The best examples of sample written statements for disability claims

Why strong written statements matter for disability claims

Forms like SSA‑16 (Disability Application) and SSA‑3373 (Function Report) are important, but they don’t always capture what your life actually looks like. That’s where written statements come in.

When people search for examples of sample written statements for disability claims, what they really want is help turning their daily struggles into clear, concrete details that a claims examiner or judge can understand.

A solid written statement can:

• Fill in the gaps that medical records don’t show (like how long it takes you to shower or why you can’t stay on task).
• Show consistency with your medical evidence.
• Give Social Security a picture of your worst days, not just the rare good ones.

You can submit written statements from:

• Yourself (a personal statement)
• Family members or close friends
• Former employers or supervisors
• Caregivers or caseworkers

Social Security calls these third‑party reports “statements” or “function reports,” and they can be especially helpful when they match what’s in your medical records and your own forms.

Short, realistic examples of sample written statements for disability claims

Let’s start with what most people want to see first: real‑world style examples. These aren’t scripts to copy word‑for‑word. Think of them as patterns you can customize.

Example of a personal statement for chronic back pain

“My name is Maria R., I am 49 years old, and I am writing this statement in support of my Social Security disability claim. I have severe lumbar degenerative disc disease and nerve damage, confirmed by MRI and EMG tests. I have been treated by Dr. Patel, a board‑certified neurologist, since 2021.

On a typical day, my lower back pain is a 7 out of 10 when I wake up. I need about 45 minutes just to get out of bed, stretch, and take my medication before I can move around my apartment. I cannot sit in a regular chair for more than 15–20 minutes without having to stand up, and I cannot stand in one place for more than about 10 minutes. I have to lie down flat with a heating pad at least three times a day for 30–45 minutes at a time.

Before my condition worsened, I worked full‑time as a customer service representative. That job required sitting at a computer and answering calls for 8 hours a day. I had to stop working in March 2023 because I was missing work 3–4 days a month due to pain flare‑ups and could not sit long enough to complete my shifts, even with accommodations. My employer allowed extra breaks, but it was still not enough.

I can no longer lift more than about 5 pounds without pain shooting down my right leg. Simple tasks like grocery shopping require help from my daughter. On bad days (at least 3 days a week), I stay in bed most of the day because walking from my bedroom to the bathroom feels like knives in my spine. I am afraid to drive more than a few miles because my right leg sometimes goes numb.

Everything I have written here is true and based on my daily experience.”

This is one of the best examples of sample written statements for disability claims because it ties symptoms to specific limits: how long she can sit, stand, walk, and how often she has bad days.

Example of a personal statement for major depression and anxiety

“My name is James L., I am 36 years old, and I am submitting this statement to explain how my major depressive disorder and generalized anxiety disorder affect my daily life and ability to work.

I have struggled with depression and anxiety for many years, but my symptoms became severe in 2022. I have been treated by psychiatrist Dr. Nguyen and a therapist at the community mental health clinic. I take prescribed antidepressant and anti‑anxiety medications, but I still have significant symptoms.

Most days, I have trouble getting out of bed. I often go 2–3 days without showering because I do not have the energy or motivation. I forget to eat meals unless my mother reminds me. My concentration is very poor. I start simple tasks like washing dishes or paying bills and then walk away and forget what I was doing.

I worked as a warehouse associate until October 2023. I began missing work frequently due to panic attacks and days when I could not stop crying. Even when I was at work, I had difficulty following instructions and staying focused. My supervisor wrote me up several times for mistakes and for leaving my workstation without permission when I felt overwhelmed. Eventually, I was let go because I could not perform my duties reliably.

I have thoughts that life is not worth living several times a week, though I have not made any attempts. I isolate myself and rarely leave the house except for medical appointments. I avoid crowds and have panic symptoms (racing heart, sweating, shaking) if I am around more than a few people. I cannot imagine being able to handle a regular work schedule or interacting with coworkers and the public on a daily basis.

This statement is accurate to the best of my knowledge.”

Notice how this example of a mental health statement focuses on behavior: missed work, hygiene, concentration, and social withdrawal.

If you want more background on depression and its symptoms, the National Institute of Mental Health (NIMH) has a helpful overview: https://www.nimh.nih.gov/health/topics/depression

Example of a third‑party statement from a spouse

“My name is Angela T., and I am the spouse of Michael T., who is applying for Social Security disability benefits. I have lived with Michael for 15 years and see him daily.

