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

Hello and welcome to the 8th 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 how non-medical sources of evidence can be helpful in a disability claim.

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.

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.

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

Hello and welcome to the 3rd 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 will discuss the term “medically determinable,” another one of those unique Social Security terms that people often have questions about.

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 relatedMRI evidence 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.

Social Security Disability Appeal Forms: What is SSA Really Trying to Ask

frustrationOne of the least discussed but perhaps most frustrating aspects of the Social Security disability process has to do with the forms that Social Security requires when you apply or appeal.  Over the years I have watched the forms evolve – and the trend is easy to detect:  Social Security’s forms never get shorter.   Instead they add questions which appear to ask for the same information again and again.

In fact, the redundancy and complicated nature of these forms led me to write a “how to” book about filling out these forms (my book is called the Disability Answer Guide and you can read more about it at www.disabilityforms.com.

The idea for my book came from a client who pointed out to me that when a person is depressed, has a limited education, is in pain, or is unable to concentrate, it can be very difficult to compose answers to a bunch of government forms that come with no instructions and seem to ask the same questions over and over.

This lament led me to the idea of a how to book where I could offer sample answers to the questions on the forms as well as a reasoned explanation from my perspective as to what information was really relevant to a  Social Security disability application and how to frame your answers to “speak SSA’s language.”

Not surprisingly I regularly receive questions about Social Security’s forms – here is an example of such a question from a person I’ll call “Neil:”

i dont know how to answer these medical question on the second part of socurity such as what your favorite hobbies, and what to do do from the time you get up and the time you go to bed

Here are my thoughts: First, I reproduced this question exactly as I received it.  I did so not to embarrass the writer but to highlight some of the problems inherent to the Social Security decision making system. Continue reading →

Heart Disease Case Study Posted

I invite you to visit my Georgia Social Security disability web site to read my latest heart disease disability case study report about a case I tried last week on behalf of a client with a longstanding cardiac disease complicated by decreased kidney function and diabetes.  Like many of the cardiac disease cases that I try, there were three viable theories of disability that could apply: (1) a listing argument; (2) a functional capacity argument and (3) a grid rule argument.

stethoscope and medical report 2I presented all three to our judge, and the judge decided to approve based on….(you’ll have to read the case study to find out).

Not surprisingly the judge looked very favorably on my client’s long, consistent work history.  The judge even put on the record his opinion that my client would never have stopped working but for his medical issues.  As I note in the case study, the medical record in this file was a little sparse – but a solid work history can go along way to greatly enhance a claimant’s credibility.

One of the arguments I had at the ready (although I did not have to use it) was the “frequent restroom break” problem associated with a drug called Lasix, that helps clear fluid from the bodies of patients with congestive heart failure.  Many of my clients are surprised to learn that I often win cases on the work performance problem of needing to go to the restroom several times an hour.   Although excess restroom breaks don’t sound like a medical issue, the practical import of this problem is excess missed time from work.

Why You Should Hate the Idea of Applying for Disability Beneifts

“I am disabled and cannot work.”   Although this is a very short sentence, it’s implications are quite profound.  For many of my clients the decision to apply for benefits and assert in writing and verbally that they can no longer earn a living is perhaps the most psychologically difficult part of the disability process.

As humans, we are programmed to believe that things will get better.  For many people, the decision to file for disability is a kind of defeat – a recognition that their physical or mental condition probably won’t improve.

In my view, clients who hate the concept of disability are my best clients.  When you walk into that hearing room, you should have the attitude that “I don’t want to be here, and I am only here because I have no other choice.”   Judges pick up on body langauge, verbal and non-verbal cues.  If your judge senses an “attitude of entitlement” your chances for a favorable decision go way down.

Whenever possible, include in your testimony statements reflecting your desire to return to productivity.   Talk about the fulfillment that work brought you.  Discuss the financial hardship that not working has brought upon your family.  Speak about hobbies and activities that you can no longer do because of your medical condition.

