Social Security Alphabet Soup

Social Security Alphabet Soup

A client recently informed me that she had no idea what I was talking about, and asked me to speak in regular English. I had just told her that the ALJ at OHO would pose a hypo to the VE based on an RFC tied to the psych CE what could be clearer?

As with many governmental agencies, the Social Security Administration (SSA) has its own unique language composed of acronyms.  Initial contact with SSA is usually made at the local District Office (DO), where a claim for Social Security Disability (SSD, Title 2) and/or Supplemental Security Income (SSI, Title 16) benefits is filed. The claims are not actually adjudicated by SSA at this level of review (Initial), but rather by Disability Determination Services (DDS, the State Agency). At DDS, the claim is handled by a Single Decision Maker (SDM, Adjudicator), with input from a medical consultant (MC) and/or a psychological consultant (PC). You will never meet an MC or PC, unlike a Consultative Evaluator (CE), who is hired by DDS to examine you.

Read More: The Value and Cost of Medical Records in a Social Security Case

If the claim is denied at Initial, a Request for Reconsideration (Recon) must be filed within 60 days. At Recon, SSA again sends the case to DDS, to be reviewed by a different Adjudicator and MC/PC.

If the claim is denied at Recon, a Request for Hearing must be filed within 60 days, and the file is sent to the Office of Hearings Operations (OHO). This is a new name for this office, which until last month was called the Office of Disability Adjudication and Review (ODAR). People who have been doing this work for a few years recall when OHO/ODAR was called the Office of Hearings and Appeals (OHA). The only thing more fun than obscure acronyms is randomly shifting acronyms.

At the disability hearing at OHO, the Administrative Law Judge (ALJ) may call on the services of a Vocational Expert (VE) and/or a Medical Expert (ME, which in the past has also been dubbed a Medical Advisor or MA). As with MC/PCs, the VE/MEs have never met you. The ALJ is required to make a finding of Residual Functional Capacity (RFC) and to determine if you are capable of Past Relevant Work (PRW). If your RFC is inconsistent with PRW, the ALJ will determine (with the assistance of the VE) if there are any other jobs you can perform – often referred to as a Step 5 finding.

Assuming you are found disabled by an ALJ, be aware that most claims are reviewed every 3-7 years. This is called a Continuing Disability Review (CDR). If your claim is denied by an ALJ, you may file an appeal with the Appeals Council (AC), and possibly Federal District Court (FDC).

Hopefully, this will guide you through the fundamentals of SSA-speak. A qualified representative can translate the more advanced acronyms – or, like my bewildered client, you can simply ask everyone to speak English.

Have more questions about social security and disability? Give us a call. We are here to answer your questions and assist with all your legal benefits needs.

More information:

How to provide for yourself while waiting for social security benefits

Factors that can end social security benefits


2017 Numbers from the Social Security Administration (SSA)

Most years the cost of living increases, which results in slight changes in the numbers used by SSA in its disability programs, and it is important to use the correct numbers. The following is a chart of some of the changes between 2016 and 2017:

  2016   2017
 Substantial Gainful Activity (SGA) monthly earnings
 If you are not blind $1130  $1170
 If you are blind  $1820 $1950
 Trial Work Period (TWP) level of monthly earnings $810 $840
 Supplemental Security Income (SSI) monthly benefit amount
 For an individual  $733 $735
 For a couple living together who are both disabled $1100 $1103
 Quarter of Coverage earnings amount $1260 $1300



Substantial Gainful Activity (SGA)2017 Numbers from the Social Security Administration (SSA)

Step 1 of the disability determination process is whether or not you are “working.” SSA defines work as the ability to engage in SGA. Unless you are self-employed, this is simply measured as a dollar amount. So, in 2017, if you are working and able to earn $1170 (gross, before taxes are taken out of your paycheck), you are engaged in SGA and SSA will determine you are not disabled without analyzing your impairments. If you are working, but earning less than $1170, you are not earning SGA, and your case will proceed to Step 2.

If you are blind, you may earn up to $1950 before SSA determines that you are engaged in SGA.

Special rules apply to self-employed individuals. If you are self-employed but believe that you are disabled, you should bring your income information to your local SSA district office. They can determine if your self-employment is SGA, and advise you about the income rules that apply in your particular situation.

