Study Guide

Lesson Six
The Case Evaluation Process Revisited

In this lesson you'll learn about the basic steps in the case evaluation process and how this extracted information is used in creating a formal argument.  From lesson four, you learned how to extract the key elements from the medical evidence that will be used as ammunition in creating an argument.  In this lesson, we will provide additional insights into the case evaluation process that will allow you to prepare a formal argument on behalf of your claimant.

Revisiting the Case Evaluation Process:

As previously mentioned in lesson four, the case evaluation process is really several processes in one. These processes result in findings that are used to create a rational argument for disability.  The three processes that make up the case evaluation process are:

1.  Review of medical evidence

2.  Performing a vocational analysis

3.  Combining the results of the two processes in preparation for
     creating an argument.

In this lesson, we’re going to revisit the case evaluation process from a slightly different angle.  We’ll attempt to show you the surface differences between the case evaluation process for adult and child cases. We will also show you how to formulate an argument based on the evidence of record. 

 
The Case Evaluation Process

As you know, in the case evaluation and vocational analysis process, you analyze the medical and vocational evidence. You then use the extracted findings to identify the claimant's signs and symptoms that directly affect his ability to perform work.  Finally, using the data gathered, you prepare a formal argument on behalf of your client.

Below, we have provided two case evaluation flow charts that will act as your guide in the evaluation process of a standard disability case. These charts will help direct you through the major steps used in formulating an allowance decision.   Please note that the case evaluation process is different for adult and child cases.

Sequential Analysis (Two Different Worlds):

We have already introduced you to the sequential analysis process for adults.  In adult cases, sequential analysis has six steps.  The last two steps ask the question, can the claimant do his past work and step six ask can he do other less demanding work.  These two questions can only be answered if the case has vocational issues as seen in most adult cases.

In a child case, sequential analysis is slightly different.  There is no vocational issue in a child case so there is no reason to ask vocational questions.  Instead of a vocational question, sequential analysis in a child case asks the question, can the child perform age appropriate activities.  This new question replaces steps five and six in the adult SA process.  Social Security has divided the two sequential processes into two categories:

Flow Chart A presented below is used with any disability case that has a vocational issue.  Only Social Security Disability Insurance (SSDI) adult cases have vocational issues.  What this means is that you’re going to use both medical and vocational data in creating an argument on behalf of the claimant.  Most SSDI cases, including disabled widower cases, now use vocational factors in reaching a final decision.  Recall that medical - vocational issue means that the case will be determined based on the claimant's medically and vocationally perceived ability or inability to perform work.

Flow Chart B presented below is designed to be used with cases that do not have vocational issues.  This is most often seen in child cases where there is no work history.  If there is no work history, then vocational analysis cannot be applied.  If there is no vocational issue, then the case will be determined based on the claimant's ability to perform normal age related activities instead of work.  This approach to case evaluation is used primarily with childhood cases where work is not an issue.

Sequential Analysis Flow Chart A:  (Adults)

The sequential analysis process with vocational issues is also referred to as an adult case.  The following list describes the step-by-step sequence of the SA process for an adult who has applied for disability benefits:

Step one:  Is there a medically determinable impairment

Medically determinable simply means that the claimant must have an impairment that can be diagnosis using acceptable medical approaches.  If the answer is no, the case is denied based on no determinable impairment.  If the answer is yes, you move to step two of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the claimant’s medical evidence.

Step two:  Does the claimant suffer from a severe impairment?

If the answer is no, the case is denied based on a non-severe impairment.  If the answer is yes, you move to step three of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the claimant’s medical evidence.

Step three: Will the claimant’s impairment last twelve months? 

If the answer is no, the case will be denied on the basis of not meeting Social Security’s duration requirement.  The duration requirement states that a claimant’s condition must last or be expected to last for twelve continuous months.  If the answer is yes, you move to step four of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the claimant’s medical evidence.

Step four:  Does the claimant’s condition meet or equal the listing? 

This step is a little different from the previous steps in sequential analysis.  This step is the first opportunity for the claimant to be allowed benefits.  If a claimant does not meet or equal the medical listings, you move to step five.  However, if the claimant’s condition is so serious that it meets or equals Social Security’s medical listing, the case would be allowed.  Most disability cases do not meet or equal the lasting.  As mentioned in an earlier lesson, most adult cases are won based on medical – vocational issues.

Step five:  Can claimant perform his past work?

