The Secret to Winning Your Disability Case

Do you want to know the most important secret about winning Social Security disability benefits? It is not enough to say you are disabled. It is not even enough to have your doctor say you are disabled. In the final analysis, the term “disabled” in itself doesn’t really mean much to the Social Security Administration (SSA). You have to prove that your medical condition (or combination of conditions) prevents you from sustaining a job. The SSA relies on accurate and complete medical records from doctors, clinics, and hospitals to determine how severe a physical or mental condition is.

“The importance of medical records in Social Security disability cases cannot be overstated,” says Nash Senior Case Manager Mitch Frazier. “I guide our clients to get the right information and best explanation of their symptoms and limitations from their medical providers. From the start, when we sign on as a client’s representative, we know they are genuinely disabled, but we also know that Social Security has strict rules and regulations for a disability claim. It takes a combined effort of our argument on behalf of our client and information from our client’s medical providers to win a disability claim.” Mitch also explains that the process of how medical records are generated and obtained can be cumbersome. “One thing that I’ve long noticed,” he says, “but am often reminded of, is that the logistics of obtaining medical records is much more complicated than our clients may realize. It really shouldn’t be, but it’s just how the system is.”

If you are applying for the first time for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits or are appealing an SSA denial of benefits, here are some essential facts you need to know about medical records in a Q&A session with Mitch Fraizer.

What medical evidence is required by Social Security?

“For a Social Security disability case, medical evidence takes many forms, including bloodwork panels; imaging studies like MRIs, CAT scans, and X-rays; physician examination and treatment notes; and mental health records. You will need up-to-date medical records to show the current state of your condition and you will also need a history of how the condition has progressed. It is also critical to include a history of your treatments. SSA wants to know what treatments you have been given and how your condition(s) have responded to those medical treatments. In some cases, the SSA will deny your claim unless you submit a detailed treatment history.

What are RFC forms?

“Simply stated, ‘residual functional capacity,’ is an evaluation of what you can still do despite your impairment(s). If, considering your age, education, and work experience, your condition(s) causes you limitations that prevent you from performing any work activity, you can qualify for benefits.

One of the most important pieces of evidence in a Social Security disability case is your own treating doctor’s opinion about your RFC. Social Security often gives substantial weight to the opinion of your personal physician because that person has first-hand knowledge of your medical condition and prognosis and is often in a better and more informed position to provide information on what you can and cannot do. If your physician submits his or her medical opinion supported by a comprehensive opinion about your RFC that is consistent with the medical evidence, you have a much stronger case and a much improved chance of being awarded disability benefits.”

“The statement from your doctor must be specific and explain your limitations. It can be a form or, better yet, a detailed letter. A statement that you are ‘disabled,’ ‘unable to work,’ or only have a specific lifting restriction, for example, is generally not enough.”

Why do I need an opinion from my doctor if Social Security has my medical records?

“You may think ‘Why do I need an opinion from my doctor, if the medical evidence is strong?’” It’s a good question, and one we are often asked by doctors themselves! The simple answer here is that adjudicators and Administrative Law Judges who decide disability cases are not doctors. They cannot easily interpret the symptoms and test results in your medical records and develop a clear picture of how severely your condition(s) may restrict your daily activities including your ability to work. Medical records alone rarely make those connections. The doctor’s opinion will help bridge that gap for the judge.”

But getting medical records is easy, right?

“I’ve had so many clients call just saying, ‘my doctor is just going to fax you the papers.’ But that rarely happens. In truth, doctors want official requests, they want authorizations, and they want to be paid for the time in assembling the records and copying them.

It also gets complicated, because each doctor’s office and each medical facility has its own rules and procedures. For example, Hospital ‘A’ wants all records to go through their central hub; clinic ‘B’ wants the doctors name to be on the request; doctors’ office ‘C’ is known by three different names; and so on. You get the idea—each place has its annoying little particulars.”

“Clients also tell us – ‘don’t get the records, I have them all.’” While a doctor or hospital may give a patient a summary sheet or discharge instructions, it is rare that the patient receives the entire record that can be important to his or her case.”

Okay, I see the importance of good medical records. How can I help win my case?

“First, I think something that is very beneficial for us is when we obtain the most accurate information possible about where you see your doctors. Some clients may say “the doctor over on Western Avenue”, and I wish that were good enough, but it’s not. The more specific information you give us, the better chance we have at obtaining your very important medical records. There is no “supercomputer” with your medical record information that can be obtained by entering in your name or Social Security Number. Unless you tell us exactly where you see the doctor, we don’t know.

And, second, carefully read and follow the guidance we give you in our update campaign emails. These are to your benefit. As part of our comprehensive client support, Nash Disability Law regularly will send you emails with direction, advice, and encouragement as together we navigate the complex path to disability benefits. Helping us get the specific information you will need from your doctor—as spelled out in the emails—is going to help you win your case.”