Establishing Disability Under the Compassionate Allowance Program

When an individual suffers from a debilitating disease or condition, working and earning a livelihood can be challenging, if not impossible.  Under these circumstances, applying for Social Security Disability Insurance (SSDI) benefits may be the best chance the individual has at obtaining a steady and reliable income.

Unfortunately, the time it takes the Social Security Administration (SSA) to determine whether an applicant qualifies for SSDI averages at about 18 months from the date the initial application was filed. During this period, many applicants must find a way to make-do with little-to-no income because they have quit their jobs or are working reduced hours due to physical or mental limitations, or because they were making more money each month than SSA allows a person to make to be eligible for SSDI benefits.  Aside from the financial struggles likely to result from such scenarios, the applicant’s uncertainty as to whether their disability claim will be approved or denied can exacerbate the stress, anxiety, pain, and other symptoms associated with their health condition.

These challenges can be especially impactful on applicants diagnosed with a severe or life-threating condition, as their health often prevents them from earning even a small amount of income while their application is pending, and because they are more likely to incur substantial medical debt for the care and treatment of their condition during this time.  The SSA recognized the additional burdens facing these applicants and responded by creating the Compassionate Allowance Program, or “CAP”, which expedites the processing of disability claims involving more critical diagnoses.

How is Disability Typically Evaluated?

In all disability claims, the SSA must determine whether the applicant’s condition is “severe” as defined within the Social Security Act.  Under the Act, a “severe” condition is one that significantly interferes with the applicant’s ability to do basic work activities for a period of 12 months or longer.  Generally, once a finding of severity has been made, the SSA must then conduct an in-depth and thorough review of the application and supporting medical records to determine whether the applicant’s condition is so severe that it would prevent them from doing the type of work they did in the past at a same or modified level, or from working in another job or role that is less physically and/or mentally demanding.  If found that their condition does in fact prevent them from doing a job from either category, he or she is considered disabled and will qualify for SSDI benefits so long as the additional, non-health-related requirements are met as well.

How does the Compassionate Allowance Program Change the Evaluation?

When applicable, the Compassionate Allowance Program changes the above analysis by removing the impact of the applicant’s condition on their ability to work from the scope of factors considered in determining disability.  The Program applies only to claims that involve a “Compassionate Allowance”, or a disease or condition the SSA has deemed to be so severe that its diagnosis alone warrants finding an applicant disabled and eligible for SSDI.  An up-to-date list of diseases and conditions that qualify for evaluation under the CAP can be found here.

How Can I File A CAP Claim?

There is no need to file an additional application form or to follow a different process when applying for disability claim that involves a CAP-eligible disease or condition.  If the application includes medical records sufficient to show that the qualifying diagnosis was correct, it will be flagged by the SSA’s screening system and scheduled for an expedited review and determination.  This accelerated process enables applicants with the most serious health concerns to receive SSDI payments much sooner than they would under the standard timeline and analysis—in as little as a week, opposed to several months.

If you have a disability that keeps you from working and need more information about the Social Security disability process, contact the attorneys at Reynolds and Gold LLC 417-883-7800.

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