How does a Social Security Disability Examiner decide a case?

Continued from: Who will decide my Social Security Disability claim?

What information is used by a disability examiner to make a decision on a claim? The examiner will rely on the following:

1. The information contained in the medical records. The medical records will be used to interpret what the claimant's RFC, or residual functional capacity is. This is a measurement of what a person can still do despite their condition. If a person is rated with an RFC that is less than what their past jobs required of them, they may be considered disabled if it is also true that they do not have the ability to switch to some form of other work.

2. The information contained in any statements obtained from the claimant's doctors. Statements from a doctor can help support a claimant's disability case if they go so far as to point out how limited the claimant is, i.e. how their condition restricts them. The statement should cite objective findings and should also give some indication as to the claimant's prognosis.

So, obviously, a statement from a doctor that simply says that their patient cannot work will not be enough. The statement must describe how the claimant is limited. For example, does the individual have difficulty sitting or standing, or lifting more than a certain amount of weight, or difficulty with grip strength, or even trouble seeing and hearing. Any physical shortcoming should be noted.

In addition to physical limitations, a claimant's medical treatment specialist (e.g. psychiatrist) may be able to indicate any mental difficulties the claimant has, such as a reduced ability to comprehend, sustain attention and concentration, recall information, or learn tasks.

3. Information regarding the claimant's work history. The disability examiner will not only review the medical records but will look at the various jobs the individual has worked prior to becoming disabled. This will be done so that the examiner can compare the claimant's current range of physical and mental abilities (and limitations) to the demands of their past jobs.

In many cases, the conclusion will be that the claimant is so limited that they are unable to go back to one of their former jobs. However, the process does not end there. The examiner also looks at past jobs to determine if the individual has the necessary skills (in combination with their age and education) to perform some type of other work. Very often, individuals who are found to be unable to return to their past work are still denied for disability because it is decided that they can do "other work".

Denials based on the ability to do other work happen frequently at the first two levels of the system and there is really nothing a claimant can do regarding this. However, at the disability hearing level, a claimant who is represented may be much more likely to prove to the administrative law judge that they can neither return to past work or do other work.

In some cases, this will be because the claimant's past jobs were previously improperly classified. In other cases, it will be because the judge has brought in a vocational expert to give testimony and the claimant's Social Security Disability attorney will be successful in challenging the statements made by the expert.

More at: Who makes the decision at the disability hearing level?

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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