There are plenty of misconceptions as to why denials on social security disability and SSI claims happen. To some extent, this may be due to the wording of notices of denial, which are largely template-assembled letters (meaning that if you lined up ten “notices of disapproved claim” from ten separate claimants, the letters would tend to look very much the same).
Claimants will often assume that one of a variety of factors may have been responsible for why they were denied on their disability application or appeal for disability benefits.

But, in every single case, a denial happens because the claimant, through the information presented in their medical records, has failed to prove that they have an inability to work at a substantial and gainful level and that this inability will last for at least one full year.

This is basically the social security administration definition of disability: that, to qualify for disability, a condition, or set of conditions (which may be physical, mental, or a combination of either) must be all of the following:

A) Severe

B) Severe enough to make it impossible for the claimant to engage in work activity at what is considered to be a substantial and gainful level

and

C) Severe enough to last at least a year.

 

Translation: to meet the social security definition of disability, a claimant’s overall condition must result in enough physical and/or mental limitations that they cannot be able to work for a full year while earning a substantial and gainful income (which is defined here: SGA, substantial activity level).

This includes, of course, the job that they last did, any work that they have done previously in the last fifteen years (their relevant past work), as well as any job that their skills and training might qualify them for and which their age and various restrictions might not disqualify them for.

Denials on disability applications and denials on disability appeals, therefore, occur because either–

1. The claimant’s rated limitations, or residual functional capacity (measured on something known as a residual functional capacity form, which is completed by a disability examiner and the examiner’s unit medical consultant at DDS, or disability determination services) is not enough to rule out their ability to go back to their former job or to do some type of other work. OR

2. The claimant has managed to return to work activity for which they earn a substantial and gainful wage while their disability application or disability appeal was pending.

Most claimants and potential claimants will assume that the outcome of a disability case will simply boil down to the information that may be found in the medical records. However, claims are as much focused on the claimant’s work history as on the medical history.

Therefore, the claimant’s ability to engage in work activity, as well as the perception of the ability to engage in (or return to) work activity (while earning a substantial and gainful income) can determine whether or not a disability claim is approved or denied.

It’s your attorney’s job to help support your claim to the best of their ability.  The Law Offices of Aaron R. Vega is committed to helping people obtain their Social Security Disability benefits with minimum hassle. We have experience with helping people across the United States win their benefits at all levels of the adjudicative process.

Whether you are only contemplating filing an initial application, awaiting a hearing, or have been mired in a seemingly endless appeals process, we have the professionalism and experience to help you.

We pride ourselves on assisting individuals at any stage of the litigation process. Many attorneys only become involved after a person has been denied, but we understand the importance of getting involved from the outset and beginning the process correctly the first time, every time.

Article via SSDRC