Winning Your Social Security Disability Case: Avoiding the Pitfalls

A person does not have to be totally incapacitated or even totally unable to perform some work activity to qualify for Social Security disability benefits. As a matter of fact, a person receiving disability benefits from SSA can earn in excess of $900.00 per month and still be considered disabled. The definition of disability requires an individual be unable to perform "substantial gainful activity" because of a medical condition. This has been interpreted as full-time competitive work, 8 hours per day, 40 hours per week. The Social Security disability program was not designed to be a strict program. The program requires that medical records, provided to SSA, allow for an assessment of the capacity for work the person has left considering the impact of the disabilities. If that assessment, called a "Residual Functional Capacity" (RFC), indicates that the person does not have the remaining capacity to work full-time, the claim is valid. SSA places the utmost importance in developing an RFC assessment for every case.

Pitfall one: SSA does not encourage assessments of functional capacity (RFC) from the treating doctors. This results in less reliable assessment in work limits to the disadvantage of the claimant.

The determination of functional capacity is performed by SSA personnel. The medical records and reports (submitted or collected in connection with the disability application) are provided to a State Agency Physician. The doctor reviews the records and determines how much sitting, standing, walking and lifting the person can perform given the findings in the medical records.Most internally completed RFC forms indicate an ability to perform full-time work. This is the point at which cases are often denied. Most of the time, the determination of limitations imposed by the medical condition does not contain input from the treating doctor.

Strategy to assure an accurate RFC assessment.

A determination of the physical limitations that result from a medical condition is not very reliable when done by a non-examining doctor. A more meaningful assessment would come from the long term treating physician. As important as this is, SSA is takes a position that RFC forms are best completed by SSA authorized representatives like the State Agency physician. This lack of interest in obtaining the information from the treating doctor doesn't reduce the weight that the decision-maker is required to place on treating physician findings and opinions. This information from the treating source is supposed to be given greater weight than the opinion of one-time examining doctors or non-examining medical sources like the State Agency physician.

Consider the language in an 11^th circuit court decision about treating physician records. "It is not only legally relevant but unquestionably logical that the opinions, diagnosis, and medical evidence of a treating physician whose familiarity with the patient's injuries, course of treatment, and responses over a considerable length of time should be given considerable weight. Accord Broughton v. Heckler, 776 F.2d 960,962 (11th Cir. 1985)

A successful claim for benefits contains significant input from treatment sources like doctors, clinics, therapists and other people involved with the treatment to the claimant.SSA has to give greater weight to reports from your doctors. This does not require a great deal of time or effort from these sources. This should not require a great expense if approached properly by the claimant and/or claimant representative.

The Basic Social Security Application Process.

Most people file the application for benefits on their own without consulting with an advocate. The applicant called claimant is responsible for the completion of forms. These forms (most specifically, the Disability Report) ask questions to obtain details such as diagnoses, symptoms, limitations and sources of medical documentation like doctors and hospitals. SSA assigns the case to an agency of the state, called Disability Determination Services (DDS). This agency requests the medical records from the sources listed on the Disability Report form. These records may be the treating doctor's progress notes or hospital discharge summaries for each hospitalization. DDS may even arrange for an "independent examination". These reports tend to be less than reliable since the exams are a one-time brief examination. Once the claimant submits the information requested, SSA takes the iniative to complete the claim file and render a decision. The claimant must get involved with the claim process to avoid getting denied benefits due to another pitfall.

Pitfall 2. The Social Security Application process is over-loaded cases tend be denied due to incomplete medical support from the treating sources.

It is of the utmost importance that the claimant makes sure specific information is included in the claim file from the doctors that care for them on a regular basis. The progress notes often do not contain any discussion by any of the claimant's doctors of the limitations caused by the medical diagnoses. Doctors tend to take a medical short-hand when conducting the monthly or other episodic appointment with a patient. Spend your appointment time with your doctor covering specific information.

Clarify the diagnosis and clarify whether the doctor has appropriate medical test results confirming the diagnosis.

The doctor can make sure the record reflects reasonable limitations in activities such as sitting, standing, walking and lifting that result from the diagnosed conditions. This can be as easy as including a statement of limitations in the progress notes. This statement can be based on the patient clear explanation of the limitations in sitting, standing and walking experienced due to the symptoms. The doctor can indicate whether the limitations are reasonable based on the severity of the medical condition. The doctor should indicate whether it is likely that you can tolerate full-time work, 8 hours per day and 40 hours per week.

To make sure this information is in the file, a dialogue must be maintained between you and your doctors. Although, Social Security doesn't seek out RFC assessments from treatment sources, the weight placed on the "treating physician" as stated above.