After you apply for Social Security or SSI disability benefits, Social Security sends your application to your state’s Disability Determination Services (DDS) agency. A claims examiner who works for DDS will request your medical records and then make a decision on your case. Claims examiners are overworked and underpaid, so it’s not unusual for them to make mistakes in deciding that you’re not disabled. Here are some of the more common errors that DDS makes on disability claims.
It’s very common for disability applicants to list on their applications several medical conditions that they suffer from. Many times, the conditions aren’t severe enough to qualify for disability benefits on their own. If the claims examiner believes that none of the medical conditions you listed on your application are severe, he or she will quickly deny you disability benefits. But if you applied for more than one medical condition, you should appeal.
Before denying you benefits, the claims examiner should have evaluated what the combined impact of your non-severe medical conditions were on your ability to work. If your combined impairments have more than a minimal effect on your ability to perform work activities, the claims examiner must give full consideration to your medical conditions to see if, combined, they create a disability. (SSR 86-8.) To support your appeal, it’s helpful to get your doctor to fill out a residual functional capacity (RFC) assessment that explains how your impairments combine to put multiple limitations on your ability to work. For more information, see our article on how your non-severe impairments are disabling.
It’s not uncommon for claims examiners to focus on the main complaint in a disability application, such as slipped lumbar disc, and ignore lesser complaints of emotional problems, such as anxiety and depression.
Even if you don’t list a “mental illness” in the medical conditions portion of your application or adult disability report, if you mention anxiety or depression in your activities of daily living questionnaire or if your doctor has noted depression or “dysthymia” (mild depression) in your medical record, the claims examiner must consider whether your psychiatric or psychological issues are affecting your ability to work. These issues can impact your ability to focus, ability to get along with others, and your ability to sustain regular attendance at full-time work.
If you feel that the claims examiner didn’t explore your mental health, state this in your request for hearing (HA-501). Before your appeal hearing, visit a psychiatrist or psychologist so that you have up-to-date mental health records to show the judge at your hearing. If you can get your doctor to fill out a mental residual functional capacity (MRFC) assessment, this will improve your chances of winning on appeal even more.
For more information, see our article on how anxiety and depression help a claim for disability.
When your medical records contain information about several illnesses and injuries and your doctor’s notes mention numerous restrictions, it’s not uncommon for a claims examiner to leave some of your limitations out of your RFC. But if the claims examiner didn’t consider each and every one of your limitations, the RFC that he or she gives you won’t properly reflect your abilities (and inabilities). Non-exertional limitations (those not having to do with strength) are most often omitted. For instance, if you have back pain, wrist problems from carpal tunnel syndrome, and you can’t stoop or reach overhead, your RFC might say that you’re limited to light work. However, your limitation on doing repetitive finger work (including typing or filing) and your inability to stoop or reach overhead greatly reduce the types of work you can do within the light work range. In your appeal request, you should state which limitations your RFC neglected to include.
If you didn't fully describe your past jobs (any jobs you had in the last 15 years) on your application, the claims examiner may have mistakenly decided that you could do your old job. Even if your residual functional capacity (RFC) assessment lists reasons you can’t do certain, that won’t help you if you didn’t specify all of the tasks you had to do in your last job. For example, if your past work was as a receptionist and your RFC says you can’t stand or walk more than two hours a day and lift more than 10 pounds occasionally, your claims examiner will likely say that you can do your old job. But if your past job included lifting delivered packages and bringing them across the building several times per day, your claims examiner should have found that you could no longer do your old job.
For more information, see our article on how to show you can't do your prior job.
In assessing whether you could switch to some type of less physically or mentally demanding work, your claims examiner will look at your last few jobs to see if you picked up any job skills that you could bring to a new type of work. Deciding you have “transferable” job skills is a fairly technical decision that needs to be based only on the jobs you’ve had over the past 15 years (and ones you did full time for a significant period of time). The assessment needs to be based on the job descriptions in the Dictionary of Occupational Titles (DOT), and your past jobs can be used only if you did the jobs as generally performed and discussed in the DOT.
If the claims examiner made a mistake in any of these steps, he or she may have decided that you have job skills that you don’t actually have. This is grounds for appeal. For more information, see our article on how to show you can't do other work.
Learn more about the proper way Social Security should assess a medical-vocational allowance claim.