Submitting Winning Evidence & What Social Security Looks For

Types Of Evidence

Social Security's Evidence Evaluation

There are three general points you must understand about how Social Security evaluates your evidence.

Human Judgment

Social Security adjudicators and administrative law judges (ALJs) have laws and rules to follow. Even so, the interpretation and application of any law, Social Security disability law included, requires human judgment. Human judgment is not perfect. Human judgment is subject to bias, ignorance, time-constraints, inconsistency, etc. Therefore, one person's judgment may be different than another's. Some human judgment is right, some wrong. Social Security's nationwide data demonstrate the nature of human judgment. At the initial and reconsideration levels, Social Security award rates vary widely from state to state, Social Security office to Social Security office. At the hearing level, some ALJs award benefits in 90% of their cases; some ALJs award benefits in 10% of their cases. And it's not just award rates; human judgment also affects wait times. Wait times for decisions can take eight months in one Social Security office, 20 in another.

Social Security Disability Law

For most, a review of any law seems complex, confusing, and very specific. Most law, Social Security disability law included, is in practice, far more general than people realize. Those who write the law leave it general so that judgment and discretion can be used to resolve legal issues. The law is written so that Social Security adjudicators and ALJs have very wide discretion in determining legal issues, making legal decisions, and ultimately, deciding if you are disabled.

Common Interpretations

Despite the imperfections of human judgment and the generalities in Social Security law, adjudicators and ALJs do generally employ a common interpretation of evidence - medical diagnoses, treatment, testing, medications, findings, and symptoms that result in a common determination of your physical, mental, and environmental limitations, and whether you are disabled. We discuss these common interpretations below.

Medical Records & What Social Security Looks For

Three Medical Records Issues

Nothing is more crucial in your Social Security Disability and SSI benefits case than your medical records. Three issues are relevant: 1) getting medical treatment, 2) making sure you accurately and completely report your medical records to Social Security, and then ensuring that it gets them, and 3) how Social Security evaluates your medical records.

Getting Proper Medical Treatment

You must be getting medical treatment and generating medical records and medical testing to prove you have a medical impairment, significant symptoms, and a disability. If you do not have proper medical treatment, it is very difficult to win a disability case. It is extremely common that I talk with clients who have a medical condition for which they have not sought medical treatment: no doctor visits, no testing, no therapy, no surgeries, no medications, etc. Your word about your medical condition and symptoms will not be enough with Social Security. Medical records from years and years ago will not be enough; your medical condition(s) years and years ago do not explain how you are recently or now.

Some claimants cannot get medical care, and most claimants are frustrated with modern medical care which often results in claimants feeling defeated when trying to obtain the medical care they need. This is understandable. But, it is critical you do your best and work persistently to obtain the medical treatment you need for your medical condition. Regardless of your situation, if you are not getting treatment, and you do not have medical records for Social Security to review, expect a denial by Social Security.

Reporting Your Medical Sources & Ensuring Social Security Obtains Them

Why This Issue is Critical

Social Security is only required by law to make "reasonable efforts" to get your medical records. Social Security will ask you about your medical providers so that it can order your medical records. However, Social Security may not get all your medical records, and you may need to get some yourself. Let's review a few good rules to follow about making sure Social Security gets your necessary medical records.

All Medical Providers

Tell Social Security about all your medical providers. I cannot tell you how often claimants forget to tell Social Security about a medical provider. Social Security cannot order what it does not know about.

Complete and Correct Information

You must give Social Security the complete and correct information about your medical providers. You must provide the name of the provider; the name of the clinic; the clinic phone number; and the clinic address including the street address, city, state, and zip code. If you have seen multiple providers at the same clinic, and you cannot remember all their names, call the clinic and ask for their names. Frequently, large clinics with several departments (primary care, orthopedics, neurology, etc.) will only send records for the specific department or provider you cite. So, if you have been treated at a clinic with several departments, and you only list one provider or department, the clinic may only send records from that one provider or department. Commonly, claimants give incorrect or incomplete information. You cannot give Social Security just a provider name, or a partial address, or just the clinic name. Social Security cannot order records if it cannot locate the provider. If Social Security cannot or does not get certain medical records, it will make a decision with the medical records it has which, of course, may result in an incorrect decision about whether you are disabled.

Getting the Records Yourself

New Medical Treatment. If you get new medical treatment after you submit your medical provider information to Social Security, it will most likely not have those new records. This is likely not a problem if the new medical records are the run-of-the-mill primary provider records as there will always be some treatment after medical records are ordered; ordering medical records usually takes 30-60 days. But, if you submit your medical provider information to Social Security, and you then have something significant occur such as medical testing, a hospitalization, or a surgery, you either need to inform Social Security about the new records, or get them yourself, and submit them to Social Security.

Early Medical Records. You may have to obtain medical records covering a time period that is well before the time you allege disability. If you have a Supplemental Security Income (SSI) claim, the earliest you can be paid benefits is your application date. Therefore Social Security will usually not order medical records much earlier than that date. If you have a Social Security Disability Income (SSDI) claim, the earliest you can be paid benefits is 12 months prior to your application date or your alleged onset date whichever is later. Therefore, Social Security usually will not order medical records much earlier than those dates. If you want Social Security to obtain medical records that occur earlier than the above-discussed dates, you will likely need to obtain them yourself, and submit them to Social Security.

Hard to Locate Medical Records. You will have to obtain records Social Security cannot find - records of closed medical clinics, records of out-of-business past employers, legal records the legal entity no longer has, records only you have (stored away in an attic or storage unit), records only your family members have, etc.

Out-of-Country Medical Records. Social Security will have great difficulty getting these records. You will have to get them.

