SSR 90-5c

It helps to review previous cases to understand the rules and processes regarding the Social Security’s definition of disabled. In many cases, common sense does not prevail until an attorney gets an opportunity to describe how the rules do not meet the intention.

Adams v. Bowen, 872 F.2d 926 (9th Cir. 1989), cert. denied, _____ U.S. _____, 110 S. Ct. 151 (1989)

The claimant, a 56-year-old diabetic, applied for disability insurance benefits under title II of the Social Security Act (the Act), contending that she was unable to work because of impaired vision. Although she did not have 20 quarters of coverage in the 40-quarter period ending with the quarter of alleged disability, she was fully insured and would have met the disability insured status requirements under section 223(c)(1) of the Act and would have been entitled to disability insurance benefits, had she established that she was statutorily blind. Section 216(i)(1)(B) of the Act provides that a person is statutorily blind if he or she has either central visual acuity of 20/200 or less in the better eye with the use of a correcting lens, or has a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees which is considered as having a central visual acuity of 20/200 or less. The evidence of record showed that the claimant’s visual acuity in each eye was approximately 20/50 and her visual fields were intact. Because of a neurological impairment, however, the claimant had difficulty processing visual information when the environment around her was moving. She would trip and fall when she walked, and she could not see well enough to put a staple in the corner of a piece of paper. A neuropsychologist stated that, because of her condition, the claimant was in many ways worse off than someone who was blind. Moreover, three ophthalmologic specialists, including the claimant’s attending physician, characterized her as being “functionally blind.” The Secretary, nonetheless, denied the claimant’s application because the evidence showed that she did not meet the statutory definition of blindness.

via SSR 90-5c.

10-14816: Leroy Simpson v. Commr. of Social Security :: Eleventh Circuit :: US Court of Appeals Cases :: Justia

Leroy Simpson appeals the district court’s order affirming the Social Security Administration’s termination of his disability insurance benefits and supplemental security income, 42 U.S.C. §§ 405(g) and 1383(c)(3). On appeal, Simpson argues that the Administrative Law Judge’s (“ALJ”) finding that he was able to perform his past relevant work is not supported by substantial evidence because the ALJ incorrectly characterized his past work as being that of a cabinet assembler rather than a cabinet maker. For the reasons stated below, we affirm.

10-14816: Leroy Simpson v. Commr. of Social Security :: Eleventh Circuit :: US Court of Appeals Cases :: Justia.

Retirement Planner: How the Windfall Elimination Provision Can Affect Your Social Security Benefit

If you paid Social Security tax on 30 years of substantial earnings you are not affected by the Windfall Elimination Provision (WEP).

The following chart shows the maximum monthly amount your benefit can be reduced because of WEP if you have fewer than 30 years of substantial earnings.  (To calculate your WEP reduction, please use our WEP Online Calculator or download our Detailed Calculator.)

The chart is easy to use.

Go to the Eligibility Year (ELY) column to find the year you reach age 62 or became totally disabled (if earlier). If your birthday is on January 1st, use the year before you reach age 62.

Go to the column that shows the number of years you paid Social Security tax on substantial earnings. The amount shown is the maximum your benefit can be reduced in your Eligibility Year because of the Windfall Elimination Provision (WEP).

Important: The amounts in the chart below do not reflect the effect of cost-of-living adjustments, early retirement, delayed retirement credits, or other factors.

Example: WEP reduces your Eligibility Year benefit before the annual cost-of-living adjustment (COLA) is added to your benefit.

If you became disabled in 2007 (ELY 2007), presume the WEP reduced your $1,340 benefit to $1,000.

In January, 2008 the 2.3% COLA increased your benefit by $23 ($1,000 x 2.3% = $23).

More examples of how other factors affect your benefit can be found in Examples of How the Windfall Elimination Provision Can Affect Your Social Security Benefit.


via Retirement Planner: How the Windfall Elimination Provision Can Affect Your Social Security Benefit.

Who is disabled?

Who is disabled?

To be con­sid­ered dis­abled, you must have a med­ical con­di­tion that lasts 12 months from your date of onset. If you are dis­abled for only 11 months, you will not be eli­gi­ble for benefits.

