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Stroke and Social Security Disability

Applying for Social Security Disability Benefits After a Stroke

According to national statistics compiled by the Internet Stroke Center, nearly 800,000 Americans suffer a stroke every year. Of these, about 185,000 are people who have had more than one stroke. Whether you’ve experienced your first stroke or are impaired due to multiple attacks, you can potentially qualify for disability benefits from the Social Security Administration (SSA).

Strokes most commonly occur in people over the age of retirement, but about one quarter of those affected are under the age of 65.

If you’ve had a stroke prior to retirement age, you must contend with how to get by without income from employment. Benefits through one or both of the SSA’s disability programs may be the answer.

There are two forms of disability benefits for people who have experienced a stroke. Medically qualifying for each will be the same, although each has its own technical qualifications.

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) both pay benefits on a monthly basis. You may meet the eligibility criteria for each program, if your stroke results in long-term or permanent impairments that prevent you from earning a gainful living.

The Financial Costs of a Stroke

The Centers for Disease Control (CDC) estimate that strokes cost $34 billion per year in the U.S. This grand total includes medical procedures, healthcare services, prescription medications, and lost work hours for all adults affected annually. When it comes to your individual direct costs, you’re potentially looking at diagnosis and initial treatment expenses as well as costs associated with long-term or permanent deficits.

A 2014 study published by the Journal of Stroke and Cerebrovascular Diseases: The Official Journal of the National Stroke Association reports the average cost of a hospital stay for a stroke patient ranges from $20,396 to $43,652. The type of stroke affects initial diagnosis and treatments costs. Many patients also have concurrent medical conditions, like heart disease, diabetes, or traumatic brain injury. These other conditions drive hospitalization costs up and affect ongoing medical expenses as well.

The costs of living with stroke-related deficits can be steep. In fact, the University of Texas Southwestern Medical Center estimates the lifetime costs of a stroke at $60,000. Your costs may include medications; physical, occupational, or speech and audiology therapy; and the costs of modifying your home or purchasing mobility assistance or other adaptive-living devices or equipment. Some patients may also require home health or residential nursing facility care.

Disability benefits through either or both of the SSA’s programs can help you pay your everyday living expenses. For many applicants, qualifying for disability also means qualifying for Medicare and/or Medicaid, which means you’ll have the coverage necessary to pay your medical and healthcare bills.

Medically Qualifying for Benefits After a Stroke

The SSA considers strokes to be disabling, but only under certain circumstances. Specifically, your stroke must cause lasting impairment(s). By this, the SSA means stroke-related limitations must have been present or must be expected to last for at least 12 months. Additionally, your stroke either meet a disability listing in the Blue Book or be able to qualify through other reviews that look at your employability given your stroke-related deficits.

Stroke disability applications are reviewed under the disability listing for Central Nervous System Vascular Event, which appears in the Blue Book under Section 11.04. This listing requires:

  • Your ability to speak or write is severely impaired or lost entirely

    OR

  • You have pronounced issues with controlling or coordinating movements with at least two extremities (arms or legs)

Even if you’re unable to qualify under Section 11.04, there may be other disability listings under which you can get approved:

  • Sections 2.02, 2.03, or 2.04 – If your vision is affected
  • Section 2.10 – if you’ve suffered hearing loss

A severe stroke can also cause personality changes, intellectual deficits, and disorders like dementia. If you’ve suffered cognitive losses or permanent brain damage, you may be able meet one of the listings in Section 12.00 of the Blue Book, which covers mental disorders.

Your doctor can help you interpret Blue Book requirements. He or she can also help you understand whether you’ll qualify under a disability listing or if you’ll need to go through additional reviews.

Qualifying for Benefits without Meeting a Disability Listing

If your stroke does not qualify under a listing but still prevents you from working, you may get approved for disability under a “medical vocational allowance.” The SSA will require you and your doctor to complete “functional report” questionnaires that detail all of your medical conditions, symptoms, treatments, and the limitations you face on a daily basis. These functional reports are an essential component of the “residual functional capacity” analysis or RFC.

Through an RFC, the SSA considers your age, job training and skills, formal education, and your all of your medical conditions in addition to your functional limitations. If all these factors combined show you cannot work in ANY job for which you’re otherwise qualified, then the SSA can grant you medical vocational allowance.

Let’s say, for example, you worked in a manufacturing position that required the use of both arms prior to your stroke. Your left arm is paralyzed or limited severely after your stroke but all your other abilities are otherwise unaffected. You can’t go back to your manufacturing job, but the SSA also needs to know if you could find a different job in which the loss of your left arm wouldn’t prevent you from performing essential job duties. If you have the skills to work in an office job, then the SSA would deny you benefits believing you should be able to find gainful employment elsewhere.

Now let’s say, for example, your stroke not only left you without the use of your left arm but with some cognitive deficits that make it difficult to concentrate, keep up with a standard work pace, or to complete complex tasks. In a case this, even if you cannot qualify under a disability listing, you may qualify under a medical vocational allowance.

How to Apply for Disability Benefits After a Stroke

Your doctor can help you gather evidence to support your disability claim. Friends or family members can assist as well. A Social Security advocate or attorney can be an invaluable resource, particularly if you need to qualify through an RFC analysis or if you’re denied benefits initially and need to file an appeal.

Just keep in mind that medical evidence is a cornerstone of your disability claim. Records may vary, based on the kind of stroke you suffered and the lasting effects you experience, but the SSA generally needs to see at least the following:

  • Results of the tests run to diagnose your stroke
  • Hospital stay records, including emergency room and/or inpatient records
  • Surgical notes from any operations you’ve undergone
  • Physical exam and progress notes from your primary care doctor or neurologist, documenting long-term or permanent losses in coordination, speech, etc.
  • Records from physical, occupational, speech, or other therapy sessions
  • Prescription medications you take or have taken and their effects
  • A detailed reporting, including long-term prognosis, from your primary care physician or neurologist

When you’re ready to apply, you have options. You can complete your application at the local office, online (for SSDI), and in some cases, even over the telephone.

  • Call 1-800-772-1213 to explore your options further,
  • Visit the SSA’s website to start your SSDI application,
  • Or go to your local SSA office to apply for SSI and/or SSDI.

Before you apply for benefits however, you should know that your application may be delayed. This is because the SSA knows many stroke patients can see significant improvements in their abilities after just a few months, even if they had severe deficits immediately following their stroke. For this reason, the SSA will often wait to review claims for at least three months from the date of the stroke.

Even if the review is delayed, you can apply now and continue to send in additional medical evidence to support your claim for benefits. Until a disability examiner is assigned to your case, you should submit your updated medical records to the local SSA office. After you receive notice that a disability examiner has been assigned, you can send additional records directly to him or her.