Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©
Disability, Social Security
New SSA Ruling for Polio Survivors with "Post-Polio Sequelae"
Two Social Security programs provide benefits based on disability. Both programs define disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to last at least a year or to result in death.
Title II Social Security Disability Insurance (SSDI) covers three categories of disabled workers and their dependents who are insured under the Social Security Act after having contributed FICA (Federal Insurance Contributions Act) tax from their earnings to the Social Security trust fund. The categories are:
- a disabled insured worker under 65;
- a disabled widow or widower age 50-60 if the deceased spouse was insured under Social Security;
and a person disabled since childhood (before age 22) who is a dependent of a deceased insured parent or a parent entitled to Title II disability benefits.
Under SSDI, disability benefits start six months after Social Security decides the disability began. After 24 months of SSDI payments, recipients are automatically enrolled, premium free, in Medicare Part A, hospital benefits. The other part of Medicare, Part B, which helps pay doctors' bills and other services, is available upon payment of a monthly premium.
Title XVI Supplemental Security Income (SSI) provides payments for individuals (including children under age 18) who are disabled and have limited income and resources. Under SSI, disability payments may begin as early as the date the individual files an application. In most states, individuals who qualify for SSI disability payments also receive Medicaid health care benefits.
Anyone fitting the above description(s) may apply for Social Security disability benefits any time after the onset of disability by phone, mail or in person at any local Social Security office. The initial claims process requires Social Security number; proof of age; names, addresses and phone numbers of doctors, hospitals, clinics and institutions with dates of treatment; a summary of jobs held and employers in the past 15 years; and a copy of the most recent W-2 form or federal tax return.
The Social Security office collects medical evidence from licensed providers and health care facilities regarding medical diagnoses, pain and other symptoms; physical examination findings; results of x-rays and tests; medications; past medical and surgical treatments; and functional activities which are affected by the disease process, such as grooming, dressing, walking, bathing, toileting and homemaking.
Other relevant information may include: work limitations involving concentration; pace in completing tasks; and limitations in standing, sitting, lifting, climbing, stooping, kneeling and manipulating items.
When the evidence from the survivor's own medical sources is inadequate, the review panel may require additional medical information from the treating professional(s) or an independent examiner, or non-medical evidence from social welfare agencies, employers, teachers and other practitioners. Ultimately, a team, consisting of a physician or psychologist, depending on the nature of the disabling condition, and a disability evaluation specialist from a state's Office of Disability Determination Services (DDS), makes decisions regarding disability.
If an individual is denied disability benefits (which is often the case), the person has 60 days to initiate an appeal. Appeals must be filed in writing and may be submitted by mail or in person to any Social Security office. The appeals process consists of four levels: reconsideration by another physician/administrator panel; hearing before an administrative law judge; review by an appeals council; and finally, an appeal to the US federal district court, a complex and expensive process. The whole process may take a year or more and may necessitate updated medical evaluations and resubmission of medical evidence forms.
Benefits continue as long as an individual remains disabled. Periodic case reviews are done to verify ongoing disability. The frequency of reviews ranges from every six months to once in seven years, depending on the expectation of recovery. Benefits will stop if the individual returns to work at a "substantial" level, defined as average earnings of $860 or more per month (January, 2006). Benefits also will stop if Social Security decides that a person's medical condition has improved to the point that the individual is no longer disabled.
In 1987, the Social Security Administration acknowledged the late effects of poliomyelitis and issued criteria for the evaluation of the ability of survivors to continue employment in its Program Operations Manual System (POMS). (The listing number for Evaluation of the Late Effects of Poliomyelitis was DI 24580.010E.3.)
On July 1st, 2003, the Social Security Administration updated the listing. It is now called DI 24580.010 Evaluation of the Postpolio Sequelae.
Survivors are advised to take an active role in the process by assisting with the collection of medical evidence and relevant information, following the claim from step to step, making copies of important documentation, meeting all deadlines, and appealing, if necessary.
For more information, call Social Security (800-772-1213) or visit www.ssa.gov. The National Organization of Social Security Claimants' Representatives (800-431-2804) can suggest an experienced disability lawyer.