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Temporary total disability benefits are paid under employer-secured insurance programs for workers compensation. Because workers comp laws and regulations vary from one state to the next, collecting both Social Security Disability (SSD) benefits and temporary total disability benefits (TTD) at the same time is largely dependent upon where you live. While it’s possible to receive both forms of disability benefit payments simultaneously in all states, the manner in which payment amounts are calculated can vary from state to state.

The Social Security Administration (SSA) has the ability under current mandates and regulations to test new review procedures and other potential program-wide updates to Social Security Disability (SSD) and Supplemental Security Income (SSI). The administration also has the ability to establish appropriate testing criteria for obtaining effective measurements regarding potential system-wide changes and the viability of their implementation throughout the entire disability program. Criteria includes the geographic testing regions and the time frame for testing procedural adjustments.

In June 2012, the SSA announced formally in the Federal Register (77 Fed. Reg. 35464) that it would be extending the testing period for two alternative models for disability determination. Understanding the alternative models requires one first understands the standard procedures utilized by the Disability Determination Services (DDS) in deciding eligibility for SSD and SSI benefit. The system-wide procedures are summarized as follows.

• DDS review of eligibility, in consultation with a DDS contracted physician or “medical expert”
• Reconsideration of any claim denied following the submission of additional documentation or the completion of a medical assessment with a DDS contracted physician.
• An appeal hearing with a presiding ALJ.

The two alternative models currently being tested were implemented by the SSA at different times and in different locations. Each alters the standard methods used by the DDS offices in the assessment of randomly selected applicants’ eligibility for SSD and SSI benefits.

The Single Decision-Maker Test

The first alternative model is known as the “single decision-maker test” and provides DDS staff the authority to approve or deny an applicant in most cases without seeking the input of a psychological or medical consultant. Under this test, DDS staff simply compare the medical documentation contained in an application with the SSA’s “Blue Book” definition of the disability and make a determination solely based on that comparison. This test eliminates the medical expert evaluation of substantiating documentation from the eligibility review process entirely.

The recent Federal Register announcement from the SSA communicated the single decision-maker test has been underway for some time and that the time frame for testing has been extended. The geographic regions in which the test is being conducted, the original date of the test’s implementation, and the extent or number of applications being reviewed under the testing procedures was not detailed in the notice. Instead, the SSA simply announced that it has been testing the process and will continue to do so until September 2013. At that time, if the SSA decides to extend the timeframe for testing again, another announcement will be made within the Federal Register.

The Prototype Test

The second alternative disability determination model the SSA is currently testing is known as the “prototype test”. This test was originally initiated in August of 1999 and has been extended annually since that date.

Under test procedures, a single decision-maker with the DDS determines initial eligibility under the same guidelines as those used in the single decision-maker test. The prototype test additionally eliminates the reconsideration review step entirely from the overall eligibility determination process. Applications initially denied benefits proceed directly to the appeal hearing stage instead.

The prototype test is currently being conducted in ten states: Alabama, Alaska, California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York and Pennsylvania. The SSA’s Federal Register announcement extended the testing period in these same states through September 2013. If further extensions are required, the SSA will issue a formal entry and announcement within the Federal Register at that time.

The Social Security Administration (SSA) recently announced it will be reviewing and potentially revising the current listing for Neurological Disorders within its “Blue Book”, the standard qualification criteria for disabling conditions under the Social Security Disability (SSD) program.

The steps involved in applying for Social Security Disability (SSD) with any disabling condition entail essentially the same processes; however, the type of disability you have does influence the information the Social Security Administration (SSA) expects you to present within your application. As July is UV Safety Awareness Month, it seems an appropriate time for discussing the eligibility criteria and disability documentation requirements for SSD applicants who suffer from various forms of skin cancer.

What Types of Skin Cancer Meet SSD Eligibility Requirements?

Melanomas, Sarcomas and Carcinomas all meet SSD eligibility standards under particular circumstances. The SSA defines the eligibility standards for each recognized disability in its “Blue Book”. The Blue Book is the document the SSA’s Disability Determination Services office utilizes when examining applications to decide if they meet the SSD eligibility criteria.

Blue Book definitions for Different Forms of Skin Cancer

Carcinomas and sarcomas must present with regional lymph node involvement or other metastases in order to qualify for SSD benefits. Melanomas qualify under several conditions, including:

• Melanomas that recur after surgical removal of skin lesions.
• Melanomas with metastases in:
• Clinically apparent nodes, diagnosed through physical exam or imaging studies, OR
• Four or more nodes even when not clinically apparent, OR
• Nearby skin tissue or distant sites.

