The Social Security Disability application and appeals process uses language, terms and acronyms that have specific meaning under the law.
This is a list of some common definitions as related to Social Security Disability claims.
Activities of Daily Living (“ADLs”) – The basic everyday activities a person does/can do such as eating, bathing, dressing, toileting, driving, etc. At some point, SSA will ask you to complete an ADL questionnaire. Your ability to do tasks will be considered by SSA in determining your ability or inability to do work within your residual function capacity (RFC).
Administrative Law Judge (ALJ) – A federal judge who conducts “bench” trials (there is no jury, nor a prosecutor affirmatively trying to prove you are not disabled). The ALJ issues an independent decision and he or she is not influenced or bound by the fact that your case was previously denied. The ALJ normally issues a decision after hearing within 2-4 months (sometimes faster).
Alleged Onset Date – The date the claimant alleges he or she became too disabled to work. Thus, it must be after you stopped substantial gainful activity (SGA).
Appeal – Following an initial denial (which is common, even for strong cases), there are four levels of administrative appeals for SSDI claims:
- Reconsideration (of the initial application)
- Requesting a hearing with an ALJ
- Appealing the ALJ’s decision with the Social Security Appeals Council
- Suit in Federal Court
Backpay (also referred to as past due benefits) –After you win your SSDI or SSI claim, you are entitled to past due benefits. In SSDI cases the farthest back you can get backpay is one year prior to your alleged onset date (even if your alleged onset date is farther in the past). Another rule for SSDI claims is that earliest your benefits can start to accrue is 5 months after the onset of your disability. In SSI cases, there is no 5 month waiting period, but the farthest back awards can be granted is the date of application.
Blue Book – The SSA explains their complex disability determination process in what is referred to as the “Blue Book” (though this is now online). These “Listings” set forth the specific medical criteria that apply to certain impairments. For a claimant to “meet” a Listing the medical record must support the specific findings outlined in the Blue Book. (It is more common to awarded disability based on the claimant’s residual functional capacity (RFC)).
Cessation of Benefits—SSA may determine that you are no longer qualified to receive Social Security Disability benefits. Your Social Security benefits will not actually be terminated for two months after you receive a notice of cessation. You can appeal this determination. To continue receiving Social Security Disability payments during the pendency of the appeal, you need to file a request for a continuation of benefits within 10 days of receiving a notice of cessation.
Continuing Disability Review–SSA periodically reviews your disability or blindness to decide if you are still disabled or blind. It is imperative that you continue getting medical care after you are found disabled.
Compassionate Allowance— SSA program whereby SSA quickly identifies claims involving diseases and other medical conditions (certain cancers, brain disorders, and rare childhood diseases) that, by definition, meet Social Security’s standards for disability benefits.
Date Last Insured (“DLI”) – The last day of the quarter a claimant meets insured status for SSDI. If you have maintained steady work before applying for benefits, this date is usually well in the future. For those that have waited some period to apply, this can become problematic as the claimant’s Alleged Onset Date (“AOD”) must be a date prior to the DLI in order to get SSDI benefits.
Dictionary of Occupational Titles (“DOT”) – Sets forth over 13,000 types of work that theoretically exist in the national economy. It is used in SSDI/SSI cases to evaluate a claimant’s past relevant work (PRW) and to determine other work a “hypothetical claimant” can still do considering the residual function capacity (RFC) of the hypothetical claimant.
Department of Disability Services (DDS) – State agencies that process the initial claims for Social Security disability are processed. DDS is responsible for developing medical evidence and rendering the initial determination on whether the claimant is or is not disabled under the law. It is not uncommon to be denied at the initial stages after applying. Most cases are won at the ALJ hearing level.
Dire Need Status—cases that are put on a special status for expediting the handling due to a claimant’s medical/extreme financial hardship, terminal illness, Veteran’s cases, and Compassionate Allowances.
Disability—statutorily defined for SSDI and SSI as an inability “to engage in 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.” 42 U.S.C. §§ 4239(d)(1)(A) and 1382c(a)(3)(A).
Hallex (Hearings, Appeals and Litigation Law Manual)—a publication by SSA which outlines policy statements and procedures in disability hearings.
Hypothetical claimant—A hypothetical person typically presented by ALJ’s to Vocational Experts at disability hearings to assess how certain conditions and limitations affect the employability of a Claimant with such limitations. A hypothetical individual may not completely reflect a Claimant’s condition, or may be introduced to the VE over several sample hypotheticals. The ALJ normally starts with a hypothetical person who has less (i.e., can do more than) limitations than the actual Claimant. Claimant (or his/her attorney) is allowed to present alternative hypothetical claimants to the VE.
Medical-Vocational Guidelines (“Grids”)—At Step 5 of the Sequential Evaluation process, these answer the question of whether a claimant is disabled based on his/her maximum RFC, age, education, and PRW. If your profile, using these factors, matches one of the rules in these Grids, the ALJ must find you disabled.
