How does Social Security Disability decide that you cannot work?

How does social security decide whether your can work or not? By evaluating your medical evidence, rating how limited you are, and then comparing this rating to the kind of work you did in the past. By using this sequential evaluation process, the social security administration can decide if you are capable of returning to one of the jobs you performed within the fifteen year period prior to becoming disabled, or whether or not you are capable of doing some type of other work that you have never done before.

In terms of physical RFC ratings, a claimant may be given a sedentary RFC, meaning they can only do sedentary work, a light RFC, meaning that they are considered incapable of doing anything other than light capacity work, or they may be given a medium RFC, meaning they can only do medium exertional work and nothing more.

RFC ratings can also rule out certain activities that the medical evidence of record suggests they can no longer do. For instance, an RFC may indicate that a person cannot have exposure to chemical agents, cannot use their hands for tasks requiring high dexterity, cannot tolerate heights (possibly due to vertigo or lower back problems, or seizure disorder), or cannot engage in activities that rely heavily on using a particular sense, such as sight or smell, or hearing.

In terms of mental RFC capacity ratings, the RFC determination may indicate that the claimant's capacity for work activity may be compromised by shortcomings in memory, shortcomings in the ability to attend to tasks and concentrate, shortcomings in the ability to learn new information and tasks and transmit information to others in the work environment, and shortcomings in the claimant's ability get along with co-workers or supervisors.

How are RFC ratings used? They are first compared to the past work of the claimant and what those individual jobs required (in terms of physical requirements and mental requirements). If the RFC rating indicates that the claimant no longer possesses the ability to do their former work, they will have passed one step of the disability evaluation process.

The next step is to evaluate whether or not the claimant has the ability to do some type of "other work" based on their age, work skills (and whether or not these skills are transferrable), and education. If the claimant, through their various RFC restrictions-limitations, is found to be unable to do their past work and is also found to be unable to do some type of other work, they will receive a Social Security Disability award, or an SSI award, depending on which program their claim was filed in.

Disability examiners make decisions on cases at the first two steps of the Social Security Disability system: the initial disability application, and the request for reconsideration appeal. The third step of the system (which is also the second appeal in the system) is the hearing. To get to a hearing you have to file a "request for hearing before an administrative law judge". Administrative law judges, or ALJs, of course, are the individuals who make decisions at this level of appeal.

How do disability hearings and administrative law judges differ from other levels of appeal and from disability examiners? Judges for one thing tend to approve higher percentages of claims. This may be because claimants usually have disability representation in the form of a lawyer or a non-attorney disability advocate. It may also be because ALJs work somewhat independently and are free of the culture of denial that seems to permeate the state disability agencies where disability examiners 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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