Social Security Disability Decisions sometimes make little sense

Someone recently described in a forum their own personal battle with the social security administration. This individual had become increasingly unable to persist at work (self-employment) and the situation worsened to the point where they could no earn an income (I should note that if your income drops below the threshold for SGA, Substantial gainful activity, then you should file for Social Security Disability).

They decided to file for disability and six months later they received, as about seven out of ten individuals typically do, a disability denial. They then did exactly what they should have done and filed their first appeal, a request for reconsideration. This, too, was denied, although much faster than the first denial.

What the poster had trouble understanding was that they had been denied despite A) the fact that their medical condition was thoroughly documented (their physician had made it clear that the claimant no longer had the ability to work and B) it was obvious, based on a long work history that, had there been no medical condition, they would have gladly continued to work.

From the standpoint of a disability claimant, it can be extraordinarily difficult to understand why a Social Security Disability or SSI claim gets denied. The claimant knows that their condition prevents work and so why shouldn't the social security administration. It doesn't seem to make sense. However, what most claimants don't realize is that...even to disability examiners, the individuals who work to make decisions on disability cases, the federal disability system very often seem to make little sense.

Let me elaborate. When disability examiners are initially trained, they are exposed to medical terminology, basic medical concepts (the lymphatic system, the respiratory system, the cardiovascular system, etc), and, of course, Social Security Disability criteria. This training, depending on the state they are trained in, may last for weeks or months. And when the training is over, the examiner is ready to begin making decisions on cases...

The only thing is, the decisions new examiners are inclined to make are usually not the decisions their new unit supervisors would have them make. Yes, when new examiners are assigned to their claim processing units, they find out very quickly that the emphasis is primarily on looking for ways to deny disability cases, not get them approved.

Learning the preferences of a unit supervisor, of course, will go a long way toward guaranteeing job survival in a DDS (disability determination services, the state agencies that make disability decisions for the social security administration). Failing to learn what cases to approve and which to deny can make for a very short career as a disability examiner.

But, wait you say---aren't disability cases decided by certain rules and procedures? Why should a unit supervisor's opinion mean anything and why should it influence the outcome of a case? Ideally, it shouldnt". But---medical records are not entirely objective as many would have you believe. In fact, it is amazing how subjective they are. In fact, ten people reading ten separate medical files may reach ten separate conclusions as to the capabilities of an individual. Due to this fact, the subjectivity of records, unit supervisors are automatically imbued with the ability to influence the outcomes of cases based on their own opinions, even biases (some are biased against mental impairment cases such as ADHD and Bipolar).

Should it be this way? No. Is there a way to fix it? Yes. Social Security could easily eliminate a great amount of subjectivity from the process by simply allowing disability examiners to send out RFC forms to the treating physicians of claimants. They already have their own unit doctors complete RFC forms on claimants, but these social security doctors have never seen nor treated these individuals. So, how valid is that? I would argue, not valid at all.

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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