How Social Security Evaluates Your Medical Records

Medical Testing

Tests/Surgeries/Procedures. Medical tests that are prescribed and performed to diagnose and assess your condition are, in and of themselves, indicators of the severity of your medical condition and symptoms. If you have not been prescribed medical testing, Social Security adjudicators/ALJs will view the absence of the testing as an indicator that your doctor does not believe your condition is severe, not even severe enough to warrant testing. If you have been prescribed medical testing, and you have not done it, Social Security adjudicators and ALJs will view the absence of the testing as an indicator that you do not believe your condition is severe, not even severe enough to undergo testing to diagnose your medical condition so that it can be treated.

Tests/Surgeries/Procedures Results. If you have had medical testing, the results are critical as they are objective measurements of the severity of your medical condition. Test results can be generally categorized in five groups: 1) normal, 2) mildly abnormal, 3) moderately abnormal, 4) markedly abnormal, or 5) extremely abnormal. If your test results are normal or mildly abnormal, Social Security will not find that your test results indicate a serious medical condition or disability. If your test results are markedly or extremely abnormal, Social Security will usually determine the test results are the basis of your disability and find you disabled - as long as you are also following prescribed treatment, taking prescribed medications, your activities of daily living (ADL) are consistent with your symptoms, and you are credible. Moderate test results are complicated. Social Security generally does not consider such results disabling. However, Social Security may find moderate test findings disabling if other factors of your case are in your favor such as you are over age 50, you have no transferrable work skills, you are illiterate, you don't speak English well, you have additional medical conditions, you are taking extreme medications or have a history of several medication changes, you have a supporting doctor statement, you or your witness are highly credible, or you have a liberal adjudicator or ALJ.

Social Security's Evaluation of Tests/Surgeries/Procedures:

1. None prescribed or performed:
   Much less likely disabled -
2. Testing prescribed but not performed:
   No real difference -
3. Testing with normal or mild findings:
   Not likely disabled -
4. Testing with moderate findings and you are under age 50:
   Less likely disabled -
5. Testing with moderate findings and you are over age 50:
   More likely disabled -
6. Testing with markedly or extremely abnormal findings:
   Likely disabled -

Medications

Your prescribed medications are indicators of the severity of your medical condition and symptoms. The more significant your medications, the more severe your medical impairment. Some claimants do not take prescribed medications for many reasons - past addiction issues, the medications are not effective, a general dislike of pills, a lack of medical insurance, etc. Social Security states it will not use the lack of medications against you if you have a good reason for not using them, but I think it does anyway as I feel Social Security generally takes the position that prescribed treatment will improve your medical condition.

Medication changes are also a good indicator of the severity of your medical condition and symptoms. Medications are changed because they are not working, or your condition is not controlled. Your medical condition and symptoms will be found more severe if your medications are changed frequently or the dosages are increased.

Social Security's Evaluation of Medications:

1. Significant medications not prescribed:
   Not likely disabled -
2. Significant medications prescribed and not taken:
   Less likely disabled -
3. Significant medications prescribed and taken:
   Much more likely disabled -
4. Significant medications prescribed, taken, and changed often:
   Likely disabled -

Assistive Devices

Assistive devices like a brace, cane, walker, scooter, wheelchair, shower chair, or an assistance pet are indicators of the severity of your medical condition and symptoms. Social Security adjudicators and ALJs are more likely to find you suffer severe symptoms or limitations if your doctor prescribes an assistive device or feels it is medically necessary. If you use an assistive device that is not prescribed by your doctor or determined medically necessary bu your doctor, Social Security will view your impairment as less severe than if it was prescribed or is medically necessary, even if your doctor knows you use your device, and even if your doctor approves of your use of the device. If your doctor prescribed the device, make sure the prescription is part of your medical record. If your doctor did not prescribe the device, but feels it is medically necessary, ask him/her to note that it is medically necessary in your medical record.

Social Security's Evaluation of Assistive Devices:

1. Devices not used or prescribed:
   No real difference -
2. Devices used but not prescribed:
   More likely disabled -
3. Devices not used but prescribed:
   No real difference -
4. Devices used and prescribed:
   Much more likely disabled -

Following Medical Care

You may be tempted to forego recommended care - physical therapy, a consult with a specialist, a surgery, etc. You will have your own reasons why you do or do not follow medical treatment, and I will not be one to tell you what is right or wrong on this issue. Though I will say that our medical system is broken, and there are many reasons prescribed treatment is inappropriate - financial gain for the provider, incompetence, ignorance, groupthink, etc. Social Security states it will not use the refusal to follow medical treatment against you if you have a good reason, but I think it does anyway as I feel Social Security generally feels prescribed treatment will improve your medical condition. So, forego recommended medical care at your own risk.

Social Security's Evaluation of Follwing Care:

1. Care not followed:
   Much less likely disabled -
2. Care followed:
   No real difference -

Doctor Statements And What Social Security Looks For

Doctor Statements Are Extremely Important In A Social Security Disability Case

General

In a Social Security disability and SSI benefits case, a doctor statement about your medical condition and your mental and physical abilities is critical. Social Security's determination about your disability case is primarily based on your medical condition. The most important thing you can do in your case is to make sure Social Security has your medical records. The second most important thing you can do in your case is to get a statement from your doctor, psychologist, or psychiatrist (hereinafter "doctor") about 1) your medical condition and 2) your "residual functional capacity" (RFC) which is your maximum physical abilities or your "mental residual functional capacity" (MRFC) which is your maximum mental and emotional abilities. If you cannot get a statement from your own treating doctor, you can get one from a non-treating doctor who is hired to evaluate you and render an opinion on your behalf.

Social Security Relies On Doctor Statements

Social Security Needs Doctor Statements. The adjudicators and administrative law judges (ALJs) at Social Security (those who decide whether you are disabled) are not doctors. Yet they read your medical records and make a judgment call about your RFC/MRFC. Then they decide if you are disabled. During this process, they use Social Security doctors to review your case or evaluate you in person. These doctors produce assessments and statements, and the adjudicators and ALJs rely on these statements when making their decisions because these doctors understand medical conditions, care, treatment, and testing; medicine; and medications.

