GA Social Security

I recently posted a case study describing a fibromyalgia disability case I tried before a very reasonable judge in the Atlanta hearing office.  I know this judge to be very fair and he tends to approve a higher than average number of claims.

In this particular case, my client was a 59 year old woman with extensive and supportive treatment records.   She was a “classic” fibromyalgia patient in that:

• she was a high achieving female
• she was over age 45
• she experiences balance problems
• she experience digestive problems
• she experiences “fibro fog”
• she has sought treatment from multiple doctors and has been fully compliant with treatment

In this case, the judge announced a favorable bench decision without the need for testimony from the vocational witness.   Interestingly, the judge based his fully favorable bench decision on the work limitations described in a consultative psychological evaluation report rather than on the fibromyalgia record.  This suggests to me that this judge, at least, remains reluctant to rely solely on fibromyalgia as the basis for a favorable decision. Read the rest

Over the past few years, Social Security has quietly made available to the public statistics about the performance of hearing offices throughout the nation as well as the approval/denial rates of the judges that staff those offices.

These statistics are on the official SSA.gov site but I have noted that the location of this information seems to change periodically.

Recently I came across a very interesting and helpful site called DisabilityJudges.com where information about the tendencies of the judges before whom you will appear are posted.  Here is a link to the subsection about Georgia hearing offices.

Nationally, the average approval rate for Social Security judges is 53%, the denial rate is 32% with the rest being dismissed or disposed of otherwise.  In Georgia, the average approval rate is 60% and the denial rate is 28%.

Interestingly, however, you may get a very different result depending on which hearing office schedules your hearing.  Around 63% of hearing scheduled in downtown Atlanta are approved but your odds could vary greatly depending on the judge assigned to your claim.  Judges with the lowest approval rate in downtown Atlanta approve just over 30% of claims brought before them, while a claimant in the next hearing room over could appear before a judge with an 82% approval rate.

Unfortunately there is no way to choose the judge that will hear your case and I’d like to think that even the judges with the stingiest approval rate will approve a deserving claim.

I recently received the following email from a reader of one of my blogs:

I have two ruptured lower back disks.  No surgery required yet. But my doc said that my permanent restriction is 70lbs. Does this mean I can win Social Security disability?

Here are my thoughts:  as I discuss on this web site there are basically three ways to win a Social Security disability case – you can:

1. meet a listing
2. meet a grid rule
3. show that your functional capacity for work has been so reduced by your medical conditions that you would not be a reliable worker at even a simple, entry-level job

Let’s analyze how a 70 lb. lifting restriction plays into these three arguments:

Do you meet a listing – the applicable listing for back injuries is 1.0 – Musculoskeletal Systems.  When you review this listing, you will see that SSA looks for a degree of impairment that prevents you from walking or using a major weight bearing joint.  A lifting restriction of 70 lbs. will not cause the level of impairment contemplated by the listing, so this argument will not fly.

Do you meet a grid rule? – the grid rules apply to claimants over the age of 50 with physical limitations.   Unfortunately there are no grid rules that apply for a claimant who has a 70 pound lifting capacity so that argument is out.

Read the rest

While delays in the Social Security decision making process have been in the news for several years, Social Security administrators have quietly been addressing the question of how to process quick approvals for claimants with incurable and extremely serious medical conditions.

Known as the “compassionate allowance” program, SSA has identified 100 medical conditions that will give rise to a rapid approval.  The complete list of compassionate allowance conditions is on the SSA web site and new conditions are periodically added to the list.   Several new conditions were just added in July, 2011.  Many of the recently added conditions involve cancers or different types of dementia. Read the rest

Today’s Wall Street Journal reports that in-house doctors at Social Security offices all over the country are resigning in protest over pay cuts, overly stressful working conditions and demands that they issue reports in practice areas outside their specialties.

Social Security uses in-house medical advisers to review your medical records and to advise SSA claims adjustors if your medical or mental health condition can support an approval.  In the past, SSA would send medical files to specialists for review – sometimes using two or three doctors on a single file.

Now, because of a growing backlog, Social Security administrators are demanding that in-house physicians review more files faster.  Further, some of the in-house doctors are resigning when Social Security personnel demand that they issue opinions outside their areas of knowledge – in one instance noted in the story a pediatrician (baby doctor) was asked to review a file of an adult with neuropathy.

