Monthly Archives

August 2013


By Applying for disability benefits when you have:

Can I Get Social Security Disability Benefits After a Stroke?

  • How Does the Social Security Administration Determine if I Qualify for Disability Benefits for a Stroke?
  • About Stroke and Disability
  • Winning Social Security Disability Benefits for Stroke by Meeting a Listing
  • Residual Functional Capacity Assessment for Stroke
  • Getting Your Doctor’s Medical Opinion

How Does the Social Security Administration Determine if I Qualify for Disability Benefits for a Stroke?

If you have had a stroke, Social Security disability benefits may be available. To determine whether you are disabled by your stroke, the Social Security Administration first considers whether your stroke and its effects are severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See Winning Social Security Disability Benefits for Stroke by Meeting a Listing. If your stroke is not severe enough to equal or meet a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your stroke), to determine whether you qualify for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Stroke.

About Stroke and Disability

What Is a Stroke?

A stroke is called a cerebrovascular accident or CVA by medical professionals. It is usually caused by either:

    • Blockage of an artery in the brain by a blood clot or fatty deposits, which is called a cerebral infarction;


  • A ruptured cerebral artery bleeding into the brain, which is called a cerebral hemorrhage.

Some strokes are caused by cerebral aneurysms.

The Social Security Administration sees large numbers of stroke cases.

Strokes Caused by Blockage of an Artery

Most strokes are caused by cerebral infarction in which an artery in the brain (see Figures 1 and 2 below) is blocked depriving the brain of blood and damaging brain tissue. An arterial thrombosis (blood clot) is the most common cause of cerebral infarction. Such a clot could form in a cerebral artery itself or in the heart as a result of a variety of heart problems and be pumped to the brain. Blockage of a cerebral artery by the fatty deposits of atherosclerosis can also deprive an area of the brain of blood and lead to infarction. Actually, many cerebral infarctions are caused by cerebrovascular disease in which a blood clot forms around fatty plaques. Unlike arteries in the heart or legs, cerebral arteries cannot be cleaned out of fatty blockages. However, if a stroke occurs as a result of a blood clot, brain damage can be lessened by clot-dissolving drugs. Medical attention must be sought within a few hours for treatment to be effective and clot-dissolving drugs pose some risk of causing deadly bleeding.

A piece of atherosclerotic plaque can break off inside one of the two internal carotid arteries in the neck, be pumped to the brain, and lodge in a cerebral artery to cause an infarction.

Veins of the Brain

Figure 1: Veins of the brain.

Base of brain

Figure 2: Base of the brain, including main arteries.

Strokes Caused by Ruptured Cerebral Artery (Cerebral Hemorrhage)

The most frequent cause of hemorrhagic CVAs is uncontrolled hypertension (high blood pressure), often related to non-compliance with medical treatment. The Social Security Administration sees many such tragic cases. Bleeding in the brain may also occur from abnormal tangles of blood vessel growths called vascular malformations and cerebral aneurysms.

Strokes Caused by Cerebral Aneurysms

Incidence of Cerebral Aneurysms

A significant number of strokes are caused by cerebral aneurysms, which are enlarged, and weak areas of a cerebral artery that can rupture and cause a subarachnoid hemorrhage (SAH). Aneurysms in the cerebral circulation are common. They are estimated to occur in between 1% and 5% of the general population and account for 5% to 15% of strokes. The most common location for cerebral aneurysms is the anterior cerebral artery. Cerebral aneurysms are twice as common in women as in men. They occur more frequently in individuals with certain disorders such as autosomal dominant polycystic kidney disease. More than one aneurysm may be present.

Millions of Americans have cerebral aneurysms. Although somewhere between 50% to 80% of aneurysms are small and do not rupture—many are only found incidentally at autopsy—that still leaves millions of individuals at risk for death or debilitating stroke.

