Social Security Disability DefinitionsAttorney Jeff Lapin
The following is a list of definitions for commonly used Social Security Administration terms and phrases in Social Security Disability (SSDI) and Supplemental Security Income (SSI) benefits cases. Some words and phrases may have a different definition depending on the situation, applicable laws, rules or regulations. Most definitions are obtained from the Social Security Administration, its rules and the Code of Federal Regulations (CFR).
These are medical providers in which the SSA will greater weight to their opinions, records and opinions. These include (1) licensed physicians; (2) licensed osteopaths; (3) licensed or certified psychologists; (4) licensed optometrists for the measurement of visual acuity and visual fields; and (5) persons authorized to send SSA a copy or summary of the medical records of a hospital, clinic, sanatariumsanitarium, medical institution, or health care facility.
Basic activities that people must engage in as a requirement of daily living. They include personal hygiene (i.e. bathing, dressing), preparing meals, shopping and general household activities (i.e. sweeping, vacuuming, dusting, laundry, and dish washing).
A judge who presides at an Administrative Hearing, where a claimant is given the opportunity to meet in person to explain the disability and its effect on the claimant’s ability to work.
An individual’s chronological age. Important as it is seen it may affect the ability to adapt to a new work situation and to work in competition with other people. There are four age categories for SSA purposes Younger Person (under age 50); Person Approaching Advanced Age (ages 50 – 54); Person of Advanced Age (ages 55-59); and Person Close to Retirement Age (ages 60 -64).
The date that a period of disability begins, or is alleged by the claimant (AOD) to have begun.
A provision of the Social Security Act that limits the amount of money a person can earn and still collect all his or her Social Security Benefits; it affects people under the age of 70 who collect Social Security retirement, dependents, or survivors’ benefits.
Social Security Disability claimants can appeal a denied claim through many levels of the Social Security Administration Disability appeals process. The levels of appeal are Reconsideration; Administrative Law Judge (ALJ) hearing; Appeals Council; appeal to the United States District Court; appeal to the United States Court of Appeals; and appeal to the United States Supreme Court.
A group of attorneys SSA employs as Administrative Appeals Judges, who have the authority to deny or dismiss a claimant’s request for review of the ALJ’s decision or order, or grant the request and either issue a decision or remand the case to an ALJ. The AC may, on its own initiative, review an ALJ’s decision and may recommend action to be taken on a claim when a claimant files a civil action. Incoming appeals are assigned to an AC member on the basis of geographic jurisdiction and rotational distribution.
An application for benefits on a form prescribed by the SSA.
By regulatory definition (20 C.F.R. § 404.1563 and § 416.963), an individual that is between age 50 to 54 years old.
By regulatory definition (20 C.F.R. § 404.1563 and § 416.963), an individual agethat is between 60 to 64 years old.
An individual appointed in writing by another individual to represent the latter individual before SSA and who has been accepted by SSA to act as an authorized representative (SSA Form 1696). An authorized representative may be an attorney but does not have to be. Any competent person can be a claimant’s authorized representative.
An individual entitled to benefits on another person’s Social Security earnings record, such as wife, husband, child, widow/widower, parent, and so on.
Actual employees’ earnings (wages) employers report, or net earnings from self-employment individuals report as self-employment income for Social Security purposes.
The abilities and aptitudes necessary to do most jobs.
The stoppage of SSDI or SSI benefits as a result of the person no longer meeting SSA’s medical or non-medical requirements.
The date a claimant’s disability ends.
A case folder generally containing an application and documentation supporting a claim for SSA benefits.
The social representative who is responsible for interviewing claimants and processing their Social Security applications and handling related matters in SSA field and branch offices.
A codification of the general and permanent rules that the executive departments and agencies of the federal government publish in the Federal Register.
Persons who are eligible for disability benefits under both the SSDI and SSI programs.
Licensed physicians (medical or osteopathic physicians), psychologists or, in certain circumstances, other health professionals such as optometrists, podiatrists, and speech-language pathologists. All CE sources must be currently licensed in the State and have the training and experience to perform the type of examination or test SSA requests. Utilized by DDS to help determine physical and mental impairments, signs or laboratory findings.
The weight given to a medical opinion from a treating source that must be adopted when all of the following criteria are present (1) the opinion is from treating source; (2) the opinion must be a medical opinion; (3) the treating source’s medical opinion is well-supported by medically acceptable clinical and laboratory diagnostic techniques; and (4) the treating source’s medical opinion is not inconsistent with the other substantial evidence in the case record.