If you are able to work only because of special devices, medications and/or assistance that you pay for out-of-pocket, the cost of these IRWEs (impairment-related work expenses) will be deducted from your income when SGA is determined. For example, if you earn $1500 per month, but have to rent a wheelchair for $200 per month and pay $200 per month for medications to control your symptoms well enough to work, SSA will consider your monthly income to be $1100. Since this is less than $1170, you are not engaged in SGA.

Trial Work Period (TWP)

If you have been disabled for at least 12 months, and then return to work, you are eligible for a TWP. During a TWP, you can both receive your Social Security Disability benefits and keep your paycheck regardless of the amount. You can receive up to 9 TWP months. A TWP month is counted only when your income exceeds $840 (in 2017). If you earn less than this, the month is not counted in your 9-month TWP. After your ninth TWP month, your disability will cease in the next month you earn SGA ($1170).

If you start working while receiving Social Security Disability benefits, you should notify SSA of the dates and amount of your income, in writing, and get a receipt for the notice. SSA will let you know what your reporting requirements are, depending on the amount of your income, and will track your TWP. A receipt of the notice may be important down the road, if SSA loses the information and later assesses you with an overpayment. If you can prove that you notified SSA of the income, it will be easier to claim a waiver of overpayment.

If you start working while you are in the process of applying for Social Security Disability benefits, provide SSA with copies of your paystubs. If you are represented, be sure to notify your representative of your work activity. If you are able to earn at SGA levels within 12 months of your alleged onset date, your claim will be denied. If it has been longer than 12 months since you last worked, you may be eligible for a closed period of disability or a TWP.

TWP does not apply in SSI-only cases.

Supplemental Security Income (SSI)

SSI is a needs-based disability program, available for disabled people without significant income or liquid resources, and who do not have an adequate earnings record to qualify for Social Security Disability benefits. The SSI benefit amount is the same for everybody, and in 2017 it is $735/month. If you and your spouse live together and are both disabled and financially eligible for SSI, you can receive a total of $1103. This is because SSA assumes you share expenses and therefore need less than twice the single rate.

Quarters of Coverage

To qualify for Social Security Disability benefits, you must be “insured” for them. This means that during the 40 quarters prior to the onset date of disability, you worked and paid taxes for 20 quarters. A “quarter” of coverage is measured as a dollar amount, and you can earn four quarters per year. In 2017, a quarter of coverage is defined as $1300 in income. So, if you earn at least $5200, you get all four quarters for the year – regardless of how long it took you to earn that amount.

If you believe you are disabled and eligible for Social Security Disability or SSI benefits, please call Maddox & Laffoon for a free consultation.

Factors That Can End Social Security Disability Benefits

Most people who are found disabled will receive SSI or Social Security disability benefits for many years, but there are six factors that can lead to a discontinuation of those benefits:

  • Return to workFactors That Can End Social Security Disability Benefits
  • Receipt of income or resources
  • Fraud
  • Medical improvement
  • Incarceration or institutionalization
  • Change in age category

Return to Work

Disability is defined as an inability to work. Therefore, if you return to work, your disability benefits might end. “Work” or “Substantial Gainful Activity” (SGA) is a term of art used by SSA, to describe work activity over and above a certain level.  In 2017 SGA is $1,170/month gross income (before taxes are taken out), or $1,950/month for blind persons.

If you are receiving Social Security Disability benefits (NOT SSI), you may be eligible for a “trial work period” (TWP) of up to 9 months. During a TWP you can work and keep both your paycheck and your disability benefit. If you earn $840 per month (in 2017), this will count as a trial work month. If you earn less, it will not count. The 9 months of trial work do not have to be consecutive, but after you have exhausted those 9 months, your disability will cease the next month that you earn SGA. You will then get two more months of benefits and then they will end. If, within 3 years of the end of your TWP, you have to stop working again because of your impairments, SSA may turn them back on again. This is your Extended Period of Eligibility, and you will need to ask for it when you apply.

The most important thing to remember is to advise SSA if you return to work, at any level. Do it in writing, and have them date-stamp a copy of the notice, in case you later need to prove you told them about it. If you do not report earned income, you may have a fraud problem.

Receipt of Income or Resources (SSI)

SSI is a needs based program (in contrast with Social Security Disability). If you are receiving SSI and you OR YOUR SPOUSE come into some money, through work, inheritance, lottery, tax return, gambling, legal settlement or gift (etc), you should go in and speak with SSA immediately. The same is true of anything of significant value, such as stocks, bonds, automobiles, real estate (etc) that could be liquidated.

