How Are Social Security Disability Benefits Claims Evaluated?

Did the Social Security Administration (SSA) recently deny your claim for disability benefits? If so, you will want to know why and – more importantly – what you can do to appeal the decision and secure the benefits that you need and deserve.

As you move forward, you should understand how the SSA evaluates disability claims. If you know what the SSA looks for in a claim for Social Security Disability (SSD) benefits, it will allow you to tackle issues that may have led to the initial denial of your claim. For instance, you may need to provide more evidence about your physical or mental impairment and how it limits your ability to work.

To learn more about how the SSA evaluates disability benefits claims and to discuss your case, contact Marks & Harrison today. Attorney Joanna L. Suyes, a member of the National Organization of Social Security Claimants’ Representatives, would be glad to assist you along with our our highly experienced and dedicated SSD benefits team.

Established in 1911, our firm serves clients from our office in Richmond and from eight other offices located throughout Virginia. Call or reach us online today for a free consultation.

How Does the SSA Decide If You Are Disabled?

Whether you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you must establish that you have a “disability” as the SSA defines that term. In other words, you must show that you suffer from a physical and/or mental impairment (or combination of impairments) that:

  • Is medically determinable,
  • Can be expected to result in death, or
  • Has lasted or can be expected to last for at least 12 consecutive months.

Your local SSA field office initially processes your application and checks whether you meet non-medical requirements. The SSA then sends your case to Virginia Disability Determination Services (DDS) to determine whether you are disabled. A DDS claims examiner will work with a medical consultant  to evaluate your case. The SSA’s evaluation will consist of a five-step, sequential process:

  1. Are you engaged in substantial gainful activity? In other words, do you earn above a certain amount each month which the SSA considers to be “substantial gainful activity” (SGA)? In 2017, the limits are $1,170 for non-blind individuals and $1,950 for those who meet the SSA’s statutory definition of blindness.If you answer no to this question, the review goes to Step 2. If you answer yes, the SSA will deny your application.
  2. Do you suffer from a “severe” impairment? The SSA will look at the symptoms of your physical or mental impairment and how they affect your ability to function. You must show that a health care provider diagnosed you based on medically acceptable clinical or diagnostic techniques. You should also provide a written statement from your doctor. Additionally, the DDS team evaluating your claim may ask you to undergo a consultative examination (CE) by your treating doctor or an independent doctor.If you answer yes to this question, your review goes to Step 3. If you answer no, the SSA will deny your application.
  3. Does your condition match a listed impairment or is it equal in severity to a listed impairment? The DDS team will determine if your symptoms match or are equal in severity to an impairment listed in the Blue Book. The book lists impairments in 14 different categories. As in Step 2, the medical evidence you provide will play a major role in the evaluation of your claim.If you answer yes to this question, and you meet all non-medical requirements, your application should be approved. However, if you answer no, your review goes to Steps 4 and 5 for an assessment of your residual functional capacity (RFC).
  4. Can you do past relevant work? The DDS team will look at the physical and mental tasks that your previous work required you to do and will determine whether you can still do those tasks after the onset of your impairment. The evaluation will focus on the skills that your past work involved and the amount of exertion that your previous jobs required.If you answer yes to this question, the SSA will deny your application. If you answer no, then your review goes to Step 5.
  5. Can you do any other work? If you cannot do the work that you did before, the DDS team will determine whether you can do any other work based on your age, education, training and work history and based on whether you have any skills that can be transferred to another line of work.If you answer yes to this question, the SSA will deny your application. However, if you answer no, and you meet all non-medical requirements, your application should be approved.

The SSA applies this five-step evaluation process when it initially reviews your SSD benefits application and at every stage in the appeals process. So, you need to keep those five steps in mind as you pursue an appeal.

If you wish to appeal a denied SSD benefits claim in Virginia, the first step would be to request reconsideration of your claim by a different DDS evaluation team. If your claim is denied again, then you can request a hearing before an administrative law judge (ALJ). (In some states, an administrative law judge hearing serves as the first stage of appeal.) The next level of appeal would be to request review of your case by the SSA Appeals Council. If your claim is still not approved during the administrative appeals process, the next step would be to file a lawsuit in the nearest federal court.

At Marks & Harrison, we can assist you at any level in the appeals process. We will not charge for the services we provide unless we secure SSD benefits for you.

How Can Our Lawyers Help with the Evaluation of Your SSD Benefits Claims?

If the SSA denied your claim, and you appeal the decision, then you must check on whether you have provided the SSA with a complete picture of your medical condition and its effect on your ability to work. A lawyer from Marks & Harrison can help you by reviewing the information you provided in your initial application. If we identify any “gaps” in your information, we can help you to quickly address those issues as you pursue your appeal.

Our law firm will ensure that you provide comprehensive, accurate and relevant information about your medical condition to the SSA. We know that the more medical evidence you provide, the better your chances of approval will be. We will make sure to:

  • Gather and present complete medical records, including records that show the onset of your mental or physical impairment and the types of treatment you have received. We will also make sure that the SSA has your most recent records. We want the SSA to see the nature and severity of your impairment and the way it limits your ability to function.
  • Get a statement from your treating doctor that fully describes your condition and how it keeps you from being able to work. The doctor should use the same terminology that the SSA uses, which will help in the evaluation of your claim.
  • Provide updated information throughout your case. It is crucial to promptly reply to any requests for additional evidence and to provide the SSA with the most up-to-date information.

Get Help from Our Virginia SSD Benefits Attorneys Today

At Marks & Harrison, we understand the important role that disability benefits play in the lives of our clients in Richmond and throughout Virginia. Our skilled and experienced SSD benefits team will work tirelessly to pursue the benefits you are due, including providing the SSA with the information it needs to evaluate your claim. To get started, call or reach us online today and receive a free consultation about your case.