Disability Benefits Post-Stroke: What Are Your Options?

Strokes are a leading cause of disability, and in the US, more than 795,000 people suffer a stroke each year. While strokes are more common in those past retirement age, around 25% occur in people under 65. If you've had two strokes and are unable to work, you may be eligible for disability benefits.

The Social Security Administration (SSA) provides disability benefits for those who are unable to work due to persistent stroke symptoms. To qualify, you must meet specific eligibility criteria and demonstrate that your stroke has severely impacted your ability to work. The SSA evaluates disability applications based on a medical reference book called the Blue Book, which includes a listing for strokes (vascular insults to the brain) in Section 11.04.

To receive disability benefits, you must provide medical evidence and documentation of your stroke and its impact on your functionality. This includes medical records, test results, hospital stays, medications, and surgeries. It's important to note that the SSA won't process your claim for at least three months after your stroke to assess the long-term impact on your health.

The process of applying for disability benefits can be challenging, and it's recommended to seek guidance from an experienced disability lawyer. They can help you navigate the complex application process and improve your chances of approval.

What are the criteria for getting disability benefits after a stroke?

To qualify for disability benefits after a stroke, you must meet the eligibility criteria set by the Social Security Administration (SSA). The SSA requires proof of your stroke as described in the Neurological Impairment section of its Blue Book. Here are the criteria you need to meet to be eligible for disability benefits:

• You must be unable to work for at least 12 months after your stroke. This means demonstrating that your stroke has resulted in long-term or permanent impairments that prevent you from earning a living.
• You must provide proof of your stroke, including medical evidence and diagnostic test results. This proof should show the severity of your stroke and how it prevents you from working.
• You must meet the SSA's definition of a disability, which is "not being able to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months".
• Your stroke must meet the listing for a stroke in the SSA's Blue Book under Section 11.04, Vascular Insult to the Brain. This section outlines three ways the SSA evaluates a 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 ability to function physically.
• Significant limitation in physical functioning (e.g. mobility impairment) and at least one of the following areas of cognitive functioning: understanding, remembering, or applying information; engaging in social interaction; concentrating, persisting, or maintaining pace; adapting or managing yourself.
• If you don't meet the criteria under Section 11.04, there are other listings under which you may still qualify for disability benefits, such as Sections 2.02, 2.03, 2.04, or 2.10 for vision or hearing impairments, or Section 12.00 for mental disorders if your stroke has caused cognitive losses or permanent brain damage.
• If you don't meet the requirements of 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, which the SSA will use to determine if there is any work you are able to do.

How do I prove my eligibility for disability benefits?

To prove eligibility for disability benefits, you must meet the Social Security Administration's (SSA) standards for disability for your particular condition. The SSA has a detailed list of conditions, commonly referred to as the Blue Book, that may qualify you for benefits if your condition is severe enough to prevent you from working.

To be eligible for Social Security Disability Insurance (SSDI), you must meet the following requirements:

• You must have worked in jobs covered by Social Security.
• Your medical condition must meet the SSA's strict definition of disability.
• You are unable to work for at least 12 months due to your disability.
• Your disability is expected to result in death or has persisted/is expected to persist for at least 12 months.
• Your condition prevents you from engaging in substantial gainful employment.

The SSA uses a Five-Step Sequential Evaluation to determine eligibility:

• Can the claimant engage in substantial gainful employment?
• Will the impairment last 12 months or result in death?
• Does the impairment meet the severity of a defined medical listing in the Blue Book?
• Can the claimant perform past relevant work?
• Can the claimant perform any other available work?

Evidence required to prove eligibility includes recent medical tests and accurate and complete records from acceptable medical sources. This can include biopsy results, medical exam reports, lab reports, imaging tests (X-rays, CT scans, MRIs), hospital records, surgical notes, therapy records, and prescription medications.

Additionally, your doctor must complete a residual functional capacity (RFC) form to assess the impact of your stroke symptoms on your ability to work. If you are applying for Supplemental Security Income (SSI), which is means-tested, you will also need to provide proof of your income and assets.

It is important to note that meeting the criteria does not guarantee approval, and the majority of SSDI claims are denied the first time. Seeking assistance from a qualified disability lawyer can increase your chances of a successful claim.

What are the different types of benefits I can apply for?

Yes, there are disability benefits available for people who have suffered strokes. Depending on the severity of the stroke, a person may be eligible for medical and cash benefits through the Social Security Administration (SSA) or their employer's long-term disability plan.

Social Security Disability Insurance (SSDI)

SSDI provides financial support to those who have become incapacitated and are unable to work due to medical issues, including strokes. This can help cover living expenses, medical care, and rehabilitation services. The benefits include monthly payments, which are based on your work history and contributions made towards Social Security taxes. SSDI recipients are also eligible for Medicare coverage after receiving disability benefits for two years.

Supplemental Security Income (SSI)

SSI is aimed at people with minimal to no work history and those with low incomes, such as the elderly. To qualify, your assets must not exceed a certain value, and your household income must be within specific limits. If approved, you will be eligible for Medicaid.

Long-Term Disability (LTD) Benefits

Following a severe stroke, you may be eligible for LTD benefits through your employer. LTD benefits are typically based on a percentage of your income and can last until retirement age or for a fixed period.

