Social Security Disability Denials: What a Denial Means

A denial doesn't necessarily mean you're disabled -- look at your denial notice to see the rationale for the denial.

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Disability denials are, unfortunately, what most disability claimants can expect to receive after they file a claim for benefits with the Social Security Administration.

Statistically (depending, to some extent, on where a disability claimant lives), initial claims have a denial rate of approximately 65%. Reconsiderations (the first step of appeals) are denied at an even higher rate (up to 85%).

Denial Notice

A notice of denial from the Social Security Administration will contain a brief description of your medical condition, the impairments that were considered, the medical and nonmedical records that were considered, and an explanation for the denial. For instance, the explanation might say that there are jobs other than your prior work that you can still do. Some denial notices will include a "technical rationale," a full explanation of the medical issues that led to the denial decision and usually a discussion of your residual functional capacity (RFC) and past jobs. If your notice doesn't include the rationale, request your file from Social Security so that you can review it. For more information, see our article on reviewing your disabiilty file before an appeal.

Technical Rationale

Here's an example of a technical rationale from Social Security excerpted from Nolo's Guide to Social Security Disability:

The claimant has said that he became unable to work as of 06/15/20xx due to “a heart condition.” He was in the hospital when he applied and was to have bypass surgery. There is no work issue.

The medical evidence documents the presence of coronary artery disease. The claimant was hospitalized 06/22/20xx due to chest pain with EKG changes suggestive of ischemia. Cardiac catheterization showed 75% obstruction of the left main coronary artery. He was discharged to await bypass surgery. Triple bypass surgery was performed 07/09/20xx. Three months after surgery, the treating physician reported that there was no chest pain. No treadmill test had been done and none was planned. The doctor said the claimant should limit lifting to 10–20 pounds.

The evidence documents the presence of a severe cardiovascular impairment. However, the findings do not meet or equal the severity of any of the listed impairments. While Listing 4.04C1.b was met at the time of the angiogram, the bypass surgery improved the condition and there is no longer any chest pain. The claimant would be restricted from lifting more than ten pounds frequently or more than 20 pounds occasionally due to his heart condition. There are no other medically imposed limitations or restrictions. The individual is capable of performing light work.

After a military career that ended in 1986, the claimant did no work until 01/93 when he was employed as a cashier in a discount liquor house. This was full-time work at SGA [substantial gainful activity] levels until 01/95. From 01/95 until AOD [alleged onset date], 6/15/20xx, he worked on weekends only, and that work was not SGA. The period 01/93–01/95 lies within the relevant 15-year period, and was of sufficient duration for him to gain the job experience necessary for average job performance. Therefore, his job as cashier has current relevance.

Demands of the job included sitting most of the day while operating a cash register, observing the merchandise being purchased, taking the customers’ money, and making change. These duties entailed the abilities to sit, see, talk, reach, handle, finger, and feel. He also demonstrated an elementary knowledge of mathematics and cash register function. It was occasionally necessary for him to stand and walk a few feet to secure a register tape, and then insert the tape into the machine.

With the exertional capacity to do light work, and, in the absence of any nonexertional limitations, this individual is able to do his past relevant work as he described it. Therefore, he is not disabled.

A Denial Does Not Mean You Can't Win Disability Benefits

The fact that your disability claim was denied does not necessarily mean that you aren't disabled. The most basic fact of the SSA disability process is simply that most cases will be denied, often because there wasn't enough medical evidence to prove the case, forcing claimants to go through the disability appeal process. Disability claimants should never resign themselves to giving up on an SSDI or SSI claim. Quite the opposite, the moment a claim is denied means that you can appeal, and the sooner you appeal, the sooner Social Security will schedule a hearing, which gives you the best chance of winning your claim.

Learn more about appealing a disability denial or arrange a consultation with a disability lawyer in your area.

Updated by: , J.D.

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