How does Social Security use Evidence to Decide an SSDI or SSI Disability Claim and Make a Decision?

Disability decisions for claims filed with the social security administration utilize a process known as sequential evaluation. Under this system, a disability examiner will essentially review the case evidence to determine if the claimant is capable of engaging in work activity while earning a livable wage (known as SGA or substantial gainful activity).

When a disability examiner at DDS (disability determination services) is working to evaluate and reach a decision on an SSDI claim (Social Security Disability insurance) or SSI (supplemental security income) case, the examiner will focus on evidence.

The "evidence" includes that evidence which has been supplied by the claimant at the time of applying for disability, and also that evidence which has been further gathered by the examiner from A) medical treatment sources, B) the claimant, C) employers (though this is not usually the case), and D) individuals who know the claimant (this is usually in the form of a third-party contact individual who has been listed by the claimant at time of filing for disability).

The evidence reviewed and evaluated by a disability examiner tends to fall into three types of categories: medical evidence, vocational evidence, and subjective assessments.

Medical evidence on a Social Security Disability or SSI case

This includes all the records that are gathered from the claimant's treatment sources, such as individual physicians, hospitals, and clinics. It will also include the results and reports obtained from any medical examinations that the claimant is sent to. These examinations are known as "consultative examinations". A CE is paid for by the social security administration and is performed by a medical physician, or psychiatrist if the exam is psychiatric in nature, or a psychologist if the exam involves memory or IQ testing.

Vocational evidence on a Social Security Disability or SSI case

This includes all the evidence that pertains to the claimant's work history. This will typically include the information that the claimant has supplied at the disability application interview regarding their past work history, as well as any work activity forms that have been requested by the disability examiner.

It may also involve any information gathered directly from the claimant's former employers (though, ordinarily, disability examiners do not take the time to contact former employers). Lastly, vocational evidence can include the testimony of a vocational expert at a disability hearing if the administrative law judge holding the hearing has determined that it is necessary.

Subjective Assessments

This correlates with information gathered from the disability claimant or from individuals who know the claimant. A good example of this is information obtained that records ADLs, or activities of daily living. To elaborate, very often disability examiners will either phone an applicant or send them them a form to complete that asks about their daily activities.

Examples of the questions that are asked include: "Are you able to cook?", "How do you go about your grocery shopping?", Can you use a vacuum cleaner?", "Can you reach into cupboards?", Can you bend down to retrieve items from cabinets?", "Do you have difficulty with personal hygeine tasks such as bathing?", etc.

The objective of this type of questioning is for the disability examiner to learn whether or not the claimant is experiencing any day-to-day functional limitations. Why are such limitations important? Because these are the same types of limitations that might be reflected in a work environment, meaning that if a person has difficulty picking up a bag of groceries, they might also have difficulty picking up a container or box.

Or if that same individual has difficulty buttoning a shirt due a hand impairment, they might also have difficulty with fine and dexterous movements involving precision tools or even in operating equipment.

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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These pages answer some of the most basic questions for individuals who are considering filing a claim.

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