Normal Retirement Age – Normal retirement age varies, depending on when a person was born. Normal retirement age ranges from age 65 for older workers to 67 years of age for those born in the year 1960 or later. Also referred to as Social Security Normal Retirement Age (SSNRA).
Occupational Base – the approximate number of occupations that a Claimant may be able to perform considering that claimant’s residual functional capacity (both exertional and mental). Unless a Listing is met or equaled, your RFC must be shown to be 0 (or insignificant numbers in the national economy).
Office of Hearing Operations (OHO) – The SSA office responsible for holding hearings and issuing decisions for determining whether or not a claimant may receive benefits. When you file a Request for Hearing, your file will normally be sent to your local Office of Hearing Operations (though at times it can be heard elsewhere due to workload if you agree to a video hearing). Your case will be assigned to an Administrative Law Judge (ALJ).
Past Relevant Work (PRW) – Work you have done in the past 15 years that was substantial gainful activity, and lasted long enough for you to learn the job. You must show that you are unable to do PRW (among other things) to be granted SSDI and/or SSI.
POMS (Program Operations Manual System)– The primary source of information used by Social Security employees to process claims for Social Security benefits.
Quarters of Coverage or QC (also referred to as Work Credits)– To be fully insured, you need at least one QC for each calendar year after you turned 21 and the earliest of the following:
- the year before you attain age 62,
- the year before you die, or
- the year before you become disabled.
The minimum number of QCs needed is 6. The maximum number needed is 40. Any year (all or part of a year) that was included in a period of disability is not included in determining the number of QCs you need. A “quarter of coverage” generally means the three-month calendar quarter. In addition, you must earn at least $1,410 in a quarter (in 2020) for it to count. However, the SSA looks at how much you earned in a year and divides that figure by the minimum amount required to earn credit for a quarter.
Request for Hearing – If your Request for Reconsideration is denied, the next step is to file a Request for Hearing with an administrative law judge (ALJ). This must be done timely. A hearing before an ALJ is the level where your claim has the greatest chance of being approved.
Request for Reconsideration – If your initial application has been denied, your next step is to file a Request for Reconsideration by a claims examiner at Disability Determination Services (DDS). You most likely will be denied again at this stage (but it is a “hoop” that must be jumped through to get to your best chance of success, a hearing before an ALJ).
Residual Functional Capacity (RFC) – The maximum remaining ability you have in order to do sustained work activities in an ordinary work setting on a regular and continuing basis due to your physical and mental limitations. A regular and continuing basis means work done for eight hours a day, for five days a week, or an equivalent schedule. Your RFC is expressed in terms of being less than sedentary, sedentary, light, medium, heavy, or very heavy work.
Res Judicata – Legal principle that does not allow a claimant to reapply for benefits under the same set of facts after getting denied by an ALJ. There are some exceptions to this, but if you receive a denial from an ALJ, you must re-file using the date after that denial.
Self-employment income – SSA considers self-employment activities and their value to your business to decide whether you have engaged in substantial gainful activity. They use three tests to determine whether your self-employment rose to substantial gainful activity (for purposes of PRW).
Severe Impairment – a mental or physical impairment or combination of impairments that significantly limits Claimant’s physical or mental abilities and interfere with the Claimant’s ability to perform basic work activities. Having a severe impairment is a Step (or prerequisite) in the Sequential Evaluation), but it alone does not mean you will be found disabled.
Sequential Evaluation – A five-step inquiry, with questions asked in a specific order, until a question is answered affirmatively or negatively in such a way that a decision can be made that a claimant is either disabled or not disabled. Click here for a graph of this inquiry.
Substantial Gainful Activity (SGA) – Work which involves significant physical and/or mental activities (typically done for pay or profit). A person who is earning more than a certain monthly amount (net of impairment-related work expenses) is ordinarily considered to be engaging in SGA. For 2021, the monthly SGA amount for 2021 is $1310 (the blind SGA is $2190).
Trial Work Period—After a person becomes eligible for disability, the person may attempt to return to the work force and still be considered disabled. If the trial work exceeds 9 months in a 60 month period, the person will no longer be considered disabled.
Transferable Skills— work skills which a claimant has demonstrated in PRW to meet the requirements of other skilled or semiskilled jobs. Transferability can be a significant issue when the Claimant has a history of skilled work.
Unsuccessful Work Attempt—work done for 6 months or less that had to be ceased due to your impairments will not be considered SGA.
Vocational Expert (VE) – An expert in jobs in the national economy that will be called to testify in most disability hearings. The VE will be asked to classify your past SGA work and normally be asked for jobs (if any) that exist for certain hypothetical claimants. The VE will use a book entitled the Dictionary of Occupational Titles (DOT) to classify your past work and other jobs in the national economy.
Waiting period – If you are awarded SSDI, there is a 5-month waiting period after the onset date (the date disability began) during which no social security disability benefits are payable.
Work Credits – See Quarters of Coverage (QC) above.
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