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The Importance of Medical Evidence in a Social Security Claim

A severe disability – whether it is physical or cognitive – can significantly restrict your ability to work and earn a living. In the absence of a robust support system, you might have to depend on others even for basic necessities. Fortunately, the Social Security Administration (SSA) provides financial assistance to those who are unable to work and sustain themselves due to a physical or cognitive disability.

There are two federal programs that provide financial assistance to disabled individuals – Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

Social Security Disability Insurance

SSDI is designed to provide financial assistance to those who have contributed to the Social Security program. In order to receive social security disability benefits, you need to meet the following criteria.

Covered Job

You must have worked in a job that is covered under the Social Security program. Barring a few exceptions, almost all the jobs in the country are covered under the program. Data shows that in 2021, more than 175 million people in the country were employed in jobs that are covered under the program. You can find the categories of work that are not covered under the Social Security program here.

Work Credits

You must have worked for a sufficiently long period of time and earned the required number of work credits. You can accrue work credits based on your yearly earnings or whether you are a salaried worker or self-employed. The amount of income needed to earn a work credit can change from one year to another. In 2022, the amount of income needed to earn a work credit is set at $1,510. The maximum number of work credits you can earn in a given year is four.

The number of work credits needed to qualify for social security disability benefits largely depends on the age at which your disability begins. Generally, you must have earned a minimum of 40 work credits and at least 20 of those credits must have been earned in the last 10 years prior to your disability.

Qualifying Disability

The condition you are suffering from can be considered a qualifying disability under the following circumstances:

  • You are totally disabled and your disability or the underlying condition which is causing it is expected to last for a period of at least one year or is expected to result in your death.
  • Your medical condition prevents you from doing the work you did prior to your disability.
  • You are unable to adjust to any other kind of work or engage in any kind of substantial gainful activity due to your medical condition.

You can find the total list of medical conditions that meet the criteria for SSDI’s qualifying disability here. If the condition you are suffering from is not listed there, the SSA will decide whether it is as severe as the conditions listed there – based on the evidence you provide.

Supplemental Security Income

SSI is designed to provide financial assistance to those who are aged, blind, or severely disabled and have little to no income. Unlike the SSDI program, the SSI program is not restricted to those who paid into the Social Security system. Anyone who meets the income and disability criteria can receive supplemental security income benefits.

If you are 65 or older, you can receive supplemental security income benefits as long as you meet the criteria for limited income – regardless of whether you are disabled.

Income Criteria for SSI Benefits

If you are an individual, your countable income cannot exceed $841 per month and the total value of resources you own cannot exceed $2,000. If you have a spouse who is also a beneficiary, your combined countable income cannot exceed $1,261 per month and the total value of resources you own cannot exceed $3,000.

It should be noted that you can earn more than the recommended countable income and might still qualify for SSI benefits, as certain types of income are not taken into account by the SSI while calculating your countable income. You can find more details about countable income here.

On the other hand, if you are under the age of 65, you need to be blind or disabled – in addition to meeting the income criteria – in order to receive SSI benefits. You can find the criteria for blindness and disability for children (under the age of 18) as well as adults here.

The Importance of Medical Evidence in Determining Your Disability

While filing a claim for social security disability benefits, you need to provide medical evidence that shows what kind of condition you are suffering from and how severe your disability is. The stronger your evidence, the greater your chances of getting approved.

Social security disability programs have very strict criteria for qualifying disabilities. If a claim is based on a medical condition that does not meet these criteria, it will be rejected – regardless of other factors.

What is unfortunate is that many people who suffer from medical conditions that meet the SSDI and SSI’s criteria for qualifying disabilities do not receive the benefits they are entitled to – simply because they failed to provide the right kind of medical evidence to substantiate their claims.

Data shows that roughly 4 out of every 10 social security disability claims are denied due to the lack of sufficient medical evidence. Data also shows that claims filed with the help of social security disability lawyers like Tudor House are more likely to be approved than claims that are filed by disabled individuals themselves.

What Are the Evidentiary Requirements for Filing a Social Security Disability Claim?

Under social security disability law, anyone who wishes to apply for social security benefits under the SSDI or SSI program needs to provide objective medical evidence from acceptable medical sources.

The term “objective medical evidence” in this context refers to medical records that can prove that you are indeed suffering from a serious medical condition and that the condition prevents you from engaging in any kind of substantial gainful activity.

The different types of records you can submit to substantiate your claim include:

  • Diagnosis reports that clearly document the condition.
  • X-rays, scans, and other imaging tests.
  • Lab test results.
  • Records of emergency room visits.
  • Records of treatments you have received.
  • List of medications you are on and the prescribed dosage.
  • Report from your physician.

It should be noted that your physician’s report should be as detailed as possible. A report that merely states that you are disabled and is not enough to substantiate your claim under social security law.

Moreover, even if your physician claims that you cannot work due to your disability, the SSA will discard their opinion, because your physician cannot determine whether you can work or not. Only the SSA can determine – based on the evidence you provide – whether you can work or not.

Ideally, the medical evidence you provide must contain the following information.

  • Type of medical condition.
  • Length of time you’ve been suffering from the condition.
  • Seriousness of the condition.
  • Effects on ability to perform day-to-day activities
  • Duration, frequency, and severity of your symptoms.
  • Precipitating factors that can trigger your symptoms.
  • Exacerbating factors that can worsen your symptoms and deteriorate your condition.
  • Response to the medications you are taking (i.e., any side effects).
  • Other factors that limit your mobility and your capacity to perform activities of daily living.

