The disability application process

Being rheumatologists, we all probably get letters on fancy lawyer letterheads asking for our office notes for a patient who is applying for disability. Then we receive more requests asking the physician to please describe in detail how much or how little work the patient can be expected to perform. Not infrequently, I even receive requests for disability assessments for patients I’ve never heard of, only to find out that I am seeing them as new patients in the coming days.

So I was excited to learn that subspecialty grand rounds was going to be given by a disability lawyer. He did a good job of explaining the law and breaking down the process.

Disability, as defined by the law, is "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which ... has lasted or can be expected to last for a continuous period of not less than 12 months."

The process of getting disability is lengthy. According to the Social Security Administration, for the past 3 years, roughly 35% of first-time applications were granted. Of applicants who were denied, only half submitted a request for reconsideration, and of those, only 12%-14% were granted disability status.

After the agency denies an applicant twice, the applicant’s next recourse is to request a hearing. At this point an administrative law judge reviews the information, hears the case, and makes a decision. Data from the past 3 years reveals that about 60% succeed at this stage. If denied, the applicant can appeal this decision, and it goes to the same judge.

If, at the end of all that, the patient still does not get disability, he can either elevate the appeal to a federal judge or file a new application altogether.

Documentation has to be submitted to the effect that the patient cannot perform his or her past work. Then the question is whether, given his age, education, and work experience, he is able to perform other kinds of work.

The gold standard for evidence of a patient’s ability to work is a physician’s description of the patient’s functional limits. This is where those onerous forms come in. In the pesky and interminable "residual functional capacity" questionnaires, we are asked to estimate how much or how little standing/sitting/lifting the patient can do in a given amount of time.

But while the disability lawyer clarified the process of getting disability, he nonetheless interpreted the process through his own perspective. I felt that the following points he made oversimplified the important questions that physicians must answer:

• Disability is really difficult to obtain. Therefore, people who are willing to put up with the process must really be in bad shape.

This is a bogus bifurcation, a fallacy of apriorism. People will do unpleasant things, like wait a very long time to get disability, if they perceive it as the better of two unpleasant options.

• He asks his audience, "Would you hire them?"

I would counter that there may be other issues that would lead an employer to not hire someone, and the law specifically states that disability status is denied or granted "regardless of ... whether or not he would be hired if he applied for work."

• It is not easy, if you have chronic pain, to lift a 10-pound weight frequently throughout the day, which is how the Department of Labor defines "light work."

But the same paragraph that defines light work as the frequent lifting of objects weighing up to 10 pounds also says, "Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls."

I think these sorts of points illustrate a line of reasoning that does not serve patients well when they seek legal advice on applying for disability. They paint a picture that gives doctors reasons to be skeptical of the process (especially when the doctor has not even met the patient yet) and may encourage patients to seek disability when they still have the ability "to engage in any substantial gainful activity."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected]

Being rheumatologists, we all probably get letters on fancy lawyer letterheads asking for our office notes for a patient who is applying for disability. Then we receive more requests asking the physician to please describe in detail how much or how little work the patient can be expected to perform. Not infrequently, I even receive requests for disability assessments for patients I’ve never heard of, only to find out that I am seeing them as new patients in the coming days.

So I was excited to learn that subspecialty grand rounds was going to be given by a disability lawyer. He did a good job of explaining the law and breaking down the process.

Disability, as defined by the law, is "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which ... has lasted or can be expected to last for a continuous period of not less than 12 months."

The process of getting disability is lengthy. According to the Social Security Administration, for the past 3 years, roughly 35% of first-time applications were granted. Of applicants who were denied, only half submitted a request for reconsideration, and of those, only 12%-14% were granted disability status.

After the agency denies an applicant twice, the applicant’s next recourse is to request a hearing. At this point an administrative law judge reviews the information, hears the case, and makes a decision. Data from the past 3 years reveals that about 60% succeed at this stage. If denied, the applicant can appeal this decision, and it goes to the same judge.

If, at the end of all that, the patient still does not get disability, he can either elevate the appeal to a federal judge or file a new application altogether.

Documentation has to be submitted to the effect that the patient cannot perform his or her past work. Then the question is whether, given his age, education, and work experience, he is able to perform other kinds of work.

