SSI

Social Security Disability evaluation of COVID-19

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The Social Security Administration (SSA) has issued policy guidance for evaluating adult disability cases that involve a diagnosis of COVID-19.

SSA needs objective evidence from an acceptable medical source to establish the existence of a medically determinable impairment for COVID-19, including long terms effects of COVID-19.

If a person as a medically determinable impairment of COVID-19, SSA must determine if the impairment is severe, and has lasted or is expected to last at least 12 months.  SSA will not combine two unrelated medically determinable impairments to meet the 12 month requirement.  However, if COVID-19 causes a new medically determinable impairment, or worsens an existing medically determinable impairment, SSA will consider there medically determinable impairments to be related.

If a person recovers from COVID-19 with no residual symptoms, limitations or restrictions, COVID-19 will not meet the duration requirement.  However, symptoms associated with COVID-19 that last for months or longer after recovery may meet the 12 month requirement when a person has long-term effects of COVID-19, one or more new medically determinable impairments caused by COVID-19, or any existing medically determinable impairment worsens because of COVID-19.  SSA may need to project the severity if it is unclear whether the medically determinable impairment will resolve.

Issues related to the COVID-19 pandemic, including eviction, medical facility closure, quarantine, job loss and insurance loss, may affect the ability to seek treatment.  SSA should consider whether lack of treatment is because of these issues.

COVID-19 by itself cannot meet a listing but it may equal a listing as an unlisted impairment or as part of a combination of impairments.  COVID-19 may affect respiratory, cardiovascular, renal, neurological, or other body symptoms.  In most cases, the listing relevant to a new medically determinable impairment caused by COVID-19 or any medically determinable impairment that has worsened because of COVID-19 will be the appropriate listing to consider.

COVID-19 cannot be medically equivalent to Listing 3.14, respiratory failure, because an infection cannot be a chronic impairment for purposes of that listing.

When determining residual functional capacity, SSA will consider functional limitations from any new medically determinable impairment caused by COVID-19, or any medically determinable impairment that have worsened because of COVID-19.  (EM 21032, April 16, 2021.)

Interpretation of new Social Security musculoskeletal listings

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On December 3, 2020, the Social Security Administration (SSA) published new listings for evaluating musculoskeletal disorders.  85 Fed. Reg. 78164.  In general, the new musculoskeletal disorders listings listings remove the “inability to ambulate effectively” criteria, have additional focus on the need for assistive devices, and require more lower-body conditions to be paired with restrictions on use of upper extremities.  The new listings became effective for cases filed after or pending after April 2, 2021.

SSA has issued additional guidance regarding the new musculoskeletal listings. When considering the need for assistive devices under the new listings, SSA is to consider the most restrictive device for which the claimant has a documented medical need.  The phrase documented medical need means evidence from a medical source that supports the medical need for an assistive device for a continuous period of at least 12 months.

The functional criteria in the new listings is met if the medical evidence shows that a claimant uses a wheeled and seated mobility device that involves the use of two hands with a documented needs lasting 12 consecutive months.  If the claimant uses a wheeled and seated mobility device that involves the use of one hand, SSA is to consider whether the claimant has a documented medical need for a two handed assistive device.  This evidence includes inability to bear weight on lower extremities, instability, inability to rise from a seated position without assistance or the use of both arms, significant weakness in the legs, or amputation of the lower extremities at or above the ankle with inability to use a prosthesis.

For certain of the new listings, all required criteria must be present simultaneously, or within a close proximity of time.  In evaluating listings with imaging requirements, SSA determines whether the findings on imaging are reasonably expected to have been present within a close proximity of time of the other required elements.  (EM-21027, April 2, 2021.)

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Social Security Disability Good Cause for Failure to Follow Prescribed Treatment

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In general, a Social Security Disability or Supplemental Security Income claimant will be found not disabled if they fail, without good cause, to follow prescribed treatment that can restore the ability to work.  However, the Social Security Administration will consider a claimant’s mental limitations when determining if they have good cause for not following prescribed treatment.  A claimant can have good cause for not following prescribed treatment when they have a psychiatric impairment and that impairment causes their refusal to follow prescribed treatment.  (HALLEX II-5-3-1, updated June 7, 2021.)

