Can my benefits claim for dementia be denied?

On Behalf of | Jul 1, 2024 | Mental Impairments, Social Security Disability

As people age, the risk of cognitive impairments increases, bringing challenges that can impact their daily lives. One of the most common suspects for cognitive impairment is dementia. Dementia is a debilitating condition that significantly affects a person’s ability to function. That is why it might come as a surprise to learn that Social Security Disability (SSD) claims for dementia can be denied due to various circumstances.

Lack of medical evidence

One of the primary reasons the Social Security Administration (SSA) denies SSD claims is the lack of sufficient medical evidence. Dementia can be complex. Each individual’s experience with dementia is unique. That is why the SSA requires comprehensive medical records to establish the severity of the condition. They may deny the claim if the medical evidence is incomplete or inadequate.

Insufficient documentation of cognitive decline

While dementia undoubtedly affects memory and thinking, the severity of the disease can be a crucial factor. The SSA considers the impact of dementia on daily activities. Can the person manage their personal finances? Can they follow instructions? Are they able to maintain proper hygiene? Without demonstrating a decline in their quality of life due to dementia, the SSA may reject their claim.

Residual functional capacity

The SSA assesses a person’s residual functional capacity (RFC). Simply put, it is the kind of work someone can still manage despite their medical limitations. The SSA may deny their claim if someone with dementia exhibits remaining skills suited for simpler jobs.

Prior denials

If an individual has a record of an SSD benefits denial, getting approved on a subsequent application can be more challenging. The SSA may view the new application as a duplicate claim. The individual may be asked to provide new evidence to overcome the prior denial.

Strengthen your claim

A compelling case hinges on medical documentation. Ensure all medical records, including diagnoses, treatment plans and assessments, are thorough and up to date. Familiarize yourself with the SSA’s Blue Book criteria for dementia and check if your medical documentation aligns with these requirements. Confirm if you have sufficient work credits. Be sure to complete all forms accurately. Most importantly, adhere strictly to prescribed treatments and therapies and maintain records of compliance.

A denial doesn’t have to be the end. The SSA offers a multistep appeals process for benefit claims. Having an advocate with experience in appealing SSD benefits claims could prove to be vital in reviewing your appeal and determining the appropriate course of action.