Will My Doctor Decide If I Get Social Security Disability?

Each state has its own disability determination services (DDS) agency, and disability examiners at these agencies are charged with making SSD and SSI claim decisions at the initial application and reconsideration levels for the social security administration. The examiner who is assigned to process your case will essentially base his or her decision on the functional limitations that can be extrapolated from your medical records and the information gathered from your work history. A disability examiner will not approve a claim unless it is clear that 1) you have a severe impairment versus a non-severe impairment; 2) the impairment will prevent you from engaging in substantial and gainful work activity at one of your past relevant jobs, or at any other job for which your vocational profile might deem you otherwise suitable, and 3) your state of disability, as defined by the social security administration, will not last less than twelve full months.

Unlike your treating physician, a disability examiner’s opinion is based not only on your mental and/or physical impairment, but also on the impact your impairment has on your ability to engage in work activity that provides a substantial, gainful income. In addition, there are periodic, external quality control reviews that evaluate disability examiners’ work performance, which many would argue pressures them to "err on the side of denials" when determining certain claims.

Nationally, about 64-70% of all disability applications are denied by disability examiners, and requests for reconsideration that are also filed with the various state disability processing agencies (usually called DDS) are even less likely to be approved; in many states, it is not unusual to see denial rates for reconsideration appeals hover around eighty percent or higher.

Because of high rates of denial early on in the disability evaluation process, and, additionally, because the disability process is so protracted (to say the least), the social security disability system is inherently discouraging to claimants.

While there is certainly no written rule at SSA that directs adjudicators to deny SSD or SSI benefits to disabled individuals, from an outsider's viewpoint it would be hard to argue that the process is not set up to wear people down, so that only those who are the most determined eventually receive benefits. And, in fact, this would also be the viewpoint of many who consider themselves insiders, such as social security employees, claimant's representatives, and disability examiners.

Accidental or not, this "strategy" is successful; most people who are turned down for disability do not appeal, perhaps because they do not realize that their chances of approval are actually quite good if they simply advance their claim forward via the social security administration's disability appeal system.

After the initial disability claim and the reconsideration appeal are both denied, you have the option of filing a request for a hearing before a federal administrative law judge, i.e. a disability judge. It is at this level of appeal that a claim, for those who have been denied previously, has the best chance for approval.

In contradiction to disability examiners who must conform even to the varied nuances of the approval-denial policies that exist within their own individual processing units, federal judges, by comparison, have a great deal of autonomy that they may exercise in their decision-making, and this may figure prominently into why, statistically, they tend to favor the claimant significantly more often than disability examiners. And, thus, the great disconnect and gulf that exists between rates of approval in claims that are decided at the state agency level, and claims that are decided at the disability hearing level where a judge presides.

Also, disability judges tend to pay considerably more attention to a treating physician’s opinions regarding your impairment and how it affects your ability to function, provided that this opinion is not out-of-line with the information contained in the physician's treatment notes. Disability examiners, on the other hand, often do not place significant value on the opinions provided by your physician, and so even a strongly supportive statement from your doctor (that is detailed with regard to remaining functionality) may not have much influence on a decision from DDS regarding your claim.

However, a detailed statement from your physician regarding your residual functional capacity (ideally captured on a form that that attempts to elicit the physician's opinions regarding the patient's functional abilities and limitations) can greatly increase your chances of approval at a disability hearing.

Therefore, it’s fair to say that, although your doctor does not decide if you get disability, a statement from him could be the deciding factor in your favor at this level of appeal in the social security disability and SSI system.

Tim Moore
mooreorlesstim3@yahoo.com
http://www.disabilityblogger.blogspot.com