Michael has Type 1 diabetes with complications, including neuropathy in his feet and hands and vision problems. Over the last two years, his condition has gotten much worse. I now help him with many basic tasks.

In the morning, I check his blood sugar because his hands shake and he has trouble feeling the lancet due to numbness. I often have to remind him to eat because if his blood sugar drops, he becomes confused and irritable. He has had several episodes where he became disoriented and I had to call 911. The last time was in February 2024.

Michael used to enjoy driving, but now he rarely drives more than a few miles because he has trouble seeing clearly at night and his feet go numb. I drive him to all medical appointments and to the grocery store. He cannot stand for long periods, so I do most of the cooking and cleaning. On bad days, he lies on the couch with his feet elevated and says they feel like they are burning.

I confirm that what I am writing here is true and based on what I personally observe.”

This is one of the examples of sample written statements for disability claims that shows how a spouse can describe specific help they provide and changes over time.

For more on diabetes complications, the CDC offers detailed information: https://www.cdc.gov/diabetes/managing/problems.html

Example of a statement from a former employer

“My name is Robert H., and I was the store manager at Westside Hardware from 2017 to 2023. I am writing this statement regarding our former employee, Sarah K., who has applied for disability benefits.

Sarah worked for us as a cashier and floor associate. Starting in early 2022, she began having increasing difficulty performing her job due to what she described as severe rheumatoid arthritis.

I observed that Sarah often had trouble standing at the register for more than short periods. She would need to sit down frequently, and sometimes she could not straighten her fingers enough to scan items quickly. We provided a stool and allowed her to sit when possible, but even with these accommodations, she struggled to keep up with customers during busy times.

Sarah also began missing work more often, usually due to pain flare‑ups or medical appointments. In the last six months of her employment, she missed 6–8 days per month. We attempted to adjust her schedule and reduce her hours, but the attendance issues and physical limitations made it difficult for her to meet the basic requirements of the job. She resigned in July 2023, explaining that her condition made it impossible to continue working.

This statement is true based on my experience supervising Sarah.”

This kind of employer letter is one of the best examples of sample written statements for disability claims because it connects medical issues to real work problems: attendance, pace, and physical limitations.

For background on rheumatoid arthritis symptoms and treatment, Mayo Clinic has a clear overview: https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Example of a short caregiver statement for cognitive impairment

“My name is Daniel P., and I am the adult son and caregiver of Linda P., who is applying for disability based on early‑onset Alzheimer’s disease. I visit her daily and manage her medications and finances.

Over the last two years, my mother has become increasingly forgetful and confused. She frequently forgets conversations we had the day before and repeats the same questions many times. She has gotten lost while walking in her own neighborhood, and I now have to accompany her if she leaves the house.

I set up a pill organizer for her medications, but even with that, she often forgets to take them unless I call or come over. She once took a double dose by mistake, which led to dizziness and a fall. She cannot safely cook alone because she has left the stove on more than once. I now prepare her meals or stay in the kitchen with her.

I handle all of her bills and important paperwork because she has paid the same bill twice and forgotten others entirely. She would not be able to manage a job that required remembering instructions or dealing with money.

Everything in this statement is based on my direct experience caring for my mother.”

This example of a caregiver statement highlights safety issues and memory problems, both very important in disability decisions.

Example of a pain‑focused statement for fibromyalgia

“My name is Nicole B., age 42, applying for disability due to fibromyalgia and chronic fatigue syndrome. I have been treated by my primary care doctor and a rheumatologist since 2020.

I experience widespread pain every day, especially in my shoulders, neck, lower back, and hips. The pain feels like a deep ache with sharp stabbing sensations if I move too quickly. I also have extreme fatigue that does not improve with rest.

Getting dressed in the morning can take up to an hour because lifting my arms to put on a shirt or bending to put on socks is very painful. I need frequent breaks when doing simple chores like washing dishes or folding laundry. I usually can only be active for about 15–20 minutes before I need to sit or lie down.

I have ‘flare’ days at least 2–3 times per week when the pain is so intense that I stay in bed most of the day. On those days, I cannot drive, shop, or do household tasks. Bright lights and loud noises make my symptoms worse. I also have trouble concentrating and often forget what I was doing in the middle of a task. I call this my ‘fibro fog.’

