Special Considerations For Qualifying For SSDI With A Rare Disease

Social Security Disability Insurance (SSDI) benefits are a financial lifeline for millions of Americans suffering from disabilities. Qualifying for these benefits, though, despite paying into the system for years just to have the opportunity to apply, is not easy. Working with an experienced disability insurance attorney to assist with filing an SSDI claim is the most effective and efficient way to get approved. This assistance is especially important if a claimant is basing their application on a rare, and relatively unknown, disease. The standards a claimant must meet to qualify as disabled are quite high, even among conditions that are known to cause significant debilitation. And, for those conditions few know exist, this burden is even more stringent. A discussion of how the Social Security Administration (SSA) assesses disability claims based upon rare diseases, as well as how a diagnosis of conditions of this type can complicate obtaining approval, will follow below.

SSA View of Rare Diseases

The SSA only awards disability benefits for conditions that create a permanent and total inability to work for at least one year, or when a disease is likely to result in death. Establishing a condition as totally disabling is generally accomplished in one of two ways. First, by meeting the criteria for a listing in the SSA Listings of Impairments, which if done, means the claimant is considered to be suffering from a severe condition that not expected to improve, and is more likely to progressively worsen. In fact, a diagnosis of certain conditions, such as Lou Gehrig’s Disease (ALS), is always accepted as disabling without the need for the presentation of further medical evidence. The Compassionate Allowance program is another component that is sometimes applicable to those with a rare disease. This program significantly expedites the approval process for certain recognized severe conditions, and reduces processing time from months or years to weeks. An experienced disability insurance attorney can help with compiling a claim that will trigger consideration under this program, as well as submit a new condition for inclusion.

Alternatively, a claimant can qualify under a vocational medical allowance, which looks at a person’s residual functional capacity to perform different types of work. The difficulty facing individuals with a rare disease is often obtaining a medically determinable diagnosis, as not all disabling conditions have been fully identified and named, and symptoms may take years to accurately diagnose.

Potential Issues with Qualification

Proving a rare disease is more than just a collection of unexplainable symptoms is the largest challenge these individuals frequently confront. The SSA will expect to see a verifiable and confirmed diagnosis of some type of impairment (assuming the disease does not fall into the group automatically considered disabling based upon an official diagnosis alone) through physical exams, lab work and/or imaging. Daily symptoms and limitations are relevant for determining what type and amount of work a claimant could tolerate, but the symptoms must relate to a medically-determinable impairment that would reasonably be expected to produce them. Additionally, this complication often manifests as a claimant bouncing around a large group of physicians looking for an answer to his/her condition, which the SSA could interpret as evidence the claimant is exaggerating or creating symptoms solely to obtain benefits. An experienced disability insurance attorney will know how to address this possible bias, and draft a disability claim that minimizes the likelihood the SSA would question the veracity of the reported symptoms/condition.

Get Legal Advice

SSDI benefits are something you work years to accumulate, and should be accessible in a time of need for any American. Farrell Disability Law understands the frustration of navigating the SSDI process, and knows how to effectively fight to get you the money you deserve. Contact the Jacksonville law firm for a free consultation.

Resource:

ssa.gov/planners/disability/dqualify.html