Demystifying

In most states, the majority of Social Security disability cases are denied twice, which results in the need to request a hearing before an Administrative Law Judge (ALJ). Obviously the ALJ makes the disability determination after the hearing, but who makes disability determinations prior to this level? Most people who are applying for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits might be surprised to learn that Social Security doesn’t make a disability determination prior to the hearing level. Those decisions are made by a state agency known as either Disability Determination Services (DDS) or the Disability Determination Bureau (DDB) depending on which state you live in. This agency is part of a state’s vocational rehabilitation services. An SSDI or SSI initial application or Request for Reconsideration claim is sent to DDS or DDB, where a disability examiner is assigned. The disability examiner will request a claimant’s medical records and possibly setup up medical appointments for exams paid for by Social Security if the disability examiner feels there is insufficient medical information to make a determination. The disability examiner will evaluate your claim based on your medical condition and vocational information, such as age, education and past work, and a medical doctor will review evidence and determine how your disability impacts your ability to work. These disability determinations, according to Social Security, are based on laws, regulations and court rulings. Once a case is medically reviewed the disability examiner will make a determination of whether the claimant is disabled and whether the disabilities meet Social Security’s requirements for disability benefits. After the disability determination is made the file is returned to the claimant’s local Social Security office and notice of either a denied claim or an approved status is sent to the claimant. As was indicated earlier, most cases are denied at the initial application level (75 percent) and the Reconsideration level (90 percent). For more information about how determinations are made on Social Security disability cases prior to the hearing level visit this link.

Michael J. Astrue, Commissioner of Social Security, announced an online version of the Social Security Statement is now available at www.socialsecurity.gov.  The new online Statement provides eligible workers with secure and convenient access to their Social Security earnings and benefit information. An SSA Statement can provide you with important information detailing how much you will be eligible to receive upon retirement, how much you and your family would be entitled to each month in benefits should you become disabled, and a convenient way for workers to verify that SSA has correct earnings information. This last point is important because Social Security retirement and disability benefits are based on average earnings over a person’s lifetime. If the earnings information is not accurate, the person may not receive all the benefits to which he or she is entitled. To get a personalized online Statement, people age 18 and older must be able to provide information about themselves that matches information already on file with Social Security.  In addition, Social Security uses Experian, an external authentication service provider, for additional verification.  People must provide their identifying information and answer security questions in order to pass this verification.  Social Security will not share a person’s Social Security number with Experian, but the identity check is an important part of this verification process. For more information about the new online Statement, please go to www.socialsecurity.gov/mystatement.  

As mentioned in a previous post entitled “Failure to Follow Prescribed Treatment,” medical evidence is a cornerstone in proving a Social Security disability claim. However, some individuals are sometimes not able to receive the necessary treatment due to various factors including lack of medical insurance or other economic barriers. In many cases, individuals experience symptoms relating to their disability before medical evidence is available. When this occurs the Social Security rules allow for a reasonable inference to be made as to the onset of a disability. Social Security Ruling 83-20 states: In some cases, it may be possible, based on the medical evidence to reasonably infer that the onset of a disabling impairment(s) occurred some time prior to the date of the first recorded medical examination, e.g., the date the claimant stopped working. How long the disease may be determined to have existed at a disabling level of severity depends on an informed judgment of the facts in the particular case. This judgment, however, must have a legitimate medical basis. Therefore, it is possible to establish the onset of a disabling condition prior to the first recorded medical evidence by evaluating other factors such as the nature of the impairment and when an individual stopped working.

