How to get disability

A checklist for how to win your disability

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by Tim Moore, Disability Representative in North Carolina

To get disability, you must show…

Disability Examiners are the individuals who decide whether or not you get approved for SSD or SSI benefits. This page is based on my experience as an examiner. It provides a list of what to do to win your case and get your disability benefits.

(Read if you live in North Carolina)

To get disability, you must show you have a severe medical condition (it can be physical or mental) that has lasted, or will eventually last, a whole year. It must be severe enough that you can’t go back to your past work. And it must be severe enough that you can’t do some type of other work, based on your age, skills, and education. This is the definition of disability used by SSA.

The List of what to do to get disability

1. File your application immediately. Many individuals put off filing because they don’t want to be on disability or they believe their condition will get better. However, if your condition is bad enough to have knocked you out of work, you need to file a claim. Here’s a page that discusses that: How to apply for disability.

2. Make sure that before you have filed, you have had medical treatment. When an examiner works on your claim, they will be looking for both old and new medical records. Older records will prove how far back your disability began. This can determine how much back pay you will get. The farther back you are disabled, the more back pay you may potentially get. You may even get retroactive benefits for up to 12 months before you applied.

To get Disability Benefits, you must have medical evidence

To be found disabled for SSD or SSI, you MUST have some medical evidence that is not older than 90 days. If you have not been seen by a doctor in the last 90 days, Social Security will send you to a consultative medical exam, or CE. This exam will provide recent evidence, but, obviously, is not as good as being seen by your doctor. Many people complain of how short these exams are, how little these doctors know about your condition, and sometimes how rude they are. Advice: get seen by your own doctor before you apply for disability.

The benefit of submitting your records when you file

3. Consider getting your medical records yourself and submitting them when you file your claim. The trick is making sure you obtain your older records back to when you became disabled, as well as the most recent ones. If you do this, you can easily make it much easier for the disability examiner to finish your case and much more quickly.

The benefit of talking to your doctor

4. Talk to your doctor or doctors before you apply for disability. This can be helpful for a couple of reasons. The first is that that your medical records need to reflect how your condition limits you. Sadly, most doctors do not put this type of information in their notes. But it’s what Social Security needs to approve your claim. Talk to your doctor about how your condition affects your daily activities. You may even decide to ask if they would be supportive of your claim by providing an objective statement.

A medical source statement is usually obtained for a disability hearing by your disability lawyer or representative and can help to win the case.

By talking to your doctor, you may get an indication of whether your doctor will support your case. Some are surprised to learn that the doctor who seemed supportive was anything but. It’s better to know this before you apply for SSD or SSI. You may even decide to switch doctors.

Do what Social Security asks…when they ask you to do it

5. If Social Security schedules you for an examination, don’t miss the appointment. As an examiner, I was amazed at how many people missed multiple examination appointments. This can slow your case down by months. However, if you go to a consultative exam, make sure you dress appropriately (nice and clean) and make sure you don’t exaggerate your condition. Some doctors are biased against disability applicants. Some have even been known to watch a person walking to their car to see if they move normally when no one is paying attention.

6. If Social Security requests that you contact them, do so quickly. Usually, this is to provide more information to help your case. Not responding can make your case less winnable. It can even get your claim denied for failure to cooperate.

File disability appeals quickly

7. If you get denied, appeal quickly. You have 60 days to file an appeal. But you should not wait at all. File immediately. If you have a lawyer, they will get a copy of the denial and file your appeal. Keep in mind that most people are denied initially and have to file 1 or 2 appeals. Usually, this means getting to a disability hearing before a judge. But you can’t do that if you don’t file your appeals, which you should do promptly.

Don’t worry about being denied initially

8. If you get denied on your disability application, and your appeal is a request for reconsideration, don’t worry about getting denied again. More than 80 percent of reconsiderations get denied. Do make sure to indicate any additional medical treatment you may have had on the reconsideration. The reconsideration step is often just a necessary step to go through so you can ask for a hearing when the reconsideration is finished. That said, some people win their disability on a reconsideration, so make sure you let Social Security know of any changes at this point.

