When a Disability Case Comes up for Review - Social Security and Medical Improvement

All disability beneficiaries (both Social Security and Supplemental Security Income disability) have to have continuing disability reviews (CDRs) periodically. All disability claims receive a "diary" date (think of this as a schedule date) for a continuing disability review when they are approved. Most individuals receive a diary date of three years, because they have conditions that may medically improve. Others receive shorter diary dates if Social Security considers the person likely to improve, or longer diary dates if social security considers that there is very little chance of medical improvement. When a disability case comes up for review, a Social Security claim representative may use one of the following methods to get the continuing medical review information. Some claims representatives schedule an appointment for their continuing disability reviews, while others do the reviews by phone or mail. Basically, it just depends on the method the field office claims representative prefers. Of course, if there is some reason a disability applicant needs to do their review in a method not preferred by the claims representative, they are within their rights to request another method. How does Social Security determine that there has been medical improvement? Social Security considers that an individual has had medical improvement if the improvement is demonstrated by either-- A) medical evidence (i.e. medical records revealing objective evidence that an individual's condition has improved or their physician states that they feel the individual is capable of working) or B) by the fact that an individual has returned to normal work activity with no subsidy from their employer--meaning that they are performing their work just as other employees who are not disabled. Unfortunately, some beneficiaries who receive their disability benefits on the basis of cancer, for example, are considered to have medically improved if they remain cancer free and their residual effects are not considered disabling. Conditions that have improved with treatment, either surgically or through rehabilitation or medication, are more likely to result in a CDR decision of medical improvement. By and large, though, most continuing disability reviews receive a continuance of disability benefits because most disability beneficiaries have not returned to work or been shown through their medical records to have had medical improvement to the point that they are not longer disabled.  This is especially true if the disability beneficiary suffers from some type of chronic condition that is very unlikely to medical improve over the course of time.

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Social Security Disability Secrets

Social Security Disability Benefit Questions

Social Security Said I can Still Work, What Does That Mean?

The Social Security administration uses a five step sequential evaluation process to determine if an individual meets the definition of disability under Social Security disability guidelines. The last two steps of the sequential evaluation process involve an individual’s ability to work.

Social Security addresses an individual's past work in step 4 of the evaluation process. When determining past work, Social Security uses the past fifteen years of relevant work activity. "Relevant work" is any work that an individual’s earnings were at SGA (substantial gainful work activity is a monthly earnings amount cutoff established by Social Security) or more for at least three months.

Social Security considers an individual's residual functional capacity to determine if they can perform any of their past relevant work. If it is determined that the claimant cannot perform any of their past work, given their limitations, Social Security moves to step 5 of the sequential evaluation process: Social Security must consider an individual’s potential ability to perform "other work".

Other work is defined as any job in the national economy that exists in sufficient numbers such that an individual might be able to perform the job when their age, education, residual functional capacity, and the transferability of their work skills are considered. If an individual’s residual functional capacity is so restrictive that--when taken in conjunction with their age, education, and skills--it prohibits their ability to perform even other types of work, they may be approved for Social Security disability benefits.

However, if Social Security determines that either A) an individual is able to perform any of their past work or B) an individual can perform some other type of work, they will receive a notice of denial.

If a claimant who has been denied does not agree with their disability decision, they should appeal it. The chances are in their favor, statistically speaking, that an administrative law judge will, in effect, disagree with the disability examiner’s original determination and approve the disability claim.









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Social Security Disability Secrets

Social Security Disability Benefits Questions



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Continuing disability reviews, how often will my social security disability or SSI case be reviewed?
How does social security define disability?
What is the Maximum You Can Earn While Applying For Social Security Disability?
Social security disability eligibility, disabled requirements
The Question of Who Qualifies for Disability Benefits
How are Social Security Disability and VA Disability Different?
If a person Qualifies For Disability, will They also Qualify For Medicare?
Do you have to be Disabled for a Year to get Social Security Disability Benefits?
Sending in a Social Security Disability Appeal

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Social Security Disability Secrets

Social Security Disability Benefit Questions

Are Social Security Determinations Based On Your Jobs?

Most SSD and SSI disability decisions are based on a perception of your residual functional capacity and how if affects your ability to perform work activity. In order to determine if you actually can perform work activity, the disability examiner or the disability judge, depending on the level your claim is at in the disability process, need to have information about the various jobs you have performed in the past fifteen years.

To that end, Social Security asks all disability applicants to provide work information at the time of their initial disability interview so that they can evaluate whether an individual is able to perform any of their past relevant work with their current residual functional capacity (what they are able to do in spite of their limitations). Relevant work is any job an individual had time to learn in which they earned substantial earnings and they stayed at for at least three months.

If Social Security determines that a person’s residual functional capacity is too restricted for them to perform any of their past jobs, they still must make a determination as to the individual’s ability to perform other types of work. When disability examiners make "other work determinations", they consider an individual's residual functional capacity, age, education, and the transferability of the individual’s work skills.

If an individual is not approved at the initial disability claim level, they should appeal their disability claim to the administrative law judge disability hearing level. Some would argue that administrative law judges have much more flexibility in making their disability determinations than disability examiners and that generally they do a more in depth investigation into an individual’s ability to work than disability examiners.

Roughly, two thirds of all disability applicants who appeal their disability claims to a disability hearing will win their disability case before an administrative law judge. This level of the disability process has the highest approval rate of all.









Return to:

Social Security Disability Secrets

Social Security Disability Benefits Questions



Other Posts

The Question of Who Qualifies for Disability Benefits
How are Social Security Disability and VA Disability Different?
If a person Qualifies For Disability, will They also Qualify For Medicare?
Do you have to be Disabled for a Year to get Social Security Disability Benefits?
How Does Social Security Decide I am Disabled?
Time limit to file a disability appeal
The social security hearing process
Social security disability eligibility, disabled requirements
If you get denied at a disability hearing, what is the next step?
Sending in a Social Security Disability Appeal

Return to:

Social Security Disability Secrets

Social Security Disability Benefit Questions