Stroke Victims: Disability Benefits And Eligibility

A stroke can cause permanent or temporary damage, including paralysis, difficulty speaking or swallowing, memory loss, and depression. If you have suffered a stroke, you may be able to qualify for disability benefits. In 2021, approximately 31% of Social Security disability beneficiaries qualified for benefits due to a disease of the nervous system and sense organs, which is how the Social Security Administration (SSA) categorizes a stroke. To qualify for disability, the SSA requires specific eligibility criteria, and you must be unable to work because of persistent symptoms.

What are the criteria for applying for disability after a stroke?

To apply for disability benefits after a stroke, you must meet certain criteria as defined by the Social Security Administration (SSA). Here are the key criteria you should be aware of:

Financial Criteria

Your income must be below a certain threshold to qualify for disability benefits. This threshold is $1,550 per month for non-blind applicants and $2,590 per month for blind applicants in 2024. This is known as the Substantial Gainful Activity (SGA) limit. Additionally, your assets must not exceed $2,000 in value, and your household income must be below a certain limit for your household size if applying for Supplemental Security Income (SSI).

Disability Severity

Your disability must be severe enough to affect your ability to perform job duties. The SSA defines this as having a "marked limitation" in physical functioning and at least one area of mental functioning.

Duration of Disability

Your disability must have lasted or be expected to last for at least 12 months. This is to ensure that the impairment is long-term.

Medical Criteria

You must provide medical proof of your stroke and its impact on your functioning. This includes medical records, examination results, test results, hospital records, medication information, and detailed reports from your doctor or neurologist. The SSA will assess your condition based on the Neurological Impairment section of their Blue Book, specifically Listing 11.04: Vascular Insult to the Brain.

To meet the criteria, you must experience at least one of the following for at least three months after your stroke:

• Inability to communicate effectively due to aphasia (sensory or motor aphasia).
• Disorganization of motor function in two extremities, impacting your ability to stand, balance, walk, or use your arms.
• Significant limitation in physical functioning, along with a marked limitation in at least one area of mental functioning, such as understanding, remembering, interacting with others, concentrating, or adapting.

Work History

You must have worked in a job where you paid Social Security taxes long enough and recently enough to qualify. Typically, this means working and paying taxes for five of the past ten years.

Age

Your age can be a factor in determining your eligibility. Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job.

Other Impairments

If you have another impairment in addition to the stroke, the SSA will consider the combined impact of these conditions on your ability to work.

Applying for Benefits

You can apply for benefits online, over the phone, or in person at your local SSA office. It is recommended to start the application process as soon as possible, as it can take several months or even years to receive benefits. If your initial application is denied, don't give up—you have the right to appeal the decision.

How do I prove my stroke qualifies for disability?

To prove that your stroke qualifies for disability benefits, you must meet the eligibility criteria set by the Social Security Administration (SSA). The SSA requires that you demonstrate a severe disability that affects your ability to perform your job duties and that your disability is expected to last at least 12 months. Additionally, your income must be below a certain threshold.

To prove your eligibility, you should provide medical evidence and documentation, including:

• Your medical history
• Results of medical examinations
• Relevant laboratory tests
• Imaging test results (X-rays, CT scans, MRI, EEG, etc.)
• Hospital records, including inpatient and emergency room visits
• Surgical notes
• Long-term prognosis reports from your doctor or neurologist
• Therapy records
• Prescription medications and their effects

The SSA will assess your application based on the impact of your stroke on your physical and mental functioning. To qualify, you must meet at least one of the following criteria for at least three consecutive months following your stroke:

• Difficulty or inability to talk or communicate due to sensory or motor aphasia
• Significant and persistent motor function issues in two extremities that impact your physical abilities
• Significant limitation in physical functioning and at least one area of cognitive functioning, such as understanding, remembering, or applying information, interacting with others, concentrating, or adapting

If you don't meet the specific listings, you may still qualify for benefits through a Residual Functional Capacity (RFC) assessment or a medical-vocational allowance. The RFC assessment will evaluate your physical and mental capabilities and determine if you are able to perform your previous job or any other job.

It is recommended to seek guidance from an experienced disability lawyer when applying for disability benefits to ensure your claim is taken seriously and to increase your chances of approval.

What are the different types of disability benefits?

If you have suffered a stroke, you may be able to qualify for disability benefits. Strokes are a leading cause of disability and can cause permanent or temporary damage, including paralysis, difficulty speaking or swallowing, memory loss, and depression.

