Why Do So Many People Who Should Not Get Disability Get Approved for it?

There is a general misconception that there are mass numbers of people receiving SSDI/SSI benefits that should not be. The purpose of today's article is to point out some of these misconceptions. Indeed there are people receiving disability benefits that should not be. However the reality is not as bad as it seems.

"I know so many people getting disability and there is not anything wrong with them! Why is it so hard for me to get approved?", says many a client to me.

Most claimants have some if not a lot of difficulty getting approved for benefits. This is especially frustrating for people who have worked hard most of their life and get denied disability despite strong medical evidence. Some cases that get approved seem that they should not have been. The disparity between which cases get approved versus those that do not has many factors. The reasons could be the region the claimant resides, if he had a good advocate or not, agency error on the part of the Social Security Administration (SSA), just to name some.

The recent trend has been to deny claims as SSA gets pressure to conserve the benefit funds. There are people receiving disability benefits that were approved several years ago that would likely be denied if they had applied more recently. There are also many more claims being submitted to SSA than years ago.

The recent economic downturn forced a higher number of people to apply for disability. Employers could no longer afford lower productivity from challenged workers. Of course these workers were among the first to go. Many of these people are aged 50+ but not yet eligible for retirement. These workers experienced extreme difficulty finding new work given their age and physical impairments. Combine that with today's tighter scrutiny on SSA's approved cases and it is simply more difficult to get approved for disability these days.

The Hidden Disability: "You get disability? You don't look like there is anything wrong with you!" say many people to my client with lupus.

A very misunderstood population is sufferers of 'hidden disabilities'. It can be much more difficult for these claimants to get approved than claimants with obvious physical or mental impairments. Hidden disabilities can include the following conditions that may not cause many visual symptoms. These could be:

• mental disabilities
• chronic pain, fibromyalgia, and fatigue disorders
• lupus and other autoimmune disorders
• diabetes
• neurological disorders

These conditions have manifestations that effect each sufferer, differently. A person suffering from lupus may experience symptoms during periodic flare-ups. Perhaps she feels generally well for a month or so and functions normally. But when her symptoms flare she may experience debilitating even life threatening symptoms that can last for weeks or months. A person that has suffered diabetes long-term may have developed secondary conditions such as diabetic neuropathy, loss of eyesight, and other serious diseases that prevent the person from being able to work on a sustained basis. A person suffering from a severe mental condition may seem fine around his home or familiar environments. What his neighbors and friends may not know is that he cannot function outside of his comfort zone due to severe anxiety, paranoia, or other severe distress. Many people, even those within the SSA may have difficulty understanding the severity of these conditions.

"I know people who get approved simply because they are drug addicts!" says the 1000th person to me.

What??

I hear this a lot from frustrated clients and friends. On one hand SSA is not supposed to deny a claimant disability simply because there is evidence of substance abuse in the medical records.

Simply put, SSA is supposed to consider substance abuse and its contribution if any, to the person's disability. Consider a person with a severe spinal condition that abuses alcohol on a regular basis. Her spinal condition will not be miraculously cured if she stops drinking. Despite even heavy alcohol abuse, SSA is to consider the actual contribution if any, of the alcohol to her conditions. Even if she stops drinking she is very likely still to suffer from pain and immobility. In this case alcohol abuse is not material to her disability and should not be a reason for SSA to deny her disability.

Mental disorders can lead to drug and/or alcohol abuse. It can be said that substance abuse only worsens the symptoms of mental problems. However, a person who suffers from severe bipolar may never be able to function normally even if he stopped using drugs. Therefore, the drug use may not be considered material to his disability.

If a person suffers from permanent and severe health problems resulting from substance abuse he can be found disabled. This may not seem fair on the surface. Alcohol abuse can be due to severe PTSD secondary to being a combat veteran or severe abuse victim. These sufferers sometimes lack the insight to seek treatment for many reasons. If he was able to stop abusing drugs and alcohol but his physicians believe he would still suffer severe mental symptoms, he should be found disabled.

Despite all the reasoning in the world, our adjudicators and judges are people just like you and me. These people must carefully consider all the facts in cases like these and are expected to be unbiased. By no means can it be said that a person is given disability benefits simply because she is a drug addict or alcoholic. In my experience it is quite difficult to get someone approved for disability that has drug and/or alcohol abuse in the medical file.

Most American adults of working age pay into the SSDI program. Barring a few issues that can prevent a person from having access to his disability benefits, he has a right to his benefits if his conditions render him disabled. We may not approve of someone's lifestyle or choices but this does not mean that a person should be denied his rights.

It is important not to jump to judgement or let media reports sway you regarding these issues. SSA does not, never did, and probably never will hand out disability benefits to just anyone. Hidden disabilities are very real and can happen to anyone. That said, it is not easy to dupe SSA into giving someone benefits that is not disabled though it does happen, sometimes. SSA takes very seriously allegations of fraud.

If you suspect that someone is collecting benefits due to a fraudulent claim, report it. Visit SSA's Website for more information.

Share your comments and questions regarding this article and I will be happy to respond!

April L. Roberts, EJD EDPNA - april@aaria.org www.aaria.org

Next up, "What are Some of the Main Reasons a Person Gets Denied Disability?"

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