Receiving an unfavorable disability decision from a Social Security administrative law judge (ALJ) can be a disappointing and frustrating experience for disability applicants ("claimants"). Adding to the frustration is the fact that claimants often struggle to understand the judge's rationale for the denial of benefits.
Unfavorable decisions usually contain special language and legal jargon that can be confusing without the help of a disability attorney. You can help make sense of your unfavorable decision using the guidemap and examples below.
The notice of an unfavorable decision means that the ALJ doesn't think that you've met Social Security's definition of disability at any point during the time period your application covers. The judge is required to explain why you're not disabled in a written opinion.
All unfavorable opinions (denials) follow the same pattern—an introduction that identifies you by name, your Social Security number, and what type of disability benefit (SSDI or SSI) your claim is for. The introduction is followed by five sections:
A cover letter should be attached to your decision stating "Notice of Decision - Unfavorable" that explains how and when to appeal your denial. If you didn't receive a cover letter, contact your local Social Security Administration field office. You can locate your office here.
To find out the reasons why the judge denied your claim, look under the Findings of Fact and Conclusions of Law section. Here, the ALJ will go through the sequential evaluation process and explain each step as it relates to your claim.
The ALJ needs to address whether you've been working at or above the level of substantial gainful activity (SGA) since your alleged onset date. Your alleged onset date is the date you're saying you became unable to work, so if you have consistent earnings of more than $1,470 per month (in 2023) after that date, the judge can't find you disabled no matter how bad your medical issues are.
The ALJ will then list your severe impairments. Severe impairments are medical conditions that significantly interfere with your ability to work. If you don't have any severe impairments, you're not eligible for disability.
The decision will explain what medical listings—certain conditions that can qualify you for automatic approval of disability benefits—the ALJ considered and why your condition didn't meet or equal the listing requirements.
Pay close attention to the section that begins "After careful consideration of the entire record, the undersigned finds that claimant has the residual functional capacity to perform…" Your residual functional capacity (RFC) is a set of limitations that reflect the ALJ's opinion on the most you're capable of doing, physically or mentally, in a work environment.
A typical RFC statement will contain restrictions on how much weight you can lift, how long you can stand or walk for, and whether you can perform skilled or unskilled jobs.
Discussion of the medical evidence. The RFC statement is followed by several pages containing an in-depth discussion of the medical evidence in your file and your testimony at the hearing, along with reasons why the ALJ thinks that you're not as limited as you say.
Evaluation of medical opinions. This section will contain an evaluation of every medical opinion in your file, including any opinions from your doctors and Social Security consultative examiners. The ALJ doesn't have to agree with every doctor's opinion, but they must explain—with reference to specific medical records—why they prefer one opinion over another.
Assessment of substance use. If your record shows a history of drug or alcohol abuse, the ALJ needs to make a determination whether the substance abuse is causing or worsening your symptoms before you can qualify for benefits.
The ALJ spends most of the decision discussing what your RFC is and referring to medical sources and hearing testimony to support the finding. The judge then uses your RFC to determine whether you can do any of the jobs you've done before.
Most people who receive an unfavorable decision are denied because the ALJ thinks that other jobs exist that they can do with their current RFC. In the decision, the ALJ will list jobs identified at your hearing by the vocational expert that could be performed by somebody with your RFC.
A denial from an ALJ doesn't have to be the end of the line. Social Security has one additional level of review, the Appeals Council. But going to the Appeals Council isn't always the smartest move. Sometimes the best thing to do is file a new initial application. To decide which path is best for you, read our article on whether you should appeal your unfavorable decision.
You have 60 days from the date of receiving your unfavorable decision to submit an appeal. If you've received a denial from an ALJ and want to appeal your case, call a disability attorney as soon as possible. You can use Nolo's lawyer directory to find a disability attorney in your area here.
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