Social Security & Disability Resources in St. Louis
Types of Programs
Any lawyer can give you run-of-the-mill answers to the questions you face as their client. The question is whether they can put the answers into everyday words that anyone can understand? I can! I want you to be able to have any and every question you propose answered in terms you can understand.
The types of cases I handle on a daily basis includes Social Security Disability, Supplemental Security Income (SSI) and VA Compensation and Pension.
Social Security Disability
Under Title II of the Social Security Disability Program an individual must have sufficient quarters of coverage in order to be insured for disability benefits. In general, the wage earner must have worked 20 of the last 40 quarters and paid taxes into the Social Security system. This is called being “insured”.
The disability program requires that an individual have a physical and/or mental impairment that prevents them from engaging in work activity for a continuous period of 12 months. In evaluating claims for disability the Social Security Administration utilizes a five-step evaluation. The 5 steps are: are you working, do you have a severe medical condition diagnosed by an acceptable medical source, what are the restrictions that are imposed as a result of those medical conditions, are those medical restrictions so severe to prevent you from engaging in any work done in the past 15 years and finally are those medical restrictions so severe that they prevent you from engaging in any other work that by reason of your prior work experience, age or education would otherwise be available.
If one is found entitled to the Social Security disability program, then one is entitled to coverage under Medicare on the 25th month of entitlement to a financial benefit from the disability program.
Supplemental Security Income (SSI)
Under Title XVI of the Social Security Act an individual must have low or no income to be eligible. This program is a needs based program but also considers resources. The resources that are countable must be less than $2000. There are some significant exclusions to resources. The most significant exclusion being a home that an individual lives in.
The disability standard under this program is the same as that of Social Security disability. Namely, an individual has to have a physical and/or mental impairment that prevents one from engaging in work activity for continuous period of 12 months. The SSI program utilizes the same five-step evaluation utilized by the disability program referenced above.
If one is found eligible for SSI benefits in general one will be found eligible for Missouri health net (Medicaid) benefits.
VA Compensation
Compensation or service-connected disability requires an individual to have had active duty military service, to have an appropriate discharge (other than dishonorable) and establish an injury or disease is related to or occurred during that period of active duty service or by reason of a legal presumption can be attributed to arising as a result of that active-duty service. In evaluating claims for compensation the Department of Veterans Affairs looks to 3 basic concepts: was an injury or disease or event documented in service (or is there a presumption that negates the need to establish this), does the individual have a current diagnosis, and finally is there a nexus or medical connection between the injury disease or event in service and the current diagnosis. All 3 elements must be present in order for the Department of Veterans Affairs to award compensation.
Unlike the Social Security Administration Disability and SSI programs that require an individual establish 100% disability, the VA system is much more similar to the workers compensation system in the State of Missouri. Namely, the VA system has a set of diagnostic codes with various percentages of disability assigned to various medical findings for each injury or disease.
A claim for an increased rating, therefore, is merely an assessment of the severity of the service-connected condition based upon this diagnostic code, and other regulatory factors enumerated by the Department of Veterans Affairs. Therefore, it is not necessary to reestablish that an injury occurred, that there is a current diagnosis, and that there is a medical nexus in a claim for an increase in the severity of the condition. The focus on those claims is merely the severity of the condition and whether certain medical findings, signs, symptoms and laboratory tests confirm the severity.
Pension
Pension or non-service-connected disability is a needs based program. However, the VA nondisability standards for income and resources are much more generous than those of the Social Security Administration SSI program. Thus, while one may not qualify for SSI based upon income and resources, one may very well qualify for a VA pension.
A VA pension is for an individual who served on active duty during a period of war who has been found to be totally and permanently disabled. The veteran need not have served in a war but needs to demonstrate service during a period of war.
A statutory provision requires the Department of Veterans Affairs to find an individual qualified for pension if the Commissioner of Social Security has found the individual disabled under their rules. The statutory provision however only applies to the pension program and not to the disability or compensation program administered by the Department of Veterans Affairs.
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