How does social security decide your disability claim?

How does social security decide your disability claim? Answer: medical evidence, medical evidence, medical evidence. Yes, it all comes down to...the medical evidence presented by you or your disability attorney.

Medical evidence, of course, takes many forms, ranging from the office notes provided by your personal doctor to the admission and discharge summaries provided by the hospitals you've been treated at. And, in the case of mental disability claims, they include the progress notes provided by a treating psychiatrist as well as any treatment summaries provided by a psychiatrist (which many psychiatrists will opt to supply, sometimes even in lieu of the actual treatment notes).

And, finally, medical evidence includes any detailed statements that you or your attorney are successful in obtaining from your treating physician. Such statements, particularly when they thoroughly describe and detail a disability applicant's remaining (or residual) functional capacity, can have a significant impact at a disability hearing held by an administrative law judge.

Social Security Disability Cases are denied on the basis of medical evidence and they are approved on the basis of medical evidence. And for this reason it is extraordinarily important for a disability applicant to list all medical sources on the disability report form at the time of application.

How does social security evaluate medical evidence in order to decide your disability claim? Here's a short answer and one that should give you a bit of insight into the daily functions of a disability examiner (if you don't already know this, disability examiners are the specialists who render determinations on Social Security Disability and SSI claims for the social security administration).

Examiners will review the medical records associated with a disability claim in one of two ways, either reading the records as they arrive in the mail, or waiting until all the records have been received and then reviewing them. Either way, though, the examiner will typically review the records, make notes from what is read, and look for the following:

1) Medical Diagnoses of specific physical and mental impairments.

2) Lab reports and values; for example, abnormal values that might be taken into consideration for liver disease and cirrhosis, kidney disease, and diabetes.

3. Imaging study reports, such as for xrays, CT scans, and MRI scans.

4. The results of specific testing, such as Pulmonary function tests (for respiratory impairments such as COPD and treadmill tests (for cardiac cases, such as those involving a heart attack).

5. Indications of a treating physician's assessment regarding a claimant's functional capacity.

6. Indications of a treating physician's assessment regarding a claimant's prognosis.

In reviewing the medical records, if the claimant appears to have significant documentation regarding a single impairment (such as asthma, epilepsy, bipolar disorder, depression, osteoarthritis, or stroke, just to use a few examples), the examiner will consider whether or not the claimant meets or equals the requirements of a listing.

What is a listing? A listing is any medical impairment, physical or mental, that is listed in the Social Security Impairment listing manual, usually referred to as the blue book. Impairments that are listed in the blue book are given very specific disability approval criteria. And, for the most part, this criteria is very difficult to qualify under.

If the disability examiner finds that the claimant in question either A) does not have a condition that is listed in the impairment listing manual or B) has a condition in the manual but cannot meet the approval criteria for that condition as set forth in the manual, then the examiner will evaluate the claim to see if a medical vocational allowance can be made.

In a medical vocational allowance, a claimant is approved for disability based on the determination that they cannot return to their past work, and cannot perform some type of other work. This type of disability determination is made with respect to a number of vocational factors that attempt to inject into the "disability evaluation process" certain real-world considerations regarding an individual's employability.

Consequently, consideration for a medical vocational allowance utilizes something referred to as the grid, a framework of rules that allow special consideration for a claimant's age, job skills, the particular jobs they have done in the past, and their level of educational attainment.

Because these factors play a role in the disability determination process, and because disability decisions are often based on vocational factors as well as medical factors, the following should be stressed.

1. Always supply detailed and correct information regarding medical treatment, both on a disability application and on a disability appeal. Also, if you have a claim that is currently being worked on and have seen a new doctor, have had some new testing, have experienced a change in your condition, or have a new diagnosis, let social security know immediately so this information can be taken into consideration.

2. Always supply detailed and correct information regarding your work history, including the titles of your past jobs, the dates employed, and the duties performed for each job. A failure to do this properly may potentially result in your past work being misclassified and may have an effect on your eventual disability determination.

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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