Question:

Outside of doctors, licensed psychologists, licensed optometrists, hospitals, and clinics, are there additional evidence sources that I could submit information from that would help substantiate my disability claim?

My answer:

Yes, other additional sources may help show the extent of your impairment and how this affects your ability to function on a daily basis. Sources of this nature are as follows: previous employers, family members, pastors/rabbis, teachers, social workers, chiropractors, naturopaths, audiologists, and speech and language pathologists. Although I have not exhausted all of the possible sources for additional evidence, the above includes the more common ones.

If you are involved with or are seeing any of the above, and if they can attest to your inability to function in a work environment, then providing information from these sources would most likely aid in supporting your claim for disability. In my practice, my clients will often get employers or family members to write statements on their behalf which confirm that they are unable to work or perform even basic household duties. We will submit these signed statements as notarized affidavits to the Judge, and they will thus become part of your disability case file.  As long as they support the idea that you cannot hold down a job based on your illness(es), they will likely be helpful.

Never underestimate the value of a resource. As a rule, it is better to over submit medical documentation than to have not submitted enough. Always make sure that you have provided a list of these type resources to your attorney and/or representative. Your attorney will know the value of a particular resource. Remember, up until the end of the disability process, you are not able to meet one on one with the judge. Your medical records are your ‘voice’ per se, and they tell your story up until such time as you are afforded a hearing in your case.

Post from: Social Security Disability Blog

Q & A: Can I submit non-medical sources of evidence in my disability claim?

Question:

I recently applied for SSDI, and I want to make sure that the medical records I am providing to the SSA are from "acceptable medical sources." Can you explain in detail what the SSA views as an acceptable medical source?

My answer:

The SSA considers an “acceptable medical source” to be any licensed physician (this includes D.O.s – Doctors of Osteopathic Medicine), licensed or certified psychologists, licensed optometrists, hospitals, clinics, and other health facilities where a claimant has been treated.

Remember, as has been previously mentioned on this blog, claimants are highly encouraged to see a physician/specialist who focuses primarily on their specific impairment. In a previous post about the importance of seeking specialized medical treatment,  for example, an individual suffering from migraine headaches and blurred vision was advised to see a headache specialist or neurologist who could substantiate their claim.

While general physicians are very knowledgeable and skilled (and are deemed to be an appropriate medical source by the SSA), I typically encourage my clients to try and see a specialist whose practice concentrates primarily on their particular impairment. These specialists will have the proper credentials, testing methods, and treatment plans for you, and your seeking their help will only serve to make your claim more credible in the eyes of the SSA.

I would like to address one last question I sometimes get from people suffering from a physical impairment like back  or neck pain. Many such claimants will see a chiropractor instead of, say, a spine specialist. Not to take away from the benefits chiropractors provide, but in my experience chiropractic records are not nearly as useful in a disability claim as compared to records from orthopedic and spine specialists or even those of D.O.s. If you are seeing a chiropractor, my best advice is to also seek a diagnosis or opinion from another type of medical source, so that you will be satisfying the SSA's "acceptable medical source" requirements.

Post from: Social Security Disability Blog

Q & A: What medical sources are considered acceptable by the SSA?

In 1990, Husseini suffered a work-related injury and applied for and received Social Security disability payments, court documents said. Of course, as is always the case when one is approved for benefits, Husseini had to agree to notify the SSA if he again obtained employment at a later date. However, when Husseini got a job in 1999 working for Catholic Charities, he decided he’d take another route.

Instead of using his own Social Security number, he simply gave the charity organization his brother's Social Security number. This way, his earnings would not be reported to the government, and he could thus continue receiving the Social Security Disability payments despite his work status. Husseini didn't report his change of work status until April of 2006, after he had already fraudulently collected approximately $111,000 in disability payments.

When Husseini’s case was brought to court, prosecutors sought a swift and severe penalty for his fraudulent actions. The Judge overseeing the case apparently sided with the prosecutors, and Husseini was thus sentenced to jail time and ordered to pay back the money.

Let this be a lesson to anyone who is on disability and then returns to work. Always be sure to report your back to work status if you end up gaining employment while on Social Security Disability!

Post from: Social Security Disability Blog

Immigrant gets prison time for stealing from the SSA

Question:

I recently applied for disability. Outside of the medical information that I provided in the initial application, how important is it that I continue to supplement my file while awaiting for a decision?

