Understanding A Social Security Disability Denial

After the long, confusing process of applying for Social Security disability benefits, it is understandably very frustrating to receive a denial. While the Social Security Administration (SSA) has no official policy to deny first-time applications, it is fairly easy to see why some people might think they do! Though the rate of denial varies from state to state, nationwide about 65% of all disability claims are denied on the first application.

Receiving a denial does not necessarily mean you will never be able to receive benefits. You can always appeal the SSA’s decision – but you must do so within 60 days from the date of the denial notice! So if your application has been denied, the very first thing you should do is contact your local Social Security office to request an appeal. This will prompt the SSA to send you the necessary forms right away, so that you can get them completed and submitted prior to the deadline. Next, it’s important to take a close look at your denial so you can understand why you were denied in the first place.

Look At Your Denial Notice

If your initial application is denied, you’ll get a notice of denial from the SSA. This document will contain a brief description of your medical condition, the impairments that were considered, the medical and nonmedical records that were considered, and it will briefly explain the SSA’s reasoning for denying your claim. Some denial notices will also include Form SSA-4268: Explanation of Determination. This form states the technical rationale that the claims examiner used in making your disability determination. If your denial notice does not include this form, you can request it from the SSA so that you can review it.

Lack of Medical Evidence

All applications for Social Security disability are evaluated on the basis of medical evidence – and the primary reason that applicants are denied is for failing to provide sufficient medical documentation to back up their claim. Even if your application included a consultative medical exam with a doctor hired by the SSA, those exams are generally quite brief and often shed little light on your actual disability determination. Instead, your disability examiner must rely on whatever medical evidence you have provided.

Look at your file to determine if there are any areas where you need to provide additional medical documentation. If your medical records contain comments from your treating doctors about your disability, note whether the comments are clear and whether they support or hurt your case. For example, if your doctor uses the phrase “light work,” he or she may not know that the SSA has a specific definition of what type of work that entails. If your doctor’s statements makes it seem like you can do more physically than you actually can, you may need to speak with your doctor about writing a new letter for your appeal or filling out a residual functional capacity (RFC) form on your behalf. If your condition is listed in the SSA Blue Book, your appeal will need to specifically provide enough medical documentation to prove all the listed criteria in order to be approved.

Understanding Residual Functional Capacity (RFC)

If your condition doesn’t match a Blue Book impairment listing, your file will also include a discussion of your residual functional capacity (RFC). Your RFC is an assessment performed by your disability claims examiner with the help of a medical consultant from your state’s Disability Determination Services (DDS). Your RFC indicates what level of physical exertion the SSA thinks you are capable of performing and it is used to determine whether you can be expected to return to your prior job.

For example, the SSA considers “light work” the ability to lift up to 20 pounds and perform a good deal of walking and standing or pushing and pulling controls. “Sedentary work” means you can lift no more than 10 pounds and that walking or standing should only be required occasionally. In addition to classifying your physical exertion ability, your RFC will also contain any other restrictions that would limit the jobs you would be able to do (for example, not being able to use your fingers or difficulty remembering instructions).

Check your RFC to make sure that the assessment is accurate and corresponds with the information provided by your treating doctor. For example, if you have a physical RFC, did the medical consultant say your level of physical exertion (such as lifting, carrying, or walking) is higher than what your treating doctor says you can do? It’s also important to check what type of doctor evaluated your application – mental impairments should always be evaluated by a psychiatrist or psychologist and children’s claims about physical impairments should always be evaluated by a pediatrician.

Medical-Vocational Grid Rules

Using your RFC as a determination of your physical abilities, your claims examiner will have determined whether you are able to return to your prior job. If the examiner decides that you are unable to do so, the medical-vocational grid rules will be applied to determine whether you can be expected to learn how to do a new job. The grid rules take into consideration your RFC, your level of education, the skill level of your past work, whether any of the skills from your past work can be transferred to another job, and your age. It is generally easier for individuals older than 55 to qualify for a “medical-vocational allowance” under the grid rules. However, other important factors – such as the skill level of your past relevant work or the transferability of your skills – can also play a role in dictating whether your appeal will be approved. A disability lawyer can help you make sure these aspects are described accurately in your appeal.

Disability Benefits May Still Be Possible

Even if your application is denied the first time, it may still be possible for you to be granted disability benefits. However, it’s important to keep in mind that you’ll need to follow the official appeals process to get the SSA to reconsider your claim. The sooner you begin the appeals process, the sooner the SSA will be able to schedule a hearing, which will give you the best chance of a successful claim.