When you apply for social security disability benefits, Disability Determination Services, the network of government agencies responsible for evaluating disability cases, will review certain criteria to see if you meet the Social Security Administration’s definition of disabled.
The Social Security Administration currently defines a disability as any medical condition, physical or mental, that prevents you from working for at least 12 months, or that is expected to result in death.
When evaluating your disability claim, Disability Determination Services will want to know these five things:
1. The severity of your disability and its symptoms
One of the first things Disability Determination Services will evaluate is your medical record. Based on this record, they will determine whether or not your condition and its symptoms meet the corresponding listing in the “Disability Evaluation Under Social Security” handbook, also known as the “Blue Book.” If your condition is not listed in the Blue Book, the disability claims examiner will check to see if it is severe enough to meet a similar listing.
If your impairment is not listed in the Blue Book, don’t fret. You can still receive disability benefits if you can prove your condition limits functioning to the point of interfering with your ability to work.
“Disability Determination Services will want all medical records that are relevant to your alleged disability. They will want all records from any medical providers that have seen you during your period of alleged disability (i.e., since you have been unable to work) that show mental or physical impairments,” says Nick Huntsman, an attorney at Myler Disability.
“In evaluating your records, the adjudicator and medical expert will review all relevant records to determine whether or not they would preclude you from doing any of your past relevant work and any other work on a full-time basis in the national economy.”
2. How your symptoms interfere with your day-to-day life
When you go to apply for benefits, the Social Security Administration will ask you to fill out a form describing how you spend a typical day. This is called an “activities of daily living” or “function report” form. It requests information about activities like cleaning your house, cooking, getting dressed, bathing, using the bathroom, etc.
“After requesting records from your medical providers, Disability Determination Services will evaluate the records they receive in conjunction with your function reports to determine whether or not your records support your alleged level of functioning,” says Huntsman.
3. How you earned a living before your disability
Disability Determination Services will also want to know what kind of work you did before you were disabled.
“Disability Determination Services will be sending you a ‘work history’ report after your application is received by the Social Security Administration. On this report, they will be looking for specific information about your jobs covering the last 15 years prior to your application,” Huntsman explains.
“They will want to know dates of employment, job titles, any supervisory duties, exertion levels in regards to length of time sitting, standing, and walking during an eight-hour period. They will also want to know the amount of weight you lifted on the job and how often.”
It’s important to be as detailed as possible when it comes to past employment, as this information will be used to determine whether your condition truly impairs your ability to work.
“In addition, they will want to know if there were any technical skills involved with your job. This information will then be used during the evaluation process to determine whether or not you can go back and perform any of your past relevant jobs or if there are any transferable skills from your previous work to something more suitable to your current limitation.
“If Disability Determination Services determines you are unable to do your past work, they will next try to determine if there are other jobs in the national economy that you could perform on a full-time basis,” says Huntsman.
4. What treatments you have tried
When evaluating your disability, Disability Determination Services will also look at whether you have sought treatment for your condition. They will want to see a record of consistent medical appointments and a list of any medications you have tried; they will also determine whether or not you are using any assistive devices, such as a cane or brace.
It’s important to follow all your doctor’s recommendations for treatment. While Disability Determination Services cannot deny you benefits for failing to follow treatment recommendations alone, they will want to know why you failed to comply with your doctor’s orders.
Acceptable reasons for not following medical treatment include: you are unable to afford care, the side effects of treatment are worse than the condition’s symptoms, or the treatment is prohibited by your religion. If, however, Disability Determination Services determines that your rationale for not complying with treatment is unreasonable, they can deny you benefits.
“Hopefully you are seeking treatment specific to your condition. If you have a heart condition, it would be expected that you would be seeing a cardiologist and getting the appropriate diagnostic testing. If you have an orthopedic disability, you should be seeking treatment with an orthopedic doctor and have imaging—MRIs, X-rays, and CT scans—that shows the severity of your condition,” says Huntsman.
“If you have not had any diagnostic testing, Disability Determination Services may send you to a consultative examiner who may perform some very limited testing. If you do not have appropriate diagnostic testing, it will be difficult for Disability Determination Services to find you disabled. However, if you have appropriate treatment and testing, it will greatly increase your chance of proving your disabling condition or conditions.”
5. Your doctor’s opinion
While it’s not required for benefit approval, Disability Determination Services will give significant weight to any written statements from your treating doctor. The Social Security Administration refers to these letters as medical source statements, and they can strengthen your disability case immensely.
In a medical source statement, your doctor should specify what disability listing you currently meet, your symptoms, treatment history, and how your condition limits your daily functioning. Your doctor should also list any treatments you have undergone and the results of those treatments, including any side effects you may have experienced.
“The more detail your medical provider can provide in regards to a medical source statement or narrative, the better. Ideally, it is best to get a medical source statement from a provider who has a longstanding treatment relationship with you and is familiar with your medical conditions and limitations,” says Huntsman.
“It is very important that any provider who fills out a narrative or medical source statement also provides medical records that support the information provided in the statement.”
The more detailed information you can give the Social Security Administration and Disability Determination Services about your disability, the smoother the process will be. But don’t get discouraged if you aren’t approved during your initial evaluation. It may take a few rounds of appeals for them to determine you meet their definition of disabled so you can start receiving the benefits you deserve. If you have any questions about your case or approvals, don’t hesitate to reach out to an experienced social security lawyer in your area.