My answer:

Medical evidence is critical in determining whether an individual will receive disability or not. You, the claimant, and/or your representative are charged with the responsibility of providing medical evidence that substantiates your claim for disability and/or proves the nature and severity of your impairment. In some cases, the SSA will help claimants obtain medical reports if the claimant has given the SSA prior permission to do so.

A word of caution: in my opinion it is better for you to provide the medical records to the SSA instead of having them request them. By doing so, not only will you have proof that you provided the SSA with your most current medical records, but you will also be able to review what documents the SSA has and is evaluating. In either case, though, there are advantages and disadvantages. For example, if you or your attorney end up requesting the medical records, there may be a cost, so be prepared.

In addition to the medical records that already exist in your file, it is IMPORTANT that you continue to supplement your file EACH TIME that you visit a doctor, specialist, counselor, etc. Remember, even if you receive a denial on your application, continue to supplement your record while you go through the appeals process. A good practice is always to request a copy of your medical records immediately at the conclusion of your doctor’s visit. Politely explain that you are in the process of applying for disability and that you need your medical records in order to supplement your file. Some individuals request their medical records once a month if they visit the same doctor weekly or bi-weekly. When receiving your medical records from any source, always make at least two (2) copies. This will allow your representative to have a copy to work from as well as provide you with an additional copy. By having an extra copy available, you will prevent incurring additional costs in the event that you need copies later.

Post from: Social Security Disability Blog

Q & A: How important is it for me to keep my Social Security file up to date with new medical records?

I am a 43 year old diabetic. I was diagnosed 7 years ago and progressed quickly from pills to insulin injections and have now been on an insulin pump for 3 years.  I have neuropathy in both legs, heart disease, and many other diabetic problems, because of high blood sugar.  I am at an ideal weight of 170 Lbs. and 5' 9" height and have always been active and try to eat healthy.   I take 40-50 units of insulin each day, but my A1C readings are still 10+. I am no longer able to perform my work assignments.  My employer (25years)had even allowed me to change to an office job but I am still not able to sit for over an hour without my legs hurting and I have had many hypo (low-sugar) episodes at work which scared everyone.  My doctor's have suggested that I quit so that I can concentrate on this disease before it kills me, but the stories of possible delays in SSDI have really concerned me and my family.  I have enough money saved to survive for a year, but that is it.  Do you think someone like me would qualify for SSDI benefits, and what would a potential wait be?

Here are my thoughts: I think that Steve has very good reason to be concerned.  When you apply for benefits, there are two times when you are likely to be approved – at the initial application stage, which will be within four to six months after application, or at the hearing stage, which could be two to three years after application.

Initial application approvals are almost always arise in cases that meet a listing.  Steve is a diabetic and the applicable listing is at Listing 9.08. State Agency adjudicators will approve diabetes cases on the listings but they will expect the medical records to document as many of the following complications:

• long standing neuropathy (numbness in extremities)
• long standing retinopathy (vision issues)
• blood sugar readings at 200 or higher over an extended period of time despite increasing dosages of insulin
• organ damage (documented by abnormal lab readings)
• frequent urination
• sexual dysfunction
• statement or checklist from treating doctor that condition equals 9.08

In my view, you need to aggressively argue to the adjudicator that your case meets a listing – do not assume that the adjudicator will figure it out.

If your case is denied at the initial application stage, it is very unlikely that a different adjudicator will approve it at reconsideration.  Statistics I have seen suggest that no more than 10 to 15% of cases are approved at the reconsideration appeal level.

Assuming that you are denied at initial and reconsideration, the wait for a hearing date can be long, very long.  Depending on where you live the wait can reach two to three years.  Steve did not say where he lives – Social Security does publish statistics about the wait times for each disability hearing office.

As far as the substance of Steve's claim, it appears that he is having a great deal of trouble keeping his blood sugar under control despite both his diet and his medicine.  I would advise Steve to bring a copy of listing 9.08 to his doctor and to enlist his doctor's support in the form of a narrative report stating that he meets the listing and that his capacity to sit, stand, concentrate, get through a workday without interruption and to avoid excessive absences has been significantly impaired by the diabetes.  You can read more about the case strategies I use in diabetes claims by clicking on the link.