Now we are entering the area of sequential analysis that will require that you review the claimant’s past work history.  Using the claimant’s medical evidence, you establish his physical or mental limitations.  You then compare the claimant’s limitations with the demands of his past work.  If the claimant is so limited that he can no longer perform the duties of his past work, then the answer to this SA question would be no.

If the answer to step five is no, you move to step six of the SA process.  If the answer to step five is yes, then the claimant would be denied based on his ability to return to the duties of his past work.

Step six:  Can the claimant do other less demanding work?

From the standpoint of a disability advocate, step six is the most important step in the sequential analysis process.  It is at this step that the advocate must bring together all of the claimant physical and mental limitations and compare these limitations to all work in the national economy. 

But, how do you rule out all work?

You rule out all work by understanding how Social Security views work.  Social Security policy contains a host of caveats that reveal those areas of interpretation that can be exploited by an advocate in order to win a case.  Our entire course is based of the use of these policies.  That is why we refer to our approach to representation as the policy approach. 

What are some of these policies?

Not only can you use the medical and vocational evidence to make the claimant appear limited, you can also use Social Security policy.  To exploit Social Security policy, you must understand how Social Security views the claimant’s:

• Age.
• Education level.
• Skill level of past work.
• Skill transferability
• Perceived RFC.

Social Security policy indicates that a person of advanced age, with less than twelve years of education, with non-professional skills, with no transferable skills with a perceived low RFC is more likely to be found disabled. 

Sequential Analysis Flow Chart B:  (Child)

The sequential analysis process for child cases is different from adults in that there are no vocational issues.  These types of cases normally involve children under age eighteen.  Normally, child cases are evaluated in exactly the same manner as adult claims minus the involvement of work issues.  In other words, in a child case, you can skip the vocational analysis process.  The following list describes the step-by-step sequence of the SA process used for children who have applied for disability benefits:

Step one:  Is there a medically determinable impairment

Medically determinable simply means that the child claimant must have an impairment that can be diagnosis using acceptable medical approaches.  If the answer is no, the case is denied based on no determinable impairment.  If the answer is yes, you move to step two of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the child’s medical evidence.

Step two:  Does the child suffer from a severe impairment?

If the answer is no, the case is denied based on a non-severe impairment.  If the answer is yes, you move to step three of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the child’s medical evidence.

Step three: Will the child’s impairment last twelve months? 

If the answer is no, the case will be denied on the basis of not meeting Social Security’s duration requirement.  The duration requirement states that a claimant’s condition must last or be expected to last for twelve continuous months.  If the answer is yes, you move to step four of the sequential analysis process.  Please note that in order to make this determination, you’ll need to review the claimant’s medical evidence.

Step four:  Does the child’s condition meet or equal the listing? 

This step is a little different from the previous steps in sequential analysis.  This step is the first opportunity for the claimant to be allowed benefits.  Social Security uses a different and less demanding listing criterion for children.  If a child does not meet or equal the childhood listings, you move to step five of SA.  However, if the child’s condition is so serious that it meets or equals Social Security’s childhood listing, the case would be allowed based on meeting or equaling the listing.  

Step five:  Can the child perform age appropriate activities?

This step is completely different in a child case.  In step five of a child case, the disability advocate must seek to show that the child claimant is incapable of performing age appropriate activities such as dressing and feeding himself.  If the claimant is unable to perform these activities as a result of his impairment, the case will be allowed.

The above approach to evaluating childhood cases began with the results of a Supreme Court decision in a case called Zebley vs. HHS.  As a result of this case, Social Security was forced to consider the effects of an impairment on a child's ability to function in a normal age appropriate manner.  This means that all physical or mental restrictions caused by a child's impairment must be evaluated as to its effects on that child's ability to perform age appropriate activity.

Organizing Evidence:

Organizing a client's evidence of record is an important part of the case evaluation process.  Organizing evidence by date, source and content will  enable you to make better sense of the data and write stronger arguments.  To address this issue, Disability Associates offers two useful products.  If you are a student of our Professional Basic program, you can use our Advocate Client Manager (ACM) Standard Edition software.  You also have the option of stepping up to our full version Office Suite software which contains an advanced version of the ACM.  You can also save money by upgrading your program to the Executive level program and receive the Suite at a significant discount.

Advocate Client Manager Software Click link below to purchase product ACM (SE) Office Suite   Upgrade to Executive

Preview of Lesson Seven:

Lesson seven will demonstrate how to effectively communicate with the Social Security Administration during the process of representing a disability claim.  This lesson will include information on writing a formal argument based on everything you have previous learned.

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