subject: Your Medical History: The Crucial Component Of Your Social Security Disability Claim [print this page] How does the Social Security Administration (SSA) decide whether your condition is disabling? Although a variety of factors are taken into account in processing your claim, the most critical component in your case lies in your medical records. It's crucial to provide the SSA with all of the information necessary to understand your medical condition and how it relates to your inability to work.
That information includes: consultations with doctors; reports of tests and evaluations such as x-rays, CAT scans, MRIs, blood tests; psychiatric examinations and consultations, if applicable; all hospitalizations and surgeries; physical rehabilitation, etc. The more medical documentation you have, the better. Be sure that you thoroughly discuss all of your symptoms and medical conditions with your doctor, including things you might consider trivial or embarrassing, like fatigue, pain and depression. Go regularly to your physician and make sure they document all of your symptoms each time, so that you have an accurate record to present to the SSA when you file your claim.
To provide even more support for claims, we ask treating physicians to give us information about how our clients' specific conditions limit their ability to work. The doctors need to be specific about why a patient cannot work, including such things as the patient's ability to sit, bend, reach, lift, concentrate or follow directions. SSA has a form called an RFC (Residual Functional Capacity), which your doctor can fill out to document your disability in a variety of areas.
After your case is sent to a disability examiner at the Disability Determination Service, the examiner and a physician will review your documentation. They may request additional medical documentation from your physician or other health providers involved in your treatment. They might also ask that you see another physician, or have additional tests, at their expense.
Once all of the medical information is gathered, they will decide whether your condition (or combination of conditions) is severe enough to be disabling, based on the merits of your records. If not, they determine if your condition is included in their List of Impairments, which includes 14 categories of the major bodily systems. Within each system, there is a breakdown of the different ailments that they consider disabling. If your medical condition is listed and your records document all of the required criteria, then you might qualify for disability benefits on that basis. If not, then they will consider how your condition affects your ability to function in three areas: daily activities; social functioning; and ability to carry out tasks associated with working. They're looking for what they call a 'marked limitation' in your ability to function. If they find that you can't work in your previous job, they will determine if you could be employed doing something else.
If your case is denied (and most are, at this level) and you progress to the appeals process, the judge who hears your case will review all of the medical data collected in your case. The judge will take testimony from you and may also call a vocational expert and/or a medical expert to testify at your hearing. The judge will then issue a written opinion in your case, usually within 60 days of the hearing. If your case is denied by the judge there are 2 additional levels of appeal but you would not testify at either level. The medical records and transcript of your hearing are reviewed to determine if the judge made a mistake or failed to properly consider all of the evidence. If the appeal is successful the case will be sent back for another hearing.
