Social Security has a very strict, narrow definition of "disability." You are not disabled in their eyes because you think you are, or even because your doctor says you are. Generally, your condition(s) must be so severe that you are not able to perform even the most basic of work-like activity for 8 hours per day. This means you are not able to hold even a sedentary (sit down) minimum wage job.
In addition to being severe, your condition(s) must last a minimum of 12 straight months OR be expected to last that long OR be expected to end in death.
Looking at applications we've seen denied in the last year, here are the basic causes of denial in most cases:
1. There Isn't Enough Hard Medical Evidence to Prove Disability.
Statements that you make about your own medical condition or symptoms are called "allegations." They are not considered evidence or proof. Another term for these allegations is "subjective evidence." Social Security believes that claimants are biased and will exaggerate to get benefits approved. So, they demand hard evidence or "objective evidence," which is medical examinations, tests, X-rays, MRI reports or other imaging studies. Many claims are denied because the claimant asks Social Security to accept their word for being disabled. They don't have the hard medical evidence to prove it. In such cases, a denial always occurs. It takes hard, objective medical evidence to win disability cases.
2. The Applicant Does Not Have Insured Status (Is not Insured)
Social Security Disability Insurance (SSDI) is issued to persons who have worked long enough and recently enough to be insured. You must meet what is called the 20/40 test. You can earn 4 work credits per year, 1 credit for each quarter. If you work 10 years consistently, you should earn 40 work credits (4 per year for 10 years). The minimum credits most people need for insured status is 20 credits out of the possible maximum of 40. Put another way, you should have worked at least 5 years out of the immediate past 10 years. If you have not,arned at least 20 credits over the past 10 years, you probably don't have enough work to be covered by SSDI. Only persons who have insured status may file for SSDI benefits, regardless of how sick or old you are. Work credits are considered first.
3. You May Be Able to Perform Easier Work Than Your Past Work.
If you are under age 55, Social Security may agree that you cannot do your past relevant work or PRW. This is not enough to find you disabled, if you are able to perform other, less demanding work, and you are under age 55. For example, your past work may all have been construction work, performed at the Heavy Exertion level (lifting 50 pounds frequently and up to 100 pounds occasionally). You are no longer able to perform this heavy exertion work. Are you disabled under Social Security rules? No, not if you are still able to perform easier work that does not require as much lifting, standing or walking. For example, you may not be able to do construction work; however, you are able to do clerical or sales work, where you can sit most of the day and lift no more than 10 pounds (called Sedentary Work). Again, your opinion that you can't do this type of work won't win the day. You need medical evidence to prove it. Also, the fact that you can't find any sedentary work, or you believe nobody will hire you to do it, does not make you disabled.
4. Social Security Didn't Get All of Your Medical Evidence.
It's up to Social Security to get and evaluate all of your available medical records. Sometimes, however, they don't get all the medical evidence. This might be because the claimant failed to tell them about all the doctors and other provicers they have seen. Or, perhaps Social Security requested all of the records but some of the medical providers simply didn't send the records in. This, a decision was made on less than the full evidence.
5. Your Disability is Based Entirely on Drug or Alcohol Abuse.
Under the law, you cannot get a disability benefit solely because of alcoholism, drug addiction or sub stance abuse. You may qualify for disability if you have another disabling condition besides substance abuse. For example, if a person is an alcoholic but also has a bad heart, he may qualify on the heart problem in spite of the alcoholism. But if alcoholism is the only impairment, it does not qualify. A disability attorney can evaluate your claim and see if you may qualify.
6. You Were Previously Denied Benefits.
If you were previously denied benefits and took your case to a hearing with an Administrative Law Judge (ALJ) and got denied, you generally cannot get another judge to change your Residual Functional Capacity (ability to work) unless.....
a) There is substantial new evidence that the first judge did not have, or
b) There are substantially different circumstances not existent at your first hearing.
So, if Judge Adams denied your benefits in 2018, Judge Zebra cannot reverse that decision and grant you benefits in a new hearing, unless either the evidence or circumstances have materially changed.
New medical evidence can certainly cause a different decision at a new hearing. Different circumstances may also get you a new decision. For example, if you were age 53 at the first hearing, but are age 55 at the new hearing, circumstances have materially changed because you are now in a new age category (advanced age, as of your 55th birthday).
It's best if a trained professional, such as disability attorney or skilled disability advocate, evaluate your case before you start on the quest for benefits. It is much, much more complicated than filing an application and waiting for approval. Most applicants will be denied on the fist and second level and must pursue the appeals process to win.
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