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Express Interviews for evidence and Social Security cards

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Effective May 28, 2021, Field Offices and Social Security Card Centers nationwide will begin offering the new Express Interview option. Express interviews are brief interviews, lasting approximately 5-7 minutes, which allow eligible individuals to apply for an original or replacement Social Security card and submit necessary evidence in person.

Although this process is intended for Social Security card customers, Express Interviews are also available for gathering evidence for processing claims and workloads.

To qualify for an Express Interview, individuals must be unable to use automated or online services AND meet current critical appointment criteria such as:

  • original cards for individuals age 12 or older;
  • replacement cards for individuals who need to update or correct their information to obtain income, resources, medical care or coverage, or other services or benefits (e.g., filing a tax return, applying for housing, or seeking an Economic Impact Payment)

Individuals unable or unwilling to send original evidence documents by mail are also qualified for an Express Interview.

Individuals must call the Field Office to pre-screen for an Express Interview. If they meet the criteria above, the employee must consider all other virtual or drop-off options available before approving an Express Interview. Non-citizens should not mail or drop off immigration documents, as non-citizens are required to have their immigration documents in their possession at all times.

Instructions on conducting the in-person interviews are listed in the Emergency Message. (EM-21041, May 27, 2021)

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COVID-19 Social Security waiver of overpayments during COVID-19

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The Social Security Administration has issued an interim final rule regarding waiver of certain overpayments that accrued during the COVID-19 pandemic. Overpayments incurred between March 1, 2020 and September 30, 2020 that Social Security did not manually process because of its cession of certain activities are eligible for a streamlined waiver process.  Social Security will assume that these overpayments were the result of Social Security ceasing certain operations and that it would be against equity and good conscience to collect them and will waive the debt.

Overpayments that qualify for the streamlined waiver process include overpayments caused by suspended Title XVI redeterminations, not processing information in the claimant’s file, and other suspended actions.  Overpayments identified through automated processes such as computer interfaces with the Veterans Administration are not eligible for streamlined waiver because those matches continued to be processed during COVID-19.

Streamlined waiver will not apply to overpayments caused by fraud or misuse of funds by a representative payee.  Only the portion of an overpayment that occurred between March 1, 2020 and September 30, 2020 is eligible for streamlined waiver.

Auxiliary beneficiaries may be eligible for streamlined waiver even if the primary beneficiary is not eligible for streamlined waiver for the overpayment.

Overpayments that are not eligible for streamlined waiver may still be eligible for the regular waiver process.

Social Security will not issue refunds outside of the regular waiver process for overpayment recovery that occurred during the pandemic period.

The streamlined waiver process applies to qualifying overpayments that Social Security identifies before December 31, 2020.

Between August 31, 2020 and December 31, 2020, overpayment notices will direct beneficiaries to contact their local field office about their overpayment or to request an overpayment waiver.  Field offices will review the case to determine if streamlined waiver applies.  If it does, the field office will document the waiver request and attest to the beneficiary’s signature.  The beneficiary will not be required to complete the full SSA-632 Request for Waiver or provide supporting information about their income and expenses to make the waiver determination.

Beginning August 31, 2020, Social Security intends to resume its normal workload.

This interim final rule is effective on August 27, 2020. Comments on the rule are due on October 26, 2020.  (Waiver of Recovery of Certain Overpayment Debts Accruing During the COVID-19 Pandemic Period, 85 Fed. Reg. 52909.)

COVID-19 Interim Assistance Reimbursement agreements

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Counties can be reimbursed for General Assistance/General Relief paid to claimants from retroactive Supplemental Security Income (SSI) benefits.  One condition of this reimbursement is the claimant signing an agreement for interim assistance reimbursement called the SSP 14.

The Social Security Administration has agreed to allow telephone attestations instead of wet signatures on the SSP 14 form for the duration of the COVID-19 state of emergency.  (ACL 20-64, June 4, 2020.)