When you are preparing to appeal a denial of disability benefits, you should request your case file so that you can review some key pieces of information. As you review your file, you'll want to note any inaccurate and missing information and look for mistakes made by the claims examiner or medical consultant, such as not considering all of your impairments or overstating your ability to work.
The Social Security Administration (SSA) now keeps all disability files in electronic format, but Social Security representatives have the authority to copy appropriate disability information in your file to a CD-ROM for you. Call your local Social Security field office to request your file; in some instances, you might even be able to persuade a representative to mail you a copy rather than requiring you to pick it up. If you can't use a CD-ROM, you may need to pay to have your file printed for you.
Your disability file should come with an "exhibit list," which is like a table of contents for everything in your file. They allow the administrative law judge (ALJ) and you or your lawyer to be able to quickly tell what is in the file and to refer to a piece of medical evidence by its assigned number on the list. Exhibit lists are compiled by the Office of Hearings Operations (OHO). After OHO creates your exhibit list, a copy is sent to you and your lawyer. The completion of an exhibit list usually signals that a case is close to being scheduled for a hearing before a judge.
Your file should also include copies of all disability applications, forms, and appeals that have been filed, as well as copies of all medical records gathered by disability examiners at Disability Determination Services (DDS). It should also contain your Social Security earnings record, any letters sent by you, your family, or your employer, or medical source statements (letters from your doctor), and all notices of prior decisions by Social Security, including the rationale for why you were denied benefits.
If you've already attended an ALJ hearing and you're appealing to the Appeals Council, your file should also contain a transcript of the hearing and the ALJ's Notice of Decision.
Look at the following records and forms to see if you can spot any errors.
Make sure your key medical records are in the file, from each doctor who is treating you for a serious impairment.
If your medical records contain comments by your treating doctor about your disability, note what they say, whether they are clear, and whether they support or hurt your case. You or your lawyer might need to contact your treating doctor for clarification of a statement or to contest a comment you think is inaccurate. For example, if your doctor mentions you can do "light work," he may not know what the SSA considers light work (standing or walking six hours out of an eight-hour day and lifting 10 pounds frequently, and up to 20 pounds occasionally). If your doctor's statement makes it seem like you can do more than you actually can, explain this to your doctor and ask the doctor to write a new letter or fill out an RFC form accurately describing your limitations.
Sometimes, a doctor doesn’t provide information the SSA needs, even if the doctor has it. For example, your doctor may have described one of your conditions but not another. Or your doctor may have said you have "arthritis with some pain" in certain joints. This isn’t enough information for the SSA to decide the severity of your arthritis. If your doctor can’t say more, Social Security can have you examined at the government’s expense through a consultative examination (CE). For instance, for arthritis, a CE doctor could take X-rays, evaluate the swelling around your joints, have blood tests done for rheumatoid arthritis, and consider how your arthritis limits your ability to carry out your daily activities.
Other times a doctor leaves out a test result that's needed to prove you fulfill the requirements of a disability listing. (Read about the impairment listing for your medical condition, if there is one.) Ask the doctor for documentation of the test, or if your doctor hasn't performed a certain required test, such as an MRI, you can ask to be sent to a CE.
Form SSA-831 is the official disability determination document used by Disability Determination Services (DDS). One copy stays with your file, and other copies go to other SSA offices, but no copy goes to you. Most of the information on the form will be of little use to you because of the codes used by the SSA, but it should contain the name of the DDS disability examiner and the DDS medical consultant who worked on your claim.
Note the name of the medical consultant who signed the SSA-831 and the number of the specialty code near his or her name. Such specialty code information can be valuable in discovering whether the wrong kind of doctor reviewed your claim. For instance, mental impairments should always be evaluated by a psychiatrist or psychologist, and children’s claims about physical impairments should always be evaluated by a pediatrician.
Your file may contain a Form SSA-4268: Explanation of Determination, stating the technical rationale the DDS claims examiner used in making your disability determination (called the Disability Determination Rationale), or the rationale may simply be attached to Form SSA-831. Because the technical rationale contains a lot more detailed information than the personalized explanation rationale you were sent with your denial notice, it is in your interest to look it over, even though it includes bureaucratic language you may not understand. By reviewing the technical rationale, you can see the step-by-step reasoning that the SSA used to deny your claim.
The technical rationale typically discusses the following:
To understand how you may be able to challenge the SSA in each of these areas, visit the above links.