At some point, Steve is going to have to make the decision to stop working and to start the disability process.  Obviously the intend of the disability laws is that Steve should wait until working become impossible, as opposed to highly uncomfortable.

Finally, I would also point out that if Steve stops working, files for disability and is turned down at initial and reconsideration, he could try to return to work.  Work attempts of three months or less are considered "unsuccessful work attempts" and can actually help a claimant by demonstrating his desire to work.  Those unsuccessful work attempts can also add money to the family's budget – not an ideal solution but perhaps a way to deal with the many months of delay when waiting for a hearing date.

Post from: Social Security Disability Blog

If I Stop Working and File for Disability, How Do I Know that my Money Won't Run Out Before my Case is Approved?

Question:

I recently received a denial following my initial disability application. I would like to review all of the evidence, both medical and other, that was considered in determining my claim. Is this a possibility? Further, is this information available to the public for review and dissemination? In essence, what rules govern confidentiality of SSA disability records?

My answer:

To begin with, I am here to tell you that you can feel at ease about your SSA records. Any information that was provided by you, as well as any additional information obtained by the SSA that is part of your claim, is protected under the Privacy Act, one of two separate and distinct laws that govern Federal agencies.

Under the Freedom of Information Act (FOIA), Federal agencies are required to provide the public with access to their files and records. However, this particular Act (FOIA) is not applicable to records maintained by the SSA. The second law, the Privacy Act, governs records such as medical evidence and other supporting documents retained by the SSA during your claim. The Privacy Act permits you only or your designated representative the opportunity to examine all records pertaining to you. This means that you may request to review all the medical documentation or other evidence that was used to evaluate your claim for disability. While you and/or your representative are provided with this opportunity, members of the public are not. Simply stated, your information is not available to the public for any type of review or dissemination.

It is important to note, however, that the SSA does reserve the right to determine whether the release of information could potentially have an adverse effect on you. If it is determined that the potential negative effects outweigh any probative value, the information requested will only be released to your authorized representative, that individual you designated in your initial application or later in writing. This is rare, however, and only applies in extreme circumstances.

One final note: Now that the SSA has converted most it's disability case files into electronic format, it is likely that you will be sent a CD containing your information/records once you request access to your records.  Here at my practice, we receive CDs containing our clients' case files a few weeks or months prior to the hearing. We are now able to see everything in our clients' files just by referring to the CD, and this is saving us from having to finger through large files to find what we need! Hopefully you will find this convenient as well, in the event that you end up requesting that SSA furnish you with your claim records.

The CD format for managing medical records is intended as a stopgap until SSA manages to establish a secure online system that attorneys and perhaps even claimants can use to access their claims files online.  Currently Social Security judges have access to records online but not attorneys.   In my view the CD format is probably less secure than the old paper format because claimants, attorneys and even Social Security personnel tend to get sloppy about leaving CD's lying around.  Almost every time I appear at a hearing office, I will see CD's containing someone else's personal medical records, Social Security numbers and Social Security claims file lying around.  If your file is on on CD, make sure to verify after your hearing your lawyer removes the CD from the hearing room computer.

Happy Friday, be sure to tune in next week for Installment 6 of my Q & A Series.

Post from: Social Security Disability Blog

Q & A: What Rules Govern the Confidentiality of MY Medical Records?

To start off 2010, here's some news of the most recent Social Security blooper: Close to six million social security recipients thought they had received a very

Doh!

special holiday bonus from no other than the Social Security Administration.  Notices received reflected that payments in January 2010 were coming one week earlier than they had in previous years.  This was great news and definitely a welcomed notice for the millions of individuals that require these payments in order to live day-to-day.  However, as quick as these notices came, a corrected notice followed.

The individuals affected are those beneficiaries who normally receive their benefits on the second, third or fourth Wednesday of each month.  In the notices mailed, erroneous information indicated payments would be received one week earlier than the date people were accustomed to receiving their benefits.  All additional information in these notices was correct.

To rectify this matter, the Social Security Administration issued a letter explaining the mistake to all beneficiaries affected.  In a statement issued by Michael J. Astrue, Commissioner of Social Security, he stated,

We apologize for the inconvenience and confusion these incorrect notices will cause.  The problem was caused by an unfortunate human error.  We are correcting the misinformation as quickly as possible, and we are reviewing our processes closely to prevent this type of mistake from happening in the future.  People receiving Social Security benefits in January 2010 should know that their payment will arrive on the same payment day that it has arrived in the past.

