The Importance of Accurate Medical Records for Florida Social Security Disability Claims

It is notoriously difficult to get prompt approval for SSDI claims. According to one study, in 2022, Florida’s Disability Determination Services (DDS) approved only 40% of initial claims and just 15% after reconsideration. Since applications take months to process, you need to come prepared with the best possible file. That requires understanding what the DDS needs to see in order to approve an application.

Disability and SSDI: What They Look For

It is not enough to prove that you are suffering or that you have been unable to work. The DDS performs this five-step analysis to determine whether you are eligible for SSDI:

1. Are you working? If your current work is “substantial gainful activity” (SGA)—earning more than $1,550 a month in 2024—you cannot qualify.
2. Is your condition “severe”? It must “significantly limit your ability to do basic work-related activities” for at least 12 months, either in the past or in the future.
3. Is it one of the disabling conditions on the SSA’s Listing of Impairments? If it is not, this is not necessarily disqualifying. However, certain ailments, such as ALS and frontotemporal dementia, can qualify for immediate acceptance through the Compassionate Allowance list. 
4. Can you do the work you were doing previously? To determine this, the DDS will examine jobs you took in the past five years and the typical activities they require. 
5. Can you do any other type of work? They “will consider your remaining ability to do other work considering your age, education, and work experience.”

How can your records best convey your level of disability?

Types of Medical Evidence

The DDS is interested in several categories of medical information:

• Objective medical evidence: “signs, laboratory findings, or both, from a medical source.”
• Medical opinion. Currently, for an adult’s claim, this “focuses on functional abilities and limitations” under working conditions. For a child’s claim under Title XVI, it is broader, encompassing daily life functions.
• Other medical evidence. This includes judgments from medical sources about treatments and prognosis.
• Evidence from a nonmedical source. This can include colleagues, employers, clergy, friends, family, and yourself.
• Prior findings of fact in the current claim.

See POMS DI 24503.005. 

Although the DDS may take a look at any type of evidence, it is not all equally helpful. For example, non-objective medical evidence and nonmedical sources can’t be used to establish a medically determinable impairment (MDI). This is why judges at a hearing would not be interested in testimony from lay witnesses about your condition.

Residual Functional Capacity

DDS claims examiners will look to determine your residual functional capacity (RFC)—what types of work you can still do. For the SSA’s purposes, there are five exertional levels of work: sedentary, light, medium, heavy, and very heavy. Sedentary work, the lowest level, requires mostly sitting; it can also involve light lifting under 10 pounds and the ability to use your hands well (as with typing). 

After reviewing your file, DDS consultants or examiners will complete RFC forms regarding your physical and mental capabilities. An RFC form:

• “Describes work-related functions a person can do on a sustained basis.
• “Addresses all functional capabilities and provides a written analysis of how the evidence in [the] file supports or refutes the following:
  • claimant allegations (including allegations of symptoms, such as pain, and their effects on functioning).
  • descriptions, observations, and all conclusions of all treating and examining sources.
  • other pertinent medical and nonmedical evidence
• “Resolves all issues of functional capacity pertinent to a determination of ability to do past relevant work or other work.
• “Provides conclusions as to functional capabilities (with a citation of pertinent evidence) and the reasoning to support these findings.”

(Source: POMS DI 24510.001)

Your own physician can complete an RFC form for your claim file. Presenting the evidence in the RFC format—in other words, the language that the agency speaks—can give you a head start by adding weight to the evidence.

Getting It Right

The time to assemble your best medical evidence is before the filing. After a claim is denied, you have the right to reconsideration. However, any new evidence you present runs a risk of being excluded unless it involves a new allegation or a worsening of your symptoms. See POMS DI 27001.001. Keeping your file up to date with findings of new or worsening conditions is a must.

Consulting an SSDI attorney before you file will help you understand what the DDS expects to see from you and your care team. Without guidance, some applicants understate their disability levels out of habit or pride; others try to exaggerate them. Claims examiners are looking for signs of exaggeration, and therefore, they will not stop to consider that an applicant may, in fact, be worse off than their statements reflect. An attorney will help you maneuver this delicate situation.

Navigating the Waters

SSDI laws and regulations are not easy to understand, and they can alter with policy shifts in government, as well as local personnel changes. Now more than ever, it is crucial to work with an experienced Florida SSDI disability attorney for your initial claim or appeals.

Contact the Law Office of Nancy L. Cavey at 727-477-3263 to schedule your free initial consultation today.