Three Types Of Doctor Statements. First, and usually unbeknownst to you, Social Security will always hire a doctor (sometimes more than one) to read your medical records and render a statement about your medical condition and your RFC/MRFC. This medical opinion will become part of your Social Security file. These statements are referred to as "DDS opinions" as the specific Social Security agency the renders the opinions is called Disability Determination Services. Second, Social Security will sometimes hire a consultative examiner (CE) to perform an in-person physical or psychological evaluation of you and write a report about your medical condition and RFC/MRFC. This medical statement will become part of your medical file. These statements are referred to as "CEs" - SSA Medical Evaluation (Mental). Third, Social Security will rely on a doctor's statement submitted by you.

Your Doctor Statement Is Extremely Important. If you are filing a new application or appealing your case, and you do not get a statement from your doctor, Social Security will usually accept the medical opinion or statement of the doctor they hired to evaluate your case because that doctor provided the only medical opinion about your RFC/MRFC. If you submit a statement from your doctor or a doctor you hired to evaluate you and the doctor finds that you are disabled, Social Security will have two medical opinions about your RFC/MRFC (your doctor and the doctor hired by Social Security), and Social Security can choose to accept the opinion of your doctor. This is how submitting a statement from your doctor can make such a big difference in your case.

Treating Doctor Statements

Statement Types And What To Include

General. There are four types of doctor's statements and each type has its own advantages and disadvantages:

1. Declaration (a written statement from your doctor),
2. Form (usually in fill-in-the-blank or checkbox style),
3. Written Questions/Interrogatories (questions given to your medical provider to answer), and
4. Letter.

Any statement type should include two things:

1. A summary of your medical condition,
2. An assessment of your RFC/MRFC, and
3. An explanation supporting the RFC/MRFC.

If you can obtain a declaration or interrogatories, they should also include:

1. An explanation of any weaknesses or problems that exist in your medical case (if any), and
2. An explanation of hard-to-understand medical information (if any).

Doctor Vs. Non-Doctor. Because of the strong focus on profit in modern medicine, it is common that claimants are treated by a physician's assistant (PA), registered nurse (RN), advanced registered nurse practitioner (ARNP), or counselor instead of a doctor. Often, a claimant thinks their medical provider is a doctor when, in fact, they are not. Social Security generally gives a statement from a PA, RN, ARNP, or counselor minimal consideration because Social Security feels they lack the education and experience of a doctor. That said, statements from a PA, RN, ARNP, or counselor are still worth doing, and you submit them if you can.

Social Security generally gives a well-supported statement by a doctor who treats you significant consideration. You should obtain as many statements from them as you can; the more treating doctors who can discuss your medical condition and support your claim for disability, the better.

Declaration

General. A declaration is a statement drafted by your attorney/representative after speaking to your doctor, usually by phone, about your medical condition, your RFC/MRFC, and any weakness or extremely complicated medical issues in your medical case. A declaration is the best type of statement for two reasons. First, it is capable of providing the most detail. Second, it is capable of providing the best explanations for the doctor's answers. There are two disadvantages of a declaration. First, it is time-consuming for both your attorney/representative and your doctor, and therefore either may not want to do it. Second, because it is the most time consuming, it is the most expensive.

Two Examples. Declaration1 and Declaration2

Form

General. A form is a document with questions that ask your doctor about your medical condition and RFC/MRFC with blanks and checkboxes as spaces for answers. They are quick to do and easy to fill out. They are the most common type of medical statement, and doctors often just fill them out during your office visit. Social Security doctors that are hired to evaluate your medical condition and RFC/MRFC fill out the same or similar forms about you, and these forms are part of your case. The two most common examples of a Social Security form are - SSA Medical RFC Form 1 and SSA Medical RFC Form 2. You can submit a RFC/MRFC form to your own doctor, or as some attorney/representatives do, you can submit customized forms that simplify the forms or add relevant questions about your medical condition. The main advantage to a form is that it can be filled out quickly. The disadvantages of a form is that 1) the doctor usually does not provide much explanation for the answers, 2) and any necessary follow-up to obtain an additional explanation is difficult. Social Security's most common criticism of a form is the lack of answer detail or explanation. Therefore, it is very important the doctor provide an explanation for his form answers - 4-5 sentences can be enough.

Sometimes your treating medical provider will address a RFC/MRFC for another government entity that should be submitted in your Social Security disability case.

Multiple Examples. RFC1 (Word) or RFC1 (PDF). RFC2 (Word) or RFC2 (PDF). MRFC (Word) or MRFC (PDF)

Interrogatories

General. Interrogatories is a fancy legal word that means written questions. Interrogatories are prepared by your attorney/representative and submitted to your doctor. Interrogatories are best used when a great deal of detail is needed - answers about complicated medical issues, unusual treatment, non-compliance with medical care, the impact of drug or alcohol use, any other weakness in your medical case, etc. Of course, interrogatories can be used to ask general questions - your medical condition and your RFC/MRFC. I feel interrogatories are best used when they are sent to your medical provider together with a form so that your medical provider can answer both. The form can address the simpler questions such as physical and mental limitations much easier and faster than interrogatories while interrogatories can ask other types of questions that focus on more detailed and specific issues. The advantage of interrogatories is that you can directly present to the doctor the issues that are most important to your case. The disadvantages are that 1) the doctor may not adequately answer the questions asked; 2) any necessary follow-up about the answers is difficult; 3) interrogatories are time-consuming for your doctor and lawyer, and therefore neither may not want to do them; and 4) because they are time-consuming, they are expensive.

Example. The following is an example of a cover letter and interrogatories: Interrogatories (PDF)

Letter

General. A letter is a statement written by your doctor. Letters are very rarely helpful. The advantage of a letter is that it can be written quickly on your doctor's own schedule. However, a letter is the least beneficial option for a statement because the doctor nearly always writes something too vague to be helpful. Usually, the doctor will 1) write that he treats you, 2) briefly describe your medical condition or symptoms, and 3) write something vague about your limitations like you are "disabled," or you "not capable of full-time work," or you are a "candidate for disability," etc. Social Security gives this type of language very little consideration for two reasons. First, Social Security requires more specificity about your medical condition and your RFC/MRFC. Second, your doctor is not an authority on disability. Social Security will not give significant weight to such a vague statement that you are "disabled" or "can't work" because that is a determination that requires a legal evaluation - one that includes more than just an evaluation of your medical condition. Letters also do not usually address specific weaknesses in your medical case. For these reasons, I very rarely recommend obtaining a letter from your doctor.

