The COVID pandemic is an unwelcome visitor into our daily lives. For some individuals, it will cause mild symptoms and pass quickly, but for others there can be severe long term effects. This post attempts to address how the Social Security Administration will evaluate a claim for disability based on Long COVID.
The Bishop Law Firm has represented Social Security Disability clients since 2009 in North Carolina. We do not get paid unless we win and we offer free case reviews. Call us today or start your free case review online now.
Types of Social Security Disability Benefits
Social Security Disability has two types of benefits (generally): Social Security Disability Insurance Benefits (SSDI) and Supplemental Security Income (SSI). SSDI is based on the credits from the work that you have done in your life while SSI is a need based program.
Social Security Disability Insurance (SSDI)
SSDI (Social Security Disability Insurance) is based on the credits from the work you have done in your life. You must be found disabled before your date last insured (DLI) to be found eligible for SSDI. Your DLI is calculated by counting your “quarters of coverage” from your earnings record. You must have 20 “quarters of coverage” of the last 40 quarters. Simply put, you must have worked 5 years of the last ten years (in general). In addition, Adult Disabled Children can be eligible for benefits off their parent’s account.
Supplemental Security Income (SSI)
SSI (Supplemental Security Income) is a need-based program and you must meet income/asset standards in addition to being found disabled under the five steps below. In 2023, SSI is $914.00 per month for an individual and $1,371 for an eligible couple. SSI will be reduced by 1/3 if you are receiving financial help from others. In NC, SSI recipients are also entitled to Medicaid.
SSI is also available for disabled children and is evaluated under a different standard than adults. Children must have a medically determinable physical or mental impairment or impairments (including emotional or learning problems) which result in marked and severe functional limitations, and the impairment(s) has lasted or can be expected to last for a continuous period of at least 12 months or be expected to result in death. Child SSI terminates when the child turns 18. The claimant will then have to reapply and be evaluated under the below adult sequential evaluation.
You must be found disabled by SSA before you are entitled to either benefit.
The Social Security Administration evaluates all claims for SSDI and SSI under a Five Step Sequential Evaluation:
- Step 1 – Are You Working (engaging in substantial gainful activity)?
- Step 2 – Is Your Condition “Severe”?
- Step 3 – Is Your Condition on the List of Disabling Conditions?
- Step 4 – Can You Do the Work You Did Previously?
- Step 5 – Can You Do Any Other Type of Work?
For a detailed discussion of the above five steps look here.
The Social Security Administration also has a duration requirement:
To meet the duration requirement, you must have a medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for at least 12 months in a row.
There are several levels to a Social Security Disability case: initial (in North Carolina, DDS, a division of Health and Human Services makes the initial and reconsideration decisions for SSA), reconsideration, a hearing before an administrative law judge, the appeals council and even federal district court. Your disability claim can be approved at any level, but the hearing is where you have your best chance of being approved.
What is COVID?
COVID 19 (or Corona Virus Disease 2019) is an infectious disease that causes mild to moderate respiratory illness in most people. However, in the at risk population, more serious illness can develop because of COVID 19, including death from complications. The at risk population includes those with cancer, chronic kidney disease, obesity, down syndrome, COPD, a weakened immune system and pregnant women to name a few.
Human coronavirus itself is not new and was first identified in the mid-1960s. The coronaviruses known previously caused the common cold. However, the particular virus that causes COVID 19 is new (novel) and can result in chronic severe illness.
The virus can spread by human contact when a person coughs, sneezes, sings, talks or breathes. COVID 19 can be spread by infected people who do not have symptoms. The CDC and WHO have recommended the use of masks, hand washing and social distancing as a means of preventing the spread of COVID 19.
According to the CDC,
The most commonly reported long-term symptoms include:
- Shortness of breath
- Joint pain
- Chest pain
Other reported long-term symptoms include:
- Difficulty with thinking and concentration (sometimes referred to as “brain fog”)
- Muscle pain
- Intermittent fever
- Fast-beating or pounding heart (also known as heart palpitations)
More serious long-term complications appear to be less common but have been reported. These have been noted to affect different organ systems in the body. These include:
- Cardiovascular: inflammation of the heart muscle
- Respiratory: lung function abnormalities
- Renal: acute kidney injury
- Dermatologic: rash, hair loss
- Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems
- Psychiatric: depression, anxiety, changes in mood
Social Security Disability for COVID
In June 2023, SSA issued a guide entitled: Long COVID: A Guide for Health Professionals on Providing Medical Evidence for Social Security Disability Claims. The guide tells medical professionals what evidence SSA needs to evaluate disability claims for those with Long COVID, or Post-COVID Conditions (PCC).
SSA reiterates in this document that the duration requirement (mentioned above) and inability to perform SGA (substantial gainful activity) applies to disability applicants with Long COVID. Essentially, SSA will evaluate COVID claims as they would any other impairment.
SSA also asks medical providers to report any medical signs of Long COVID they have observed. Some examples of Long COVID symptoms: difficulty breathing or shortness of breath; cough or abnormal auscultation of the lungs; fever, heart palpitations; weight loss, edema; weakness; muscle pain; cognitive difficulties; mental health issues, etc.
If you are unable to work because of Long COVID, it would be advisable to ask your medical provider to read SSA’s above guide. The SSA is looking for a medical history with diagnosis, onset, duration, prognosis as well as objective testing.
When it comes to evaluating a claim for Social Security Disability, the name of your impairment is not as important as the severity of your symptoms. SSA can generally use three ways to find you disabled: the listings, the grid rules (Medical Vocation Guidelines) or on the combination of your impairments.
To date, there is not a listing specifically for COVID. However, other listings may be helpful such as 3.00 Respiratory, 4.00 Cardiovascular or 11.00 Neurological. It should be noted that most listings are very difficult to meet.
The Medical Vocational Guidelines (Grid Rules) can help someone over the age of 50 that is reduced to sedentary work from their COVID residuals.
Also, if you have been diagnosed with several impairments and also have COVID residuals (which is common in the at-risk population), you may be found disabled based on the combination of your impairments.
However, as noted above, SSA does have a 12 month duration requirement. If you acquire COVID 19, recover and are able to return to work within 12 months, you would not be eligible for Social Security Disability benefits.
If you have been diagnosed with COVID, are unable to work and it appears that your symptoms are going to last for 12 months or more, you should file a claim for SSDI or SSI as soon as possible. If you recover within 12 months, you can withdraw your claim for disability benefits.
The Bishop Law Firm represents Social Security Disability clients in Raleigh, Durham, Fayetteville, Cary, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids , Winston Salem, Garner, Greensboro, Greenville and surrounding areas in North Carolina. Call us today for a free case review, (919) 615-3095 or start online now.