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Month: January 2010

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

Hello and welcome to the 7th installment of my Q & A series, which is designed to cover some of the more elusive topics associated with the Social Security Disability claims process. In this post, I discuss what types of medical providers are deemed as “acceptable medical sources” by the Social Security Administration.

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.

Immigrant gets prison time for stealing from the SSA

This past November, Mohammad Husseini was sentenced to six months prison time and ordered to pay back the $111,000 he “stole” from the Social Security Administration. The behind bars59-year-old immigrant from Afghanistan, who became a U.S. citizen in 1978, had been fraudulently receiving Social Security Disability benefits since 1999.

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!

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

Hello and welcome to the 6th installment of my Q & A series, which is designed to cover some of the more elusive topics associated with the Social Security Disability claims process. In this post, I discuss the importance of keeping your disability case file up to date with new medical records as your claim progresses.

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 aupdate your medical records 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.

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

I have written extensively on this blog about the claim processing delays that continue to plague Social Security disability.  I suspect that there are a lot of folks out there who are suffering and struggling trying to stay at work, perhaps at the expense of their health, because they are concerned that if they stop working, they will run out of savings before their case is decided.  I recently received the following question from a gentleman named Steve who is fighting diabetes and diabetic complications and who finds himself with this quandary:

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.

diabetes1Initial 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. Continue reading →

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

Hello and welcome to the 5th installment of my Q & A series, which is designed to cover some of the more elusive topics associated with the Social Security Disability claims process. In this post, I answer a question regarding the confidentiality of a Social Security Disability claimant’s medical records.

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 youConfidential SSA Records 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 Social Security CDpractice, 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.

Millions receive incorrect notice from Social Security concerning benefit payment dates

First of all, I want to say happy 2010 to everyone. 2009 was another year that went by super fast, and I think part of that has to do with the heavy number of hearings we had this past year. In trying to cure the Social Security backlog, Social Security had disability attorneys like me attending hearings it seems just about every week. Although we expect a busy year in 2010, I am sure it cannot possibly rival 2009!

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!
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.

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