WHY SO MANY GET DENIED

Being denied for Social Security disability is the rule, not the exception.  The latest Alabama statistics show that 74.9 percent of all initial applications will be rejected at the first level.  The reason is that the review of a disability application on the first level is rather mechanical.  A disability specialist, who is not a doctor, compares your medical file with the "disability handbook."  And very few applications will meet a listing for disability.  All kinds of things can go wrong in this approach:

1. The medical evidence may not be complete.  All it takes sometimes is for one doctor to fail to send in your file.
2. The medical evidence may not be legible.  I get medical records all the time that neither I or anyone on my staff can read.
3. The medical records usually do not give the vocational implications of your condition:  they will not say that you are limited to lifting 10 pounds, sitting for 1 hour at a time, or standing for only 10 minutes at a time.  That may all be true - but not one doctor in 1,000 reports it in your routine medical file.
4. Medical records are too generalized.  For example:  "Patient presents for pain in the left lumbar region.  X-ray shows mild DJD at the L5-S1.  RX for Tramdal 50 mg., 3 X day.  Return in 30 days"
5. Closely akin to # 3 above, the medical records do not provide Social Security with your "Residual Functional Capacity" (RFC) - which is what they will use to determine if you can perform your past relevant work or any other work in the national economy.

It has been my experience that in 9 out 10 cases, claims cannot be won merely on what is in the routine medical record sent to Social Security by your doctor, unless you have a catastrophic disease that is expected to end in death.  More has to be done.  Someone must "further develop" the case before it can be favorably decided.  Here are some of the things that a good and thorough advocate would do with a case like that:

• Try to get a function report from your doctor - showing in specific terms--how does the patient's condition limit her ability to work, i.e., how is her ability to sit, stand, walk, lift, carry, bend, stoop, follow instructions, concentrate, get along with others, etc. limit her in job functioning?
• If medical evidence is skimpy--or from a long time ago, get updated examinations and documentation.
• Write a  brief in which the pertinent medical and vocational information is summarized in concise, easy to read form.
• Quote the rules and regulations that apply to the case, using 20 CFR 404, Subpart P, Appendix I or II.  If the Grid Rules do not direct a finding of "disabled," present a theory of the case that will direct a finding of "disabled."
• Stay in touch with the disability specialist who is examining the case and use that relationship to be a positive liason between patient and examiner.  (That's really what the term advocate means, a "go-between" or "mediator," or "one that argues the cause of another").

Please see my  other blog post on this site titled "Why Lady Luck May Decide Your Claim."  Contact me at (256) 799-0297 if you have questions about your Social Security disability claim.  Or, view our website.