Understanding A Social Security Disability Denial

After the long, confusing process of applying for Social Security disability benefits, it is understandably very frustrating to receive a denial. While the Social Security Administration (SSA) has no official policy to deny first-time applications, it is fairly easy to see why some people might think they do! Though the rate of denial varies from state to state, nationwide about 65% of all disability claims are denied on the first application.

Receiving a denial does not necessarily mean you will never be able to receive benefits. You can always appeal the SSA’s decision – but you must do so within 60 days from the date of the denial notice! So if your application has been denied, the very first thing you should do is contact your local Social Security office to request an appeal. This will prompt the SSA to send you the necessary forms right away, so that you can get them completed and submitted prior to the deadline. Next, it’s important to take a close look at your denial so you can understand why you were denied in the first place.

Look At Your Denial Notice

If your initial application is denied, you’ll get a notice of denial from the SSA. This document will contain a brief description of your medical condition, the impairments that were considered, the medical and nonmedical records that were considered, and it will briefly explain the SSA’s reasoning for denying your claim. Some denial notices will also include Form SSA-4268: Explanation of Determination. This form states the technical rationale that the claims examiner used in making your disability determination. If your denial notice does not include this form, you can request it from the SSA so that you can review it.


Lack of Medical Evidence

All applications for Social Security disability are evaluated on the basis of medical evidence – and the primary reason that applicants are denied is for failing to provide sufficient medical documentation to back up their claim. Even if your application included a consultative medical exam with a doctor hired by the SSA, those exams are generally quite brief and often shed little light on your actual disability determination. Instead, your disability examiner must rely on whatever medical evidence you have provided.

Look at your file to determine if there are any areas where you need to provide additional medical documentation. If your medical records contain comments from your treating doctors about your disability, note whether the comments are clear and whether they support or hurt your case. For example, if your doctor uses the phrase “light work,” he or she may not know that the SSA has a specific definition of what type of work that entails. If your doctor’s statements makes it seem like you can do more physically than you actually can, you may need to speak with your doctor about writing a new letter for your appeal or filling out a residual functional capacity (RFC) form on your behalf. If your condition is listed in the SSA Blue Book, your appeal will need to specifically provide enough medical documentation to prove all the listed criteria in order to be approved.

Understanding Residual Functional Capacity (RFC)

If your condition doesn’t match a Blue Book impairment listing, your file will also include a discussion of your residual functional capacity (RFC). Your RFC is an assessment performed by your disability claims examiner with the help of a medical consultant from your state’s Disability Determination Services (DDS). Your RFC indicates what level of physical exertion the SSA thinks you are capable of performing and it is used to determine whether you can be expected to return to your prior job.

For example, the SSA considers “light work” the ability to lift up to 20 pounds and perform a good deal of walking and standing or pushing and pulling controls. “Sedentary work” means you can lift no more than 10 pounds and that walking or standing should only be required occasionally. In addition to classifying your physical exertion ability, your RFC will also contain any other restrictions that would limit the jobs you would be able to do (for example, not being able to use your fingers or difficulty remembering instructions).

Check your RFC to make sure that the assessment is accurate and corresponds with the information provided by your treating doctor. For example, if you have a physical RFC, did the medical consultant say your level of physical exertion (such as lifting, carrying, or walking) is higher than what your treating doctor says you can do? It’s also important to check what type of doctor evaluated your application – mental impairments should always be evaluated by a psychiatrist or psychologist and children’s claims about physical impairments should always be evaluated by a pediatrician.

Medical-Vocational Grid Rules

Using your RFC as a determination of your physical abilities, your claims examiner will have determined whether you are able to return to your prior job. If the examiner decides that you are unable to do so, the medical-vocational grid rules will be applied to determine whether you can be expected to learn how to do a new job. The grid rules take into consideration your RFC, your level of education, the skill level of your past work, whether any of the skills from your past work can be transferred to another job, and your age. It is generally easier for individuals older than 55 to qualify for a “medical-vocational allowance” under the grid rules. However, other important factors – such as the skill level of your past relevant work or the transferability of your skills – can also play a role in dictating whether your appeal will be approved. A disability lawyer can help you make sure these aspects are described accurately in your appeal.