Example. An example of a common and disappointing letter - Treating Medical Provider Letter

Non-Treating Medical Expert Statement

General

A non-treating medical expert is a doctor who does not regularly treat you for your medical condition. A non-treating medical expert can be hired to offer an opinion about you, your medical condition, your RFC/MRFC, and any weakness in your case. As stated above, Social Security will obtain a non-treating medical opinion from one of its own medical providers which will be a written opinion based on a file review or a written opinion based on a one-time evaluation of you. If you are not treated by a doctor, or you have one, but they will not write a statement on your behalf, you should try to hire your own non-treating medical expert to either 1) write a report for you after reading your medical records, or 2) perform an evaluation of you, read your medical records, and then write a report.

Written Report or Evaluation

Written Report. A medical expert can review your medical records and write a report about 1) their opinion of your medical condition, history, or records; and 2) their opinion of your RFC/MRFC. Sometimes they will also fill out a RFC/MRFC form. Written reports are less common than evaluations and typically most helpful when you have a complicated medical condition, and the expert is needed to address that complication.

Example: Non-Treating Medical Expert Report

Non-Treating Medical Expert Report. A non-treating medical expert can perform an in-person evaluation of you which is usually arranged by your attorney/representative. Your attorney/representative will send the medical expert some of your most important medical records. Only some records are sent due to the medical expert's hourly cost. A medical expert's cost is dramatically higher if they are asked to read a 300-700 page medical file vs. 30-50 pages of pertinent medical records. The medical expert will usually evaluate you for 30-90 minutes (psychological exams are usually the longer ones), and write a written report discussing primarily three things: 1) their medical exam findings, 2) their opinion of your medical condition/history/records, and 3) their opinion of your RFC/MRFC. Sometimes a hired medical expert will also fill out a RFC/MRFC form. Reports are usually two to eight pages long (psychological exams are usually the longer ones).

Example: Hired Non-Treating Medical Expert Evaluation

Costs

Costs for non-treating medical opinions are generally as follows:

1. A treating doctor's declaration is usually free about one-quarter of the time, and $100-$200 the rest of the time;
2. A treating doctor's interrogatories usually costs about $300-$700 per hour and usually take about one to three hours to complete;
3. A treating doctor's form is usually free about half the time and usually about $100-$200 half the time;
4. A treating doctor's letter is usually free if it's quick and bad, and usually about $100-$200 if it's good;
5. A medical expert's evaluation and opinion usually cost about $300-$700;
6. A medical expert's medical record review and written report usually cost about $200-$400 per hour and usually take about one to three hours to complete (but this varies widely); and
7. A treating PA, RN, ARNP, or counselor's statement is usually free most of the time, and usually $50-$100 if there is a charge.

How Social Security Evaluates Doctor Statements & RFC Opinions

Social Security Evaluation

1. No doctor statement:
   No real difference -
2. Your ARNP, RN, PA, or counselor statement:
   More likely disabled -
3. Social Security doctor statement indicating disability:
   Likely disabled -
4. Your doctor statement indicating disability:
   Likely disabled -
5. Social Security doctor statement indicating non-disability:
   Much less likely disabled -
6. Your doctor statement indicating non-disability:
   Not likely disabled -

Friends & Family Statements - What Social Security Wants

Two Types Of Statements - Written & Oral

People always ask, "Should I get a statement from a friend or family member about my condition?" The answer is yes. A written statement or lay person testimony from a family, friend, employer, or teacher can help you win your Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefit case if done correctly.

A written statement from a friend, family member, teacher, employer or supervisor, and co-worker are referred to as a "layperson statement" or "lay statement." An oral statement is hearing testimony, or "layperson testimony." A friend, family member, teacher, employer or supervisor, or co-worker can submit a written statement or testify at your hearing (if you have one). It is usually not necessary to do both.

A friend, family member, teacher, employer or supervisor, or co-worker statement or testimony is not just helpful, but necessary when the claimant is as follows:

1. A child;
2. Too tough for his or her own good and therefore cannot accurately detail their limitations;
3. Cognitively impaired and cannot therefore communicate or understand the nature of their limitations; and
4. Most commonly, simply a bad communicator who overstates, understates, forgets, or is easily confused.

Written Statement

You should submit one to five statements to Social Security. Ultimately, the goal of the lay statement is twofold: 1) the layperson describes the problems they see you having, and 2) the layperson describes the help they give to you to perform activities of daily living (ADLs), or school or work tasks. It is very important the layperson writes about what they observe of you, NOT what you tell them about you. A statement should either be in legible handwriting or typed. The statement should not be more than two pages.

What To Include In A Written Statement

1. An opening sentence of what the layperson is writing about and the time period addressed, as obviously, you want someone to write about their observations of you during the time you allege disability (e.g., "I am writing to you about my observations of my sister, Jane Doe, from May 2020 to now");
2. How the lay person knows you;
3. How many days (and hours per day) in an average week or month the layperson spends time with you (the more time they spend with you, the better they know you, and the more weight Social Security will give the statement);
4. What limitations the layperson observes of you when they spend time with you;
   • Friend or family member - difficulties they observe you have with housework, errand running, caring for children, cooking, cleaning, showering, taking medications, general physical limitations (e.g., sitting, standing, walking, lifting, or handling), and general emotional limitations (e.g., irritability with others, anger outbursts, crying spells, panic attacks, or isolating yourself), etc.;
   • Employer, co-worker, teacher - excessive tardiness, excessive breaks, excessive absenteeism, and general physical and emotional limitations;
5. What your layperson does to help you with any of the limitations described above;
6. What you are doing when you spend time together;
• Friend or family member - if you are shopping, cleaning, or barbecuing, etc., it will have a different impact on Social Security than if you are home resting, simply talking, isolating, or lying down, etc.;
• Employer, co-worker, or teacher - what they observe of you while you are at work/school; and
7. A signature and date.

