Demystifying

Pneumoconiosis, also known as Black Lung disease, is a respiratory illness that results from the inhalation of coal dust over many years. Symptoms of Black Lung are characterized by impaired lung function, difficulties breathing or shortness of breath, fatigue, a chronic cough or cold or ongoing chest pains. The Black Lung benefit program established by the Federal Coal Mine Health and Safety Act of 1969 provides monthly benefit payments to coal miners who have become totally disabled as a result of Black Lung disease.  The Affordable Care Act (aka “Obamacare”) made it easier for the widows and dependents of deceased coal miners to receive benefits as a result of pneumoconiosis. Pursuant to federal law, Black Lung Disease becomes a “total disability” once it reaches a level of severity where the miner is not only unable to do his previous coal mining work, but also cannot (with consideration of education, work experience and other various work available) meet the physical demands of other coal mine work. Federal law also provides for an irrebuttable presumption of total disability due to pneumoconiosis when “complicated pneumoconiosis” is diagnosed by chest x-rays, biopsy, or autopsy. The Black Lung program offers payments and medical treatment for coal miners totally disabled from pneumoconiosis. Medical payments are limited to the treatment of conditions directly related to Black Lung disease and only totally disabled former miners can qualify for these types of benefits. Medical expenses covered range from certain medical, surgical, hospital, nursing care, rehabilitation services and other drug and equipment expenses.  The Division of Coal Mine Workers’ Compensation within the Department of Labor is responsible for distribution of Black Lung benefit payments. Black Lung benefit payments are determined by reference to the federal employee salary scales, and increase automatically when federal salaries are increased. The rate payable to a minor child or widow may be increased depending on the number of qualified dependents, generally 50 percent of the basic rate if one dependent qualifies. Additionally 75 percent for two dependents and 100 percent for three or more dependents. Black Lung monthly benefits rates for 2011-2012 may be found here. For more information on Black Lung benefits please visit the United Mine Workers of America.

If you are over the age of 62 and have earned enough work credits for Social Security Retirement benefits you may be interested in filing for early retirement. An eligible person is able to file for these early benefits any time after they have reached the age of 62 and up until full retirement age. However, if you choose to start collecting retirement benefits prior to full retirement age you will be penalized, meaning your monthly benefit amount is reduced. The earlier you start collecting these benefits the higher the deduction will be. Please click here to view SSA’s retirement planner. If you have stopped working and choose to collect early retirement benefits due to your health you may also want to consider filing and application for Social Security Disability. If you are found to be disabled your monthly benefit amount will be increased to the value of your full retirement benefits.  If there are any months you received early retirement benefits and are owed retroactive disability payments, you will be paid the difference between the early retirement benefits and value of the full retirement benefits. For example, if you are entitled to $1000 in full retirement benefits and choose to take early retirement benefits at age 62 you will be entitled to 80% of the full value. Therefore, you would get $800 per month. If you were later found disabled your monthly benefit amount would be increased to $1000. You would also be awarded the $200 difference for any overlapping months you received retirement benefits and were found to be disabled. However, if you are never approved for Social Security Disability benefits your monthly payments will remain at the reduced level. Even if you have filed for early retirement benefits, you will not qualify for Medicare until you reach age 65. If you are approved for Social Security Disability you will become eligible for Medicare 30 months after the onset date of your disability, meaning you may be eligible to start receiving Medicare benefits prior to age 65.

You may be one of the many people who are currently collecting either Social Security retirement or disability payments the old fashion way – by check. If that is the case soon you will not see that Social Security check in the mailbox any longer. The Social Security Administration has mandated that anyone receiving Social Security checks, including those who receive Social Security Disability Insurance (SSDI) or Supplement Security (SSI) payments, must sign-up for electronic payments by March 1, 2013 because Social Security will no longer issue paper checks. There are two ways to receive electronic payments, direct deposit and through a Direct Express card. Direct deposit payments will be directly deposited into a bank account of your choosing. Those who do not have a bank account, or who do not wish to do direct deposit, will have to receive their payments through a Direct Express card, which works similarly to a debit card. Those who do not sign-up for direct deposit by the deadline will receive a Direct Express card and will begin receiving payments through the card as of March 1, 2013. For more information on how to setup direct deposit visit: http://www.ssa.gov/deposit/. Social Security Statements Available Online Another technological advance Social Security is now using is to offer Social Security statements online. These statements were previously mailed out. Many times people who are applying for SSDI question what their monthly payments would be if they are found disabled. Earlier this year Social Security unveiled online access to Social Security statements to allow people to get estimates for retirement, disability and survivor’s benefits. To access these online statements you must be at least 18 years old, have a valid Social Security number, have a valid e-mail address and have a valid mailing address. To access this feature visit: http://www.socialsecurity.gov/mystatement/.