Disability by Definition for Adults under SSA Guidelines

In addition to meeting the condition-specific criteria listed above, individuals who apply for SSD benefits with skin cancer must also meet the standard definition of disability according to SSA guidelines. According the standard definition, in order to be found eligible for disability benefits, applicants must:

• Be unable to maintain gainful employment as a result of physical and/or mental impairment,
• Have either a terminal condition or one that is expected to last no less than 12 months,
• Have a “medically determinable impairment”, or one that can be proven through standard medical evaluation, diagnosis and documentation.

What Constitutes a “Medically Determinable Impairment”?

The clear and consistent documentation of a medical condition is what’s required in order for applicants to establish a “medically determinable impairment” under SSD eligibility guidelines. Applicants document their own symptoms, signs and other details of their medical condition in their application for SSD benefits. Those same details must also be supported by the formal medical documentation that is present in the exhibit file, including lab tests, doctors’ records and other diagnostic details and documents. Statements from the physicians that have treated the condition must also be present in the application in order to satisfy eligibility requirements.

Meeting the SSA’s Skin Cancer Criteria for SSD Benefits

When applying for SSD with a diagnosis of skin cancer, applicants should work closely with their treating physicians to document their illness under the SSA’s Blue Book definition of their specific disease. It can also be helpful to have legal assistance from a Social Security lawyer in navigating the application and review processes for SSD benefits.

A disability attorney that is familiar with the system can assist in putting together a thorough and complete application that meets the SSA’s guidelines. In doing so, he or she may also be able to shorten the wait for a determination on eligibility and get you the benefits to which you may be entitled sooner as a result.

As Mental Health Awareness Month, July is perhaps the most appropriate time for reviewing the types of mental diseases and disorders that qualify under the Social Security Administration’s (SSA’s) guidelines for disability benefits. There are a number of conditions that can meet the SSA’s guidelines, though it’s important to understand that there are condition-specific eligibility requirements as well as general disability requirements that the SSA applies to every application for Social Security Disability (SSD) benefits.

General Disability Requirements

Any application for SSD benefits must meet certain basic requirements in order to be found eligible for benefits regardless of the type of disability driving the application. The applicant must have a condition that:

• Prevents him/her from holding gainful employment,
• Is expected to last 12 or more consecutive months and/or result in death, and
• Can be proven under standard medical documentation practices.

Condition-Specific Disability Requirements

Every application for SSD benefits must contain thorough medical documentation supporting the claim for disability. That documentation should include letters from treating physicians and mental health service providers as well as medical records. Medical records should include any and all disability-related test results, treatments undertaken, and any other pertinent details related to the diagnosis, management and outlook for the condition.

Each mental illness and disorder recognized under the SSA’s guidelines has specific criteria that must be met in order to qualify for SSD benefits. The condition-specific definitions for each potentially eligible condition can be found on the SSA’s website.

What Conditions are covered Under SSD?

There are many different categories of mental illnesses and disorders that may qualify for SSD benefits. The following conditions are generally considered eligible under the SSA’s guidelines, though applicants must still meet the general disability requirements and condition-specific criteria before receiving disability benefits.

• Organic Mental Disorders
• Psychotic Disorders, including Paranoid and Schizophrenic Conditions
• Affective Disorders
• Mental Retardation
• Anxiety Disorders and Related Conditions
• Somatoform Disorders
• Personality Disorders
• Substance Addictive Disorders
• Autistic Disorders and Other Pervasive Developmental Disorders

Supporting the Claim for SSD with a Mental Illness or Disorder

Again, each condition in the SSA’s Blue Book list (standard list of potentially disabling conditions) has specific criteria which must be met in order for an SSD application to adequately support a claim for disability benefits. For this reason, it’s essential that the applicant work closely with his or her mental health care provider(s) and other treating physicians in order to effectively document the disability and substantiate the claim for SSD benefits.

Substantiating any medical condition under the SSA’s eligibility guidelines can be challenging, but supporting a claim with a mental illness or disorder diagnosis can be even more complex, especially given the fact that many mental health issues affect each individual differently. Having legal assistance when filing an SSD application can be helpful, particularly in cases where mental illness is the primary reason for the disability.

A Social Security lawyer accustomed to working on mental health-related SSD claims can help put together a more thorough case file and adequately detailed application for disability benefits. In the process, he or she can help increase the chances of the application being approved as well.