The Social Security Disability Insurance (SSDI) program pays benefits to people who cannot work due to a severe medical condition that is expected to last at least one year. To determine an applicant’s eligibility for disability benefits, the Social Security Administration (SSA) conducts a five-step sequential evaluation that involves a review of the applicant’s medical records.
During this review, the SSA will not ask your doctors to decide if you are disabled. Instead, the SSA will make an independent determination regarding your disability by reviewing all medical evidence for any illness, injury, or condition that limits your ability to work. As part of the disability determination process, the SSA will request and review copies of medical evidence from hospitals, clinics, or other health facilities.
First, SSA will determine if you are engaging in any substantial gainful activity by reason of any medically determinable impairment. If you are not, SSA proceeds to step two. At step two, the medical evaluation begins. SSA will determine if you have a severe impairment that interferes with basic work-related activities. At step three of the sequential evaluation, SSA reviews your medical records to determine if your condition meets or equals the severity of a Listing-level impairment. “Listings” are medical conditions that are considered so severe that an individual is found disabled if their condition matches the criteria as defined by SSA. If you have an impairment that meets or equals one of the Listings, you will be found to be disabled. If you do not have an impairment that meets or equals a Listing, SSA will continue to the next step of the disability determination to determine if you are disabled.
If you do not meet or equal a Listing, SSA will assess your residual functional capacity (or RFC). Your RFC is a functional assessment of your maximum ability to do sustained work-related physical and mental activities on a regular full-time basis (8 hours a day, for 5 days a week), despite the limitations resulting from your medical condition. If your residual functional capacity prevents you from being able to perform your past work or any other work in the national economy, you will be found disabled by SSA
How Far Back Does Disability Look at Records?
To understand the period of time SSA requests and review medical records, it is first important to understand the alleged onset date of your disability. This refers to the first day that you meet the definition of disability as defined by SSA regulations. Before your disability can begin, you must meet certain entitlement or eligibility factors. To meet the SSA’s criteria of disability, the medical evidence must demonstrate that you cannot perform substantial gainful activity (SGA) due to your severe medical condition starting from your alleged onset date of disability.
Substantial gainful activity is work that involves significant and productive duties and pays more than a current monthly income limit set by the Social Security Administration. The SSA uses earning guidelines to evaluate whether your work activity is at a substantial gainful activity level. These guidelines can change each year. In 2024, the SGA amount for non-blind individuals is $1,550. If you work and earn more than $1,550 per month this year, you may be ineligible for SSDI or SSI (Supplemental Security Income) benefits. You can find each year’s guidelines on the SSA website here.
According to SSA regulations, the analyst reviewing your claim will review the alleged onset date of your disability and request all medical records that cover the period from the 12 months prior to the alleged onset date. These records include hospital records, doctor’s notes, laboratory tests, and therapy reports. In many cases, SSA examiners may require regular medical updates. Therefore, recent records within the last three months from the most recent update may be necessary. A lack of medical records from the alleged onset date may result in a denial of benefits. It is thus critical that you take the necessary steps to obtain and prepare your medical records before applying for SSDI benefits.
Keep in mind that the SSA will not pay retroactive pay over 12 months prior to the month of your application. Therefore, the adjudicators will not review remote medical evidence dated prior to the relevant time period in your case.
Obtaining and Preparing Medical Records for Your Application
To ensure you have all the medical records relevant to your case, do the following:
Contact doctors’ offices directly
The first point of contact should be your doctors or healthcare providers. They keep detailed records of your health history. When you are considering an application for disability benefits, create a list of all the doctors or hospitals you have visited since 12 months prior to your alleged onset date. Contact their offices and request your medical records. Most medical providers have a specific process for this, often requiring a written request. Be specific about what you need. This includes diagnostic reports, treatment plans, and prescriptions.
Reach out to hospitals and all medical offices
If you have been admitted to a hospital due to your disability, the hospital will also have important records, and therefore the date of your hospitalization should be listed on your application. Contact the hospital’s records department directly. Just like with requesting records from your doctor’s office, you may need a written request including your signed authorization when requesting records for a hospital or other healthcare facility. Make sure to ask for all relevant documents, including admission records, discharge summaries, and surgical reports.
