People who apply for disability benefits are approved or denied based on their ability to work. Claimants will not be awarded SSD or SSI unless they can prove that their impairment is severe enough to preclude them from performing their current job or any other type of work for which they may be suited.
Disability examiners at the state Disability Determination Services (DDS) agency are in charge of making all decisions on initial applications and reconsideration appeals for Social Security. When a claimant applies for disability, the examiner reviews the medical and work history to determine if the claimant could be expected to earn a living despite his or her impairment.
In reviewing medical records for social security disability and SSI disability claims, disability examiners try to determine what activities a claimant can and cannot perform, known as his residual functional capacity (RFC). Detailed physician notes, preferably from a doctor with a lot of experience treating the impairment in question, can help a lot when it comes to a disability RFC rating. Ideally a claimant’s medical records will include not only a diagnosis and prognosis (how the condition is expected to progress over time), but also specifics as to how the medical condition affects the claimant’s ability to perform routine tasks, such as bending, lifting, memory, concentration, etc.
Disability examiners take into consideration a claimant’s functional limitations before assigning a rating of heavy, medium, light, or sedentary exertional work. In most cases, disability examiners must take their decision to the doctor assigned to their unit for approval before it becomes final, although in some cases Social Security does allow disability examiners to act as single decision makers (SDMs).
Typically, those approved for heavy or medium exertional work have a harder time winning SSD/SSI than those who are approved for light exertional work (with the exception of those filing on the basis of a mental impairment). The medium RFC rating requires that one be capable of lifting 25 pounds frequently, and 50 pounds occasionally.
Unfortunately, there are a lot of people approved for medium work by disability examiners who should have been given a rating for light exertional work, and this may be part of the reason so many DDS denials are later overturned by federal administrative law judges.
This is because, although many will deny it, the disability determination process is not entirely objective, and the personal experiences and beliefs of the examiners do come into play — they’re only human. Consider this: The average disability examiner is under 30, and therefore probably has little or no experience with chronic pain or illness, so it is difficult for the average examiner to truly empathize with most applicants. Also, being relatively young, the examiner may not realize exactly how much stress 50 pounds can place on an older adult, particularly one with a condition like degenerative disc disease, fibromyalgia, arthritis, or spinal stenosis.
Even some physicians lose the ability to empathize with their patients over time. It’s basic psychology — the more you hear complaints of pain and suffering, the more you become desensitized to them. So it’s very important that those filing for SSD/SSI tell their physician that they are seeking disability, and to ask that the doctor include detailed information regarding any functional limitations in his notes.