How Will Social Security Decide a Disability Case that's filed?

All Social Security Disability (SSD) and Supplemental Security Income (SSI) cases are decided based on the medical evidence supplied, either by the claimant or the claimant’s legal representative, to the social security administration. It can’t be stressed enough, really, how important it is for a claimant to take the time to put together a medical history that supplies all of the medical facilities at which he or she has received treatment, including names of treating physicians, addresses, and accurate phone numbers. This may take some extra time and calling around before filing the initial claim, but putting down that you received treatment “at the cardiac treatment center on the west side” is not really all that helpful to a disability examiner when it comes to tracking down your records. Do not be lazy in this respect—if you don’t provide accurate contact information to the examiner, you will delay your case for weeks, even months, or your treatment records may not be located at all, which could mean the difference between being awarded disability or being turned down altogether.

What types of medical evidence can help you win disability benefits? The answer to this question is, potentially anything and everything. Doctor’s notes, records of being admitted and discharged from hospitals and emergency rooms, and above all, any detailed statements from your treating physician that supply information as to your residual functional capacity (the actions you are able to perform despite your medical condition), will help a disability examiner or judge evaluate your claim. This goes for any disability claims made on the basis of mental conditions as well—any psychiatric records, admittance and discharge from medical facilities, evaluations, and treatment summaries provided by your psychiatrist are very important to your case.

How does a disability examiner (an employee of the state disability determination services agency who makes SSD/SSI decisions for the federal social security administration) use medical evidence to evaluate a claim? The examiner will look over all of the medical records and make notes on any medical diagnoses, lab reports, x-rays, CT scans, spirometry (pulmonary functioning) tests, etc., and decide if the records support the claim of an impairment, and if that impairment meets the criteria of a listing in the blue book (a manual that lists medical conditions that the social security administration deems potentially disabling). If the examiner determines that the claimant has a condition that is not listed in the blue book, or has a condition in the blue book but does not present with all of the symptoms required to be approved for that listing (it’s hard to meet all of the criteria necessary to qualify for a listing as they are very specific), then the examiner will decide if a medical vocational allowance should be granted to the claimant. The medical vocational allowance, or Med-voc, is awarded to those with documented medical conditions that, although not specifically listed in the blue book, still prevent an individual from engaging in substantial gainful activity (SGA). Currently the SGA amount is $940 per month, so if your condition prevents you from earning more than that, you may qualify for a medical vocational allowance.

Medical vocational allowances often hinge on statements from a treating physician regarding a patient’s residual functional capacity as well as the physician’s opinion about your chances of recovery in the future, or the likely progression of your illness. If your physician backs up the claim that you cannot perform your current job, then the disability examiner, before awarding a medical vocational allowance, will try to determine if you could perform some past work, or other type of work. The examiner will use a vocational grid to make this determination, which is designed to ensure that examiners in all states take into consideration a claimant’s job skills, past work, education and age before suggesting other employment to which he or she may be suited.

When it comes to disability claims that are awarded on the basis of medical vocational allowances, a complete work history can be as important as complete medical history. Again, do not be lazy or cut corners when you supply your work history with your initial application. List not only past jobs and any titles you have held, but also your specific duties, so that there is no guesswork on the part of the examiner as to what you are or are not capable of doing. Also, list good contact information for your past supervisors so that they can confirm your employment and the capacity in which you acted while in your position.

If at any point in the process you have new information that is relative to your case, be it new test results, medication, treatments, or diagnosis, be sure to supply it to your social security office immediately so that a disability examiner will consider it when deciding your case.


For information on Social Security Disability, visit the

Social Security Disability Benefits Resource Center