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How to file for disability, Filing for SSI
Disability Requirements, Disability Status
How long is the wait?, Disability Application
The Social Security List of Impairments
Qualifying for Disability, Mental Disability
Disability Lawyer Info, Disability Back Pay

Qualifying for Social Security Disability or SSI



 
Qualifications for disability

Qualifying for disability benefits with the social security administration is based primarily on the information derived from a claimant's medical records. What do the medical records need to say? Ideally, for an adult individual to be approved, the medical records would simply make it extremely clear to the disability claim decision-maker that the claimant could no longer engage in substantial and gainful work activity.

Notes:

1. If the claim is at the disability application or reconsideration appeal level, the decision maker will be a disability examiner; if the claim is at the hearing level, the decision maker will be a federal administrative law judge.

2. Substantial and gainful activity is defined as being able to earn at least a certain dollar amount each month (to see the current SGA amount: SGA and Social Security Disability). And the demonstrated inability to work at this level is necessary for qualifying for disability benefits with social security.

Unfortunately, the great majority of medical records do not do this. They do not provide the type of information that will allow a decision maker on a Social Security Disability or SSI claim to conclude A) that a claimant cannot engage in substantial gainful work activity while performing work they have done in the past or B) that a claimant cannot engage in substantial gainful work activity while performing some type of other work that their job skills might make them qualified for.



Qualifications for disability - What does SSA need from your medical records?

What type of information is social security looking for in a claimant's medical records, and why is it not easily found?

In general terms, Social security adjudicators are really looking for concrete evidence of a claimant's inability to engage in normal daily activities.

In more specific terms, disability examiners and disability judges are looking for evidence that a claimant cannot engage in the types of activities that would be required in one of their past jobs or in some type of other work.

So, for this reason, decision makers will look for qualifications, or signs in the medical treatment records that indicate that the individual has trouble with: lifting, reaching, bending, sitting, standing, grasping, etc, etc. If the claimant has alleged one or mental impairments on their claim, the decision maker may look for evidence indicating that the claimant has difficulty with memory, or concentration and attention, or difficulty getting along with coworkers and supervisors.

The entire picture drawn by a claimant's physical and/or mental treatment records will allow a disability examiner or a disability judge to compare a claimant's remaining capabilities (referred to as residual functional capacity) to the requirements of their former jobs, as well as the requirements of other jobs that they might be thought capable of doing, given their age, education, and job skills.

But, again with the unfortunate part: most physicians do not typically include notes and observations in their medical treatment notes as to what a claimant can or cannot do, in light of their condition.

For example, while a doctor's treatment notes will usually include a diagnosis, a prognosis, or a prescription, very seldom will a treating physician indicate that a patient with carpal tunnel syndrome has difficulty picking up small objects, or that a patient with anxiety disorder has difficulty adapting to changing environments, or that a patient with degenerative disc disease has difficulty standing more than a certain amount of minutes.

Sadly, the doctors who provide front line treatment for patients do not take the time to record this information in their notes, which then become the medical records that are evaluated by the social security administration.

What happens when a disability examiner or a disability judge cannot find the specific evidence in the medical records that they are looking for, the type of evidence that paints a clear picture of what a claimant can still do or no longer do? They are forced to extrapolate; that is, they are forced to draw conclusions to the best extent possible. Often, this is very difficult. And very often this is why a disability examiner will contact individuals who are filing for disability to ask them about their routine daily activities.

Of course, this is exactly why qualified and competent disability attorneys and non-attorney claimant representatives will attempt to retrieve from a claimant's treating physicians the type of information that is absent from the medical records. They do this by asking the physician to complete a detailed and objective statement on the claimant's behalf, one that asks the doctor to actually rate their patient's ability to perform certain physical or mental tasks. These types of statements are known as medical source statements and residual functional capacity statements.

Are such statements effective? Yes, without a doubt. Statements from treating physicians can often form the basis for a Social Security Disability or SSI disability approval, particularly when presented in co-ordination will updated medical records at a hearing where both the claimant and their representative appear at a hearing together to present the facts of the case to a disability judge.

Can these statements be provided at earlier steps of the process such as the disability application or reconsideration appeal. Yes, they can.

However, disability examiners, who work in state-level processing agencies (known as DDS, or disability determination services, these are the agencies that make medical decisions for SSA), tend to give little credence to such statements. Which, of course, is not surprising as more than seventy percent of initial claims are denied by disability examiners throughout the country, while adminsitrative law judges tend to approve the majority of claimants who appear before them.








Essential Questions

What is the Social Security Disability SSI list of impairments?

Can you work while getting or applying for Disability?

How Often Does Social Security Approve Disability The First Time You Apply?

Tips for getting Social Security Disability or SSI benefits approved

What medical conditions will get you approved for disability?

What kind of Mental Problems Qualify for Disability?

Receiving a Disability Award Letter

Conditions Social Security will recognize as a disability

Previously answered questions regarding SSD and SSI

Applying for disability in your state



Most popular topics on SSDRC.com

Social Security Disability SSI Questions

The listings, list of disabling impairments

Can a mental illness qualify you for disability?

Disability Lawyers prevent unnecessary denials

How much Social Security Disability SSI back pay?

How to apply for disability for a child or children

Filing a Social Security Disability SSI application

Filing for disability - when to file

How to apply for disability - where to apply

Qualifications for disability benefits

How to Prove you are disabled and Win your Disability Benefits

Qualifying for Disability - The Process

How to get disability for depression

Getting disability for fibromyalgia

SSI disability for children with ADHD

What is the Application Process for Social Security Disability and SSI?

Common Mistakes to avoid after being denied for Disability

Social Security Disability SSI Exam tips

More Social Security Disability SSI Questions

Social Security Disability SSI definitions

What makes you eligible for Social Security Disability or SSI?



New and featured pages on SSDRC.com

Who can help me file for disability?




Related pages:

What determines your disability benefit amount?
Will an inheritance stop my disability benefits?
What happens to my disability benefits if I move out of state?
Who qualifies for disability? - Qualifying is based on evidence of functional limitations
How to qualify for disability - The Process of Qualifying for Benefits
To qualify for Social Security Disability or SSI, how severe must a condition be?
Can You Qualify for Disability if you did not work much?
How Do You Qualify For Disability without Money To Go To the Doctor?
The Qualification Criteria for Social Security Disability
What If You Did Not Work Long Enough To Qualify For Disability?
Qualifying for disability benefits with the social security administration
Qualifying for Disability - What is Social Security Looking for?
Do You Qualify For Social Security Disability Insurance?
What do you Need to Prove to Qualify for Disability Benefits?
What kind of Mental Problems Qualify for Disability?
Do You Have To Qualify For SSI Financially?
How does work qualify you for disability? (work credits)



These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing a SSDI or SSI disability application

Can you get temporary Social Security Disability or SSI benefits?

Permanent Social Security Disability

What is the difference between Social Security Disability and SSI?

Who is eligible for SSI disability?

Can I Be Eligible For SSI And Social Security Disability At The Same Time?

What makes a person eligible to receive disability benefits?

Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?

What happens if I file a disability application and it is denied by a disability examiner or Judge?









For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.