A common “rumor” that circulates among SSDI or SSI applicants is that everyone who applies for SSA disability benefits is denied the first time they apply. Why does this rumor persist? Because the estimated denial rate at the application level can be as high as 70%.
So is this true? No, the Social Security Administration does not automatically deny all first time disability applications, but when 7 out of 10 applications are denied, it can seem like it.
So who gets approved immediately for disability benefits?
• Compassionate Allowance Cases
Compassionate Allowances (CAL) program identifies diseases and other medical condition that the Social Security Administration knows meets their Listing of Impairments. The CAL program allows the Social Security Administration to identity these conditions based on information the SSA can quickly gather. As of 2011, there are 100 conditions on the Compassionate Allowance list including acute leukemia, adrenal cancer, Early-Onset Alzheimer’s Disease, bone cancer and bladder cancer.
• Conditions which automatically meet a listing on the SSA Listing of Impairments
Claimants may win Social Security Disability benefits if they have a severe mental or physical health condition which “meets or exceeds a listing” on the SSA Listing of Impairments (informally known as the Blue Book). The SSA has constructed this listing and concludes that if a claimant has a condition that meet or exceeds a listing they will be unable to perform substantial gainful activity for at least 12 continuous months.
So what happens if you have a condition that does not meet or equal a listing and is not on the SSA Compassionate Allowance list? Do you have any other options?
Proving you are disabled through a medical vocational allowance
If your condition does not meet a listing and it is not part of the compassionate allowance program it can be very hard to win the first time you apply for SSI or SSDI benefits, especially if you do not understand how the SSA makes their disability determination.
To make a disability determination the SSA uses a process called the sequential evaluation process. It is a 5 step process that evaluates the following questions.
1. Are you working and making too much money?
Claimants who are working and earning more than $1,000 a month in 2011 will generally be determined not to have a disability and will be denied Social Security Disability benefits.
If you are not engaged in substantial gainful activity the Social Security Administration proceeds to the next step.
2. Is your disability or condition “severe”?
The SSA will evaluate whether they believe your condition interferes with your work. If they do not believe it is severe they will deny your disability claim. If they do believe it is severe they will proceed to step 3.
3. Is your condition found in the SSA Listing of Impairments?
The Listing of Medical Impairments is a list of all of the major body systems and the disabilities, diseases or conditions that the SSA believes may make a claimant automatically disabled. If your condition is on the list the SSA will determine if it is as severe as the listed condition. If it is, they will find you are disabled. If not, they will proceed to step 4.
4. Can you do the job you did previously?
If your condition is not on the Listing of Impairments and the SSA decides it may impair or interfere with your ability to perform your current job they will proceed to step 5, if not, they will deny you Social Security Disability benefits.
5. Can you be retrained for other types of work?
The SSA will evaluate your medical conditions, age, work history, education, and work skills and determines if you can perform your current job or any job you have done in the past and if you are able to retrain for new work. If they decide this is not possible, they will approve your disability claim. If the SSA believes you could perform past work or retrain for new employment they will deny SSI or SSDI disability benefits.
As you can see, if your condition is on the compassionate allowance list or meets or exceeds the listing in the SSA Blue Book, assuming you meet the nonmedical requirements of either SSI or SSDI, you will be approved by the 3rd step in the process. If not, you will have to make it to step 5 and prove that you do not have the residual capacity to work.
So back to the question: Are all disability applications denied the first time the applicant applies. No, but unless you can win benefits by step 3 in the sequential evaluation process, it can be very hard to win without filing multiple disability appeals.