Unearned income will reduce your SSI benefit dollar for dollar. Earned income will reduce your SSI benefit $1 for every $2 earned.

If you have resources in excess of $2,000, you do not qualify for any SSI that month. SSA can help you understand the rules and how they apply to your unique circumstances.

[Read More: Should I Try and Work During a SSD Review Process?]


If you do not report income or resources, you may be found to have engaged in welfare fraud. In that event, your benefits will end, you will be assessed an overpayment, and you should contact a criminal attorney.

Medical Improvement

SSA will periodically review your case. This typically happens every 3 to 7 years, and is known as a “continuing disability review” (CDR). A CDR is usually less rigorous than the original application process, but if SSA determines that your condition has improved, and that you are now able to work, your benefits will end.

If you receive a CDR notice that you are no longer disabled, you may appeal that decision by filing a request for reconsideration within 60 days. If you wish to continue receiving your benefits while the appeal is pending, however, you must file it within 10 days.

The best way to stave off a discontinuation of benefits through CDR is to continue getting appropriate medical and/or mental health treatment for your disabling conditions. If you are not getting treatment, there will be an assumption that you do not need it because your conditions have improved.

[Read more: Social Security and Chronic Fatigue Syndrome and Fibromyalgia]

Incarceration or Institutionalization

If you end up in prison or in an institution for 30 days or more, your benefits will be placed in suspension. If you are released within 12 months, the benefits can be reinstated, but if it is longer than 12 months you must reapply.

Change in Age Category

Turning 18: Children receiving SSI benefits will have their condition re-evaluated upon turning 18 according to adult eligibility requirement standards which can result in loss of benefits.

Reaching Retirement Age: When you reach normal retirement age, your Social Security Disability benefits (DIB) will be changed to Social Security Retirement benefits (RIB). You should not see much of a change, although depending on the circumstances of your work history, your RIB may be significantly different than the SSI benefit amount.

Most factors leading to a cessation of SSI or Social Security Disability benefits are fact-based, and are properly addressed by the SSA District Office. If you have any questions or concerns about the possible cessation of your benefits, or believe that SSA has made an error, you should contact an experienced  Social Security Disability Lawyer.


Social Security and Chronic Fatigue Syndrome and Fibromyalgia

Does the Social Security Administration recognize Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS) as the basis for disability?

The short answer is “yes,” but unfortunately there are no objective medical tests to prove the existence of these illnesses, so it is important to know what SSA is looking for.

Prior to 1999 many SSA adjudicators did not recognize CFS or FM as real physical impairments, although they were often treated as disabling mental conditions. In 1999, the SSA issued Social Security Ruling 99-2p, which provided guidelines for evaluating cases involving CTS (FM was included as a footnote). In 2012 SSA issued Social Security Ruling 12-2p specifically addressing FM, and in 2014 a new Ruling updated the process for evaluating CFS.Social Security and Chronic Fatigue Syndrome and Fibromyalgia

SSR 12-2p Evaluation of Fibromyalgia

FM must be diagnosed by a licensed physician, preferably a Rheumatologist. The diagnosis must be supported by medical evidence of all three of the following:

  1. A history of widespread pain in all quadrants of the body (both sides and both above and below the waist) and axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back) – that has persisted for at least 3 months. The pain may fluctuate in intensity and may not always be present.
  1. At least 11 of the 18 tender points on physical examination OR repeated manifestations of six or more FM symptoms or co-occurring conditions (eg. fatigue, fibro fog, waking unrefreshed, depression, anxiety disorder, IBS, muscle weakness, headache, abdominal pain, numbness or tingling, dizziness, insomnia, Raynaud’s, tinnitus, vomiting …)
  1. Evidence that other disorders that could cause the symptoms were excluded.

SSR 14-1p Evaluating Cases Involving Chronic Fatigue Syndrome

CFS must be diagnosed by a licensed physician. The hallmark of CFS is the presence of clinically evaluated, persistent or relapsing chronic fatigue that:

  • Is of new of definite onset (it has not been lifelong)
  • Cannot be explained by another physical or mental disorder
  • Is not the result of ongoing exertion
  • Is not substantially alleviated by rest
  • Results in substantial reduction in previous levels of occupational, educational, social or personal activities

In addition, there must be evidence of 4 or more of the following symptoms that persisted or recurred during 6 or more months of illness and did not pre-date the fatigue:

  • Postexertional malaise lasting more than 24 hours
  • Self-reported impairment in short-term memory or concentration
  • Sore throat
  • Tender cervical or axillary lymph nodes
  • Muscle pain
  • Multi-joint pain without joint swelling or redness
  • Headaches of a new type, pattern, or severity
  • Waking unrefreshed

Once you have proven the existence of FM or CFS, you must also prove that the condition causes functional limitations that would preclude your ability to work. This is usually done with your sworn testimony at a disability hearing, written statements from your medical providers, and lay statements from friends, relatives or former employers who have observed you. Fortunately most SSA adjudicators now recognize FM and CFS as physical impairments, and acknowledge the symptoms which can be very disabling. As with any condition, the more medical evidence you can muster, the better your chances to convince SSA that you are indeed disabled.

