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All posts by Jonathan.

How Do Job Training Programs Affect Continuing Disability Reviews

In my practice I do not see very many continuing disability review (CDR) cases.   If you are not familiar with this term, a “continuing disability review” involves a review by Social Security as to whether an approved claimant remains disabled.  For example, there are some medical conditions that can and do improve over time and with treatment.   I have been involved in many cases – especially those in which the claimant is in his 20’s or 30’s – when the judge specifically includes in his decision that a particular claimant should be reviewed in 1 year, or perhaps 3 years.

In theory, every Social Security disability case will be subject to a CDR.  In reality, because of the current backlog, I rarely hear from my clients that their cases are being reviewed.   The few cases that do seem to end up in a CDR typically involve younger claimants.

I am not usually called upon to handle CDR cases because Continue reading →

Can Claimant With Sporadic Work History Collect on Working Spouse’s Earnings Record?

I regularly get calls from potential clients who apply for Social Security disability, only to discover that they do not have enough credits to pursue a Title II SSDI claim.  In such cases, the only other option would be to pursue a Title XVI SSI claim.  However, SSI benefits are usually lower ($674 per month for an individual in 2009) and, more importantly, SSI payments are subject to offset if the claimant has a spouse who works.

I see this a lot among self employed people, or salespeople who are paid in cash and do not have money withheld for Social Security taxes.   Here is an email I received from the wife of such a claimant:

I have worked and paid into social security since 1965.  My husband worked on and off for the past 30 years, but has not regularly paid in to social security.  Ten years ago he was diagnosed with MS and he has been unable to work at all.  I went to Social Security to ask if I could get disability payments for him and they told me that I earned too much money ($45,000 annually).  I am now about to retire at age 60 and would like to collect disability for him.  I’ve gone through web searches and there is such a mire of information – I don’t know where to begin.  Can he collect against the money I’ve paid in?  He is completely dependent on me.

Jonathan’s response: unfortunately I think that you are out of luck. Continue reading →

Lack of Consistency Among Social Security Judges a Problem

“Do I have a good case?”  Inevitably I hear this question from every client I meet.  I hear it again during my pre-hearing conference and I hear it again immediately after the hearing.

If you have been waiting for disability benefits for 2+ years, you don’t care about statistics, about Social Security’s re-engineering, new Judges, processes to eliminate backlogs or anything other than whether you won.  And I would consider you perfectly reasonable to take this stance.

At the end of the day, however, I am not the one who makes the decision in your hearing.  My job is to identify the best argument supporting your claim for disability and to ask you the right questions to present that argument to the judge.  Beyond that, you can only hope that your judge is rational, reasonable and that he takes the time to listen to you. Continue reading →

Should Approved Claimant Report New Medical Problems to Social Security During Continuing Disability Review?

I don’t get a lot of questions about “continuing disability reviews” (CDR).  Here is one that raises an important issue.  For those not familiar with the term, a CDR is the process by which Social Security evaluates approved claimants to confirm that they still meet the requirements for disability under Social Security’s rules.

Sometimes, judges will specifically provide for a review in 12 months.  The official Social Security disability web sites provides that all cases are to be reviewed every 36 months (although it has been my observation that the 36 month reviews have been performed at random).  Although I have not seen any regulations to this effect, I suspect that the cases which are reviewed may be ones where improvement might be most likely.   For example, if your approval is based on a condition that could be corrected by (invasive) surgery, your case might be flagged for review.

You should also understand that disability attorneys like me rarely get involved in CDR cases.  Why?  Continue reading →

What Strategy Should Narcolepsy Claimant Use to Win Benefits?

Back in 2006, I wrote a blog post entitled “Narcolepsy as a Basis for Social Security Disability.”  In that post, I noted that there is no “listing” for narcolepsy, meaning that a successful claim would have to rely on a “functional capacity” argument and that you may need more than strictly medical evidence to persuade your judge.

