What is the Maximum You Can Earn While Applying For Social Security Disability?

Social Security is a total disability program, which means that you can only earn so much money and still be able to be considered eligible to apply for Social Security disability benefits.

The definition of disability for Social Security requires that an applicant has been unable to work at a substantial gainful work activity level for the past twelve months, or expects to be unable to work at this level for twelve months, or has a condition that is expected to result in death.

Looking at the Social Security definition of disability, you can clearly see that there are limitations to the amount of earnings a person can have while being eligible to either apply for disability (or receive disability benefits).

What is the earnings limit? Each year, Social Security sets a monthly gross earnings amount that it is considered equivalent to substantial gainful work activity (SGA), and if an individual exceeds that monthly amount their disability claim will be denied without a medical determination.

If an individual is working, can they apply for disability benefits and receive a medical determination? Yes, if their earnings are under the substantial gainful activity amount. However, they must provide Social Security with information about their work activity such as the hours they work and rate of pay so that an SGA (substantial gainful activity) determination can be included with the disability claim.

If a person is self-employed, Social Security will have to address the amount of hours that the individual works at their business and their net self-employment earnings.

Self employed or corporate officers may be denied, even if they are not taking any money from the business, if the worth of their work as performed in the local economy is over the SGA monthly limit.

If an individual is contemplating filing for disability, they should check with their local Social Security office to ascertain what the current monthly SGA amount is prior to making their disability appointment. If they are earning over that amount monthly, there is very little use in filing an application for disability benefits until A) they stop work or B) their gross monthly earnings are under the substantial work activity limit.







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Why Do I Have A Claim For SSI Instead Of Social Security Disability?

Generally, individuals who have only SSI disability claims are those who A) have not worked much in recent years, B) have not worked at all, such as minor-age children, and C) individuals who worked but did not work enough to be insured for title 2 social security disability benefits. SSI, otherwise known as Supplemental Security Income disability, is a need based disability program that does not depend upon “insured status” like Social Security disability; rather it is based upon an individual’s income and resources.

Most adults who apply for disability benefits with the Social Security administration will be evaluated for both Social Security disability and SSI disability eligibility. And many will be entitled to SSI benefits during the five-month waiting period that is applied to all Social Security beneficiaries.

Additionally, SSI is the only true disability program for minor age children. A child’s eligibility depends upon their parent’s income and resources until they are age 18.

If an individual is entitled to SSI disability only, is the medical determination process any different? Absolutely not. All disability applicants must go through the same medical determination process. All disability claims are sent to state disability agencies--typically known as DDS, or disability determination services--for a medical determination.

What happens at a DDS? A disability examiner will obtain all of the disability applicant’s medical treatment records from the medical sources the individual provided at their initial disability interview. If the disability examiner determines there is enough information in the individual’s medical records (after the medical evidence of record, of course, has been requested from the claimant's medical treatment sources and then received), they make a medical decision.

If there is not enough information in the claimant's medical records, meaning that the claimant does not have recent medical record documentation, or the claimant has one or more physical or mental conditions that are not sufficiently addressed by the medical evidence that has been obtained, social security may schedule the individual for a CE, or consultative examination, to obtain the information necessary to make their medical determination.

For those who are unaware, a consultative exam, or social security medical exam, will be conducted by an independent physician or, in the case of a mental impairment, an independent psychiatrist or psychologist. These exams are paid for by the social security administration. If you are scheduled to go to such an exam, it is generally a signal that the disability examiner is attempting to get your case decided and closed. Note: if you are scheduled for a consultative examination, by all means go. Not going can slow a case down at the very least, or have an adverse effect on the case at the worst.

Social Security disability and SSI have different non-disability criteria. For instance, Social Security disability does not have resource (assets)limitations and SSI does not depend upon insured status (insured status is based on quarters of coverage that are earned through an individual's work activity). SSI has no waiting period for disability benefits while Social Security disability has a five-month waiting period before being eligible to receive monthly disability benefits.

Finally, Social Security disability has no "end of the line" review once a medical decision has been made on a case. SSI applicants must have a final income and resource review even after being medically approved for disability. And if they are over the limits, their disability claim may still be denied. By contrast, Social Security disability applicants will receive their disability benefits when approved (once they have served their five-month waiting period, of course--which is very many instances, due to how long cases can drag on as a result of the appeals process, may already be served out by the time a claimant receives a favorable notice of decision.






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Social Security Disability and Jobs Within the National Economy

If you apply for disability benefits from the social security administration, either under the SSI or social security disability program, there will be a good chance that your claim will be denied at the initial claim (aka disability application) level. Not to sound morose, but, statistically, that's simply how it plays out for the majority of all individuals filing disability claims.

