The most common reason the Social Security Administration denies social security disability applications is for medical reasons. Medical denials happen for two reasons:
- Insufficient medical evidence to support the social security disability claim
- Inadequate documentation of how the disability impacts your ability to work
Telling your doctor you intend to apply for social security disability benefits can help decrease the chance of a medical denial. Ideally, this conversation should happen BEFORE you submit your application (if your doctor was the one who initially suggested you apply, consider yourself ahead of the game).
Why Should I Talk to My Doctor?
If you must submit your medical records with the application, why is it important to talk to your doctor? Because despite all the information medical records contain, they generally don’t include the information the disability examiner ACTUALLY needs to determine whether you qualify for social security disability benefits. Social security disability benefits are paid only when the disability prevents you from engaging in substantial gainful activity (in 2020 that means you earn less than $1,260 per month). Therefore, simply having a documented diagnosis of a disability in your medical records – even one included in the SSA’s Bluebook, a listing of more than 100 disabling medical conditions – isn’t enough to qualify for benefits.
When evaluating a social security disability application, the SSA looks for information about your residual functional capacity. Your residual functional capacity, or RFC, describes the tasks and activities you can perform despite the disability. Most medical records include the diagnosis along with records and/or reports of X-rays, MRIs, and other diagnostic tests supporting it; they typically do not include information about how that diagnosis affects your ability to perform specific tasks. Even when they do, the information usually isn’t descriptive enough to help the SSA determine whether the disability interferes with your ability to do your job (or any other comparable job).
Talking to your doctor (this includes both your primary physician and any specialists) before you apply for social security disability ensures that your medical records contain the information the SSA needs to accurately evaluate your claim. This is even more important now that the SSA has changed the way it views medical opinions. In the past, the opinion of treating physicians used to carry an enormous amount of weight in the SSA’s disability determinations; now, a treating physician’s opinion is equal to that of the SSA’s medical evaluators – even if the evaluator has never met you. If your doctor knows you intend to apply for social security disability benefits, he can properly document the disability’s impact on your daily life in the file, thus making it more valuable than the opinion of the SSA evaluator.
How to Talk to your Doctor
Just as important as talking to your doctor before you apply is HOW you talk to him about how the disability impacts your daily life. Be as specific as possible when discussing the frequency, severity, and duration of your pain, providing examples that relate to job-specific tasks. Use numbers when you can, which paint a much clearer picture for the disability examiner (or the administrative law judge, if you have to appeal a denial) of the disability’s impact.
For example, if you worked as an administrative assistant before you became disabled, telling your doctor that you have pain while sitting and trouble using your hands is too generic and will likely result in a medical denial. Instead, you would want to describe your symptoms as follows:
- I can sit for 45 minutes before I must stand, stretch, and walk around to alleviate the pain. It is 10-15 minutes before I can sit again.
- I have to take 3-4 stretch breaks per day, every day.
- I cannot lift my arms higher than a 90-degree angle to my body for more than 5 minutes.
- I used to be able to type 80 words per minute, but pain and weakness in my hands have dropped that down to 40 words per minute.
- Tremors in my hands make it difficult to sort and file papers, so tasks that used to take 10 minutes now take 30-40; performing these tasks also leaves my hands and arms so fatigued that I cannot do any other work involving my hands for 45-60 minutes.
Providing such detailed descriptions at each appointment ensures your medical records will contain a clear, consistent record of how your disability interferes with your ability to work, increasing the chances that your application will be approved. It also shows a pattern that strengthens your claim that the disability is not improving. This is important because social security disability benefits are only paid if your disability is expected to last a year or longer.
Never Mention SSD Benefits on First Visit
One caveat: it is not recommended that you discuss social security disability benefits at your first doctor’s appointment. Remember that social security disability is only paid if the disability lasts, or is expected to last, one year or more AND if it interferes with your ability to engage in substantial gainful activity. In many cases it is impossible to know, before you even visit a doctor and undergo some type of treatment, whether your disability will meet these criteria.
Mentioning at the first appointment that you intend to apply for social security disability benefits could potentially raise a red flag to the doctor and lead him to believe that you are being untruthful about how your condition affects your ability to work. If the doctor includes these impressions in your medical record, it could negatively impact your application.