Applying for SSI – Part 2: what you need to prove

Seal of the United States Social Security Admi...

In Part 1 of the SSI application saga, we learned that one cannot submit an application for adult SSI benefits until the “claimant” has turned 18. And we learned that you will spend several hours filling out forms, either online or on paper.

Before we go much further describing the process, let’s touch on the odds of success. A search of the web indicates that only 1/3 to 1/2 of the applicants for SSI receive benefits based on the initial application. (The odds get better in the appeals process.)  I’ve heard that the success rate is lower for claimants with mental illness (as opposed to claimants with physical impairments), and is also lower for young people (as opposed to claimants older than 50.) Here we are, filing claims on behalf of young people with mental health challenges. The odds are not so good; what can we do to improve them?

Answer: we can know something about the criteria being used to determine eligibility, and give the Social Security Administration (SSA) information about the claimant that plays into their criteria framework. Making the strongest case possible with the initial application may prevent you from having to go through the appeal process.

We went through appeals, maybe in part because at the start I didn’t have some of the information I’m about to share. Warning: this gets a little complicated. I’m providing a few links for explanations, but do not dismay if you’re still confused.  Plenty of websites provide similar info, plus you can talk to attorneys who specialize in SSI. The ones I spoke to (over the phone) were amazingly free with explanations of the system.

You’d think that filling out all the forms that Social Security tells you to would be enough. That’s all they ask for; why would it even occur to you to give them more? Here’s one piece of advice we received:  claims are evaluated based on the paperwork received. The more paper, the better! So at your application appointment,  in addition to the required forms, bring copies of as many relevant documents as you can, from doctors, therapists, schools, etc. They’ll take it, and it will be considered.

Here’s one document that’s key:  Residual Functional Capacity forms filled out by the claimant’s psychiatrist, psychologist, and/or therapist. Residual Functional Capacity refers to what a person can do, once their disabilities are accounted for. The lower the RFC, the lower the person’s ability to hold a job.

An RFC form is not included in the forms SSA tells you to fill out, but it strengthens your case immeasurably to have one. Go figure.

Here is a link explaining the need for RFC forms:  http://www.ultimatedisabilityguide.com/rfc_forms.html

The webpage above includes a link to an RFC form for mental disabilities (see the right-hand side of the page.) There are several versions of these forms, and I guess any one of them will do the trick. You can do a search on “residual functional capacity form mental” and look at the choices. Here’s a link to another RFC form, just for the sake of comparison:  http://ssaconnect.com/tfiles/SSA-4734-F4-SUP.pdf

As an attorney told me, the big thing with RFC is that the claimant needs to be documented as having at least two of the following conditions due to his/her mental impairments:

  • “Marked” or “Severe” limitations in activities of daily living
  • “Marked” or “Severe” limitations in maintaining social functioning
  • “Marked” or “Severe” deficiencies of concentration, persistence or pace
  • “Repeated” or “Continual” episodes of decompensation
The following link does an excellent job describing what the disability criteria are:  http://www.serranolawyers.com/SS%20Psych%20Cases.htm
Isn’t it nice for these attorneys to spell it out for us?  Take your time with this link; there’s a lot of good info here. In a future post I’ll talk more about the Global Assessment of Functioning chart that appears at the bottom of the page in the link.  Note that, for the best chance of receiving SSI benefits,  the claimant’s GAF scores should be under 50.
I had never heard the term “decompensation” before dealing with SSI. If you need a little more explanation about it, especially as it relates to SSI claims, here’s a link to follow: http://www.disabilitysecrets.com/mic2.html#b

So, get the claimant’s doctor(s) and/or therapist(s) to fill out an RFC form, either before the application appointment or within 1-2 months after.  Rather than trusting they’ll mail it to the SSA, have them give it to you, maybe during a routine appointment.  You can then submit it to SSA. Keep a copy for your records, of course!

In our experience, mental health professionals don’t all have a firm grip (and some have no clue) on what SSA is looking for in terms of evidence of disability. If for some reason the RFC form isn’t happening, ask the professional to frame his/her written assessment of the teen’s condition in the terms outlined above.

[If you really, really like legalese and want to read the SSA’s version of how it determines eligibility for mental disorders, follow this link:

http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm

Makes you appreciate the SerranoLawyers version, doesn’t it?]

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About janet565

I've lived in the Inland Empire of Southern California since 1982. Born and raised in New Jersey, I've also lived in upstate New York and in Oregon. My profession involves maps and geography, which is usually very interesting. My hobbies are pretty boring - none of them involve tigers (or ligers) or jumping out of aircraft - so they do not bear mention here. I hope you find the blog useful, and wish you well....

3 responses to “Applying for SSI – Part 2: what you need to prove”

  1. Get the facts says :

    Whoa, such a handy webpage.

    Like

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