After you attend a disability appeal hearing and the administrative law judge (ALJ) has heard your case, the judge will send a written opinion (decision) to you. The decision will state whether you were approved or denied, and explains the basis for the judge’s decision.
A disability approval can be either full or partial. The difference is the dates for which you'll receive disability benefits. When you applied for disability, you provided the SSA with an alleged onset date. This is the date you felt you became disabled due to your condition. But the judge doesn't need to agree with this onset date when awarding you benefits.
A full approval means that the ALJ agrees with you as to the date you became disabled. If you win a full approval (called a fully favorable decision), you will be awarded benefits back to your alleged onset date.
When an ALJ doesn't agree with your alleged onset date, yet finds you disabled, it is called a partially favorable decision. In this case, the judge's opinion will explain why the ALJ disagreed with the alleged onset date and will provide the date the ALJ believes the disability began. This date is then called your established onset date. If the established onset date is later then the onset date you alleged on your application, the amount of back pay you will receive will be less (although it won't affect your future monthly payments). For more information on how your back payments will be affected, see our article on past due benefits.
Another way a judge can make a partial approval is by approving you for a "closed period" of benefits. In this case, the judge believes that you were disabled when you applied, but are no longer disabled. The judge will approve you from your alleged onset date or a later onset date, to the date he or she believes your condition improved to the point where you weren't disabled. For more information, see our article on closed periods of disability benefits.
Lastly, the ALJ might deny your disability claim outright. If the ALJ denies your claim, you have 60 days to ask the Appeals Council (AC) to review your case. Your appeal must be in writing and, in order to be successful, must demonstrate that the ALJ’s decision was not based on substantial evidence. New and material evidence, such as lab results the ALJ did not review, can also be grounds for an appeal. Although you can file an appeal with the AC on your own, you have a greater chance of success if you consult an attorney with experience in appealing disability denials. For more information, see our article on appealing a disability denial to the Appeals Council.
The judge's written opinion (explanation) of the decision will outline each step of the judge's five-step evaluation process and apply the facts of your case at each step.
The first step of the analysis is usually straightforward: you may not be engaged in a substantial gainful activity, or SGA (generally, earning $1,260 per month from work in 2020). If you are earning $1,260 or more per month your benefits will be denied, unless the judge agrees that your work was an unsuccessful work attempt. If the judge finds you are not performing SGA, the opinion will proceed to discussion of step two.
At step two, the ALJ discusses whether your impairments are “severe” according to the SSA’s definition. An impairment is considered severe if it interferes with basic work-related activities (such as sitting, standing, bending, getting along with others, following directions, and so on). During this step, the ALJ will briefly explain why, or why not, your impairment is severe. If your impairment is not severe, your claim is denied. If your claim is based on multiple impairments, it is not uncommon for an ALJ to find some of the listed impairments severe, and others not severe. If the ALJ determines that you have at least one severe impairment, the opinion will proceed to discussion of the third step of the analysis.
At the third step of the analysis, the written opinion will discuss whether your impairment meets or equals one of the medical conditions (called a listing) that qualify for automatic approval. If your condition does meet or equal a disability listing, the hearing decision will explain why your illness qualifies. For example, if you suffer from disabling asthma that has required repeated hospitalizations, the decision will review each hospitalization and the treatment you received, and explain why your condition meets the listing requirements for asthma. If your impairment does not meet or equal a listing, the ALJ will discuss why not, in detail, and continue to step four of the analysis.
During this step, the decision will discuss the jobs you performed in the past, including your duties, the hours you worked, how long you were with your employer, and your reasons for leaving. The ALJ will discuss the type of work you cannot do and the type of work you can do and state what your exertional capacity is (heavy, medium, light, or sedentary work). For example, "Claimant is precluded from heavy lifting due to aneurysm. Claimant can lift and carry 25 pounds frequently and up to 50 pounds occasionally. The claimant’s exertional limitations translate into a maximum sustained RFC for medium work." (RFC stands for residual functional capacity.)
The opinion will next discuss whether the judge or vocational expert (VE) felt you could still do your past work in light of your testimony and the medical evidence. If a VE testified that you could still do your old job, or if the ALJ felt you could still perform your past work, the opinion will explain why, and you will be denied. However, if the ALJ concluded you can no longer do your past work, the opinion will continue to the final step. (Read our article on proving you can't do your past work.)
Step five of the analysis is the usually most detailed portion of the opinion. In this final step, the ALJ will discuss your documented symptoms, review in writing the opinions of your treating physicians and any examinations perform by the SSA, and discuss laboratory or imaging results, as well as review the statements you made in the hearing about your condition. If any inconsistencies exist in your records or in your testimony, the ALJ will discuss them at this point and state whether they affected the outcome of the claim. ALJs frequently use this portion of the analysis to discuss the credibility of the claimant and whether the ALJ believed the testimony given.
The ALJ will next discuss the extent of your education, your age, and the skills you acquired at your previous relevant jobs. The judge will assert whether a medical-vocational rule applies to your situation, and whether, under that rule, you are expected to be able to "adjust" to other work. The ALJ will also review any questions posed to a VE and discuss what, if any, jobs the VE felt you could perform, and the jobs the judge believes to be in your range, if any. Only if there is a med-voc rule that says you are disabled or if there are no jobs you can do will the judge end the decision by saying that you are granted disability benefits. (Read our article on how to prove there are no other jobs you can do.)
Updated February 4, 2020