Victories: Winning Benefits After Social Security Took Back Its Own Approval

Part of an occasional series on how we win cases. Client details are omitted or changed. Every case turns on its own facts, and past results do not predict future ones.

We won full disability benefits for a man in his early sixties whose claim Social Security had denied twice. The administrative law judge issued a fully favorable decision, which means monthly benefits going forward and past-due benefits for the period he had already been disabled. The agency had approved the same claim once before and then taken the approval back. If you have been denied, a free consultation costs nothing, and the deadline to appeal is 60 days.

He had spent decades in heavy construction as a self-employed contractor, and by the time he applied, his back, knees, and hands no longer let him do that work. State agency examiners approved the claim at the initial level. They found that he could still do light work, that his self-employment gave the agency no past relevant work to hold against him, and that at his age the medical-vocational guidelines directed an award. A federal quality review unit then pulled the file before the award issued, because nothing in it documented what his self-employed construction work had required of him day to day. Rather than develop that part of the record, the state agency denied the claim for insufficient evidence.

Reconsideration denied the claim again and found that none of his impairments were severe, a finding that ends a claim at step two of the sequential evaluation. The vocational section of that same denial still recited a light residual functional capacity and the same grid rule that had supported the approval. We argued that inconsistency at the hearing and quoted both findings out of the one document.

We also did the development the agency had skipped. No one had ever asked him what his self-employed work actually involved, so we put its exertional demands in the record. The file contained no treating source opinion of any kind, and we obtained function-by-function statements from the primary care physicians who had treated him for years. We amended the alleged onset date to what the medical records supported rather than the earlier date he had estimated on the application.

The judge agreed. The decision found him limited to a full range of light work with no past relevant work to return to, and at his age and with that capacity, Rule 202.04 of the medical-vocational guidelines directs a finding of disabled. The award was full rather than a closed period, so his benefits continue. Our fee was withheld from the past-due benefits and approved by the judge, and he was never billed for the representation.

Age is one of the most important facts in a disability claim, and the rules get meaningfully more favorable when a claimant turns 50, again at 55, and again at 60. A denial notice is a piece of agency paperwork, and it is frequently inconsistent with the agency’s own file. Request a free consultation or call us at 617-683-1983, and we will read your file before you decide anything.