Who Decides What Is Disabling?

by Jennifer Scherf

All the time I hear, “but my doctor says I’m disabled, isn’t that enough?”

The answer is no. The Social Security Administration (SSA) is self-governing. This means that SSA gets to define what disability means, what the requirements for disability in your case are and if you meet their requirements. Your doctor’s statement that you are disabled is merely his or her opinion, but there is a very good chance that your doctor didn’t follow SSA’s guidelines when reaching this conclusion, so SSA treats this opinion as one factor when deciding your case and nothing more.

This also means that SSA gets to decide if it followed its own rules when applying the facts of your specific case to its standards. For the most part, this system works, but it means that you have to play by the SSA’s rules and that you and your representative have to lay out the facts in the way that SSA is looking for.

Age, education, work background and other factors all come into play when SSA is deciding whether or not you are “disabled” as they define that term. The definition is not static; it changes based on the above factors, and no two cases are going to be identical.

When proving disability due to physical limitations, statements regarding your limitations are much more helpful. Having your doctor say you cannot lift more than 10 pounds, or that you have to elevate your legs at least half of the day carry much more weight than a statement that you are disabled. More often than not, you must show you are unable to do any kind of work that exists in the national economy — not that you could get the job, that it pays what you are used to, that you are interested in that area or that you have the skills to do it — but that you cannot physically do it on a full-time basis.

When trying to prove disability due to a mental impairment, you must show you have a marked (i.e., severe) impairment in at least two of the three following areas: concentration/persistence and pace, social functioning and activities of daily living.

Workers’ compensation impairment ratings are treated the same way — they are merely opinions. The one agency that SSA does give a lot of weight to is the Department of Veterans Affairs (VA). If the VA determines that you are disabled under its guidelines, SSA will give this opinion more weight because similar factors are used by the VA.

Knowing this and having a knowledgeable representative assisting you can make the difference between receiving disability benefits and wondering why you did not.

Additional information can be found online at www.socialsecurityjustice.com.

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