Recently, I received an email from a gentleman named Michael who asked for some additional information:

I have narcolepsy and even the maximum doses of medications don’t help. I keep losing jobs and will be losing my current job due to this. I do exceptionally well at my job when I feel alright, but I spend at least twenty hours of the day not functional. I’m currently telecommuting full-time and I still can’t stay awake and clear long enough each day to do my work. When I work on-site at a job, people accuse me of being an alcoholic or drug addict because I look terrible and slur my words and fall asleep several times per day. The only thing that prolongs my jobs is that when I’m feeling alright, I am sharper than most and unusually productive. So, they smell my breath and check my arms for tracks and I try to convince them that I’m just tired and that usually suffices for a while, but once again I’m losing my job. I am getting worse as I get older and I can’t maintain myself or watch my own child or regularly brush my teeth, etc. It’s a horrible situation and I’m looking at losing everything (job loss) and I don’t think I will be able to recover my finances this time because my narcolepsy is getting so bad. How could I get disability for this? What happens if a treatment comes around that works, can I get back off disability? If I can somehow start a business and hire other people to do the work in order to get off disability, would I be penalized for trying to get off disability? Even working full-time telecommuting, I get accused of being drunk or using drugs because I randomly sound drunk or on drugs even over the phone. It is so frustrating. Please advise as to what options I have, if any, and thank you for writing something up on the web about this.

Here are my thoughts: Yes, narcolepsy can be the basis for a Social Security disability claim.  Please refer to my August, 2006 blog post referenced above.   If a new treatment is developed, you may absolutely terminate your disability – in fact, if you return to work you are required to notify the Social Security Administration. Continue reading →

What Happens to my Case if I Return to Work While Waiting for my Hearing?

With delays in the hearing process reaching 2 years, I frequently get questions from potential clients about the implications of returning to work.  Here is a typical question:

i’m 57 yrs old & have filed for ssd due to herniated discs & arthritis of the knee. what happens to my case if i return to work before i get a hearing? i don’t know how long i’ll be able to work , but i got to try.

Jonathan Ginsberg’s response: If you have read this blog and educated yourself about Social Security, you know that the main issue in any Social Security case turns on whether you can perform some type of work reliably 8 hours a day, 5 days a week with normal breaks.  If you are working, by definition, you are not disabled.

Attempting to work while your case is pending may or may not be a problem.  If you try to work and last only a few days or even a few weeks, the judge will see that as an “unsuccessful work attempt” that demonstrates your sincere desire to work and your inability to do so.

Once you stay at a job for more than 3 months, however, it starts to look like you have the capacity to perform “substantial activity.”

Remember that Social Security’s definition of disability looks to whether you have missed or are likely to miss 12 consecutive months because of your impairment.  I have represented several clients who missed 12 months, and then returned to work and we argued for a “closed period” of disability.   If you are out of work for less than 12 months, you are not likely to be approved so you and/or your lawyer should pay attention to the timing of events in your case.

I generally advise my clients that they will earn more money and they will be more fulfilled if they are able to work and I encourage them to do so.  However you need to be realistic about your capabilities – you do not want to go back to work just long enough to damage your Social Security case but not long enough to support yourself over the long run.

How Do You Evaluate Whether Your Child’s SSI Case is Viable?

I recently received the following email from a reader of this blog:

I am just wondering if I am wasting my time, my son has been diagnosed adhd for about 4 years now, I think its more but we havent gotten there yet. He is in regular classes but is also in resource at school, he also had to be held back a grade due to his problems the first year being diagnosed. Would he possibly qualify at all for disability benefits.

Jonathan Ginsberg’s response: In order to win a child disability case, you will need to show that your child meets a Listing.  The Listings for children are different than the Listings for adults.  You can review the childhood disability listings by clicking on the link.

The Listing for ADHD may be found at Listing 112.00 Mental Disorders-Childhood.   I can tell you from experience that you will have an uphill battle with an ADHD claim.  There are a lot of parents out there who are filing disability claims on behalf of children and basing their claims on ADD or ADHD.  That is not to say that ADD or ADHD is not real or that it is not debilitating for your child.   I just want you to know that judges and medical experts called at hearings will be skeptical.

I would not recommend pursuing an ADHD claim on your own – you will be benefit greatly by consulting with an experienced disability lawyer.  Best of luck to you.

Is it Possible to Get an Early Favorable Decision in a Fibromyalgia Case?

Yesterday, I met with a fibromyalgia disability client in a pre-hearing session.  A hearing is scheduled in my client’s case in about 10 days and I met with my client and her husband to discuss what I call the “theory of our case” so my client would have a clear idea about what we were trying to prove.  In addition I use the pre-hearing meeting to practice questions and answers so that my client can avoid easily correctable mistakes.

