If Social Security has denied your disability claim, you'll want to appeal. And when you're preparing to appeal, you should request your Social Security case file so that you can review some key pieces of information. As you review your file, you'll want to note any of the following:
Here's how to get your hands on a copy of your Social Security disability file and the key issues to look for when reviewing its contents.
The Social Security Administration (SSA) keeps all disability files in electronic format. But you can get a copy of your file in one of three formats:
You can request your file directly from the Social Security field office or hearing office where your case is pending. You can also call Social Security's toll-free national number at 800-772-1213. Whether you request your file over the phone or in person, you'll need to provide Social Security with the following information about you:
Once it's ready, Social Security can give you access to the content of your file online (through your My Social Security account) or mail it to you at the address you provide. You might also be able to arrange to pick it up at your local office, but don't expect to get it the same day you ask for it. It can take a week or two to receive your Social Security file.
Your disability file should come with an "exhibit list," which is like a table of contents for everything in your file. The list is designed to make it easier for you, your lawyer, and the administrative law judge (ALJ) conducting your appeal hearing to be able to quickly tell what's in the file and to find 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 an ALJ hearing.
Your file should include copies of all disability applications, forms, and appeals that you've filed, as well as copies of all medical records gathered by disability examiners at your state's Disability Determination Services (DDS) office. It should also contain the following:
If you've already had 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.
Once you've received your Social Security file, look at the following records and forms to see if you can spot any errors or missing information.
Make sure your file contains key medical records from each doctor 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're 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's notes mention that you can do "light work," it might be that your doctor doesn't know that Social Security considers light work:
If your healthcare provider's statement makes it seem like you can do more than you actually can, explain this to your doctor. Then ask the doctor to write a new letter or fill out an RFC form accurately describing your limitations.
Sometimes, a doctor doesn't provide the information Social Security needs, even if the doctor has it. For example, your doctor might have described one of your conditions but not another. Or your doctor could have said you have "arthritis with some pain" in certain joints. This isn't enough information for Social Security 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 do any or all of the following:
Other times a doctor might leave out a test result that you need to prove you meet the requirements of a disability listing. Ask your doctor for documentation of the test, or if your doctor hasn't performed a certain required test, such as an MRI, you can request one, or ask Social Security for a CE to get the test done.
Form SSA-831 is the official disability determination document used by DDS. One copy stays with your file, and other copies are sent to other Social Security offices. But you don't automatically get a copy.
Most of the information on the form will be of little use to you because of the codes Social Security uses. But the form should contain the names 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 the consultant's 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 based on physical impairments should always be evaluated by a pediatrician.
Your file might contain Form SSA-4268: Explanation of Determination, explaining the technical rationale the DDS claims examiner used in making your disability determination (called the Disability Determination Rationale). This rationale could also be attached to Form SSA-831.
The technical rationale contains a lot more detailed information than the personalized explanation included in your denial notice. So it's in your interest to look it over, even though it includes bureaucratic language that can be difficult to understand. By reviewing the technical rationale, you can see the step-by-step reasoning that Social Security used to deny your claim.
The technical rationale typically discusses the following:
Example of a Technical Rationale:
The claimant has alleged disability since 5/1/2022 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'll need to correct them.
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 Social Security didn't consider your impairments severe enough, or DDS said you could do your past work, your file might 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 form to make sure that the information is actually true. Note the limitations and abilities the medical consultant from DDS gave you and answer the following questions:
Understanding Social Security's reasons for denying you benefits and determining if DDS made any mistakes is complicated. You might want to discuss your case with a disability lawyer.
If you were denied benefits for a mental disability claim, there are two other forms you'll want to review carefully:
The mental RFC is Form SSA-4734-F4-SUP: Mental Residual Functional Capacity Assessment. Ask the following questions as you review your mental RFC.
The PRTF is Form SSA-2506-BK: Psychiatric Review Technique Form. This form is used to ensure the DDS psychiatrist or psychologist reviewing your case considers all the important information about your mental impairment. Read this form carefully (or have someone read it for you) to see if the medical consultant considered all the pertinent information in your file. Look for errors like:
You can try to investigate the problems with the mental RFC yourself, but to analyze it fully, you'll need to know a good deal about how Social Security is required to evaluate mental impairments.
If you find any mistakes in your Social Security file, or if something seems incorrect, you might benefit from contacting a disability attorney to help you prepare your appeal. Disability lawyers are experienced in finding errors in Social Security's rationale and developing arguments for why you should've been found disabled.
Updated November 11, 2022