Disability Benefits Post-Stroke: What You Need To Know

A stroke, or cerebrovascular accident, occurs when there is a block or break in one of the blood vessels that carry oxygenated blood to the brain. It can cause a range of physical and mental limitations, and in severe cases, can significantly impact a person's ability to work. As such, those who have suffered a stroke may be eligible for disability benefits. To qualify, individuals must meet certain criteria and provide evidence that their condition meets the relevant medical listings.

What is a stroke?

A stroke is a medical emergency that occurs when there is an issue with blood flow to the brain. This can be due to a blocked artery or bleeding in the brain, resulting in brain cells dying from a lack of oxygen. Within minutes, stroke victims may lose the ability to speak, experience memory problems, or suffer paralysis on one side of their body.

There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes, which account for about 80% of all strokes, occur when blood flow to the brain is blocked, usually by a blood clot. Hemorrhagic strokes, on the other hand, are caused by sudden bleeding in the brain, resulting in pressure on and damage to brain cells.

Strokes are a leading cause of disability and death worldwide. They can cause lasting brain damage and a range of disabilities, including paralysis, difficulty with language and memory, emotional and personality changes, and vision and balance problems. The effects of a stroke depend on where in the brain it occurs and how long the brain is deprived of blood and oxygen.

The treatment for a stroke depends on the type and location of the stroke, as well as the severity of the bleeding. Ischemic strokes are typically treated with thrombolytic drugs to dissolve clots and restore circulation, while hemorrhagic strokes focus on reducing blood pressure and improving clotting to stop the bleeding.

How to qualify for disability after a stroke

A stroke is a medical emergency that occurs when a blood vessel travelling to the brain is blocked or ruptures, causing brain damage. While some people recover almost completely from strokes, many others are left with long-term or permanent disabilities. If you are unable to work for at least 12 months after your stroke, you can file a claim for Social Security disability benefits.

Proving your stroke

To qualify for disability benefits, you must provide proof of your stroke. This proof is described in the Neurological Impairment section of the Social Security Administration's (SSA) Blue Book. You will need to include the results of the tests used to diagnose your stroke, as well as hospital records, surgical notes, physical exam notes, and records from any therapy sessions.

Qualifying under the Blue Book

The SSA evaluates strokes under section 11.04, "vascular insult to the brain". There are three ways to qualify under this section:

• You are unable to communicate effectively due to sensory or motor aphasia (damage to the parts of the brain that control language).
• You are unable to control motor function in at least two extremities (either an arm and a leg, or two arms or two legs), causing extreme difficulty in performing basic movements such as balancing while walking, standing up from a seated position, or using your upper extremities.
• You have "marked" limitations in both physical and mental functioning, specifically in the mental areas of understanding information, interacting with others, concentrating on tasks, and adapting to changes.

Qualifying under another listing

If you don't meet the criteria under section 11.04, you may still qualify under another listing. For example, if you have lost your vision after a stroke, you may qualify under listing 2.02, "loss of visual acuity".

Qualifying through a medical vocational allowance

If you don't meet the criteria under any of the listings, you may still qualify for benefits through a medical vocational allowance. For this, your doctor must describe your limitations on a Residual Functional Capacity evaluation form. The SSA will then examine this form, along with your work history and skills, to determine if there is any work that you can do. If they cannot find suitable work, you will be eligible for benefits.

Types of disability benefits

If you are unable to work due to a stroke, you may be eligible for Social Security Disability benefits. There are two types of benefits, both paid monthly:

Social Security Disability Insurance (SSDI)

SSDI is a federal insurance program funded by payroll taxes. It is available to workers who have paid into the system over the years. The amount paid each month depends on your lifetime earnings and contributions. Eligibility is based on your age, disability, how long you worked, and citizenship status.

Supplemental Security Income (SSI)

SSI is available even if you haven't paid into the Social Security system, but it is needs-based. To qualify, you must show that you have no other assets to support you.

It is possible to qualify for both SSDI and SSI at the same time, but the amount paid by one program may affect the amount paid by the other. As of 2022, there is a federally mandated cap of $841 per month for individuals.

To qualify for Social Security Disability benefits after a stroke, you must be unable to work for at least 12 months. You must also provide proof of your stroke as described in the Neurological Impairment section of the Social Security Administration's (SSA) Blue Book.

The SSA will determine whether you are disabled by asking the following five questions:

• Are you currently working? If you are working and consistently making more than a certain amount per month, you will probably not be considered disabled.
• Does your disability prevent you from performing basic work-related activities (walking, standing, sitting, remembering)?
• Does your disabling medical condition meet or equal the severity of a listing found in the Blue Book list of medical conditions?
• Are you able to do the work you did prior to your disability?
• Can you make an adjustment to do any other type of work?