So you have waited anywhere between 2 and 6 months to hear something from the Social Security Administration after filing your initial application. You got all that paperwork that Disability Determination Services sent you about your work and day to day life, and sent it back, filled out (and taking a lot of time and effort to do that). You finally have that letter in the mail you have been waiting for deciding your claim… and it’s a denial. You read through, and it makes seemingly wild claims saying that your condition simply isn’t severe enough to warrant being considered disabled. It’s time for: Dealing with the initial application denial 101. Step 1: Don’t panic. You are in good company. Getting an initial application approved is a lot like getting into a highly ranked university when you’re not a legacy…expect a 70% denial rate. Step 2: If you have a case manager, call him/her immediately, with the letter in front of you. This is a major development they will want to know about. This person will then schedule you in for an appeal of your claim to the next level. Be prepared to answer questions about the date of the letter, and maybe to read portions of it (just in case you got the letter before your case manager did). Step 2a: If you don’t have a case manager, still don’t panic, and look at the date of the letter and remember it. You have 60 days from this date to file the next step in the process. Step 3: Make a list of everywhere you have sought medical treatment at since filing your initial application, and write down when your first outpatient visit was, your most recent visit was, and if there is any scheduled upcoming visits. Note the conditions treated and doctor’s seen. Also note any in-patient stays, any ER visits, and any medical tests. Next, make a list of your current medications, noting who prescribed them, or if they are OTC, what they are for, and what side effects you have. Finally, note any new conditions, any changes in your conditions or daily activities, and new things you are finding you can no longer do, since you filed your most recent initial application or request for reconsideration (if your denial was on that level). Remember, you can always file your appeal online at www.ssa.gov. If you are represented, your case manager can file for you, after he or she has had a chance to talk with you about everything in step three. Denials are infuriating, there is no question about it. Appeals are a necessary step for a great many claimant’s in the process, and a lot of claimant’s find the most success on the hearing level. Just like an Adult Disability Report, preparation can make for a timely and smooth appeal sendout. It’s not something to wait to do, but not something to panic about.

The Social Security Administration’s (SSA) rules require approved disability claims to be supported by evidence obtained by the SSA and provided by you, the claimant. Medical opinions are a common form of evidence and often form the basis of an approval or denial of a claim. Although the SSA might be able to determine whether you are disabled by your medical records alone, it can be very advantageous for your regular doctor to provide a medical opinion regarding your condition. Medical opinions provided by your regular medical provider, known as a “treating source,” are typically given more weight than the “consultative examiners” used by the SSA. Treating sources include doctors or other professionals you have seen in the past, including family doctors, specialists, psychologists and therapists. Per 20 C.F.R. 404.1527(d)(2), opinions regarding your conditions provided by a treating source that are well-supported and are not inconsistent with the rest of the available records are given what is called “controlling weight” – that means the SSA must treat the opinion is true, particularly in cases where the opinion states that you are unable to do certain tasks. Even if the treating source’s opinion is not found to be well-supported or is inconsistent with the available evidence, the opinion can be given more weight than other doctors or consultative examiners used by the SSA. Treating sources with whom you have an established and long-term treatment relationship are given more weight under 404.1527(d)(2)(i) and (d)(2)(ii). Also, the SSA considers how much an opinion by any source (not just a treating source) is supported by the medical evidence, how consistent the opinion is with the available record, whether the opinion is written by a specialist in the appropriate field (such as a psychiatrist, rheumatologist, etcetera), and any other factors raised by you, the claimant. This means opinions by doctors who see you frequently for illnesses or conditions in which they specialize are usually considered “better” than opinions by consultative examiners that have only seen you for an hour during a single examination. Sometimes an opinion from a claimant’s regular family doctor can mean the difference between getting approved for benefits on an initial application and having to wait over a year and a half for an Administrative Law Judge to finally approve your claim. Attorneys and case managers at Greeman Toomey regularly encourage our clients to speak with their regular doctors about providing medical opinions and we work with those doctors to ensure opinions from treating sources get to the SSA as soon as possible.  

