Definitions of terms that are unique to the Social Security Administration will help disability claimant’s properly address fundamental issues with their claims. Being familiar with the language of Social Security Disability and SSI can be very helpful. Here are some key terms and their definitions. Unless you work with Social Security benefits daily, it is never a bad idea to seek the assistance of an expert who can help make the application process as straightforward as possible.
Administrative Law Judge (ALJ) – In the context of Social Security, this person is a federal judge who both presides over adjudications of disability claims in a bench trial format.
Alleged Onset Date (AOD) – This date is set by the person claiming benefits, and is the date when disability began. Another way of saying this is the AOD is the date that you became too sick to work. Many people use the date that their last work ended as their AOD. For disability benefits, your AOD must precede your DLI, though reaching back further than 17 months from your file date will not result in additional back benefits.
Blue Book – Though now found online, this document contains the specific medical criteria that apply to the evaluation of impairments. A claimant “meets a listing” but having medical records that establish symptoms and diagnoses as set forth here.
Compassionate Allowance – The definition of this term is diseases and other medical conditions that, by definition, meet Social Security’s standards for awarding disability benefits. The list may be found here.
Date Last Insured (DLI) – This is the last day of the quarter a claimant meets insured status for disability or blindness. For many Claimants who maintained steady work before becoming disabled, this date falls approximately five years after last working. A Claimant’s Alleged Onset Date must fall prior to this date in order to claim disability benefits.
Dictionary of Occupational Titles (DOT) – This text is a publication produced by the U.S. Department of Labor, and is used by Social Security to define over 13,000 different types of work. Though this text is regarded as obsolete, it is still the “Jobs Bible” that is used in disability proceedings to evaluate past work as well as to identify other work that a hypothetical individual may do. Job titles include a job description, strength requirement, skill requirements, and other items of note. One can search the DOT here.
Dire/Critical Status – These cases are discussed thoroughly in HALLEX I-2-1-40, and are given special processing consideration which often expedites the handling and adjudication of such claims. Examples of cases that qualify for such treatment include Terminal Illness, 100% Permanent and Total Veterans Disability, Wounded Warriors, Compassionate Allowances, food/shelter/medication deficient claimants, and certain mental health cases.
Disability Hearing – A legal proceeding before an Administrative Law Judge, where Claimants and other witnesses such as medical experts and vocational experts answer questions under oath. The hearing is informal, but are recorded, and all evidence should be submitted for consideration more than five days prior to the hearing. Social Security offers more insight here.
Disability Insurance Benefits (DIB) – These benefits are payable to Claimants who are disabled and who have a sufficient work history to be considered “insured,” meaning that they worked long enough and paid Social Security taxes. These benefits are also called SSDI, SSD, Title II Benefits, and just plain “disability”.
Exertional Impairments – Limitations and restrictions imposed by impairments and symptoms that affect a Claimant’s ability to meet the strength demands of jobs (sitting, standing, walking, lifting, carrying, pushing, and pulling).
File Date – This is the date on which an SSI or SSDI case was filed. By definition, SSI Claimants cannot claim benefits prior to this date, and SSDI Claimants can claim up to a year of benefits prior to this date by setting their AOD appropriately.
Five-Step Evaluation – This is the process that Social Security follows when deciding whether or not you are disabled. Read more about this process.
HALLEX (Hearings, Appeals and Litigation Law Manual) – This is a publication from the Social Security Administration’s Office of Hearing Operations which lists policy statements and procedures for carrying out the SSA’s guiding principles.
Hypothetical Individual – This individual is typically presented by ALJs to VEs are disability hearings to assess how certain conditions and limitations affect the employability of a Claimant suffering those limitations. A hypothetical individual may not completely reflect a Claimant’s condition, or may be introduced to the VE over several iterations. Claimants should ensure that their vocational exertional and non-exertional limitations are all reflected when this testimony occurs.
In-Kind Support – In the context of an SSI definition, this is the value if the food, shelter, and support that someone else provides for the Claimant. In-kind support may actually reduce SSI benefits since the Claimant is receiving something of value.
