June 9, 2016

Anatomy of a Social Security Disability Hearing Part III: The Decision

When the Administrative Law Judge (ALJ) makes a determination about your disability claim, he or she does not simply send you a letter that says “Congratulations! You have been found disabled!” or “Sorry, but you do not qualify for disability.”  The Social Security Administration (SSA) requires the ALJ to provide you with a thorough explanation of the decision.  When you get your hearing decision letter, the first part will briefly tell you whether you won or lost.  Attached to that letter will be the actual decision, which is typically about five to fifteen pages long.  The overall document is a little overwhelming, so here is a breakdown of the different parts:

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Jurisdiction and Procedural History

This part of the decision summarizes the technical details about the case, including:

  • The type of benefits for which you applied (Social Security Disability Insurance or Supplemental Security Income)
  • The dates of your application, denials, and appeals requests
  • The names of the attorney and any experts who appeared at the hearing
  • A summary of anything that happened after the hearing (e.g., additional evidence added to the record)
  • Any other procedural issues

Issues

This part of the decision recites the definition of disability according to Social Security’s rules.  If you have a Social Security Disability Insurance (SSDI) claim, it will also discuss your Date Last Insured (DLI).  The final sentence of this section is a statement of whether the judge did or did not find that you are disabled under Social Security’s rules.

Applicable Law

This part of the decision is complete “boilerplate” – that is, it is a generic description that doesn’t contain any details unique to your case.  Every decision from every ALJ contains this language.  This section describes the five-step sequential evaluation that the judge must follow in making a decision.  It also defines many of the technical terms that the ALJ will use later in the decision.

Findings of Fact and Conclusions of Law

This is the part of the decision in which the ALJ sets out the facts supporting his or her decision in your case.  A typical adult decision contains these numbered sections.

1.  If you have an SSDI claim, the date of your Date Last Insured.

2.  Whether you engaged in substantial gainful activity since your alleged onset date

3.  A description of your “severe impairments.”

Some ALJs simply list your “severe impairments,” which are the diagnoses you have whose symptoms have “more than a minimal” impact on your work-related functioning.  Others provide more details, citing medical records that relate to each of those impairments.  The ALJ might also list impairments that he or she considers to be “non-severe” – often these are diagnoses that show up in your medical records but don’t cause you any functional problems.  Sometimes, my clients get confused or even upset because the judge’s decision contains references to impairments they didn’t know they had.  For example, I’ve had clients who feel a little insulted when the judge points out a diagnosis of obesity.  I reassure them that the judge is not trying to hurt their feelings or criticize their weight; he is simply trying to make sure that he has addressed every diagnosis raised in the record so his decision complies with Social Security’s rules.

In this section, if any of your impairments are mental health diagnoses, the ALJ must use a “special technique” to evaluate your functioning before determining whether your mental health impairments are severe or not.  The ALJ typically devotes a paragraph to each of four broad functional areas: activities of daily living; social functioning; concentration, persistence, and pace; and episodes of decompensation.  The ALJ considers the extent of your limitations in each of these areas caused specifically by your mental health impairments.

4.  Whether any of your impairments meet or equal one of the impairments in Social Security’s Listing of Impairments.

The ALJ must name all of the listings he or she considered.  Typically, the judge also cites medical evidence (or the absence of required medical evidence) to support his or her findings.

5.  A complete description of your residual functional capacity (RFC).

This is typically the longest and most detailed part of the decision.  The judge is required to address several types of evidence in the opinion, but the judges typically address these things in no particular order.

Medical source statements: The ALJ is required to address any statement or opinion from any doctor who treated you, examined you, or reviewed your medical records.  The ALJ must specifically state how much weight he or she gives to each of those opinions and why.

Symptoms: In your application documents and your hearing testimony, you explained how your symptoms (such as pain, fatigue, or anxiety) affect your ability to work.  The ALJ must determine whether there is a logical connection between your severe impairments and the symptoms you describe.  Then the judge must decide whether the evidence in the case supports your description of how severely your symptoms limit you.  This part of an unfavorable decision can be really difficult to read – it can make you feel like the judge is calling you a liar or saying you are exaggerating your symptoms.  It may also feel like the judge is nit-picking the details of your life, or that she denied your claim simply because you took that vacation to Florida last year or because you babysat your granddaughter for a few days.  It is hard not to take these comments personally.  However, when the judge makes an unfavorable decision, she tries to point out all of the evidence in the file that supports her decision.  She’s not trying to insult you; she’s trying to write a decision that clearly shows her rationale.

Other evidence: The judge typically gives a summary of your treatment records, pointing out test results and objective evidence that supports his decision.  If there is conflicting evidence in the file, he must explain why he chose to accept the conclusions of some evidence while rejecting others.

6.  Whether you can return to any past work.

You may remember that, at your hearing, the judge asked the vocational expert several questions about whether certain functional limitations would allow someone of your age, education, and work experience to return to the work you had done in the past.  In this part of the decision, the judge lists and classifies your past work according to the vocational expert’s testimony and reports whether the limitations she assessed in the RFC in #5 allow you to return to that work.

7.  Your age and its corresponding age category under Social Security’s rules.

8.  Your education level and ability to communicate in English.

9.  Whether any of your past work gave you skills that would transfer to other types of work (i.e., would help you find other kinds of work more easily).

10.  Whether, based on your age, education, and past work experience, you are able to perform any other type of work in the national economy.

Similarly to the analysis in #6, the judge reports whether the vocational expert was able to find an adequate number of jobs that would accommodate the limitations she assessed in the RFC in #5.

11.  Whether you meet Social Security’s definition of “disabled.”

After all the analysis in the previous ten sections, the judge finally states whether you are disabled under Social Security’s rules.  If he finds you disabled, he states the date he found that you became disabled and, if he finds that you had a closed period of disability, the date that he found your disability ended.

Decision

This paragraph is simply a formal statement of the ALJ’s decision.

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Every Social Security decision has the same basic format, but some details might be different from those I described above.  For example, a partially favorable decision is typically much longer than a normal decision because the judge has more issues to address.  A decision in a child’s case has a different format because the disability evaluation process is different for children.  However, this outline should give you an idea of where to look for the things you want to find when you receive your decision.  Of course, your attorney or representative is the best person to call if you have questions about your decision, because he or she will know about the specific issues in your case.

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