As least the Social Security Administration has openly admitted their mistake, has taken swift action to rectify the current problem, and is enacting procedures to prevent any future ones. If you are one of the claimants affected by this mistake, just know that your Social Security payments will continue as normal.

Post from: Social Security Disability Blog

Millions receive incorrect notice from Social Security concerning benefit payment dates

Never before in the history of technology has there been such an array of sources available for an individual to stay in contact with friends and family far and near.  One feature of social media sites like Twitter and Facebook that attracts millions of users per day is their short learning curve.  The simplicity of these sites coupled with the fact that these mediums are free to the public attracts record amounts of new signees daily, and there appears to be no signs of a recession in sight.  Although these type mediums are great tools in which to stay in contact or reunite with high school friends and distant family, a danger lurks within, which most users are either not aware of or simply take for granted.  A mistake concerning privacy control on either of these social network sites could be the deciding factor on whether a disability applicant will receive benefits or not.

Facebook, Twitter and MySpace share the same premise for social contact; however, these social forums differ in their rules and regulations.  Most of these sites are in real-time with postings denoting both a date and time for each post.  For instance, the popular sites of Facebook and MySpace provide its users with the ability to post an indefinite supply of pictures and comments to a user’s network or followers, while its rival, Twitter is limited to micro blogs, those postings confined to only 140 characters. Creating messages under such a restricted limit often causes posts of only quick thoughts.  Although most Twitter users voice frustration on being restricted to the mere 140 characters (spaces included), 140 characters unwisely utilized by “Jane Doe,” the social security applicant, could lead to irreparable harm and the demise of her disability application.  To show how a simple post on Twitter can go from fun to disaster with the click of button (less than two seconds), let us take a brief look at a sample tweet.  “Went on our family vacation, enjoyed synchronized swimming class at the hotel's pool and walking around Disney World.  Great time!”  Although not a proper sentence, common to the Twitter world, this 116 character long tweet is the precursor for an impending disaster.  Yes, as a post, it sufficiently allowed followers to learn and have a glimpse of her recent travel; in the social security world, however, it could be considered a costly mistake.

There are several key facts and words in the sample tweet above that warrants further review and/or poses additional questions.  Who are your followers?  Do you truly know each person that is following you?  Past and present users understand that anyone can open a Twitter account following answering only a few questions.  The ability to follow anyone of interest is possible within minutes after that.  The ALJ (Administrative Law Judge) assigned to your disability case just may be one that is interested in following you.  Potential followers are not limited to just those individuals in the Social Security family, it is important not to forget past and present co-workers, employers, estranged family members, and even former wives/husbands and girlfriends/boyfriends.  Since users have the flexibility to create their own username, identities may or may not be reflected in their selected username.  For the disability applicant who has stated that she suffers incredible pain, requires pain medication, is only able to be mobile a limited amount of time per day, and is unable to follow-through with a set of basic instructions, posting comments related to taking a “synchronized swimming class” and “walking around Disney World” grossly contradicts information noted within her disability application.  One happy but careless tweet has the potential to cost this woman her disability claim if the information posted falls into the hands of her disability decision maker.  There are two lessons that can be learned through this example.  First, the information noted on any disability application should reflect a true and accurate representation of an individual’s limitations.  Second, by taking the time to check the privacy selections on your account, you can select postings be only visible to those individuals that you wholeheartedly know and trust.  I have seen close to a hundred accounts and only a handful has been marked private requiring the author’s permission and prior knowledge before granting any individual the ability to follow them via their postings.

I have mentioned the hazards that exist with Twitter; however, Facebook and MySpace are not void of privacy problems either.  Users of these two sites are able to upload pictures which has the potential to unlock another beast that users will be forced to reckon with if those innocent pictures of the disability applicant skiing, enjoying a family vacation at the beach, celebrating following a win from their favorite SEC football team fall in the hands of an adversary. Like Twitter users, Facebook and MySpace afford its users privacy features as it relates to both picture viewing by others and wall-to-wall posting and comment visibility.  The problem is that individuals do not take the time necessary to enact these controls.

