The two criteria used by disability examiners to make a decision on a case
Disability examiners who make decisions for Social Security will reject or deny a claim based on two main criteria: 1) Does the applicant have a serious, ongoing physical or mental condition (with no expectation of improvement over a period of 12 months); and 2) Does the applicant's condition prevent him from performing past work, or any other work, given his work history and current limitations.
In order to determine the severity and nature of an applicant's medical condition, a disability examiner requests medical records from all medical treatment sources listed on the disability report form that is completed at the time of application.
If you are filing for disability, be sure to include the correct contact information for all individuals or facilities from which you have received medical treatment. Disability examiners sometimes have to request records from physicians repeatedly before receiving them, and the process is only delayed further when they are working with incorrect addresses or phone numbers.
After receiving your medical records, a disability examiner will review them and determine if your condition meets a listing in the official disability book of impairments, "Disability Evaluation under Social Security."
This book is commonly referred to as the blue book, the listing book, and the "Social Security Disability list of impairments". It lists criteria that must be met to establish that the applicant has an impairment that Social Security recognizes as a disability. There are listings for both children and adults, and some claims are approved on the basis of meeting a listing alone, though this is not typical.
When a disability application is approved, it is because, although the individual does not have a condition that meets any of the listings, the limitations caused by his physical or mental condition are such that he is unable to participate in substantial, gainful employment. Approvals that are granted on this basis, rather than on the basis of meeting a blue book listing, are called medical vocational allowances.
Before approving a medical vocational allowance, the disability examiner must determine your residual functional capacity. The residual functional capacity evaluation is a form that lists specific physical or cognitive tasks that you are still capable of performing, based on the information in your medical records.
After determining your RFC, the disability examiner looks at your particular medical vocational profile with the purpose of determining if you are still capable of performing work, either at a job you have performed in the past 15 years, or a job that you could be expected to perform given your job skills, age, education, etc., and at which you could earn at least the current substantial gainful activity (SGA) amount each month.
You will be approved for SSD or SSI if a disability examiner or judge decides that your condition is severe enough to prevent you from performing past work or any other work, but this is not an easy hurdle to pass. Other work can be any type of work, even if this job is not really an option in your particular state or locality.
A large percentage of applications and reconsideration appeals are denied by disability examiners based on the claimant's ability to perform other work. However, the chances of approval rise at the level of a disability hearing held by an administrative law judge.
That is why it is important for those who are truly in need of disability benefits to continue to appeal until they have the chance to appear in person before a judge. Over half of all disability denials are overturned by disability judges.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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