Non-Exertional Impairments -Limitations and restrictions imposed by impairments and symptoms that affect a Claimant’s ability to meet the demands of jobs other than strength related. Examples of such limitations may be issues with nervousness, depression, maintaining attention or concentration, understanding or remembering detailed instructions, seeing or hearing, reaching, handling, stooping, climbing, crawling, or crouching.
Occupational Base – This is the approximate number of occupations that an Claimant may be able to perform with their exertional and nonexertional impairments. See SSR 83-10 and SSR 96-9p. Eroding a Claimant’s occupational base is a key step in proving that a Claimant who has a non-listing-level-impairment is still disabled.
Past Relevant Work (PRW) – Work that you have done within the past 15 years, that was substantial gainful activity, and that lasted long enough for you to learn to do it.
Program Operations Manual System (POMS) – This source of information used by Social Security employees to process claims for Social Security benefits.
Quarter of Coverage (QC) – A QC is the basic unit for determining whether a worker is insured for Title II Disability benefits. No matter how high your earnings may be, you can not earn more than 4 QC’s in one year, and in 2018, a QC is granted from $1,320 of earnings.
Reconsideration – If your initial claim for benefits was denied, this is the first appeal, when a review by a different disability claims examiner is made. The approval rate at this phase is very low, typically averaging 11-12%.
Res Judicata – “A matter already judged.” In disability terms, this happens when a decision has been made on a prior disability claim, and that claim cannot be reopened. Though there are sometimes reasons why old cases can be reopened, ones that cannot indicate that future cases cannot include this time period that has already been unfavorable decided.
Residual Functional Capacity (RFC) – This represents the most work that can be done given the Claimant’s mental and physical conditions. It is generally desirable to reduce a Claimant’s residual functional capacity to as low levels as possible. RFCs = Below Sedentary, Sedentary, Light, Medium, Heavy, and Very Heavy.
Severe Impairment – This is a mental or physical illness or combination of illnesses that significantly limits Claimant’s physical or mental abilities and interfere with the Claimant’s ability to perform basic work activities.
Skill Transferability – See SSR 82-41. Transferability means applying work skills which a person has demonstrated in vocationally relevant past jobs to meet the requirements of other skilled or semiskilled jobs. Transferability may be at issue when listings are not met, and when the Claimant has a history of skilled work.
Specific Vocational Preparation (SVP) – This is the amount of time that a typical worker will take to learn techniques, acquire information, and develop the faculties needed for average performance at a job. SVP is graded from 1 to 9 based on complexity of the work.
Substantial Gainful Activity (SGA) – This is the amount of money that a worker must earn in a month to be considered to be engaging in SGA or work. Whether or not a worker can engage in SGA ($1,180 in 2018) is frequently the difference between winning and losing a claim. Blind individuals can earn more ($1,970 in 2018) and be considered to not be engaging in SGA.
Supplemental Security Income (SSI) – Social Security administers this program which pays benefits to aged, blind, or disabled people with limited income and resources. Read more about SSI here.
Title II Benefits – These benefits are payable to Claimants who are disabled and who have a sufficient work history to be considered “insured,” meaning that they worked long enough and paid Social Security taxes. These benefits are also called SSDI, SSD, Disability Insurance Benefits, and just plain “disability”. Read more about Title II benefits here.
Title XVI Benefits – Another name for SSI, the benefits that are paid to aged, blind, or disabled people with limited income and resources. Read more about Title XVI benefits here.
Unearned Income – This is money that comes in from non-work activities such as SSA benefits, pensions, disability payments, unemployment, interest income, dividends, and cash from friends and relatives. This income may affect the ability to claim SSI benefits but generally does not affect Disability Insurance Benefits.
Vocational Expert (VE) – This individual will be called to testify at many hearings about matters concerning performance of jobs, and the numbers of jobs available. The most frequent subjects of VE testimony include, DOT classification of past relevant work (job title, DOT number, and SVP), identification of transferable skills, and identification of DOT jobs that a hypothetical Claimant may be able to perform given specified limitations including job title, DOT number, SVP, and the numbers of those jobs that occur in the national economy.