Compassionate Allowances are a way of quickly identifying diseases and other medical conditions that clearly qualify for Social Security and Supplemental Security Income disability benefits.  It allows the agency to electronically target and make speedy decisions for the most obviously disabled individuals.

There are now 88 medical conditions that qualify for compassionate allowance.  About half of these conditions are forms of cancer, while the other have are made up of rare diseases, many of which affect children.  Among the more common conditions that now qualify for an early approval:

• early onset Alzheimer's Disease
• mixed dementia
• idiopathic pulmonary fibrosis
• mucosal melanoma

A full list of all of the compassionate allowance conditions may be found by clicking on the link which will take you to Social Security's internal Program Operations Manual System (POMS).

If you or a loved one are afflicted by any of the conditions described under the compassionate allowance program, it is very important that you make that fact known to the adjudicator who is assigned to your claim.  You should not assume that the state agency adjudicator is familiar with the compassionate allowance list.

Post from: Social Security Disability Blog

Social Security Adds More Conditions to "Compassionate Allowance" Program

I am a 43 year old diabetic. I was diagnosed 7 years ago and progressed quickly from pills to insulin injections and have now been on an insulin pump for 3 years.  I have neuropathy in both legs, heart disease, and many other diabetic problems, because of high blood sugar.  I am at an ideal weight of 170 Lbs. and 5' 9" height and have always been active and try to eat healthy.   I take 40-50 units of insulin each day, but my A1C readings are still 10+. I am no longer able to perform my work assignments.  My employer (25years)had even allowed me to change to an office job but I am still not able to sit for over an hour without my legs hurting and I have had many hypo (low-sugar) episodes at work which scared everyone.  My doctor's have suggested that I quit so that I can concentrate on this disease before it kills me, but the stories of possible delays in SSDI have really concerned me and my family.  I have enough money saved to survive for a year, but that is it.  Do you think someone like me would qualify for SSDI benefits, and what would a potential wait be?

Here are my thoughts: I think that Steve has very good reason to be concerned.  When you apply for benefits, there are two times when you are likely to be approved – at the initial application stage, which will be within four to six months after application, or at the hearing stage, which could be two to three years after application.

Initial application approvals are almost always arise in cases that meet a listing.  Steve is a diabetic and the applicable listing is at Listing 9.08. State Agency adjudicators will approve diabetes cases on the listings but they will expect the medical records to document as many of the following complications:

• long standing neuropathy (numbness in extremities)
• long standing retinopathy (vision issues)
• blood sugar readings at 200 or higher over an extended period of time despite increasing dosages of insulin
• organ damage (documented by abnormal lab readings)
• frequent urination
• sexual dysfunction
• statement or checklist from treating doctor that condition equals 9.08

In my view, you need to aggressively argue to the adjudicator that your case meets a listing – do not assume that the adjudicator will figure it out.

If your case is denied at the initial application stage, it is very unlikely that a different adjudicator will approve it at reconsideration.  Statistics I have seen suggest that no more than 10 to 15% of cases are approved at the reconsideration appeal level.

Assuming that you are denied at initial and reconsideration, the wait for a hearing date can be long, very long.  Depending on where you live the wait can reach two to three years.  Steve did not say where he lives – Social Security does publish statistics about the wait times for each disability hearing office.

As far as the substance of Steve's claim, it appears that he is having a great deal of trouble keeping his blood sugar under control despite both his diet and his medicine.  I would advise Steve to bring a copy of listing 9.08 to his doctor and to enlist his doctor's support in the form of a narrative report stating that he meets the listing and that his capacity to sit, stand, concentrate, get through a workday without interruption and to avoid excessive absences has been significantly impaired by the diabetes.  You can read more about the case strategies I use in diabetes claims by clicking on the link.

At some point, Steve is going to have to make the decision to stop working and to start the disability process.  Obviously the intend of the disability laws is that Steve should wait until working become impossible, as opposed to highly uncomfortable.

Finally, I would also point out that if Steve stops working, files for disability and is turned down at initial and reconsideration, he could try to return to work.  Work attempts of three months or less are considered "unsuccessful work attempts" and can actually help a claimant by demonstrating his desire to work.  Those unsuccessful work attempts can also add money to the family's budget – not an ideal solution but perhaps a way to deal with the many months of delay when waiting for a hearing date.

Post from: Social Security Disability Blog

If I Stop Working and File for Disability, How Do I Know that my Money Won't Run Out Before my Case is Approved?

When Georgia Congressman John Lewis set reduction of SSA’s disability case backlog as one of his top priorities, the Atlanta North processing time for claims was the worst in the country at 828 days, and in Atlanta proper it was 750 days.  He noted that “people are waiting years for benefits they deserve, some are even dying while waiting. This is simply wrong…Somehow the richest, most powerful nation in the world must find a way to meet the needs of these Americans. They have suffered enough. They should not suffer at the hands of their government.”

Mr. Lewis testified before the Budget Committee, and urged his colleagues on the House Ways and Means Committee to give SSA the funds needed to hire more Administrative Law Judges and disability claims staff.

Last month, Social Security Commissioner Michael Astrue announced that for the first time in a decade, the agency ended its fiscal year with fewer pending disability hearings than in the previous year.  It closed FY 2009 with 722,822 pending hearings – a reduction of more than 37,000 cases from its 760,813 hearings pending at the start of the fiscal year.  Processing time for cases also improved over the same period, dropping from an average of 514 days in FY 2008 to 491 days in FY 2009.

“Our backlog reduction plan is working, and progress is accelerating,” Commissioner Astrue said.  “Even in the face of a significant increase in our workloads as a result of the worst recession since the Great Depression, we have reduced the hearings backlog for nine consecutive months.  Thanks to the efforts of thousands of hardworking Social Security employees and the additional funding we received from President Obama and the Congress, we have exceeded our backlog reduction goal for this year.”   Click on the link to see SSA’s recent news release discussing these developments.

Despite Commissioner Astrue's positive spin on the statistical improvement, in real life I am still seeing delays of 2 to 3 years.  We are seeing some cases processing through the case very quickly and I suspect that these fast tracked cases have something to do with making the statistics look better.

We have also seen thousands of cases shifted from the Atlanta North hearing office to Atlanta and from Atlanta to Columbus and Macon.  These temporary fixes may result in a short term improvement in the statistics related to delays but only time will tell if the recent backlog improvement is a true trend.

We are also seeing increasing delays in the processing of hearing decisions following the hearings.  I have several cases in my office that I tried in March in which a hearing decision has not yet been issued.   The hearing offices advise us that they do not have enough staff to help the judges.

I do think that Commissioner Astrue is making the backlog a priority in his office and I applaud him for his efforts.  Moving a large bureaucracy like SSA is not an easy task and I wish him the best of luck in this undertaking.

Post from: Social Security Disability Blog

SSA’s Disability Case Backlog Reduced for First Time in a Decade

Fast forward to 2009.  That two to three month period is now four to six months.  Here's why:  about 18 months ago, the Social Security Administration convinced Congress to allocate more money to hire new administrative law judges, and SSA immediately hired around 100 new judges.  At the same time, Social Security put into process its conversion from paper files to electronic files and they created the infrastructure to provide for video hearings.

In Atlanta, where I practice, SSA created a video hearing ODAR office in Marietta, Georgia with three hearing rooms available to handle video hearings.

The good news – Social Security is now equipped to offer claimants administrative hearings.  The bad news:  the hearing offices often do not have enough support staff to process all of the decisions being issued by new judges and judges appearing by video.

As I noted back in 2007, the judges themselves do not actually write the decisions – that task is assigned to "decision writers" – individuals who may be staff lawyers or paralegals who are not in attendance at the hearings but who prepare the decisions for the judges' review.

Even though the decision writers follow a standard hearing template, the decision has to be written, proofread and sent to the judge for review.  Since the judge may not see a decision for weeks or months after the hearing, he most likely will not remember the case, meaning that he will have to review the file and verify that the decision reflects his thoughts.

Because of the volume, I am seeing delays of four to six months between the hearing dates and the issuance of a decision.

This delay can be especially frustrating for claimants who are expecting favorable decisions.  In some cases, judges announce at the hearing that they plan to approve a particular case.   The claimant leaves the hearing office happy, knowing that a big lump sum check is headed his way along with monthly benefits and access to Medicare.  Imagine how frustrated that claimant will become when there is a six month wait in the issuance of a decision.

Unfortunately there is just not a whole lot anyone can do about these growing delays.   As an advocate for my clients, the last thing I want to do is anger a judge by demanding that my cases be moved to the front of the line.   Social Security judges work hard and they know that there is a decision processing problem.   Complaining by a lawyer or a claimant is not going to help.   And since the judge has the power to change his mind, I am not a big fan of demanding action by calling your Congressperson.

While frustration and anger is understandable, there is no remedy unless and until Social Security hires more staff to support its expanded judicial corps.

Post from: Social Security Disability Blog

I Have to Wait How Long for my Hearing Decision?

This month's NOSSCR (National Association of Social Security Claimant's Representatives) newsletter contains a story about SSA Commissioner Michael Astrue's efforts to increase the productivity of the judges and to reduce backlogs.  As noted before, I applaud SSA's transition to electronic file folders and it does appear that Commissioner Astrue's efforts are beginning to pay off.

I scanned the report from the NOSSCR Forum bulletin, which you can download by clicking on the link here: ssdelays

Post from: Social Security Disability Blog

Hearing Delays Statistics Updated

Jonathan Ginsberg responds:  Steve, it sounds like you have a difficult choice to make.  I would certainly not be happy to learn that my lawyer had retired and transferred my file to someone else without any notice to me.  Most lawyers I know would at least make an effort to contact their clients if closing their practice.  You do say that you are homeless – is it possible that your lawyer was not able to get in touch with you?

With regard to the new lawyer, he may very well be very capable.  On the other hand I would be concerned that he never made any effort to contact you.  From my perspective the fact that the new lawyer has never met you is less important than knowing whether he has thoroughly reviewed your file.  What you don't want to happen is ending up at a hearing where the medical records are not updated and the lawyer does not have a clear theory of your case.   Periodically lawyers from other States will hire me to represent a client in a Georgia hearing.  As long as I am familiar with the file and know what I want to prove, I can spend an hour with the client prior to the hearing and be sufficiently prepared.

I would suggest that you contact the new lawyer and try to meet with him today or a minimum of an hour before the hearing.  Ask him if the file is  updated and if he has a working theory of your case.  I would also ask him to level with you – if the case is not ready to try or if he is not ready, I'd rather ask for a continuance and wait a couple more months than to lose a winnable case because the file wasn't updated or the lawyer wasn't ready.

At the end of the day, you want to win – it doesn't matter who the lawyer is.  The records in your file and the opinion of your doctors is far more important.  These factors are where I would put my focus.  Good luck and let me know how it turns out.

Post from: Social Security Disability Blog

Last Minute Lawyer Substitution – Is This a Problem?

Commissioner Astrue says that the new judges will begin training in April and should be prepared hear full calendars by the end of 2008.

The press release does not say where the new judges will be stationed, but I presume that the hearing offices with the biggest backlogs – like Atlanta – will likely get new judges.  The downtown Atlanta hearing office recently moved to larger quarters with more hearing rooms, which is a good sign.

Thanks to my loyal reader Mike for bringing this press release to my attention.

Post from: Social Security Disability Blog

Finally, Some Good News About the Hearing Office Backlogs

Social Security acknowledges the problems and contends that these delays are the result of personnel shortages and growing numbers of claimants.

Let me tell you about a different explanation – one that comes directly from the mouth of a sitting Social Security hearing judge.

