A medical source statement can be an effective tool

What happens when a disability claimant's medical records fail to establish that they no longer have the ability to derive a substantial, gainful income from the performance of work activity? Their claim may be denied or they may be sent to a consultative medical exam, performed by an independent physician, for the purpose of gathering additional documentation. Such exams, though, rarely result in the approval of a claim. And, in fact, in most cases consultative medical exams are scheduled simply to satisfy a "recency of evidence" requirement, thus allowing a case to be closed.

In actuality, one of the most effective tools for winning a social security disability or SSI claim is the submission of a medical source statement from a claimant's treatment physician.

What is a medical source statement? It may take the form of a residual functional capacity assessment such as the RFC form used by the social security administration (a multi-page checkoff form that allows a physician to address a claimant's functionality and limitations). Or it may be presented as a letter from a treating physician. In either case, however, it is vital that the form is sufficiently detailed to the extent that a claims adjudicator can determine what the claimant's limitations are in the opinion of the treating physician.









For information on Social Security Disability, visit the

Social Security Disability SSI Resource Center




















Additional Resources

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The claimant's ability to work

The social security administration's definition of disability focuses on a claimant's ability to work. And, for this reason, disability adjudicators (disability examiners at the application and reconsideration levels and administrative law judges at the hearing level) look for evidence of functional limitations when reviewing medical evidence. Specific examples would include a claimant's limitations with regard to the ability to sit, stand, walk, stoop, crouch, reach overhead, lift more than a certain weight or grasp objects.

Unfortunately, most treatment notes and hospital records are lacking in this regard, i.e. they fail to document a claimant's functional limitations, past or present. Yet, this is exactly the type of information that the social security administration is looking for when deciding claims.







For information on Social Security Disability, visit the

Social Security Disability SSI Resource Center




















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What physicians and claimants should know

Practically every person who files for disability benefits understands that their medical records will be used to determine whether or not they are approved. And every physician who becomes aware of a patient's disability application knows, or should know, that the information they furnish to the social security administration may play a large role in deciding the outcome of their patient's claim. However, beyond this, the vast majority of claimants and physicians know relatively little about the approval criteria used by SSA for disability claims.

So,how does one qualify for disability benefits from the social security administration and what must a claimant's records demonstrate in order for this to occur?

For both title II (social security disability) and title 16 (SSI disability) benefits, a claimant must satisfy the following requirements:

1. They must have a severe condition (though SSA has little difficulty differentiating a severe impairment from a non-severe impairment, the process is, still, largely subjective).

2. For the condition to be considered disabling, it must have a duration of at least one year and, in that time, it must limit an individual's ability to work and earn at least a substantial and gainful income while in the performance of past work or suitable other work (as determined by one's age, education, work skills, and rated residual functional capacity).








For information on Social Security Disability, visit the

Social Security Disability SSI Resource Center




















Additional Resources

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Information contained in the records

Disability claims that have been filed with the social security administration are adjudicated on the basis of what a claimant's medical records have to say about their condition. And for claims that are inevitably approved, the information contained in the records do the following:

1. Establish the onset date of a claimant's disability (necessary for the calcuation of back pay benefits and for determining the onset of medicare eligibility).

2. Establish a current state of disability (necessary for the approval of ongoing benefits).









For information on Social Security Disability, visit the

Social Security Disability SSI Resource Center





















Additional Resources

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