Will Social Security find you disabled? How is this done?
Once your Social Security Disability claim arrives at the state disability agency, a disability examiner requests your medical information from the various sources of treatment that you listed on your application for disability benefits. As they receive your medical information, they check to see if there are current medical records to address all of the medical and/or mental conditions you allege.
They do this because while older medical records can establish how long you have had a particular condition and how long it has impaired your ability to work (as well as how much you may potentially receive in back pay), it is the information obtained from current medical records that establishes whether or not a person is disabled according to the guidelines used by the Social Security Administration.
Current Medical Records and What happens if you don't have them
Social Security usually uses a twelve-month evaluation period to establish the severity of your conditions (in other words, to identify any limitations you might have'mental or physical, or both'that might interfere with work activity or, in the case of children, the inability to engage in age-appropriate activities).
Of course, some individuals have more than a year's worth of medical records, and others have less than a year. While Social Security likes to have a twelve-month medical history to make their disability decision, they are unable to make a disability determination without current medical records. Social Security considers medical records to be current if they are three months old or less; if you have no medical records within the last three months there is a good chance they will schedule a consultative examination for a current status of your disabling condition or conditions.
Once the medical evidence is in your disability file, the disability examiner begins the five step sequential disability evaluation process to determine if you are disabled according to the guidelines of the Social Security Disability program.
The first step of the sequential evaluation is to determine if your disabling condition is preventing you from performing substantial gainful work activity. If you are performing SGA-level work, it does not matter what your medical condition is--your disability claim will be denied. If you are not working and earning SGA-level earnings, however, the examiner will move to step two.
Step two is an evaluation of the severity of your disabling condition and a determination as to how long your impairment expected to last. Social Security guidelines require that an impairment last twelve continuous months in order for a person to be considered disabled. The objective medical evidence in your medical records is used to establish the existence and severity of your disabling condition.
How is this done? By evaluating your medical records, the disability examiner will be able to give you a rating with regard to your RFC, or residual functional capacity.
An RFC rating is a statement of what you are ability to do, functionally, despite having one or more conditions. Of course, the initial goal of the RFC assessment is to determine if your condition is severe or non-severe. If it is non-severe, you will be denied for disability. If your disabling condition is severe, the examiner moves to step three.
Step three is an evaluation to determine if you meet or equal the criteria of a Social Security Disability impairment listing. Social Security has a disability guidebook that contains impairment listings which list the criteria needed to meet the Social Security Disability severity requirements. The book is titled "Disability Evaluation under Social Security' and is often referred to as the blue book (in printed form, the cover is blue) or simply as the Social Security Disability list of impairments.
This guidebook contains both adult and children's impairment listings. At this point, if you meet or equal the requirements of an impairment listing, you may be found disabled. If not, the examiner must continue the process to steps four and five. Both of these steps involve an evaluation of your ability to work and perform substantial and gainful work activity when your residual functional capacity is considered.
To consider your residual functional abilities, a disability examiner will evaluate how your medical condition has affected your ability to do basic work-related activities such as:
The fourth step of the sequential evaluation process is a determination as to your ability to perform any of your past relevant types of work. To do this they must assess all of your past relevant work (any job you have performed in the past fifteen years in which you earned SGA, performed for three months or more, and had time to fully learn) to decide if you are still able to do any of those jobs.
If you are not able to do any of your past work, the examiner continues to fifth and final step of the disability evaluation process.
The Fifth Step
The fifth step is an evaluation of your ability to perform any other type of work when your age, residual functional capability, transferability of your work skills, and education are considered. If the disability examiner determines that your disabling condition is so restrictive that it not only precludes your past work but any kind of other work in the national economy, you may be found disabled.
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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