There are two main types of disability benefits that you can apply for: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both are offered by the Social Security Administration (SSA) and supplement the income of individuals who are unable to work due to a medical disability. However, SSDI and SSI serve two distinct populations.

SSDI is available to those who have "paid into" the system through taxable income. In other words, SSDI is intended for individuals who used to work but can no longer do so due to a physical or mental impairment. To qualify for SSDI, you must have earned 20 or more "quarters of coverage" (QCs) in the last 10 years and be fully insured. The physical or mental disability must be expected to last for a minimum of 12 months or until death.

SSI, on the other hand, serves as a safety net for those who do not qualify for SSDI and have limited means. SSI assists low-income individuals who have not worked enough to earn the credits necessary to qualify for SSDI. SSI is based on an individual's financial need and is determined by calculating their resources, such as cash or property. SSI is also available to individuals who are 65 or older, adults who are disabled, and children who are blind or disabled.

It is important to note that the process of applying for disability benefits can be challenging and may take several months or even years. It is recommended to seek legal assistance when applying for disability benefits to increase your chances of approval.

How do I apply for disability benefits?

If you have suffered a stroke and are looking to apply for disability benefits, there are a few things you should know and steps you should take. Firstly, it is important to understand the eligibility criteria for disability benefits. To qualify for disability benefits, you must meet certain medical and financial criteria.

Medical Criteria

According to the Social Security Administration (SSA), to qualify for disability benefits after a stroke, you must demonstrate that you are unable to work due to persistent symptoms. The SSA's Blue Book, which lists qualifying medical conditions, categorizes strokes as neurological conditions in Section 11.04. To meet the requirements, you must provide evidence of at least one of the following symptoms:

• Inability to communicate needs effectively or understand basic commands due to aphasia.
• Disorganization of motor function in two extremities, impacting your ability to stand, balance, or use your upper extremities.
• Marked limitation in physical movement and at least one area of mental functioning, such as understanding information, interacting with others, concentrating, or adapting.

These symptoms must be present for at least three months after the stroke.

Financial Criteria

In addition to the medical criteria, there are also financial requirements to be eligible for disability benefits. These requirements vary depending on the specific program you are applying for. For Social Security Disability Insurance (SSDI), you must have a work history and not earn more than the Substantial Gainful Activity (SGA) limit, which is $1,550 per month for non-blind applicants and $2,590 for blind applicants in 2024. For Supplemental Security Income (SSI), there is no work history requirement, but your income and assets must be below certain limits.

Application Process

You can apply for disability benefits through the SSA online, over the phone, or in person at your local SSA office. The application process can be challenging, and it is recommended to seek guidance from a qualified disability lawyer. The process may take several months to years, and having legal representation can increase your chances of approval. During the application process, you will need to provide medical evidence, such as physical exam notes, test results, hospital records, medication information, and doctor's opinions.

Appeals

If your initial application is denied, don't be discouraged. Most initial applications are denied, and you have the right to appeal the decision. The SSA has a four-step appeal process: Request for Reconsideration, hearing with an Administrative Law Judge (ALJ), review by the Appeals Council, and Federal Court review. It is highly recommended to obtain legal counsel during the appeal process to improve your chances of success.

My application was denied, what now?

If your application for disability benefits following a stroke has been denied, there are several steps you can take to appeal the decision. It's important to remember that being denied initially is common—almost 70% of applications are denied at first.

Request for Reconsideration

First, you can file a Request for Reconsideration with the Social Security Administration (SSA). This will prompt a complete review of your case by an examiner who was not involved in the original decision. If they also decide against you, you can request a hearing.

Hearing

You can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the SSA and review SSDI cases. They will either uphold or overturn the decision to deny benefits. It is highly recommended that you obtain legal counsel at this stage to increase your chances of success. If the ALJ denies your claim, you can request that the Appeals Council review your case.

Appeals Council

If the ALJ does not grant your claim, you can request that the Appeals Council review your case. If they decline to hear your case, you can take it to the final step in the appeal process.

Federal Court Review

The final step in the appeal process is filing a suit in U.S. District Court.

Consult a Lawyer

Navigating the appeals process can be challenging, so it is advisable to consult an experienced disability lawyer who can guide you through the process and increase your chances of a successful outcome. They can help you collect and submit relevant medical evidence, obtain doctors' opinions, and prepare you for questioning by the judge.

Frequently asked questions