Cushing’s syndrome challenges the human body in a variety of ways, making even day-to-day activities difficult to complete. For this reason, individuals with Cushing’s syndrome may need financial assistance to offset the expenses associated with lost income and medical treatment. If you have Cushing’s syndrome and can no longer work, you may be eligible to receive Social Security Disability benefits.
Continue reading for information about qualifying for disability benefits in the United States.
BENEFIT PROGRAMS AND DEFINING DISABILITY
For an individual to qualify for disability benefits with Cushing’s syndrome, he or she must meet the Social Security Administration’s (SSA) definition of adult disability. This definition is made up of the following requirements:
- The adult is unable to engage in Substantial Gainful Activity (SGA). The SSA considers SGA to be earning $1,040 or more a month; and
- The adult cannot do the work they did prior to becoming disabled nor can the adult be retrained to do a different type of work; and
- The adult must have a diagnosed physical or mental health condition that has lasted or is expected to last at least one year or result in death.
Individuals who meet these requirements may be eligible to receive disability benefits from one, or both, of the federal benefit programs run by the SSA. These programs are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each has different technical eligibility requirements.
SSDI – SSDI is offered to disabled workers and their eligible dependents. To qualify for SSDI you must have worked for a specific amount of time and you must have paid a specific amount of Social Security taxes in the past. It is important to note that SSDI benefits are paid only to individuals with long term disabilities. For this reason, the SSA has a 5 month waiting period in place. Essentially, this means that a person will not be eligible to receive SSDI until five months after becoming disabled. To learn more about qualifying for SSDI, visit this page.
SSI – Unlike SSDI, SSI does not require employment history because this program is not funded through Social Security taxes. SSI is a need-based program and is funded through general tax revenues. There are two principal criteria for this program. First you must be over age 65, be blind, or be disabled. Secondly, you must meet very strict financial regulations. To determine your eligibility the SSA will evaluate your income and financial resources. These include wages, pensions, stock holdings, real estate, cash savings, and other benefit programs. For more information regarding SSI, visit this page.
HOW TO MEET MEDICAL ELIGIBILITY FOR SSD BENEFITS WITH CUSHING’S SYNDROME
If you meet the SSA’s definition of disability and the SSI or SSDI technical eligibility requirements, you will then be evaluated medically. Many conditions and their medical eligibility criteria are listed in the SSA’s publication of disability conditions—known as the Blue Book.
Unfortunately Cushing’s syndrome is not specifically listed in the “Blue Book”. However, individuals with Cushing’s syndrome may qualify for benefits under a separate listing related to their specific impairments and limitations. These may include the following listings:
Access all Blue Book listings, here.
Because Cushing’s syndrome affects people in different ways and has a variety of different symptoms, it is not likely that an individual with this condition will fit under one specific listing. If you find that this is the case, you may qualify under something known as a medical vocational allowance.
Essentially, a medical vocational allowance is when the SSA evaluates a disability claim and finds that although the applicant’s specific condition is not listed in the Blue Book, the person is in fact disabled by their condition. The SSA will look at factors such as physical ability, mental ability, age, and job training.
APPLYING FOR SSD BENEFITS
To prepare for your application you will need to gather all medical records and documents that can help demonstrate the degree of your impairment. Medical documentation should include a record of your diagnosis, the findings of physical and mental examinations, a history of treatments and your response to them, as well as written statements from your treating physicians.
It is important to keep in mind that over half of applications are initially denied. This is because most applications are found to be incomplete or do not include enough information. Be sure to give as much detail as you can on your application and provide full responses to all questions.
To begin your application you can submit the necessary paperwork on the SSA’s website or in person at your local Social Security office. After submitting your initial application, you should receive a decision within several months.
RECEIVING A DECISION
If your application is denied, it is important that you do not panic. You are allowed to appeal this decision within 60 days of receiving notice of denial. Filing an appeal will give you the chance to provide the SSA with updated information and make a stronger case for yourself. At this point in the application process, it may be in your best interest to retain the services of a qualified Social Security Disability attorney or advocate.
The appeals process is complicated and can be quite overwhelming. A legal processional will have a thorough understanding of the system and can work with you to present your case in the most successful manner.
If you have concerns about paying for an attorney, you should keep in mind that you will not be required to pay your attorney unless you are awarded benefits. Even then, the SSA has set specific limits on the amount of money a Social Security Disability attorney is allowed to charge. To learn more about how an attorney is paid, click here.
SOCIAL SECURITY DISABILITY APPEAL
The appeals process consists of two parts—the reconsideration and the appeal hearing. Some states don’t have reconsideration and go straight to the appeal hearing. If, however, your state requires reconsideration, you will have to submit the following forms:
- The Reconsideration Disability Report- intended to provide the SSA with new information about your claim; and
- The Request for Reconsideration- intended to state your intent to appeal the SSA’s decision; and
- Authorization to Disclose Information to the SSA- intended as a medical release form.
The reconsideration stage of the appeals process provides applicants with the chance to refute any incorrect conclusions, to provide additional medical records, and to correct any errors made during the initial application.
If you are denied at the reconsideration stage, you will move on to the appeal hearing. During the appeal hearing, claimants are required to appear in front of an Administrative Law Judge (ALJ) to present their claim. Applicants are strongly advised to have legal representation at this point in the process.
Although the Social Security Disability appeals process is complicated, it is often a necessary step toward receiving financial assistance. In fact, many more applicants are approved at the appeals level than during the initial application. Once you are awarded benefits, you will be able to focus on your health rather than your finances.
Author: Molly Clarke (Winter, 2013)
Editor’s Note: Molly Clarke is a writer for Social Security Disability Help where she works to promote disability awareness and to assist individuals throughout the Social Security Disability application process. You can contact Molly at [email protected]