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Topic: DAC Claim and SGA issues  (Read 585 times)
Solotreker
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« on: May 14, 2017, 09:19:37 AM »

     I filed a Disabled Adult Child claim to see if my adult daughter's disability benefit could be linked to her father's Social Security (currently linked to her own work history.) The claim sat for months without action.  When I finally got a local SS representative on the phone she said that it was likely stalled because my daughter's income was too high.  This woman questioned why my daughter was even on disability! 
     The fact is, my daughter who works at the Zoo making popcorn and cotton candy, now loves her job and works as many hours as they will give her.  She averages about $800-$900 month in good weather.  Practically nothing in the winter months!  She is paid every 2 weeks and in March received 3 paychecks which put her earnings at about $1400 for that month.  And it will happen again in June.  How do we deal with this?  Will the SSA consider an average over several months or do they go strictly by the monthly income???
     I have now been scheduled with an appointment to deal with the DAC claim on May 22nd. I have no idea what they want to know.  Will I need to justify her March income issue?  Should I be prepared to fully explain her disability?  Should I have her entire SS history in front of me for that call? 
     Any suggestions on how to deal with this is greatly appreciated.
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Different Perspective
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« Reply #1 on: May 14, 2017, 03:03:19 PM »

At this point, SSA may not be interested in her medical condition.  They may only be interested in whether she is performing Significant Gainful Activity.  Every time her employer reports monthly earnings of over $1170 in a month, she is, in the eyes of SSA, performing SGA.  I will let others explain the technicality of how by-weekly payrolls are used to calculate SGA.

To qualify on her father's account, SSA will, of course, want proof that the father is drawing Social Security, either because of age or disability, or is deceased.

The fact that she "works as many hours as they will give her" suggests that if an employer would give her more hours, she would work them and could, in fact, perform SGA.  What would prevent her from "making popcorn and cotton candy" in a movie theater or other places (a mall) and make SGA all year round?  How would her Medically Determinable Impairment prevent her selling ice cream, candy bars, etc. behind a counter? 

Assuming she can prove she cannot perform SGA today, SSA will next be interested in onset.  When was your daughter proven to meet the SSA definition of disability?  Before, or after, she turned 22?  She had to have worked some to be eligible for Social Security Disability Insurance Benefits on her own account.  When did she work?   Did she work at SGA levels at any time after she turned 22 but before she was adjudicated as disabled? 
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Additional Info: My Different Perspective comes from a lifetime of being near, working with and for those with disabilities, working for the Easter Seal Society, working for the Disability Determination Services (20+ years) and working as a case assistant to an attorney who, until he retired, worked on SSA disability cases exclusively and have attended approximately 185 Hearings. I have great empathy for the truly disabled and greater antipathy for those who try to game or scam the system. With my background, I quickly make distinctions between the two. I am ready to admit my error as soon as the evidence proves me wrong. Any posts I make are based on my experience, memory and current research. Anything, particularly opinions, I post should be verified by someone who has access to the entire case record and not just selected shorts offered by those seeking information, preferably by a competent attorney or non-attorney representative who thoroughly understands SSA law.
Lit Love
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« Reply #2 on: May 14, 2017, 05:47:50 PM »

Can she manage money from customers by herself?  Could she run a CC transaction at a theatre?  If not, and she's only making popcorn, it can be argued she has a subsidized job.  --Her employer is paying her full wages but she can't perform them on her own.

Can I ask how close she was to qualifying due to her IQ?
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Solotreker
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« Reply #3 on: May 14, 2017, 08:07:57 PM »

I believe we're all set in qualifying for the DAC with the possible exception of her SGA.  Her father is retired, she was disabled from birth (IQ74, autistic tendencies, poor executive functioning).  Was granted SSI at 18 and after working part-time menial jobs for several years, she qualified for Disability.  After a recent review her official diagnosis for SSA is now Anxiety Disorder.  Clearly the result of not being able to function normally thru out her life.   She is easily over stressed in most work settings.  This zoo job is new and looks hopeful, but even so she still makes mistakes and comes home in tears too often.  Goes back the next day, gladly.  Just needs a lot of "down" time to function well.

Your responses to my questions are very helpful.  I am assuming these are issues which will be discussed at the appointment I have.  I am NOT her guardian, but just her Representative Payee.

I hope that I can get the people in charge to understand that while she seems to be thriving, it is only because of my assistance and her financial support from SSA.  Without those benefits, she will flounder and you'll likely be seeing her on one of those horrid reality shows where people live in squaller!
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« Reply #4 on: May 14, 2017, 08:42:25 PM »

https://www.ssa.gov/redbook/  Make sure you review the SSA Red Book of Work Incentives.

