This is by far the most frequently asked question that I ever receive.  People often assume that there must be a magical medical condition or perhaps a special statement from their doctor that would green light their claim for disability benefits.  Unfortunately, I can attest to the fact that neither of these exist, with a few exceptions.  Let me explain.

In terms of medical conditions, there are certain conditions that “green light” a claim.  These conditions meet the requirements of what the SSA calls the Compassionate Allowances program.  If a person provides medical evidence demonstrating that they suffer from a condition that is extremely severe or likely to result in death, their claim can be expedited and approved.  I have handled many of these cases over the years.  Examples of these types of conditions include ALS/Parkinsonism Dementia Complex, Systemic Degos Disease, Early-Onset Alzheimer’s Disease, heart transplant graft failure, inoperable kidney cancer, etc.  There are many conditions the meet the requirements of the Compassionate Allowances program, therefore if you feel your condition may be considered extremely severe, seek help from an expert immediately so that we may submit your claim for expedited review and consideration.

Unfortunately, there are a myriad of severe conditions that do not meet the Compassionate Allowance program requirements.  In these situations, the SSA will go through what it calls the Sequential Evaluation Process to determine whether or not a person is disabled.  Part of our job in representing someone is to ensure that the best, most effective arguments are made concerning how a person is disabled in light of the SSA’s rules from the first day that we begin working on your claim.  We are experts in each step of the process, as well as, the SSA’s Program Operations Manual System (POMS) and the other sources that the SSA uses to determine whether or not a claim should be approved.

In terms of statements from your doctors, generally speaking, there is not any particular statement that would yield a favorable decision from the SSA.  However, an expert knows the right questions to ask your doctor to yield the evidence that is needed to demonstrate how severe your disability truly is.  Medical records often lack certain nuggets of information that are sometimes vital to qualifying someone for disability benefits.  We can draft specific forms called Residual Functional Capacity Questionnaires and send these forms to your doctor to get his/her opinions on these important factors. 

Let me give you an example.  At Step 3 of the SSA’s Sequential Evaluation process, the SSA will look at what they call the “Listings of Impairments” to see if a person’s condition(s) meet these requirements. Let’s say that you have a low back injury.  You have an MRI that demonstrates spinal stenosis with compromise of the spinal cord.  You also have reports from your spine specialist indicating that there is evidence of nerve root compression, limitations in your range of motion, muscle weakness, atrophy of the calf muscle and reflex loss.  However, your doctor has not documented whether or not he has performed any straight leg raising tests.  You would have all of the evidence needed to demonstrate that you meet the requirements of this listing, except for one.  An expert representative could spot this missing piece of evidence and ask your doctor to provide us the results of these tests or to perform them and let us know his/her findings.  Unfortunately, unless you know what you are looking for, your claim could be denied simply because the information needed to approve it was not in the records that were provided. 

In a nutshell, there are many ways that your claim can be approved, far too many to cover in a blog such as this.  That is why you should hire an accredited representative to handle your claim as soon as possible.  We are so confident in our work that we do not charge a fee unless we win your case.  It’s that simple.  Let us carry the burden of developing evidence and documenting hundreds or thousands of pages of medical records.  It’s truly our passion.  As always, we continue to serve Vacaville, Fairfield, Vallejo and all surrounding areas.  Reach us today at 707-580-9220.