Because Social Security is a vast government agency, it has come up with a very formalized structure to determine whether you are disabled. This structure, which is called the “five step sequential evaluation process” requires Social Security decision makers to look at every case in a particular order.
While the evaluation process is the same in every case, Social Security continues to have issues with consistency in decision making. I regularly see instances where Social Security adjudicators or judges come to different conclusions in cases with almost identical facts.
While you cannot choose the adjudicator or judge, you can improve your chances by presenting a properly documented case and a clear argument as to why you are disabled. Because I try hundreds of cases before dozens of different judges every year, I have a fairly good idea what Social Security is looking for. I know that Social Security personnel are overworked and their offices are understaffed. Therefore, a big part of my representation is to narrow the issues, present relevant evidence and respect the adjudicator or judge’s time.
How Does Social Security Define the Word “Disabled?”
Social Security looks at disability primarily in terms of how your medical condition affects your capacity to work. Your medical condition is important in that it explains why you may not be able to work but a case consisting solely of medical information will not be approved unless your medical condition is so severe that you can barely function. This is called “meeting a listing” and is very difficult to do 1.
Instead, most disability cases come down to the question of whether the symptoms you experience leave you unable to perform the duties of a simple, entry-level, sit down type of job. If we can show that you cannot get through an 8 hour day, 5 days a week without problems like:
- excessive breaks
- missing too many days from work
- inability to sit or stand long enough at a time to complete work tasks
- unacceptable lapses in concentration and attention
- a too slow work pace
- inability to act in a socially acceptable manner
- we have a good chance at winning
I cannot emphasize enough the need to focus on specific problems with performance on a simple job. This is what Social Security decision makers are looking for and this is what we must provide to them.
Need for Thorough and Updated Documentation
In addition to “speaking Social Security’s language” regarding your work capacity, another major concern of adjudicators and judges has to do with evidence. Understand that Social Security decision makers review files all day long from people who say that they are disabled. Your statements alone, however, will not be enough.
Social Security expects that your file will contain evidence that supports your claim. Ideally this evidence consists of medical records with the following characteristics:
- your medical treatment should be consistent over a long period of time
- at the time a decision is made in your case, your records should be current (at least within the past 6 to 8 months)
- there should be no suggestion that you are malingering or drug seeking
- your medical providers should acknowledge that your symptoms or medication side effects are troublesome
- your records should suggest that you have not been cured enough to resume work activities
Obviously, medical providers are primarily in the business of treating you, not documenting a file for a disability review. Further, a doctor who is treating you will document his successes more so than less successful treatment. While judges are trained to “read between the lines,” I have had success requesting and presenting functional capacity checklists to medical providers.
These functional capacity forms, which I customize for each case, are based on the official Social Security forms and they ask the medical provider questions about my client’s capacity to perform certain tasks. I specifically do not ask the physician if my client is “disabled” since that work has a specific legal connotation for Social Security purposes and physicians are not likely to be trained to reach legal conclusions. However I find that these relatively short forms are not threatening to physicians and I usually get a reasonable level of cooperation.
When deciding if you qualify for disability under Social Security rules, adjudicators and judges look for well documented files that identify specific work limitations. If you focus on work activity limitations as opposed to medical issues only, you greatly improve your chances at a favorable decision.