Appeal Ready

A finished file, page by page

This person is made up. We wrote this file to show what a finished appeal file looks like. No real person's records are in it. The black bars show where private details would be.

  1. Page 1 of 8 · Cover and contents

    Everything in one place, numbered, so nothing gets lost.

    Sample · made-up person

    Appeal file: Dana Sample

    Name
    Dana Sample
    Social Security number
    Date of birth
    Address
    Claim number
    Appeal stage
    Hearing, after reconsideration was denied
    Hearing status
    Requested Nov 20XX; date not set yet
    Prepared
    Feb 20XX
    Prepared by
    Appeal Ready (case preparation; not a law firm)

    Contents

    SectionPages
    Cover and contents1
    Start-here summary2
    Records log3
    Dated timeline4
    The denial, point by point5
    What the doctors say6
    Work history7
    Still missing, and how to send it8
    Denial letters: 8 pages, 2 letters9–16
    Hearing request receipt: 2 pages17–18
    Dana's statement: 3 pages19–21
    Medical records: 212 pages, 4 providers22–233

    233 pages in all. Every page has a number at the bottom, and the summary, timeline and denial pages point to those numbers.

  2. Page 2 of 8 · Start-here summary

    The one page a busy reader needs first.

    Sample · made-up person

    Who Dana is

    Dana Sample is in their fifties and spent about 22 years in warehouse and other on-your-feet jobs. On Mar 14, 20X1, Dana hurt their lower back lifting a case at work. An MRI showed a herniated disc in the low back pressing on a nerve to the left leg. Three injections and five months of physical therapy helped only for short stretches. Dana stopped working on Aug 30, 20X1.

    What was denied, and when

    Applied for disability
    Jan 18, 20X2 (p. 9)
    First denial
    Jun 3, 20X2 (p. 9)
    Reconsideration denied
    Oct 4, 20X2 (p. 13)
    Hearing requested
    Nov 1, 20X2 (p. 17)

    The three reasons the letter gave

    Reason in the letterAnswered on
    Condition improved with treatmentp. 5, reason 1
    Can walk, sit and use arms and legsp. 5, reason 2
    Can do other, lighter workp. 5, reason 3; pp. 6–7

    Still open: one set of new records and one signature. Both are listed on p. 8.

  3. Page 3 of 8 · Records log

    Proof that every office was asked, and chased.

    Sample · made-up person

    Each office got a written request with Dana's signed release. Requests went out in Dec 20X2; follow-ups ran into 20X3.

    ProviderAsked forFollow-upsReceived
    Example Family ClinicAll visits from 3/20X1. Sent 12/5Called 12/1212/19 · 38 pp.
    Sample County HospitalER visit and MRI. Sent 12/5Called 12/14; faxed again 12/211/4 · 22 pp.
    Sample OrthopedicsAll visits from 6/20X1. Sent 12/5Called 12/12; called 1/31/16 · 96 pp.
    Example Physical Therapy4/20X1 to 11/20X1. Sent 12/5Called 12/12; faxed again 12/19; called 1/31/9 · 56 pp.
    Sample Orthopedics (new visits)Visits after 1/16. Sent 2/1Called 2/8Open

    Received so far: 212 pages from 4 providers. The last row is still open; see p. 8.

  4. Page 4 of 8 · Dated timeline

    Your story in order, each line tied to a record.

    Sample · made-up person

    DateWhat happenedSource
    Mar 14, 20X1Hurt low back lifting a case at work; seen in the ERSample County Hospital, p. 61
    Mar 16, 20X1Clinic visit; light duty, no lifting over 10 lbExample Family Clinic, p. 24
    Apr 20, 20X1Physical therapy starts, twice a weekExample Physical Therapy, p. 179
    May 25, 20X1MRI: herniated disc low in the back, pressing on a left leg nerveSample County Hospital, p. 76
    Jun 8, 20X1First orthopedic visit; pain down left leg, numb footSample Orthopedics, p. 83
    Jul 13, 20X1First spine injectionSample Orthopedics, p. 94
    Aug 30, 20X1Last day of work; light-duty job endedExample Family Clinic, p. 41
    Sep 21, 20X1Second spine injectionSample Orthopedics, p. 109
    Nov 9, 20X1Physical therapy ends; goals not metExample Physical Therapy, p. 231
    Jan 18, 20X2Applies for disabilityInitial denial letter, p. 9
    Jun 3, 20X2First denialInitial denial letter, p. 9
    Jul 22, 20X2Third spine injectionSample Orthopedics, p. 146
    Oct 4, 20X2Reconsideration deniedReconsideration letter, p. 13
    Nov 1, 20X2Hearing requestedHearing request receipt, p. 17
    Jan 10, 20X3Orthopedist fills out a statement of Dana's limitsSample Orthopedics, p. 175

  5. Page 5 of 8 · The denial, point by point

    Each reason in the letter, next to what the records say.

    Sample · made-up person

    Each reason below is quoted from the reconsideration letter. Next to it is what the records show, with page numbers. This page lists records only. It does not argue the case.

    Reason 1 of 3

    What the letter says

    “The medical evidence shows that your condition has improved with treatment.” (p. 14)

    What the records show

    After each of three injections, pain eased for 2 to 3 weeks, then came back (Sample Orthopedics, pp. 101, 116, 153). Physical therapy ended on Nov 9, 20X1 with its goals not met (Example Physical Therapy, p. 231). A repeat MRI on Mar 2, 20X2 showed the disc herniation unchanged (Sample Orthopedics, p. 128).

