major enhancements to social security disability … · major enhancements to social security...

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Social Security Disability MAJOR ENHANCEMENTS TO SOCIAL SECURITY DISABILITY HELPS EVERYONE.

15th Annual Substance Use Disorder/Co-Occurring

Disorder Conference

September 22 - 23, 2014

Lansing Center, Lansing, MI

JAMES PARRISH PROFESSIONAL RELATIONS OFFICER FOR DDS.

Tahquamenon Falls

www.ssa.gov

APPLY FOR BENEFITS:

Social Security retirement/spouse’s benefits Social Security disability benefits Medicare Extra Help with your Medicare prescription drug costs

• Age 62 or older; based on earnings record • Spouse age 62 or older; minor/disabled adult children; spouse under 62

caring for child

RETIREMENT INSURANCE – SOCIAL SECURITY

• Payment based on deceased worker’s earnings record • Widow(er) [age 60]; disabled widow(er) [age 50]; minor/disabled adult

children; widow(er) caring for child

SURVIVOR INSURANCE – SOCIAL SECURITY

• Based on earnings record and disability determination • Spouse age 62 or older; minor/disabled adult children; spouse under 62

caring for child

DISABILITY INSURANCE – SOCIAL SECURITY

• Needs-based - must have limited income and resources to be eligible • Must also be blind, disabled, or age 65 or older • No benefits payable to spouses/dependents

SSI – SUPPLEMENTAL SECURITY INCOME

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What is Substantial Gainful Activity (SGA)? “ Gainful” work activity is: Work performed for pay or profit; $1040

per month or Work of a nature generally performed

for pay or profit; or Work intended for profit, whether or not

a profit is realized.

Title II SSDI

Social Security Disability Insurance

Medicare

Title XVI SSI

Supplemental Security Income Medicaid

Social Security Disability Benefit Programs

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Distinctive Features SSDI SSI

FUNDED BY FICA

TAXES GENERALLY

UNAFFECTED BY OTHER INCOME, RESOURCES OR LIVING ARRANGEMET

FUNDED BY GENERAL TAX REVENUES

AFFECTED BY CHANGES IN INCOME, RESOURCES AND LIVING ARRANGEMENTS

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Distinctive Features

BE MEDICALLY DISABLED

HAVE WORKED LONG ENOUGH IN JOBS COVERED BY SOCIAL SECURITY, OR BE A WIDOW OR A DISBLED ADULT CHILD

BE MEDICALLY DISABLED

NEEDS BASED i.e.; LIMITED INCOME AND RESOURCES BELOW: $2000/INDIVIDUAL $3000/COUPLE

SSDI SSI

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Distinctive Features

BENEFIT AMOUNT IS BASED UPON LEVEL OF EARNINGS OVER WORK YEARS MEDICARE COVERAGE STARTS AFTER 24 MONTHS OF ENTITLEMENT

AMOUNT OF PAYMENT IS BASED UPON INCOME AND LIVING ARRANAGEMENT IMMEDIATE MEDICAID

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Social Security and SSI Both programs make payments to people with

disabilities

Definition of Adult Disability:

A physical and/or mental condition that prevents you from doing substantial work for 12 months or is expected to result in

death. Disability Determination Services also

considers age, education & work experience

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SSI Benefits for Children:

A medical condition or combination of impairments preventing them from doing things that children the same age normally do for at least 12 months, or expected to result in death.

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Social Security Disability Social Security will forward the application to the state Disability Determination Services (DDS) agency that:

obtains medical evidence obtains vocational evidence and makes the disability decision for the Social Security Administration

In Michigan, there are four offices: Lansing Detroit Kalamazoo Traverse City

SSA/DDS IS MOVING CASES

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Social Security Disability Programs are handled by the Disability Determination Service in Michigan.

• Is NOT a partial or short-term disability • Eligibility is separate from any other program. • The DDS makes the medical determinations for

both Social Security Disability SSDI and SSI

• The medical criteria is the same for both programs.

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Medical Program Based on a Medical Diagnosis

Disability Claim Adjudicators, Licensed Physician and Psychologist work together to make the correct Decision!

“All allegations must be documented”

Social Security laws and regulations require that we thoroughly document all claims for disability.

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Treating Source Evidence The claimant’s treating source is often in the best possible position to provide detailed longitudinal information about the claimant.

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A medical report from the treating source should be detailed enough to determine: Medical History, Clinical findings, Testing and Laboratory findings Diagnosis Treatment Medical source statement Nature, severity, and limiting effects of impairment

Probable duration Remaining capacity to work.

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www.socialsecurity.gov Disability Evaluation Under Social

Security Blue book

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Major Body Systems Adult

Musculoskeletal System, Respiratory System, Cardiovascular System, Digestive System, Genito-Urinary System, Hemic and Lymphatic System, Skin, Endocrine System and Obesity, Impairments that Affect Multiple

Body Systems Neurological, Mental Disorders, Neoplastic Diseases, Malignant, Immune System,

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Category of Mental Impairments

12.02 Organic mental disorders: 12.03 Schizophrenic, paranoid and other psychotic disorders: 12.04 Affective disorders: 12.05 Intellectual disability: 12.06 Anxiety-related disorders: 12.07 Somatoform disorders: 12.08 Personality disorders: 12.09 Substance addiction disorders: 12.10 Autistic disorder and other pervasive developmental disorders:

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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.

