Every year, more than 795,000 people in the United States have a stroke.Center for Disease Control, April 2022
Attorney Chad Delesk of Balin Law explains Social Security’s rules for Disability Benefits after suffering a stroke.
The following post is adapted from the transcript from this video:
Can I get Social Security Disability Benefits after having a Stroke?
A lot of times I have clients call me and ask me whether or not they can get disability benefits based upon them having a stroke. Now, the simple answer to that is “yes”. The long answer is, “well, it depends” and it really depends on the severity of your stroke and how long that severity is expected to last.
What are Social Security’s requirements to get Disability Benefits?
To be able to qualify for disability benefits with the Social Security Administration, you have to show that you have a physical and or mental impairment that significantly impacts your ability to perform work on a sustained basis for at least a duration of 12 months, or be expected to result in death.
SSA’s Rules Specifically Related to Strokes
Now there’s actually two ways that we assess strokes with Social Security. One is under the medical listings and Social Security publishes what they call the listing of impairments and it’s exactly that. It’s a list of various impairments under different body systems and it lists out criteria that you need to meet in order to establish disability. Now, there’s actually one on point for strokes, which is under listing 11.04 (SSA Bluebook – Disability Evaluation Under Social Security – 11.04 Vascular insult to the brain). I’m just going to read from it directly here, because it does get complicated here as far as what it requires.
There’s actually three sub parts to it, A, B and C and if you meet any of those, either A, B or C, Social Security will automatically find that you’re disabled.
A. Sensory or motor aphasia
Now under A, it requires “sensory or motor aphasia resulting in ineffective speech or communication” and that has to persist for at least three months after the original stroke. What does that mean? Well, Social Security does provide some examples of what that means. Inability to follow one-step commands is an example, or inability to tell someone your basic personal needs without assistance is another example (from section 11.00E1 of Disability Evaluation Under Social Security, ssa.gov). So that’s the first criteria that you could possibly meet.
B. Disorganization of motor function in two extremities
The second under B is disorganization of motor function in two extremities, and that’s important; the two extremities part. Resulting in an extreme limitation in the ability to either stand up from a seated position, to balance while standing or walking or use the upper extremities. Again, this must persist for at least three months after the insult.
So the first part that I emphasize under part B is the two extremities. So you must have two extremities that are extremely limited and it could be both legs. It could be both arms or it could be one arm and one leg. Examples would be inability to “stand up from a seated position”, which means that once you’re seated in order to stand up you either need assistance from another individual or you need an assisted device such as two canes or a walker. Okay, that would satisfied that criteria.
The other was balance while standing or walking. So you cannot remain upright without assistance from an assisted device and it has to be either two canes, two crutches or a walker, so that you’re using both of those upper extremities. Remember we need two upper extremities involved. The third was use of the upper extremities. So both arms are significantly impacted to where you have difficulty feeling, fingering, grasping, reaching, lifting, carrying. Now that’s under part B.
C. Marked limitation in physical functioning and in one of 4 areas of mental functioning
The third part is part C, which requires “marked limitation in physical functioning”. Again, I’m going to read from this and in one of the following areas of mental functioning. So it’s a hybrid situation. So the physical limitations don’t rise to the level of being extreme. So Social Security has a 5-point system where they rate Severity. It goes:
So we talked about “extreme”, which was in the last subset under B, and that’s a complete inability to do those functions. Now “marked” is a little bit less, it’s one rung below “extreme” and that is seriously impacted. That’s what that means. That’s how Social Security defines it.
It’s very murky, but “marked” limitation in physical functioning. What are examples of that? Well, it could be uncorrectable blurred vision, double vision. It could be difficulty breathing and you need to use a portable CPAP machine, or it could be episodes of aspiration that happen at least once a week. So that would fulfill the marked limitation in physical functioning.
The areas of mental functioning that Social Security looks at, there’s four areas.
- One is understanding, remembering, or applying information.
- Another is interacting with others.
- A third is concentrating, persisting and maintaining pace.
- The last is adapting or managing one’s self.
So you need a “marked” limitation in one of those mental areas. So that’s why I say it’s a hybrid because they’re combining both the physical and the mental functioning to find that you meet this criteria.
What if I don’t perfectly meet the requirements in A., B., or C.? Could I still be approved for Disability Benefits?
Yes. The other way is they look at what limitations flow from your stroke and any other impairments that you have. Then they determine what limitations you have and then in turn, what jobs might be out there for you. Now, you may not meet or equal one of these listings, but you might be so significantly impacted by your stroke and other conditions that you cannot perform any work.
One of the things we typically talk about is off task behavior or absenteeism. So maybe you’re so fatigued, or maybe you have cognitive deficits that don’t quite rise to the level of meeting a listing, but they still cause you to be off task at work. Most of the time, if you’re off task anywhere from 10 to 20% or more of the time, Social Security will come back and say that you can’t perform any work.
Similarly, if you have limitation to just one upper extremity, say it’s your dominant arm and you can’t use it. Well while you’re not impacted in two extremities, most jobs require pretty frequent use of both of your upper extremities. So if you can’t use your dominant hand, there’s probably not a whole lot of jobs out there that you can do.
There’s other impairments and limitations that could affect your ability to work and we want to make sure that we cover all those because the more conditions you’re treated for the less number of jobs Social Security will be able to say that you can do.
A great example of this was our client Deborah, who experienced a Cerebellar Stroke and also had other conditions such as high blood pressure and diabetes. After being denied Disability several times, she came to Balin Law and finally won her case.
Still have questions?
If you have any questions about stroke and qualifying for disability benefits, please reach out to us at any time. We can also help you file an initial application. We can be reached at 866-49-BALIN, B-A-L-I-N. Of course, you can go to our website, Balinlaw.com. You can use a chat feature or you can send us an email and we’ll be in contact with you as soon as possible.
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