Disability Benefits May Still Be Possible

Even if your application is denied the first time, it may still be possible for you to be granted disability benefits. However, it’s important to keep in mind that you’ll need to follow the official appeals process to get the SSA to reconsider your claim. The sooner you begin the appeals process, the sooner the SSA will be able to schedule a hearing, which will give you the best chance of a successful claim.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (5)
  • glad2bme
    3 years ago

    Not sure if your research and acquired knowledge on this subject will allow you or anyone else on here to answer myself question, but thought I would post it anyway…

    I heard that if your employment background is one of being a public school teacher that you are likely to never qualify because majority of teachers do not pay into the Medicare/Medicaid/Social Security System as most other employees do?

    If this is true, it is extremely disheartening because I did not work long enough in this field to attain the benefits available through the TRS (Teacher Retirement System) either to be able to apply for disability benefits through them either. And prior to this I mostly worked part time, or from home, or not at all while raising my small children. So could this mean because I made these decisions that seemed right for our family at the time and then chose a very necessary and important career path that I am out of luck of ever receiving help? If true, it’s just another injustice going on in this country for people who choose to do the right thing and live a life of honesty and integrity!

  • Carla Kienast
    3 years ago

    Hi Mariah: This is a very difficult and often disheartening process and the fact that most people are already suffering financially makes the denial especially stressful. I haven’t applied for Social Security disability but am still struggling with a disability claim through insurance provided by my previous employer. You didn’t mention employing legal support (the route I’ve taken), but this might be helpful for some people. It can be expensive up front, but it might also be the difference of having the claim denied again vs. approved. Lawyers who specialize in these claims are very adept of making sure the claim is as strong as possible and understand the applicable laws. Thanks for a great article.

  • Mariah Z. Leach moderator author
    3 years ago

    Hi Carla ~

    This article is just meant to focus on understanding how and why claims may get denied – I’ve got another article coming up on how to appeal a denial and I most certainly recommend legal support during that process! As you say it is a very difficult and often disheartening process – and in my attempts to cover it thoroughly I got long-winded and had to split the topic into two articles! Keep your eye out for the second one!

    ~Mariah~

  • Dana Williams
    3 years ago

    This is a very important article to read for those of us whose RD has become so disabling that we are unable to work. When I first applied for Social Security Disability, I already had been given a service connected 100%, total and permanent disability rating by the VA for rheumatoid disease. That did not carry significant weight for the Social Security Administration, and, despite all the medical records I submitted, I was declined. It turned out that the reason for the denial was that, when completing the exhaustive application, my responses reflected what I was physically able to do during the diminishing periods of time when my RD wasn’t overwhelming me. I didn’t seek legal support for my second application, but I did reply more completely to the questions. I also provided explanations wherever there was room to. So, for example, when the question addressed how independently I could dress myself, I responded that while there were times when I did not need assistance, There were also times when I was completely dependent on help. I also spoke of the impact of the unpredictability of the disease on being a reliable employee. In short, when I reapplied for Social Security Disability benefits, I did my best to fully explain just how disabling RD is. I was awarded the disability benefit after I resubmitted my application, and it has been an important component of financially keeping my head above water. Obtaining that disability benefit also allowed me to qualify for Medicare several years earlier than would otherwise have been the case.

  • Jillian S moderator
    3 years ago

    Hi Dana,
    Thank you so much for taking the time to share your story. Though it sounds like a long and winding road, you should be so proud of yourself for staying hopeful and reapplying for SSD benefits. I am so glad to hear that you were approved not only for these benefits but qualified for medicare early. Eliminating financial stress is an important component especially when living with a chronic disease.
    I know that your experience will inspire many other members of our community to not get discouraged after SSD denial. You are proof that that future approval is possible!
    It is so helpful and reassuring to learn from one another and members like you who are willing to share their experiences make that possible.
    Thanks for being a part of our community- we are lucky to have you.

    Best,
    Jillian (Rheumatoidarthritis.net Team)

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