If you suffer from injuries or illnesses that make it difficult or impossible for you to continue working and earning an income, you may be able to receive Social Security disability benefits. However, the process of applying for disability benefits can be complicated, and applications are often denied. When appealing a disability denial, it is important to understand the factors that will be reviewed to determine whether you are disabled and eligible to receive benefits.

Analysis of Whether a Person Is Disabled

When reviewing a plaintiff’s appeal of the denial of Social Security disability benefits, an Administrative Law Judge (ALJ) is required to perform a five-step analysis in which the following questions are considered, in order:

• Is the plaintiff currently unemployed?
• Do the plaintiff’s medical issues constitute a severe impairment?
• Is the plaintiff’s impairment one of the specific impairments listed in Social Security regulations, or is it equal to one of these impairments?
• Is the plaintiff unable to perform work in their former job?
• Is the plaintiff unable to perform work in another occupation?

An answer of “yes” to either step three or step five will result in a finding that the plaintiff is disabled. If the plaintiff can meet the requirements of step four and show that they are unable to perform work they have done in the past, the Commissioner of Social Security has the burden of proof to show that the plaintiff should be able to find work based on the available jobs in the national economy that meet their physical limitations.

When a person applies for Social Security disability benefits, there are many different factors that are considered to determine whether the person is considered to be disabled. A person must suffer from a physical or mental impairment that is “medically determinable,” and this condition must have lasted or be expected to last at least 12 months. An impairment must also affect a person’s ability to find gainful employment.

If a Social Security disability claim is denied, an applicant may appeal this decision, and an administrative hearing before an Administrative Law Judge (ALJ) may be held to review the case and determine whether the person is disabled. An ALJ will follow a multi-step process to evaluate the person’s claim, and one important step in this process is determining whether the claimant’s condition meets or equals any of the items included in the Listing of Impairments in the Social Security Code of Regulations.

Magistrate Reverses ALJ’s Decision Based on Improper Analysis of Listing of Impairments

One recent case in Illinois demonstrates the role that the Listing of Impairments may play in an administrative hearing. In Angela L. H. v. Commissioner of Social Security, a woman’s disability claim had been denied, and after appealing this decision, the ALJ who reviewed the case determined that she was not disabled, since her impairments permitted her to find work other than what she had previously performed.

When applying for Social Security disability benefits, a person will need to provide evidence to show that they have severe physical or mental impairments that affect their ability to find gainful employment. If disability benefits are denied, a person can appeal this decision, and their case will be heard by an Administrative Law Judge (ALJ). In these types of hearings, the ALJ must base their decision on evidence provided by both sides, as well as the opinions of medical and vocational experts. Any additional evidence considered by the ALJ is known as “extra-record evidence,” and certain rules apply regarding when this type of evidence can be used.

Magistrate Reverses ALJ’s Decision Based on Reliance on Extra-Record Evidence

A recent case in Illinois, Elizabeth D. v. Commissioner of Social Security, illustrates when extra-record evidence can and cannot be used by an ALJ. In this case, a woman had been found disabled in 2003 after receiving kidney and pancreas transplants. In 2011, Social Security determined that she was no longer disabled, and she appealed this decision, stating that in addition to her prior medical issues, she also suffered from extreme fatigue, depression, anxiety, migraines, and personality disorder.

When reviewing the evidence, the ALJ chose to give limited weight to the opinions of a doctor who had been treating the plaintiff since 2003, since this doctor’s opinions relied heavily on the plaintiff’s subjective complaints. Instead, the ALJ gave great weight to the opinion of a doctor who saw the plaintiff twice in preparation for hysterectomy surgery. This doctor stated that the plaintiff had an exercise capacity of 10 METs.