Especially the information on Trial Work Periods.  Basically, in a rolling 60 month (5 year) period, she can make any amount for 9 months (it does not need to be consecutive).  If she makes $840+, then it counts as one of her Trial Work months.  Once she has used 9 Trial work months, her benefits will be stopped if she makes over SGA.  She can get benefits under Extended Period of Eligibility if her earnings then fall below SGA within 3 years.

https://www.ssa.gov/oact/cola/twp.html
https://www.ssa.gov/redbook/eng/ssdi-only-employment-supports.htm
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Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
Lit Love
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« Reply #5 on: May 14, 2017, 08:43:08 PM »

Make it clear that her IQ is an issue.  While she might not meet the Listing, it is certainly an issue.  When SS staff sees her impairment listed as anxiety, that is something that can improve, so remind them of the serious, ongoing issues that have effected her ability to function since birth.  

And, no, SS will assume she can perform her job without special accommodations unless they're told.  If she can't it'll help to explain why not.  If her supervisor is aware of her disability and makes special accommodations, tell them.  The fact that she has had so many issues at similar jobs points to the likelihood of her getting extra help at this job.

Sorry if the DAC inquiry has caused extra work for you, but it'll help her once the SGA question is resolved.
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Solotreker
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« Reply #6 on: May 15, 2017, 02:06:49 PM »

Lit Love: Thanks for the response.  So glad to see that someone "gets it"!  The IQ issue seems to be overlooked because it is 4 points below SSA's qualification, yet well within range of The American Association for Mental Retardation's definition.  While many of her life skills have been honed to normalcy, she still functions on a mental and emotional level of about 4th grade; 5th grade at best. She's lucky, it could be worse!  But, would anyone truly expect a 10 year old to be able to function well in the adult work place?  She will never be able to fully support herself, despite her efforts to maintain what ever employment she has been able to acquire.

I'm just hoping that I can make this point to the system/people in charge of deciding if she will receive financial support!
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Lit Love
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« Reply #7 on: May 15, 2017, 03:07:18 PM »

You're welcome!

Just because she doesn't meet a Listing, doesn't mean it's not a severe impairment or that SS should or can ignore it.  A SS staff member quickly looking at her SGA and a diagnosis of Anxiety will not understand the scope of her issues, or even someone looking at your posts without looking back.
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Solotreker
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« Reply #8 on: May 23, 2017, 12:31:55 AM »

Well, a quick follow up.  I had a phone appointment with a local SSA rep yesterday.  He told me that I could file a DAC claim, but that he would have to deny it.  Apparently there was a 4 month stretch in 2008 when my daughter earned just over the SGA limit.  It is apparently a deal breaker.  It won't affect her current benefits, but disqualifies her for the increased amount she would receive under her father's SS account.

After talking for quite awhile I decided to file the claim anyway and then I guess I'll try to appeal the decision.  This rep said that was fine, but reminded me that it was highly unlikely to ever pass.

He was, however, very helpful and understanding with most of my concerns regarding my daughter's future.  Well, and he did mention that she may be reviewed sometime soon.  Not surprised.  Oh well. 

We have scheduled a series of appointments with a psychologist in an effort to deal with her anxiety and gain some support for this process.  I'd like to find a professional who would advocate for her continued support.

Always thankful that I can come here with concerns and questions!
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Lit Love
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« Reply #9 on: May 23, 2017, 09:30:36 AM »

Well, a quick follow up.  I had a phone appointment with a local SSA rep yesterday.  He told me that I could file a DAC claim, but that he would have to deny it.  Apparently there was a 4 month stretch in 2008 when my daughter earned just over the SGA limit.  It is apparently a deal breaker.  It won't affect her current benefits, but disqualifies her for the increased amount she would receive under her father's SS account.

After talking for quite awhile I decided to file the claim anyway and then I guess I'll try to appeal the decision.  This rep said that was fine, but reminded me that it was highly unlikely to ever pass.

He was, however, very helpful and understanding with most of my concerns regarding my daughter's future.  Well, and he did mention that she may be reviewed sometime soon.  Not surprised.  Oh well. 

We have scheduled a series of appointments with a psychologist in an effort to deal with her anxiety and gain some support for this process.  I'd like to find a professional who would advocate for her continued support.

Always thankful that I can come here with concerns and questions!

I agree with you.  If the claim is denied I would appeal it through to at least the ALJ level.  You have her educational records after all.

How old was she then?  What type of job was it?  I think it can be argued that was an UWA. 