Request records from the SSA
If you have previously submitted medical records to the SSA, they may still have them on file. To get these records, you need to submit a request to the SSA. This can be done by mail or through their website. Keep in mind that it may take some time for the SSA to process your request, so it’s advisable to initiate the process of obtaining medical records as early as possible. This proactive approach allows for ample time to address any delays or issues that may arise, ensuring that you have all the necessary documentation ready when it’s time to submit your application.
Prepare your medical records for application
Once you have all your records, organize them chronologically. This includes diagnoses, treatments, and any changes in your health. In the disability application, you must list all of the treatments you have received since your disability began. Organizing your medical records in advance of filing will help you ensure the accuracy of your application.
Strengthening Your Application with Medical Evidence
Medical evidence is crucial in SSDI claims as it provides objective documentation of the claimant’s impairments, helping the SSA accurately assess disability. Here’s what you should do to get the medical evidence needed to support your SSDI claim:
Maintain consistent medical treatment
SSDI cases are won and lost based on the strength of the medical records. The support of your doctors is invaluable during the disability application and appeals process. However, your doctors can’t evaluate your medical condition unless you attend scheduled appointments, tests, evaluations, or other procedures. These evaluations are important to document the symptoms and limitations you experience as a result of your disability. If you have a condition that affects your ability to work, you should continue to treat and document that condition.
Gather and provide all relevant medical evidence
When you are ready to file an application for Social Security disability benefits, you must prepare a list of all the medical impairments that prevent you from working. You should also compile a list of the doctors and physicians who treat those conditions. Typically, this list includes the doctors you have seen in the last 1.5 years prior to your application or in the 12 months prior to the onset date of your disability.
In some cases, you may be required to prove that you were disabled prior to the 1.5 years prior to your application. In order to be eligible for SSDI benefits, you must be insured for benefits and prove that you became disabled prior to your date last insured (DLI). Your DLI is the last day in the last quarter when your disability insured status is met. In situations where you were last insured on a past date, you will need to prove that your disability began prior to your DLI. Therefore, you must obtain your medical records prior to your DLI and submit them along with your application.
You should also submit an updated list of the medication, dosages, and side effects prior to submitting your application. As with listing your medications, be as thorough and complete as possible when listing any medical test you have undergone since the date of your disability. This helps the disability examiner ensure they are not missing critical evidence of your disability.
Consult with a specialized advocate or attorney
Seeking advice from professionals who specialize in Social Security disability can make a significant difference. An SSDI attorney or advocate can assist you in navigating the complex SSDI process, from guiding you on what evidence to gather and how to present it most effectively to strengthen your case to avoiding common mistakes. They can also help you compile a list of the physicians who treated you prior to your alleged onset date.
And if your initial application is denied, your attorney can assist you in the appeals process. It may take subsequent appeals until a case is successful. Often, it’s about presenting the right evidence in the right way. Your advocate or attorney can help you refine your approach for appeal.
Medical records are crucial to SSDI applications. We at LaPorte Law Firm can help ensure you have all the medical records and other documentation you need to strengthen your SSDI claim. Reach out to us today for a free consultation.
FAQs
Typically, the SSA will review the medical review in the year prior to the alleged onset date of your disability. Your alleged onset date refers to the beginning of the relevant time period in your case. Because the SSA does not pay retroactive pay over 12 months prior to the month of your application, the adjudicators will not review remote medical evidence dated prior to the relevant time period in your case.
The SSA will want to see records from any “acceptable medical source” during the relevant period. An acceptable medical source is a licensed physician, licensed psychologist, licensed optometrist, licensed podiatrist, qualified speech-language pathologist, licensed audiologist, or licensed nurse practitioner.This may include physical examinations, psychiatric treatment notes, procedure notes, and any hospital or emergency room treatment.
Evidence from other medical sources may help show the extent of your disability. Other sources can include social welfare agencies, educational records, and treatment records from other healthcare professionals such as naturopaths, chiropractors, and audiologists. You can also submit statements from former employers, friends, or family members who are personally familiar with your medical condition.
You may have a mental or physical condition that has lasted since birth or for many years. For Social Security disability purposes, the onset of your disability does not begin until you cannot perform any substantial gainful activity work due to your mental or physical condition. If the condition you had in the past now prevents you from performing full-time work, the SSA will consider whether it is a disabling impairment. Keep in mind that for a past condition to be a disabling impairment, you must have updated medical treatment to document your disability.
