SSD Disability

Monday, August 3, 2009

How does Social Security Disability Consider Your Medical History?

Approvals for disability benefits, and denials, are based on a number of factors, both medical and vocational in nature. However, the process really does begin with an applicant's medical history.

As soon as a disability claims examiner receives a social security disability or SSI disability claim from a social security field office, the first substantial act the examiner will perform in processing the case will be to request the claimant's medical records. These requests are based on information provided by the claimant at the time of application, and, obviously, this underscores how important it is that a claimant provide detailed information regarding their diagnoses, dates of treatment, and places of treatment. Leaving out a single source of medical treatment can potentially disadvantage a claim. For example, if older sources of treatment are not listed by a claimant when they file for disability, this may make it difficult for the social security administration to substantiate the claimant's alleged onset date (when they claim their disability began). If recent medical treatment sources are not listed, this may make it difficult to prove that the claimant is currently disabled.

What information is looked for in a claimant's medical history? Essentially, anything that confirms a diagnosis of a condition as well as the existence of functional limitations.

Social Security disability and SSI disability cases are based on the notion that a claimant must be totally disabled to qualify for disability benefits; however, for the social security administration "totally disabled" means being unable to work (either at a job a person has performed in the past, or at some other form of work) at a certain level. That level is known as SGA or substantial gainful activity, something that is defined in terms of a gross monthly income limit. An applicant who works and earns this amount or more will not be eligible to receive disability benefits.

One significant problem that surfaces in the processing of social security disability and SSI claims is the fact that most physician's treatment notes devote relatively little time and attention to notating the impact of a patient's condition on their ability to function, or engage in normal daily activities, including work activity.

Despite this fact, however, every individual who files for disability will have their functional capacity rated by both a disability examiner and either a medical consultant or a psychological consultant who is attached to the disability examiner's processing unit. Obviously, since this residual functional capacity rating is being delivered by an individual who is not a medical professional (the disability examiner) and by a physician or psychologist who has never treated, or even met, the claimant, the validity of the rating is somewhat questionable. Which may be borne out by the great divergence in approval rates between the first two levels of the social security disability system and the third level of the system where decisions are made by administrative law judges.

How does social security consider your medical history? It's probably safe to say that the information contained in your medical records is the chief determinant of the decision you receive on your claim.

However, disability decisions are medical and vocational (work-related) in nature. Meaning that a claimant's work history, the identification of the jobs worked by a claimant, the demands of those jobs, and the skills associated with each job, can have an enormous impact on the outcome of a case.