Understanding Medical Evidence in an SSDI Claim: What the SSA Reviews
Applying for SSDI? learn how to manage medical Evidence from Day One
You’ve probably heard that getting approved for Social Security Disability Insurance (SSDI) can be difficult. What often gets overlooked is an understanding of how the details of your medical condition are examined. Whether you're applying for the first time or navigating an appeal, it may help to understand the types of evidence the SSA reviews and how this information is generally evaluated.
How to Start Your SSDI Application with Organized Evidence
To start disability benefits, you’ll need to file an initial application through the Social Security Administration (SSA). But filing the application is just the first step—it's what you submit with that application that examiners look at to evaluate your claim.
According to SSA guidelines, an SSDI application is reviewed using medical and vocational evidence that helps the agency determine whether a person meets the SSA’s definition of disability. They review your records to understand the medical impairments you have and how those impairments relate to SSA’s disability evaluation criteria.
You can apply:
Online at ssa.gov
By calling 1-800-772-1213
Or by visiting your local SSA office
Make sure to gather your documentation before you apply, so your evidence is ready to go when SSA begins reviewing your claim.
What Types of Evidence Count for SSDI?
The SSA considers many forms of evidence in your disability claim. SSA documentation often emphasizes the value of having a clear, complete record of your medical and work history when the agency reviews a claim. Here are the main categories:
✅ Medical Evidence
Clinical notes from doctors, hospitals, and clinics
Imaging results (X-rays, MRIs, CT scans)
Laboratory findings (blood work, biopsy results)
Treatment plans and response to therapy or medication
Statements from treating physicians (preferably using SSA-accepted formats)
✅ Non-Medical Evidence
Work history reports to determine if you have enough work credits, and to determine the type of work you’ve done
Function reports detailing how your condition affects daily living
Third-party statements (from family, friends, caregivers)
Vocational evaluations or job performance records
What is the Blue Book and Why It Matters
The Blue Book—officially titled Disability Evaluation Under Social Security—is SSA’s guide to evaluating medical impairments. It lists specific criteria for each condition that can qualify for SSDI.
Each listing in the Blue Book outlines:
Required medical findings
Duration of symptoms
Types of objective tests needed
If a condition lines up with a Blue Book listing, the SSA may not need to go through the remaining steps of the disability review. This is part of the five-step sequential process outlined in the Code of Federal Regulations Section 404.1520.
How and When to Submit Evidence to SSA
Evidence can be submitted:
During the initial application
During reconsideration (first appeal)
Before your Administrative Law Judge (ALJ) hearing
Key SSA Forms for Submitting Evidence
SSA-827: Authorization to release medical information
SSA-3368: Disability Report – Adult (initial)
SSA-3441: Disability Report – Appeal
SSA-3373: Function Report – Adult
SSA-3380: Third Party Function Report
You or your attorney can submit evidence through:
The SSA online portal
Fax (to the SSA or hearing office)
Mail (to your local SSA office or hearing office)
Who Reviews the Evidence?
At the initial and reconsideration stages, evidence is reviewed by:
Disability Determination Services (DDS) examiners
Consulting medical professionals working with SSA
At the ALJ hearing stage, it’s reviewed by:
An Administrative Law Judge
Possibly a Medical Expert (ME) or Vocational Expert (VE)
Each reviewer is looking for consistency, completeness, and how well the evidence maps to SSA’s disability standards.
Example: trail of evidence
❌ Insufficient Evidence Example:
Jane has lupus. Her doctor’s note says she is "often tired and unable to work." But the records don’t include lab tests, imaging, or detailed notes on how the condition affects her activities of daily living. The SSA examiner concludes the evidence is too vague and denies her claim.
✅ Well-Documented Evidence Example:
Jane’s updated records now include:
ANA lab results confirming lupus diagnosis
Rheumatologist’s clinical notes documenting joint pain, fatigue, and flare-ups
Function Report showing she can’t stand more than 15 minutes
Mental health notes showing depression related to her condition
Medication history and side effects
In this example, the updated documentation includes more of the information the SSA typically considers when it reviews lupus under the Blue Book listing rules, which may help reduce the need for additional follow-up requests. According to SSA, a claimant can meet the Lupus listing if:
"A. Involvement of two or more organs/body systems, with:
One of the organs/body systems involved to at least a moderate level of severity; and
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss)."
OR
"B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs and one of the following at a marked level:
Limitation of activities of daily living;
Limitation in maintaining social functioning;
Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace."
In this example, the updated records give the SSA a fuller view of her condition and how it affects her daily functioning, based on the agency’s evaluation criteria. Her evidence now more closely meets SSA’s standard.
What Applicants Commonly Look At When Gathering SSDI Evidence
Review SSA medical criteria. Many applicants explore the SSA’s Blue Book to understand how different conditions are described. (You can also use our quick Blue Book reference tool, which links directly to SSA.gov.)
Medical records that include clear notes, test results, and treatment details. Applicants often find it helpful when their healthcare providers document specific clinical findings, test results, and treatment responses.
Describe symptoms clearly. Records that note how often symptoms occur, how long they last, and how they affect daily activities can give the SSA a clearer picture of a person’s functioning.
Note treatment effects. Some applicants include information in their medical documentation about medication side effects or therapy limitations if they affect daily life. You can get copies of your prescription records and the side effects for your medication from your pharmacy.
Stay organized. Keeping medical reports, visit summaries, and test results in one place can make it easier to respond if the SSA requests additional information. Many people also keep a journal of symptoms and struggles.
Summary: Pulling Your SSDI Evidence Together
You don’t need legal training to organize helpful SSDI evidence. What matters most is that your medical records give the SSA a clear picture of your condition and how it affects daily functioning. Lab results, treatment notes, and activity-based statements can all contribute to that picture when they’re complete and up to date. Reviewing your documentation alongside SSA guidelines may help you understand what information the agency typically considers. If you ever feel unsure about your situation, you can reach out to the SSA or speak with a licensed SSDI attorney or SSDI representative to get help.
FAQ
Q: What medical evidence does the SSA usually review in an SSDI claim?
A: The SSA generally looks at medical records such as physician notes, diagnostic tests, imaging, treatment summaries, and information about how a condition affects daily activities. These records help the agency understand the nature and severity of a person’s impairment.
Q: Does the SSA require my doctor to complete a special form?
A: The SSA may request information from your healthcare providers using standard SSA forms, but doctors are not required to use a single universal form for every condition. The agency can gather the medical details it needs through records, questionnaires, or follow-up requests.
Q: How long does an SSDI decision typically take?
A: Timelines vary, but many applicants receive an initial determination in several months. The length of the process can depend on factors such as how quickly medical records arrive and whether additional exams or documentation are needed.
References
Social Security Administration. (n.d.). Disability Evaluation Under Social Security (Blue Book). https://www.ssa.gov/disability/professionals/bluebook/
Social Security Administration. (n.d.). Forms. https://www.ssa.gov/forms/
Disclaimer & AI Ethical Statement
Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. Consult with a qualified healthcare provider for any medical concerns or questions. Consult with a licensed attorney for legal advice.
AI Ethical Statement: This article includes information sourced from government health websites, reputable academic journals, non-profit organizations, and is generated with the help of AI. A human author has substantially edited, arranged, and reviewed all content, exercising creative control over the final output. People and machines make mistakes. Please contact us if you see a correction that needs to be made.