    Reason 2 of 3

    What the letter says

    “Although you have back pain, you are able to walk, sit, and use your arms and legs in a satisfactory manner.” (p. 14)

    What the records show

    Orthopedic exams record a numb left foot and a weak left ankle on Jun 8, 20X1, Mar 2, 20X2 and Sep 14, 20X2 (Sample Orthopedics, pp. 83, 128, 160). The family clinic noted a slow, guarded walk (Example Family Clinic, p. 50). Physical therapy measured 20 minutes of sitting before Dana had to stand up (Example Physical Therapy, p. 229).

    Reason 3 of 3

    What the letter says

    “Your condition keeps you from doing the job you had, but it does not keep you from doing other work that is less physically demanding.” (p. 14)

    What the records show

    The treating orthopedist's statement of Jan 10, 20X3 limits sitting to about 2 hours and standing and walking to about 2 hours in a workday, and lifting to 10 lb now and then. It expects Dana off task about 20% of the day and absent 3 or more days a month (Sample Orthopedics, pp. 175–177; summary on p. 6). The statement is dated after the reconsideration letter.

  6. Page 6 of 8 · What the doctors say Dana can and cannot do

    The limits that matter, in the doctor's own words.

    Sample · made-up person

    Who said it
    Treating orthopedist, Sample Orthopedics
    Treating Dana since
    Jun 8, 20X1
    Date of statement
    Jan 10, 20X3
    Original
    Sample Orthopedics, pp. 175–177
    ActivityLimitPage
    SittingAbout 2 hours in a workday; 20 minutes at a time175
    Standing and walkingAbout 2 hours in a workday; 15 minutes at a time175
    Changing positionNeeds to switch between sitting and standing at will175
    Lifting10 lb now and then; never 20 lb or more176
    Bending and stoopingRarely176
    Time off taskAbout 20% of the workday176
    Days missed3 or more a month177

    In the doctor's words

    “Pain and left leg numbness get worse after 20 minutes of sitting or standing. Has had three injections and physical therapy with short relief only.” (p. 176)

    The physical therapy records measured the same 20-minute sitting limit (Example Physical Therapy, p. 229).

  7. Page 7 of 8 · Work history

    What the old jobs demanded, to compare with today.

    Sample · made-up person

    JobYearsWhat it required
    Warehouse order picker and loader9 years, to 20X1Lifting 50 lb often, up to 75 lb; on feet all shift; 10-hour shifts, 4 days a week
    Grocery stock clerk7 yearsLifting 40–50 lb cases; standing and bending all shift; 8-hour shifts
    Food packing line worker6 yearsStanding at a line all shift; lifting 30–40 lb boxes; 8-hour shifts

    After the injury, the warehouse gave Dana light duty from Apr to Aug 20X1: seated sorting with no lifting over 10 lb. That work ended on Aug 30, 20X1 (Example Family Clinic, p. 41).

    Job details come from Dana's statement (pp. 19–21).

  8. Page 8 of 8 · Still missing, and how to send it

    What is not done yet, stated plainly. Then it is ready to send.

    Sample · made-up person

    Not done yet

    • Sample Orthopedics: notes from visits after Jan 16, 20X3. Asked Feb 1, called Feb 8, not received yet. We add them and update this index when they arrive.
    • Dana's statement on daily life (pp. 19–21): written with Dana from the kickoff call. Not signed yet. Dana signs and dates p. 21.

    Index of documents

    DocumentPages
    File guide (summary, log, timeline, denial, limits, work history, this page)1–8
    Initial denial letter9–12
    Reconsideration denial letter13–16
    Hearing request receipt17–18
    Dana's statement on daily life (unsigned)19–21
    Example Family Clinic records22–59
    Sample County Hospital records60–81
    Sample Orthopedics records, with doctor's statement82–177
    Example Physical Therapy records178–233

    How it gets to Social Security

    Appeal Ready does not send anything to Social Security. Dana, or Dana's representative, sends this packet to Social Security. The hearing request receipt (p. 17) shows which office has the case.

    When the two open items above are closed, this file is ready to send.

That is the whole file.

A real file has the claimant's own records and the reasons from their own letter, not these.

What a finished file looks like

Pages from a finished sample file, for a made-up person. Tap a page to see it full size.

  1. Page 1 of 4 shown · Dated timeline

    Dated timeline from the sample file for a made-up person

    Every doctor visit in date order: what the person reported, what the doctor found, and the page it came from.

  2. Page 2 of 4 shown · Criteria map

    Criteria map from the sample file for a made-up person

    Each part of the rule Social Security applies, next to what the records say about it, with page numbers.

  3. Page 3 of 4 shown · Hearing prep sheet, page 1

    Hearing prep sheet, page 1 from the sample file for a made-up person

    Facts only, for the representative: key dates, and what the records hold and lack.

  4. Page 4 of 4 shown · Hearing prep sheet, page 2

    Hearing prep sheet, page 2 from the sample file for a made-up person

    What is still missing, and what the person said set next to what the records show.

Sample · made-up person. Every name, date and record in it is invented.

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