There are 9.4 million military veterans receiving Social Security benefits, which means that almost one out of every four adult Social Security beneficiaries has served in the United States. Two out of every five recipients either are veterans or reside with family members who are veterans. Veteran recipients are overwhelmingly male compared with all adult Social Security beneficiaries who are more evenly split between males and females. Fourteen percent of veterans receiving Social Security benefits have income below 150 percent of poverty, while 25 percent of all adult Social Security beneficiaries are below this level. Military veterans constitute an important subgroup of beneficiaries of the Old-Age, Survivors, and Disability Insurance (Social Security) program. The number of veterans who receive Social Security benefits grew steadily from the late 1960’s through the mid-1990’s but has since leveled off. Since 1957, millions of people on active duty in the military have been covered by Social Security and have paid Social Security taxes. Social Security has covered inactive duty service in the armed forces reserves (such as weekend drills) since 1988. As a result, these veterans are able to draw Social Security retirement benefits along with their military retirement benefits. Special extra earnings for military service from 1957 through 2001 can be credited to your Social Security benefits. These extra earnings credits can help people qualify for Social Security and/or increase the amount of Social Security Benefit received. For those who served as Military personnel between 1957 and 1977, credits equal $300 for each quarter of active-duty pay. Those serving between 1978 and 2001 receive credits equal to an additional $100 in earnings for each $300 they receive in active-duty pay (total credits may not exceed $1,200 a year). Earnings in 2002 and later are not supplemented with credits. For each month of active-duty service from September 1940 through 1956, a person is credited with $160 of earnings for the purpose of computing Social Security benefits. Although veterans may have received military credits to supplement their earnings in active-duty pay years before 2002, those particular years of earnings are not necessarily included in the highest-earning years that are used to calculate Social Security benefits (for retirement benefits, the highest 35 years of wage-indexed earnings are used). It is reduced by the dollar amount of your monthly other benefit. Special Veterans Benefits is not the same as Supplemental Security Income (SSI). It is a separate benefit program and is financed by the United States Treasury.  

If you’ve ever wondered what sort of people collect Social Security disability benefits, that precise question is answered every year in Social Security’s Annual Statistical Report on the Disability Insurance Program. To be eligible for the Social Security Disability Insurance (SSDI) program you must: Be insured for benefits (must have enough work credits based on taxes). Be younger than full retirement age (retirement age is between the ages of 65 and 67 if you were born from 1937 to 1959 and age 67 for everyone born 1960 and later). Apply for SSDI benefits and have a defined disability, as classified by the Social Security Administration. The 2011 SSDI Annual Report shows that there are 9.8 million people who are receiving SSDI benefits. Some quick facts about recipients: The average age of a recipient is 53. More than 52 percent of the recipients are men. The average monthly benefit paid was $1,111. Payments to beneficiaries in 2011 totaled more than $10 billion. At least 7 percent of the population in the following states are collecting Social Security disability benefits: Alabama Arkansas Kentucky Maine Mississippi West Virginia A Breakdown for Impairments for Which Benefits are Paid  Mental Impairments (32 percent) The majority of these recipients receive benefits for conditions such as psychotic disorders and affective disorders like depression, anxiety and personality disorders, while a smaller portion receive benefits for an intellectual disability such as autism. Musculoskeletal Conditions (29 percent) Such conditions would include back or spinal injuries, disc disease, injuries to the vertebrae and arthritis. Circulatory Conditions (9 Percent) Heart and cardiovascular conditions makeup this category. Some of the most common conditions include heart disease, heart failure, arrhythmias and aneurysms. Nervous System Conditions (9 Percent) Neurological impairments such as multiple sclerosis, muscular dystrophy, cerebral palsy, brain tumors and Parkinson’s disease fall into this category. Other Conditions The remainders of the 21 percent of people who are on SSDI benefits suffer from other types of injuries or diseases. These can include cancer, infectious disease, seizures and respiratory illnesses. For a more extensive breakdown of the 2011 Social Security Disability Insurance Program’s Annual Report visit the following link:    http://www.socialsecurity.gov/disability/professionals/procontacts.htm    

Lots of people ask what they can do to help make their Social Security disability case stronger. As we discussed in a previous blog entry, the Social Security Administration primarily bases its decisions on your medical record. For the SSA, the strongest type of medical evidence is called “objective medical evidence.” Objective medical evidence means laboratory findings (20 C.F.R. §§ 404.1528(c), 404.1529, and 415.929). Some examples include X-rays, MRIs, CT scans, nerve conduction studies, or I.Q. tests. The SSA considers laboratory findings to be the best way to determine whether your allegations of disability are credible. This means that whenever possible, medical tests and imaging should be obtained to help substantiate your symptoms. If a test result demonstrates that your symptoms are as severe as you are alleging, Federal regulations require the Social Security Administration to consider this objective medical finding as very strong evidence of disability (20 C.F.R. §§ 404.1527, 416.927, 404.1929, and 415.929).