As a practical matter, Social Security’s problems finding and retaining qualified in-house doctors will only impact your case in that you are less likely to get a favorable decision earlier on in the process.   My experience has been at hearings, judges usually pay little attention to the findings of the State Agency in house physicians – and now that I am aware of the credibility issues discussed in the WSJ article, I will look a little more carefully at the qualifications of these physicians and object where appropriate.

These internal problems at Social Security highlight the need for every claimant to submit complete and properly identified medical records to Social Security along with opinion evidence from treating physicians that identify specific activity limitations which impact your capacity to work.

Over the past few months, I have seen more and more instances where Social Security has failed to send denial notices to me (the attorney), to my client, or to either of us.  Even worse, SSA has shown an unwillingness to acknowledge its mistakes, and is dismissing claims despite the lack of notice.

• In one case, both my client and I received a denial notice in mid March, although the letter inside was dated late February.  According to Social Security’s regulations, reconsideration and hearing request appeals must be filed within sixty (60) days from receipt of a denial notice.   In this case, my paralegal called Social Security and they advised us that their system showed that the 60 days response period began as of the date on the letter even though SSA did not mail the denial notice until almost 4 weeks after it was printed.

Fortunately in this case, we were able to file the appeal within 60 days from the date on the letter but I wonder how often a denial notice is mailed several weeks after the denial notice is printed.

What you can do:  save both the denial notice and the envelope showing the postmark.

• On another case, my client received a denial notice but I did not.  Unfortunately, my client suffers with a mental illness and he did not advise me of his receipt of the denial.  When I learned that his claim had been turned down, I filed an appeal along with a request for “good cause” for late filing of the appeal but that was turned down.  My client has to start over. Read the rest

In order to win disability benefits, you will need to convince a Social Security decision maker – either an adjudicator (claims adjuster) or a judge – that you do not have the capacity to perform work activities for 8 hours a day, 5 days a week.

You will win if the judge finds that you would not be a reliable worker because of things like:

• excessive breaks during the day
• excessive absences from work
• problems with attention and concentration
• inability to perform basic physical activities such as sitting, standing, lifting and carrying

While Social Security likes to present itself as claimant friendly and informal, in fact, you must be very specific with any and all SSA personnel when describing your limitations. Read the rest

One of the questions I always ask new clients in my office has to do with the “onset date” they have chosen for their applications.  When you apply, either online or over the phone, Social Security will ask you when your disability began.

Usually the appropriate answer is the date you stopped working.  In other words, if you were fired or resigned on March 3, your onset date could be March 4.

However, a little more thought into choosing an onset date can produce significantly more money for you.

First, as I discussed on the 5 Month Waiting Period page on this site, you do not get paid the first 5 full months after you are found disabled.  This means, that if you use March 4 as your onset date, the 5 month waiting period begins with April and runs through August.  If you had used February 28, the 5 month waiting period would start with March and run through July.  If your benefit amount is $1,500 per month, you will receive an additional $1,500 in past due benefits.

Second, recognize that your disability may begin prior to the date you actually stop working.  Examples of this include:

• you may stop working in February, but remain on the books and get paid through March.  Social Security is concerned with the date you lost the ability to perform your job, not the dates you were paid salary
• the last few weeks or months of your employment may have seen you working at half strength.  Perhaps you got special considerations from your boss or help from a co-workers.  In such a case, it would appropriate to use the last day you were able to properly complete your job tasks.
• you may have gone from full time to part time.  Your onset date could be your last day of full time work
• you may have left one job and tried another but only lasted 2 months.  Generally any work attempt that lasts less than 3 months is considered an “unsuccessful work attempt” by Social Security, so your onset date could be the last date you worked full time at your previous job

If you choose an onset date that is not supported by the evidence, you can change it – this happens all the time at hearings.  However, it is much easier to move an onset date forward than to move it back.  So if you have not yet applied, note that Social Security will ask you about your onset date and choose the earliest possible date you can.  Try to avoid choosing a date in the middle of the month – instead use the last day of the previous month.  Finally do not assume that you onset date has to be after you stopped working.

If you have any questions about choosing an onset date, please feel free to contact me by phone at 770-393-4985 or email.