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How to Win a Social Security Disability Appeal

— June 9, 2021

The Social Security Disability appeals process is complex and a small error could result in a negative outcome.

Nationally, approximately sixty-four percent of initial Social Security Disability applications are denied. However, applicants have the right to appeal the Social Security Administration’s (SSA) decision.

While Social Security is a federal program, every state has a Disability Determination Services office and an Office of Disability Adjudication and Review. Reviews are conducted on the state level. The percentage of successful appeals varies from state to state, but in every case, the success rate is significantly higher than the approval of initial applications.

There are four levels of appeals available: reconsideration of the decision, Administrative Law Judge hearing, a review by the Appeals Council, and an appeal filed in Federal Court.

Factors That Impact Appeals

The thoroughness of your appeal application impacts your chances of success. For example, the details in your medical records are vital in appealing a denial. Additionally, the severity of your condition will factor into whether your claim is approved. Unfortunately, some types of impairments are more difficult to prove.

It is essential to be honest and not exaggerate your condition. Nonetheless, if you are suffering from chronic pain or a mental illness that fluctuates in intensity, an appeal will be more challenging.

There is no guarantee of success when you appeal the denial of your Social Security Disability benefits. However, there are some things you could do that will increase your chances.

Request Your Appeal on Time

After every decision made regarding your claim, you have sixty days to submit a request for an appeal. Failing to comply with this deadline will likely result in your appeal being denied. A request for reconsideration, an Administrative Law Judge hearing, or an Appeals Council review requires submitting specific paperwork that you could find on the Social Security Administration’s website or your local Social Security Office. You could also speak with an experienced Philadelphia Social Security Disability attorney.

Appeals Letter

The required Social Security forms requesting an appeal provide a small area to explain your position. The first stages of an appeal could be critical, so it is important to state your position clearly. Attaching an additional appeals letter along with the official form permits you space to carefully outline the issues and problems with the decision.

When the SSA denies a disability claim, it provides the claimant with a denial letter that includes the disability determination rationale or an explanation of determination. This explanation should list the reasons why the claim was denied, the sources used to evaluate the claim, a description of your medical condition, and how your impairment was assessed.

The explanation of determination should serve as a guide for your appeals letter. First, you should carefully review the information for errors or misstatements. By using the denial letter as an outline, you could tailor your response to the problems the SSA cited. In addition to your written clarification, you should submit any records, statements, documents, or other information that support your position. The denial letter should provide an outline for what additional medical evidence is necessary.

Additional Medical Evidence

X-ray of person with broken collarbone; image by Harlie Raethel, via
X-ray of person with broken collarbone; image by Harlie Raethel, via

One of the most common reasons initial Social Security Disability claims are denied is insufficient medical evidence. When you file an appeal, you should provide any new medical evidence and documentation that you failed to include in your original application. To obtain this new evidence, you should speak with your treating physician to determine if additional tests are available or if they could provide more evidence that strengthens your position.

New medical evidence could also include a letter of support from your treating physician. If you have seen multiple doctors or specialists, you should request letters from them as well. A letter of support, or medical condition statement, connects the dots. By thoroughly explaining your medical treatment and linking your condition to your physical limitations and inability to work, an overall picture of your impairment will develop.

During the appeals process, it is crucial to keep doctor’s appointments, continue medical treatment, and take your prescribed medications. You do not want to give the impression that you are avoiding treatment to exacerbate your condition.

Blue Book Listing

The SSA publishes the Blue Book, a more common term for the Disability Evaluation Under Social Security. This publication was designed to be used by healthcare professionals when evaluating disability claims and lists various eligible medical conditions and supporting criteria. You should review your medical condition with your doctor to determine if you meet the requirements for a listed condition. In some cases, your impairment might encompass partial criteria from several listed conditions. Tailoring your evidence to meet a listed impairment will improve your chances for a positive outcome.

Residual Function Capacity (RFC)

In addition to a letter of support, you could request that your doctor complete an RFC form for your appeal. An RFC is beneficial if your impairment is not listed in SSA’s Blue Book. The RFC will specifically detail how your medical condition impacts your inability to perform the tasks necessary for your job. Coupled with a medical statement, an RFC provides compelling evidence.

Hire an Experienced Social Security Disability Attorney

The Social Security Disability appeals process is complex and a small error could result in a negative outcome. You have a right to knowledgeable legal representation. While it is possible to win an appeal on your own, especially if you have strong medical evidence, an experienced Bucks County Social Security Disability attorney who understands the process and could evaluate and gather evidence is an invaluable asset.

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