Who Has to Prove What in a Social Security Disability Claim? The Sequential Process

Who Has to Prove What in a Social Security Disability Claim?

Understanding the Burden of Proof—and Why It Changes During Your Case

Part Eight of Powell & Denny’s Guide to Social Security Disability Benefits

“I’ve given Social Security all of my medical records. Doesn’t Social Security have to prove I can work?”

Not exactly.

One of the biggest misunderstandings about disability claims is who has the responsibility of proving disability.  Many people assume Social Security must prove they are able to work.  Others believe they must prove every aspect of their claim from beginning to end.

The truth is somewhere in between.

One of the unique features of Social Security Disability law is that the burden of proof changes during the disability evaluation process.

Understanding when—and why—that happens helps explain why some disability claims are approved while others are denied.

Where We Are in the Disability Process

The Powell & Denny Guide to Social Security Disability

✓ Part One

How Social Security Decides Disability

✓ Part Two

Can You Work?

✓ Part Three

Severe Impairment

✓ Part Four

Do You Meet a Listing?

✓ Part Five

Residual Functional Capacity

✓ Part Six

Can You Perform Other Work?

✓ Part Seven

Pain and Other Symptoms

═══════════════════════════════

► PART EIGHT

Who Has to Prove What?

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End of Series

The Burden Begins With You

When you file a disability claim, you have the responsibility of proving that you satisfy the requirements for disability benefits.

That makes sense.  After all, you know more about your medical conditions than anyone else.

You are responsible for providing information about:

• your medical treatment;
• your work history;
• your education;
• your medications;
• your symptoms; and
• how your medical conditions affect your ability to work.

Social Security then reviews that information as it works through the five-step evaluation process.

Through Step Four, the Burden Is on the Claimant

As we’ve discussed throughout this series, the first four steps ask questions about you.

Can you work?  Do you have severe impairments?  Do you meet a Listing?  Can you return to your past relevant work?

At each of those steps, you must present evidence supporting your claim.  That evidence often includes:

• medical records;
• imaging studies;
• physician opinions;
• treatment history;
• your testimony;
• and other information describing your functional limitations.

Figure 1

Claimant’s Responsibility

Step One

│

Step Two

│

Step Three

│

Step Four

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Burden Shifts

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Step Five

Then Something Important Changes

If Social Security determines that you cannot return to your past relevant work, something significant happens.

The disability evaluation reaches Step Five.

At that point, Social Security must identify other work that a person with your Residual Functional Capacity, age, education, and work experience can still perform.

This is often described as a shift in the burden of proof.

That doesn’t mean you automatically win your disability claim.

It simply means Social Security must go forward with evidence showing that other work exists that you are capable of performing.

Why Vocational Experts Become So Important

If you’ve attended a disability hearing, you’ve probably seen a Vocational Expert.

Many claimants wonder:  “Who is that person?”

The Vocational Expert does not decide your case; instead, the Judge asks that expert a series of hypothetical questions.  For example:

Assume an individual of the claimant’s age, education, work history, and Residual Functional Capacity…

Could that individual perform the claimant’s past work?

If not…

Could that individual perform any other work?

The answers to those questions often become an important part of the Judge’s decision.

Recommended Reading: What is the Vocational Expert’s Role

Why Medical Evidence Still Matters

Even after the burden shifts, medical evidence remains critically important.

Why?  Because the Vocational Expert’s testimony is only as accurate as the limitations included in the Judge’s hypothetical questions.

If pain, fatigue, medication side effects, difficulty concentrating, or other limitations are not fully considered, the vocational testimony may not accurately reflect the claimant’s true ability to work.

That’s one reason why documenting functional limitations throughout your medical treatment is so important.

Powell & Denny Practice Tip

Winning a disability claim isn’t simply about proving you have a medical condition.

It’s about proving how that condition affects your ability to sustain full-time employment.

The stronger the medical evidence describing those limitations, the more accurately your case can be evaluated throughout the disability process.

Why Understanding the Burden Matters

Many people become discouraged after receiving an unfavorable decision because they assume Social Security simply didn’t believe them.  Sometimes the issue is more complicated.  The dispute may involve:

• whether medical records adequately document functional limitations;
• whether the claimant can perform past work;
• whether other work exists;
• or whether the vocational evidence accurately reflects the claimant’s limitations.

Understanding who must prove each issue helps explain why disability claims can become so complex.

The Bottom Line

Throughout this series we’ve explained how Social Security evaluates disability claims.

You’ve learned that disability claims are not decided by diagnosis alone; instead, Social Security asks a series of questions concerning your ability to perform substantial work.

Hopefully now you better understand:

• why Step One focuses on work activity;
• why Step Two evaluates severe impairments;
• why failing to meet a Listing does not end your claim;
• why Residual Functional Capacity often becomes the most important issue;
• how pain and other symptoms affect disability claims; and
• why vocational evidence becomes so important at Step Five.

Perhaps most importantly, you now understand that disability claims are built on evidence, not assumptions.

That knowledge alone will place you in a better position to understand the disability process and to work with your attorney in presenting the strongest claim possible.

Thank You for Reading This Series

We hope this eight-part guide has helped you better understand how Social Security Disability claims are evaluated.

Every claim is different.

Every person’s medical condition is unique.

But the process Social Security follows remains remarkably consistent.

Understanding that process is often the first step toward understanding your own case.

If you have questions about your disability claim or would like to discuss your situation, we invite you to contact Powell & Denny.

We’re always happy to listen.

At Powell & Denny, we have represented injured and disabled workers throughout Alabama for more than 30 years. We understand that serious claims are rarely decided by a diagnosis alone. They are decided by how the injury affects the person’s ability to function, work, and earn a living.

If you have questions about an Alabama Workers’ Compensation claim, or a claim for Social Security Disability benefits, don’t hesitate to contact the experienced attorneys at Powell and Denny today a free consultation; remember. Virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live, and remember-there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Offices in Birmingham, Alabama and Huntsville, AL

 

Recommended Reading

If you’re just joining us, we encourage you to begin with Part One and work through the series in order:

• Part One: How Social Security Decides Disability
• Part Two: Can You Work and Still Receive Disability Benefits?
• Part Three: What Is a Severe Impairment?
• Part Four: Do You Have to Meet a Listing?
• Part Five: Residual Functional Capacity (RFC)
• Part Six: Can You Perform Other Work?
• Part Seven: Can Chronic Pain Qualify You for Disability Benefits?