In determining eligibility for disability insurance benefits, Social Security must first determine your “residual functional capacity” or RFC. This is an assessment of your ability to work, taking into account any documented physical or mental impairments that you have. By law, Social Security must take all of your limitations into account when formulating an RFC.

Magistrate: Social Security Acknowledged Disability Applicant's Severe Headaches, Yet Did Not Account for Them in RFC

That does not, however, mean that Social Security officials always follow the law. A recent decision from a federal magistrate judge here in Illinois, Charlene J. v. Saul, provides a case in point. This case actually involves a plaintiff who filed for Supplemental Security Income (SSI) benefits. SSI is a type of benefit available to low-income individuals who do not enough of a work history to qualify for disability insurance (SSDI). That said, Social Security uses the same RFC standards when assessing SSI and SSDI claims, so the issues discussed here also apply to disability cases.

Here, a Social Security administrative law judge (ALJ) determined the plaintiff suffered from a number of impairments, including the loss of vision in one eye, type-2 diabetes, and chronic headaches. The ALJ then found that despite these conditions, the plaintiff had the RFC to perform a “full range of medium work” with certain limits. Based on this RFC, the ALJ said the plaintiff could still perform her prior job as a cashier and denied her application for benefits.

Even if you are unable to return to your previous job due to a medical condition, Social Security will not award you disability benefits unless it is satisfied that you are incapable of performing any type of meaningful work. The opinions of your treating physician are often critical towards proving this is the case. Of course, some Social Security administrative law judges may try to “play doctor” and attempt to disregard (or misrepresent) the views of your actual physicians.

Take this recent decision from a federal magistrate judge here in Illinois, T.D.B. v. Saul. The plaintiff in this case previously worked as a registered nurse. In 2007, she suffered a serious wrist injury when she was attacked by a patient. The plaintiff's physician subsequently diagnosed her with chronic regional pain syndrome (CRPS). By 2010, the physician concluded the plaintiff had “reached maximum medical improvement,” which is a legal term used in connection with workers' compensation proceedings. At the time, this meant the plaintiff would be limited to “full-time sedentary work.”

In 2012, however, the treating physician revised this diagnosis. In a separate letter to the workers' compensation insurance adjuster assigned to the plaintiff's claim, the doctor said the plaintiff was “essentially unemployable,” i.e., she was no longer medically capable of returning to work in any capacity on a full-time basis.

It is not uncommon for Social Security officials to initially deny your claim for disability benefits. Fortunately, you have certain appeal rights. In fact, there are four levels to the disability appeals process. First, you can ask for reconsideration. Second, you may request a hearing before an administrative law judge (ALJ). Third, you can seek review of the ALJ's decision with Social Security's Appeals Council. Finally, you can seek judicial review of a “final” decision to deny benefits in federal court.

Illinois Magistrate Dismisses Social Security Appeal Filed One Day Late

At each stage of the appeals process, there are strict deadlines that you are expected to understand and comply with. If you file an appeal even one day late, a court may refuse to hear your case, regardless of the underlying merits. So it is critical that you act promptly to address a negative decision from Social Security.

For example, in a February 2020 case, McGhee v. Commissioner of Social Security, an Illinois federal magistrate judge granted the government's motion to dismiss an appeal brought by an unsuccessful disability applicant. The applicant previously went through the first three stages of the appeals process described above. In November 2017, an ALJ rejected the applicant's claim. The applicant then sought review from the Appeals Council.