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Intellectual Disability regulations. 12.05 Intellectual disability: intellectual disability refers to significantly sub average general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22.

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Intellectual disability:

A. Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, or bathing) and inability to follow directions, such that the use of standardized measures of intellectual functioning is precluded; OR

B. A valid verbal, performance, or full scale IQ of 59 or less; OR

C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function;

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12.09 Substance addiction disorders: Behavioral changes or physical changes associated with the regular use of substances that affect the central nervous system. The required level of severity for these disorders is met when the requirements in any of the following (A through I) are satisfied. A. Organic mental disorders. Evaluate under 12.02. B. Depressive syndrome. Evaluate under 12.04. C. Anxiety disorders. Evaluate under 12.06. D. Personality disorders. Evaluate under 12.08. E. Peripheral neuropathies. Evaluate under 11.14. F. Liver damage. Evaluate under 5.05. G. Gastritis. Evaluate under 5.00. H. Pancreatitis. Evaluate under 5.08. I. Seizures. Evaluate under 11.02 or 11.03.

A person in military service who is being treated for a severe impairment usually continues to receive full pay. Active duty status and/or receipt of pay does not, in itself, indicate SGA. An SGA determination is based on actual work activity.

Substantial Gainful Activity $1,070/mo. for non-blind, disabled; $1,800/mo. for blind.

Military Casualty Cases Post Traumatic Stress Disorder

Acute Stress Disorder and Post Traumatic Stress Disorder

For both ASD and PTSD, essential features are exposure to a traumatic event that need not be outside the normal range of human experience but that arouses “intense fear, helplessness or horror,” followed by development of characteristic symptoms

ASD and PTSD Exposure can occur through direct

experience OR through witnessing or learning about a traumatic event that caused “actual or threatened death,” “serious injury,” or “threat to the physical integrity” of oneself or others

ASD and PTSD Acute Stress Disorder: occurs within

4 weeks of the traumatic event Post Traumatic Stress Disorder:

greater than one month (acute PTSD is diagnosed less than 3 months; chronic PTSD if duration is 3 months or greater)

Dissociative Symptom Cluster of ASD and PTSD A subjective sense of numbing,

detachment or absence of emotional responsiveness

Reduced awareness of surroundings DE realization/depersonalization Amnesia, inability to recall aspects of

the trauma

Re-experiencing Symptom Cluster of ASD and PTSD

Recurrent and intrusive distressing recollections

Recurrent distressing dreams of the event

Feeling as if the event were recurring, flashbacks

Intense distress with exposure to internal/external cues

Physical reactivity to cues

Avoidance Symptom Cluster of ASD and PTSD Avoid thoughts, feelings or

conversations related to the trauma Avoid activities, places or people that

arouse recollection of the event Inability to recall Marked decrease in interest in activities Feeling detached Restricted range of affect Sense of a foreshortened future

Arousal Symptom Cluster of ASD and PTSD Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper vigilance Exaggerated startle response

ASD and PTSD Many of these claims come to the

agency for physical issues only to discover other issues related to TBI/PTSD

Seeing claims involving soldiers that have been in multiple IED blasts

The soldiers with ASD/PTSD have engaged in firefights, lost buddies, exposed to picking up the wounded or dead, and may have been physically wounded as a result of the combat.

ASD and PTSD

Few soldiers have prior psychiatric history Some may have had involvement with

alcohol/substance abuse prior to trauma Medical records are limited in duration due

to the nature of these cases Seeing cases 3 months to one year or more

after the trauma

Military Casualty Cases Traumatic Brain Injury

Presenter

Presentation Notes

Traumatic Brain Injuries result from damage to the brain tissue from an external force that produces either a temporary of permanent loss of physical and mental functioning. Sxs can be mild, moderate or severe. Medical records that include the following information may be indicators of a significant TBI: Exposure to an IED blast, motor vehicle accident or fall Treatment for any injury sustained during a blast, motor vehicle accident or fall Traumatic amputation Brain neurosurgery Fractured skull, closed head injury, gunshot wound to head, concussion, traumatic loss of consciousness, amnesia or coma CVA �Third party information may also indicate a possible TBI. For example, information from a spouse, parents, or others that indicates personality change, distractibility, forgetfulness, emotional lability, problems learning new material or difficulty solving problems is highly suggestive that a veteran or victim of an accident has experienced a TBI and this should trigger appropriate development and further medical evaluation. The guidelines for evaluating impairments caused by cerebral trauma are contained in 11.18. Listing 11.18 states that cerebral trauma is to be evaluated under 11.02, 11.03, 11.04, and 12.02, as applicable.

