Note: The SSDI, SSI disability system is federal and nationally standardized, though there are state differences in approval rates, wait times, the number of appeals available–as of the time of this writing–and even the name given to the stage disability agency (DDS, or the Bureau or Division of Disability Determination). Now, to answer the question…
The processing of winning disability benefits in North Carolina is normally not an easy one.
First of all, it takes a long time to receive a decision on a case. How long? Three to four months on initial claims, on average, but sometimes as long as six months for the initial decision.
Secondly, the percentage of approved initial claims is low. Roughly 30-33 percent of cases are awarded, meaning 67-70 percent of all initial claims are typically denied in any given year.
Thirdly, there is the fact that winning disability benefits requires a claimant to prove that they have significant functional limitations.
Why is this an issue? One of the great stumbling blocks encountered in most cases–and this applies in every state, not simply North Carolina–is the fact that most medical records obtained from doctors give very little attention to the ways in which a person is affected by their condition, i.e. their functional limitations.
As we have stated, Social Security is not concerned with the diagnosis of a condition that you have. Instead Social Security, and it’s evaluation process, is focused on how a condition affects your ability to engage in normal daily activities, and your ability to perform work activity.
If you have ever seen copies of your own medical records, then you have probably noticed that the records will indicate your diagnosed condition, any observations that have been made on your visits to the doctor, reports of any lab values or imaging studies (such as x-rays), and possibly a prognosis.
But, usually, there is very little mention of any trouble you might have in a functional area, such as trouble bending at the waist, trouble grasping small objects with your hands, reaching into overhead cabinets, lifting more than 25 or 50 pounds, etcetera.
Doctors, for the most part, simply do not record this information into their treatment notes. Unfortunately, this is the type of information that Social Security needs to approve a person who is hoping to win disability benefits.
So, with this in mind, what can you do to help ensure that your case satisfies the requirements for disability?
1. You may wish to review your own medical records.
And, in fact, if you obtain your medical records and submit them when you file your disability claim (which can sometimes result in a faster decision — waiting on medical records is usually the single largest delay on a case), you can use this as an opportunity to see what your physician has indicated in their treatment notes.
In some cases, claimants have been able to learn early on in the process that their doctor was not supportive of their case, or that the information that was recorded in their medical records was simply not very detailed and helpful in winning benefits.
In such instances, a person filing for disability may find it wise to begin mentioning how their condition affects them when they visit their doctor, hoping the doctor will incorporate this information into their medical records. They may also choose to discuss with their doctor the fact that they are seeking disability benefits, in an attempt to ascertain whether the doctor will be supportive of their claim.
2. You may wish to get a statement from your physician in support of your case.
A statement from a claimant’s can literally have the effect of winning a case. However, there are two things to remember.
First of all, when we say “statement”, we do not mean a short handwritten note from a doctor. Very often, however, this is what a doctor will attempt to provide. Obviously, most physicians have an extremely limited understanding of how the federal disability benefits system works.
What is needed from the doctor is a detailed and objective statement that actually clarifies all the various ways in which the patient is limited from engaging in normal daily activities.
Usually, a statement in this format will be referred to as a medical source statement, or a residual functional capacity form.
On this type of form, among other things, the doctor will indicate the strength levels of the patient, how long they can sit, stand, or walk, as well as how much range of motion they possess in their limbs, and, additionally, any limitations they might have with regard to vision or hearing.
There are, of course, other areas of function that are addressed by a physician statement. Very often, this type of statement will simply be a multi-page form that asks the doctor questions and then supplies checkbox choices for the doctor.
A physician statement can be a powerful tool for winning a case. However, this brings us to the second point.
Unfortunately, contrary to the Social Security Administration’s own guidelines for deciding cases, a statement from a physician will very often have little effect at the initial claim or reconsideration appeal level.
This is because decisions on SSD and SSI cases at the first two levels of the system are made by disability examiners. Disability examiners must answer to their own unit supervisors who are usually under pressure to keep the number of approvals down.
Therefore, despite the fact that social security regulations state that a qualified statement from a physician must be given consideration, very often at the first two levels of the system such a statement is practically ignored.
At the Social Security Disability hearing level, however, the medical statement, if it is supported by the information contained in the physician’s medical records, will be given consideration and weight, potentially “controlling weight” on the case.
If your case gets to the disability hearing level in North Carolina, your representative will not only obtain your most recent medical record updates, but should also attempt to obtain at least one medical source statement from one of your treating physicians.
In fact, it can be argued that how disability judges view the physician statement may account for the wide divergence in the number of cases approved at the hearing level versus the number of cases approved at the first two levels of the system.
Which is exactly why the person who has been denied on the disability application, and then on the reconsideration appeal, should not give up, but should pursue their case to a hearing.