During our meeting, my client mentioned how frustrating it has been for her to wait over 2 years to get a hearing and she asked me if this type of delay was typical.  My initial response was that fibromyalgia cases were rarely approved at the administrative (initial application or reconsideration) levels because there is no “listing” for fibromyalgia and adjudicators at the State Agencies did not have the expertise or authority to issue early approvals.

After my client left, I thought more about my response – is it possible for a fibromyalgia claimant to get an early approval from a State Agency adjudicator?

I think that it is possible, but a claimant would need strong support from her treating physician.  As I have discussed before on these pages, there are several “theories” or arguments under which a claimant can win his/her case.  The Listing argument constitutes the most straightforward theory.  If your condition meets or equals a Listing, you have consistent and extensive medical treatment records, and your doctor will prepare a narrative or complete a form that tracks the listing, and you make the adjudicator aware that a listing is involved, you greatly improve your chances at an early approval.  Do not, by the way, assume that the adjudicator will recognize your case as a “listing level” case – you need to make that argument clearly when you submit your paperwork.

If there is no listing that describes your condition (such as fibromyalgia), you will need to argue for disability based on another theory.  If you are 50 years old or older with a physical impairment, a limited education and a limited work skill background, you should look at the “grid rules” to see if you can be found disabled based on the grids.  Grid based decisions do not call for judgment and State Agency adjudicators will issue favorable decisions in grid cases.  Here, too, you need to point out that your case is a “grid” case and identify the specific grid.

Fibromyalgia cases can fit within the grids, although my experience has been that most fibromyalgia patients are high acheiving, Type A individuals who often have too much education and work skills to fit neatly within the grids.

If you do not meet a listing or a grid, you’re remaining argument will be a “functional capacity” argument.  It has been my experience that State Agency adjudicators do not often approve cases arising from functional capacity limitations because reaching a conclusion about a claimant’s “residual functional capacity” is a legal decision that requires judgment and adjudicators are not given much authority to make quasi-judicial decisions.

However, if you submit a completed functional capacity evaluation from a treating  physician (or two, or three) along with treatment notes, along with a request that the adjudicator take that functional capacity evaluation to the non-examining State Agency medical consultant and/or the adjudicator’s supervisor, there is a chance that your fibromyalgia case can be flagged for special review.

I hope you have picked up on a theme in what I have written about dealing with the State Agency adjudicators.  You cannot and should not assume that they will find a reason to approve your case.  You need to politely suggest a direction for their actions.  You need to lay out very clearly your argument for disability and you need to explain why a particular item of evidence is particularly relevant.  Finally, you need to realize that the State Agency adjudicators are overworked and underpaid and that they are given limited authority.  Do not hesitate to ask your adjudicator to take your file to a supervisor or to a medical or psychological consultant in the State Agency office.

How Does a VA Disability Rating Help my SSDI Case?

I recently received the following email from a reader of this blog.

I have a claim going now for SSDI and have not recieved a decision yet however after reading your blog I am very curious about your experience with VA disability and SSDI. I am 100% disabled and receive VA disability. How does or can this affect my SSDI claim?

Jonathan Ginsberg responds: Generally, a disability finding by the VA will be of great benefit in your Social Security case.  The Social Security law provides that judges must consider VA findings as evidence in your favor.  It has been my experience that any SSDI case that also has a 100% VA disaiblity finding has been a winner.  Even cases where the VA disability rating is less than 100% are usually approved.

May an Incarcerated Felon Receive Social Security Disability Benefits?

I recently received an email question from a blog reader about the eligibility of a convicted felon for Social Security disability benefits.  There is a simple answer here – you may not collect disability benefits during the time you are incarcerated.  Social Security ruling 83-28 addresses this situation directly.

Assuming that Social Security will accept an application for disability benefits from a claimant who is incarcerated, I do not believe that the adjudication process actually stops during the incarceration.  I have actually attended hearings held in prison.  The problem – incarcerated claimants often do not get treatment from physicians who are very interested in filling out forms or helping the prisonor/claimant.  Further, judges tend to be somewhat skeptical about the credibility of an imprisoned claimant.  Bottom line – it is an uphill battle for many reasons.

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