Social Security carefully reviews your medical records for evidence of disability
"What does Social Security look for in your medical records?" This, surprisingly, is a question I don't hear very often. However, I remain convinced that the great majority of individuals filing for disability benefits has wondered at some during an application or appeal just what it is that social security looks for when evaluating their medical records. In other words, how do you get approved?
1. How far back will Social Security look at your medical records?
2. The best medical records for a disability claim 3. Medical records at disability hearings
4. Disability hearing decisions
Here's a basic answer to the question and it applies to all levels of the system, which, for most claimants, will be the disability application level, the request for reconsideration, and the disability hearing. It also applies to both types of adjudicators -- examiners who render disability determinations at the initial and reconsideration stages and ALJs (ALJ means administrative law judge) who decide the outcome of disability hearings.
In reviewing your medical records, the social security administration looks for evidence of a claimant's inability to earn at least a certain minimum level of income (known as SGA or substantial gainful activity) while engaging in the performance of either A) past work (potentially any job that has been done in the last 15 years) or B) other work (which can include a wide range of work, but which may be limited to certain types of work as determined by an individual's age, education, skills, and functional limitations).
If you're thinking to yourself, "I thought working made me ineligible for disability", you are incorrect. However, this is a common mistake made by many, simply because the social security definition of disability is a little complex. In actuality, the social security administration states that an individual is considered disabled and eligible to receive benefits if they cannot work and earn at least a certain amount (defined as SGA) for a period of at least a year.
How does this all translate for the individuals who work on Social Security Disability and SSI claims? Here's how:
A disability examiner who is assigned to a case reads the medical evidence that is associated with it and develops a synopsis or summary that allows the examiner to conceptualize what the claimant's physical and/or mental limitations are. This synopsis is used to develop an RFC form, or residual functional capacity form, which basically states what the claimant is incapable of doing.
This preliminary RFC and the examiner's writeup or synopsis are reviewed by the medical consultant (or psychiatrist, depending on the impairments in question) who is attached to the examiner's unit. Following this consultation, a final residual functional capacity determination will be made (in other words, the final RFC will be based on what the doctor agrees to) and the examiner will begin to examine the vocational aspects of the case.
How is this done? The examiner will review the claimant's work history and determine the functional requirements of the claimant's past work. If the claimant's current functional capacity assessment precludes the ability to engage in past work, then the examiner will proceed to the next step in the evaluation process.
The next step is to evaluate whether or not the claimant can perform some type of other work. Other work may include a wide range of jobs that the claimant has never performed but may be capable of performing based on the claimant's age, education, job skills, and current limitations (indicated by residual functional capacity assessment).
It goes without saying that "other work" is the step at which many claimants are denied their disability benefits. And at a hearing, of course, representation provided by an individual who is familiar with vocational factors (as well as how to engage in a discussion of work hypotheticals) can literally make the difference between winning or losing a case.
However, this discussion of the decision process utilized by examiners at the initial claim and reconsideration levels also highlights the importance of providing the social security administration with a complete and detailed description of one's work history.
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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