Impairment in the United States

Impairment Related Work Expenses (IRWEs)

Impairment Related Work Expenses (IRWEs) are an important and often overlooked SSI/SSDI work incentive. These expenses can be used to reduce the earned income countable in calculating the SSI payment and in determining whether an SSDI beneficiary is performing Substantial Gainful Activity.

SSA issued new POMS on Impairment Related Work Expenses at the beginning of 2004.

IRWEs are deductible when:

• The item or service enables you to work;
• You need the item or service because of your disabling impairment;
• You paid the cost and are not reimbursed by another source, for example Medicare, Medicaid, or private insurance;
• The cost is “reasonable”that is, it represents the standard charge for the item or service in your community; and
• You paid the expense in a month that you are or were working.

The 2004 POMS appear to expand the application of IRWEs. Under the old POMS, IRWEs were
only deductible if the claimant needed the item or service because of the disabling impairment(s) identified by the Disability Determination Service in the eligibility process. In 2004, the POMS provide that IRWEs apply where:

• The IRWE items or services correlate with the DDS’s established medical basis of disability, or
• The IRWE items or services correlate with any medically established impirment(s) being treated by a physician ro health care provider.

This means that IRWEs include items and services needed because of impairments that
developed after application or that were not considered by DDS during the application process.
In addition to expanding the application of IRWEs, the new POMS are useful in that they
provide Field Office detailed instructions for recognizing and processing IRWEs. Perhaps even
more importantly, the new POMS may reflect heightened attention by SSA to work incentives
generally.

Impairment (Plans)

This section introduces, discusses and describes the basics of impairment. Then, cross references and a brief overview about Plans is provided. Finally, the subject of Reorganizations in relation with impairment is examined. Note that a list of cross references, bibliography and other resources appears at the end of this entry.