Cash and in-kind, earned and unearned income, which is used to determine the monthly SSI benefit amount – the greater the countable income, the less the monthly payment. There are a number of exclusions to countable income specified in the Act. Regulations include a standard disregard of $65.00 per month of earned income and $20.00 per month unearned income, other than in-kind support and maintenance and income based on need.
The degree to which an individual’s statements about pain or other symptoms and their functional effects can be believed and accepted as true in determining whether an individual is disabled. When evaluating the credibility of an individual’s statements, the adjudicator must consider the entire case record and give specific reasons for the weight given to the individual’s statement.
The date of last insured is the last date covered by your Social Security insurance. To receive benefits for Social Security Disability in CT, you must be found disabled prior to this date.
A written statement of the applicable issues, law, facts, rationale, findings, and conclusions in a case decided by an Administrative Law Judge, the Appeals Council, or a district court.
Income and resources of people responsible for the recipient’s welfare, which include a spouse, parent, parent’s spouse, sponsor of an alien or sponsor’s spouse, that are considered as belonging to a person who files for SSI benefits. Based on the idea that those who have a responsibility for one another share their income and resources. It does not matter if money is actually provided to an eligible individual for deeming to apply. Certain income and resources of these people are not “deemed” including governmental benefits, alimony, child support and tax refunds.
A refusal of the benefits or action claimed or requested.
A publication drafted by the United States Department of Labor. It provides standardized occupational information, including the most typical characteristics of jobs as they exist throughout the American economy. Classifies jobs based on a number of factors, such as worker actions, exertional level and skill requirements in order to facilitate the placement of applicants in positions that match their qualifications. The DOT has played a prominent role in social security hearings and ALJs are required to take administrative notice of the DOT under Social Security regulations.
The claimant is, or soon will be, without food, medicine, or shelter.
Medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months for persons under the age of 18 years old.
The inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work or any other substantial gainful work that exists in the national economy. There are different rules for determining disability for individuals who are statutorily blind.
Individuals who are disabled and meet certain employment qualifications can file a Social Security Disability claim. Those who do not meet employment qualifications (such as children) may be eligible for Supplemental Security Income benefits.
A Federally funded agency of a state which makes disability and blindness determinations in Social Security and SSI disability claims.
All initial disability claims are evaluated by a disability examiner prior to the Administrative Hearing. These individuals determine whether a claimant meets the medical eligibility requirements to get SSDI or SSI benefits.
SSA benefits paid to disabled individuals, their spouses, and their dependents, under Title II of the Act.
An impairment that is (a) expected to result in death; or (b) has lasted or is expected to last for a continuous period of at least 12 months.
Official record of an individual’s wage and self-employment income on which Social Security taxed are paid, or, in some instances, income or activity on which gratuitous wage credits are based.
Limitations that only arise due to a particular work environment such as extreme heat or cold; wetness; humidity; noise; vibration; fumes, odors, dusts, gases, or poor ventilation; hazards (machinery, heights, etc.).
Restrictions that result in an inability to tolerate some physical feature(s) of the work setting that occurs in certain industries or types of work, such as an inability to tolerate dust or fumes, cold or hot temperatures or loud noises.
Any record or document submitted to, or obtained by, SSA relating to the individual’s claim for benefits. Evidence includes, but is not limited to, (1) objective medical evidence such as medical signs and laboratory findings; (2) other evidence from medical sources, such as medical history, opinions, and dstatemetnnts about treatment; (3) statements the individual or others make about the individual’s impairment(s), restrictions, daily activities, efforts to work, or any other relevant statements the individual makes to medical sources during the course of treatment or to SSA employees during interviews, in letters, or in testimony during administrative hearings; (4) information from other sources such as public and private social welfare agencies, observations by non-medical sources, and other practitioners; (5) decisions by any governmental or nongovernmental agencies about whether the individual is disabled or blind; or (6) at the ALJ and AC levels, certain findings other than the ultimate determination about whether the individual is disabled, made by DDS medical or psychological consultants and other programs physicians or psychologists, and opinions expressed by medical advisors based on their review of the evidence in the individual’s case records.
This addresses an individual’s limitations and restrictions of physical strength and defines the individual’s remaining abilities to perform each of seven strength demands standing, walking, sitting, lifting, carrying, pushing, and pulling. Each function should be considered separately.
Limitations and restrictions imposed by impairment(s) and related symptoms, such as pain, that affect only your ability to meet the strength demands of jobs. Examples of items considered exertional include sitting; standing; walking; lifting; carrying; pushing; and pulling.
A determination or decision which results in an outcome fully or partially favorable (advantageous) to the claimant.
Stands for the Federal Insurance Contributions Act. It is basically the tax provisions, that is, the partial funding of, the Social Security Act, as they appear in the Internal Revenue Code.