I am not going to name this judge for obvious reasons, but I can tell you that he does not work out of the Atlanta hearing office – in fact, the hearing office where he works has a better than average wait time – in his office, hearings are usually scheduled within 9 or 10 months after the hearing is requested.

My case had actually taken a lot longer – my client had been waiting over 2 and 1/2 years.  After the hearing, the judge explained why. 

It seems that my case involved an unusual medical issue – one about which the judge was unfamiliar.  As such, he had noted on the file that he wanted a medical expert to testify.  In my experience, medical experts appear about 25% of the time when a judge needs help understanding the nature of a disease or condition, treatment options and the patient's prognosis. 

When a medical expert is called, someone in the hearing office has to coordinate the judge's calendar, the claimant lawyer's calendar, the medical expert's calendar, and arrange for a vocational expert.  Further, because medical experts are often hard to pin down, judges like to schedule 4 or 5 cases on the same day with the medical expert.

It turns out that the scheduling clerk in this particular hearing office decided that all this coordination and scheduling was too much trouble.  The clerk gathered up all the cases that were marked as "needing medical expert testimony" and she hid them away in a file cabinet.  The clerk's deed was only uncovered when someone from the hearing office administrative staff noticed a spike in the "pending cases" statistics and started digging.

What we have, therefore, is a situation where a rogue or incompetant office clerk single handedly caused over a year's delay in hundreds of serious disability cases.  The judge said to me that he had been instructed to put his existing caseload on hold in order to process through the backlog as quickly as he could.

The judge also told me that he had no staff to help him – and he basically had no liason with attorneys to try to expedite the processing of these cases – in other words, if there was a situation where the judge might need an MRI report or other document, he had no way of communicating this need to the attorney prior to the hearing.  (I did not ask, but I suspect that this judge did not feel comfortable with ex parte communications with claimant's counsel or that he felt that such communications were support staff duties).

My case, in fact, was a second hearing – at the first hearing six months prior, the judge announced that he needed to ask a medical expert a few questions and the the "hearing" could be conducted by telephone, and that I could participate at my office.  Instead, a hearing was scheduled, necessitating a multi-hour drive.  When I got there, the judge apologized and said that he had not become aware of the mix up until the weekend before the hearing and had no way to get in touch with me.   Although I ended up winning my case, I lost a good four hours that day driving back and forth for what amounted to a 10 minute conversation with the medical expert.

My point here – Social Security has a real mess on its hands and the solutions are not quite as simple as "adding more personnel."  New and existing staff people need to have some idea what to do and efficient processing systems need to be put into place.  Currently we are far from even minimal competence in these areas.

Post from: Social Security Disability Blog

A Disturbing Explanation for Why Hearing Schedules are So Far Behind

Here is part one of the CBS report.

www.cbsnews.com/sections/i_video/main500251.shtml

Here is part two of the CBS report:

www.cbsnews.com/sections/i_video/main500251.shtml

Post from: Social Security Disability Blog

CBS News Reports on Social Security Disability Claim Delays

Earlier this month a federal judge blocked Social Security from sending out letters to employers advising them of discrepancies between workers' Social Security information and government records.   Illegals often use fake Social Security numbers when applying for jobs.  SSA contends that a judicial requirement that the agency revise the letters or delay mailing them will cause significant harm to Social Security and may interfere with its ability to perform "core functions," including, presumably,  the adjudication and claim management of disabilty cases.

Acting Social Security deputy commissioner David Rust told the federal judge that SSA expects a significant increase in its workload during the first quarter of 2008 and that the agency is already facing a staffing shortage.

From my perspective as a disability lawyer, I am already seeing hearing files that are not properly prepared, and delays of up to three years for hearings.  A system that is already straining is lurching towards total chaos.

Technorati Tags: social security delays, immigration rules and social security administration, Judge Maxine Chesney, David A. Rust

Post from: Social Security Disability Blog

Immigration Dispute May Result in Increased Disability Delays