Examples

Examples of layperson statements: Family Member Statement (PDF), Supervisor Statement (PDF), Teacher Statement (PDF).

Hearing Testimony

Someone can testify at your hearing. Hearings are generally one hour long which is a limited amount of time to present your case. Because of the limited time, you should plan on taking testimony from only one witness. Make sure your witness has three qualities: 1) they have observed you, 2) they can communicate well about your limitations, and 3) they support your claim for disability. Please make sure you talk to your witness before your hearing. It is common that a witness does not agree that the claimant is severely limited or disabled. Obviously, such testimony will hurt your case. Due to the time constraints, your witness's testimony should be to the point and, in most circumstances, should be limited to about five minutes. In some cases, the administrative law judge (ALJ) may determine there is no time for a witness. In these cases, you should ask the ALJ to allow you to submit a post-hearing written witness statement which is nearly always allowed.

How Social Security Evaluates Family/Friend/Employer/Teacher Statements & Testimony

Social Security generally gives moderate (as opposed to significant) consideration to written statements from your family and friends because it usually believes family and friends are biased in your favor. Social Security generally gives more weight to employer, co-worker, or teacher statements because Social Security believes they are less likely to be bias in your favor.

Social Security's Evaluation

1. No lay statement:
   No real difference -
2. Friend or family member statement that you suffer serious limitations and who sees you occasionally:
   More likely disabled -
3. Friend or family member statement that you suffer serious limitations and who sees you frequently:
   Much more likely disabled -
4. Co-worker, supervisor, or teacher statement that you suffer serious limitations:
   Much more likely disabled -

Social Security Disability Forms: What Social Security Looks At

Overview

You will fill out a variety of Social Security forms - most at the initial and reconsideration levels, a few at the hearing level, and none at the appeals council or federal court levels. The forms requiring the most attention are those asking about your functioning or activities of daily living (ADLs), work history, and medical sources.

How To Answer The Forms - Generally

There are three overall principles you should follow in filling out the forms:

Be Honest

The truth will come out in your case. The issues you address in your forms will likely also be included in your medical records, friends/family statements, or in your hearing testimony (if you have a hearing). If your statements on your forms differ from these other sources, Social Security will usually conclude you are not telling the truth, and that will obviously hurt your case.

Be Complete

Understand that you are trying to convince Social Security you are disabled. It is your job to include the information Social Security needs to find you disabled. If you are too casual, or brief, or sloppy in giving Social Security information on its forms, Social Security will be more likely to rule against you than for you. Use your own additional pages if you need to. Simply include them with the forms. Commonly, extra space or pages are needed. Do not use the back of the forms because they are often not scanned into your electronic file.

Don't Exaggerate Your Abilities

If you exaggerate, you are writing that you can physically and mentally do more than you actually can, or you have performed more work duties and skills than you actually did. Neither is helpful to you. If you exaggerate your pain or limitations, your claims will likely be inconsistent with your medical records.

How To Answer The Forms - Specifically

Function Forms

Importance. The forms asking about your functioning or ADLs are important because you are telling Social Security what you can and cannot do; how much your medical condition and symptoms affect you; and ultimately, you're telling Social Security whether you're disabled. Social Security looks closely at these forms. If you can perform ADLs without difficulty, Social Security can find you not disabled based on your ADLs alone - even if your medical records show you have a significant medical condition. If you are denied, Social Security will regularly quote your form statements about what you said you could do.

Function Forms. For adults, the most common form you'll be given about your functioning is a Function Report - SSA 3373. For children, the most common forms you'll be given about their functioning are the following:

1. Disability Report - Child - SSA-3820-BK,
2. Function Report - Child Birth to 1st Birthday - SSA-3375-BK,
3. Function Report - Child Age 1 to 3rd Birthday - SSA-3376-BK,
4. Function Report - Child Age 3 to 6th Birthday - SSA-3377-BK,
5. Function Report - Child Age 6 to 12th Birthday - SSA-3378-BK, and
6. Function Report - Child Age 12 to 18th Birthday - SSA-3379-BK.

Poor Functioning. If you have difficulty doing ADLs or if you need help doing ADLs, you must tell Social Security. Otherwise, Social Security presumes you perform your ADLs satisfactorily. Obviously, the more difficulty you have, the more likely Social Security will find you disabled.

Killer ADLs. Social Security finds certain ADL's so significant that the existence of any one will either give Social Security pause about awarding benefits, or cause it to deny your case. Those ADLs are - vacations, yard work, moving furniture, chopping wood, auto mechanic work, caring for pre-kindergarten children without help (usually your own kids), and most types of significant physical exercise (e.g., hiking, running, or gym time that is not physical therapy).

Poorly Worded Questions & How to Answer Them. I think many of the functioning questions are poorly worded. These questions ask what activities you do, but 1) they do not ask how well you do them, or 2) they don't ask what activities you cannot do. Therefore, your answers are often not accurate as they usually indicate you are capable of doing more than you actually can. Here are two examples.

The first example is the first question about functioning asked on Social Security's Function Report, "Describe what you do from the time you wake up until going to bed." Most claimants usually think of the activities they do all day. Then, they list them. The claimant does not write how well they do the activities as the question does not ask that. The claimant also does not list what they don't do as the question doesn't ask that; it asks what they do do. Thus, the claimant answers the question by listing all the activities they do in the day without any mention of problems they have when doing them. The claimant, therefore, has given Social Security's a summary of their day, their life, that is inaccurate. When Social Security denies the claimant, it will cite from the form that the claimant can perform x, y, and z activities in the day.