A publication that provides a uniform system for making available to the public proposal and final regulations and legal notices issued by federal agencies.
SSDI benefits for workers and widows usually cannot begin for 5 months after the established onset of the a disability.
A process used to determine if someone is disabled if they do not fall within a listed impairment. Generally, the steps are 1) Are you working? 2) Is your impairment severe? 3) Does your impairment equal or exceed those the SSA has listed? 4) Can you do your past work? and 5) Can you do any other type of work?
Something that occurs one-third to two-thirds of the time within an 8-hour workday (cumulative, not continuous).
A decision which results in an outcome fully consistent with the requested by the claimant.
Is defined as (a) work performed for pay or profit; (b) work of a nature generally performed for pay or profit; or (c) work intended for profit, whether or not a profit is realized.
A term used to refer to the table of Medical-Vocational rules found in Appendix 2, Subpart P of Title 20 of the Code of Federal Regulations.
The operations and procedures manual for processing and adjudicating claims at the Office of Hearings and Appeals and Appeals Council levels of adjudication.
Same standing requirement as light and medium work but with a heavier lifting requirement than medium work.
Generally, any item received that cannot be used as, or to obtain, food, clothing, or shelter, the SSA will not consider as income.
The receipt by an individual of any property or service which he can apply, either directly or by sale or conversion, to meeting his basic needs. Consists of both earned income and unearned income. Earned income includes money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, and some royalties and honoraria. Unearned income includes money received from all other sources, e.g., gifts, interest, Social Security benefits, Veterans benefits, and pensions. Unearned Income also includes “in-kind income” (free food, clothing or shelter) and “deemed income” (some of the income of a spouse, or parent, or sponsor of an alien).
Income which is not in the form of cash or negotiable instruments as compensation for employment (i.e., real property, food, clothing, room, and board).
Unearned income in the form of food, clothing, or shelter that is given to an individual or that an individual receives because someone else pays for it.
A basic factor of entitlement to benefits for SSDI benefits. It is used to determine whether an individual has sufficient work coverage to be insured for SSDI benefits.
Anatomical, physiological, or psychological phenomena which can be shown by the use of a medically acceptable laboratory diagnostic techniques. Examples include diagnostic techniques such as chemical tests, electrophysiological studies (i.e. electrocardiogram, electroencephalogram, radiological studies (i.e. X-rays) and psychological tests.
Requires the ability to stand up to six hours in an eight hour work day, lift up to 10 pounds frequently and up to 20 pounds occasionally.
Certain severe medical descriptions and conditions, found in Appendix 1, Subpart P, of Part 404 of Title 20 of the Code of Federal Regulations, which automatically are deemed to be disabling.
A Medical doctor, osteopath, podiatrist, optometrist, or clinical psychologist under contractual agreement with the Office of Hearings and Appeals to provide expert advice or medical opinions to the Administrative Law Judge in individual disability cases at the hearing level.
A statement from a physician, psychologist, or other acceptable medical source that reflects a judgment about the nature and severity of an individual’s impairment(s), including the individual’s symptoms, diagnosis, and prognosis; what the individual can still do despite impairment(s); and the individual’s physical and mental restrictions.
A term used by SSA to describe objective medical evidence. It is often used to mean the clinical and laboratory diagnostic techniques that the medical source uses are in accordance with the medical standards that are generally accepted within the medical community as the appropriate techniques to establish the existence and severity of an impairment.
A physical or mental impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings-not only by the individual’s statement of symptoms.
An impairment that results from anatomical, physiological, or psychological abnormalities whichthat can be shown by medically acceptable clinical and laboratory diagnostic techniques.
Used by SSA to determine disability due to exertional impairments at Step 5 of the Sequential Evaluation Process. The guidelines, or the “grids,” consider a claimant’s exertional level as well asnd the claimant’s age, education and work history.
Requires the ability to stand up to six hours in an eight hour work day, lift up to 25 pounds frequently and 50 pounds occasionally.
An acceptable medical source who provides evidence about individualsclaimants that they themselves have not examined or treated. All evidence from a non-examining source is opinion evidence.
Considers all work-related limitations and restrictions that do not depend on an individual’s physical strength andwhich are not reflected in the seven strength demands such as sitting, standing and , walking, and so on. Abilities assessed as non-exertional include postural activities (stooping, bending, climbing, and similar activitiesso on), manipulative (reaching, handling, fingering and similar activitiesso on), visual (seeing), communicative (hearing and speaking), and mental (understanding and remembering instructions and responding appropriately to supervision). In addition to these activities, it also considersincludes the ability to tolerate various environmental factors, such as dust and fumes, temperature extremes and similar items, and so on.