Medical Professionals Who Are Considered Acceptable Medical Sources by the SSA

  • Licensed physicians
  • Licensed optometrists
  • Licensed podiatrists
  • Licensed audiologists
  • Licensed or certified psychologists
  • Qualified speech and language pathologists
  • Advanced registered nurse practitioners
  • Advanced practice registered nurses
  • Physician assistants

It should be noted that a medical professional can give their expert opinion only in their chosen field of specialty. For instance, a podiatrist can only give their opinion on foot-related impairments, not on other medical conditions. If you are suffering from multiple conditions, you might have to get reports from multiple specialists in order to substantiate your claim.

It should also be noted that reports and diagnoses from alternative medicine practitioners are not considered valid medical evidence by the SSA. Similarly, statements from your family members, coworkers, neighbors, and friends are not considered medical evidence.

How Your Medical Evidence Will Be Used to Determine Your Disability

Once you file a social security disability claim, you will be asked to complete and submit what is called an Activities of Daily Living (ADL) questionnaire. The questionnaire is designed to find out whether you are capable of performing day-to-day activities like showering, dressing, cleaning, cooking, eating, getting around, and many more.

Based on the medical evidence you provide and your responses to the questions on the ADL questionnaire, the claims examiners at Disability Determination Services (DDS) can determine the extent to which your disability restricts your ability to perform day-to-day activities and whether you can work or not.

The claims examiners will take your functional limitations into account to determine your residual functional capacity (RFC) – the amount of physical work you are capable of doing.

They will consider a wide range of factors while assessing your RFC. These include:

  • How long you can sit or stand.
  • Whether you can reach forward or overhead and if so, to what extent.
  • Whether you can crouch, stoop, or bend, and if so, to what extent.
  • Whether you can climb stairs.
  • Whether you can grip and hold on to objects or perform other activities that might require dexterity in your fingers.
  • Whether you can hear.
  • Whether you can see.

Based on these factors, the claims examiners can determine whether you are capable of working or not.

What Is a Consultative Examination?

If the claims examiners are unable to determine whether you have a qualifying physical or cognitive disability, they might contact your physician and ask for more information. If your physician is unable to provide the required information or if the information they provide is not sufficient to determine whether you have a qualifying disability, the claims examiners might ask you to undergo a consultative exam.

A consultative exam will be performed by a physician of their choosing, not your own doctor and the SSA will pay the fees for the exam. If the report provided by the independent physician differs from the report provided by your own physician, the claims examiners will give more weight to the one which is backed by substantial evidence.

How a Michigan Disability Lawyer Can Develop the Medical Evidence Needed for Your Claim

One of the advantages of hiring an experienced social security disability lawyer is that they can collect, compile, and present the medical evidence needed to substantiate your claim. Your lawyer can get the records they need from your physician as well as other specialists who might have treated you in the past. Apart from medical records, your lawyer will also ask all your physicians to give their opinion on your condition.

After gathering all the medical evidence they need, your lawyer will review them carefully, determine what is relevant to your claim, and submit them with your application. They will remove any information or record that is not relevant to your claim or that might affect your chances of getting approved.

Submitting the right records is very important, because the administrative law judge (ALJ) will not have the time to go through hundreds of pages of medical records. An experienced lawyer can make the judge’s job easier by submitting only the pieces of evidence that are relevant to your social security disability case and improve your chances.

What Happens if Your Claim Is Denied?

While having an experienced social security disability attorney on your side can significantly improve your chances of getting approved, it is not a guarantee. In fact, data shows that nearly 2 out of 3 disability claims filed under the SSDI and SSI programs are denied. If your claim is denied, there are several legal options available for you to appeal the decision.

Request for Reconsideration

If your claim is denied, your social security disability lawyer will file what is called a request for reconsideration. Once the request is filed, your claim will be reviewed by a medical professional and a claims examiner who was not part of the team that rejected your claim in the first place. If your claim is denied even after reconsideration, your attorney will appeal the decision and request for a hearing before an ALJ.

ALJ Hearing

Before the hearing, your attorney will tell you what you can expect at the hearing, what kind of questions you might be asked, what you should and should not say, and more. Based on the reasons cited in the denial letter, your attorney will devise an appropriate strategy to get your claim approved.

At the hearing, your legal representation will make the case for approving your claim by presenting new evidence (if any) and by getting expert witnesses to testify in support of your claim. The SSA, for its part, will defend its decision by getting vocational experts as well as other experts to testify about your condition and why they believe you are capable of working.

Appeals Council

If your claim is denied by the judge, your social security disability attorney can file a request to get your case reviewed by the Appeals Council. The council will consider your request for a review only under the following circumstances:

  • If the ALJ abused their discretionary power in any way.
  • If a legal or procedural error was made at the hearing.
  • If the decision made by the ALJ is not backed by evidence.

Federal Court Review

The final step in the appeals process is the federal court review. In this step, your attorney will file a lawsuit in US District Court. The federal judge who reviews your case has the authority to reverse the decisions made by the ALJ and the Appeals Council.

Need to File for Social Security Benefits? Our Social Security Disability Attorneys Are Here to Assist You

The skilled social security disability lawyers at The Lobb Law Firm know that filing for SSDI or SSI disability benefits can be a tedious and complicated task. Even the slightest mistake or oversight on your part can lead to your claim getting rejected.

We have extensive experience in helping Michigan residents get the disability benefits they need. Our team knows which claims examiners look for and what kind of evidence can increase your chances of getting approved. In case your claim has been denied, we can file an appeal, argue before the judge on your behalf, and do everything in our capacity to help you get the benefits you require.

If you are in need of experienced and trustworthy social security lawyers to handle your claim, just pick up your phone and call our firm today at 248-591-4090. You may also fill out our online contact form to schedule a free consultation with one of our top-rated social security disability lawyers. We are based in Southfield, MI, but proudly serve Detroit and the surrounding communities.