Social Security Disability Claim was Denied: What Happened?

There are a number of different reasons claimants’ applications for Social Security disability benefits are denied.  They range from a variety of technical reasons, e.g. you haven’t paid enough into the systems, to denials based on the merits of your case.

Denial Based on Merits of Your Case

For this blog post I will focus on the latter, turn downs based on the merits of the case, by that I mean the Social Security Administration (SSA) just does not believe you have an ailment whose symptoms are severe enough to meet the criteria contained in the Social Security Act’s “listings.”

These “listings” really are lists of diagnoses with their attendant criteria or symptoms that the SSA requires to be documented in your medical records for you to meet that particular listing.

For example, here are the criteria for 5.08Weight loss due to any digestive disorder:

Despite continuing treatment as prescribed, with BMI of less than 17.50 calculated on at least two evaluations at least 60 days apart within a consecutive 6-month period.

Now, very few physicians memorialize your doctors’ visits in the language that the SSA demands.  They don’t have to.  They aren’t creating medical records in anticipation of them being reviewed by the SSA, but for their use only.

Accordingly, the SSA will issue a denial based on the merits of your case because the criteria required by the “listings” is not there.

We try and remedy this situation by sending copies of the pertinent “listings” to your primary treating physician and asking them that if they feel you meet the criteria could they track that language in a letter of support.

If they don’t have time for that, we ask that they fill out a short Medical Source Opinion form that does just about the same thing, but in less detail.

Either way can be effective and fill in the holes your doctor left in your medical records that are keeping you from being awarded the Social Security disability benefits you are owed.

If you suffer from a severe impairment that is expected to last more than twelve months and that prevents you from doing any of your past or other work, please contact our office nearest to you to set up a free consultation appointment to discuss your situation.