Of course, social networking sites have tremendous benefits and appear to be a trend that will linger for years to come.  However, users need to exercise great caution while deploying these social media services.  These sites reinforce the old adage “a picture is worth a thousand words.”  Pictures depicting a full range of abilities otherwise not stated in a disability application may in fact be the “straw that broke the camels back,” so to speak.  Disability applicants are highly encouraged to take the time necessary to enact privacy features on any social media site they use.   It only takes a few minutes.  Failure to do so could result in negative consequences for your Social Security Disability claim.

Post from: Social Security Disability Blog

Social Media (Twitter, Facebook, MySpace): Friend or Foe?

Question:

I have a disability hearing scheduled for next month in my Multiple Sclerosis disability case. As I have been unable to work for over a year, I have limited financial resources. I have read that an Administrative Law Judge often solicits the testimony of a medical expert on complex medical issues. Here are my questions: Who is responsible for assuring that the medical expert testifies at my Social Security disability hearing? And who compensates the medical expert? Is there any responsibility on my part?

My answer:

This is a great question and one I have not actually been asked. You are correct that Judges (ALJs) often seek the testimony of medical expert witnesses (MEs) in complex medical situations like yours.  Since ALJ’s have no direct communication with medical professionals and are not medically trained, testimony from medical experts provide ALJ’s with a more complete and detailed understanding of your medical and/or mental situation prior to his/her issuance of an opinion in your matter.

Here’s how it works: Each hearing office maintains a roster of medical experts who routinely testify as expert witnesses in disability hearings. If you spend enough time at any one Social Security hearing office, then you will likely start to notice the familiar faces of some of these medical experts, many of which are retired doctors who have a wealth of medical knowledge that can be used to help the judge make a well-informed decision.

Since the ALJ is the individual that solicits the expert’s opinion, the SSA incurs the costs of paying the medical expert. So in answer to your question, you are not responsible for compensating the ME. It is all taken care of by the SSA.

Also, since you are pursuing a Multiple Sclerosis disability claim, I would like to tell you and any one else interested that I have been working on a website dedicated solely to the topic of Multiple Sclerosis and Social Security Disability. Because I have seen a lot of MS disability claims over the years, I figured I would  share some tips and knowledge on the subject. Please visit the site by clicking on the link, and be sure to let me know what you think!

Post from: Social Security Disability Blog

Q & A: Who is responsible for calling upon and compensating the Medical Expert witness?

Question:

I understand that in order to qualify for Social Security Disability benefits, my condition must be a medically determinable physical or mental impairment.  Can you explain exactly what a medically determinable physical or mental impairment is?

My answer:

The terminology or "lingo" used by the Social Security Administration is often confusing.  A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological or psychological abnormalities which can be determined by medically acceptable clinical and laboratory diagnostic techniques.  In essence, a physical or mental impairment must be substantiated by medical evidence consisting or signs, symptoms and laboratory findings.   An applicant’s statement of symptoms alone is not enough to meet the requirements of a “medically determinable physical or mental impairment.”  In a nutshell: There must be medical evidence that substantiates the symptoms experienced.  For example, if you are experiencing debilitating migraine headaches, you need to have medical tests done in order to establish the root cause of the headaches.  Your saying alone that you have migraine headaches is not enough.

I cannot over emphasize the need for specialized medical and mental related test(s) in determining an individual’s impairment.  Although general physicians are skilled doctors and deserve all the accolades available, Social Security Disability applicants must seek, in addition to the opinions of a general physician, the opinions/diagnoses of specialists when making application for disability.  These specialized opinions are critical in order for an applicant to be awarded disability. Let's quickly take the above example of someone suffering from debilitating migraine headaches. In their case, it would be wise to seek the opinion of a headache specialist or neurologist while pursuing their claim. On my migraine headaches and disability website, I posted an entire article about the benefit of seeking specialized treatment while pursuing a disability claim, which can be accessed by clicking on the link.

I understand that most applicants are unable to shoulder the costs of seeing a specialist and that most government-assisted programs do not cover these types of costs.  I encourage applicants to solicit the financial help of family members as well as explore other available means so that they are able to see a physician specializing in their medical condition.

Post from: Social Security Disability Blog

Q & A: What is the Definition of "Medically Determinable"?