Disability Determination

The SSD Determination Process

The SSA uses a five-step process to decide if you are disabled:
  1. Are you working?
  2. Is your medical condition “severe?"
  3. Is your medical condition on the Listing of Impairments?
  4. Can you do the work you did before?
  5. Can you do any other type of work?

View a more detailed flow chart of this process (PDF)

After you submit your application, the Social Security Administration (SSA) will review it to make sure you meet their basic program requirements. For Social Security Disability (SSD) applicants, they will check whether you have worked enough years to qualify. For SSI applicants, they will check to see that you meet the income qualifications.

If you meet these requirements, the SSA will send your application to Disability Determination Services offices in your state. The state agency completes the disability decision by compiling your medical records and following a five-step process to decide.

Compassionate Allowances

The Compassionate Allowance Program is a list of medical conditions (currently consisting of 88 conditions) considered so severe that once an applicant's medical condition is confirmed by the SSA, he/she will automatically qualify for SSD. This allows the SSA to more quickly provide benefits to the most obviously disabled individuals.

PH is currently not included in the Compassionate Allowance Program, but PHA is actively advocating for the inclusion of “pulmonary arterial hypertension – with NYHA/WHO class IV symptoms and/or severely reduced exercise capacity” in the list of Compassionate Allowances.

Learn more about Compassionate Allowances

After the Decision is Made

If your application is approved, you will receive a letter that states the amount of your benefit and when your payments will start. If your application is not approved, the letter will explain why and tell you how you can make an appeal.

Once you are determined to be disabled, you will remain on SSD unless you earn too much or your health improves. The SSA will review your condition every 18 months to seven years, depending on if your condition is expected to improve and to what extent.

If your condition is:

  • Expected to improve, your review will probably occur about every 1.5 years
  • Possible improvement, your review will probably occur about every 3 years
  • Not expected to improve, you should expect a review no sooner than 7 years

Most PH patients should expect review every 3 to 7 years. An exception is if you had a transplant before your disability claim was approved; your claim will likely be reviewed about a year later to see how you are doing.

 

 


Contact us with insurance questions, success stories, suggestions, or requests to volunteer.


Helpful Disability Resources

SSA.gov is the official U.S. Government site for the Social Security Administration.

Social Security Handbook on the Web includes the provisions of the Social Security Act, regulations issued under the Act, and precedential case decisions (rulings). It is a readable, easy to understand resource for the very complex Social Security programs and services.

Caring Voice Coalition has free programs to help patients with insurance reimbursement, financial assistance, patient support services, public advocacy, and the SSD application and appeals process.

Advocacy for Patients with Chronic Illnesses provides information, advice and advocacy regarding retrieval of medical information, obtaining and keeping health insurance, obtaining coverage for your treatment, applying for SSD and asserting your rights. Also publishes a Know Your Rights handbook.

National Organization of Social Security Claimants’ Representatives (NOSSCR) is an association of over 3,900 attorneys and other advocates who represent Social Security and Supplemental Security Income claimants.

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The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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NORD

The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas.