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Getting Disability Benefits With Spondylitis

Posted on January 28, 2021

Article written by
Annie Keller

  • Different types of disability benefits are available for people with spondylitis who qualify.
  • Approval for disability depends on your inability to work.
  • You may appeal if you are denied disability benefits.

Sometimes, even the best accommodations at work aren’t enough to help you keep your job when you have spondylitis. Symptoms such as back pain, joint pain, and reduced mobility can easily overwhelm you to the point where work is no longer possible.

When people in the United States living with spondylitis or ankylosing spondylitis can no longer work, many seek Social Security disability benefits to replace lost income. Transitioning from working full-time to receiving disability can be difficult. “It was a hard adjustment for me to go from work to disability,” wrote one MySpondylitisTeam member.

The process of applying for a disability claim can feel intimidating. Facing the appeals process if you aren’t approved can be all the more daunting.

Understanding the process ahead of time can make applying easier, including what the U.S. Social Security Administration (SSA) considers to determine disability and what information you’ll need to provide.

Disability Benefit Programs in the United States

There are two different federal disability programs in the United States, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify for either program, you must have a disability that stops you from doing your current job or any other form of gainful employment.

SSDI provides benefits to people with a recent full-time work history. The funds are drawn from payroll taxes. If you are approved for SSDI, you can receive benefits six months after the date your disability began. You are eligible for Medicare 24 months after you start receiving SSDI.

SSI offers disability benefits to low-income individuals, regardless of work history. If you are approved, you can receive benefits in the next month. Additionally, you may be eligible for back payments of SSI if you became disabled before your SSI was approved.

In most states, SSI eligibility qualifies you for Medicaid. In Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, and the Northern Mariana Islands, you have to apply for Medicaid separately from SSI, but the criteria are the same for both. Eligibility criteria for SSI recipients varies across states.

Almost every state provides an SSI supplement, with the exception of Arizona, Mississippi, North Dakota, and West Virginia. The eligibility rules for supplements vary by state.

There is an asset cap to receiving Supplemental Security Income: $2,000 in assets for individuals or $3,000 for couples. The Social Security Administration has a list of which assets (“resources”) are considered. Your primary residence, household belongings, and one personal vehicle are not counted among these assets.

It’s possible to get both SSDI and SSI if you have very limited funds and have a work history.

Defining Disability

The SSA evaluates several factors when determining whether someone’s disability makes them eligible for benefits. Criteria for eligibility include the following:

  • You are likely ineligible for monthly benefits if you earn $1,260 or more a month. If you earn less than that amount, you may still be eligible for a reduced amount.
  • You must be incapable of performing basic tasks required for most jobs, including standing for extended periods, walking, lifting, sitting, and remembering. You must not have been able to perform these tasks for at least 12 months.
  • You must have a recognized disability. The Social Security Administration provides a Listing of Impairments that prevent working. Spondylitis is listed under Immune System Disorders, under the heading "Inflammatory arthritis.”
  • You must be unable to do any work you did previously. If you’re applying for SSI, a past work history is not necessary.
  • You must be unable to do any other form of sustainable work, sometimes called “substantial gainful activity.” The Social Security Administration will consider your diagnosis, age, medical history, education, and work history, as well as any other skills you have that might be applied to work.

Applying for SSDI and SSI

There’s a lot of paperwork needed to apply for disability benefits for people with spondylitis. The Social Security Administration offers a checklist of necessary application information. Below is a summary of what you’ll need to provide.

Information About Yourself and Your Family Members

  • Your full legal name, date of birth, and Social Security number
  • Full names and dates of birth of your current or previous spouses, and dates of marriage, divorce, or death
  • Full names and dates of birth of your children
  • Bank account information

Medical Evidence About Your Spondylitis

  • The name and contact information for your neurologist and other medical providers who can discuss your condition
  • A complete list of medications, both past and present, that you have taken, as well as results from any medical imaging and tests you’ve undergone, such as X-rays or tests for human leukocyte antigen B27 (HLA-B27)
  • A description of how the symptoms of spondylitis impact your ability to do activities like shopping, cooking, cleaning, and other tasks of daily living

Total Employment History

  • Earnings from the past year
  • Any current employers or ones you have worked for in the past two years
  • A complete work history from the past 15 years, including any jobs from before you became disabled
  • Whether you are getting or intend to receive workers’ compensation
  • Dates of military service

Documents

  • Birth certificate
  • Social Security card
  • Proof of citizenship
  • W-2 or other tax forms from the previous year
  • Any medical records about your condition
  • Proof of any workers’ compensation you have received

Being prepared and thorough is essential to your success. “When you go to the hearing, or if you can get to the investigator beforehand, make absolutely sure that they have all radiology reports,” shared a MySpondylitisTeam member.

You can apply for SSDI online if you aren’t currently receiving benefits and if you haven’t been denied in the past 60 days. You may use this approach if you were born in the United States, have never been married, and are between 18 and 65. If you don’t meet any of those criteria, you can still apply at a local Social Security office or over the phone.

Appealing a Disability-Application Rejection

The SSA takes an average of three to five months to process an application for disability benefits. Getting final approval may take even longer. “Be prepared for a long, drawn-out battle, unless you get extremely lucky. Mine took five years total,” cautioned one MySpondylitisTeam member.

Only 21 percent of those who applied for disability benefits between 2009 and 2018 were approved on their first attempt. A MySpondylitisTeam member reported being among the fortunate few to receive approval during the first round: “I went to their doctors after they wanted me to, and eight months later, I got my first check for SSDI.”

You can appeal the decision if your application is denied. The first step is reconsideration, when your case will be evaluated by someone who did not take part in the first evaluation. About 2 percent of applications that weren’t approved the first time were approved during reconsideration from 2009 through 2018.

If necessary, you have the option of filing a second appeal, which includes a hearing by an administrative law judge trained in disability laws. You may have a disability attorney represent you at this hearing. Some law firms specialize in disability hearings. In most cases, these disability lawyers do not require a set, upfront payment; rather, they will take a percentage of any benefits you do receive. “I had to get a disability lawyer, one that worked free and charged after winning. He won for me,” a MySpondylitisTeam member reported.

If you are denied at this level, you can ask the Appeals Council to review your case and make a decision on it. About 8 percent of SSDI claims between 2009 and 2018 were approved during a hearing with an administrative law judge or the Appeals Council. If you are denied at this level, your last remaining option is a federal court hearing.

Waiting for approval of your disability benefits can be stressful. MySpondylitisTeam members have shared their firsthand experiences and advice on how to get approval and cope with the evaluation process.

  • “Try and get all your medical records together for the past two years, and file on your own first.”
  • “If you get your situation about your job termination in writing, that will help as well.”
  • “I tried to do a part-time job and failed. That was also a factor in my approval.”
  • “I would concentrate on your chronic pain.”

Get the Support You Need

MySpondylitisTeam is the social network for people with spondylitis. Join more than 59,000 members in asking questions, giving advice, and sharing stories with others who understand life with spondylitis.

Have you applied for Social Security disability benefits for spondylitis? Do you have any advice about the process? Comment below or start a conversation on MySpondylitisTeam.

References

  1. Disability Benefits — Social Security Administration
  2. Supplemental Security Income (SSI) — Social Security Administration
  3. Understanding SSI — SSI Eligibility — Social Security Administration
  4. How You Qualify | Disability Benefits — Social Security Administration
  5. Part III — Listing of Impairments — Social Security Administration
  6. Disability Evaluation Under Social Security: 14.00 Immune System Disorders — Adult — Social Security Administration
  7. Adult Disability Starter Kit — Social Security Administration
  8. Who is eligible for Supplemental Security Income (SSI)? — AARP
  9. SSI VS SSDI: What They Are & How They Differ — Benefits Access Blog — National Council On Aging
  10. Annual Statistical Report on the Social Security Disability Insurance Program, 2019 — Outcomes of Applications for Disability Benefits — Social Security Administration
  11. Federal Court Review Process — Social Security Administration
  12. Appeals Council Review Process in OARO — Social Security Administration
  13. Social Security Administration's Hearing Process, OHO — Social Security Administration

Annie specializes in writing about medicine, medical devices, and biotech. Learn more about her here.

A MySpondylitisTeam Member said:

I never went for disability. Really didn’t need to. But my life has definitely changed.

posted 5 days ago

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