Disability Coverage

Does trigeminal neuralgia qualify me for disability benefits?

Sometimes the pain of trigeminal neuralgia or the side effects from medication or surgery become such a problem that people are unable to work. The Social Security Administration extends disability benefits to individuals who cannot work because they have a medical condition that is expected to last at least one year or to result in death. When considering the eligibility of applicants, Social Security looks for recent work based on the applicant’s age at the time he or she becomes disabled. In order to qualify for benefits, applicants must have worked long enough to be eligible. 

According to the social security administration, people should file for benefits as soon as they become disabled, unable to perform their work duties because of a disability. Applications are taken online at www.socialsecurity.gov. Individuals may also file a claim or make an appointment for filing a claim by calling 1-800-772-1213. 

This is the language that defines disability in the Social Security Act:

Disability requires the inability to work at any “substantial gainful activity” because of a medically determinable physical or mental impairment expected to result in death or to last for at least 12 months. Further, such impairments must be demonstrable by medically acceptable clinical and laboratory diagnostic techniques.

This is the standard related to chronic pain:

An individual’s statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings, established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of a medical impairment that results from anatomical, physiological, or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged
and which, when considered with all evidence required to be furnished under this paragraph (including statements of the individual or his physician as to the intensity and persistence of such pain or other symptoms which may reasonably be accepted as consistent with the medical signs and findings), would lead to a conclusion that the individual is under a disability. Objective medical evidence of pain or other symptoms established by medically acceptable clinical or laboratory techniques (for example, deteriorating nerve or muscle tissue) must be considered in reaching a conclusion as to whether the individual us under a disability.”
October 9, 1984
Public Law 98-460, Section 3(a)( 1)

Applying for disability benefits for trigeminal neuralgia- documents

In addition to forms for the individual with a disability to complete, the Social Security Administration asks every applicant for the following information: 

  • Social security number. 
  • Birth certificate or baptismal certificate. 
  • Names and dosages of all the applicant’s medicines. 
  • Names, addresses, and phone numbers of the applicant’s health care providers. This includes hospitals, doctors, clinics, and institutions that provided services. Dates of service are also required. 
  • Medical records from physicians, therapists, caseworkers, hospitals, and clinics. 
  • Laboratory test results. 
  • Summary of work, which includes where the applicant works and the type of work performed.  
  • A copy of the applicant’s most recent Wage and Tax Statement (W-2) Form. If the applicant is self-employed, a federal tax return for the previous year will be required. 

Next steps

Social Security will check to see if the applicant has worked enough years to qualify for benefits, will evaluate current work activities, and will forward applications to a state office to review for disability determination. Professionals in the state agency ask the applicant’s health care providers for information about the disabling condition. The agency will ask what the medical condition is, when it began, and how it limits activities.  Medical tests and treatment will also be considered. 

Social Security also reviews secondary medical issues such as depression or anxiety, which can be secondary to TN and neuropathic facial pain. Claims are reviewed for regular visits to a physician, which provide documentation of illness. An individual’s compliance with a physician’s orders is also important. 

Individuals who are completing paperwork for the Social Security Administration must adhere to the deadlines of all appeals. Applications are often denied twice. If a claim is denied a second time, a hearing with a Social Security judge is scheduled. Most states have a back-log of claims, often taking two years or more for a claim to reach a hearing date. 

At most hearings, a vocational specialist attends to help the judge determine if an individual might be able to perform any vocation. Social Security looks at an individual to determine if any functional capacity remains. If a claim is denied at the hearing, an appeal process follows. If an individual’s application is approved at any point, his or her attorney is allowed 25% of back benefits and additional monies for expenses. 

This isn’t an easy safety net for facial-pain patients to qualify for but some people have been deemed incapacitated enough to get it. 

An Important Distinction 

The Social Security Administration manages two programs that provide benefits based on disability or blindness, the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program.  

SSDI provides benefits to disabled persons who are “insured” by workers’ contributions to the Social Security trust fund. These contributions are based on your earnings (or those of your spouse or parents) as required by the Federal Insurance Contributions Act (FICA). Title II of the Social Security Act authorizes SSDI benefits. Your dependents may also be eligible for benefits from your earnings record. The health care coverage provided under SSDI is Medicare, a federally funded program. Most SSDI beneficiaries must complete a 5-month waiting period to qualify for cash benefits and an additional 24-month waiting period to qualify for Medicare. The 5-month waiting period begins with the first full calendar month after the onset of a disability. 

Disability payments

The SSI program makes cash assistance payments to disabled persons (including children) who have limited income and resources. The Federal Government funds SSI from general tax revenues. Many states pay a supplemental benefit to persons in addition to their Federal benefits. Other states manage their own programs and make their payments separately. Title XVI of the Social Security Act authorizes SSI benefits. The health care coverage provided under SSI is Medicaid, a jointly-funded, Federal-State health insurance program for persons with limited income and resources. There is no waiting period required to qualify for SSI cash payments, and in most states Medicaid benefits are available to most SSI recipients, also without a waiting period. 

The SSDI and SSI programs share many concepts and terms, however, there are also many very important differences in the rules affecting eligibility and benefit payments. Many persons may apply or be eligible for benefits under both programs. People who qualify under each are called concurrent beneficiaries.

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