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Estate and Elder Law

Compassionate Allowance Initiative

 Did you know that today as many as 5.3 million Americans are living with Alzheimer's Disease? A disease which destroys brain cells, causing problems with memory, thinking and behavior, severe enough to affect work, lifelong hobbies or social life? Alzheimer's gets worse over time, and it is fatal. Did you know that today it is the seventh-leading cause of death in the United States?

Some memory lapse is normal. Forgetting where you put your keys or forgetting where you parked your car or forgetting the name of a person to whom you were recently introduced is not unusual. However forgetting the names of your children, the faces of love ones, your address, birthdays - is not normal. Let me share with you an analogy I was given by a doctor of Alzheimer's Disease patients -  Consider your brain is a file cabinet. Consider that your brain stores information in appropriate folders & correctly files them in the file cabinet Now consider that your brain, when trying to retrieve information from the file cabinet, looks in the wrong file or the wrong cabinet drawer. That, I was told in brief, is an example of Alzheimer's Disease.

There is no such a thing as senior moment. Memory loss is not a normal part of the aging process. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing. Alzheimer's disease gradually and painfully destroys a person's memory and ability to learn and carry out daily activities such as thinking, talking, eating, ability to connect with others, walk, find his or her way home and go to the bathroom. As the disease progresses, individuals may also experience changes in personality and behavior. Unfortunately, there is no cure for Azheimer's disease. Rather significant forgetfulness is often due to a degenerative disease - dementia.

What is Social Security Disability Insurance (SSDI)?

Social security disability benefits (SSDI) are paid to individuals who have worked for enough years and have a condition that is so severe that they are unable to work at any job. Administered by the SSA, it takes into consideration a person's work history, education and training. SSDI makes monthly payments to eligible disabled individuals and is a significant benefit for individuals with early-onset Alzheimer's disease. In addition to a monthly payment, it serves as entry to Medicare benefits for those under the age of 65. Family members (e.g., spouses and minor children) may also be eligible for benefits based on the applicant's work record.

Most people are diagnosed with Alzheimer's disease after retirement. these people have no need for social security disability because they are already collecting retirement social security. In other words, social security disability is an issue for people who are diagnosed with Alzheimer's disease while they are in their working years.

So how does social security judge eligibility of these benefits?

Eligibility for social security disability benefits is judged based on your ability to perform any "substantial gainful work." this is not measured by your ability to continue working at your present job, your present type of work, within your profession, or at the same level of employment or pay. Instead, social security simply looks at your ability to perform any kind of paid work. This is where education and training plays a role.  You are considered able to perform substantial gainful work if there is work you could do. In 208 that work ahs to earn you $940 per month.

So, the fact that you may not be able to perform your current job for much longer does not mean that you would be immediately eligible for social security disability benefits. However, if and when you are unable to continue with your current job because of your medical condition, you begin the process of applying for social security benefits even though you are unlikely to qualify right away. Social security will then determine if there is other work you could do, and will probably deny your claim for disability benefits unless and until you attempt to do such work. At minimum this will begin the process of establishing your disability, which will make it faster and easier for you to obtain disability benefits if and when your disability later becomes severe enough that you cannot perform any substantial gainful work.  

Until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals. Often SSDI would claim that there was some work an Alzheimer's patient could do and therefore deny the claim.  

The following announcement appeared in the media: February 11, 2010 - In its effort to improve and expedite the disability determination process, the Social Security Administration (SSA) has announced that it will add early-onset Alzheimer's disease to its Compassionate Allowances Initiative. The initiative identifies debilitating diseases and medical conditions that meet the SSA's disability standards for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI). Inclusion in the initiative allows for faster payment of Social Security benefits to individuals with Alzheimer's disease. 

The import of this  announcement  is that SSA understands that the cognitive impairment caused by Alzheimer's disease leaves individuals unable to maintain gainful employment and are therefore deserving of an expedited disability determination. This decision will, hopefully, simplify and streamline the SDI/SSI application process and decrease the waiting time for benefits, which for some has lasted as long as three years. 

What is the Compassionate Allowance Initiative?

Under this initiative, the Social Security Administration (SSA) finds individuals with certain diseases/conditions eligible for social security disability (SSDI) and supplemental security income (SSI) benefits. In other words, the very nature of the disease creates eligibility for SSDI benefits.  It is important to note that applicants still have to meet other SSDI criteria and/or SSI criteria. In any event,  many whose illness or disease falls in the Compassionate Allowance Initiative  are considered eligible by virtue of the disease and therefore are fast-tracked for a favorable decision.

What is Supplemental Security Income (SSI)?

Supplemental Security Income benefits (SSI) are paid each month to individuals who are aged, blind or disabled and have limited income and resources (assets). The "disability" criteria for SSI are the same as for SSDI benefits. Unlike SSDI, eligibility for SSI is not based on prior work experience. In addition, in most states, individuals who receive SSI are also automatically eligible for Medicaid (medical assistance) benefits.

Why is this important to individuals with early-onset Alzheimer's disease and related dementias?

Social Security disability benefits are very important to those with early-onset (younger-onset) Alzheimer's and related dementias because these individuals are often initially denied benefits - but usually win on appeal. Those affected by early-onset Alzheimer's are often simultaneously faced with the enormous challenges that the disease presents, while also undergoing a long disability decision process that is financially and emotionally draining. By adding Alzheimer's disease to the list of "Compassionate Allowance" conditions, it will simplify and streamline the SSDI/SSI application process and should result in receiving SSDI/SSI benefits in an expedited manner.

In conclusion, until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals. This decision will simplify and streamline the SSDI/SSI application process. There are currently an estimated 5.3 million Americans with Alzheimer's disease. Although the majority of Alzheimer cases are individuals age 65 and older, a significant number of people under age 65 are also affected by this fatal disease and have few financial options other than the Social Security disability program.

Ramsey A. Bahrawy is an attorney licensed to practice law in Massachusetts. His practice concentrates on estate planning and administration, elder law, and personal injury litigation. He welcomes the opportunity to discuss the contents of this article, and any other legal matter in his practice area, with you. He can be reached at BAHRAWY LAW OFFICES, 55 Main Street, North Andover, MA 01845 (978) 682-1141. You may also view more of his biographical information, plus other helpful information, such as his blog, at his law firm website at