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Hearing Strategies for Claimants with Multiple Medical Problems

multiple medical problems and social security disabilityGreg writes:  “I have seen many if not all of your YouTube videos and have to say you probably are the best disability lawyer on there. My case is rather unusual in the sense that I do not have one injury, I have three. I have a bad back, one herniated disk that causes a lot of pain for me and three bulging disks that are bad in their own right. My right hip is bad and needs replacement, I am on year 6 since it’s discovery. I also have two feet that have chronic pain from bad plantar fasciitis that have both been operated on with little to no success.”

“How on earth do I and my lawyers tackle this in a manner in which I can get approved ??? Should I have my primary doctor do a functional test on me for all three injuries or have each specialist do a functional test on each injury? Secondly is an MRI going to sway a judge more than an X-ray when these days X-ray specialists write their findings and send it to the treating doctors themselves.”

“Any advice would be much appreciated, and keep up your great work with helping us needy and injured.”

–Thanks, Greg

Greg, here are my thoughts. First, thanks for the kind words about my YouTube channel. I do put a lot of effort into creating these videos and I appreciate your positive feedback.

As far as your medical issues are concerned, I would defer to your lawyer who obviously can review and assess your medical problems. Speaking generally, however, my experience has been that it would likely be an uphill battle to base your disability case on planar faciitis since that condition is usually not totally disabling. It can eliminate categories of jobs that require more than minimal standing and walking but probably not sitting jobs. Continue reading →

The importance of doctor support in a disability claim (and why this is the case)

Doctors play a pivotal role in the social security disability process. Their contributions of expertise and documentation provide insight to an applicant’s mental and/or physical condition, and this insight may prove useful when a social security adjudicator is reviewing a claimant’s file. In essence, what a doctor’s contributions to a claimant’s disability file can influence the ultimate decision made by the Social Security Administrative Law Judge. For this reason, it is often said that medical records and documentation are the backbone of a successful disability claim, but in this post we look beyond that to discuss the logic of why a doctor’s opinions are so important.

Imagine you have a condition like migraine headaches, and you are trying to win disability benefits. Well, in this case, it may be difficult to prove something like migraines can prevent you from working. This is where the doctor comes in to save the day. If you are able to see some kind of migraine specialist or neurologist whose office notes from your visits illustrate the severity of your migraines, you are that much closer to winning your disability claim. This is why it is always recommended that you seek the services of a doctor who specializes in your condition, whatever that condition may be. A specialist’s notes may be seen by the SSA as even more credible and as stronger evidence backing up your claim.

Cardiologists, rheumatologists, neurologists and orthopedic surgeons are examples of those physicians who specialize in certain areas of medicine, and such specialty doctors should definitely be consulted with over the course of your claim. They can provide certain testing, are knowledgeable of certain procedures, and have the right skills to render a better diagnosis of your condition and judgment of how it impacts your ability to work. Having that firm diagnosis of a condition and backup from a doctor can prove so valuable in your case.

Another reason doctors play an important role in disability claims is probably because of the strict standards doctors operate under today. I read an interesting article in the Chattanooga Times Free Press, dated April 7, 2010, which is titled Doctors face board specialty ‘expiration dates’ and which discusses just how strict the standards are today for practicing doctors. The article states that prior to the 1990s, doctors who had received specialized training in certain areas were only required to obtain certification ONCE. There were no additional requirements for retesting. In essence, once a doctor was certified, he or she was certified for the duration of his or her practice. Now, however, doctors constantly face the requirement of having to take tests and participate in continuing education to renew their board certification.

This seems like good news for the disability claimant, not just because doctors are held to higher standards, but because the work and opinions of doctors are highly regarded by the SSA. Social Security Judges certainly seem to put a premium on quality medical records. But aside from that, just knowing our doctors’ skills are up to date is a reassuring factor.

To sum up, doctor support is very important in a disability claim, and this is especially the case when it comes to board-certified specialists. Their diagnoses and treatment plans not only can speed up a disability process, but also can assist in winning one as well.

The Consultative Exam (CE): Part 1

I have been asked a few questions which relate to the Consultative Examination (CE), which is basically a doctor’s appointment sometimes scheduled on your behalf by the SSA if they feel that additional medical testing/evidence is required to help them render a decision in your case. In this and the following two posts, I will answer questions about the consultative exam and explain in further detail what you can expect at the CE.

Question:

If the medical records I submitted with my claim are determined to be inadequate to make a disability determination, is there a possibility that additional information would be requested by the SSA on my behalf?

Answer:

The answer to your question is ‘maybe.’ If additional medical information is requested and/or a clarification is needed, your original treating source (physician, specialist, psychiatrist, etc.) is the first preferred source to contact. However, there is a second option available, which is the scheduling of a consultative examination (commonly known as a CE) through an independent source.

