Social Security Disability Tips - how a claim gets worked on

Here are a few informational tips about how your disability claim will be processed and evaluated, and this comes from my own experience as a disability examiner for the Social Security Administration's DDS, or disability determination services.

Once you file a claim for disability with Social Security, the claim is sent to a state disability agency known as DDS, or disability determination services for a medical disability determination. Once in the agency, it is assigned to a case-processing specialist known as a disability examiner.

Medical Records and Consultative Examinations

The disability examiner reviews the medical sources you provided in your disability application. If the examiner determines that there are no "current medical records" (medical treatment records that are no more than ninety days old), they will contact you to set up a consultative examination or multiple consultative examinations so that they have the current status of your physical and/or mental condition.

A consultative examination is usually a short physical or mental examination performed by a doctor who has been paid by Social Security. Consultative exams, CE for short, are not the best medical information sources, but if there is no other medical information or no current medical information, the examiner has no other choice but to use a consultative examination to give them enough information to make your medical disability decision.

In my opinion, a CE most often does not lead to an approval for disability benefits, unless it is something that involves objective testing such as psychological testing, memory scale testing, or some other medical testing that provides objective measurement. The point I am trying to get to is that, if at all possible, you should try to have some current medical treatment to address your impairments. Medical records from a doctor who is familiar with you will provide a better evaluation of your disabling condition than a doctor who sees you for ten minutes at a CE.

Information about daily activities may affect your claim

In addition to current medical treatment information, your disability examiner needs to have information about your ability to function in daily life to make their disability decision. They may contact you or your third-party contact person (a person you list at the time of filing your disability claim who has an opportunity to observe you performing daily activities such as shopping, cleaning house, mowing the lawn, etc) and ask to what extent you are able to perform normal activities.

Rather than personally contacting you or your third party, the disability examiner can accomplish this by sending out an activities of daily living questionnaire to you to complete and return, and a third party questionnaire to your third-party contact person to complete and return.

These questionnaires are to get an idea of how debilitating your condition really is with respect to the activities you routinely perform each day. You should speak with the person you designated as your third-party contact before the disability examiner contacts them or sends them their third party questionnaire.

Why? Information provided to the examiner about activities of daily living (ADL) is often used to deny SSDI claims and SSI disability claims so you and your third-party person should take the time to answer the questions to the best of your ability. This is one reason why it is very important to give Social Security a third-party person who truly knows about your disabling condition and how it affects you, versus someone you only casually and occasionally interact with.

Residual Functional Capacity and Jobs

The disability examiner uses all of the medical information in conjunction with the questionnaires to get an idea of what your residual functional capacity is. Residual functional capacity is what you are able to do in spite of the limitations of your impairments and it is compared to the information that is obtained regarding your work history, specifically the demands of your past work, as well as the skills that your past jobs required (because your skill levels will be used to answer the question of whether or not you can switch to some type of other work, even if you are unable to return to any of your former jobs).

To make your medical disability decision, the examiner needs information about the jobs that you performed in the past. However, the examiner will be primarily concerned with only the jobs that are deemed to be relevant and which occur in the "relevant period", i.e. the fifteen years prior to filing for disability.

Providing a detailed work history, that includes dates of employment, as well as a comprehensive list of duties performed in your past jobs, will help the examiner determine if you are capable of performing any of your past work, or finding gainful employment in some other kind of other work when considering your residual functional capacity, education, age, and job skills.

The effect of providing inaccurate information

However, if you provide an inaccurate job title, this may cause the examiner to misidentify your job. Even if you provide the right job title, but only provide a short description (under the assumption that the examiner will "automatically" understand what your job entailed), you run the risk of the examiner matching your short description with a job of the same title, but which is not even remotely the same job that you performed. This may cause the examiner to overestimate your skill levels, or underestimate the demands of your past work, both situations that may cause your claim to be denied on the basis of your being able to either A) return to your past work or B) engage in other work.

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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