Receiving the disability benefits you’re entitled to can be challenging if you don’t provide comprehensive, well-organized medical evidence to the officials reviewing your claim. This is true whether you’re applying for disability benefits with Veterans Affairs (VA) or through Social Security Disability Insurance (SSDI), Supplementary Security Income (SSI), or private disability insurance. Without proper medical evidence, your claim can be denied. Understanding the importance of comprehensive medical evidence empowers you to take control of your claim.
For example, missing medical documents, lab test results, or treatment notes can leave gaps in your claim, making it harder for decision-makers to assess your disability. Using ambiguous or generic language may fail to express the full scope of your condition. Using precise medical terminology is also essential, and the submitted medical data should demonstrate a diagnosis and connect the ailment to your work limits or functional impairments. Additionally, differences in opinions among healthcare professionals might confuse claims examiners, potentially leading to claim denials.
The Potential Impact of Inadequate Medical Evidence on Your Disability Claim
According to the National Organization of Social Security Claimants Representatives (NOSSCR), initial claims for disability with the Social Security Administration (SSA) were denied 61% of the time in 2023. At reconsideration, that number jumped to an 85% denial rate.
Similarly, private insurers deny long-term disability (LTD) claims 50% to 70% of the time, alleging, in part, that there were improper or insufficient medical records and diagnostic test results.
After filing a VA claim, many veterans receive a disability rating that underestimates the actual severity of their condition because the medical data presented may not have fully conveyed the impact of their disability or correctly showed it was service-connected.
Medical Evidence Required for Disability Claims
For SSDI and SSI
Under the two disability benefit programs (SSDI and SSI) administered by the SSA, individuals who file a disability claim are responsible for providing medical evidence showing their impairment and its severity. The medical evidence typically originates from what the SSA deems as “acceptable sources” who have treated or evaluated the claimant for the impairment.
These ‘acceptable sources’ include licensed physicians, psychologists, optometrists, podiatrists, audiologists, qualified speech-language pathologists, and licensed advanced practice registered nurses (APRNs).
Many disability cases with the SSA are also resolved based on medical data from “treating sources.” The term “treating source” refers to the claimant’s “acceptable medical source” who gives or has provided medical treatment or evaluation to the claimant and has, or has had, an ongoing treatment connection with the claimant.
Physicians, psychologists, and other healthcare professionals prepare medical reports about an individual’s impairment. These reports should include medical history, clinical findings, laboratory findings (e.g., blood pressure, X-rays), diagnosis, treatment, prognosis, and a statement specifying what the applicant can do despite their disability.
Such details should describe, but not be limited to, the individual’s capacity to execute work-related tasks such as sitting, standing, walking, lifting, carrying, managing objects, hearing, speaking, and traveling. In cases involving mental impairments, the statement should explain the individual’s capacity to understand, follow, and remember instructions and the individual’s ability to respond appropriately to workplace supervisors, co-workers, and job pressures.
For the VA
Disability claims filed with the VA require medical evidence that demonstrates the veteran has a physical or mental disability. The evidence should also show that the disability is due to an event, injury, or disease related to the veteran’s military service. Moreover, a nexus letter issued by a medical professional explaining the relationship, or “nexus,” between a veteran’s present medical condition and military service can help in the claims decision process.
For Private Insurers
When making a disability benefit claim with a private insurance carrier, an applicant should provide proof of loss. This proof is based on delivering thorough medical records, the foundation for the application process. An Attending Physician Statement (APS) is a key component of the disability benefits application process and should completed by at least one of the applicant’s treating physicians. The statement includes the claimant’s diagnosis and restrictions due to their medical condition. Insurers often request functional capacity evaluations (FCEs), which assess the applicant’s physical and cognitive abilities to perform work, as key evidence in disability claims. They may also request authorization to obtain the applicant’s underlying treatment records to understand better the history and course of an illness and prognosis for improvement.
Discover Trajector Medical’s Medical Evidence Services
Clear and precise medical documentation is critical to the success of a disability claim. Well-organized materials may increase approval rates, faster processing times, and higher benefits.
If you are unsure about the medical evidence process, there’s hope. Speak with one of Trajector Medical’s licensed medical specialists at no upfront cost. For “more than a decade, the company has compiled medical evidence for clients to support their pursuit of Social Security, VA, and other benefits. Their expertise could be the key to your successful claim.
Recently, recorded testimonial videos from Trajector Medical clients surpassed the 1,000 mark on YouTube. Many clients have explained how the company supported their pursuit of disability benefits and helped change their lives. These success stories may inspire you and show you that with the proper medical evidence, your claim can be successful, too.