If you get denied for disability, what will the reason be? Well, some claims are denied on the basis of SGA, which stands for substantial gainful work activity. This basically means that the claimant was working and earning too much. Typically, this type of denial occurs at the social security office before the case ever has the chance to be sent to a disability examiner, though sometimes it happens after medical development (gathering and evaluating the medical records) has begun.

Some claims, a small percentage, are denied due to NSI, or non-severe impairment. This basically means that the disability examiner was easily able to conclude that the claimant's alleged condition was not even remotely disabling. Example: sprained wrist.

However, most claims are denied using the rationale that the claimant can return to their past work (one of the jobs they performed within the past 15 years), OR the rationale that, even if they can't return to their past work, they can do some form of other work.

"Other work" is sort of a catch-all way to deny a lot of social security disability and SSI claims. Basically, this is what happens: a disability examiner will identify the claimant's past jobs, what the exertional requirements of those past jobs were, and what the skill levels of those past jobs were (represented by numbered ratings). If it is determined that the claimant cannot go back to one of their past relevant jobs, the examiner will consult a resource book that lists thousands upon thousands of jobs in the national economy and try to come up with three jobs that match the exertional requirements and skill levels of the claimant's past work. Very often, this is quite easy for the examiner to do, meaning that the claimant will be denied for disability on the basis that they can perform some type of other work.

This is basically what is meant by jobs within the national economy, the simple fact that a disability adjudicator was able to identify three jobs that the claimant could potentially perform other than work that they've done in the past. In fact, many disability examiner processing units already have preset sheets of "other work jobs" that a claimant might be able to do based on exertion level and work skill level.

Here's one problem, though, with the whole concept: when disability examiners scout for "other jobs" in the reference book (known as the DOT, or dictionary of occupational titles), it is done without regard for geographical location. Meaning, those jobs might exist in the national economy but only a thousand miles away on the other side of the country. Not an easy proposition for older workers (fortunately, the vocational rules give consideration for older workers). Here's another problem: the reference work used by disability adjudicators is very much out of date. It would probably not be a stretch to say that there are hundreds or even thousands of jobs that exist today, that have been created in the last 15 years, that are not in the DOT. Technology jobs would likely be a good example of this.

This is all the more reason, of course, for supplying accurate and detailed information about your work history when you file for disability. It is very important to not only include job titles and dates of employment, but also detailed descriptions of what was actually done on each job. Because this can make the difference as to how a job is identified by a disability examiner. And how a job is identified can have a decisional impact on a claim.

Note: some DDS agencies are now putting extra special emphasis on researching all jobs listed by a claimant at the time of application in an effort to strengthen denials that are issued on the basis of a claimant's ability to return to their past work.








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Social Security Disability, Alcoholism, and Unable to Afford a Doctor

An anonymous individual recently left the following scenario and questions in a comment on another post. Here is the comment along with a response immediately following.

"I joined the Navy in 1972. Soon after i enlisted, I was drinking heavily and was discharged ( General Discharge ) for unsuitability because of drinking, I was not drinking before I went in the service. I have been in and out of detox's and been in 4-5 treatment centers but still drink. I am not drinking now because I throw up blood when I drink, cant afford a doctor because I have not worked in over 5 yrs and the last job i had I was fired because of drinking what should i do?"



Anonymous,

Social Security does not award disability on the basis of alcoholism anymore. In fact, the involvement of alcohol is most often considered a hindrance to being awarded disability benefits. However, many individuals who have alcohol problems are eventually approved, as they subsequently suffer from other illnesses that, largely, that result from their alcoholism.

It appears that you have other medical problems that need to be addressed. With the brief amount of information you left, I would have no idea what the cause of your bleeding might be. Esophageal varices or ulcers come to mind and both of these conditions could potentially entitle you to disability benefits with Social Security. However, keep in mind that Social Security will evaluate whether your peripheral medical conditions would resolve if you stopped drinking. If a disability adjudicator judges that to be the case, your disability claim could be denied.

Since you have a gap in your work history, it would also be hard to say if you would be eligible for Social Security disability, SSI disability, or both programs. SSI is a need based program and SSD is a program available to individuals who have secured insured status for coverage as a result of their work activity. But, in truth, many claimants will have little idea regarding their program eligibility until they actually initiate a disability claim with SSA.

One thing is certain, though. If you hope to be approved for disability benefits, you need to establish some type of medical treatment history for your medical problems. I don't know about your specific area, but many localities have free clinics to help with medical treatment when individuals have no other resources. Of course, I must say this with several grains of salt as budget cuts are widespread and common these days.

