We do not request reimbursement of costs
(such as repayment for obtaining medical records)
from veterans nor from people who suffer from multiple sclerosis.

Presumptive Disability

What is Presumptive Disability?

A condition that is presumed to be totally disabling is referred to as presumptive disability. These conditions include loss of speech, total hearing loss, blindness, loss of limbs, and more.

Veterans Affairs (VA) assumes that serving in the military can lead to certain types of disabilities. However, there may be highly variable circumstances surrounding a veteran’s military service. If someone gets diagnosed with a very severe condition, they may consider applying for presumptive disability benefits.

Conditions that may qualify for presumptive disability benefits

Several severe medical conditions may automatically qualify for presumptive disability benefits. To be eligible, a condition must profoundly limit a person in normal daily living.

When an individual applies for Supplemental Security Income (SSI), they can apply for presumptive disability at the same time. Because SSI applications take a long time to review, presumptive disorder can permit people to get immediate help when required. Conditions that may qualify for presumptive illness payments include:

  • Complete blindness, in which there is no perception of light in either of the eyes
  • Complete deafness, in which there is no perception of sound in either of the ears
  • Cerebral palsy, muscular atrophy, and muscular dystrophy can cause a marked limitation in walking, coordination of arms or hands, and speaking
  • Leg amputation at the hip
  • Down syndrome
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Low birth weight in children
  • Back injury or spinal cord injury that prevent a person from ambulating without bilateral handheld devices or a walker
  • HIV
  • AIDS 
  • Amyotrophic lateral sclerosis (ALS)
  • End-stage renal disease that requires chronic dialysis, with the medical records containing a CMS-2728-U3 report, which is a medical evidence report

Terminal disorders, which have a life expectancy of six months or less, must include evidence via a physician’s signed statement, telephone confirmation, or opinion from a knowledgeable official or specialist. Immobility without a wheelchair or bed confinement are other qualifying conditions.

Low-weight babies qualify for presumptive disability

Babies who are low weight at birth or under six months old with extremely low weight qualify for disability:

  • Babies at 37 weeks weighing under 4 pounds, 6 ounces
  • Babies at 36 weeks weighing less than 4 pounds, 2 ounces
  • Babies at 35 weeks weighing under 3 pounds, 12 ounces
  • Babies at 34 weeks weighing less than 3 pounds, 5 ounces 
  • Babies at 33 weeks weighing less than 2 pounds, 15 ounces
  • Babies weighing less than 2 pounds, 10 ounces at birth

Children may also qualify for presumptive disability. Some syndromes considered presumptive illness in children include Down syndrome, neurodevelopmental impairment, and intellectual disability.

Length of time to get benefits from the SSA for presumptive disability

Is-Nephrotic-Syndrome-a-DisabilityThe Social Security Administration (SSA) may approve a person’s application for presumptive disability right away. If this happens, then they will begin to receive benefits within a week or a few days after the approval. 

However, in some cases, the payments for the presumptive illness may continue for six months, giving the DDA time to perform a complete review of the initial application. When the SSI application gets approved, the SSI benefits begin and the presumptive disability benefits end.

How to Apply for Presumptive Disability

Call the SSA at 1-800-772-1213. An individual can apply for payments at the same time they apply for SSI presumptive disability. Only the SSA will determine approval or denial of an application. In the case of certain medical conditions, the SSA might approve the application only after it gets confirmation from a trusted medical source. A reliable medical source may be a social worker, a doctor, or school personnel.

In some situations, the SSA field office may deny your application and forward it to Disability Determination Services (DDS), who is then responsible for making the disability determination. The DDS is more flexible in granting benefits for an applicant’s presumptive illness. They might grant benefits to individuals that have a disorder, but do not fulfill all the symptoms or conditions stated in the Blue Book.

What isn’t considered a presumptive disability?

Non-presumptive disorders require veterans to provide sufficient evidence about their health condition. They need to prove that their health condition was either caused by or worsened due to their military service. 

A veteran may consider applying if their disability is severe or gets worse over time. However, all veterans must file first with the SSA to have their disability percentage determined. If a veteran gets a disability rating of 0% for connection with service, it falls under non-compensate disability, and payments are not granted.

File a disability claim by taking legal assistance

Contacting a disability lawyer is the first step to obtaining disability benefits. An experienced disability attorney can guide you through the application process and provide information about your options for accessing the financial assistance you need.

To schedule a consultation, call our Florida, New Jersey, Pennsylvania, or Texas  office at 1-888-774-7243 or contact us online. You can also follow us on Facebook to learn more about SSDI/SSI benefits.

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