Understanding Disability Benefits for Dementia Patients

Explore whether you or a loved one meet the social security administration requirements for disability benefits due to dementia and early on Alzheimers

It is estimated that 48.9 million Americans have a disability of some sort.

To provide them with some sort of assistance, the Social Security Administration (SSA), along with other organizations, offers them certain disability benefits to help them navigate their lives. The SSA now considers dementia and Early Onset Alzheimer’s a disability as well. And as per their regulations, if you or your loved one suffers from dementia, you might be able to claim these benefits if you meet certain criteria.

Before we look into what those are, let’s have a look at what exactly the SSA is and what the benefits they provide include.

The Social Security Administration

The U.S social security administration is an independent agency of the Federal government. Their primary function is to run social security programs to assist those who’ve retired, have disabilities and so on. Through these, they’ve made available Social Security Disability Insurance (SSDI) and Social Security Income (SSI) for those with disabilities.

Compassionate Allowance Initiative

The compassionate allowance initiative is a way to make the process of claiming SSDIs and SSIs much quicker. People with early-onset Alzheimer’s, Lewy body dementia, mixed dementia, and other mentioned illnesses can use this expedited route to get their needs met.

This kind of initiative is extremely important for those with dementia or Alzheimer’s because they generally have their claims denied or permitted through appeal. Another way to speed up the process is to hire a qualified social security attorney.

Supplemental Security Income

This kind of income is available to those who are blind or have a disability. It is also available to those above the age of 65.

Blue Book Listings and Why They Matter

Now, certain disability claims, especially dementia-related claims, are evaluated through blue book listings. To qualify for the requirements in the listings you need to meet the criteria below:

11.04 – Central Nervous System Vascular Accidents or Strokes

Sensory Aphasia refers to a condition where the patient loses the ability to communicate effectively and has a difficult time forming words, phrases or understanding. Motor aphasia indicates severe problems with motor functions and movement. This could be through difficulties in walking, standing or other forms of movement.

This must occur in at least two extremities.

11.06 – Parkinson’s Disease

Under this, the person should be experiencing severe rigidity, bradykinesia or tremors. Like the above, this should be experienced within at least two extremities and disrupt the ability to stand, or walk.

12.02 – Neurocognitive Disorders

Neurocognitive disorders include loss of memory, loss of cognitive or linguistic ability, poor concentration and poor social skills. The inability to interact appropriately in social situations is also included.

When Are You Entitled to Apply for Disability Benefits

If you have dementia or early-onset Alzheimer’s disease, you can apply for disability benefits under the following conditions. The benefits include Social Security Disability Income and Supplemental Social Security Income. You can only apply for the former if you have not claimed retirement benefits.

However, when you do reach the age of retirement, you will be awarded retirement benefits instead of SSDI.

To qualify for any of the above, your symptoms must be severe enough to prevent you from working for at least 12 months or more.

What Qualifies as Dementia & Alzheimer’s

Now the last of the above listings (12.02), is the one most commonly applied to dementia. Below is what you need to prove to qualify as a dementia patient to claim disability benefits. If you can prove either one of the following the SSA must then determine the severity of the condition and how it affects your day-to-day functioning.

  • Poor short term memory
  • Difficulty with learning and comprehension
  • Loss of linguistic ability and poor speech
  • Poor attention span
  • Inappropriate social behavior or poor social skills
  • Lack of physical coordination
  • Poor organizational skills and judgment

The Next Step

If you meet one of the above criteria, and the SSA is satisfied that it is severe enough, they will evaluate the effect on your functioning. To meet these criteria, you must have a severe limitation in one of the following criteria or a more than moderate limitation in two or more.

  • The ability to comprehend, or recall
  • Concentration and focus required to complete a task at a reasonable pace
  • Adaptation to one’s environment, management of normal hazards and practical day-to-day skills
  • Social interaction

If you have sufficiently proved difficult in both these areas, you will then be evaluated on another scale. These might include determining your residual functional capacity and a few other mandatory qualifications.

Understanding “Residual Functional Capacity”

If despite the evidence provided, the SSA determines that you do not meet the criteria for dementia or Alzheimer’s disease, they may choose to evaluate your “residual functional capacity” (RFC).

So what exactly is RFC?

RFC is the limit to what you can do, despite your psychological or physical limitations. It is measured with the standard of a 40-hour workweek to determine your ability.

Now, based on your physical limitations you may only be able to perform simple, mildly exertive tasks. Due to impairment in cognitive functions, you might not be able to perform at a high skill level. In this case, your physician might recommend limiting activity to very simple tasks, in line with your ability.

Another aspect that will be evaluated, is your ability to perform in a group or public setting. For those suffering from early-onset Alzheimer’s or dementia social interaction may be quite limited. Their social interactions may need constant supervision.

In addition to this, fatigue is also recognized as an inhibitor to perform these kinds of activities. If a patient is unable to work due to high levels of fatigue caused due to illness or severe medication, they will also have a lower residual functional capacity.

In short, the lower your ability, the lower your RFC, and the higher your chances of having a successful disability claim.

But keep in mind, the most important aspect of having a successful claim is valid proof and evidence supporting your claim.

Medical Evidence and Third-Party Statements

The most important type of proof you can have in your disability benefits claim is medical records and a doctor’s verdict. When making your claim, be sure to include all hospital receipts, prescriptions, test results, clinic notes and a doctor’s statement regarding any of the criteria you say you meet.

For certain types of dementia like dementia with Lewy bodies, it will also help to provide brain scan results. If the patient is seeing a psychiatrist, it will also help to get a psychiatry evaluation for proof of illness. Keep in mind that all the evidence you can gather counts towards establishing your needs.

If the patient is seeing a speech therapist for their Alzheimer’s a report from the therapist will also help.

In addition to medical records and statements, personal statements from family, friends, and relatives can also contribute. However, it is advisable to stick to people who live in close quarters and at least meet the patient regularly.

To prove an inability to perform at work, statements from previous employers might also be helpful.

How to Initiate the Application Process for Disability Benefits

To initiate the application, you need to set up an appointment with the Social Security Administration office. Once you do this, you then have to fill up a form for your claim. If you’re only applying for SSDI, the process can be completed on the SSA website itself.

Within the application, be sure to fill in as much detail as possible, the day-to-day difficulties, however insignificant they may seem. For example, difficulty in grocery shopping, making the bed, opening doors – are all worth mentioning in your form. You will also need to work closely with your physician to help support your claim.

Also, be sure to mention any mental illnesses that may be affecting functioning.

Do You Need a Social Security Lawyer?

If you’ve tried and gotten a rejection for your disability benefits application, don’t be disheartened. It is unfortunate, but most people do have their application rejected the first time. What you can do is work with a social security attorney to help you file an appeal and get it accepted the next time.

Having a lawyer on your side significantly improves your chances, because they are more familiar with the administrative and legal processes involved. Consider getting one to help you from the very start for a smoother experience. You can also use your initial consultation to gauge whether your lawyer is right for your case.

Get in touch with us for a free consultation, and we’ll help you get the process started as soon as possible!