For many people living with ankylosing spondylitis (AS), applying for Social Security disability benefits can be exhausting. When Social Security denies a claim, it can feel personal and confusing. A denial means that, based on the evidence reviewed and the rules applied at that stage of the process, Social Security has concluded that the claimant is not disabled under its standards.
In prior issues of Spondylitis Plus, the Social Security Administration’s general framework for evaluating disability claims has been discussed. This article focuses on what happens after a denial, why so many claims are denied early in the process, and how the appeals system works, particularly for people with chronic inflammatory conditions like AS.
Reading the Denial Notice and Appeal Deadlines
When Social Security denies a disability claim, it sends a written denial notice. The notice explains, in general terms, why the claim was denied, lists the evidence that was considered, restates key information such as the alleged onset date, and, in disability insurance cases, may reference the date last insured. The notice also sets the deadline for filing an appeal.
In most cases, an appeal must be filed within 60 days of the notice date, with a five-day mailing presumption. Late appeals may be accepted for good cause, such as a notice not received or sent to the wrong address. Deadlines vary by case stage, so read the denial notice carefully.
Why So Many Claims Are Denied at the Initial and Reconsideration Levels
A large percentage of disability claims are denied at the initial level and again at the reconsideration level, not because the claimant’s condition is minor, but because of how those early decisions are made.
At the initial stage, Social Security evaluates claims primarily through a review of medical records, forms, and other written evidence. The decision-maker does not meet the claimant. Initial and reconsideration determinations are typically handled through state Disability Determination Services, which makes decisions on behalf of Social Security. In some cases, Social Security may also arrange a consultative examination with a physician or psychologist.
Early decisions can be difficult in cases involving chronic pain and inflammatory conditions because pain, fatigue, stiffness, and other subjective symptoms are inherently challenging to evaluate from written records alone. These symptoms may fluctuate, worsen with sustained activity, or interfere with the ability to maintain a regular work schedule, even if they are not always documented in detail in treatment notes.
Consultative examinations can also play an important role early in the process. These exams are typically brief and are intended to supplement the existing medical evidence. While consultative exams are a legitimate part of the process, they may not fully reflect how a claimant functions over time, particularly where symptoms vary or worsen with prolonged activity.
Another common problem early in the process is that a person’s medical records may be limited. Many people apply for disability only after their condition has already made work difficult, so the records may not yet fully show ongoing treatment, changes in therapy, or how the condition affects daily functioning.
Mental impairments may also be insufficiently documented early in the process. Chronic pain, fatigue, sleep disruption, depression, anxiety, and cognitive symptoms can affect the ability to meet the mental demands of work.
What Social Security’s Own Data Shows
Social Security publishes annual data showing how disability claims are decided at each stage of the process. Historically, over 60 percent of initial claims and roughly 85 percent of reconsideration claims are denied, though rates vary by year.
Approval rates improve at the hearing level. Historically, about half of claims that reach a hearing before an Administrative Law Judge are approved, with the remainder denied or dismissed. These outcomes depend on the facts of each case, but the data shows that many people who ultimately receive benefits do so only after pursuing an appeal.
The Reconsideration Appeal
After an initial denial, the first appeal is called a request for reconsideration. At this stage, the claim is reviewed again, typically by a different adjudicator. Reconsideration remains largely a paper review, and the same general standards apply.
Because reconsideration does not involve testimony or an opportunity to explain limitations directly, many claims are denied again at this stage. While discouraging, reconsideration is often a necessary step before a hearing can be requested.
What Happens at a Hearing
A hearing before an Administrative Law Judge gives the claimant a chance to answer questions directly. The Judge is a lawyer who works for Social Security, evaluates the evidence, and issues a written decision. There is no government trial attorney arguing against the claimant.
Hearings may be in person, by video, or by telephone. The Judge may ask about work history, daily activities, symptoms, and how AS affects functioning over time.
In most cases, the Judge will hear testimony from a vocational witness. The witness responds to hypothetical questions assuming physical and mental limitations and whether a person with those limitations could perform past work or other work in the national economy.
Sometimes, the Judge may also call a medical expert. Experts are independent contractors who review evidence and provide neutral testimony about medical issues.
The claimant’s representative has the opportunity to ask questions, help develop the record, and cross-examine the vocational witness and any medical expert who testifies. For people with AS, this process allows functional limitations to be explored in greater detail.
Review After the Hearing: the Appeals Council
If the claim is denied after the hearing, the next level of review is the Appeals Council. The Appeals Council does not hold a new hearing. Instead, it conducts a paper review of the case. A claimant or representative may submit a written statement or brief explaining why the Administrative Law Judge’s decision involved legal or factual error. The Appeals Council may deny review, remand the case for further proceedings, or, in rare cases, reverse the decision and issue a favorable determination.
Representation and the Appeals Process
Some claimants proceed through the disability process on their own, while others choose to have representation. Both attorney and non-attorney representatives are permitted to represent claimants before Social Security. Individuals seeking representation should understand the qualifications and experience of the person who may represent them.
A representative may assist a claimant at any stage of the process, including the initial application. Representatives may help claimants complete forms, communicate with Social Security, ensure that medical evidence is submitted, develop a theory of the case, and prepare for hearings.
Ankylosing Spondylitis and Social Security’s Rules
Social Security evaluates all disability claims under its regulations, including the medical listings. Some claims meet or equal the severity of a listed impairment; many others proceed beyond that stage and are evaluated based on the claimant’s ability to perform past work or other work, given their functional limitations.
For people with AS, cases are often decided based on how the condition affects sustained work activity over time. Physical and mental limitations are considered in determining whether someone can maintain full-time employment.
Final Thoughts
Being denied disability benefits is difficult, but it is often part of the process rather than the final word. Social Security’s own data shows that many people who ultimately receive benefits do so only after pursuing an appeal. That is why persistence matters. Understanding the process and continuing to pursue one’s rights, even after a denial, can make a meaningful difference over time.
Disclaimer: This article is for general informational purposes only and does not constitute legal advice. Social Security disability cases are highly fact-specific, and readers should consult appropriate resources or professionals regarding their individual circumstances.
