What type of disability claims regularly get approved by Social Security judges?
Over the past 25+ years, I have represented several thousand claimants and certain characteristics are common to winning cases. Here is what I look for when evaluating claims:
Age of Claimant
In my experience disability judges are more likely to approve claims filed by men and women who are 50 years or older. This does not mean that a 30 year old or a 40 year old can’t win, but if you are younger than 50 we will need a stronger medical record and support from a treating doctor (ideally a specialist) in the form of a functional capacity evaluation.
Older claimants typically do better for several reasons:
- many 50+ applicants have long, consistent work records – judges tend to give individuals with long work histories the benefit of the doubt. They assume that you would not leave a good paying job/career to wait 2 or 3 years with the hope that Social Security will award benefits. Judges also recognize that people with a long work history find social and personal fulfillment in working and such a person would not leave a good job close to retirement age unless there was a very good reason.
- Social Security retirement kicks in as early as age 62. If the judge approves your claim and you are in your 50’s, the Social Security disability trust fund will only be on the hook for a few years. By contrast, an approved 30 year old claimant will be a drain on the trust fund for 20 or 30 years.
- Judges recognize that older claimants will recover more slowly from serious medical problems.
- Judges recognize that fewer jobs, especially entry-level jobs, are available in the real world for a 50+ man or woman with significant medical problems
- Most judges are age 50 or older and they subconsciously identify more closely with an older claimant as opposed to a younger individual.
Long, Consistent Work History
My experience has been that judges give much more weight to the testimony of claimants who have long and consistent work histories. If you have worked for 15 or 20 years, you have obviously paid thousands of dollars into the Social Security system, and most administrative law judges will assume that you would not leave a long standing job to sit at home for 2+ years hoping to recover disability benefits.
Obviously your medical record needs to support your claim for disability but a long work history enhances your credibility and starts you off in a positive light with the judge.
Case File that Contains Objective Evidence of a Significant Medical Problem
Disability judges are under a great deal of pressure to limit their approvals. From the judge’s perspective, it is much easier to find your testimony credible if it is supported by one or more objective medical tests such as:
- CT scan
- Doppler studies
- pulmonary function tests
Understand that every disability applicant on the judges’ calendar comes in and says “I am not able to work anymore and I am disabled.” Your testimony serves to confirm what is already in the record. The days when a judge might approve a claimant based mainly on believable testimony but in the absence of a compelling medical record are over.
This is why disability claims based on more subjective factors, such as fibromyalgia, chronic pain syndrome, complex regional pain syndrome and some mental health disorders, are more and more difficult to win.
This is also why claims based on mental health disorders will require both a long history of psychological or psychiatric care and strong support from a treating specialist.
Medical Conditions that Directly Impact Work Performance
Social Security defines “disability” in terms of how your medical problem impacts your capacity for work. Therefore it stands to reason that the strongest cases are those which result in symptoms that interfere with work performance. This is why I focus mostly on symptoms and medication side effects. Examples of symptoms and medication side effects that I look for include:
- medical conditions that cause bathroom issues (excessive urination, diarrhea, constipation, bowel or bladder incontinence)
- medical conditions that require legs to be extended at waist or chest level
- medical conditions that result in unscheduled breaks during the day at irregular times
- medical conditions that result in missing days from work
- medical conditions that require medications which cause extreme drowsiness or fatigue
- medical conditions that result in very limited capacity to exert (i.e., difficulty climbing stairs, walking more than a few feet)
- medical conditions that result in very limited use of both hands
- medical conditions that necessitate medications with severe and intrusive side effects
You will notice that I did not include pain in my list of symptoms. This is not because I believe that pain is not important – it most certainly is. However, just about everyone applying for disability will be complaining of pain. Pain is very subjective and your judge will look to other factors to evaluate your complaints of pain:
- are complaints of pain consistent with the underlying diagnosis?
- have treating doctors attempted multiple therapies to alleviate pain (including physical therapy, injections, increasing dosages of pain medications)?
Strong Support from a Treating Physician
Remember that the main issue in your disability claim asks why you are not able to perform the duties of a simple, entry level job. Your doctor’s notes, by contrast, are focused on describing your complaints and discussing the success or failure of treatment options.
Your judge has to “translate” medical records into specific work activity limitations. For example, if you have a herniated disc at L4/5 with radiating pain into your left lower leg, what specifically does that mean in terms of your capacity to sit, stand, lift, carry, or function reliably without unscheduled breaks?
If your treating doctor is willing to help us by explaining how your medical issues impact your capacity for work, we stand a much better chance at winning. I typically use functional capacity evaluation forms that I have customized then sent to the doctor to complete. These forms use the language that Social Security uses and my success rate increases significantly when I can get your doctor to complete one of these forms.
Sometimes, your doctor may be more comfortable drafting a narrative report – the format doesn’t really matter as long as your doctor is willing to talk about work activity limitations. This holds true for both physical disabilities as well as mental health disabilities.
Although your medical records will carry the most weight when your case is being evaluated by a disability adjudicator or a disability judge, your statements and testimony can tip the balance. Judges, in particular, expect you to approach the disability application process with the attitude that you do not want to be here, that you would willingly try to return to work, and that you would much rather be working than collecting disability checks.
If you come across as a person who has “given up,” or who has already decided that you are disabled and deserving of a monthly check, judges will discount your testimony. In some cases, an “attitude of entitlement” will tip the balance against you and result in a claim denial.
Understand that every day, the judge in your case will be meeting men and women who are asking that judge to obligate the Social Security disability trust fund for thousands of dollars of benefits payable to you over the next 5, 10, 15 or 20 years. Judges are under a great deal of political pressure to limit claim approvals. You want the judge to see you as a reluctant, but deserving disability claimant.
I learned a long time ago that Social Security disability is not about your medical problems. Instead, our focus needs to be on how those medical problems create work activity limitations. If you keep your focus on work limitations serious enough to keep you from obtaining or keeping a simple, entry-level job, your chances of winning go up significantly.