9. If you go to a disability hearing in front of an administrative law judge, or ALJ, it will be very important to have gotten your most recent medical records. This is because prior to your hearing, the responsibility for getting your medical records shifts from Social Security…to you and/or your lawyer. Meaning that if you show up at a hearing without your medical record updates, you have no chance of being approved.

10. Get a letter from your doctor to win your disability

A doctor’s statement can, and often does, win a case. But not just any statement. It cannot be a short note stating “Patient is disabled” (I have seen many of these). This type of statement will not influence a case.

A statement from a physician that wins a case will focus on the kinds of limitations that Social Security is concerned with. And since few doctors have any idea what Social Security is looking for in a medical source statement, many disability representatives will send the doctor a check-off form that allows them to check what limitations the claimant has.

11. Get a lawyer because this is what they will do at your hearing

If you have a disability lawyer or representative at your hearing, this individual will get your most recent records, try to get statements from your doctors, and formulate what is called “a theory of the case”, which is an argument for why your case qualifies you for disability. If you don’t have a lawyer when you go to the hearing, ask the judge to postpone your hearing and get a lawyer. Social Security law is complex and this is no time for a DIY approach. Disability cases take too long and have too much riding on them to take unnecessary chances.

More on what your lawyer does at a hearing to get you disability

At the hearing level, you win by highlighting enough physical or mental limitations so it becomes clear that you cannot do any other type of work. Sometimes, the limitations simply amount to a person being of a certain age, with a certain level of job skills, and not being able to lift more than a certain amount of weight. Sometimes, the individual’s condition will be purely mental such as reduced ability to concentrate or remember.

Some cases will be more complex and will require a theory or argument for winning. For instance, there are certain nonexertional limitations (such as depression or anxiety) that can sufficiently lessen the number of potential jobs available to a claimant, and, thus, result in an approval.

This is the list of what you should do to help win your SSD or SSI disability benefits. Next, we will describe the two ways in which disability claims can be approved.

The first way of getting approved and winning disability

Social Security has a list of impairments. In printed form, this was known as the blue book. If you have a medical condition on the list and your medical evidence shows you fit the criteria for the condition, you may be awarded disability. However, two things. First, not every medical condition is in the blue book listings. Fibromyalgia is not there. Neither is carpal tunnel syndrome. Second, it can be very difficult to get a disability award this way because the criteria is very strict, even if you are genuinely disabled and unable to work. How does Social Security deal with this?

The second way of getting approved and winning disability

Most people are approved by getting what is called a “medical vocational allowance” approval. This means that a disability examiner (or a judge at a hearing) will look at your medical evidence and your work history. They will determine what you are still able to do with the limitations you have as a result of your medical condition. Then they will determine if you can go back to your past work, which is potentially any of the jobs you did in the last 15 years.

What if Social Security decides you can’t do your past work?

If the examiner or judge decides you can’t go back to a former job, you have cleared one hurdle. But this does not mean you are approved. The next step is where Social Security decides if you can do some type of other work.

What does Social Security take into account when they decide if you can or cannot do other work? Here are the four factors they look at:

1) Your age;
2) Your education;
3) Your skill levels, and
4) The extent to which your impairment, or combination of impairments, limits your ability to do things (sit, stand, walk, lift, carry, push, pull, hear, see, smell, concentrate, remember, function among others, etc). This is what Social Security refers to as your RFC, or residual functional capacity.

Disability examiners and judges take all of these factors, which are your medical and vocational factors, and “plug them in” to a set of medical-vocational rules known as “the grid” to determine which particular rule you fall under.

Some rules will direct a decision of “not disabled”, while others will direct a decision of “disabled” and will result in you winning your disability benefits. Obviously, you want your case to be directed by a med-voc rule that directs a decision of disabled, i.e. approval or allowance.

This is why you need to supply, when you file for disability, accurate and detailed information about your work history as well as your medical history.

Additional pages if you live in North Carolina: