Medical Proof That Wins (and Loses) Social Security Disability Claims

Welcome to Season 1, Episode 36 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "Medical Proof That Wins (and Loses) Social Security Disability Claims."

When it comes to Social Security Disability, medical proof is everything. But here’s the catch - not all medical evidence is created equal. Many people think that having a diagnosis, or even a letter from their doctor saying they can’t work, should be enough to qualify for benefits. Unfortunately, that’s not how the Social Security Administration sees it. The SSA wants more than a label or a sympathetic note. They’re looking for detailed, consistent, and credible documentation that tells the full story of your limitations - what you can do, what you can’t, and how your condition truly affects your daily life. In this episode of Winning Isn’t Easy, associate attorney Krysti Monaco steps in as host to break down what kind of medical evidence really matters. She’ll explain the crucial role your treating physicians play, how their opinions can make or break your case, and why Residual Functional Capacity (RFC) forms often carry more weight than lengthy or expensive evaluations. You’ll also learn why the SSA doesn’t apply an “average man” test, what types of medical proof they actually rely on, and the practical steps you can take to make sure your claim is built on strong, persuasive evidence - not just paperwork. Because in the world of Social Security Disability, it’s not just about proving you’re sick - it’s about proving how your condition limits your ability to work. Winning Isn’t Easy, but with the right medical evidence, you can give your claim the credibility and clarity it deserves.

In this episode, we'll cover the following topics:

One - Does the Social Security Administration Use an “Average Man” Test in Determining My Entitlement to Social Security Disability Benefits?

Two - What Are the Five Things That the Social Security Administration Needs From Your Treating Physician That Can Make or Break Your Social Security Disability Claim?

Three - My Doctor Says That They Don’t Have Special Expertise to Estimate My Capacity for Performing Work-Related Activities and Won’t Fill Out a Residual Functional Capacity Form in Support of My Social Security Disability Claim. What Should I Do?

Four - Why Your Physician Should Not Refer You to a Functional Capacity Evaluation to Help You Win Your Social Security Disability Claim

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Transcript

Christy Monaco [00:00:00]:
 Foreign welcome back to Winning Isn't Easy, Social Security Disability Benefits, the podcast where we break down everything you need to know about navigating the complicated Social Security system. I'm your host, Christy Monaco. Before we get started, I have to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to say this, so I've said it. But nothing prevents me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played during that process, and what you need to know to get the disability benefits you deserve. So off we go. When it comes to Social Security disability, medical proof is everything.
 
 Christy Monaco [00:00:49]:
 But here's the catch. Not all medical evidence is created equal. Many people assume that having a diagnosis or even a declaration of disability from their doctor saying they can't work is enough to win benefits. Unfortunately, I'm here to tell you that's not how the system works. The Social Security Administration is looking for far more than a label or a sympathetic letter from your doctor. They want a detailed, consistent and credible documentation that paints a clear picture of what you can and cannot do. That's why in today's episode, this information is so important to you. We're going to walk you through what medical evidence really matters to Social Security, the role your treating physicians are going to play, and how their opinions can make or break your case.
 
 Christy Monaco [00:01:31]:
 We'll talk about residual functional capacity forms, why those carry so much weight, and why expensive functional capacity evaluations often aren't the golden ticket that people think they are. By the end of today's episode, you're going to understand whether Social Security uses an average man test, what kind of medical proof that they actually rely on, and the critical steps you can take to make sure your claim is backed by the strongest possible evidence. So today we're going to talk about four things. First, does the Social Security Administration use an average man test in determining my entitlement to Social Security benefits? Second, what are the five things that the Social Security Administration needs from your treating physician that can make or break your Social Security claim? Third, your doctor says they don't have special expertise to estimate my capacity for performing work related activities and they won't fill out residual functional capacity forms in support of my claim. What should I do? And last, why your physician should not refer you to a functional capacity evaluation to help win your Social Security claim. All right, let's get started. We're going to take a break moment while we really get in this episode. Welcome back to Winning Isn't Easy.
 
 Christy Monaco [00:02:50]:
 So let's kick this off. Does the Social Security Administration use an average man test in determining your entitlement to Social Security benefits? Well, you may have heard the term average man used on legal TV shows and are wondering whether the Social Security Administration uses that test to determine your entitlement to those benefits. Well, the answer is no. There is no single test to determine whether a person has a disabling impairment. Can they return to the latest job they held in the five years before they became disabled, or can they return to any work that exists in the national economy? I get this question all the time. Do I qualify for disability benefits? And that's a really hard question for me to answer as an attorney. Because while there are a listing of impairments that do help you get approved, and if you meet Social Security's very strict criteria, you can get approved automatically. It's oftentimes less about what your condition is and more about how your condition impacts your ability to function.
 