Effects of Rupture

If a stroke occurs, the prognosis is grave, with a mortality of about 40% to 50% within 30 days of the first rupture. For surviving patients with SAH, about 30% have significant neurological abnormalities. For instance, following SAH, 15% to 20% of individuals will develop hydrocephalus (fluid accumulation on the brain) and require further neurosurgical procedures to treat that serious brain disorder.

The following scale is widely used by physicians to describe a patient’s condition after SAH:

Grade Description
1. Asymptomatic or slight headache, slight neck (nuchal) rigidity
2. Moderate to severe headache, neck rigidity, no neurological abnormalities other than cranial nerve paralysis (palsy)
3. Drowsiness, confusion, or mild focal neurological deficit
4. Stupor, moderate to severe hemiparesis, possible early decerebrate rigidity
5. Deep coma, decerebrate rigidity, moribund appearance

Re-bleeding Risk

If a person has experienced one rupture (bleeding episode) from an aneurysm, the risk of future bleeding is increased to 10 times that of someone with a no rupture history. If the aneurysm was large (10 mm or more), the risk of rebleeding is even higher.

If an aneurysm has not bled previously, data indicates a low bleeding risk of 0.05% per year; in aneurysms less than 7 mm, the 5-year risk approaches zero in the absence of a bleeding history. However, the size of an aneurysm is not the only consideration—aneurysms putting pressure on vital brain structures, such as a cranial nerve (see Figure 3 below), require surgical intervention at a smaller size.

Cranial nerves

Figure 3: Cranial nerves at the base of the brain.

Diagnosis and Surgical Treatment of Cerebral Aneurysms

Many unruptured cerebral aneurysms can now be identified with CTA or MRA, without the more invasive catheter angiography. However, catheter angiography better diagnoses SAH. Angiography of any type is not perfect and can fail to identify small aneurysms of less than 3 mm.

Cerebral aneurysms may be treated surgically to reduce the risk of rupture, rebleeding, or brain damage from pressure the aneurysm places on brain tissue. Surgery to place a metal clip on the neck of an aneurysm that connects it to a parent vessel has been the standard treatment in the past. This procedure is major brain surgery and requires a craniotomy. A piece of the skull (skull flap) is sawed under general anesthesia and laid back for entry into the brain. This surgery has risks and the surgical risks for small aneurysms considerably exceed the risks of conservative (non-surgical) treatment.

A second surgical option has been the use of detachable coils of various sizes and shapes, which can be inserted without opening the skull. These coils are advanced by microcatheter to the aneurysm through the femoral artery in the leg, and then up through the carotid artery in the neck into the cerebral circulation. The coil is then detached inside the aneurysm to block blood flow through the neck of the aneurysm into its main body. Thus, the patient is spared the very invasive craniotomy. Although the risk of rebleeding after coiling is slightly greater than after clipping, the safety of coiling appears greater in many instances. Medical judgment in individual cases is still required to determine the best treatment option, but it is likely that coiling will continue to replace a significant number of cases that would otherwise have required clipping.

Diagnosis of Stroke

Evidence that a CVA has occurred is based on history and physical examination, as well as neuroimaging with computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA) of the brain. Cerebral catheter angiography, a much older procedure than CTA or MRA, is still sometimes used. It carries some risk and is not needed to evaluate most CVAs. Cerebral catheter angiography involves direct injection of x-ray contrast material to outline the arteries of the brain. A catheter is threaded through the femoral artery in the leg, up into a carotid artery in the neck, and then manipulated into the cerebral circulation where contrast injection takes place.

Recovery from Stroke

Brain cells that are killed by a stroke are not replaced with new cells. The brain cannot re-grow any part of itself. But it can re-arrange brain cell connections to some degree to compensate for injury. The ability of the brain to compensate for injury decreases with age. Recovery from stroke depends on the ability of remaining brain areas to perform necessary functions, and recovery of areas not permanently damaged by the CVA. Rehabilitation is very important in achieving maximum possible recovery, and should be instituted as soon as possible after the CVA.

