How Medical Professionals Can Help Student Loan Borrowers with Disabilities

This blog contains tips for medical professionals to help patients access the Total and Permanent Disability discharge program for federal student loan borrowers. To learn about the structure and history of the program, read our program brief here. Recommendations for policymakers to protect and improve the program can be found here. 

Medical professionals play an important role in helping people with disabilities access federal benefits, such as the U.S. Department of Education’s Total and Permanent Disability (TPD) discharge program, which eliminates federal student loan debt for qualified borrowers. Between 2020-2025, the Education Department approved $18.7 billion in debt relief for nearly 633,000 borrowers with a total and permanent disability, and recent improvements to the program make it easier than ever for borrowers to access debt relief. Without the support of medical professionals—who attest to a patient’s qualifying disability—these borrowers would not be debt free today.

However, medical professionals can sometimes be a barrier to a borrower’s debt relief when they decline to complete the required form or complete it incorrectly. To overcome misconceptions about the TPD discharge program and to provide practical tips for completing a borrower’s TPD application, the Education Department launched an FAQ-style website for medical professionals. Armed with this information, medical professionals can help more of their patients get federal student loan debt relief.

Student Loan Borrowers with Disabilities

One in four adults in the United States—more than 70 million people—have at least one disability. Of them, more than 11 million people get Social Security disability benefits, which are only available to people who cannot work due to a severe medical condition. The financial impact of having a disability is devastating, from significantly reduced income to various “hidden costs,” including the unpaid labor of any family members acting as caregivers and higher spending on food and services. As a result, people with disabilities are more likely to struggle with paying their bills. Because student loan debt is a known contributor to financial stress and hardship, people with disabilities who also hold student loan debt may be at greater risk of financial hardship.

Although it is difficult to estimate the total number of disabled student loan borrowers, examining the relationship between age and disability offers insights into a sub-population of people who may be most vulnerable to the financial strain of holding student debt.

Serious disability is more prevalent in older populations. Two in five adults 65 years of age and older have a disability, and a growing number of older Americans also have student loan debt. According to Education Department data, 3.59 million people 60 years of age and older hold $155 billion in federal student loan debt. That includes 89,800 borrowers 81 years of age and older who hold $2.6 billion in debt. Many of these older student loan borrowers may have disabilities that would qualify them for loan discharge, and they need the support of medical professionals to access debt relief.

What is the Total and Permanent Disability (TPD) discharge program?

Congress created the TPD discharge program to help prevent the financial hardship of student loan borrowers who become disabled. Under federal law, people who become totally and permanently disabled are eligible to get a discharge of their federal student loans and TEACH Grant service obligations. The Education Department defines total and permanent disability as “the inability to engage in any substantial gainful activity by a reason of a medically determinable physical or mental impairment that can be expected to result in death, or has lasted for a continuous period of at least 60 months, or can be expected to last for a continuous period of at least 60 months.”

The TPD discharge program is administered independently of other federal and state disability benefits programs. That means medical providers should not apply diagnostic standards from other disability programs, and borrowers need not qualify for other programs to be eligible for TPD discharge.

Some borrowers can get their loans discharged under TPD based on qualifying disability determinations from the U.S. Department of Veterans Affairs or the Social Security Administration. Other borrowers must submit an application that is completed by an authorized medical professional, which includes state-licensed doctors of medicine, doctors of osteopathy/ osteopathic medicine, nurse practitioners, and physician assistants, as well as U.S.-licensed certified psychologists. These providers do not need special certification or additional state or federal authorization to complete TPD discharge applications.

Resources for Medical Professionals

TPD Application Process

Borrowers seeking TPD discharge must have their medical provider complete the application form. The provider will indicate whether the borrower has a medically determinable physical or mental impairment, the severity of the impairment, and the length of the impairment. The form also asks for comments about the borrower’s diagnosis and the limitations of the borrower’s physical and mental functionality.

There are two ways a borrower can have their medical provider complete the TPD discharge application. The original method requires a borrower to print an application form, complete and sign one page, and have their provider complete and sign another page. The borrower must then mail or fax the application to the Education Department, or scan and upload the document to StudentAid.gov.

Alternatively, a borrower can complete a new online form on StudentAid.gov. After logging into their account, a borrower can attest to their eligibility for TPD discharge and agree to place their loans in forbearance pending discharge approval. They can also enter the email address of their medical provider, who will then automatically receive the form to sign and submit electronically.

However, some borrowers experience roadblocks getting their application completed. For example, some borrowers reported to the Education Department that their medical provider refused to complete the application—not because the provider disagreed that the patient had a qualifying disability, but because they did not think they were allowed to complete the form based on misconceptions about the program rules. Other borrowers are denied approval because their provider left items on the form blank, or there were issues with the provider’s license or signature.

These preventable missteps delay debt relief to qualified borrowers and can lead some borrowers to give up on pursuing TPD discharge.

Federal Resources for Medical Professionals

To help medical professionals understand their role in the TPD discharge process, the Education Department created a website with information about the program’s requirements and tips for accurately completing the application. These tips supplement the more detailed instructions provided on the application.

Several tips from the Department’s website stand out:

1. Borrowers who work and earn income can qualify for TPD discharge provided they are not engaged in substantial gainful activity. It is solely within the professional judgement of the medical provider to determine whether the borrower can engage in substantial gainful activity, and the government does not monitor a person’s income after receiving a TPD discharge.
2. On the TPD discharge application, authorized medical professionals must provide their state and professional license number, which the Education Department’s TPD contractor verifies against state licensing databases. If the license number is missing, illegible, or expired, the contractor will first attempt to contact the provider to correct the information. The Department does not otherwise communicate with state medical licensing boards.
3. The authorized medical professional must answer all questions and write answers in every text box, even if to indicate “not applicable.” Missed questions or blank text boxes could result in rejection of the application. In addition, medical providers should not use insurance codes or abbreviations when describing the borrower’s disabling conditions or limitations.

A growing number of Americans report having disabilities and may qualify for federal benefits. Many of these same people may also have student loans, and older Americans in particular may be more likely to have disabilities while carrying student loan debt. The Education Department offers debt relief to qualifying student loan borrowers with disabilities to protect them from financial hardship. Still, borrowers and their medical providers must complete the forms correctly and completely to qualify. When medical providers follow the tips outlined on the Department’s new website, borrowers can be assured they will get the timely debt relief they need.

Bradley D. Custer is a higher education policy expert in Washington, D.C. He previously worked at three public higher education institutions, the Center for American Progress, and the U.S. Department of Education. He holds a Ph.D. in higher, adult, and lifelong education from Michigan State University.