Dementia / Alzheimer’s Disease and qualifying for Social Security Disability Benefits

Summary: Can I get disability benefits if I am suffering from the effects of dementia?

One of the major causes of disability worldwide, dementia affects not only the individual, but their families, friends, and caregivers. In 2017, approximately 131,000 Americans between the ages of 30 and 64 were diagnosed with dementia. The severe limitations of the disorder make it unlikely that an individual with dementia could hold any job. If you are suffering from the effects of Dementia such as Alzheimer’s Disease you may qualify for disability benefits.

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If you are suffering from the effects of Dementia and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are.

Dementia is a progressive condition where the ability to process thought deteriorates, affecting memory, comprehension, orientation, learning capacity, calculation, communication and judgment and is usually accompanied by changes in behavior and emotions.

Dementia can be divided in three stages: early stage, middle stage and late stage.

The early stage is often overlooked because onset of dementia is gradual. Symptoms include forgetfulness, losing track of time, and getting lost easily. During the middle stage, symptoms become more obvious and restricting:

•    forgetting names or events
•   difficulty communicating
•   getting lost at home
•   behavioral changes such as wandering off
•   needing assistance with personal care

At the late stage of dementia, serious problems with memory and physical signs and symptoms become obvious:

•   difficulty recognizing family and friends
•   being unaware of time and place
•   difficulty walking
•    requiring assistance with personal care
•   behavior changes, such as aggression

Any of these symptoms can cause you to miss work and jeopardize your ability to maintain employment.

Other disorders that are associated with or cause dementia include Huntington’s disease, traumatic brain injury, Parkinson’s disease, and Creutzfeldt-Jakob disease.

Several factors can contribute to the development of dementia, including:

•    Infections and immune disorders.
•   Metabolic or endocrine problems.
•   Low levels of certain nutrients.
•   Side effects of medications.
•   Brain tumors.
•   Subdural bleeding.
•   Drug or alcohol abuse.
•   Certain forms of hydrocephalus (fluid buildup on the brain).

How can I qualify for SSDI if I have dementia?

If you have some form of dementia, you probably have poor memory and attention skills and cannot perform any type of work.

Social Security has created a manual called the Blue Book which lists impairments Social Security considers disabling and may automatically qualify for benefits. The Social Security Administration recognizes dementia as an impairment in two different sections of its Blue Book: Section 11.17 Neurodegenerative disorders of the central nervous system and Section 12.02 Neurocognitive disorders.

If you have some physical deterioration in addition to cognitive limitations, Social Security will evaluate your dementia under Section 11.17.

To qualify for disability benefits under this listing, you must be able to prove the following:

•    You are unable to use at least 2 extremities, such as arms, legs or both, so that you are unable to stand up from a seated position without help, or balance while standing or walking

OR

•   You are able to move independently, but with difficulty, and have limitations in one of the following:
•   Understanding, remembering, or applying information
•   Interacting with others
•   Concentrating and finishing tasks
•   Adapting to changes and taking care of yourself.

If your symptoms are mental or cognitive only, Social Security will evaluate your condition under Section 12.02 Neurocognitive disorders.

They will review your medical history for the following:

1.    Documented medical evidence of significant cognitive decline in one or more of the cognitive areas:
   
   1.   Learning and memory
   2.   Complex attention (ability to switch tasks and not lose focus);
   3.   Executive function (making plans and following through);
   4.   Language (ability to remember words, name objects);
   5.   Perceptual-motor (hand-eye coordination); or
   6.   Social cognition (ability to behave properly around others).

   
   AND

2.   Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (“extreme” means not being able to perform a task independently and “marked” means you can perform a task by yourself only occasionally):
   
   1.    Understanding, remembering, or applying information.
   2.   Interacting with others.
   3.   Concentrating on tasks.
   4.   Taking care of yourself.

Social Security will want to see results of any tests that confirm your diagnosis including neuropsychological testing (tests which examines cognitive functioning) and intelligence tests as well as documentation of medical visits and evidence of any hospitalizations.

You should also provide your doctors’ notes documenting progressive dementia and complete an Activities of Daily Living form (ADL). In the ADL form you will be able to describe your daily activities and your ability to perform tasks such as cooking, cleaning, shopping, getting dressed and taking care of pets.

Social Security realizes that some applicants who suffer from dementia function well only because they have a strong support system.

In addition to reviewing your medical records, Social Security will look for evidence to support your claim from your family, friends, social workers and group homes. Social Security will want to see that you have a medically documented history of dementia over a period of at least 2 years, and evidence of both of the following:

1.   Medical treatment, mental health therapy, psychosocial support, or living in a highly structured setting that is ongoing and that diminishes the symptoms and signs of your mental disorder; AND
2.   You have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.

If your symptoms don’t match a listing, but you still can’t work, you may be able to qualify for Social Security Disability benefits by demonstrating your medical condition prevents you from working at your old job or any other job.

You may be experiencing difficulty speaking, loss of balance, and memory and concentration problems. Social Security will conduct a Residual Functional Capacity (RFC) assessment to evaluate your physical and mental capabilities to determine if there is any job you can do, taking into consideration your age, education and whether or not you can drive. If Social Security decides you cannot do your old job or don’t have the skills to perform a new job, you may be approved disability benefits.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Individuals who are 55 or older often fall under a grid rule, meaning they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits. You can apply for SSDI if you are not currently receiving retirement benefits; once you reach full retirement age, SSDI benefits automatically change to retirement benefits.

You may also be eligible for Social Security Disability benefits if you have another medical condition; for example, some heart and blood circulation problems, stroke, and diabetes.

One disorder alone may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.

Social Security also has basic financial requirements.

You must satisfy some basic financial requirements before you are eligible for Social Security disability benefits.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.

What if I don’t qualify for SSDI?

If you earn too much income, or if you haven’t worked long enough to earn enough work credits, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

You should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) coverage protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. LTD coverage is good only as long as you are employed, however, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Also, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged; most initial claims are, and you will have the opportunity to appeal. There are four steps to the Social Security appeal process:

1.   File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.   If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.   Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI?

Dementia is a particularly disabling condition and it is likely that you will be approved for disability benefits; however, applying for SSDI can be a long, complex process that can take several months.

Given the mental and cognitive challenges experienced by individuals with dementia, you will need some assistance in filing your claim from a family member, friend, or caretaker. Your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

If you are suffering from the effects of Alzheimer’s Disease/Dementia and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!

Do I need a disability attorney for a long-term disability insurance claim?

The process of filing a claim for long-term insurance is also a complex process and you will likely need some assistance.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court - all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.