Getting Records for a Child SSI Disability Claim

I’ve only said this about a thousand times here. Disability cases boil down to what’s in the records. Typically, that means medical evidence in medical records. However, for an SSI child disability claim, records can also include school records, and this can be the case whether the child’s impairment is physical or is a mental impairment.

Why would you have to gather school records for a child who is applying for disability on the basis of, say, ADHD, autism, a learning disability, or impaired cognitive functioning (mental retardation, or borderline intellectual functioning)? Because child disability claims are very different from adult cases.

For adults who file for disability, the deciding factor will be whether or not the individual can engage in work activity, either past work or some type of other work.

For child disability claims (SSI), cases are decided on the basis of whether not the claimant can engage in age-appropriate activities. This typically boils down to intellectual and academic performance in comparison to one’s peers. And, of course, even a physical impairment, such as seizure disorder or asthma, can have an effect on things like this. One has simply to remember that the social security administration is chiefly concerned with functionality. The reason why (i.e. the condition itself) is largely irrelevant.

What type of academic records do you gather for a child SSI disability claim and how do you gather them? Let’s discuss the “how” first. This can vary tremendously, depending on the school district. Sometimes, record requests are sent to a centralized records department for a school district, sometimes they are sent to a school’s guidance office, sometimes they are sent to a school’s main office (the principal’s office), and sometimes, less frequently, they are sent to the direct attention of a teacher.

How will you know where to send the record request to? There’s really only one way, especially since protocol can vary even between different schools in the very same school district. You should call the school in question and ask them where a request for records on a student in attendance should be sent. As always, of course, send a release form and make sure the request is detailed enough so that you’ll actually get back the records you need (otherwise, you could end up getting nothing but grade reports when what you really need is achievement and IQ records).

Problems you may run into in gathering records from a school may include A) general incompetence and B) the school’s operating schedule. Regarding A, it can be difficult to gather academic records because many schools (this may or may not surprise people) are run poorly from an administrative standpoint. Regarding B, it can be very difficult to obtain records when a school is on break. Summer breaks can literally mean an inability to obtain records for months at a time, which can be extremely problematic for a disability hearing that is being held in a summer month.

What type of records will be requested on a child SSI Disability claim? Really, anything that may point to functionality and impaired functioning. Logically, this includes grade reports, IEPs, and copies of specialized testing, such as intelligence testing and academic achievement testing. However, it can, and should, also include completed questionaires from a child’s teacher, or teachers. Such questionaires can deliver (to an administrative law judge holding a hearing) a detailed first-hand account from the one individual who is uniquely qualified to report on a child’s ability to engage in age-appropriate activities in a school setting; namely, the child’s teacher.

How do you send such a questionaire to a teacher? You may first wish to determine which teacher to send the form to. If the child has a single teacher, the choice is obvious. If the child has multiple teachers such as in higher grade levels, this may be a matter of sending multiple questionaires in the hope that at least one teacher will fill one out and return it.

Where are teacher’s questionaires obtained? This is not the type of form that is used by the social security administration, which is odd considering that SSA will obtain reports on a adult claimant’s ADLs, or activities of daily living. However, SSA also does not send RFC, or residual functional capacity forms, to a claimant’s doctors, so this should not be too surprising.

Teacher’s questionaires are typically sent out by a claimant’s disability attorney, and generally this effort is only made in preparation for a disability hearing.

As this is the case, a parent who is filing for child disability benefits may actually wish to ask their chosen disability representative if an attempt will be made to obtain such a questionaire. Not doing so is equivalent to being less prepared for a hearing than ideally would be the case. And for this reason, a parent who learns that their child’s attorney will not attempt to gather such information may wish to find other representation.

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Social Security Disability and SSI, what is the difference?
Can I win my social security disability claim?

Social Security Disability and Proving you Can"t Work - Other Work

On this blog, I’ve spoken many times about the various aspects of the disability process, including both medical and vocational factors such as past work, medical records, the medical vocational allowance, and the social security definition of disability.

Another factor of the social security disability and SSI disability process, however, is a concept known as other work. What is “other work” and how does it play into the disability process? Basically, this way—when you apply for disability (either SSD or SSI), your case has to pass several tests.

The first is that you must have a severe impairment. What is a severe impairment in the eyes of the social security administration? The actual concept of a “severe impairment” is somewhat subjective; however, most individuals who process disability claims would agree that a sprained wrist or sprained ankle would not qualify as a severe impairment, whereas a ruptured disc or a broken limb would. Can you be denied for disability if your condition is judged to be non-severe? Yes, however, denials issued for an NSI (non-severe impairment) are infrequent, simply because most individuals do not file for disability on the basis of minor medical issues.

