This chapter reviews the Americans with Disabilities Act, the possibility of requesting and receiving workplace accommodations, what programs are available when you are no longer able to work, and some detail regarding what helps when applying for disability benefits. Changes in the disability determination process and resources for applying are included.

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Qualifying for Benefits

You do not have to be completely and totally disabled to qualify for SSDI, only unable to engage in paid work. But you should apply as soon as possible after you become disabled because it takes at least sixty to ninety days to process your initial claim. The qualifying process involves filing an application and supporting documentation through a local field office that then forwards the materials to a state Disability Determination Services (DDS) office.

A DDS examiner then works with a medical or psychological consultant to study your documentation and make a determination. Additional data may be requested. (Note: At this level the applicant does not have any personal contact with any of these professionals.) If the application is denied, the applicant can ask DDS to reconsider. A new examiner/consultant team then reviews the application. If your application is denied a second time, the next step is an appeal to an Administrative Law Judge (ALJ) in the SSA Office of Hearings who will hold a hearing where the applicant can testify and present new evidence. If denied at this level, the applicant can appeal to SSA’s Appeals Council and then bring suit in federal court.

The SSA is supposed to use the following five-step sequential evaluation process to determine whether an applicant qualifies for benefits:

1. Is the applicant engaging in substantial gainful activity? (The answer must be “no.”)

2.Does the applicant have an impairment that has more than a minimal effect on the applicant’s ability to perform basic work tasks? (The impairment must be expected to last twelve months or result in death.)

• Does the applicant’s impairment meet or equal the medical criteria for an impairment in SSA’s listing of impairments? (This list includes over 150 categories presumed to meet the severity test. You can bet that chemical and electrical sensitivities are not on it.) If the impairment is not listed or the condition does not match listed criteria, then it must be the “medical equivalent” of one of the listings. Criteria for mental impairments are more subjective and focus more on subjective evaluation of the person’s functional limitations than those for physical impairments, which must be documented by medical fact. Some conditions, however, must be assessed by functional limitation, e.g., musculoskeletal conditions. But awards for musculoskeletal conditions are infrequent. Sensitivities fall into the category of impairments that are difficult to document by medical fact, and therefore proving functional limitation is crucial.

• Comparing the applicant’s Residual Functional Capacity (RFC) with the physical and mental demands of the applicant’s past work, can the applicant perform his or her past work? If medical evidence does not substantiate a condition of adequate severity in SSA listings, the adjudicator must determine what the applicant can still do in a work setting. The examiners must use “all relevant medical and nonmedical evidence,” such as statements from others about the applicant’s symptoms. If it is determined that the applicant can still perform past work, the claim is denied.

• Can the applicant perform other work in the national economy? This is determined using the RFC, age, and educational and skill level of the applicant.

The application process is standard, but leaves room for complex decision making by the adjudicators. For example, if the person cannot be deemed disabled on the basis of medical evidence only, the adjudicator must then decide if the applicant can perform prior or other available work despite their condition. The SSA’s medical vocational rules suggest that older, less educated, and less skilled people are more likely to be given benefits. (See discussion of this process later in this chapter under “Is the Application Process Fair?”)