📋 OFFICIAL GUIDE · 2025
Disability Claim Guide
SSI & SSDI
Apply for disability benefits · SSI vs SSDI · appeal · medical evidence · RFC forms
Use immediately — ready-to-use templates, letters, checklists, legal references.
⚖️ SSI vs SSDI: key differences
SSI
- Need-based (low income/assets)
- No work history required
- Federal + state supplement
- Medical + financial criteria
- Max federal rate $943 (2025)
SSDI
- Based on work credits
- Must have paid FICA taxes
- Higher monthly benefit (avg ~$1,537)
- Medical criteria only
- 5-month waiting period
42 U.S.C. § 423 20 CFR § 416.202 Both programs require severe disability expected ≥12 months or terminal.
📝 Application walkthrough (step by step)
- Initial preparation: Gather medical records, work history, contact info for doctors.
- Online or phone: Apply at ssa.gov/disability or call 1-800-772-1213.
- Disability interview: SSA will call (approx. 45–60 min). Be ready with details.
- Medical evidence submission: SSA requests records; you can add your own.
- Decision (3–6 months): Initial determination. 65% are denied.
- Reconsideration (if denied): File within 60 days. New reviewer.
- ALJ hearing: If denied again, request hearing before administrative law judge.
- Appeals Council & federal court: Further appeals if needed.
20 CFR § 404.900 series for appeal rights.
🔄 Appeal process (4 levels)
- Reconsideration: 60 days from denial. File form SSA-561. New examiner.
- Hearing by ALJ: 60 days from reconsideration denial. Form HA-501. You can bring representative.
- Appeals Council: 60 days from ALJ decision. They review errors.
- Federal District Court: 60 days from Appeals Council denial.
20 CFR § 404.967 · 42 U.S.C. § 405(g) judicial review.
🩺 Medical evidence guide (what SSA needs)
- Treatment records: from all providers (primary, specialists, therapists).
- Diagnostic tests: MRI, X-ray, blood work, mental status exams.
- Medication list & side effects.
- Functional limitations: how your condition limits sitting, standing, memory, etc.
- Statements from doctors: medical source statement (like RFC form).
- Consistency: treatment compliance and objective findings.
SSR 16-3p · 20 CFR § 404.1520c (most important evidence).
📄 RFC (Residual Functional Capacity) form
Used by SSA to determine what you can still do despite limitations. Below is a ready-to-use template for your doctor.
| Exertional level | ☐ Sedentary ☐ Light ☐ Medium ☐ Heavy |
| Lift/carry (max) | ____ lbs occasionally, ____ lbs frequently |
| Stand/walk (total) | ____ hours in 8-hour day |
| Sit (total) | ____ hours in 8-hour day |
| Postural limits | ☐ Climbing ☐ Balancing ☐ Stooping ☐ Kneeling ☐ Crouching |
| Manipulative limits | ☐ Reaching ☐ Handling ☐ Fingering ☐ Feeling |
| Mental limits | ☐ Memory ☐ Concentration ☐ Social interaction ☐ Adaptation |
SSA-4734-BK (RFC form) · SSR 96-8p.
📌 Ready-to-use templates & letters
✉️ Medical source statement request (doctor letter)
[Date]
Re: [Patient name] – Medical opinion for disability claim
Dear Dr. [Last name],
I am applying for SSDI/SSI. Please complete the attached RFC form or provide a narrative describing my functional limitations. Include objective findings, diagnosis, prognosis, and restrictions. Your opinion is crucial.
Thank you,
[Your name] · [Phone] · [SSN last 4 digits]
📋 Appeal request letter (reconsideration)
Date: ________
To: Disability Determination Services
Re: [Name], SSN [xxx-xx-xxxx] – Request for Reconsideration
I disagree with the initial denial dated [date]. I am requesting reconsideration. Additional medical evidence is attached. My condition [describe worsening]. I meet listing [if known].
Sincerely,
[Signature]
✅ Medical evidence checklist (use immediately)
Complete treatment records (last 5 years)
Hospitalization & surgery notes
Imaging reports (MRI, CT, X-ray)
Mental health therapy notes
Medication list & side effects
Physical therapy / rehab records
Doctor’s functional statement (RFC)
Work history & job demands
📅 Daily activities log (for pain/fatigue)
Date: _____ | Pain level (0-10): _____
Morning: [e.g., rested, made breakfast, rested 2h]
Afternoon: [e.g., short walk, needed nap]
Evening: [e.g., watched TV, difficulty cooking]
Notes: [symptoms, help needed]
⚡ Legal references (key statutes & regulations)
- 42 U.S.C. § 423 (SSDI)
- 42 U.S.C. § 1382 (SSI)
- 20 CFR § 404.1501 (SSDI)
- 20 CFR § 416.901 (SSI)
- SSR 16-3p (symptom evaluation)
- SSR 96-8p (RFC assessment)
- 20 CFR § 404.1520 (5-step)
- 20 CFR § 404.1567 (exertional)
- POMS DI 24510.001
📲 Need expert help or representation?
prsolucoes.com
Disability advocates · free case review · forms & appeals
🧠 Understanding the 5-step disability evaluation
Step 1: Are you working? (Substantial gainful activity – SGA). If earnings > $1,550/month (2025), generally not disabled. 20 CFR § 404.1571.