Having a severe impairment is the first test to pass. If a claimant’s condition is judged to be severe, then the next test involves “duration”. For the social security administration, this means that a severe impairment must last for at least 12 months. Does this mean that you must be disabled for 12 months before you can apply? No, social security can evaluate your medical records and make a determination as to whether or not your condition will be expected to last 12 months or longer.

A claimant must have a severe impairment and this impairment must last, or be expected to last for, 12 months or longer. But what makes it disabling? In other words, what makes a person qualify for disability. Answer:the inability to perform work.

A person who qualifies for disability will have a severe impairment, lasting not less than a year that A) prevents from working at one of their former jobs and B) prevents them from working at some type of other work.

Many people who explain the disability process tend to stop at this point, because it can get a little confusing. Here’s why—the social security definition of disability does not imply that a claimant cannot work. It actually means that, to be considered disabled, a claimant cannot have the ability to work and earn more than a certain threshold of income. That threshold is known as sga, or substantial gainful activity.

So, let’s recap. Qualifying for disability means that your impairment must be severe, must last a year or longer, and must prevent you from being able to engage in your past work or some form of other work activity while earning more than a certain minimum monthly amount (sga, mentioned in the prior paragraph).

Now, what is “other work”? Well, first let’s define past work. Past work may potentially include any job that you did in the last 15 years (known as “the relevant period”). Other work is potentially any kind of work that you might possibly be able to do anywhere in the national economy, i.e. anywhere in the country.

“Other work” is the step in the process by which many applicants for disability get denied. Why? Because it is often fairly easy to conclude that a claimant is incapable, based on their functional limitations, to go back to their past work. However, it is sometimes even easier to assert that while a claimant cannot do their past work, they can neverthless perform some type of other work (even if those jobs don’t exist in your immediate area).

Fortunately, there is a mechanism in the disability process that adds some fairness into the equation. And that mechanism is the grid, a system of vocational rules that affect what types of other work a claimant can be considered capable of doing. These vocational rules take into account a person’s age, the types of job skills they have developed over the course of their work history, the specific physical or mental limitations that they possess as a result of their condition, and even (to a small degree) their education level.

Getting a claimant approved on the basis of these rules means getting them a medical vocational allowance. And this means more than simply referring to a claimant’s medical evidence. It means having familiarity with the vocational grid rules used by SSA, it means having a knowledge of basic limitiations (for example, the inability to crouch, stoop, maintain balance, concentrate, remember, etc, etc) and how those limitations affect one’s work ability, and it also means knowing how point out to an administrative law judge (at a disability hearing) how a claimant’s vocational profile and functional limitations make it impossible to engage in past work or other work.

Obviously, “other work” is a step in the disability process where many individuals get denied. However, with proper preparation before a hearing (typically, this means having a competent attorney who specializes in social security disability and SSI cases), a successful argument can be made that a claimant is incapable of performing other work, resulting in an approval of disability benefits.

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Is Morbid Obesity Considered A Disability?

Social Security used to have a specific medical listing that covered morbid obesity, however in recent years this listing has been dropped. Now morbid obesity has to be evaluated in conjunction with other impairments that may be exacerbated by obesity such as asthma, cardiovascular conditions, arthritis or by the increased functional limitations caused by an individual’s obesity.

Initially, Social Security had a chart that addressed specific weights and heights that established morbid obesity; however since the demise of the medical listing it depends upon treating physicians or consultative physicians to establish the fact that an individual has morbid obesity. Basically, Social Security considers morbid obesity to be a severe impairment, either alone or in conjunction with other medical problems that significantly limit an individual’s ability to perform significant work activity or activities of daily living (i.e. personal grooming, walking, driving, etc.).

Since the rule change in October, 1999, Social Security has evaluated obesity under other listings. For example, if an individual has morbid obesity and arthritis, the individual will most likely be evaluated under the musculoskeletal listings. Likewise, if an individual has heart or breathing problems, obesity may be evaluated under a cardiovascular or asthma listing. However, if an individual does not meet any of these listings in the social security impairment listing manual, they may still be approved via a medical vocational allowance.

What is a medical vocational allowance? Medical vocational allowances are based upon an individual’s age, educational background, past work, medical and/or mental conditions, and residual functional capacity (what an individual is able to do in spite of their medical and/or mental impairments).

So the simple answer to this question is, yes, morbid obesity is considered to be a disabling medical condition just like any other severe medical or mental condition. And just like other impairments, it is evaluated under the five step sequential Social Security disability evaluation process. Remember, first and foremost, eligibility for Social Security disability benefits depends upon functional ability rather than being diagnosed with a specific medical and/or mental condition.

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