 Christy Monaco [00:03:47]:
 So the Social Security Administration recognizes that you are a unique individual and that your experience of medical condition is different from anyone else's. In other words, your symptoms and what you can do despite your symptoms and restrictions and limitations may be very different from somebody else's experience with the same condition. For example, you might have a heart condition and be capable of low stress work of a sedentary nature, and another person with that same heart condition could have shortness of breath without exertion, palpitations, side effects of medication and anxiety, and that person would not even be able to do sedentary work on a sustained basis and as a result would be entitled to Social Security disability benefits. You may have a low tolerance for pain while someone else can soldier on despite their pain. Your experience of pain might make it impossible for you to do other work in the national economy, while someone else might be able to do sedentary work despite the pain that they're feeling. Every person is different. But the Social Security Administration uses the same five step sequential evaluation to determine an individual's entitlement to benefits. So they must consider your individual circumstances in determining the nature, severity, extent, and duration of your impairment, how well you're able to function in the workplace and at home, what benefit, if any, have you received from treatment? And are you experiencing any side effects of medication that your doctors are prescribing? So there is no average man test.
 
 Christy Monaco [00:05:09]:
 Okay, let's take a break.
 
 Speaker B [00:05:11]:
 Are you considering filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security Disability Benefits, which will cover everything you need to know about the Social Security Disability Benefits claims process. Request your free copy of the book@kvlaw.com today.
 
 Christy Monaco [00:05:46]:
 Welcome back. So now I want to touch on the five things that the Social Security Administration needs from your treating physicians that can make or break your disability claim. A letter from your doctor. Ooh, I get this one all the time. Attorney Monaco. I have this great letter from my doctor. I get it and it says my patient is disabled. Well, a letter from your doctor saying that you're disabled isn't what Social Security is looking for and deciding whether or not you meet the five Step Sequential Evaluation.
 
 Christy Monaco [00:06:12]:
 Now, they do recognize that your doctor can provide a longitude history of your medically determinable impairments that are the basis of your claim. That's why it's important when you go see the doctor that you're giving them an interval history at each visit about your symptoms and functionality. Your doctor can comment on how long your medical conditions can be expected to last and expected to limit your ability to function. Your doctor can explain the nature, severity, extent and duration of your medically determinable impairments that can't necessarily be gleaned from medical records. Your doctor can comment on your functionality when performing activities of daily living. They can comment on how well or unwell you are at functioning while doing work activities, and they can comment on the effects of treatment, including side effects and medication. A lot of this information can rarely be found in medical records, which is why it's helpful to have a Residual Functional Capacity form for your disabling conditions completed by your treating physicians. What's an RFC form? We've talked about it before, but let's dive in.
 
 Christy Monaco [00:07:09]:
 RFC forms or Residual Functional Capacity Forms were created by Social Security Disability attorneys and they're based on specific medical conditions that document your functional abilities. We base these forms off the five step sequential evaluation so we can get that additional information that may be missing from your medical records. Oftentimes we go see a doctor every month or every two or three weeks and a lot of time lapses in between your medical visits. Sometimes when we go see a doctor, we're having a good day and the doctor asks us how we're feeling and we say we're having a great day, but we're failing to discuss what happened from the last appointment to this appointment. These Residual Functional capacity forms really capture that. It talks about what your symptoms are, how they impact your ability to do things like sit, stand, lift, carry, interact with others, keep up with pace and persistence Requirements concentration interacting with supervisors or coworkers, not just the public. So these forms were created by Social Security attorneys to assist us and to extract additional information from medical records that doctors don't often includes. And this information can help Social Security determine the severity of your impairment, your ability to go back to the lightest job you've held in the last five years since you became disabled and your capacity for other work in the national economy.
 
 Christy Monaco [00:08:24]:
 Remember, they're following that strict five step sequential evaluation, not the average man test. So they're looking at their criteria. Are you working over SGA Step 1 Step 2 Do you have a medically determinable impairment? 3D meta listing 4. Can you do the lightest job you've held in the last five years? And five Is there any other job that exists in the national economy that you can do? I didn't say average man in any of those steps. So we have to keep that in mind. Now let's take a break. Welcome back to Winning Isn't Easy. Let's move on.
 