Headache. Confusion. Light-headedness Dizziness. A person with mild TBI

may remain conscious or may experience a loss of consciousness for a few seconds or minutes.

Blurred vision. Tired eyes.

Ringing in the ears. Bad taste in the mouth. Fatigue. Lethargy. Sleep pattern changes. Behavioural/mood

changes. Trouble with memory,

concentration, attention, or thinking.

Mild TBI Symptoms

Presenter

Presentation Notes

These are examples of some of the milder symptoms that an individual with TBI may have – it says nothing regarding disability; however, it can help to determine an MDI and to evaluate the impact on functioning. These symptoms can be debilitating if frequent occurrences. Longitudinal information, including frequency of episodes and types of treatment necessary need to be thoroughly documented.

Severe TBI may show the same symptoms of mild TBI

Headache that gets worse or does not go away.

Repeated vomiting or nausea

Convulsions or seizures. Dilation of one or both

pupils Inability to awaken from

sleep

Slurred speech. Weakness or

numbness in the extremities

Loss of coordination Increased confusion. Restlessness. Agitation.

Moderate to Severe TBI

Presenter

Presentation Notes

Again, severity needs to be clearly established by medical evidence and functional information. Consider appropriate testing when severity cannot be established by the claimant’s medical providers. Evaluate based on the sxs ALLEGED not those assumed to be associated with a TBI.

Several facts stand out regarding combat-related Traumatic Brain Injury

Being in proximity to blast can lead to brain damage even if the soldier’s own vehicle not the target.

Improvised Explosive Devices (IED) Soldiers may be exposed to more

than one IED attack. More IED exposure means increased likelihood of acquired brain damage.

Evaluation of alleged or possible combat-related TBI

Frontal lobes especially vulnerable to damage from IED blasts.

Cognitive symptoms of frontal lobe damage may include: Memory/concentration problems Slowed info processing Impaired problem solving

Evaluation of alleged or possible combat-related TBI

Psychiatric symptoms due to frontal lobe damage may include: Impaired impulse control/disinhibition Behavior problems Irritability Personality changes Depression

Higher level Language Verbal Organization/Sequencing Comprehension of Subtleties of

Language Figurative/abstract

Cognitive-Communicative Deficits Attention/Memory Judgment/Reasoning/Verbal Problem

Solving

TBI/CVA Effects on Language

Presenter

Presentation Notes

Deficits in higher level language skills and pragmatic communication skills or social language skills are frequently seen in individuals with a traumatic brain injury or when a stroke occurs in the right hemisphere or non-dominant hemisphere. Language deficits may be less apparent as the individual is generally able to engage in simple communication tasks but difficulty becomes more evident as more communication demands are placed on the individual or the individual attempts to return to tasks or work situations. Higher level language difficulties include problems with organizing and expressing their thoughts in a logical sequence or relating information in a concise and coherent manner. An individual, who previously may have been quite verbal, now has difficulty being understood by others because his communication is difficult to follow. There is no logical order to what they are trying to express. Difficulty with verbally expressing ideas or contributing effectively to discussions may impact an individual’s return to prior work in which strong verbal communication skills were needed. Other higher language deficits include understanding abstract language including figurative language or sarcasm. They may not be able to discriminate the difference between sarcasm and a serious statement or their ability to interpret indirect comments may be limited. If another coworker says, “Gee, it’s hot in here,” they do not understand the person is indirectly asking them to open the window next to them. They also may misinterpret a sarcastic statement as a serious comment and become offending lead in to potential interpersonal difficulties in the work setting.

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THE DISABILITY DECISION

A step-by-step process • Engaging in SGA? • Severe impairment(s) • Meets the listings • equals the listings • Past work – Other work • Vocational allowance

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• If your Claim is Denied

• Our written decision will tell you why.

• You have 60 days to appeal our decision

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Work Incentives Planning and Assistance

Social Security has a Work Incentives Planning and Assistance program (WIPA) that will help answer questions about Social Security’s work incentives and help you make a decision about working WIPA projects are community-based organizations that work to enable beneficiaries with disabilities to make informed choices about work, and to support working beneficiaries to make a successful transition to financial independence. WIPA services are available at no cost to current SSDI and SSI beneficiaries between the ages of 14 to 64 who are interested in learning about work incentives, are seeking employment, or are currently employed.

Cathy Clack, AWIC (Area Work Incentive Coordinator) E-Mail: [email protected] Kevin Troup, PASS ( Plan to Achieve Self-Support) Specialist for SSA Call: 1 (866) 318-1858 ext. 28449 E-Mail: [email protected]

Work Incentive Planning and Assistance

Disability Determination Service Professional Relations Officers

James V. Parrish Professional Relations Officer 1-800-632-1097 ext. 6738# E-Mail [email protected] Marcia Shantz Professional Relations Officer (800)383-7155 , ext. 66921 E-Mail [email protected] Shiba Sanders RN/Professional Relations Officer 1-800-383-7155, ext. 66866 E-Mail [email protected]

mailto:[email protected]



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