The second example is the second question about functioning asked on Social Security's Function Report, "Do you take care of anyone else such as a wife-husband, children, grandchildren, parents, friend, other? If 'YES,' for whom do you care, and what do you do for them?" Most claimants usually think of what they do for others - usually their kids. Then, they list those things. Again, the claimant does not write how well they do the tasks as the question did not ask that. The claimant also does not list what they don't or can't do as the question asked what they actually do. Thus again, the claimant will give an inaccurate picture of activities.

For each and every question that asks about your abilities, activities, or functioning, write three parts to your answer. First, list the tasks you are able to do. Second, if you have difficulty doing a task you list, or you do it infrequently, write that down, and tell Social Security why. Third, write down common tasks you are unable to do, and tell Social Security why. Include additional pages if necessary. For example, if the question asks, "What type of housework do you do?" A reasonable answer may be, "I lightly dust about once per week. I can sweep. I vacuum about twice a week. I am not able to vacuum under furniture because it requires me to bend down. I cannot carry the vacuum cleaner upstairs because it is too heavy. My son does that for me. I can do half-loads of laundry, but not full loads because they are too heavy. I can usually take out the garbage, but I make sure the bag is light or half full. I can wash dishes at the sink for ten minutes before I have to sit down. I cannot load the dishwasher because I cannot bend. I cannot scrub a floor, toilet, or tub, and my family helps me with those tasks. I cannot mop. I can do housework for about 30-45 minutes at a time before I have to rest and alleviate my pain. I can do housework for about an hour a day in total. Three to four days a week, I can do no housework at all."

Work History Forms

Overview. The two most important issues in filling out Social Security forms about your past work are 1) remembering all your jobs in the last 15 years, and 2) filing out your job duties correctly. The most common job forms Social Security will ask you to fill out are as follows:

1. Work Activity Report - SSA 821;
2. Work History Report - SSA 3369; and
3. Disability Report Adult - SSA 3368 (part of this form relates to jobs and job duties).

Remembering. Remembering every job in the last 15 years is not easy. If you cannot remember, ask Social Security to send or give you your Detailed Earnings Query (DEQY) (pronounced "dee-quee"). This form will list, by year, every employer for whom you have worked. However, the DEQY lists your past employer's corporate name which may be different than the name with which you are familiar. For example, if you worked for Johnson Construction and its registered corporate name is J and A Industries, LLC, then J and A Industries, LLC will be the name listed on the DEQY.

If you forget some employers, Social Security at the initial or reconsideration level may not follow up with you. However, if you attend a hearing, the administrative law judge conducting the hearing will walk you through your DEQY if your work forms look incomplete. At the hearing, you may be unprepared to discuss what you did at certain jobs for certain employers, and your unprepared on-the-spot answers may be incomplete or incorrect which may hurt your case. So, get your DEQY.

Job Duties. Do not exaggerate your job title or your work duties. Disability is based in part on your past work and your work skills. Although it is understandable that you may want to puff up your work responsibilities or skills, don't. The more work skills you have, the easier Social Security can find other work for you. Do not write you supervised others if you did not. Do not write you were an assistant manager or manager when you were not. Do not write you performed work tasks or work skills you did not. The case is not about your ego. Your case may rest entirely on the issue of your work skills, especially if you are over age 50.

Medical Source Forms

Informing Social Security about your medical sources and getting your medical records are reviewed here - Medical Records/Evidence.

How Social Security Evaluates Your Forms

Social Security's Evaluation

1. You indicate significant limitations but your answers are short and/or vague:
   More likely disabled -
2. You indicate significant limitations and your answers are detailed:
   Much more likely disabled -
3. You do not indicate significant limitations:
   Not likely disabled -

Keeping a Diary & What Social Security Looks For

Value of a Diary

Submitting a diary in a Social Security disability and SSI benefits case is helpful. It can show the severity of your symptoms and limitations. You should keep a diary while your Social Security disability case is pending. Its purpose is to provide Social Security with a better understanding of your daily life, your medical condition and symptoms, and your limitations. Presumably, if you are alleging disability, you are having problems carrying out activities of daily living (ADLs) and normal tasks. Your diary must include these problems. Few lawyers recommend you keep a diary, and diaries are not commonly submitted to Social Security. However, for the reason I just discussed, I believe they are helpful. Your diary must be a certain length and capable of being scanned into your electronic Social Security file.

Length

The main problem with a diary is the time it takes to read it. Neither your lawyer nor a Social Security adjudicator or administrative law judge (ALJ) is going to be fond of doing all the normal work your case involves and also reading a two-year-long diary. Therefore, your diary should not be too long or too hard to read. Write very legibly or type it. I recommend your diary be no longer than about 50 wide-ruled notebook pages as I feel any diary longer will not be thoroughly read by a Social Security adjudicator or ALJ. Each notebook page has about 25 lines. If you write two five-sentence entries per week, you will be able to include 250 entries on 50 pages. The average wait-time for a hearing in America from an initial application is about 24 months or about 105 weeks. So, if your case goes all the way to a hearing, two entries per week will result in 210 total diary entries. Since a 50-page diary can accommodate 250 total diary entries, a twice-a-week diary can be kept to 50 total pages or less.

Scanned Records - Not Paper

Your Social Security file is electronic, not paper. The pages of your diary will need to be scanned into your electronic Social Security file. Therefore, your diary must be written on loose-leaf notebook paper with removable pages. An old-fashioned diary in a spiral notebook or a classic diary with a lock on are very difficult to scan. If you do not have a lawyer, you will need to mail the diary pages to SOcial Security; keep your own copy in case Social Security misplaces what you send - this is always a reality abut what you submit to Social Security. If you have a lawyer, they can scan your diary.