 Christy Monaco [00:09:04]:
 So your doctor says they don't have special expertise to estimate your capacity for performing work related activities and they won't fill out residual functional capacity forms in support of your claim. What should you do? Well, Social Security does not require that a physician have any special expertise or training when rendering opinion about your functional restrictions and limitations and what you can do despite your disabling impairments. Determining what you can do requires the exercise of professional judgment to figure it out whether your symptoms are in fact attributable to your diagnosis, whether your symptoms are consistent with the nature of the medical signs and findings, whether your claim symptom related limitations are reasonably consistent with the medical signs and findings on examination and diagnostic studies and any restrictions and limitations that you might have. These are things that physicians do on everyday basis. The Social Security Administration is more interested in your doctor's perspective based on repeated examinations and treatment of you rather than any special expertise that your physician might have in rendering an opinion about your functional restrictions and limitations. You should explain to your physician that they don't need that special expertise in estimating your capacity for warming work. Ask them once again. I need you to base this off your treatment of your history with me, your observations of me, and then ask them again if they'll fill out the residual functional capacity form.
 
 Christy Monaco [00:10:20]:
 Your physician should obtain your opinion about your ability to do work related activities and then exercise their professional judgment to determine whether your claimed limitations are consistent with the nature of your medical impairment and what they know about you. This Goes back to your history that you're giving your doctors at each appointment. When you ask your doctor to fill out residual functional capacity form, they're basing their opinion off of what you tell them, especially if you have subjective conditions like pain or migraines. This is where the logs come into play. Social Security is looking at frequency and. And duration. And so we want to make sure with subjective conditions like pain and migraines that we are keeping a log. On Monday, I had a migraine.
 
 Christy Monaco [00:11:00]:
 I woke up with it. What did you have to do to fix it? You had to take some medication and lie down in a cold, dark room. How long did it take to cure that migraine? Five hours. But it was still 20% there. And you're going to write that down in your little journal. And then when you go see your physician at your next appointment, you're going to take that journal to them and you're going to say, doc, this is what I've been going through since the last time that I saw you. I've had 15 migraines. It's been three weeks.
 
 Christy Monaco [00:11:25]:
 15 migraines out of 21 days. Seems like a lot. This is how long they've lasted. I want you to make this a part of my record. And then when you ask your physician to fill out your migraine residual functional capacity form, your physician can reflect back on those medical records and those journals you gave them. And when the question is asked, how frequent are these migraines happening? The answer is right there for him. You had 15 migraines in a period of 21 days, or if it's a longer period. We're asking them to judge.
 
 Christy Monaco [00:11:53]:
 Then they have all that documentation there, but that's on you. You have to make sure that you're being a team with your physicians and providing them with the information that you already know when you're going to these appointments. Because if you don't tell them, they don't know it. They don't put it in their medical records, and then Social Security never finds out. Now, if your doctor still won't fill out a residual functional capacity form, time to change physicians. You want to find a physician who is not only a great treating provider, but is willing to support your claim for Social Security disability benefits by helping you fill out these forms. They're not make or break, but they are crucial to getting to point to Social Security as to what your symptoms are and how those symptoms impact your ability to function. So remember, you're a team with your doctor.
 
 Christy Monaco [00:12:37]:
 All right, let's take a break Struggling.
 
 Speaker B [00:12:40]:
 With your Social Security disability case? The right attorney can make all the difference. Get our booklet the key to hiring a Great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Christy Monaco [00:13:20]:
 Welcome back. All right, so this is one I get a lot why your physician should not refer you to a functional capacity evaluation to help you win your Social Security disability claim. You may have asked your physician to comment on your restrictions and limitations or to fill out a residual functional capacity form and your doctor in response may have told you that they don't do that. They don't have the expertise and they don't fill out residual functional capacity forms or comment on restrictions and limitations unless you undergo what's called a functional capacity evaluation. Now, those tests can be expensive and they're not often covered by health insurance. So does the Social Security Administration want you to undergo a functional capacity evaluation? Well, they're trying to determine how long your medically determinable impairments are expected to last or how they limit your ability to function. In other words, how long can you sit, stand, walk? How much can you lift? Do you need to alternate sitting and standing? Do you have problems using your upper extremities? And can you perform sustained work activity eight hours a day, five days a week? If you're under 50, Social Security must determine your capacity to perform full time sedentary work. Sedentary work requires that you sit at least 6 hours out of 8 hour workday, stand or walk intermittently 2 hours per day and occasionally lift 10 pounds or frequently lift lighter objects.
 
