After more than three decades of winning disability claims, meeting with hundreds of claimants, and taking on cases of every stripe, we’ve learned some valuable lessons.
Today, when we meet a new client we can tell in just minutes if their case looks good for approval.
For you, that’s great news!
Are there cases we accept that don’t fit the mold? Sure, but usually – if we stick to our tried-and-true formula – we end up winning nearly every case.
We base our formula on a few secrets that might surprise you.
The Basics: Your Work, Age, and Education
Work History
Why would you work for a dozen years at the same high paying job and suddenly leave?
Disability judges tend to give credibility to any claimant with a consistent work history over many years, since there is usually a good reason to leave a high-paying, stable job.
Judges routinely favor claimants who come to the table with a solid work history.
Age
We accept clients who are over 45 and here’s why. Judges tend to look more kindly on claimants aged 50 and over, and over 55 approval chances get an added boost.
Education Level
Social Security law was written to extend the helping hand a little farther to less educated individuals with high school degrees, or less.
A college education, however, won’t make or break a case and we are happy to represent clients with a bachelor’s or graduate degree.
These six factors will help you decide if the time is right to file a disability claim, by estimating your chances of success.
How to Calculate Your Odds
- Objective medical tests
Documentation using objective medical tests is worth its weight in gold.
For this reason, some conditions like fibromyalgia or dizziness that are tough to document have long odds of approval.
We look for ultrasounds and EMGs, electrocardiograms (ECG), electroencephalograms (EEG), and echocardiograms. Imaging such as CT, MRI and PET scans can be valuable evidence.
Sometimes X-rays aren’t enough. When it comes to imaging, at least one MRI or CT should usually be part of the file.
- Regular doctor visits
Claimants who have an established relationship with their provider have an advantage. If you attend regular doctor visits, this works in your favor.
Social Security doesn’t consider lack of health insurance (or lack of funds) as an excuse to not visit the doctor, however.
Lack of regular doctor visits won’t destroy your chances, however, especially since Social Security is willing to send you to a doctor (at their expense) for an exam.
- The double-edge sword that is the VA
Our experience has been that if a claimant comes in with a 90-100% VA disability rating, this is strong evidence for most judges.
Social Security isn’t required to accept a prior VA finding of disability, but with a high VA disability rating, SSD approval usually follows.
It’s important to understand that SSDI/SSI doesn’t work the same way the VA does. VA disability works on a percentage, so you can get a percentage (say, 10% for a hand injury, 30% for a back injury: total 40% disabled) that leads to a monthly check.
SSDI/SSI is all or nothing: you get 100% or you receive no funds.
If you’ve already won VA benefits, the downside is that many disabled veterans have gotten most (or all) of their medical care at the VA, where medical records aren’t of the best quality.
- Specialists vs. family doctors
Social Security judges like objective evidence, but they love medical evidence from specialists. This means a judge will have less confidence in the opinions of a family doc, and more in the word of a specialist.
It may not seem fair, but that is the reality of disability evaluation.
For example, if you have chronic obstructive pulmonary disease (COPD) and have been treated by your family doctor for ten years, those medical records may carry less importance than a single visit to a pulmonologist.
The reason? The pulmonologist will do specialized testing like pulmonary function tests (PFTs).
We’ve also observed that when a family doc sends a letter or adds a personalized note to the disability file, it rarely sways Social Security toward approval.
- The RFC rules
Judges who review Social Security claims are experts on law, not medicine, so they put a lot of faith in how doctors “interpret” medical records into exact work limitations.
Work limitations are rated using a form called “residual functional capacity (RFC).”
The two-page RFC is completed by a treating or Social Security physician and list what you – the claimant – can still do.
This is known as your “residual functional capacity.”
Let’s break that down. It’s residual, which means, “What you have left,” and functional which means, “What you can do.” Finally, the word capacity refers to ability.
Can you lift 25 pounds frequently? Stand on your feet for more than four hours? Those ratings are part and parcel of your RFC.
In other words, almost all the objective medical evidence gets summarized into an RFC.
An RFC that limits a claimant to sedentary work, when combined with age (older), work history (longer), and education (lower), proves our theory – and results in a favorable decision 95% of the time.
- Is your impairment “real?”
Some illnesses just don’t show up on tests, like fibromyalgia, chronic pain, and chronic dizziness. These illnesses can be distressing and make it hard to complete daily activities – but they are often impossible to prove.
Most judges are caring, and may even be able to see that the disability applicant is unsteady, or in pain, but without proper evidence they cannot make a finding of disabled.
Most judges are reluctant to approve cases without lab results, imaging, and/or a long history of doctor visits.
We will take these cases if the record shows specialist notes, ongoing treatment, and strong support from the primary care doc.
Impairments that tend to get approved:
- Uncontrolled diabetes with neuropathy and/or retinopathy
- Stroke with significant loss of ability to ambulate or speak
- Schizophrenia, with multiple hospitalizations
- Circulatory system problems with deep vein thrombosis (DVT)
- Anemia with more than three transfusions within six months
- Low back pain or cervical (neck) pain with radiation into the lower legs, or one or both arms (respectively), supported by an MRI that shows one or more herniated discs or spinal cord impingement
- Irritable bowel disorders (IBS) such as Crohn’s disease, colitis, inflammatory bowel disorder, with significant weight loss
- Multiple sclerosis
- Lupus
- Traumatic brain injury (TBI), documented by MRI and psychiatric treatment records, especially with slow recovery or significant loss of IQ
- Epilepsy or seizure disorders uncontrolled by medications
- Rheumatoid arthritis (RA), with tender, warm and swollen joints upon exam
- Congestive heart failure, with heart capacity at 30% or less as shown by Ejection Fraction (EF)
- Liver disease supported by abnormal lab test results
- Blood diseases supported by abnormal lab test results
- Major Depression with suicidal ideation with inpatient hospitalizations and/or one or more suicide attempts
- Cancer diagnosis, especially with recurrence
- Any condition that impairs the use of both hands (for example, burns)
Examples of difficult-to-win cases:
- chronic headaches without specific cause
- Sjogren’s syndrome
- mild depression and/or anxiety
- back pain with improvement after surgical intervention
- mild to moderate loss of vision
- injuries with projected recovery within one year
- fibromyalgia
- digestive issues without significant weight loss
- chronic fatigue syndrome (CFS)
- sleep apnea
- chronic regional pain syndrome (CRPS)
- non-insulin dependent diabetes
- asthma, without evidence of hospitalizations
- intellectual deficit (low IQ) with evidence of job history
- multiple environmental sensitivities
- pernicious anemia
- osteoarthritis
- mood disorders without adherence to meds
We’ve only begun to dig into the depths of the Social Security
Disability system.
Let our experience work for you.