Understanding the Social Security disability evaluation process is important because it helps us understand how to prepare a better claim.
The Application
The first step in the disability process is for us to submit an application. On the application we include information about the doctors you seen, the medical tests you have had, procedures you have had, and medications you are taking. We also include information about your work history and your education.
Once we submit the application it goes to the local Social Security office. At that office they make some technical determinations in your case. For example, they look at your work record to determine whether you have worked for long enough to qualify for disability insurance benefits. They also look at whether you are currently working (if you are doing substantial work, you are not disabled) and whether you meet the income and asset requirements for SSI.
If you meet the technical requirements for disability, they will send your claim to a state agency called the Disability Determination Services, or “DDS.” Once your claim gets to DDS it is assigned to a person called a Claims Examiner. The Claims Examiner is the person who will make the decision about whether you meet the medical requirements of disability.
The Claims Examiner
When the Claims Examiner gets your claim, that person will review the application and request the medical records from the medical sources you have listed. When those medical records are received, the Claims Examiner will write a short, usually one page, summary of those medical records. Then the Claims Examiner will send the claim to a different person at DDS called a Medical Consultant.
The Medical Consultant
The Medical Consultant will review your medical records and make a list of limitations in what Social Security calls “Basic Work Activities.” Basic work activities are the basic things that you need to do to be able to do any job. For physical activities, basic work activities include things like sitting, standing, walking, lifting, carrying, bending, kneeling, climbing stairs, and other similar activities. For mental activities, basic work activities include things like being able to remember and follow simple instructions, being able to get along with supervisors and coworkers, being able to work without being distracted by or distracting others, being able to maintain normal standards of hygiene and dress, and being able to maintain normal schedules.
A normal list of limitations in basic work activities will look something like this.
This person can occasionally lift 20 pounds and frequently lift 15 pounds. He can stand and/or walk about six hours in an eight hour workday. Likewise, he can sit for about six hours in an eight hour workday. He can occasionally (up to one third of the workday) climb ramps/stairs, ladders/ropes/scaffolds, balance, stoop, kneel, crouch and, crawl. He can reach overhead with both arms occasionally. He can do simple, routine work with occasional contact with others.
Making the Decision
After creating this list of limitations, the Medical Consultant will send the case back to the Claims Examiner. The Claims Examiner will then compare the list of limitations with the physical and mental requirements of the work that you have done in the past 15 years, called past relevant work. If the Claims Examiner determines that you can do any of your past relevant work, then you will be found not disabled. If you are determined to not be able to do any of your past relevant work, then the Claims Examiner will compare the list of limitations to all other work available anywhere in the national economy. If the Claims Examiner finds other work available your claim will be denied. If, on the other hand, there is no other work available you will be found disabled.
There are a couple of special situations to be aware of regarding age. If you are age 50 or older and you have never done a sit-down type of job and you don’t have the skills for a sit-down type of job, Social Security does not expect that you will work a sit-down job in the future. Therefore, even if you are found capable from a physical and mental standpoint of a sit-down type of job, Social Security will not require that you return to that job and will instead find that you are disabled.
Similarly, at age 55 if you are limited to what is called light work, which is work that requires standing on your feet for about 6 of 8 hours and lifting 20 pounds occasionally during the workday, and you have only done heavier manual labor types of work, Social Security will find that you are unable to return to other work and award disability.
Understanding this process, helps us to understand what sources Social Security looks to to determine your eligibility for disability benefits and what information Social Security is looking for in those sources.
How To Build a Better Claim
First, the primary source of information for Social Security about your disability is the medical records. That means that your limitations should be documented clearly and completely in those medical records.
Second, Social Security will be looking for limitations in basic work activities in those medical records. That means that you should make sure to discuss with your doctor how your medical conditions limit your ability to do daily activities such as cooking, cleaning, shopping, and interacting with others. The more specific and detailed the examples your doctor writes into the medical records the better.
If for example, you are over the age of 50 and your past work has all been truck driving, you will need to establish in the record that you are now limited to lifting less than 20 pounds occasionally and you are limited to standing/walking for less than six of eight hours. That means that you want to provide your doctor with examples from your daily activities that establish these limitations.
On the other hand, if you are under the age of 50 you will need to establish that you are unable to sustain any activities for an eight-hour workday sufficient for you to work. For example, if you have depression that keeps you from leaving the house several days a month you will need to establish that limitation in the medical record to show that you are unable to maintain normal schedules. If you have back pain that requires you to lay down for several hours during a normal eight-hour work., You will need to establish that in the medical records.
Using these simple techniques can substantially improve the quality of the evidence Social Security relies on determine your disability. Of course, having this information will not guarantee that you will win your case. However, having this information will definitely help you build a better claim and make your chances of winning much higher.