Limitations and restrictions imposed by your impairment(s) and related symptoms, such as pain, that affect only your ability to meet the demands of jobs other than the strength demands, we consider that you have only nonexertional limitations or restrictions. Examples of items considered non-exertional include psychological conditions; communication; postural (reaching, handling, stooping, climbing, crawling, or crouching); hearing; seeing/ vision; environmental limitations; and balance.
An impairment or combination of impairments is not severe if it does not significantly limit your physical or mental ability to do basic work activities.
Evidence obtained from the application of medically acceptable clinical and laboratory diagnostic techniques.
Occurring from very little up to one-third of the time ina ann 8-hour workday (cumulative, not continuous).
The SSA component responsible for hearing and deciding appeals under the Act and processing requests for review of ALJ decisions and dismissal orders.
The date that a period of disability begins, or is alleged by the claimant (AOD) to have begun.
A decision based on the written case record without any personal appearance or submission of other evidence by the claimant at a hearing.
May include statements or reports from a claimant, the claimant’s treating or examining physician or psychologist, and other people relating to the claimant’s medical history, diagnosis, prescribed, daily activities, efforts to work, and any other evidence showing how his or her impairment(s) and any related symptoms affect his or her ability to work.
Sources of evidence other than acceptable medical sources.
An excess payment; the amount an individual received for any period which exceeds the total amount which should have been paid for that period.
A decision which results in an outcome not fully congruent with that requested by the claimant, such as the finding of a later disability onset date than that alleged.
The sums of benefits which have accumulated from the date of entitlement to the date of payment on a disability claim.
Work that an individual performed within the past fifteen years before the time of adjudication (or before the dae last insured for disability)and which was performed for a sufficient period of time for the individual to learn the job and which constituted substantial gainful activity.
In SSDI cases, a continuous period of time in which an individual is disabileddisabled, which begins on the date of onset established by SSA and ends with the month of termination or at other times specified in the Code of Federal Regulations.
A statement of intent (or that can be construed as intent) to file an application for benefits, the date of which can be used as a filing date.
Skills which require little or no vocational adjustment in terms of tools, work processes, work setting, or the industry.
A general reference source about SSDI and SSI benefits. Published by the SSA its purpose is to give a working knowledge of technical provisions so that rehabilitation professionals, advocates and counselors can appropriately advise individuals with disabilities who express an interest in starting or returning to work.
An individual or organization selected by SSA to receive benefits on behalf of a beneficiary.
A request for a hearing before an Administrative Law Judge following denial at the reconsideration level.
The impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what a person can do in a work setting. Residual functional capacity is the most a person can still do despite their limitations. It is comprised of four parts physical abilities; mental abilities; other abilities affected by impairment; and total limiting effects.
Resources are anything you own, such as a bank accounts, stocks, business assets, real property, or personal property. that you can use for your support and maintenance. Only applicable to SSI claims.
Requires the ability to sit up to six hours in an eight hour work day, lift light objects such as files and paperwork frequently during the day, and lifting objects weighing up to 10 pounds occasionally during the day.
The amount of an individual’s net earnings from self-employment income subject to Social Security tax and counted for Social Security benefit purposes.
More complex than unskilled work and distinctly simpler than the more highly skilled types of jobs. They contain more variables and require more judgment than do unskilled occupations. Even though semiskilled occupations require more than 30 days to learn, the content of work activities in some semiskilled jobs may be little more than unskilled.
Work that needs some skills but does not require doing more complex work duties. Semi-skilled jobs may require alertness, coordination and dexterity. Semi-skilled work is between unskilled and skilled work.
An impairment or combination of impairments that significantly limits your physical or mental ability to do basic work activities.
Anatomical, physiological, or psychological abnormalities whichthat can be observed apart from the individual’s statements (symptoms). Signs must be shown through the use of medically acceptable clinical diagnostic techniques. Psychiatric signs are medically demonstrable phenomena which indicates specific abnormalities of behavior, affect, thought, memory, orientation, and contact with reality. They must also be shown by observable facts that can be medically described and evaluated.
More complex and varied than unskilled and semiskilled occupations. They require more training time and often a higher educational attainment. Abstract thinking in specialized fields may be required, as for chemists and architects. Special artistic talents and mastery of a musical instrument may be involved, as for school band instructors. Practical knowledge of machinery and understanding of charts and technical manuals may be needed by an automobile mechanic. The president or chief executive officer of a business organization may need exceptional ability to deal with people, organize various data, and make difficult decisions in several areas of knowledge.