SSA will also con­sider your age, edu­ca­tion and past work in its deter­mi­na­tion. It does not mat­ter whether you can­not find a job or that you can’t go back to your old job. SSA only con­sid­ers whether you are able to work at any job on a sus­tained basis.

Your dis­abil­ity claim is reviewed by a med­ical expert and by a voca­tional expert. The med­ical expert will deter­mine the sever­ity of your dis­abil­ity. The voca­tional expert con­sid­ers your age, edu­ca­tion, past work, and trans­fer­able skills. Usu­ally a per­son with a med­ical condition(s) who is over 50, can’t do pre­vi­ous work, is lim­ited to seden­tary work, and has no trans­fer­able skills, is con­sid­ered dis­abled. How­ever, if you are under 50, have a high school edu­ca­tion, and have had jobs with trans­fer­able skills, you will have a more dif­fi­cult time with the voca­tional expert. The VE will assume you can learn to do a vari­ety of other jobs even if there are no jobs available.

The Law Office of Tina Laine spe­cial­izes in cross exam­in­ing the expert wit­nesses and ques­tion­ing their deci­sions. Call 714 565‑7855 for a free consultation.

Closed Period

To be con­sid­ered dis­abled your med­ical con­di­tion must last 12 months. If your con­di­tion is healed in 12 months and you go back to work, you can be awarded a “Closed Period” and receive your retroac­tive ben­e­fits for 7 months – the first five months are exempt. So, even if you’ve gone back to work, you may be eli­gi­ble for months of retroac­tive pay.

By law, you can file appli­ca­tions your­self. How­ever, sta­tis­tics show that you have a bet­ter chance of win­ning your case when you have a lawyer who spe­cial­izes in SSDI.

How are ben­e­fits calculated

Ben­e­fits are cal­cu­lated by the num­ber of years you worked and by the amount you earned each year. To be eli­gi­ble for Social Secu­rity RETIREMENT you must have worked for 40 quar­ters – 10 years. How­ever, to be eli­gi­ble for Social Secu­rity DISABILITY, you must have worked 5 of the last 10 years. For instance, if you worked for 10 years and earned your 40 quar­ters, you will be eli­gi­ble for retire­ment ben­e­fits when you are 65. But if you stopped work­ing and pay­ing your FICAtaxes for five years prior to becom­ing dis­abled, you will not be eli­gi­ble for dis­abil­ity ben­e­fits. You have not worked 5 of the last 10 years. You will have to wait until your retire­ment age to col­lect any Social Secu­rity benefits.

You may con­tact SSA at 1–800-772‑1213 and ask them to send you a copy of your earn­ings record which will show you exactly what your ben­e­fits are for your­self and any eli­gi­ble fam­ily member.

SSI and SSDI Together
Sup­ple­men­tal Secu­rity Income (SSI) is avail­able for peo­ple who have not worked and earned the nec­es­sary quar­ters to be eli­gi­ble for reg­u­lar Social Secu­rity. They must also have very lim­ited income and less than $2000 in assets. They may own a car and a house. If they qual­ify for dis­abil­ity, they will receive a mea­ger monthly ben­e­fit and will receive Medi-Cal.

Some peo­ple who have earned their 40 quar­ters and have worked 5 of the last ten years my qual­ify for both SSI and SSDI. They must have earned mea­ger yearly salaries so that their SSDI pay­ments are under the amount paid by SSI. If this is so, they will receive the full amount of SSDIthat they earned, plus they will receive SSI to add up to the SSI max­i­mum. They will qual­ify for both Medi-Care and Medi-Cal.

When to apply

It is impor­tant that your SSDI claim is filed timely. Ben­e­fits will be paid only one year retroac­tively from the onset date plus 5 months exemp­tion. Sup­pose you are dis­abled on 1/1/08. You would be eli­gi­ble for ben­e­fits from 6/1/08 – five months from your date of onset. But sup­pose you don’t con­tact SSA to apply for ben­e­fits until 1/1/10 – or 24 months after your date of onset. Social Secu­rity ben­e­fits will be paid retroac­tively from 1/1/09. So you have lost ben­e­fits from 6/1/08 to 1/1/09 because you did not file timely.

If you are fil­ing for SSI ben­e­fits, the date you call SSA to apply for ben­e­fits is con­sid­ered your onset date. SSI does not pay the one-year retroac­tive benefits.