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Helper
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« Reply #10 on: May 23, 2017, 01:44:55 PM »

Well, a quick follow up.  I had a phone appointment with a local SSA rep yesterday.  He told me that I could file a DAC claim, but that he would have to deny it.  Apparently there was a 4 month stretch in 2008 when my daughter earned just over the SGA limit.  It is apparently a deal breaker.  It won't affect her current benefits, but disqualifies her for the increased amount she would receive under her father's SS account.

After talking for quite awhile I decided to file the claim anyway and then I guess I'll try to appeal the decision.  This rep said that was fine, but reminded me that it was highly unlikely to ever pass.

He was, however, very helpful and understanding with most of my concerns regarding my daughter's future.  Well, and he did mention that she may be reviewed sometime soon.  Not surprised.  Oh well. 

We have scheduled a series of appointments with a psychologist in an effort to deal with her anxiety and gain some support for this process.  I'd like to find a professional who would advocate for her continued support.

Always thankful that I can come here with concerns and questions!

I agree with you.  If the claim is denied I would appeal it through to at least the ALJ level.  You have her educational records after all.

How old was she then?  What type of job was it?  I think it can be argued that was an UWA. 





Plus, depending on the job & the support that she received, you may be able to say it was a subsidized/special conditions work environment, particularly if she had a job coach or anything at that point.  https://www.ssa.gov/disabilityresearch/wi/subsidies.htm
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Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
Just Me
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« Reply #11 on: May 23, 2017, 03:03:53 PM »

If she was otherwise eligible for DAC, her making SGA for a few months shouldn't make her ineligible for DAC. Maybe I am misunderstanding.
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Hope the size of a mustard seed can produce Faith that can move mountains.
Age at Application: 50
Disability: DDD, nerve damage upper & lower extremities, RA
Date Applied: First Applied Feb 2002, Denied May 2003. Applied again Oct 2003, Approved June 2004
Solotreker
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« Reply #12 on: May 24, 2017, 10:54:54 AM »

Thank you, all.  More info to assist me, but I wish I had thought it this before the call with SSA.  I was told that the 4 months of overage is not debatable when seeking an increase in benefits. It will not affect her current standing, however.

Since then I've looked back and see that it was a change of jobs and that it didn't work out for her (UWA!)  The denial is done, but I will put together the information I need (with the right wording I'm learning here!) to start the appeal process.

Interestingly, any SGA overage she's ever had was in 2008 and never more then $100 over.  It does make me wonder if the SGA limit was at issue here.  I wonder what the national data on SGA overages would look like.  Just out of curiosity!

He also said that there was little chance of the appeal being approved and that likely most disability lawyers wouldn't be interested in assisting because there is too little payout.  So, I'm on my own.  But, that's okay.  It's how I got her qualified in the first place at age 18.  Once the judge met her, looked at the reports and listened to her "story" her original denial was reversed.  Maybe we can do this again!  But, if not, there is no lose to what she's getting now.
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Helper
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« Reply #13 on: May 24, 2017, 11:24:14 AM »

Thank you, all.  More info to assist me, but I wish I had thought it this before the call with SSA.  I was told that the 4 months of overage is not debatable when seeking an increase in benefits. It will not affect her current standing, however.

Since then I've looked back and see that it was a change of jobs and that it didn't work out for her (UWA!)  The denial is done, but I will put together the information I need (with the right wording I'm learning here!) to start the appeal process.

Interestingly, any SGA overage she's ever had was in 2008 and never more then $100 over.  It does make me wonder if the SGA limit was at issue here.  I wonder what the national data on SGA overages would look like.  Just out of curiosity!

He also said that there was little chance of the appeal being approved and that likely most disability lawyers wouldn't be interested in assisting because there is too little payout.  So, I'm on my own.  But, that's okay.  It's how I got her qualified in the first place at age 18.  Once the judge met her, looked at the reports and listened to her "story" her original denial was reversed.  Maybe we can do this again!  But, if not, there is no lose to what she's getting now.

If you want a representative, I would at least call a couple attorneys or non-attorney representatives.  The SSA rep already gave you bad info at least once, so I think you need to ask the lawyer/non-attorney representative if they will take the case before trusting someone else's word on it.  I am not convinced that the rep knows what someone else will do or not do - especially since it is not a super complicated case (& should not take that much work for the rep to research & appeal).  The hard part of proving she is disabled is already done.
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Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations

« Last Edit: May 24, 2017, 11:58:52 AM by Helper »
Lit Love
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« Reply #14 on: May 24, 2017, 11:56:16 AM »

How old was she during those four months of work?  This is important.

This rep has no business trying to discourage you from appealing.  Your daughter has had a lifelong impairment.  These are not complex legal questions and I think it's likely you'll be approved on appeal. 
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