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Ginsberg Law Offices

Month: May 2007

Recommended Blog: Disability Doc

I recently ran across a very useful disability blog called "Disability Doc," published by a medical doctor named Keith Holden.  Dr. Holden has extensive experience in the Social Security world, having been involved in training State Agency adjudicators and consultants.

I find this site especially helpful in its discussions of the medical listings published by Social Security disability.   Cases that clearly meet the listings are often approved early – the ones that don’t meet a listing end up in front of a judge where we argue for disability under a "functional capacity" theory or under a "grid" theory.

If your case meets a listing, you can avoid the two year delays and the hassle of filing appeals and endless paperwork.  Dr. Holden’s discussion of the listings helps demystify the complicated medical jargon found in the actual text of the listings themselves.

Compare for example the actual listing for chronic heart failure in the listings with Dr. Holden’s explanation of chronic heart failure.  You will see that the Disability Doc’s explanation contains definitions of medical terms, it describes the symptoms and it describes the tests needed to prove that you meet this listing. 

It appears that Dr. Holden is adding pages about various listings over time. Right now, he has explanations of several of the most commonly seen listings, including cardiovascular disease, genitourinary diseases, Down’s Syndrome, some cancers and some musculoskeletal problems, blood disorders. 

Realize that most physicians are focused on treating you, not on issuing narrative reports that track Social Security listings.  I think that you will find the articles and discussions on the Disability Doc’s web site very useful in helping you understand the Social Security listings and other Social Security issues from an insider’s perspective.

[tags] disability doc, Dr. Keith Holden, Social Security listings [/tags]

How Does a Judge Resolve Unclear or Conflicting Medical Evidence in a Disability Hearing?

Mr. Ginsberg,
I am a dwm 45, no children, no criminal record, no drug/alcohol problems. I have been diagnosed to have Major Depression, Generalized Anxiety, Schizoid Personality Disorders. I have had 23 jobs in the last ten years with several gaps of unemployment. I have had two psychological tests with conflicting results but were all deemed valid/reliable. I just had my ALJ hearing two months ago and in addition to my ongoing psychiatry treatment for the past two yrs, has ordered a mental CE, waiting for the results and a final decision. My treating psychiatrist this month sent a letter to my disability judge stating that I am a ‘diagnostic puzzle’ and have tried all pharmacological agent groups with no success. He also stated that he has been treating me for the past two yrs. He suspects I have a pervasive developmental disorder. He concluded the letter by stating that there have been no signs of malingering and I have been very compliant.

After my hearing, my disability rep. told me that I have a 50/50 chance of winning. My question to you Mr. Ginsberg, is what does the ALJ do when there are conflicting test results but they are all reliable/valid? Does he flip a coin to make a decision?

–Mike
 
Jonathan Ginsberg responds:  Mike, thank you for your question.  Your case illustrates why judges have a very difficult job.  I like to say that the word "judge" is both a noun and a verb.  The best judges look at the evidence but they also observe and listen to the claimant.   Not every claimant falls into a net category.
 
Some judges are better at this task than others.  I know some judges who will deny any case where there is conflicting or confusing evidence, while there are others who take a holistic approach to judging and they try to picture you (the claimant) trying to get through an 8 hour workday, five days a week.  Fortunately most judges try to do the right thing and will look at you as a whole person, rather than as the human manifestation of a large paper file.
 
This is also a case where a functional capacity evaluation might be appropriate.  As I regularly point out on this blog and elsewhere, Social Security disability is about your capacity to function in a work environment.  To that extent a neat and clean diagnosis is not essential.  Even if your treating psychiatrist cannot label your condition, he should be able to comment about limitations that arise from your mental health condition as a whole.  Assuming that reliability, attendance, interaction with co-workers, supervisors and the public would be impaired, he could offer an opinion that would help a judge assign an appropriate vocational profile.
 
You might also think about searching for a psychiatrist or psychologist who can be more definitive in his/her diagnosis.  There is no question that judges prefer a solid diagnosis and it may be that your case is too complex for your current physician and/or therapist.
 
If you lose, you have the right to appeal as well as to file a new application.  If your current medical record turns out to be insufficient to win your case, you and your lawyer might think about how to build a stronger record for the next attempt.
 
Good luck and let me know how it turns out.
 
[tags] functional capacity evaluation, conflicting evidence, diagnostic puzzle [/tags]
 
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