WHO ULTIMATELY DECIDES DISABILITY CASES?

Most Social Security disability cases are ultimately decided by a federal administrative law judge (ALJ).

   
A hearing, which lasts about one hour, considers your testimony, your attorney's arguments, the medical evidence, and the testimony of a vocational witness.

Specific factors which play a large part in the judge's decision include:

• Age of the claimant
• Education
• Past work experience (over the past 15 years only)
• Medical Evidence
• Residual Functional Capacity
• Transferable Skills from past work

I will discuss Residual Functional Capacity (RFC) here, since the other factors are self-explanatory.

RFC is the maximum that an individual can still do in terms of work-related activity.  In short, can much can the individual lift and carry?  How long can he/she stand, walk and sit?  How often can the claimant reach, bend, squat, kneel or balance?  In terms of the mental demands of work, what is the claimant's restrictions on understanding, remembering and carrying out simple instructions?  How much of the time will the individual be off task due to problems with concentration or focus?

How will these limitations affect the ability to perform jobs at the various exertion levels:  very heavy, heavy, medium, light and sedentary?  Will the claimant be able to perform skilled, semi-skilled or unskilled work?  How many jobs are there in the national economy that fits the claimant's Residual Functional Capacity?  (A question for the vocational expert).

From a practical point of view, most claims are decided on the claimant's ability to perform either light or sedentary level jobs at the unskilled level. 

There are so many technical issues that go into a Social Security disability appeal that I'm surprised that anyone would undertake this venture without representation. (I think many claimants do so because they don't know what they are getting into).

It is far from just telling your story to the judge.  It's more about proving that you meet all of the technical demands of Social Security's regulations.  

You need an understanding of medical evidence, grid rules, Social Security Listings, transferable skills and exertion levels--just to name a few things.  You will also need to know how to question (cross examine) the government's vocational expert.  If the expert gives unfavorable testimony, as they often do, it leaves your decision lingering in critical condition between life and death.  Asking the right questions can be the life-saver of your claim.

The judge who hears your case will require proof, not just a good story.










ADMINISTRATIVE LAW JUDGES CAN BE VERY SKEPTICAL!