Remember – your job at a hearing is to paint a picture – and the picture you want to paint should reflect a person who is a fighter, not a “taker.”

Avoid statements like “no one would hire me,” or “I can’t do anything since I became disabled.”   Your job is to provide the judge with an accurate description of your symptoms, not to make conclusions about your work capacity.   The work capacity determination is the judge’ s job, not yours.

Disability hearings often turn on the claimant’ s credibility – if the judge finds you believeable and a truthful witness, you are most likely headed for a positive result.

What “Theories of Disability” Work to Win Cases?

As a large federal bureaucracy, the Social Security Administration has a dizzying array of procedures and forms that it uses to process disability cases.   Social Security procedure manuals require disability adjudicators and judges to use something called a “sequential evaluation process” to evaluate every disability case.   In case you are interested, the five steps of the process are as follows:

  1. Are You Working?
  2. Is Your Condition “Severe”
  3. Does Your Condition Meet a Listing?
  4. Can You Perform Your Past Relevant Work?
  5. Can You Perform Any Work

Hundreds of words have been written about each step of this process and the Appeals Council and District Courts produce voluminous written opinions that explain what each of these words mean and how they should be applied.
As a busy attorney dealing with disability cases on a day to day basis, I don’t have the time or patience to deal with the minutia of Social Security jurisprudence. I worry about what it takes to win.

With apologies to the drafters of Social Security’s POMS – Programs Operation Manual System, it has been my experience that there are 3 ways to win a case:

  1. Meet a listing
  2. Prove that your functional capacity for work (i.e. Residual Functional Capacity) is less than sedentary
  3. Meet a grid rule

You can read more about how I apply these three “theories of disability” in a back case by clicking on the link.

In my experience about 15 of cases that end up at hearings are decided under a listing theory and about 15% are grid rule cases.  That leaves approximately 70% of the cases that I try as RFC cases.  Note that my percentages may be similar or different that what you might experience where you live.

In my view, Social Security disability practice fits fairly neatly into this three theory box.  I use this approach in every case in my office and I am always able to fit the facts of any particular case into one, two or all three of these arguments.

For this reason, it was a little troublesome when I received the following email from one of my readers:

I have a lawyer handling my disability case. My problem is that she doesnt seem to know some of the disability language. For instance she didn’t know what a RFC form was. She wanted to know where I get this language from.I told her that i research disability on the internet andthats where I get a lot of information. She said there is no such thing and that my doctor will make a narrative report on me. Is there any such thing as an RFC form or is the language different now?

My answer to the reader is “no, Social Security has not changed its language.”  An RFC form is a checklist that Social Security personnel use to evaluate a claimant’s RFC.   Here is a copy of the RFC form that Social Security uses internally.  In my practice I edit this form to include a number of additional questions that I know will help me win my case.  You can find a copy of my practice form along with suggested responses in my book, the Disability Answer Guide.

Now, a narrative report will work but I think that an functional capacity form is a superior instrument in that it conforms to Social Security’s internal procedures and “speaks SSA’s language.”   Narrative reports – in which a doctor writes a letter that identifies specific limitations and diagnoses – is a document more often seen in personal injury or workers’ compensation cases.

I would like to give my reader’s attorney the benefit of the doubt – perhaps she is familiar with Form 4734 and doesn’t call it an “RFC form.”    I would suggest, however, that any claimant or attorney not familiar with the term “RFC” may want to take a few minutes to learn about this concept since it is frequently the basis of Social Security hearing decisions.

A brief, shameless plug:  I am teaching a course about building a Social Security disability practice at Solo Practice University.  If you are a lawyer looking to add Social Security or one of a number of specialties to your law practice I would strongly suggest that you take a look at the SPU web site and consider enrolling.

