According to Social Security, 64% of people who apply for disability are denied after their initial application for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. Even more people (86%) receive a denial letter after they've requested reconsideration, the first step of the disability appeals process.
So statistically, most applicants get denied for SSDI or SSI two times before they have their best shot at getting benefits with a disability hearing. If you've been denied Social Security disability, read your denial letter closely to figure out the reasons why the agency denied your claim—and find out what type of evidence you'll need to show that your claim shouldn't have been denied.
Denial letters are pretty short—typically two or three pages. You can recognize a denial letter because it will say "Notice of Disapproved Claim" near the top of the first page. Denial letters contain a brief description of your medical impairments, the records that the Social Security Administration (SSA) considered in making the decision, and an explanation for the denial.
Denial notices should also include a "technical rationale" (a full explanation of the medical issues involved in the decision) and a discussion of your residual functional capacity (limitations about what you can and can't do at work). If your denial letter doesn't include the rationale, you should request your file from Social Security so you can review it before you appeal.
Social Security may have denied your claim for many reasons, but the most common is that the agency thinks that you can still work full-time—either because you're still able to do your past work or because you can do other, less demanding work. For example, if Social Security thinks that you can do an easier type of job than you've done before, your denial letter might say something like this:
Other reasons the agency may have denied your claim include:
Social Security can also deny your claim if you don't meet the financial eligibility requirements to receive SSDI or SSI.
Deciphering a denial letter can be tricky. For most applicants, the key to finding out why you were denied lies in the technical rationale (sometimes referred to as the "Disability Determination Rationale").
Here, Social Security will list your severe impairments along with any functional limitations you have as a result. Work-related functional limitations can be exertional—such as limits on how much weight you can lift or how far you can walk—or non-exertional, like restrictions on using your fingers to type or how long you can concentrate on tasks.
The set of work-related functional limitations in your denial letter is known as your residual functional capacity (RFC). Social Security compares your RFC with your past work to see if you could still do those jobs today. If you can't, the agency then needs to determine whether other jobs exist that you could perform, despite the restrictions in your RFC. Social Security will deny your claim if you can return to your past work or perform other jobs.
All limitations in your RFC need to be supported by medical evidence. The evidence used to arrive at your RFC is discussed in the technical rationale (in fairly dry language—the letter will refer to you as "the claimant" rather than your personal name, for instance). Here's an example using excerpts from Nolo's Guide to Social Security Disability:
These paragraphs of the rationale discuss the evidence that Social Security used to arrive at an RFC for light work. Note that the agency considered the objective imaging (EKG), surgical records, and the doctor's opinion before concluding that, while the claimant didn't automatically qualify for disability by meeting a listing, the claimant shouldn't perform any work that requires lifting more than 20 pounds occasionally.
If you think that Social Security didn't consider medical evidence that shows you're more limited than what your RFC says, you should submit those records with your appeal. In the above example, if the claimant did, in fact, have a treadmill test showing severe dyspnea (shortness of breath) on exertion, the agency likely should have included additional restrictions in the RFC.
Most applicants are denied because Social Security thinks they can still work full-time. The agency will state what types of jobs they think you can do in the denial letter and explain how they arrived at that conclusion. Using the work history and RFC from the example claimant above, here's how the technical rationale might look:
In this section, Social Security established that the claimant had past relevant work (going back 15 years) as a winery worker and hadn't been earning at the substantial gainful activity level (around $1,500) since the alleged onset date (when the disability began) of June 15, 2023. The agency then compared the demands of the past work with the claimant's current RFC.
The claimant has a current RFC for light work, which rules out the winery worker position (which is classified as medium work because it requires lifting 50 pounds). But because Social Security found other jobs at the light level, such as cashier, the agency denied the claimant's application for benefits.
Read another example of a technical rationale in our article on reviewing your disability file.
This is a question disability attorneys often hear from clients who've already been awarded workers' compensation or veterans benefits—systems that have different standards of disability. Having a doctor write a note saying that you're "totally and permanently disabled" might have significance for those programs, but it doesn't fulfill Social Security's requirements.
Much of the confusion comes from the fact that workers' comp and VA benefits can award disability payments based on a percentage rating (for instance, 65% disabled), which Social Security doesn't do. These benefits are also awarded based on a link between your current disability and your activities at your past job or while in service. So you might qualify for VA benefits or workers' compensation under the standards of those programs, but not yet meet Social Security's definition of disability.
It's also worth noting that Social Security doesn't require you to be comatose or in an iron lung in order to receive benefits. For example, you can still work (up to a certain amount) and receive SSDI or SSI benefits at the same time. And applicants 50 years of age and older may get benefits even if they're able to do some other jobs under the medical-vocational grid rules.
Finally, if you've been out of full-time employment for at least one year but you've since returned to work due to improved health, you might qualify for a closed period of disability.
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 contain enough medical evidence to establish disability. Fortunately, you can fix this when you appeal. The following are some tips to help you home in on issues on your application.
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.
The fact that Social Security denied your disability claim doesn't necessarily mean that you aren't disabled. Most cases will be denied, but don't give up on your claim, whether it's for SSI or SSDI. (Social Security denies more applicants for SSI than it does for SSDI, partly because there are more SSI applicants each year.)
The moment you receive your denial letter, you can appeal the denial. And the sooner you appeal, the sooner Social Security can schedule a disability 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 after a hearing, read our article on unfavorable decisions from judges to understand your next steps—even then, it's not over. You can head to the Appeals Council to try to get your claim heard a fourth time.
Updated January 8, 2024