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CNN Report on September 11 PTSD Scam Misses the Mark

disability scamsCNN is reporting that more than 100 New York City firefighters have been indicted in connection with disability fraud.  These firefighters filed claims for disability under the World Trade Center Disability Law, a source of benefits available only to New York City employees injured as a result of their service on September 11, 2001.

According to CNN, these disability claimants were coached (the CNN article is silent as to who did the coaching) about how to behave to win benefits that can amount to $50,000 per year for total disability.

Investigators discovered, however, that some of these permanently injured claimants were, in fact, working – in one case, teaching martial arts – despite their claimed disability.

Presumably these dishonest, retired firefighters will face civil fines or perhaps criminal prosecution for their actions. Continue reading →

Is it Possible to Recover Past Due Benefits for a Disabiling Condition that Began 20 Years Ago

how far back can I go to collect disabilityI recently received an email from a blog reader who tells me that she has recently been approved for SSDI based on a stroke.  However, she was diagnosed with another disabling medication condition 20 years ago but never applied.  Is there anything she can do about the older medical condition and recovering 20 years worth of past due benefits.

Here is my analysis: first, this is a difficult question to answer because I do not have all of the facts.  For example there are circumstances where an informal communication with Social Security could be considered an application.  There are also cases where even an unintentional misstatement by a Social Security employee could toll the statute of limitations.  Continue reading →

Fibromyalgia Better Understood – New Testing and Treatment Hopefully on the Way

new research about physiology of fibromyalgia painUSA Today published a very interesting article on December 15, 2013 about a research which identifies a physiological cause for fibromyalgia.  Currently, fibromyalgia is recognized as a medical “syndrome,” which means that it can be identified by symptoms, while the source of those symptoms remains unknown.  In the case of fibromyalgia, the American College of Rheumatology has published guidelines for physicians to use for diagnostic purposes, although treatment options remain limited.

The USA Today story quotes neurologist Anne Louise Oaklander at the Massachusetts General Hospital in Boston.  Dr. Oaklander has published two studies which show that at least half the cases of diagnosed fibromyalgia arise from small fiber neuopathy, in which patients get faulty signals from tiny nerves all over the body, thereby causing symptoms.  Here is a direct link to Dr. Oaklander’s article.

Researchers at Albany Medical College published a paper showing that fibromyalgia patients have excessive nerve fibers lining the blood vessels of the skin.  This excess of nerve fibers can lead to increased sensitivity to pain.  Interestingly, women have more of these fibers than men, which is consistent with statistics which show more female fibro patients than male patients.  Here is a link to the news release from Dr. Frank Rice who conducted the research at Albany Medical College, and who now leads a research team at a private company. Continue reading →

A Social Security Disability Insider Reveals How SSA Views Part Time Work

There is a social bookmarking site on the Internet called Reddit.com which offers fascinating insight about many topics, including Social Security disability.  Specifically, Reddit has a feature called “Ask Me Anything” where users who have “insider” status volunteer to answer questions from visitors.  For obvious reasons, most of these insiders appear anonymously.

If you search “Social Security disability” you will see that several Social Security adjudicators have volunteered to answer questions about their work. I have never before visited a site where such “no holds barred” information was available and I encourage you to check it out.

I ran across one conversational thread from an adjudicator regarding part time work. The anonymous adjudicator answered a question about how SSA evaluates claimants who show earnings at less than “substantial gainful activity” (SGA) during the time they claim to be disabled [1. In 2013 the SGA limits are $1,070 per month for a non-blind worker.  Since SSA defines “disability” as the inability to perform SGA level work, you could, in theory, be found disabled if you show earnings at less than SGA amounts.]. Continue reading →

How to Testify Credibly About Sexual, Emotional or Physical Abuse in a Social Security Hearing

abuse and PTSD or depressionOne of the more troubling parts about practicing Social Security disability law involves hearing stories of how my clients suffered horrific abuse.  I would estimate that at least 75% of my cases involving mental illness also include a history of abuse.  It is no surprise to me that anyone who was abused by a parent or authority figure, or by a person physically stronger would continue to suffer physical and emotional wounds for years to come.

Because a claimant’s history of abuse helps explain current symptoms – depression, social phobia, anxiety, etc. – I think it is necessary to question my client about the abuse he or she experienced during that client’s disability hearing.  Obviously this is a difficult and uncomfortable task – I have no desire to dredge up bad memories or to make my client relive a terrifying experience – but I have to bring this information about in testimony so the judge can better understand what my client is going through.