Effects of Stoke

CVAs can be of all degrees of severity, and the type of damage they do depends on where in the brain they occur. Some CVAs cause death immediately, while others may cause little limitation. There might be good recovery, or very little.

Strokes can have many effects depending on what areas of the brain are damaged (see Figure 4 below):

  • Weakness, paralysis, numbness. Most CVA claimants are awarded disability benefits because of limitations in movement or motor ability, such as weakness and paralysis in an arm and leg on the same side of the body as a result of blockage (occlusion) in the middle cerebral artery or one of its branches.
  • Speech and language problems. Strokes sometimes produce some degree of loss of ability to understand or express certain aspects of written or spoken language in various combinations (known as aphasia).
  • Personality changes. A CVA far forward (anterior) in a frontal lobe might produce personality changes if it is large enough, without any physical limitations.
  • Vision problems. A CVA might involve the occipital lobes in the back of the brain. The occipital lobes process primary visual information and a stroke in that area would produce visual losses either in acuity (sharpness) or visual fields (how wide an area a person can see) without any other impairment. Major strokes that are not in the occipital lobes may result in visual field losses in the form of loss of half of the person’s visual field. Each half of the brain carries half the total visual information. Most CVAs only involve one side of the brain and therefore at the worst can only eliminate half of a person’s visual field in a pattern called homonymous hemianopsia0.
  • Balance problems. Strokes affecting the parietal lobes of the brain can produce distortions in the mental construction of space and cause loss of an awareness of body parts, a condition known as unilateral neglect. It is important that the neurological examination of a patient after a CVA detect unilateral neglect, because non-awareness of a limb makes it as functionally useless as paralysis. Strokes affecting the posterior circulation to the cerebellum can affect balance and ability to walk without producing any actual weakness.

Circle of Willis

Figure 4: The Circle of Willis, showing main cerebral arteries and the parts of the brain they supply.

Continue to Winning Social Security Disability Benefits for Stroke by Meeting a Listing.

Employment questionnaire

By Disability forms

Social Security Disability Employment Questionnaire

When an issue in your Social Security disability benefits case is whether your brief work qualifies as an unsuccessful work attempt, especially if the work lasted more than three months but less than six months, it may be useful to send your former employer this questionnaire to complete. You can also download and print the full PDF version of the Social Security Disability Employment Questionnaire.

To: _________________________________

Re: _________________________________

SSN: _________________________________

Please answer the following questions.

Did you grant any of the following special considerations to allow this employee to work? (Check all that apply.)

SSD employment questionnaire

Please explain any items checked above and describe any other special considerations granted:



Was the employee hired because of family relationship, past association with the employer or other altruistic reason? Yes ___ No ___

Explain Yes answer: ____________________________________________________________________


Did the employee have trouble relating to co-workers? Yes ___ No ___

Explain Yes answer: ____________________________________________________________________


Did the employee have trouble relating to the public? Yes ___ No ___

Explain Yes answer: ____________________________________________________________________


Did the employee have trouble dealing with normal work stress? Yes ___ No ___

Explain Yes answer: ____________________________________________________________________


Did the employee have trouble following directions? Yes ___ No ___

Explain Yes answer: ____________________________________________________________________


Did the employee have trouble maintaining attention and concentration? Yes ___ No ___

Explain Yes answer: _____________________________________________________________________


Was the employee frequently absent from work? Yes ___ No ___

Was the employee’s work satisfactory? Yes ___ No ___

If the employee no longer works for you, when did his/her employment end and why?




Space for any additional remarks you may wish to provide:





Signature: ______________________________

Title: ______________________________

Date: ______________________________

Telephone Number: __________________________

Continue to the full PDF version of the Social Security Disability Employment Questionnaire.

