How Judges Decide Social Security Disability Claims

Does an ALJ review your disability claim from scratch?

The judge decides the issues again rather than grading the earlier denial. SSA describes its administrative law judges as conducting impartial “de novo” hearings, which is the term for that kind of fresh review. The two determinations before the hearing are part of the file. They are not a starting score the judge has to beat or defend.

The regulation describes the judge's role in plain terms. Under 20 CFR 404.944, at the hearing the judge “looks fully into the issues” and questions you and the other witnesses. The judge can accept documents that are material to the issues, and can reopen the hearing before the decision notice is mailed to take in new and material evidence.

The scope of the hearing is set by SSA's hearings manual, HALLEX I-2-2-1. The issues before the judge include the issues from the earlier determinations that were not decided entirely in your favor. The judge may also consider a new issue that has never been decided, and must give the parties advance notice of any issue, new or previously decided, that the judge will consider.

You and your representative may look at the evidence in your file and submit new evidence. That matters more than most people expect. A hearing is not a review of the file as it stood months ago. It is a decision on the record as it stands now, and the medical records added since reconsideration are part of the record the judge decides on.

We represent adults in disability hearings across the country, and you can read how we prepare for one on our disability hearings page.

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The five-step sequence a judge applies to every disability claim

The judge applies the same five steps, in the same order, that SSA uses at every level of a disability claim. Under 20 CFR 404.1520, if the judge can find you disabled or not disabled at a step, the decision is made there and the judge does not go on to the next step.

1. Work activity. If you are doing substantial gainful activity (SGA), meaning work at a level SSA counts as substantial and gainful, the finding is not disabled regardless of your medical condition.
2. Severity. You must have a severe medically determinable impairment that meets the duration requirement.
3. The listings. If your impairment meets or equals a listing in appendix 1 and meets the duration requirement, the finding is disabled without looking at age, education or work experience.
4. Past relevant work. The judge compares your residual functional capacity (RFC), the most you can still do despite your limitations, with the demands of your past relevant work.
5. Other work. The judge considers your RFC with your age, education and work experience to decide whether you can adjust to other work.

Between steps three and four, the judge assesses your RFC from all the relevant medical and other evidence. The RFC is carried into both of the last two steps, so it does much of the work in any decision that reaches them. A full walk-through of each step is in our guide to the five-step disability evaluation, and the RFC itself has its own guide on residual functional capacity.

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How the judge weighs medical opinions in a disability claim

For claims filed on or after March 27, 2017, no medical opinion gets automatic weight. Under 20 CFR 404.1520c, SSA “will not defer or give any specific evidentiary weight, including controlling weight” to any medical opinion, and that includes opinions from your own doctors. The SSI version of the same rule sits at 20 CFR 416.920c.

Instead, the judge decides how persuasive each opinion is, using five factors:

• Supportability: how well the source backs the opinion with objective medical evidence and explanation.
• Consistency: how well the opinion fits the other medical and nonmedical evidence in the file.
• Relationship with you: the length, frequency, purpose and extent of the treatment relationship, and whether the source examined you.
• Specialization.
• Other factors.

Supportability and consistency are the most important factors, and the decision must explain how the judge considered both. The judge may, but is not required to, explain the other three.

This changes what a useful opinion looks like. A one-line note saying you cannot work carries little on its own, much the way a contractor's estimate with no itemized lines tells a homeowner very little about the repair. An opinion that names specific limits, points to the test results and treatment notes behind them, and lines up with the rest of the record gives the judge something to weigh. We ask treating sources for that kind of opinion because the regulation tells us that is what gets evaluated.

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How SSR 16-3p shapes the judge's view of your disability symptoms

Your statements about pain, fatigue and other symptoms are evaluated under Social Security Ruling 16-3p, effective March 28, 2016, in a two-step process.

1. The judge first decides whether you have a medically determinable impairment that could reasonably be expected to produce the symptoms you describe. At this step the judge does not weigh how severe the symptoms are.
2. The judge then evaluates the intensity and persistence of those symptoms and how far they limit your ability to do work-related activities.

SSR 16-3p dropped the word “credibility.” Symptom evaluation is not an examination of your character, and the judge does not assess your overall truthfulness. The question is how your symptoms limit your functioning, measured against the evidence.

The ruling lists the factors the judge considers: your daily activities; the location, duration, frequency and intensity of your symptoms; what brings them on or makes them worse; the type, dosage, effectiveness and side effects of your medication; treatment other than medication; other measures you use for relief, such as lying flat or changing position; and any other factors about your functional limits.

Normal test results do not end the inquiry. The ruling says SSA will not disregard your statements about the intensity, persistence and limiting effects of symptoms solely because the objective medical evidence does not substantiate the degree of impairment you describe. It also requires the decision to contain specific reasons for the weight given to your symptoms, clear enough for a reviewer to follow.

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What the written decision on your disability claim must contain

The judge must put the decision in writing, with findings of fact and the reasons for the decision. Under 20 CFR 404.953, the decision must rest on the preponderance of the evidence, and a copy is mailed to all the parties at their last known address.

The findings follow the five steps. A decision that reaches step five will state your RFC, explain how persuasive the judge found each medical source, and give the reasons for the weight given to your symptoms, because 404.1520c and SSR 16-3p both require that explanation.

In some cases the judge may announce a fully favorable decision orally at the end of the hearing, sometimes called a bench decision. The rule allows this only in categories of cases SSA identifies in advance. A written decision then follows that incorporates the oral decision by reference.

Read the decision closely when it arrives. The written reasons are what a later reviewer looks at. If you disagree with the decision, you have 60 days from the date you receive the notice to ask the Appeals Council to review it, a step we cover in our guide to the Appeals Council and federal court.

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