The Value (and cost) of Medical Records in a Social Security Case

By law, the Social Security Administration (SSA) is required to consider all medical evidence relevant to your impairments, before determining whether they are disabling. What is written in your doctors’ treatment notes, x-ray and MRI reports, evaluations, hospital records, and therapy notes is the most important factor in winning your case. If you do not receive treatment, or are unable to access your treatment records, it is unlikely that your Social Security Disability claim will be approved.The Value (and cost) of Medical Records in a Social Security Case

Medical records can be very expensive to obtain, especially in the State of Washington, where medical providers and their copy companies are permitted by State law to charge more than any other State in the country. In Washington State you will be charged a $25 administrative fee just to start the process, then $1.12 per page to copy the records. (this drops to 84¢ per page after the first 30 pages). To obtain a copy of a modest 20 page medical record, it will cost you $47.40. If you have been hospitalized, it is not uncommon for the records to number over 100 pages, which would cost you $117.40 in Washington. Compare this with New York where 20 pages would cost $15, or Oregon where you would have to shell out only $56.25 for a 100-page hospital record. Fourteen States have passed laws requiring that medical providers give patients a copy of their records for free when they are needed to support a Social Security Disability claim. (CO, CT, GA, KY, MA, MI, NE, NV, OH, RI, TN, TX, VT and WV).

At the Initial and Reconsideration levels of review, SSA will obtain your medical records as a matter of course. It is important that you advise SSA of all your medical and mental health providers, as well as any hospitalizations, physical therapy, and consultations with specialists. If SSA does not know about a medical record, it cannot get it for you. The cost problem arises at the hearing level of appeal, where the normal process is for you to update your records for the Administrative Law Judge (ALJ). Assuming you do not live in one of the 14 States where you can get a copy for free, there are ways to obtain the medical records you need and may not be able to afford.

Ask Your Doctor In Person

Many medical providers will provide you with a free copy of your medical records, if you ask them nicely. While they are permitted by State law to charge $47.40 for 20 pages, they are not required to.

The Value (and cost) of Medical Records in a Social Security CaseSSA May Obtain the Records

Remember that you only need to get the new records, and SSA will send you an Exhibit List so you will know the date of the most recent medical records that are already in your file (look at the list of “F” exhibits). If you cannot afford to update your medical records, you should contact the Office of Disability Adjudication and Review, in writing, with a list of your medical providers and their addresses, and a request that they update the records for you. This request should be made at least a month prior to your scheduled hearing, to give the ALJ’s staff time to get them. Washington State law requires that the medical records be provided within 15 business days from the date of the request – but often there are backlogs and unexpected delays.

Ask For Your Records In Electronic Format

There is a federal law that can help reduce the cost of you medical records: the Health Information Technology for Economic and Clinical Health (HITECH) Act, 42 U.S. Code §17935. Subsection (e) requires that, if you request your records electronically, your medical providers must provide them, and charge you no more than their actual cost to do. This eliminates the “per page” cost, as well as a flat administrative fee to pick up your file and look at it. You should be charged only for the time necessary for a staff person to move the electronic file onto a disc + the cost of the disc + the postage to send it to you.

There are some limitations to HITECH, and it is a relatively new law, so not all medical providers and copy companies are aware of it. In cases where it works well, however, it can cut that $47.40 or $117.40 to less than $10.

Hire a Representative

If you have a representative to help you with your appeal, he or she will update your records for you prior to your hearing. While law firms are not permitted to pay for your costs outright, they can front them if you agree to reimburse them at the conclusion of your case. Usually you receive a back-award of Social Security Disability benefits at the end, making the cost of medical records relatively painless at that point.

Even if you have a representative, you may want to ask your doctors if they would give you a copy of your records for free. You should also ask your representative to use HITECH to reduce your costs.