Disability or Not? A Judge's Perspective

Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

This week we’re diving into an area that provokes anxiety not just for patients, but for physicians as well: the daunting world of disability. I sat down with my longtime friend and former disability judge, George Evans, a man whose career has spanned nearly three decades within the federal Social Security system. George shared not only his personal journey—from government attorney to senior judge and now to representing clients privately—but also demystified the intricate framework that determines who qualifies for disability and why. Together, we dug into the nuances of what disability truly means under the law, the difference between SSI and SSDI, and how overwhelming this process can be for the average person.

What was most eye-opening in our conversation is how many layers there are to being determined “disabled.” It’s not only about having a legitimate medical condition, it’s about meeting stringent, highly specific legal and medical criteria, and often, about successfully navigating a bureaucratic process that seems stacked against the claimant. George explained how age, work history, and even the specific judge assigned to your case can radically impact your odds of success. He also stressed that getting quality legal representation can make all the difference—because any misstep early in the process may be hard, if not impossible, to fix. In the end, it’s clearer than ever that having someone knowledgeable by your side is essential in taking on this system.

PODCAST NOTES 

• Understanding “Disability” Legally: The official Social Security definition of disability isn’t just “not being able to work.” You must prove you are unable to perform substantial gainful activity for 12 consecutive months, and every single word in that definition carries legal significance and requirements. Temporary conditions, short-term setbacks, or partial disabilities do not qualify; you have to be fully out of work for at least a year.

• SSI versus SSDI—Two Separate Systems: There are two main disability programs under the Social Security Act. SSI (Supplemental Security Income) is strictly need-based, requiring you to have limited income and assets (generally no more than $2,000, excluding a home and a car), while SSDI (Title II) is an insurance program for people who have worked and paid into Social Security. The differences between them affect your benefits, eligibility criteria, and the kind of health coverage you ultimately receive (Medicaid with SSI, Medicare with SSDI, but only after a 24-month waiting period).

• Why Timing and Application Dates Matter: For SSI, the day you apply sets the start of your eligibility; you can’t get back payments for any time before your application date, so filing promptly is crucial. On the SSDI side, there’s a potential for up to 12 months of retroactive benefits, provided you’ve met insured status and can prove your disability started earlier, but there’s always a five-month waiting period before checks begin, making it all the more important to act quickly and accurately.

• Physical Disabilities vs. Mental/Emotional Claims: While both physical and psychological impairments are covered, physical claims—particularly those affecting the ability to stand, walk, lift, or perform basic tasks—are generally easier to win due to concrete vocational “grid rules.” Mental health claims are more subjective and thus more challenging, often requiring clear-cut documentation of occupational and social inability that is difficult to establish objectively.

• Age and Work History Significantly Impact Eligibility: The rules are much more lenient for older workers, especially those over 50, and even more so over 60. Past relevant work (within the last five years) and ability to transition to similar work dictate decisions. It is much harder for younger individuals (under 50) to qualify unless they are profoundly impaired, because the system expects them to adapt to less demanding jobs.

• Navigating the Step System is Difficult: The initial and reconsideration stages are handled at the state level, and statistically reject 70% or more of applicants—even those with valid disabilities. Only when cases reach a federal Administrative Law Judge (ALJ) do approval rates improve. Without representation, it’s easy to make mistakes during the initial stages that can harm your chances later when your case is under review.

• The Vital Role of Legal Representation: Judge Evans strongly emphasized that representation isn’t just helpful—it’s nearly mandatory. Navigating paperwork, gathering the right medical evidence, and knowing how to answer questions for the record are essential, and attorneys or advocates only take a one-time fee (capped at 25% of past-due benefits) if you win your case; there’s nothing to pay out-of-pocket if you don’t prevail.

• Honesty and Consistency Can Make or Break Your Claim: One of the biggest mistakes claimants make is exaggerating or misrepresenting their symptoms. Judges rely heavily on credibility, and inconsistency or outright dishonesty can lead them to question your entire application, even if your underlying disability is real. The takeaway—always tell the truth and prepare honestly with your representative before your hearing.

In conclusion, disability—at least as it’s defined and decided by Social Security—isn’t just a matter of whether you can work, but whether you can prove, through a complex and tightly defined process, that your condition meets every technical requirement. If you find yourself needing to file, don’t try to go it alone. Reach out for expert help from someone who really knows the ropes—it can save you time, money, and a lot of frustration. 

Stay educated. Stay healthy. 

Till next week.