How Social Security Evaluates Your Diary

Social Security's Evaluation

1. No diary:
   No real difference -
2. Diary describing serious daily limitations:
   More likely disabled -
3. Diary with pictures describing serious daily limitations:
   Much more likely disabled -
4. Diary describing minimal daily limitations:
   Much less likely disabled -

Other Government Records & What Social Security Looks For

Why They're Important

In a Social Security disability and SSI benefits case, records of your involvement with another government entity may help show your limitations and functioning. Therefore, Social Security will usually want that information which includes but is not limited to the following:

1. Veteran's Administration (VA),
2. State workers' compensation,
3. State disability programs,
4. State unemployment,
5. State child protective services (CPS), and
6. Court records related to a civil or criminal case (this is rare).

VA

There are three types of VA records that need always be submitted in your Social Security disability case. First, your medical records. Second, your VA rating decision. Third, your compensation and pension (C&P) exams performed to determine your rating.

Usually when Social Security orders your VA records, it actually orders your VA medical records. As a result, your rating decision is not included. Your VA rating is discussed in your medical records. However, you want to obtain and submit your rating decision for two reasons. First, it establishes clearly what your rating is and why (medical records are not always clear on this point). Second, it establishes when your rating was determined which is important to Social Security in determining when you became disabled (under Social Security's rules).

Your C&P exams are sometimes included in a medical records order, and if you are certain they are included, you do not have to order them separately. If they are not included, order them. They are medical evaluations. The medical providers who wrote the exam reports found you suffered restrictions. They are of significant importance in any Social Security disability case.

Worker's Comp. Records

There are two things going on in a worker's compensation case, and people often get them confused. First, the state will determine if your injury happened on the job. Second, the state will determine the severity of your injury. If worker's compensation ruled against you (denied your claim) because it found your injury did not occur on the job, that does not mean you are not injured, and it does not mean you should keep those records from Social Security. Whether you were injured on the job has nothing to do with the severity of your injury. A workers' comp. case, won or lost, will nearly always include medical evidence that is relevant to your Social Security disability case. Submit these records.

State Disability

If you live in a state that pays you benefits if you are disabled, the state will have obtained a statement from your doctor that you have significant physical or mental restrictions or that you are disabled, or the state will have paid for a physical or mental consultative examination (CE) of you wherein a medical professional will have evaluated you and written a report that you are highly restricted or disabled. In either case, these assessments are helpful to your case, and you should submit them to Social Security.

State Unemployment

These records may be helpful or hurtful to your case. Generally, if you received or are receiving unemployment benefits, and you have not made the state aware of your limitations, you are telling the state and prospective employers you can work. In other words, you are telling them you are not disabled. In this case, you will not be able to receive Social Security disability benefits during the time you received or are receiving unemployment benefits, and therefore submitting unemployment records are unnecessary. You will nearly always simply have to argue that your disability began sometime after your unemployment ended. If, however, you received or are receiving unemployment benefits, and you told the state and prospective employers of your mental or physical limitations, then you need you to submit to Social Security your unemployment records to prove you have revealed your limitations (disability) to the state.

CPS Records

These records may be helpful or hurtful to your case. Usually, CPS involvement in your life is rarely good. If CPS is involved in your life because you had or are having difficulty caring for yourself or your children due to a medical condition, CPS records will be very helpful in establishing disability with Social Security as the records will usually show you have difficulty caring for your children or you cannot successfully care for them. If CPS is involved in your life for reasons other than your medical condition, these records will likely not be relevant to your disability case, and you will not need to submit these records to Social Security.

Civil or Criminal Court Records

These records can either be helpful or hurtful to your case. Sometimes you will submit them, sometimes you will not, and very rarely Social Security will request them. If you are not the defendant in a case, these records are rarely helpful because the case is rarely about your actions. So, most civil or criminal records you will consider submitting are ones where you are the defendant - you did something wrong. You will have to make a judgment call about whether submitting them will be helpful or hurtful to your case.

In the very rare circumstance that Social Security requests these records, it will be looking to see how active you are as you clearly have the physical or mental capabilities to do whatever your court case is about.

Most lawyers do not submit these records because they fear if places their client in a bad light. After all, doing things wrong or being unlikeable rarely works in your favor.

However, these court records can be helpful if you are alleging disability - most commonly if you suffer a mental health impairment. For example, you allege disability based on a mental health impairment, and you argue you have difficulty getting along with others and handling the stressors and pressure of everyday life. If you have a civil or criminal court case involving an assault, a threat, property damage, etc., these records may help prove your point.

How Social Security Evaluates Other Government Records

VA Records

1. VA records with a disability rating below 60%:
   No real difference -
2. VA records with a disability rating between 60-80% and you are under age 50:
   No real difference -
3. VA records with a disability rating between 60-80% and you are over age 50:
   More likely disabled -
4. VA records with a disability rating above 80% at any age:
   Much More Likely disabled -
5. VA records with a disability rating above 50% and a determination of unemployability at any age:
   Likely disabled -

Worker's Comp. Records

1. Workers's comp. records demonstrating work limitations but not total disability and you are under age 50:
   No real difference -
2. Workers's comp. records demonstrating work limitations but not total disability and you are over age 50:
   Much more likely disabled -
3. Worker's comp. records demonstrating total disability at any age:
   Likely disabled -

Unemployment Records

1. Unemployment records not demonstrating work limitations:
   Likely not disabled -
2. Unemployment records demonstrating work limitations:
   Much more likely disabled -

State Disability Records

1. State disability records demonstrating work limitations but not total disability and you are under age 50:
   Much less likely disabled -
2. State disability records demonstrating work limitations but not total disability and you are over age 50:
   More likely disabled -
3. State disability records demonstrating total disability at any age:
   Likely disabled -

Court Records

1. CPS/court records that do not address your medical condition:
   No real difference -
2. Court records demonstrating significant physical or mental difficulties:
   Much more likely disabled -
3. CPS records demonstrating you cannot care for yourself or your kids due to your medical condition:
   Likely disabled -

Pictures In A Disability Case: What Social Security Looks For

General - Submitting Pictures To Social Security

A picture says a 1,000 words right? Submitting pictures in a Social Security disability and SSI benefits case is important because they can demonstrate the severity of your medical condition. Sometimes, compared to words, pictures can provide Social Security with a better understanding of your daily life, your medical condition and symptoms, and your limitations. Pictures are most useful when they are taken of 1) your body or of 2) home modifications made because of your limitations. Few lawyers recommend you take and submit pictures, and pictures are not commonly submitted. However, I believe they can help prove disability.