In the event that recent medical record documentation cannot be obtained by an adjudicator, a CE, or consultative examination, will be scheduled and performed by an independent doctor who has been contracted by social security to perform such services. Consultative examinations, unfortunately, are often of little value to claimants, particularly when the exam is physical. Having said that, though...some cases are won on the basis of the report submitted by the doctor who performed the consultative medical exam. So you should always go to such an exam if one is scheduled (that and the fact that your claim could be denied if you refuse to go to an examination appointment).

If you are eligible to receive treatment from a VA, you should definitely explore this (if you're not already doing so) since a record of diagnosis and treatment will be needed to substantiate a claim for disability.







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Social Security Disability SSI and Living Donors

Someone under the name of "anonymous" recently left this comment and question. The comment itself was lost but I have reposted it here along with a response.

"I am a living donor, (liver) in 2002. After 7years, i was hospitalized for a diaphragmatic hernia (severe) due to the donation. After some time for healing, (6 months or so) i started having severe pain again in the upper right quad of my stomach. After an MRI cat scan and upper GI, i am told that my cecum and lower intestines (among other things) remain in the upper right quad. Nothing they can do. Adhesions galore. Pain everyday. Many bowel problems(never know when). On top of all this, i am bi-polar, depressed, and suffer migraines. My question - are living donors with continuing problems something that is taken into consideration by SSI since it is a relatively new area in medicine? Do they know enough about what happens in a donation and it's ramifications to make an educated decision? Thanks much."


Anonymous,

I am not aware of any specific guidelines in the Social Security disability guide book, "Disability Evaluation Under Social Security", that address the problems a living donor might have. In fact, I've never seen a case based on the residual disabling conditions associated with being a living donor. Your situation sounds like it has been very debilitating. But, frankly, whether they have "enough" education about donor medical issues does not even play into how the disability examiner is going to make the determination.

So is there a chance that you might qualify for Social Security disability or SSI? Fortunately, Social Security disability (and SSI, of course) is based upon residual functional capacity--what you are able to do in spite of the limitations caused by your mental and/or medical conditions--rather than what your specific disabling condition is.

If Social Security finds that your residual functional capacity rating is so restrictive that you cannot return to your past work and is so restrictive as to rule out any other types of work (for which you might otherwise be thought capable of performing), then you may be approved for disability through a medical vocational allowance.

However, I cannot say anything for sure as I am not even sure that you have stopped working. One fundamental part of the Social Security disability equation is that you have been unable to work for the past twelve months, or that there exists the expectation that you will be unable to work at a substantial work level for twelve months due to your disabling condition or conditions.

If you are working and earning over the substantial gainful activity (SGA) amount (this is a gross monthly earnings amount that, for the social security administration, correlates with a person's ability to work at a substantial and gainful level), your disability claim will be denied at the Social Security office rather than being sent to a disability examiner for an actual medical determination.

However, if you are not working, or are working under SGA, it appears that you would be a good candidate to file for Social Security disability and/or SSI disability (whether your application is for SSD, SSI, or for both programs, as is the case with concurrent claims, would be determined at a social security field office).

I hope this information helps you decide what you should do with regard to filing a disability claim with Social Security.






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Why Will A Social Security Disability Application Get Denied?

There are basically two types of disability application denials: technical and medical. If a disability application is denied for technical reasons, the application will never be sent for a medical determination. Technical denials include lack of insured status denials, performance of SGA denials, and res judicata denials.


The first type

1. Lack of insured status denial- A disability denial that is based upon an individual not having earned enough quarters of coverage to be insured for disability benefits. Quarters of coverage can be earned at a rate of four per year provided an individual has earned enough money for that year. An individual’s age at the time of they became disabled determines how many quarters of coverage are needed to be eligible for Social Security disability.

2. Performance of SGA denial- Each year Social Security determines a gross monthly earnings amount that it considers to equate with substantial gainful work activity. If an individual is earning over this amount, their disability claim will be denied.

3. Res judicata denial- A disability denial that is based upon a decision made in the past that was after the date an individual was last insured for Social Security disability. If the person has no new work activity, Social Security deems the Social Security disability issue closed.

4. Failure to cooperate denial- This is a denial that is based upon an individual’s failure to provide information or paperwork that is necessary to process their disability claim (whether or not a failure to cooperate denial is technical or medical will depend on where it occurs, i.e. at the social security field office or at the disability determination services agency).

The second type

The second type of denial is a medical denial. Medical denial decisions are made by disability examiners at the state disability agency and are based upon an individual’s medical impairment, residual functional capacity, work history, age, and education. Disability examiners can also deny a claim for failure to cooperate if an individual does not provide them with information or fails to attend a consultative examination, and these denials are considered medical denials.




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