Because of these symptoms, I cannot maintain a regular work schedule or perform even light work on a consistent basis. I miss many social events and depend on my family for help with errands and transportation.

This statement accurately describes my daily life.”

This is another one of the best examples of sample written statements for disability claims because it shows frequency of flare‑ups and how unpredictable limitations make steady work unrealistic.

For more on fibromyalgia, the NIH offers up‑to‑date information: https://www.niams.nih.gov/health-topics/fibromyalgia

How to model your own statement on these real examples

Now that you’ve seen several examples of sample written statements for disability claims, let’s break down what they have in common so you can build your own.

They typically:

• Start with your name, age, and relationship to the claimant (if you’re not the claimant).
• Briefly mention the main diagnosis and treating providers.
• Describe a typical day, focusing on what you can and cannot do.
• Include specific limits: how long you can sit, stand, walk, lift, focus, or be around others.
• Explain how often you have bad days or flare‑ups.
• Connect symptoms to work problems: attendance, pace, mistakes, safety, or interactions with others.
• End with a simple truth statement like, “This is true to the best of my knowledge.”

When you’re writing, imagine you’re talking to someone who has never met you and knows nothing about your condition. That’s basically what you’re doing.

2024–2025 tips: Writing statements that match how Social Security really reviews claims

Social Security rules don’t change every week, but the way decisions are documented and reviewed has gotten tighter over the years. As of 2024–2025, a few trends stand out:

• Consistency matters more than drama. Your statement doesn’t need dramatic language. It needs to line up with your medical records and your answers on SSA forms.
• Function beats diagnosis. The diagnosis (like “degenerative disc disease”) is important, but decision‑makers care even more about what you can still do despite it. That’s why these examples include sitting, standing, lifting, concentration, and social limits.
• Third‑party statements are increasingly important. Statements from spouses, friends, and former employers can confirm your story and fill in details that medical notes leave out.
• Digital records and portals. Many people now upload written statements through the Social Security online portal or submit them electronically through representatives. Clear, typed statements are easier to read and scan into the system.

For current official guidance, you can always check Social Security’s own disability information pages: https://www.ssa.gov/benefits/disability/

FAQ: Common questions about examples of sample written statements for disability claims

How long should my written statement be?
Most good statements are one to three pages, typed and double‑spaced. The best examples of sample written statements for disability claims are long enough to explain your situation but short enough that someone will actually read the whole thing. Clear and specific beats long and vague.

Can I copy a sample word‑for‑word?
You shouldn’t. These examples include patterns and phrases you can borrow, but your statement needs to reflect your own symptoms, limits, and daily routine. If your statement sounds copied or doesn’t match your medical records, it can hurt your credibility.

Do I need a lawyer to write my statement?
Not necessarily. Many people write their own. However, disability attorneys and representatives see thousands of claims and can help you shape your statement. If you work with a representative, they may provide their own example of a format to follow.

Should I talk about my good days or only bad days?
You should mention both, but focus on your worst days and how often they happen. The strongest examples of sample written statements for disability claims explain that, for example, you might have 2–3 “better” days per week but still can’t reliably work full‑time because you never know when pain or symptoms will spike.

Can family and friends send statements directly to Social Security?
Yes. They can write and sign their statements and either give them to you to submit or send them directly to the Social Security office handling your claim. Including their name, contact information, and relationship to you makes the statement more useful.

Is it okay to mention side effects from medication?
Yes. Many real examples of written statements talk about drowsiness, dizziness, bathroom issues, or mental fog from medication. Just be specific about how those side effects affect your ability to work or function day‑to‑day.

Final thoughts: Use examples, but tell your story

Using these examples of sample written statements for disability claims as a guide can make the process feel less overwhelming. But the goal isn’t to sound like Maria, James, or Nicole. The goal is to sound like you, on your worst days, being honest and specific.

If you:

• Explain your daily routine in detail,
• Describe clear limits (time, distance, weight, frequency), and
• Connect your symptoms to work problems and safety issues,

you’re already doing what the strongest real‑world examples do.

When in doubt, ask yourself: “If a stranger read this, would they really understand why I can’t hold a full‑time job?” If the answer is yes, you’re on the right track.