In preparing my clients for testimony about prior abuse, I suggest one of two ways to present this evidence. Continue reading →

Reaction to 60 Minutes Disability Segment: Truth or Fantasy?

what is state of Social Security disability systemThis past Sunday, 60 Minutes aired a segment called Disability USA, in which correspondent Steve Kroft reported on the “alarming state of the federal disability program” which has exploded in size and is about to run out of money.  Kroft interviewed Senator Tom Coburn (who is also a medical doctor), several current and former Social Security employees and former associate attorneys for a national law firm that advertises heavily [1. I have previously written and spoken about Senator Coburn’s efforts to expose fraud and inefficiency in the SSA disability program].

The gist of the story is that hundreds of thousands of able-bodied people have been approved for disability and are costing taxpayers millions of dollars.  Further, the story suggested that disability lawyers are culpable in the outsize growth of the disability program because they advertise heavily.  Further, there was an implication that at least some disability lawyers game the system with inappropriate and/or illegal relationships with doctors and judges.  Several of the judges and SSA employees interviewed opined that the disability program has devolved into a last resort unemployment program rather than one focused on people with serious disabilities.

I have no doubt that fair minded American taxpayers who have no experience with the disability program were and are appalled at a system which appears to be out of control and rife with fraud and manipulation. Continue reading →

Functional Capacity Evaluations: Helpful or Hurtful?

Social Security FCEHere is a question I received from a blog reader:

I have been told I should qualify for disability because of my permanent restrictions set by my FCE. I was put in a light category. What do you think?

Here is my response:

First, let’s clarify what a functional capacity evaluation is and why it is important to Social Security.  Functional capacity evaluations (abbreviated FCE) are a set of tests and evalautions designed to objectively determine your capacity to perform the physical demands of work [1. Here is Wikipedia’s definition of an FCE].  A physical FCE will categorize you as:

  • able to perform heavy work
  • able to perform medium work
  • able to perform light work
  • able to perform sedentary work
  • unable to perform sedentary work

Social Security has defined each of these terms – click here for the definitions.

An FCE can be preformed by a rehabilitation supplier, a physical therapist or a physician.  A formal FCE may involve one or two days of testing along with interpretation by a trained health care provider.  An informal FCE may involve a checklist form completed by your doctor. Continue reading →

Payment Processing Mistakes Made by Social Security Result in Accusations of Claimant Fraud

SSD overpaymentsYou are going to be hearing a lot about Social Security disability fraud in coming months.  With the disability trust fund about to run out of money, Congress will find itself moving money from other programs into the disability fund to shore it up.

With their attention drawn to the disability programs, legislators will demand more accountability from Social Security administrators.  Fraud against the program will be a focus.

A recent USA Today story about fraud was entitled Feds: 36,000 Get Improper Disability.  The news article cited a GAO report showing that Social Security issued $1.3 billion in disability payments to people who had jobs from December, 2010 through January, 2013 and that Social Security is going to aggressively pursue recovery of these overpayments.

According to the news story Social Security has trouble tracking earnings during the five month waiting period applicable in SSDI claims.  Claimant earnings did not reach the wage-earner’s record and Social Security issued payment for months where an approved claimant was not eligible.

While this USA Today story and others like it are sure to inflame the passions of those who are convinced that 80% of disability claims are fraudulent, the truth is a little less newsworthy. Continue reading →

Stong Case Undermined by Simple Problem (Maybe)

Weakness Word on Breaking Weak Chain LinksI tried an interesting case this week that illustrates the importance of presenting a complete case to your judge.

My case involved a man in his early thirties with a significant hip problem.  He had been born with a bone deformity in his hip that was surgically repaired during his childhood and he was able to work a variety of physically demanding jobs during his 20’s.

By age 30, however, he was experiencing severe hip pain such that he could not drive a truck or perform his job.  He met with a surgeon and underwent hip replacement surgery.  I should note that surgeons rarely recommend hip replacement surgery for individuals younger than 50 because artificial hips rarely last more than 15 years and current medical technology does not allow for more than two hip replacement over one’s lifetime. Continue reading →

Obesity and SSDI

The American Medical Association recently released a report [1. The AMA has recently designated obesity as a disease.] officially recognizing obesity as a disease.

With one in three Americans falling in the obese or super-obese BMI spectrum, the AMA hopes that by defining morbid obesity [2. The  University of Rochester Medical Center defines morbid obesity as follows:  if a person is 100 pounds over his/her ideal body weight, has a BMI of 40 or more, or 35 or more and experiencing obesity-related health conditions, such as high blood pressure or diabetes.] as a disease the medical community will implement more aggressive efforts to combat this debilitating condition (and the ancillary diseases associated with it) and prompt insurance companies to pay for treatments, counseling, and medication reimbursements.

What does this mean in the context of Social Security Disability?

Just because obesity has garnered much more attention as a debilitating disease by various members of the medical community, don’t assume SSDI will follow suit.  Currently obesity is not listed in the Social Security Administration’s Listing of Impairments, or database of diseases that will automatically qualify a claimant to receive disability benefits. Continue reading →

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