Example of a Technical Rationale:
The claimant has alleged disability since 5/1/2018 due to “diabetic, hearing, heart.” When he has diabetic attacks, he has cold sweats, shakes, and acts drunk. The DO claims representative noted that he had a hearing aid and occasionally needed questions repeated.
The evidence reveals the presence of insulin-dependent diabetes. There are allegations of frequent diabetic attacks, but there are no medical records to support this. A general consultative examination was obtained, as there was insufficient evidence from the treating source to evaluate severity. This revealed the following abnormal findings. He wore a hearing aid and had difficulty hearing a tuning fork. The lower extremities showed some mild chronic venous insufficiency, but there was no evidence of diabetic neuropathy. No heart problem was documented. There is X-ray evidence of an abdominal aortic aneurysm. This is asymptomatic and surgery is not anticipated. There is no complaint of chest pain. A consultative hearing evaluation was done since further documentation of severity was needed. The audiogram showed bilateral hearing loss between 65 to 85 decibels. Speech discrimination is 88 percent and a hearing aid is recommended and used by the claimant. He can hear loud conversational speech and can hear over the phone.
None of the above impairments is of the severity described in the Listing of Impairments. The combination of impairments also does not meet or equal the listed impairments. Per SSA-4734-F4, dated September 10, 1984, heavy lifting would be precluded due to the aneurysm. The claimant can lift and carry 25 pounds frequently and up to 50 pounds occasionally. The hearing deficit and alleged insulin reactions would preclude work around dangerous machinery or at heights.
The claimant is 60 years old and has completed nine years of school, which is considered to be limited education. He has worked for 34 years as a wire drawer for a wire company. This heavy, semiskilled work performed in a noisy and hazardous work setting required him to be on his feet all day, frequently lift 50-pound coils of wire, and occasionally lift coils that weigh 100 pounds. Demands of his past relevant work correlate to those of Wire Drawer (wire), DOT 614.382-010.
The claimant’s exertional limitations in themselves, as translated into a maximum sustained RFC for medium work, would prevent him from doing his past relevant work. The special medical-vocational characteristics pertaining to cases that feature arduous, unskilled work are not present.
The exertional capability to do medium work presents a potential occupational base of approximately 2,500 unskilled sedentary, light, and medium occupations, which represent a significant vocational opportunity for claimant. This individual’s hearing impairment and the medical restriction to avoid working around dangerous machinery and at heights would only minimally narrow that potential occupational base. Looking at the claimant's age, education, and past work experience under the framework provided by medical-vocational rule 203.04, he is expected to effectuate a vocational accommodation to other work.
Some examples of unskilled occupations that are within his RFC include: Bagger (ret. tr.), DOT 920.687-014, Turner (can. & preserv.), DOT 522.687-038, and Crate Liner (furn.), DOT 920.687- 078.
Your file will contain Form SSA-3369-F6: Vocational Report or other forms where you documented your work history, and your past jobs will be mentioned somewhere within the technical rationale. If DDS made inaccurate statements about your previous work history, you will need to correct it. Compare what you put on your forms against what DDS said on your denial rationale. If it's necessary to correct your file regarding your work history, you can ask your employer or coworkers to submit written information to the DDS regarding your work duties, performance, or dates worked.
If your claim was denied because your impairments were considered not severe (mild or slight), or DDS said you could do your past work, your file may not include an RFC form. But if DDS said you can do other, less demanding work than your past jobs, your file should contain a physical RFC form (Form SSA-4734-U8: Residual Functional Capacity Assessment).
Check the RFC forms to make sure that the information is actually true. Note the limitations and abilities the medical consultant from DDS gave you. Do you agree with them? Do they contradict your treating doctor? Did the medical consultant say you have more exertional ability (such as lifting, carrying, walking) than your treating doctor says you have? Did the medical consultant fail to give you limitations suggested by your treating doctor, such as avoiding excessive fumes or restrictions on frequent bending of your back?
As you can see, understanding the SSA's rationale for denying you benefits and whether they made any mistakes is complicated. Disability lawyers are experienced in finding errors in the SSA's rationale and arguments for why you should have been found disabled. But if you aren't sure you want to hire a lawyer, then at least learn more about how the RFC analysis works.
If you were denied benefits for a mental disability claim, there are two other forms you'll want to review carefully: the mental RFC and the PRTF.
The mental RFC form is Form SSA- 4734-F4-SUP: Mental Residual Functional Capacity Assessment. Ask the following questions as you review your mental RFC.