Public Health Law Map - Beta 5 - Medical and Public Health Law Site

normal eyes and kidneys and no peripheral neuropathy has a disease but not an
impairment.
Regardless of how severe the impairment is, it must last or be expected to last 12
months to qualify for disability payments under Social Security. The person who is
in a coma for a month after a head injury is clearly severely disabled for that
month. However, if they have full use of their arms and legs, can see and hear, and
come out of the coma with cognitive function intact, then they do not qualify for
SSA Disability. On the other hand, the impairment does not have to have existed
for 12 months before disability is granted. If the coma patient also has a crushed
spinal cord and is going to be paraplegic, then the patient’s guardian can apply for
disability immediately. If the physician supports the prognosis that the disability
will last for more than 12 months, the patient may be on SSA Disability and/or SSI
before he or she regains consciousness.
f) Social Factors
The person’s age and education are also factors in whether they qualify for
disability. Individuals who are less than fifty years old must be more severely
disabled to qualify than those who are older. The principle is that young people with
a good basic education should be able to learn new skills and go back to work. If
the claimant is over 55 and has limited education, the program acknowledges that
retraining or changing careers is not a reasonable option. Age fifty to fifty-five is a
gray area where some will qualify and some will not.
The other important consideration is credibility. The claimant is asked to tell the
DDS how their functioning is limited by their disease and by their pain. The level of
pain and how it affects their life is often very important in determining disability.
Regardless of how bad the degenerative disc disease appears on X ray, if the
claimant can go deer hunting, he can obviously walk more than 100 feet. On the
other hand, someone whose X rays don’t look too bad may have such severe pain
that he has given up all social activities, and cannot sit long enough to watch a TV
program. A claimant who can do things that he or she likes but can’t do work is not
very credible.
g) Medicare and Medicaid
Individuals who are on Social Security Disability or SSI may also qualify for the
government health insurance programs. As with disability, income and resources
determine which programs apply. If the patient is on SSD, then he or she may apply
for Medicare after two years. This is a big hole in the system since an employer
only has to allow continuation of private health insurance under COBRA for 18
months.
In contrast, the individual who has SSI, with or without SSD, probably qualifies for
Medicaid immediately. Although most people think of Medicaid as a program for
poor women and children, more than three quarters of all Medicaid benefits go
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