If you are dealing with a condition that keeps you from working, chances are you’ve seen a doctor or two for tests, taken medicines or even tried treatments or surgery.
In the complex web of disability determination, the role of this medical evidence is paramount, as it ultimately determines the trajectory of whether someone will be approved for disability.
As the Social Security Administration (SSA) carefully examines claims, they focus on the medical evidence to decide if someone qualifies for benefits. This medical proof is crucial because it shapes how disability is understood and whether people get the help they need.
Attorney David S. Bary, of Joyce and Bary Law, said his team evaluates every intake for technical and medical issues.
“We want to ensure that the potential lead has worked enough to be eligible for SSDI benefits,” he said. “If they are not insured for Social Security disability insurance (SSDI), our team will gather financial information to determine SSI (Supplemental Security Income) eligibility. Next, we determine the alleged medical impairments to determine their severity and whether they are supported by objective medical evidence. Our team determines the viability of a disability claim through current medical treatment, work background and prognosis.”
The evaluation process
Ultimately, the SSA uses a five-step evaluation process to make a disability determination:
Step 1: You must prove you are not engaged in substantial gainful activity (your earnings are not more than the SSA’s designated limit.
Step 2: A claims examiner searches for medically determinable impairment severe enough to interfere with work-related activities that will last at least 12 months or result in your death.
Step 3: An examiner takes a closer look at the severity of your condition. The SSA uses the Blue Book in this step – a book maintained by the SSA that lists medical criteria considered so to be severe that a person with a condition that meets or exceeds the criteria is found to be disabled.
If your condition is listed, that does not guarantee your claim will be approved. Listings are extremely restrictive. Most claims are won at steps 4 or 5.
If you are not found to be disabled at Step 3 because your condition does not meet or equal a listing, the medical evidence will be used to assess your ability to engage in substantial gainful activity.
Required medical records
Bary said he and his team work with their clients to identify your medical providers and collect the appropriate records needed to assemble a case.
“The alleged medical impairments must be well documented and supported by objective medical evidence (things like abnormal exams, lab work, diagnostic imaging and surgical history),” Bary said. “I recommend all my new clients communicate the severity of their symptoms and resulting limitations to their medical providers.”
Items Bary looks for will help him to establish:
- The specific diagnosis related to the condition that prevents you from working.
- The date of diagnosis.
- The severity of symptoms.
- Your prognosis, or how your medical provider expects your condition to progress, including whether it is expected to last for more than a year or result in your death.
- The treatments you’ve tried and the results of those treatments.
- Your current list of medications.
- Physical or mental limitations you’ve experienced because of your condition.
The importance of medical providers and their opinion
It’s also important to understand that there are specific medical sources the SSA deems acceptable, including:
- Physicians
- Psychiatrists
- Psychologists
- Optometrists
- Podiatrists
- Speech pathologists
- Audiologists
- Physician assistants
- Advanced registered nurse practitioners
While you may work with other types of health care professionals not listed, if they are your only source, your case will not be successful.
As such, the medical providers listed play an important role in the evaluation of someone who is attempting to win a disability case. The SSA will review their opinions for persuasiveness.
“A decision-maker must consider several statutory factors when determining the credibility of a medical provider’s opinion. Therefore, objective medical findings must support the opinion,” Bary said. “A general statement from a medical provider that their patient is ‘disabled’ or ‘cannot work’ is not helpful.”
Bary said he prepares medical source statements that ask for specific physical or mental limitations like ability to sit, stand, walk, deal with work stress and reliability.
“Medical evidence is crucial to winning a disability case,” Bary said. “Helpful medical records contain the results of thorough exams, discuss signs and symptoms and document diagnostic and treatment modalities.”
If you have been out of work for some time, you might have lost your health insurance or have a hard time paying for a doctor’s visit. Bary said his team helps clients connect with free or low-cost providers who can continue your treatment for the time you are without coverage.
Understanding disability law and the requirements can be overwhelming. Proactive disability attorneys take on that burden to help their clients build their claims for disability benefits.
“Our team works with our clients to determine the best strategy and way to achieve successful outcomes,” Bary said. “Being proactive includes ensuring all forms are completed and obtaining objective medical evidence and opinions from treating providers.”
To learn more about disability law and how an attorney can assist you in your claim, click or tap here.