In the U.S., fewer than half of people who apply for disability benefits — about 45% — are ultimately accepted, says Lisa Ekman with the National Organization of Social Security Claimants’ Representatives. Getting a hearing takes an average of nearly 600 days. It may become even harder for those whose disability is difficult to see or measure.

Recently, the Social Security Administration introduced changes to fight fraud and streamline the application process, including a new rule that removes special consideration given to a person’s longtime doctor. “Those changes would now put the evidence from a treating physician on the same weight as evidence from a medical consultant employed to do a one-time brief examination or a medical consultant they had do a review of the paper file and may have never examined the individual,” Ekman said. She said this could lead to more denials for disabled people with complex conditions like lupus, multiple sclerosis or schizophrenia. These illnesses can affect patients in very different ways and may be hard for an unfamiliar doctor or nurse to evaluate.

More denials can ultimately lead to more appeals, which will increase the Administration backlog. That backlog started snowballing about 10 years ago, said Jason Fichtner, former acting deputy commissioner of the Social Security Administration. During the recession, a lot of people who applied for benefits were disabled, but not necessarily unable to work.

There are now more than a million people across the country waiting for hearings, and, adding to the strain, the administration’s core operating budget has shrunk by 10% since 2010.