For applicants who pursue Social Security disability claims based on mental health impairments, Global Assessment of Functioning (GAF) scores can play an important role. GAF scores are made by treating providers who perform Diagnostical and Statistical Manual of Mental Disorders (DSM-IV-TR) assessments. Courts have held that Social Security must consider GAF scores when evaluating a claimant’s mental health impairments. For example, the Eighth Circuit has discussed the necessity of an administrative law judge to “consider a claimant’s total GAF score history.” Pate-Fires v. Astrue, 564 F.3d 935, 944 (8th Cir. 2009) (citing Colon v. Barnhart, 424 F.Supp.2d 805, 813-14 (E.D.Pa. 2006)). Courts have also held that a history of low GAF scores is indicative of an inability to work. In Brueggemann v. Barnhart, the vocational expert testified that a claimant with a GAF score of 50 could not work. Brueggemann v. Barnhart, 348 F.3d 689, 695 (8th Cir. 2003). Other courts have made similar rulings. See, e.g., Cruse v. U.S. Dep’t of Health & Human Servs., 49 F.3d 614, 618 (10th Cir. 1995) (holding that the ALJ’s conclusion that a claimant was not disabled was not supported by substantial evidence where the ALJ misinterpreted or ignored the claimant’s psychiatric assessment rating indicating the claimant had marked mental impairment, which would substantially impair his ability to work); Golubchick v. Barnhart, No. CV-03-3362, 2004 WL 1790188, at *7 (E.D.N.Y. Aug 9, 2004) (emphasizing a medical expert’s testimony that a GAF score below 50 is generally incompatible with the ability to work); Mook v. Barnhart, No. 02-2347, 2004 WL 955327, at *6 (D.Kan. April 26, 2004) (noting a VE’s testimony that a claimant’s GAF score of 50 would eliminate any possible jobs in the national economy). Despite these court rulings, many administrative law judges are unfamiliar with GAF scores and the implication they have on the disability process. An experienced advocate like the attorneys at Greeman Toomey can help educate the judge on GAF scores and the implications they have for your case. Contact us at 1-877-332-3252 or at www.greemantoomey.com today.

The Social Security Administration (SSA) maintains a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, the SSA must decide if it is of equal severity to a medical condition that is on the list. The rules state that an Administrative Law Judge must consider the opinion of a physician or psychologist designated by the Commissioner concerning medical equivalence whenever a claimant is not engaging in substantial gainful activity and has a severe impairment(s) that does not “meet” the requirements of a listing. The equaling analysis is often performed by a non-examining State agency physician at the initial and reconsideration levels. However, in most cases there are additional medical records presented before a hearing that were not available at the time of the prior determinations by the SSA. Social Security Ruling 96-6p requires an Administrative Law Judge to obtain an updated medical opinion from a medical expert in the following circumstances: When no additional medical evidence is received, but in the opinion of the Administrative Law Judge or the Appeals Council the symptoms, signs, and laboratory findings reported in the case record suggest that a judgment of equivalence may be reasonable; or When additional medical evidence is received that in the opinion of the Administrative Law Judge or the Appeals Council may change the State agency medical or psychological consultant’s finding that the impairment(s) is not equivalent in severity to any impairment in the Listing of Impairments. Therefore, if an Administrative Law Judge believes that the evidence suggests a medical equivalence may be reasonable, or that additional evidence may change the State agency’s prior medical equivalence determination, an updated opinion about medical equivalence is required.

Medical records play a crucial part in showing whether someone is eligible for Disability Insurance Benefits and Supplemental Security Income. Your records are the primary source used by the Social Security Administration, the state-level Disability Determination Services (DDS), and the SSA Administrative Law Judges to determine whether you are disabled under the SSA’s rules. The SSA does ask claimants to provide any records the claimant may already possess, but claimants do not have the primary responsibility to gather medical records. The SSA has the duty to gather a claimant’s relevant medical records both under the United States Code and SSA’s own regulations. Once a claimant has given the SSA permission to request medical records, the SSA and DDS will request medical records from the medical providers named by the claimant (such as hospitals, clinics, and mental health professionals). The regulations also require ALJs to work toward clarifying a claimant’s medical records if the records already gathered are too incomplete or deficient to provide a basis for a determination of disability. Unfortunately, the SSA and DDS are not always able to fully update a claimant’s medical records for a variety of reasons. In those situations, a claimant can gather his or her own medical records and submit them to the SSA and DDS. A claimant who is represented by an attorney does have an easier option: the claimant can have his or her attorney gather and submit the medical records on his or her behalf. Gathering medical records is only one of the many tasks our attorneys perform for our clients; we also provide legal advice to our clients regarding Social Security benefits and we use our experience and education to make compelling legal arguments for our clients to help ensure they receive benefits.

