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  RickyRacer2020

  April 20, 2024 at 8:11 am Reply

  For those looking in, here is what is happening:

  Once the Adult Function Report is submitted, a DDS Rep gets the case and, the applicant is in the early part of Step 3 of 5, of the Disability Application Evaluation Process.

  * At Step 3, the SSA is determining the severity of the alleged condition to see if it qualifies for an immediate approval of benefits. If it does, the application will be reviewed, signed off on and sent for payment processing.
  * If the applicant does not get an approval at Step 3, their application moves to Steps 4 and 5 where their case will be largely decided on expected functional limits of the conditions and the **Functional Work Abilities** criteria. Essentially, the SSA will determine if the applicant can do their current job, past job, a similar job, a new job or adapt to some other job such as a menial, low level entry level one. It’s at these Steps (#4 and #5) that basically all denials come from which in turn, bear out the overall 70% statistical Denial rate.
  * **”Functional Work Abilities”** are one’s abilities to do things like: sit, stand, see, hear, speak, carry, persist, remember, communicate socially, understand, concentrate, adapt and etc. These abilities, as determined by the SSA, are used at Steps 4 and 5 to determine if an applicant can do their current job, past job, a new job, some other job or, any job at all because, at Work’s fundamental core, these are the abilities needed to do it, regardless of the job being done. Related to Functional Work Abilities, watch this video from a doctor who does SSA Disability Exams:  [https://www.youtube.com/watch?v=bhTqTtGOIkI](https://www.youtube.com/watch?v=bhTqTtGOIkI)

  Four pieces of info + any 3rd Party supporting evidence are used by the SSA to determine an applicant’s Functional Ability to Work:

  1. The statements on the Adult Function Report (Form SSA 3373 BK) the applicant filled out long ago
  2. Expected limits of the alleged condition: the SSA already knows them
  3. Results from the Medical Consultation Exam and Mental Health Psych Exam
  4. The summary Residual Functional Capacity documents (the RFC), Form SSA 4734 BK and Form SSA 4734 FP-Sup created from the two exams – Google them to see the criteria info being evaluated.

  Historical statistics demonstrate that it is highly unlikely that the condition(s) being alleged and the statements on the applicant’s Adult Function Report submitted long ago, will match up and or, be supported by the the fact finding of the SSA. Those facts, when combined with the applicant’s age, education, job skills and experience, will likely show the applicant has the Functional Ability to Work and thus, a Denial being issued.

  If one wishes to appeal the denial by asking for Reconsideration (Recon), that process usually takes another six months or so and, has a 88% statistical likelihood of resulting in another Denial. In other words, at Recon, one is about three times more likely to be denied than at Initial.

  **Finally,** Whether just beginning the SSDI app process or for those on any of its 5 Steps, the link below graphically illustrates (in sequential order) the decision making steps the SSA uses to determine disability eligibility: [https://www.ssa.gov/policy/docs/rsnotes/rsn2013-01.html](https://www.ssa.gov/policy/docs/rsnotes/rsn2013-01.html)

  Notice the first decision on the chart is about financial eligibility — making SGA ($1550 per month before taxes). The second step is about having a “Catastrophically Disabling Condition”. Step 3 is about how severe the alleged condition is and its impact on current work are. Step 4 deals with being able to do past or similar work based on the claimant’s skills, education and experience. Finally, Step 5 is about doing any work at all. Notice that 5 of 7 outcomes within the evaluation / decision making process will result in a denial.