Very often, claims for social security disability and ssi benefits are denied on the basis of duration.

What exactly are durational denials?

A durational denial occurs when a disability examiner determines that a claimant's medical condition has not been disabling for at least a 12 month period, or cannot be projected to be disabling for at least this long.

Note: an occasional misunderstanding among claimants is that they cannot file a disability application before their condition has kept them out of work for 12 months. In actuality, however, a claimant can file a disability application as soon as their condition prevents them from working, or their earnings drop below the sga (substantial gainful activity) level as a result of their condition.

The 12 month time frame, of course, is a principal factor in the Social Security Administration's definition of disability. Unfortunately, the practice of projecting whether or not a claimant's disability will last 12 months or longer is just as integral to the disability determination process.

The deficits regarding claim decisions based on projections have to do with subjectivity on the part of the DDS examiner, as well as on the part of the DDS medical consultant with whom the examiner must consult prior to rendering a decision on a claim.

Though every decision made on a case is, to some degree, a subjective and interpretative event, forecasting whether or not a claimant's condition will exacerbate or remiss within a 12 month period is even more so a judgment call.

And, quite frequently (as the differences in approval rates between DDS and the Office of Hearings & Appeals will attest), DDS decisions are often the result of faulty forecasting.

For example, in one case adjudicated in the North Carolina DDS, a claimant suffering from 2nd and 3rd degree burns covering up to 25 percent of her body, and also suffering from renal failure, was given a denial based on duration.

This denial was issued even after the DDS medical consultant was presented with a letter from the director of the UNC (University of North Carolina) Hospital burn center, stating that the claimant would not be expected to improve significantly within a twelve calendar month period.

Such instances, by themselves, go a long way toward invalidating the manner in which denials based on duration are issued, specifically as the use of projections is concerned. Unfortunately, they also call into question the ability of DDS physicians to reasonably extrapolate RFC (residual functional capacity) conclusions based on a reading of a claimant's medical records.