Unlike retirement Social Security, claimants for disability benefits under Social Security’s rules must prove that they are disabled. SSA defines disability in terms of work capacity – according to the government, you are disabled if you cannot engage in “substantial gainful activity” because of a medically determinable condition or conditions that has lasted or is expected to last 12 consecutive months or result in death.
This definition sounds complicated but in layman’s terms you essentially have to prove that you could not reliably perform even a simple, one or two step entry level, unskilled job. In my experience, job reliability concerns are of most concern to a judge. I have won many cases by proving that my client would need to take too many unscheduled bathroom breaks or that her pace of work would be too slow or that he has an inability to engage appropriately with co-workers, supervisors or the general public.
When I prepare a case, I always go into court with a clear argument as to why my client meets SSA’s disability requirements. As SSA is a governmental agency and governmental agencies tend to have their own lingo and system for analyzing a problem or issue, you will greatly improve your chances if you understand what the SSA judge is looking for and you and/or your lawyer make some effort to speak their language.
When a judge analyzes a Social Security disability case, he considers in a “big picture” sense three different grounds for disability. If you understand these arguments or “theories of disability” and can adapt your case to one or more of these arguments, you will greatly increase your chances for a successful out come.
Perhaps the fastest and easiest argument for disability relates to Social Security’s listings. Published in the Code of Federal Regulations, a listing is made up of a detailed description of a very specific medical issue and a description of associated activity limitations that usually go along with this issue. In drafting the listings, Social Security has broken the body down into 14 different body systems – such as the musculoskeletal system, the cardiovascular system, the genitourinary system, the immune system, mental health systems, etc. The adult listings may be found at Social Security’s Blue Book, which can be accessed online.
If your condition meets a listing, you win quickly and often without the need for a hearing. Listing level cases are often decided early by SSA adjudicators and statistically less than 20% of claims are approved early under a listing argument
A second and far more common theory of disability relates to what is known as your functional capacity for work. In a functional capacity case, you would argue that your condition or conditions have created limitations on your capacity to perform work like activities that you would not be a reliable worker. For example, if you have a medical condition that requires numerous, unscheduled bathroom breaks, or if you have a condition that results in uncontrollable outbursts such that your pace of work would be too slow, or if you experience pain to the point where you could not maintain sufficient attention and concentration, you could be approved based on a functional capacity argument.
Successful functional capacity cases usually require the support of a treating physician or mental health professional who will go on record by completing a functional capacity form that details the specific job limitations that exist in your case.
Finally, a third argument for disability is known as a “grid rule” argument. The grid rules refer to a set of rules that apply to individuals over age 50 who have a limited education and a physical medical impairment. By publishing the grids, Social Security recognizes that men and women over age 50 have a much more difficult time entering the work force, especially if these men and women have a limited education and work background.
If you are over age 50 and your impairment is physical (not mental) in nature, take a look at the grid rules to see if you might qualify.
Disability claimants can present one, two or even three relevant arguments for disability when they appear before a Social Security judge. If you know what you are trying to prove and you have lined up support from treating physicians, your chances at success will increase greatly if your frame your case argument in the specialized language used in Social Security disability hearing rooms.
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