Winning a Social Security Disability Appeal or SSI Appeal

You will have the best chance of winning a disability appeal when you provide some or all of the following:

1) Additional medical evidence.
2) Updated medical evidence.
3) Statements from a physician who has a history of treating you.
4) An argument for approval based on the facts of the case and a knowledge of Social Security rules and regulations.

If the appeal you are filing is for what is known as request for reconsideration, the chances are that you won't have more recent, or updated, medical evidence to provide. This is simply because the disability application and the reconsideration are often separated by just a few weeks.

However, if your appeal is for a disability hearing, there will be months of separation between the time you request the hearing and the time you get a hearing date. Therefore, there will nearly always be additional medical evidence to gather simply due to the passage of time.

Note: Social Security does not gather your medical evidence for you at the hearing level. You, or your disability attorney if you are represented, will need to obtain your most recent records and submit these to the hearing office.

In some cases, however, particularly if you have a disability attorney or disability representative, it may come to light that Social Security did not obtain all your records that needed to be considered. When this occurs, it will be important for you and your attorney to obtain the evidence and make it available to the hearing office. Discovering that Social Security did not obtain and consider all your records will generally not be known until the full file or exhibit list can be viewed, something the attorney will do prior to the disability hearing.

Statements from your doctors can certainly help you win your disability appeal. However, these should not be generic statements, but rather specific statements that testify as to your functional limitations. The type of statement that can assist your case is called a medical source statement and this is usually obtained by your disability representative or lawyer before a hearing is held. It is usually not obtained for a reconsideration appeal since disability examiners who work on those appeals generally do not give those statements much consideration.

Finally, an argument for approval of your case is sometimes referred to as a theory of the case. In essence, this is simply an assertion that you, the claimant, with your age, level of education, type of work history, and types of physical and/or mental limitations do, in fact, meet the Social Security definition of disability. This claim will have to be supported by an analysis of the medical evidence, and usually an analysis of your past work history. The attorney who represents you at the hearing may also have to cross-examine a vocational expert or a medical expert if the judge has such experts called for the hearing.

Disability appeals can be won when the evidence has been gathered and properly considered. And appeals can provide a path to winning, whereas simply filing a new disability claim can be synonymous to spinning one's wheels. Nonetheless, many applicants do this.

Filing a new claim instead of filing a disability appeal

In just about every instance, it makes more sense for a disability claimant to appeal their case rather than filing a new disability claim (the exception to this rule is when their case has been denied on a technicality, such as too much monthly income or assets, and then only if this issue has changed since the initial filing). This is because, each time a claim is appealed its chances of approval increase.

All disability appeals, both SSD and SSI, are evaluated in the same state agency that makes disability determinations on the initial claim for the federal social security administration. This agency is called disability determination services (DDS) in most states, although its name may vary slightly from state to state.

Given the fact that the same agency renders a decision in the appeal as in the initial claim, some applicants may wonder if appealing their claim is a waste of time, or if a case really has any better chance of being approved upon appeal if the same agency is considering the same facts.

The answer to this question is that, yes, it is almost always in a claimant's best interest to file an appeal with social security. First of all, about 15 percent of all claims that were denied the first time they were considered, will be approved upon review. The first appeal to DDS, or request for reconsideration, is also an opportunity to introduce any new medical evidence in support of the claim that was not available or was for whatever reason omitted when the application was first filed.

Okay, so that still leaves about 85 percent of applicants who are denied disability benefits even after they have appealed the decision. However, an appeal, even if it is denied, is still useful in that it helps to move the case forward to the second level of appeal, which is to request a hearing before an administrative disability judge.

At this level, a case stands its greatest chance of winning'about half of all disability claims are approved when they are heard before a judge, and more than half are approved when the claimant has legal representation, either a disability lawyer or non-attorney advocate.

Factors that affect the chances of winning

If you are older, or if your past work history includes jobs that required physical exertion or certain repetitive movements (as in the case of carpal tunnel syndrome), you stand an even better chance of being approved for benefits upon reconsideration appeal or at a disability hearing.

However, anyone who suffers with a disabling medical condition, be it physical or mental, can win disability benefits. That is, provided they can supply medical records to document that they have been diagnosed with the condition by a medical professional, have sought treatment, and are still experiencing symptoms that prevent them from earning enough to make a living.

To sum it up, the chances of winning a disability appeal are, like those of winning an initial claim, directly related to the quality of medical evidence provided to the examiner or judge making the determination, and the expertise with which this evidence is presented. That is why it is highly recommended that disability claimants retain legal counsel if they are planning to appear before an administrative judge, or even sooner if they are having difficulty gathering the information needed to support their claim.

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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