Monthly headache diary

By Disability forms

Social Security Disability Monthly Headache Diary

If you think you will have trouble providing sufficiently detailed information at your Social Security disability hearing, the exercise of keeping a daily diary until the time of your hearing is excellent preparation for testifying. And for episodic impairments like headaches, a diary helps quantify problems. You can also download and print the full PDF version of the Social Security Disability Monthly Headache Diary.

SSD headache diary

Continue to the full PDF version of the Social Security Disability Monthly Headache Diary.

Monthly wage information

By Disability forms

Social Security Disability Monthly Wage Information

If your earnings are close to the substantial gainful activity level (see 20 C.F.R. § 404.1574), documentation from your employer may be essential to show the Social Security disability examiner that you are not actually performing substantial gainful activity. Your W-2 form may work fine for last year, especially if there is no question concerning the dates you worked. If there is a question about the dates worked last year, you may need information from your employer.

If you are working in the current year and a recent paystub does not show all necessary information, you may need earnings information from the employer. This form will gather it. You can also download and print the full PDF version of the Social Security Disability Monthly Wage Information Form.

Note that this form asks about vacation and sick pay. According to POMS DI 10505.010 C, only earnings paid as a result of actual work activity count. Thus, sick pay and vacation pay do not count for determining eligibility for Social Security disability benefits, although according to POMS DI 10505.010 D, bonuses do count.

To: ______________________________________________________

Re: ______________________________________________________

SSN: _____________________________________________________

Please show monthly gross income and income from vacation or sick pay for the months and years indicated:

SSD monthly wage information

Date: ________________________________
Signature: ________________________________

Title: ________________________________
Print Name: ________________________________

Continue to the full PDF version of the Social Security Disability Monthly Wage Information Form.

How long does the disability process take?

By Frequently Asked Questions

How long does the disability process take?

Should I apply for disability?

If your answers match the ones below, the Social Security Administration (SSA) is likely to award you benefits.

  • Are you gainfully employed? No
  • Do you have a severe impairment? Yes
  • Will your impairment last 12 months or result in death? Yes
  • Does your disability meet one of SSA’s listed impairments? If yes, you qualify. If no …
  • Are you able to work? No

How long do disability appeals take?

When should I apply for disability benefits?

Unless you have an obvious long-term disability, the best time to apply for Social Security disability benefits is 6-9 months after you stop working.

What does a disability lawyer do?

The big-picture answer is: analyze what needs to be proven to win benefits, figure out how to prove it, and gather the necessary evidence. Some of the specific tasks are:

  • Obtain reports from treating doctors that are consistent with Social Security regulations
  • Refer claimants to specialists for additional reports that answer questions raised by Social Security regulations
  • Obtain a vocational expert’s evaluation of the claimant’s ability to work
  • Ask that a prior application for benefits be reopened
  • Seek a waiver of a time limit
  • Request subpoenas to insure the presence of crucial witnesses or documents
  • Advise the claimant on how best to prepare for and testify at the hearing
  • Object to improper evidence or procedures at the hearing
  • Cross-examine adverse witnesses
  • Present a closing statement
  • Submit a written summary of the evidence and argument
  • If the claimant wins, make sure the SSA correctly calculates benefits
  • If the claimant loses, request review of the hearing decision by the Appeals Council

How long will I wait for a disability hearing?

It can take up to two years from request until a hearing is held and a decision issued, but the time varies from state to state.

What are hearings like?

They are private, held in a small conference room, and last an hour or so. You will be asked about your education, training, work experience, symptoms, limitations, and daily activities.

What if I don’t file my disability appeal on time?

If you have not filed your appeal within 65 days of the date on your denial letter, you have to start over with a new claim. That new claim may result in the loss of back benefits.

What is the biggest mistake made by disability applicants?

Because the majority of appeals are granted at a hearing, failing to appeal a denial to the hearing level is the number one error … and unfortunately very common.

More detailed information on these and other common claimant questions is available in the library below.

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