If you don't qualify based on the Blue Book listings, you may still be eligible for benefits through a Medical Vocational Allowance. Your doctor must describe your limitations on a Residual Functional Capacity evaluation form, which the SSA will examine along with your work history and skills to determine if you are able to work.

Applying for disability benefits

If you are unable to work due to the effects of a stroke, you may be eligible for Social Security Disability benefits. The Social Security Administration (SSA) offers two types of benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both are paid on a monthly basis, but there are different criteria for eligibility.

SSDI

SSDI is for workers who have paid into the system over the years through their taxes. The amount paid each month depends on your lifetime earnings and contributions. To be eligible, you must have worked and paid Social Security taxes for five of the past ten years. If you are under 31, you may not need to have worked quite as long.

SSI

SSI is needs-based and is available even if you haven't paid into the Social Security system. To qualify, you must show that you have no other assets that could support you and meet certain income and asset limits.

Qualifying for Disability Benefits After a Stroke

To qualify for disability benefits after a stroke, you must meet certain medical and financial criteria.

#### Medical Criteria

The SSA has a listing for strokes in its Blue Book under "Vascular insult to the brain" in the Neurological section 11.04. To qualify under this listing, you must meet one of the following three criteria:

• Sensory or motor aphasia resulting in ineffective speech or communication that persists for at least three consecutive months after the stroke.
• Disorganization of motor function in two extremities (arms, legs, or one arm and one leg) resulting in extreme difficulty with basic movements such as standing up, balancing while walking, or using your arms. This condition must also persist for at least three consecutive months after the stroke.
• "Marked" limitation in physical functioning and at least one area of mental functioning, including understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself. This limitation must also persist for at least three consecutive months after the stroke.

If you don't meet the criteria under the Blue Book listing, you may still qualify for disability benefits if your stroke has resulted in other disabilities, such as vision loss or hearing loss.

#### Financial Criteria

In addition to meeting the medical criteria, you must also meet certain financial criteria to qualify for disability benefits. For SSDI, you must earn less than $1,350 per month (as of 2022). For SSI, there are certain income and asset limits that you must meet to qualify.

Application Process

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security field office. The application process can be overwhelming, and it is recommended to consult with a disability attorney or advocate to ensure you meet all the criteria and have the necessary documentation.

The SSA will often wait at least three months from the date of the stroke to review claims, as many stroke patients can see significant improvements during this time. However, you can apply immediately and continue to send in additional medical evidence to support your claim.

Tips for Applying

• Gather all your medical records and ensure that everything has been documented.
• Continue to see your doctor and follow the treatment plan.
• If your memory has been affected by the stroke, consider seeking help from a family member, friend, or disability attorney to assist with your claim.
• Consult a neurologist for treatment, as this will carry more weight than a diagnosis from a family physician or internist.

How much do disability benefits pay?

If you become disabled and unable to work, you may be entitled to disability benefits. These benefits can come from private insurance, state programs, workers’ compensation, or the Social Security Administration. The amount you receive depends on your circumstances and the programs you take advantage of.

Private Disability Insurance

If you have private disability insurance, the amount you receive depends on the terms of your policy. Long-term disability policies typically replace between 40% to 65% of pre-tax earnings, with higher-paying policies costing more. Some policies also have a cap on the total payout.

State Disability Insurance

A small number of states offer disability insurance programs, and benefits vary by state. For example, California's State Disability Insurance program offers short-term disability benefits of about 60% to 70% of wages.

Workers' Compensation Disability

Workers' compensation disability benefits pay a percentage of lost wages, depending on state rules and whether the injury is permanent or temporary, full or partial. In Florida, for example, a permanent total disability could entitle you to 66.7% of average weekly wages.

Social Security Disability Insurance (SSDI)

SSDI benefits are based on your work history and how much you've paid into Social Security. The maximum monthly SSDI benefit for 2024 is $3,822, but most people receive less. The average monthly benefit is around $1,500.

To qualify for SSDI, you must have worked in jobs covered by Social Security and have a medical condition that meets their strict definition of disability. Benefits are generally paid monthly to people who are unable to work for a year or more. There is usually a 5-month waiting period before benefits start.

Supplemental Security Income (SSI)

SSI is a needs-based program, so you must show that you have no other assets that could support you. In 2023, the maximum SSI benefit was $914 for individuals and $1,371 for eligible individuals and their spouses.

Frequently asked questions