No one needs an attorney or a representative to apply for Social Security disability benefits. The process is described as “non adversarial,” which means that the Social Security Administration (SSA) tries to be accessible, and to help you through the process of applying and gathering medical evidence. However, most people find communications from the government hard to understand, deadlines hard to meet, and legal standards hard to prove on their own. Hiring an experienced attorney is risk-free: Because payment is on a contingency basis, your attorney only gets paid if you win. If you lose your case or decide not to pursue Social Security benefits, your attorney’s work is free. This encourages attorneys to only take cases they believe have merit, and it should encourage you to consider hiring an attorney to help you with this complicated process from the very beginning. If you win your case, and the Social Security Administration decides you are or have been disabled at any point in time, an attorney will typically receive 25% of back pay owed to you by the SSA. This amount is limited to $6000. The SSA considers and approves the fee agreement between you and your representative before any attorney fees are paid. So, why hire an attorney? Because hiring an experienced attorney is risk free, and makes the long and often frustrating process of applying for Social Security benefits much more navigable. Having an attorney cannot make this process any quicker, but it can help ensure you do not miss key steps or evidence, which gives you the best chance of winning your claim. Attorneys will contact your doctors and therapists, gather all the evidence you need for your case, and request opinions from your doctors and caretakers in ways designed to highlight the strongest parts of your claim. They will take time to answer your questions about your case and about the Social Security disability process. Most importantly, they will make legal arguments at your hearing and have a detailed understanding of the current case law, which makes it much more likely you will be successful in your claim. It’s one of the only legal fields where you can get an attorney’s advice without any out-of-pocket costs. Really, the question is – why not hire an attorney to represent you in your Social Security disability case?

The Social Security Administration considers disability cases based on a medical and vocational (work related) criteria. The first step in proving you are disabled to earn Social Security Disability Insurance (SSDI) benefits is to show that you are unable to perform the type of work you used to perform, prior to being disabled. In addition to this you must show you are unable to do “other work.” An applicant’s age and past work experience factor greatly in whether an SSDI claim is successful when considering physical disabilities, but not necessarily mental health disabilities. The two magic ages where it is easier to show that you are disabled under Social Security’s rules are 55 and 50. At age 55 you have to show that you cannot do your past work because of your disabilities and that you can’t perform more physically demanding work. At age 50 showing you can’t perform past work would not be as important as showing you are unable to do work where you have to walk, stand and lift a lot. Disabilities dealing with the back, neck, hips, legs, arms, ankles and feet would all fit into this category. Those under age 50 have more of a burden to prove they are disabled when claiming physical disabilities. If you are under age 50 you have to show that you are unable to do both past relevant work and any “other work.” This means a claimant’s ability to do work classified as sedentary, light, medium, heavy or very heavy will be considered. Social Security will consider your ability to sit, stand, walk, lift, carry, push and pull among other actions. For more information on how Social Security considers Past Relevant Work visit: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR82-62-di-02.html   For more information about “Other Work” Social Security considers visit: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR83-10-di-02.html

As a case manager, I conduct interviews with clients, complete initial applications, and file appeals. I also answer incoming calls from clients and make sure SSA is updated when necessary. One of the questions clients commonly ask is – when do I need to call my case manager? You should contact your case manager right away if you: Change your address Change your phone number Receive a new diagnosis Are hospitalize Return to work Receive a decision from Social Security regarding your claim We periodically update your medical information so it is not necessary to contact us each time you go to the doctor or start treating at a new clinic. However, it is important that you maintain a list with the names and telephone numbers of all doctors, clinics, and hospitals you treat with or at so when we request updated information you will have it easily available. My advice to all our clients is simple: keep treating with your doctors and keep in touch with my office if you move or change your telephone number. Medical evidence is extremely important in proving a claim for disability — you need to continue to treat with your doctor and follow the recommended treatment plan. Absent medical evidence supporting your claim, it will be very difficult to prove disability. Also, let your doctors know you have filed for Social Security disability. Their opinion as to your diagnoses, the severity of your impairments, and what limitations you may have is given considerable weight. Following these guidelines will ensure that your case manager can get in touch with you and that SSA will have all the relevant information at each stage of the disability claim process.