communicative function at a level generally acquired by children no more than one-half the child's chronological age, documented by: (1) An appropriate standardized test; or
(2) Other medical findings of equivalent cognitive/communicative abnormality, such as the inability to use simple verbal or nonverbal behavior to communicate basic needs or concepts; or c. Social function at a level generally acquired by children no more than one-half the child's chronological age, documented by: (1) An appropriate standardized test; or (2) Other medical findings of an equivalent abnormality of social functioning, exemplified by serious inability to achieve age-appropriate autonomy as manifested by excessive clinging or extreme separation anxiety; or d. Attainment of development or function generally acquired by children no more than two-thirds of the child's chronological age in two or more areas covered by a., b., or c., as measured by an appropriate standardized test or other appropriate medical findings. 2. For children (age 3 to attainment of age 18), resulting in at least two of the following: a. Marked impairment in age-appropriate cognitive/ communicative function, documented by medical findings (including consideration of historical and other information from parents or other individuals who have knowledge of the child, when such information is needed and available) and including, if necessary, the results of appropriate standardized psychological tests, or for children under age 6, by appropriate tests of language and communication; or b. Marked impairment in age-appropriate social functioning, documented by history and medical findings (including consideration of information from parents or other individuals who have knowledge of the child, when such information is needed and available) and including, if necessary, the results of appropriate standardized tests; or c. Marked impairment in age-appropriate personal functioning, documented by history and medical findings (including consideration of information from parents or other individuals who have knowledge of the child, when such information is needed and available) and including, if necessary, appropriate standardized tests; or d. Marked difficulties in maintaining concentration, persistence, or pace. http://www.socialsecurity.gov/disability/professionals/bluebook/112.00-mentaldisorders-childhood.htm
Social Security Administration: 800-772-1213 Resources Social Security Online: www.socialsecurity.gov File certain applications for benefits including Disability and Retirement. Get a Social Security Statement Appeal a decision Find out if you qualify for benefits Estimate future benefits Greenbook Consultative Examinations: A Guide for Health Professionals: http://www.socialsecurity.gov/disability/professionals/greenbook/index.htm Listings of Impairments: http://www.socialsecurity.gov/disability/professionals/bluebook/adultlistings.htm For information about employment with SSA Social Security Administration Office of Disability Programs Professional Relations Branch 4670 Annex Building 6401 Security Boulevard Baltimore, Maryland 21235 The IMA Group: www.industrialmed.com
Social Security Requirements Adult Consultative Examination Report Content Guidelines (Boldface type indicates additional requirements not found in the General Report) A. General 1. Identify claimant a. Include the claimant s claim number, and b. Indicate that the claimant provided proof of identity by showing a valid and current government photo ID (e.g., U.S. State-issued driver s license, U.S. State-issued non-driver identity card, U.S. passport, U.S. military ID, student or school ID, etc.) or c. Provide a physical description of the claimant, to help ensure that the person being examined is the claimant, except if the treating source is the CE source. 2. Longitudinal medical history a. Cite the medical records and any other documents reviewed during the course of the evaluation. b. Identify the person(s) providing the oral medical history and an assessment of the accuracy of such information. B. Current Medical History Describe and discuss: 1. The primary symptom(s) alleged as the reason for not working. This discussion must include: a. History of the onset and progress of the disorder; b. The claimant's statement of current symptom(s); c. Type(s) and effect(s) of any treatment; d. Claimant s typical daily activities. 2. Dates and results of relevant hospitalizations, surgical operations, and diagnostic procedures. 3. Past and current participation and success or failure in rehabilitation, group homes or half-way houses, inpatient or outpatient treatment. C. Past Medical History Describe and discuss (when appropriate) other significant past illnesses, injuries, operations, and diagnostic procedures with dates of the events. D. Current Medication List name, dose and frequency of medication(s); including both beneficial and adverse effects. E. Social and Family History Include the following: 1. Relevant information, including longitudinal history of relations with parents, family, peers, spouses, co-workers, etc.;
2. Educational background (special education, college courses/degree, special vocational training); 3. Relevant history of legal or occupational problems associated with the disorder; 4. Involvement in hobbies and/or regular group activities (church, social clubs, participation in sports teams, etc.); 5. A description of the claimant s attempt(s) to return to work and the results (e.g., de-compensation, missed work due to inability to handle stress); 6. Detailed longitudinal discussion of any history of alcohol, licit and illicit drug abuse, and comments on the effects of substance abuse on functioning; if there is no history of substance abuse, include a statement to that effect. F. Physical Examination Describe and discuss (when appropriate): 1. General appearance, nutritional status, behavior (such as cooperativeness), any apparent abnormalities; 2. General observations, including whether the claimant came to the examination alone or accompanied; distance and mode of transportation; and, if by automobile, who drove; 3. General motor behavior, including involuntary movements, restlessness, and psychomotor retardation or agitation. G. Mental Status Evaluation Include the following specific observations: 1. Manner and approach to evaluation; 2. Dress, grooming, hygiene and presentation; 3. Mood and affect; 4. Eye contact; 5. Expressive/receptive language; 6. Recall/memory, including working, recent and remote; 7. Orientation in all 4 spheres; 8. Concentration and attention; 9. Thought processes and content; 10. Perceptual abnormalities; 11. Suicidal/homicidal ideation; 12. Judgment/insight; 13. Estimated level of intelligence. H. Interpretation of psychological and/or clinical testing. (If the interpretation is provided separately, the report sheet should state the interpreting medical source's name and address) 1. Identify the medical source (name and address) providing the formal interpretation of the psychological and/or clinical tests when that source is other than the individual signing the CE report. 2. Provide interpretation of psychological and/or clinical testing results that takes into account, and correlates with, the history and examination findings. I. Additional Information the report should also contain the following:
1. A full multiaxial classification per American Psychiatric Association standard nomenclature as set forth in the most recent Diagnostic and Statistical Manual of Mental Disorders 2. Prognosis and recommendations for treatment, if indicated. Also, recommendations for any other evaluation (for example, neurological examination), if needed 3. For claimants with intellectual impairment: a. Current documentation of IQ by a standardized, well-recognized, individually administered measure. Acceptable instruments will have a recent and representative normative sample of the target population, a mean of approximately 100 and standard deviation of approximately 15 in the general population, and cover a broad range of cognitive and perceptual-motor functions. b. Verbal IQ, Performance IQ, and Full Scale IQ scores, or their equivalents, together with the individual subtest scores. c. Interpretation of the scores and assessment of the validity of the obtained scores, indicating any factors that influenced the claimant's attitude or degree of cooperation. d. Consistency of the obtained test results with the claimant's educational, vocational, and social background. e. A comprehensive and detailed description of adaptive behavior in the areas of personal, social, academic, and occupational functioning during the developmental period. J. Medical source statement Include the following: 1. A statement regarding the nature and extent of the mental disorder. 2. An assessment of the claimant s abilities and limitations based on medical history, observations during examination, and results of relevant laboratory tests; and an opinion regarding the ability to: a. Understand, carry out, and remember instructions (both complex and one-two step); b. Sustain concentration and persist in work-related activity at reasonable pace; c. Maintain effective social interaction on a consistent and independent basis, with supervisors, co-workers, and the public; and d. Deal with normal pressures in a competitive work setting. 3. If hazards should be avoided or limited (e.g., operating machinery due to medication side effect), specify which ones and why. 4. Discussion of any apparent discrepancies in medical history or in examination findings and how discrepancies resolved. 5. A statement regarding malingering, if applicable. 6. A statement regarding the capability to manage funds. http://www.socialsecurity.gov/disability/professionals/greenbook/ce-adult.htm