Hearing Testimony Tip: Know How Much You Can Lift and How Far You Can Walk

In my law office, I always try to schedule a pre-hearing meeting with my client one to two weeks prior to my client’s hearing.  I use this meeting to discuss the “big picture” issues and to practice asking and answering questions that my client is likely to face.

One line of questioning that always comes up relates to my client’s capacity to perform various physical activities, such as lifting, sitting, standing and walking.  Physical activities like these are known as “exertional” activities by the Social Security Administration and one’s exertional capacity is almost always a factor in questions asked of the vocational witness.

For Social Security purposes, your exertional capacity is defined as follows:

Sedentary: Requires the ability to sit up to six hours in an eight hour work day, lift light objects such as files and paperwork frequently during the day, and objects weighing up to 10 pounds occasionally during the day.

Light: Requires the ability to stand up to six hours in an eight hour work day, lift up to 10 pounds frequently and up to 20 pounds occasionally.

Medium: Requires the ability to stand up to six hours in an eight hour work day, lift up to 25 pounds frequently and 50 pounds occasionally.

Heavy: Same standing as light and medium, lifting heavier than medium.

As you can see, each of these definitions includes some very specific numbers.  When you prepare to testify, you will need to be prepared to discuss your capacities. Continue reading →

Should I File for Social Security if I Also Have a Pending Workers’ Comp and LTD Claim

Social Security disability cases often interface with workers’ compensation and short term or long term disability cases.  I recently received a question from a lady named Helena, who asks the following:

I have been working in the medical field for over 13 years and more.  I am on short term disability. Can I apply for ssi due to my job may have caused my problem from lifting patients, pushing, pulling heavy patients to machines and other duties.  This job was very stressful and I am taking anti depressants and I am  seeing a psychiatrist.

Here are my thoughts: Helena certainly has the right to file for Social Security disability.  However, I would advise her to speak to her workers’  compensation lawyer prior to doing so.   Workers’ compensation claims can involve a significant amount of money when they settle and filing for disability can impact the value of your workers’ compensation claim.

The value of a workers’ compensation claim often turns on the uncertainty that exists in terms of the claimant’s prognosis for returning to work as well as uncertainty about the claimant’s future medical treatment.  When you file a Social Security claim you are basically saying that you cannot work, and you will be bringing Medicare into the discussion in terms of future medical care.  Medicare’s involvement also may affect your settlement because Medicare may demand that part of your settlement be set-aside to cover future medical care.

Long term and short term disability claims may also be impacted by a Social Security claim.

Bottom line – I would try to involve your lawyer as a point person to advise you about the various benefits to which you may be entitled and to help you decide about the timing or wisdom of pursuing these benefits.

What Factors Does Social Security Consider in a Diabetes Disability Case

Many Social Security disability claimants have been diagnosed with diabetes.  What does it take to win?  Here is a question I received from a reader of this blog:

Jane, my girlfriend of 25 years (54 yrs old) has been diagnosed with Type I Diabetes for 35 years. She has had a number of problems over the years (uncontrollable diarrhea, Retinopathy, Neuropathy) all of which were more or less under control until recently. She has suffered a massive hemorrhage in one of her eyes and is completely blind in one eye. The eye may be able to be helped by surgery but one thing is for certain it will never be as good as it was 3 weeks ago.  Jane has been employed as a land surveyor (self employed last 10 yrs) for 30 years and it is very difficult to carry on with the physical impairments brought on by diabetes.  Given her age I would very much like to get her on a government sponsored disability program so as to supplement my earnings while waiting for SS retirement to kick in at age 62. Do you think I have any chance of this? Given your experience which of the numerous symptoms of diabetes are the easiest to document for a SSDI claim?

Here are my thoughts: under Social Security’s definitions, Jane is “closely approaching advanced age” and has a skilled work background, and quite possibly transferrable skills.   Her educational background is not mentioned but I will assume that she has a college education.  As such, it is unlikely that any of the medical-vocational guidelines (the grid rules) will apply.

I would therefore analyze her case as Continue reading →

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