Requires qualifications in which (1) a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced or (2) dealing with people, facts, or figures or abstract ideas at a high level of complexity.
Knowledge of a work activity which requires the exercise of significant judgment that goes beyond the carrying out of simple job duties and is acquired through performance of an occupation which is above the unskilled level (requires more than 30 days to learn). It is practical and familiar knowledge of the principles and processes of an art, science or trade, combined with the ability to apply them in practice in a proper and approved manner. This includes activities like making precise measurements, reading blueprints, and setting up and operating complex machinery. A skill gives a person a special advantage over unskilled workers in the labor market. Skills refer to experience and demonstrated proficiency with work activities in particular tasks or jobs. Job titles, in themselves, are not determinative of skill level.
The SSDI program is administered by the Social Security Administration, and is designed to help individuals financially who are unable to work due to a disability. Also called Title II benefits.
The field office is responsible for verifying Social Security disability nonmedical eligibility requirements, which may include age, employment, marital status, citizenship/residency and Social Security coverage information, and additionally, for SSI eligibility, income, resources, and living arrangement information. The field office sends the case to a State Disability Determination Services (DDS) for evaluation of disability.
State agency, fully funded by the federal government, that are responsible for developing medical evidence and rendering the initial determination on whether the claimant is or is not disabled or blind under the law. After obtaining the medical and other evidence, the DDS makes a disability determination by utilizing a two-person adjudicative team consisting of a medical or psychological consultant and a disability examiner.
Work activity that is both substantial and gainful. The SSA uses earnings guidelines to evaluate your work activity to decide whether the work activity should be considered substantial gainful activity. Generally, in 2010 and 2011, earnings averaging over $1,000.00 a month demonstrate SGA.
The performance of significant physical or mental duties, or a combination of both, which are productive in nature. For activity to be substantial it need not necessarily be performed on a full-time basis; work activity performed on a part-time basis may also be substantial.
The SSI program is administered by the Social Security Administration, and is designed to supplement the income of individuals who are disabled, blind, over the age of 65, and who qualify as low-income. Also called Title XVI benefits.
The amount to be paid to an eligible individual (or eligible individual and his eligible spouse) for SSI purposes.
Benefits payable to certain family members when an individual insured under SSDI dies.
A person’s description of his/her physical or mental impairments. Signs Anatomical, physiological, or psychological abnormalities which can be observed, apart from your statements (symptoms). Signs must be shown by medically acceptable clinical diagnostic techniques. Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, such as abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated.
Applying work skills which that a person has demonstrated in vocationally relevant past jobs to meet the requirements of other skilled or semiskilled jobs. Transferability is distinct from the usage of skills recently learned in school which that may serve as a basis for direct entry into skilled work.
A treating source is a person’s own physician, psychologist, or other acceptable medical source who has provided the person with medical treatment or evaluation and has or has had an ongoing treatment relationship with the person. The treating source is usually the best source of medical evidence about the nature and severity of a claimant individual’s impairment(s).
Allows a disabled person receiving SSDI benefits to attempt work or running a business for at least 9 months and still receive full SSDI benefits. The 9 months does not need to be consecutive and your trial work period will last until you accumulate 9 months within a rolling 60-month period.
The least complex types of work. Jobs are unskilled when persons can usually learn to do them in 30 days or less.
Work that needs little or no judgment to do simple duties that can be learned on the job in a short period of time. It may or may not require considerable strength.
A failed effort by a disabled individual to do substantial work that either stopped or produced earnings below the Substantial Gainful Activity level after 6 months or less because of either the individual’s disabling condition or elimination of the special services or assistance that the individual needed in order to work.
Is the amount of change an individual can reasonably be expected to make in their job skills to permit them to be able to find substantial gainful employment.
They are a person’s age, education and work experience.
Those services identified in the Rehabilitation Act of 1973, as amended, that are provided by a State Vocational Rehabilitation agency (VR) in an individualized plan for employment necessary to assist an individual with a disability in preparing for, securing, retaining, or regaining an employment outcome that is consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual.
A period of five (5) full, consecutive calendar months following an established onset date for disability in which no disability benefits are paid. Applicable to SSDI benefits only.
Skills and abilities an individual has acquired through work he or she had done that show the type of work he or she may be expected to do.
The contributions paid through payroll taxes into the Social Security system. These contributions are called “credits.” You may earn up to four credits per year. Forty (40) credits are needed for adults seeking SSDI benefits. For disability you must have at least 20 work credits during the last 40 calendar quarters. The amount of money needed to earn a “credit” changes from year-to-year.
By regulatory definition an individual between age 18 through 49.