The SSD Determination Process
The SSA uses a five-step process to decide if you are disabled:
- Are you working?
- Is your medical condition “severe?"
- Is your medical condition on the Listing of Impairments?
- Can you do the work you did before?
- 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 the Disability Determination Services office in your state. The state agency completes the disability decision by compiling your medical records and following a five-step process to decide.
The Compassionate Allowance Program is a list of medical conditions (currently consisting of 224 conditions) considered so severe that, once an applicant's medical condition is confirmed by the SSA, s/he 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 will tell you how you can 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 18 months
- 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 or suggestions.