Medical Vocational Allowance

If you are unable to work due to medical problems caused by a stroke but do not meet the specific listings in the SSA's Blue Book, you may still be eligible for benefits through a Medical Vocational Allowance. Your doctor will need to describe your limitations on a Residual Functional Capacity evaluation form, which the SSA will use, along with your work history and skills, to determine if you are able to work.

Universal Credit (UC)

UC is the main benefit for working-age people and can provide support with housing costs and other living expenses.

Illness or Disability Benefits

Financial support is available for those who are unwell or have a disability, including help with health costs and home adaptations.

Carer's Benefits

If someone is providing care for you after your stroke, they may be entitled to financial support through carer's benefits.

It is important to note that the availability and eligibility criteria for these benefits may vary depending on your location and specific circumstances. It is always recommended to seek advice from a professional or a relevant organisation to understand your options and the application process.

How do I file a claim for disability benefits?

If you have suffered a stroke and are seeking to file a claim for disability benefits, there are a number of options available to you. The Social Security Administration (SSA) offers Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits. Additionally, if you are a veteran, you may be eligible for VA disability benefits. Here is a step-by-step guide on how to file a claim for disability benefits:

Step 1: Determine Your Eligibility

Before initiating the claims process, it is important to assess whether you meet the eligibility criteria for disability benefits. For SSDI and SSI benefits, you must be unable to work for at least 12 months following your stroke. Your disability must be classified as severe, meaning it affects your ability to perform job duties. Additionally, your monthly earnings must be $1,040 or less per month.

Step 2: Gather Documentation

To support your claim, you will need to provide comprehensive documentation of your stroke and its impact on your functionality. This includes medical records, examination results, laboratory tests, imaging tests (such as X-rays, CT scans, MRIs), hospital records, surgical notes, therapy records, and prescription medications. You may also need to provide information about your work history, wages, and any workers' compensation claims.

Step 3: Understand the Blue Book Listings

The SSA evaluates disability applications based on a medical reference book called the Blue Book. For stroke victims, the relevant listing is 11.04: Vascular Insult to the Brain. To qualify, you must meet at least one of the following criteria for at least three consecutive months post-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 (e.g., mobility impairment) coupled with limitations in cognitive functioning, such as understanding, remembering, interacting with others, concentrating, or adapting.

If you do not meet the requirements under this listing, there are alternative listings for hearing loss (2.10), loss of visual efficiency (2.04), and mental disorders (Section 12.00).

Step 4: Complete the Residual Functional Capacity Form

If you don't meet any of the Blue Book listings, you may still qualify for benefits through a Medical Vocational Allowance. Your doctor will need to describe your limitations on a Residual Functional Capacity (RFC) evaluation form. The SSA will consider your evaluation, work history, and skills to determine if you are capable of working.

Step 5: Submit Your Claim

You can file your claim for SSDI or SSI benefits online through the SSA website, or by calling their toll-free number: 1-800-772-1213. If you are deaf or hard of hearing, you can use the TTY number: 1-800-325-0778. Additionally, if you are a veteran seeking VA disability benefits, you can file your claim online, by mail, or in person at a VA regional office.

Remember, the claims process can be complex, and it is recommended to consult with a qualified social security disability lawyer or trained professional to guide you through the process and ensure your claim is thoroughly prepared.

What are the chances of my application being approved?

The chances of your application for disability benefits being approved depend on several factors. Firstly, you must meet specific eligibility criteria set by the Social Security Administration (SSA). Secondly, the severity and persistence of your stroke symptoms will impact your application's success. Thirdly, providing comprehensive medical records and evidence is crucial for a higher chance of approval.

• Eligibility Criteria: The SSA requires that you are unable to work due to persistent symptoms. They will assess impairment in at least one of three areas: sensory or motor aphasia, disorganization of motor function, and limitation of mental functioning.
• Severity and Persistence of Symptoms: Your stroke symptoms must significantly impact your ability to work and perform daily tasks. Common symptoms include paralysis, difficulty speaking or swallowing, memory loss, emotional difficulties, and problems with motor coordination. These symptoms should be persistent and expected to last at least 12 months.
• Medical Evidence: It is crucial to provide comprehensive medical records and evidence to support your application. This includes physical exams, medical notes, test results, hospital records, medication information, and detailed reports from your doctor or neurologist regarding your long-term prognosis.
• Blue Book Listing: The SSA has a listing for strokes under Section 11.04, Vascular Insult to the Brain, in their Blue Book of qualifying medical conditions. To qualify under this listing, you must meet specific criteria, such as demonstrating ineffective speech or communication due to aphasia or significant motor function disorganization in two extremities.
• Residual Functional Capacity (RFC): If you don't meet the Blue Book listing, you may still qualify through an RFC assessment. Your doctor must describe your limitations on an RFC evaluation form, which the SSA will consider along with your work history and skills to determine if you can work.
• Additional Qualifying Conditions: If you have other qualifying conditions or impairments, including arthritis or diabetes, including them in your application can improve your chances of approval.
• Financial Requirements: Ensure you meet the basic financial requirements for disability benefits, such as having a disability expected to last 12 months and earning below the specified income limits.
• Legal Representation: Consider seeking legal assistance from a qualified social security disability lawyer. They can guide you through the complex application process, ensure you meet the necessary criteria, and increase your chances of a successful application or appeal.

While the above factors are crucial, it's important to note that the approval process can be challenging, and initial applications are often denied. However, persistence is essential, as the chances of winning an appeal are significantly better. Don't hesitate to seek legal guidance and support throughout the process.

Frequently asked questions