The gold standard for evidence of a patient’s ability to work is a physician’s description of the patient’s functional limits. This is where those onerous forms come in. In the pesky and interminable "residual functional capacity" questionnaires, we are asked to estimate how much or how little standing/sitting/lifting the patient can do in a given amount of time.

But while the disability lawyer clarified the process of getting disability, he nonetheless interpreted the process through his own perspective. I felt that the following points he made oversimplified the important questions that physicians must answer:

• Disability is really difficult to obtain. Therefore, people who are willing to put up with the process must really be in bad shape.

This is a bogus bifurcation, a fallacy of apriorism. People will do unpleasant things, like wait a very long time to get disability, if they perceive it as the better of two unpleasant options.

• He asks his audience, "Would you hire them?"

I would counter that there may be other issues that would lead an employer to not hire someone, and the law specifically states that disability status is denied or granted "regardless of ... whether or not he would be hired if he applied for work."

• It is not easy, if you have chronic pain, to lift a 10-pound weight frequently throughout the day, which is how the Department of Labor defines "light work."

But the same paragraph that defines light work as the frequent lifting of objects weighing up to 10 pounds also says, "Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls."

I think these sorts of points illustrate a line of reasoning that does not serve patients well when they seek legal advice on applying for disability. They paint a picture that gives doctors reasons to be skeptical of the process (especially when the doctor has not even met the patient yet) and may encourage patients to seek disability when they still have the ability "to engage in any substantial gainful activity."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected]

Being rheumatologists, we all probably get letters on fancy lawyer letterheads asking for our office notes for a patient who is applying for disability. Then we receive more requests asking the physician to please describe in detail how much or how little work the patient can be expected to perform. Not infrequently, I even receive requests for disability assessments for patients I’ve never heard of, only to find out that I am seeing them as new patients in the coming days.

So I was excited to learn that subspecialty grand rounds was going to be given by a disability lawyer. He did a good job of explaining the law and breaking down the process.

Disability, as defined by the law, is "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which ... has lasted or can be expected to last for a continuous period of not less than 12 months."

The process of getting disability is lengthy. According to the Social Security Administration, for the past 3 years, roughly 35% of first-time applications were granted. Of applicants who were denied, only half submitted a request for reconsideration, and of those, only 12%-14% were granted disability status.

After the agency denies an applicant twice, the applicant’s next recourse is to request a hearing. At this point an administrative law judge reviews the information, hears the case, and makes a decision. Data from the past 3 years reveals that about 60% succeed at this stage. If denied, the applicant can appeal this decision, and it goes to the same judge.

If, at the end of all that, the patient still does not get disability, he can either elevate the appeal to a federal judge or file a new application altogether.

Documentation has to be submitted to the effect that the patient cannot perform his or her past work. Then the question is whether, given his age, education, and work experience, he is able to perform other kinds of work.

The gold standard for evidence of a patient’s ability to work is a physician’s description of the patient’s functional limits. This is where those onerous forms come in. In the pesky and interminable "residual functional capacity" questionnaires, we are asked to estimate how much or how little standing/sitting/lifting the patient can do in a given amount of time.

But while the disability lawyer clarified the process of getting disability, he nonetheless interpreted the process through his own perspective. I felt that the following points he made oversimplified the important questions that physicians must answer:

• Disability is really difficult to obtain. Therefore, people who are willing to put up with the process must really be in bad shape.

This is a bogus bifurcation, a fallacy of apriorism. People will do unpleasant things, like wait a very long time to get disability, if they perceive it as the better of two unpleasant options.

• He asks his audience, "Would you hire them?"

I would counter that there may be other issues that would lead an employer to not hire someone, and the law specifically states that disability status is denied or granted "regardless of ... whether or not he would be hired if he applied for work."

• It is not easy, if you have chronic pain, to lift a 10-pound weight frequently throughout the day, which is how the Department of Labor defines "light work."

But the same paragraph that defines light work as the frequent lifting of objects weighing up to 10 pounds also says, "Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls."

I think these sorts of points illustrate a line of reasoning that does not serve patients well when they seek legal advice on applying for disability. They paint a picture that gives doctors reasons to be skeptical of the process (especially when the doctor has not even met the patient yet) and may encourage patients to seek disability when they still have the ability "to engage in any substantial gainful activity."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected]