SSI Presumptive Disability or Blindness
If you have applied for Supplemental Security Income (SSI) and your case is pending at the initial level at Disability Adjudication Services (DAS in GA) or Disability Determination Services (DDS in other states), you may be eligible for presumptive disability (PD) or presumptive blindness (PB) for 6 months while DAS or DDS develops and reviews your case. The SSI PD or PB benefits begin the month after the SSI application is filed.
During and post Covid-19 pandemic, there have been long delays at the initial level of DAS and DDS. Although these presumptive benefits typically do not have to be repaid if a later decision is unfavorable, the Social Security Administration (SSA) will recoup the presumptive SSI benefits from your SSI backpay or the first 6 installments of your ongoing SSI checks. You will not have to pay an attorney fee during this presumptive SSI backpay period.
The following medical conditions may qualify you for a PD or PB determination: https://www.ssa.gov/ssi/text-expedite-ussi.htm
1. amputation of a leg at the hip;
2. allegation of total deafness; that is, no sound perception in either ear;
3. allegation of total blindness; that is, no light perception in either eye;
4. allegation of bed confinement or immobility without a wheelchair, walker, or crutches, due to a longstanding condition excluding recent accident and recent surgery;
5. allegation of stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm;
6. allegation of cerebral palsy, muscular dystrophy, or muscular atrophy and marked difficulty in walking (for example the use of braces), speaking, or coordination of the hands or arms;
7. allegation of Down syndrome;
8. allegation of intellectual disability or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basic self-care activities (such as toileting, eating, dressing, or bathing) made by another person filing on behalf of a claimant who is at least 4 years of age;
9. a child has not attained his or her first birthday and the birth certificate or other medical evidence shows a weight below 1,200 grams (2 pounds, 10 ounces) at birth:
10. a child has not attained his or her first birthday and available medical evidence shows a gestational age (GA) at birth with these corresponding birth-weights:
– GA: 37-40 weeks; weight at birth: 2000 grams (4 pounds, 6 ounces) or less;
– GA: 36 weeks; weight at birth: 1875 grams (4 pounds, 2 ounces) or less;
– GA: 35 weeks; weight at birth: 1700 grams (3 pounds, 12 ounces) or less;
– GA: 34 weeks; weight at birth: 1500 grams (3 pounds, 5 ounces) or less; or
– GA: 33 weeks; weight at birth: at least 1200 grams, but no more than 1325 grams (2 pounds, 15 ounces) or less;
– GA: 32 weeks; weight at birth; at least 1,200 grams (2 pounds, 10 ounces), but less than 1,325 grams (2 pounds, 15 ounces);
11. symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS); Form SSA-4814-F5 or SSA-4815-F6 is needed;
12. a physician confirms by telephone or in a signed statement that an individual has a terminal illness with a life expectancy of six months or less; or a physician or knowledgeable hospice official (for example, hospice coordinator, staff nurse, social worker or medical records custodian) confirms that an individual is receiving hospice services because of a terminal illness;
13. allegation of a spinal cord injury producing an inability to ambulate without the use of a walker or bilateral hand-held assistive devices for more than two weeks with confirmation of such status from an acceptable medical source;
14. allegation of end-stage renal disease (ESRD) requiring chronic dialysis and the file contains a completed CMS-2728-U3 (End Stage Renal Disease Medical Evidence Report-Medicare Entitlement and/or Patient Registration); or
15. allegation of amyotrophic lateral sclerosis (ALS) known as Lou Gehrig’s disease.
According to NOSSCR www.nosscr.org, the following impairments are less likely to be approved for PD or PB:
1. Respiratory impairments without “Convincing evidence” (like a pulmonary function tests) that the claim will be allowed;
2. Back impairments without traumatic injury to the spinal cord;
3. Impairments requiring medical deferment (ie may improve) unless there is “convincing evidence that those impairments meet severity and durational requirements.” These impairments include but are not limited to: cancer, coronary artery bypass graft, myocardial infarction, drug therapy for cardiac impairments, cerebrovascular accident (CVA), traumatic brain injury (TBI) and first-time psychotic episodes.
The Social Security Administration’s decision to grant PD or PB payments is based on “the severity of your condition, the evidence available at the time, and the high likelihood that your claim will be ultimately approved.”
If you are a disabled adult, child or vet, call our disability attorneys and staff at 404-479-4431 or visit www.kathleenflynnlaw.com/we-care to file appeals for service connected veterans benefits or SSI/SSDI applications, requests for reconsideration, requests for hearing, requests for review of unfavorable ALJ decisions with Appeals Council briefs and to pursue cases in US District Court #socialsecurity #ssdi #ssi #disabilitylawyer #disabilityattorney #socialsecuritydisability #disabledwidow #disabledwidower #ssdilawyer #ssdiattorney #ssiattorneys #ssilawyers #dib #childssi #childdac #veteransbenefits #overpayment #SSIattorneyfee #SSDIattorneyfee #presumptivedisability