Social Security Disability Resource Center

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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 an 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?

  • What medical conditions will get you approved for disability?

  • What kind of Mental Problems Qualify for Disability?

  • Which conditions will social security recognize as a disability?

  • Tips for getting Social Security Disability or SSI benefits approved

  • SSDRC Homepage:

    Social Security Disability and SSI Resource Center

    The Most Basic questions about Getting Disability Benefits

    Social Security Disability SSI and whether or not you can work

    Common Mistakes to avoid after being denied for Disability

    Social Security Disability SSI Questions and Answers

    More Social Security Disability SSI Questions and Answers

    Common Questions about Social Security Disability and SSI

    Winning Social Security Disability or SSI Benefits

    The SSI Disability Benefits Program

    Medical exams for disability claims

    Applying for Disability in various states

    Social Security Disability SSI and Doctors - Yours and Theirs

    Social Security Disability and SSI Claim Reviews

    Social Security Disability SSI System and Benefits for Children

    Denials, Appeals, and Getting a Disability Lawyer or Representative

    What you should know about Social Security Disability and SSI Denials

    Questions about Disability Lawyers and Hiring a Disability Attorney

    Frequently asked questions about getting Denied for Disability Benefits

    FAQ on Disability Claim Representation

    Disability hearings before Judges

    Selecting and hiring Disability Lawyers

    Various Types of Benefits including SSI, Mental, and Child benefits

    Social Security and SSI based on Mental Disability

    Social Security Disability or SSI Benefits for Children

    Disability Benefits through Social Security

    Filing for Social Security Disability or SSI Benefits

    Social Security Disability SSI: Medical Evidence and Records

    Filing your claim for disability benefits

    Eligibility for receiving disability benefits

    Info about Social Security Disability Approvals and Being Approved

    FAQ on Social Security Disability SSI decisions

    The SSD SSI Decision Process and what gets taken into consideration

    Resources on this site

    Social Security Disability, SSI Terms and Definitions

    Previously answered questions regarding SSD and SSI

    For Individuals living in North Carolina

    Applying for Disability in North Carolina

    North Carolina Disability Lawyer

    Related pages:

    What does a Social Security Disability Examiner do?
    Can I Talk To the Disability Examiner Working On My Case?
    How Does A Social Security Disability Examiner Determine a Personís Functional Limitations?
    What happens if the Social Security disability examiner cannot find all the needed medical records?
    How long does it take for an examiner to review a disability case?
    Will the the SSA Examiner Call or Contact me about my Social Security Disability or SSI Claim?
    What tools are used by a Social Security Disability Examiner to Make a Claim Decision?
    After you file for SSD, the Disability Examiner may contact you for additional information
    Social Security Disability and Bilateral Hearing Loss
    The regulation for SSDI Retroactive Benefits?
    Will I qualify for disability Benefits in Wisconsin?
    If you apply for disability in in Wisconsin
    Getting a Disability Lawyer in Wisconsin

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

    How to file for disability, SSD or SSI
    How to file for Disability and what medical conditions qualify
    How long will it take to get disability?
    What if your disability gets denied?
    How to Prove you are disabled and qualify to win disability benefits
    How to get disability with a mental condition
    How long for Social Security Disability Back pay
    Social Security Disability SSI eligibility