As a disability examiner working on both social security disability and SSI disability claims (FYI: though the two programs are separate from each other, claims in both programs are handled exactly the same way), I sometimes enountered this question. The honest answer, of course, is that there is no way to avoid being denied on a claim if the medical evidence is not in support of the case and if the social security administration, as a result of this, comes to the conclusion that the claimant has the ability to work and earn a substantial and gainful income.
Having said that, however, it should be pointed out that many claims are turned down even when medical evidence exists which clearly indicates that the individual is incapable of working and earning even a minimally-supporting income. Why does this happen? very often, this occurs because the medical evidence that might substantiate the claim was not made available to the disability examiner who was working on the case. In other cases, it happens because even if solid medical evidence was obtained there was not enough “recent” medical evidence made available.
Both scenarios fully illustrate the fact that disability claims filed with the social security administration rely entirely on what a claimant’s history of treatment, i.e. their medical records, have to say about both their condition and the limiting effects imposed upon them by their condition.
In light of this, what advice can be offered to someone who is either filing a new disability claim, or who is filing an appeal after having been denied on a claim?
The answer is fairly simple: When filing a claim or appeal, be sure to provide detailed information regarding medical providers, including names of physicians, names of facilities where treatment has been provided, addresses of facilities, and dates of treatment. Additionally, claimants should provide a list of all diagnosed conditions as well as any special tests or procedures that have been performed.
Providing this type of information should allow a disability examiner who has been assigned to a case to do the following:
1. Gather sufficient medical record documentation to fully ascertain what the claimant’s residual functional capacity might be (residual functional capacity is simply a measurement of what a person is still capable of doing, despite their physical or mental illness).
2. Gather enough information to determine if the claimant was fully disabled, per social security administration guidelines, as of the date that was alleged on the disability application. This, of course, refers to onset. Onset is vitally important because proving the existence of a disability as far back as possible will have a dramatic effect on the amount of back pay that can be received.
And most importantly,
3. Gather enough recent medical record documentation so that the social security administration can determine that the claimant is currently disabled, in addition to being disabled in the past. Without the ability to determine that the claimant is currently disabled, a disability case cannot be approved. And proving “current” disability can only be accomplished by providing social security with medical records that are not older than sixty days. Records that are older than sixty days are considered to be aged and less likely to be indicative of a person’s current condition.
Social Security Disability and SSI cases are decided on the strength of what a claimant’s medical records have to say about them and their condition. And in cases where the evidence supports a claimant’s allegations of disability, a claim will be approved. However, approvals cannot occur if the social security administration is not given the means by which to obtain all the necessary records. And this is why supplying SSA with detailed information regarding medical treatment sources cannot be understated.
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