 Christy Monaco [00:14:34]:
 A functional capacity evaluation is a series of tests that's used to identify your physical skills, functional capabilities, activity, endurance, work tolerance. It can be as short as two hours or as long as six to eight hours, and it's administered over one to two days by an occupational therapist or a physical therapist. It can be very expensive, costing anywhere between $1,000 to $2,000. Worse yet, the opinion of a physical therapist or an occupational therapist is not an acceptable source and your physician would then need to review that and endorse the fce. Is it really needed? No. Social Security Administration will never ask you to undergo a functional capacity evaluation and prefers that your physician gives your residual functional capacity by preferably filling out a residual functional capacity form. And here's one thing that I like to point out about functional capacity evaluations A lot of conditions that many individuals suffer from have good days and bad days. And a lot of the bad days are a reflection of physical exertion on what might have been a good day or a decent day.
 
 Christy Monaco [00:15:35]:
 And so sometimes functional capacity evaluations aren't a true reflection of that person's sustained work capacity. Okay? Because if I'm suffering from a condition like fibromyalgia and, and I go to a functional capacity evaluation and I wake up this morning and I'm having a really good day, I'm feeling pretty good, you know, baseline for what I'm going through. And I go to a functional capacity evaluation and I do my lifting, my standing, my pushing, my pulling, you know, using my hands. And it's a six hour test. Okay? That worksheet that you get from the physical or occupational therapist does not reflect how I feel tomorrow. And I will guarantee you that tomorrow when I wake up, I am not going to feel good. I may be in a flare, my joints are probably going to be sore, I may have a migraine from doing too much activity. And that report, it's not reflecting any of that.
 
 Christy Monaco [00:16:23]:
 And unfortunately, because it's not reflected in the report, Social Security is never going to know about that. And so a functional capacity evaluation is a snapshot in time. It's not a realistic picture of what I'm going through. To get a realistic picture, we want Social Security to go back to your medical records because that's going to show the history, that's going to show all of your complaints, the frequency, the duration, what, what helps it, what triggers it, what exacerbates it. A functional capacity evaluation. Snapshot in time today. How I'm feeling right now could be a good day. Many conditions have good days and bad days.
 
 Christy Monaco [00:16:54]:
 That's expected. We don't want to be the person who has a great day gets a functional capacity evaluation because we think it's going to make our case. And then it shows we can do heavy work or medium work or even light work or even sedentary work for that matter. We wanna make sure if you do go to a functional capacity evaluation despite the last 20 minutes of this conversation, call the physical therapist the next day and let them know how you're feeling. Call your physician the next day and let them know how you're feeling so that those can be included in the report. If the occupational therapist or physical therapist refuses to include it in the report, then call your doctor so that when he calls and endorses that report, he can say, I see this report. I had an appointment with my client the next she could barely sit. She could barely lift up.
 
 Christy Monaco [00:17:41]:
 Her back was so sore she had a chronic migraine. She couldn't get out of bed. Those things really, really need to be documented. Okay? Now, if your physician won't address your restrictions and limitations or insists that you have an FCE back again to this find a new physician. Remember, you and your physician are a team. We want to make sure that we're all on the same page. I spit a lot at you.
 
 Speaker B [00:18:02]:
 Again.
 
 Christy Monaco [00:18:03]:
 Like we said last episode, if you have any questions about functional capacity evaluations, please reach out to us on our website. Email us on our podcast page. We will answer your questions, whether it's personally or on a next episode. So that's going to be it for today's Winning is an Easy Episode. We hope that we gave you a clear picture of what kind of medical proof really makes a difference in your Social Security claim. Remember, it's not about having a diagnosis, it's about sewing Social Security exactly how your condition limits your ability to work. If you take away one thing from this episode, let it be this. The right medical evidence, documented the right way, can be the difference between winning and losing your case.
 
 Christy Monaco [00:18:40]:
 Now, if you found this episode helpful, please take a moment to like our page, leave a review, share it with your friends and family. Don't forget to subscribe to the podcast so you'll be notified when any new episode drops. And again, we would love to hear from you. At the beginning of each episode description, you'll find a link where you can send us your questions or comments. We may even feature them in a future episode. So join us next week for another insightful discussion and thank you for listening.