Body Pictures

Medical records do not contain pictures, and sometimes medical records do a poor job of describing the nature of a medical condition. If you have a medical condition that is visually striking, severe, or unusual, you should take pictures and submit them to Social Security (e.g., skin conditions, infections, nodules from rheumatoid arthritis or gout, joint swelling, severe muscle atrophy, contracture of a finger, severe scarring, joint or bone deformities, and unusual posture).

Home Modifications Pictures

Presumably, if you are alleging disability, you are having problems carrying out everyday tasks. In some cases, home modifications are made to address those problems. Modifications can include but are not limited to the following:

1. Safety/grab bars,
2. Handrails,
3. Ramps,
4. Removal of doors,
5. Removal of locks,
6. Additional lighting,
7. Shower or bathtub modifications,
8. Shower seats,
9. Moving your bed to another room, and
10. Obtaining a new chair or bed to sit/lie in.

If you have made these home modifications, take a picture and submit them to Social Security.

Submitting Pictures To Social Security

Your Social Security file is electronic, not paper. All records are scanned into your Social Security file. Hence, Social Security will be very hesitant to accept actual photos. You will not be able to submit or download pictures in an electronic format. And, Social Security adjudicators and administrative law judges (the decision-makers in your case) will not inspect your body part or house. Therefore, you should submit pictures in one of two ways. First, print your pictures onto an 8x11 piece of paper (your pictures can be smaller than 8x11), and then submit the paper copy of the pictures. Second, tape your pictures onto a piece of 8x11 paper, copy them with a photocopier, and then submit the photocopy.

If you do not have a medical condition that is visually striking, or you have not made home modifications, that's okay. Most medical conditions are not visually striking, and most people do not make home modifications. You can still be found disabled.

Tip. A picture copy will be darker than the picture. Therefore, when you take the picture, make sure it is done with plenty of light. If the picture is too dark, the copied picture may be too dark to see any detail.

How Social Security Evaluates Pictures In Your Disability Case

Social Security's Evaluation

1. No pictures:
   No real difference -
2. Pictures showing minimal to moderate impairment abnormalities or home modifications:
   More likely disabled -
3. Pictures showing significant impairment abnormalities or home modifications:
   Much more likely disabled -

Employment Records In Your Social Security Disability Case

Importance Of Your Employment Records & What Social Security Looks For

Social Security will evaluate your work and employment records to determine whether you are disabled. It is concerned about the work you have done in the last 15 years wherein you engaged in Substantial Gainful Activity (SGA) - Social Security calls this work Past Relevant Work (PRW). Your work and employment records are specifically relevant to Steps 1, 4, and 5 of the Adult 5-Step Disability Evaluation Process and Steps 1 of the Child 3-Step Disability Evaluation Process. At Step 1, you must show you are not working (engaging in substantial gainful activity) and you meet the Durational Requirement. At Step 4, you must show you cannot perform your PRW. At Step 5, if you are over age 50, you must show you cannot perform other work related to your PRW. Hence, Social Security must understand the details of how you performed your PRW.

Social Security Will Have Some Of Your Employment Records

Social Security will have three sources of information about your work. First, Social Security has your tax information showing every employer you have ever worked for and how much money you made from each employer for each year. This information will include self-employment income if you have filed and paid taxes. This information will not include any under-the-table work/income. This information will not include any details about your work duties. Second, because the tax information Social Security has does not include the work duties of your jobs, Social Security will send you forms to fill out so that you can provide that information: who you worked for; what work duties you performed; and the physical, mental, social, and environmental requirements of each job. How you fill out these forms is important - Filling Out Social Security Forms.

Additional Employment Information You May Need To Submit

You may need to submit additional information in four circumstances.

Problems at Work

If you have had difficulties performing work, you should submit that information:

1. Statements from a supervisor or coworkers indicating trouble you had on the job with people, duties, processes, and attendance;
2. Statements from family members indicating trouble you had at home as a result of your job; and
3. Pay stubs which will indicate when you work, how much you worked, and how much you were paid.

Unknown Work

You may have engaged in work Social Security does not know about. This occurs in two ways: 1) you have under-the-table work; and 2) you have engaged in work so recent in time to your interaction with Social Security, that it does not yet have information about your work. Social Security will learn of your unknown work only if it specifically asks about it; then you will have to provide the information it asks about which is generally limited to your pay stubs. Again, if you had trouble at these jobs, you should provide statements from others indicating the same.

Hearing Questions

If you attend a hearing, the ALJ will always ask you a few clarifying questions about your past relevant work. These questions supplement your work history forms you fill out for Social Security - how much did you lift on the job, how long did you stand, did you use a computer, did you supervise anyone, etc. Hearing time spent on these issues is about five minutes.

Employment Record Mistakes

You may have mistakes in your employment records, and they generally occur in one of two ways. First, you have income attributed to you, and you never worked for that employer or earned that income. This is rarely a problem in your disability case because you can usually just deny that work/income, and Social Security will believe you. And, the income you are noted to have received from the job will nearly always 1) increase your chance of meeting the necessary Social Security Quarters of Coverage (QC) eligibility requirements for Social Security Disability (SSDI) benefits, and 2) increase your SSDI monthly benefit amount. Second, you worked and earned money, but it does not appear in your Social Security/tax records. The missing income will make you less likely to meet QC requirements, and it will likely result in a lower monthly benefit amount. To remedy this situation, you will need to get your W-2 forms and your tax returns that relate to the missing income in question, and submit them to Social Security.

Related Work/Employment Information

Whether you can work while your Social Security disability case is pending and whether you can work while you are getting Social Security benefits is covered here - How Working Affects Your Social Security/SSI Disability Case.