Why Do So Many People Who Should Not Get Disability Get Approved for it? SSD in a Nutshell Series Blog 2

canstockphoto15449778The Social Security Disability Program is difficult to navigate and understand. Adding to those difficulties is the perception there are mass numbers of people receiving benefits that should not be. The purpose of today’s blog is to explain some of these misconceptions.  Indeed there are people receiving disability benefits that should not be. However the reality is not as bad as it seems.

“I know of people who are getting disability and there is not anything wrong with them!  Why is it so hard for me to get approved?”, say many people I talk to.

Most claimants have some if not a lot of difficulty getting approved for benefits.  This is especially frustrating for people who have worked hard most of their life and get denied disability despite strong medical evidence. Some cases that get approved seem that they should not have been.  The disparity between which cases get approved versus those that do not has many factors.  The reasons could be the region the claimant resides, if he had a good advocate or not, agency error on the part of SSA, just to name some.

The trend of a higher percentage of cases being denied compared to a decade or so ago is very real.  There are people getting benefits who were approved when it was easier to do so versus getting approved, today. If these same individuals were to apply for benefits now, they would have a higher likelihood of being denied.

The recent economic downturn forced a higher number of people to apply for disability. Employers who could no longer afford lower productivity from challenged workers. Of course these workers were among the first to go. Many of these people are from the older population not yet eligible for retirement but have extreme difficulty finding new work. Combine that with today’s tighter scrutiny on SSA’s approved cases and it is simply more difficult to get approved for disability these days.

The Hidden Disability: “You get disability?  You don’t look like there is anything wrong with you!” say many people to my client with lupus.

A very misunderstood population is sufferers of ‘hidden disabilities’.  Hidden disabilities can include the following conditions that may not cause many visual symptoms.  These could be:

  • mental disabilities
  • chronic pain and fatigue disorders
  • lupus and other autoimmune disorders
  • diabetes
  • neurological disorders

These conditions have manifestations that effect each sufferer, differently. A person suffering from lupus may experience symptoms during periodic flare-ups.  Perhaps she feels generally well for a month or so and functions normally. But when her symptoms flare she may experience debilitating even life threatening symptoms that can last for weeks or months.  A person that has suffered diabetes long-term may have developed secondary conditions such as diabetic neuropathy, loss of eyesight, and other serious diseases that prevent the person from being able to work on a sustained basis. A person suffering from a severe mental condition may seem fine around his home or familiar environments.  What his neighbors and friends may not know is that he cannot function outside of his comfort zone due to severe anxiety, paranoia, or other severe distress. A disabled person may have good days. If he has more bad days than good in terms of severe symptoms that would cause him to miss a lot of work, he may meet the requirements for disability.

On another note… Social Security (SSA) is supposed to conduct periodic reviews of approved cases to see if claimants have medically improved enough to perform substantial work. As an advocate I have seen many seriously impaired people be reviewed every 3 years by SSA. At the same time, others with conditions that can easily improve over time never experience a review. The process is not a perfect one and I promise to address the issue of continuing disability reviews in a future blog.

There are problems with unscrupulous attorneys, advocates, and doctors along with a margin of error that plague any disability process. Given the uphill battle to win a disability case across the board, most people who are receiving benefits are rightfully doing so.

“I know people who get approved simply because they are drug addicts!”

What? I hear this a lot from frustrated clients and friends. On one hand SSA is not supposed to deny a claimant disability because of evidence of drug and alcohol abuse. Yet substance abuse noted in medical records can cause a person to be denied his disability benefits, unfairly.

This is a tough area of disability and thankfully there are some amazing mental health professionals working with SSA to educate adjudicators and judges on how to recognize severe mental disabilities in the presence of substance abuse.

Simply put, SSA is supposed to consider substance abuse and its contribution if any, to the person’s disability. Consider a person with a severe spinal condition that abuses alcohol on a regular basis. Her spinal condition will not be miraculously cured if she stops drinking. Despite even heavy alcohol abuse, SSA is to consider the actual contribution, if any, of the alcohol to her conditions.  Even if she stops drinking she is very likely still to suffer from pain and immobility. In this case alcohol abuse is not material to her disability and should not be a reason for SSA to deny her disability.

Mental disorders can lead to drug and/or alcohol abuse.  It can be said that substance abuse only worsens the symptoms of mental problems.  However, a person who suffers from severe bipolar disorder may never be able to function normally even if he stopped using drugs.  Therefore, the drug use may not be considered material to his disability. If a person suffers from permanent and severe health problems resulting from substance abuse he  can be found disabled. This may not seem fair on the surface. Alcohol abuse can be due to severe PTSD secondary to being a combat veteran or severe abuse victim.  These sufferers sometimes lack the insight to seek treatment for many reasons. If he was able to stop abusing drugs and alcohol but his physicians believe he would still suffer severe mental symptoms, he should be found disabled.

Despite all the reasoning in the world, our adjudicators and judges are people just like you and me. These people must carefully consider all the facts in cases like these and are expected to be unbiased.  By no means can it be said that a person is given disability benefits simply because she is a drug addict or alcoholic. In my experience it is quite difficult to get someone approved for disability that has drug and/or alcohol abuse in the medical file.

Stand back and consider for a moment…

Most American adults of working age pay into the SSDI program.  Barring a few issues that can prevent a person from having access to his disability benefits, he has a right to his benefits if his conditions render him disabled. We may not approve of someone’s lifestyle or choices but this does not mean that a person should be denied his rights.  That would be un-American.  Not everyone wishes to disclose the reason they receive benefits and when not required by law, many reserve that right.  For example, the neighbor that tells you he is disabled due to a bad back but seems to have no back issues may actually be suffering from a mental illness and does not believe it is anyone else’s business to know that.

It is important not to jump to judgement or let media reports sway you regarding these issues. SSA does not, never did, and probably never will hand out disability benefits to just anyone. Hidden disabilities are very real and can happen to anyone. That said, it is not easy to dupe SSA into giving someone benefits that is not disabled though it does happen. SSA takes very seriously allegations of fraud. If you suspect that someone is collecting benefits due to a fraudulent claim, report it.  Visit SSA’s Website for more information.

Share your comments and questions regarding this blog and I will be happy to respond!

Next up, “What are Some of the Main Reasons a Person Gets Denied Disability?”

©2016 Aaria Consulting, LLC and April L. Roberts.  All rights reserved.

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Filed under Basics of Social Security Disability, Disability Advocates, Social Security Fraud, SSDI, SSI, Uncategorized

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