Social Security Disability Denials: What a Denial Means

Disability denials are what most disability applicants (64%) receive after they file a claim for benefits with the Social Security Administration. Even more applicants (87%) receive a denial letter after a "reconsideration" (where the applicant asks a different claims examiner to review the claim).

A denial means that you'll need to file an appeal and hope that Social Security finds an error or changes its mind—because you have more evidence to offer or your condition has gotten worse.

The standard language found in disability denial letters can make them difficult to understand fully without the help of a disability attorney or advocate. Here's how to figure out what a decision denying disability benefits means.

What's in a Denial Letter From Social Security?

A Notice of Denial from the Social Security Administration will contain:

• a brief description of your medical condition
• the impairments that Social Security considered
• the medical and nonmedical records that Social Security considered, and
• an explanation for the denial.

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). Your RFC is the level of work you can do: medium, light, or sedentary.

If your denial letter doesn't include the rationale, request your file from Social Security so that you can review it. (For more information on getting your file, see our article on reviewing your disability file before an appeal.)

Understanding the Reason for Your Denial

Social Security may have denied your initial claim for many reasons. Here are the most common reasons for denial:

• You still have the ability to do work you've done in the past.
• You have the ability to do a different type of work that's less demanding.
• You haven't followed your doctor's treatment recommendations, and Social Security thinks your condition might improve if you did.
• You failed to show up for a consultative exam with a doctor paid for by Social Security.
• You were working above the "substantial gainful activity" level when you applied for benefits.
• Your alcohol and drug use are "material" to your claim (meaning your medical condition might improve if you quit drinking or using drugs).

Your denial letter will likely refer to one or more of these reasons. For instance, if Social Security is denying you for the first reason, your denial letter might say something like this:

Read more about the six reasons Social Security may medically deny your claim.

Translating the Technical Rationale for Your Denial

The technical rationale (also called the "Disability Determination Rationale") will be on a separate page, typewritten on an "Explanation of Determination " form. In the rationale, Social Security will usually list the impairments an applicant ("claimant") has and whether they're severe. The agency will then go on to describe any type of functional limitations the claimant has that might prevent certain types of work. Limitations can include exertional limitations (such as lifting and carrying items, and walking and standing) and nonexertional limitations (such as using the fingers, stooping or crouching, or being around dust or fumes).

Exertional limitations determine what level of work the claimant is able to do (medium, light, or sedentary). For example, a claimant who can't stand and walk more than two hours a day will get a sedentary RFC. That means that the claimant isn't capable of doing any work that's categorized as light or medium. If the claimant's past jobs were light or medium, Social Security would have to agree that a claimant with a sedentary RFC can no longer do them.

Here are two examples of parts of a technical rationale from Social Security excerpted from Nolo's Guide to Social Security Disability:

In the above example, Social Security agrees that the claimant has a severe impairment and was disabled before bypass surgery. But since he no longer has chest pain and can lift to 20 pounds occasionally and up to 10 pounds frequently, the agency says that he has an RFC for light work. Examples of light work that Social Security might expect the claimant to be able to do include food assembler, dog bather, and cashier.

What Social Security means by "there is no work issue" means that the claimant isn't currently working above the substantial gainful activity limit. Social Security won't consider anyone who's working above that limit (about $1,500) for disability benefits.

In the second example, Social Security establishes that this claimant has prior relevant work as a cashier (because the work was done in the past 15 years). Social Security describes the job duties of that position, which the agency classifies as light work. Social Security states that the claimant has no nonexertional limitations that might limit the types of light work he could do. For instance, if the claimant had difficulty using his fingers for fine motor skills, he could no longer do the job of cashier. But without any nonexertional limitations, Social Security finds that there is no reason the claimant can't return to the type of work he was doing as a cashier since the claimant has an RFC for light work.

Figuring Out Why Social Security May Have Denied Your Claim

When reading through your decision letter and technical rationale, consider what you may have done—or didn't do—that led to the denial. Often the reason for a denial is that the application didn't have enough medical evidence to prove the case. Here are some tips to help you home in on issues on your application.

Did you submit information on all of your medical treatment? On your application, did you include the addresses and phone numbers of all medical providers you've visited (hospitals, clinics, and doctor's offices), the names of physicians providing treatment, and the dates of treatment? This type of medical information about your disability is extremely important. When you file your appeal, be especially detailed when listing any doctors, clinics, and hospitals you've visited since your disability began.

Were your doctors' reports detailed and accurate? For your appeal, you can improve the quality of your medical records by talking to your doctor about the functional limitations caused by your illness. For example, if you have a severe back condition, tell your doctor how long it takes for your pain to become unmanageable after sitting or standing. And let your doctor know about the activities you can no longer do because of your condition. You can also ask your doctor to fill out a "residual functional capacity" (RFC) form.

Requesting an appeal gives you a chance to get more medical evidence, including any imaging or test results that could prove the severity of your condition and, most importantly, a supportive medical statement from your doctor.

A Denial Doesn't Mean You Can't Win Disability Benefits

The fact that Social Security denied your disability claim doesn't necessarily mean that you aren't disabled. Most cases will be denied, but disability claimants shouldn't resign themselves to giving up on a claim, whether it's for SSI or SSDI. Social Security denies more applicants for Supplemental Security Income (SSI) than it does for Social Security disability insurance (SSDI), partly because there are more SSI applicants each year.

But the moment you receive your denial letter, you can appeal the denial. And the sooner you appeal, the sooner Social Security will schedule a hearing, which gives you the best chance of winning your claim. Before your hearing, you might consider hiring a lawyer or advocate, to make the best use of your time in front of the judge.

If you're denied Social Security disability three times (initial application, reconsideration, and hearing), read our article on understanding a disability denial from a Social Security judge. Even then, it's not over. You can still head to the Appeals Council to try to get your claim heard a fourth time.

_{Updated February 3, 2023}