Again, your treating source is the preferred choice for additional examinations as long as the following requirements are met:

  • Your treating source (physicians, specialist, psychiatrists, etc.) is qualified;
  • He/she has access to the testing equipment required to perform the examination and/or requested testing;
  • He/she is willing to perform the requested examination and/or tests for a set fee, established by the state in which you have made application in;
  • He/she is able to furnish a complete report within a specified time limit

However, as mentioned above, there are provisions that allow for an independent source, that person other than the treating source, to conduct a consultative examination and any future testing. Those instances in which an independent source would be considered over a treating source are as follows:

  • The treating source cannot or does not prefer to conduct the requested examination;
  • Conflicts and/or inconsistencies exist in the claimant’s file which are unable to be rectified by going back to the treating source;
  • The claimant prefers an independent source and presents a valid reason for doing so;
  • The treating source is considered an unproductive source

So, when the SSA determines it necessary to schedule a CE, they will contact the independent source, schedule the appointment, and then notify you of the appointment date and time.

The types of additional testing and/or examinations requested are strictly limited to the additional evidence needed in order to render a decision on the claimant’s application for disability. Tests conducted outside of the needed information requested are not permissible unless the examination warrants additional testing. In this event, the treating source must have prior approval before conducting further tests.

Please stay tuned for Part 2 and Part 3 of this mini-series on the consultative exam.

Q & A: How much and what kind of information has to be present in my medical records?

Throughout my Q & A Series, I have discussed the importance of medical records many, many times. Hopefully you are starting to get the idea that you can’t win a disability claim without good medical evidence to back up your claim! Now, I’d like to address one last question about what kind of information should be contained within the records that you submit with your claim for disability.

Question:

I recently applied for disability and was denied. Now, I am in the appeals process and want to make sure that the medical records I submit contain the right information.  How much and what kind of information is needed in my medical reports? If my medical reports are too vague, can this hurt me?

My answer:

As mentioned in other posts, until you are afforded a hearing in your case, medical records are all you have. Your documents represent you. They tell your story – a story that needs to fully represent your medical condition. When medical records are vague and/or critical test results are missing, either one or two things could happen. First, your case or hearing can be prolonged until such time as the needed tests have been completed and the record supplemented, or 2) You will receive an additional denial. As a claimant, you do not want either of these two things to happen. This process already takes long enough without additional delays and denials.

Although we often assume that medical reports submitted by our treating physicians have all of the required information, it is critical that claimants know what the SSA is expecting to ensure that their medical records are complete and/or provide the necessary information. If you receive copies of your medical records, take the time to review them and see what types of records are being given to the SSA. Again, continued delay and/or the receiving a second denial should be no one’s objective.

Medical reports, meeting the SSA guidelines, should consist of six primary pieces:

Medical history

Clinical findings (results of ALL physical and/or mental status examinations)

Diagnoses

Laboratory findings (blood pressure, x-rays, urinalysis, CBC, etc.)

Treatment prescribed with response and prognosis; and

Physician’s statement or form providing his/her opinion as to those things a claimant remains able to do despite his/her impairment.

This statement or form should include an analysis of an individual’s ability to perform work-related activities such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling.

In instances where a mental impairment exists, the physician’s statement or form should describe the claimant’s ability to comprehend, carry out and remember instructions, as well as his/her ability to respond appropriately to supervision, coworkers, and work-related pressures consistent within a working environment.

Again, medical records are the cornerstone in any disability case.  Outside of the claimant’s physical presence during a hearing, medical records and the content that exist within these records are the most important factor in determining whether an individual receives disability benefits or not.

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: How important is it for me to keep my Social Security file up to date with new medical records?

Hello and welcome to the 6th 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 the importance of keeping your disability case file up to date with new medical records as your claim progresses.

Question:

I recently applied for disability. Outside of the medical information that I provided in the initial application, how important is it that I continue to supplement my file while awaiting for a decision?

My answer:

Medical evidence is critical in determining whether an individual will receive disability or not. You, the claimant, and/or your representative are charged with the responsibility of providing medical evidence that substantiates your claim for disability and/or proves the nature and severity of your impairment. In some cases, the SSA will help claimants obtain medical reports if the claimant has given the SSA prior permission to do so.

A word of caution: in my opinion it is better for you to provide the medical records to the SSA instead of having them request them. By doing so, not only will you have proof that you provided the SSA with your most current medical records, but you will also be able to review what documents the SSA has and is evaluating. In either case, though, there are advantages and disadvantages. For example, if you or your attorney end up requesting the medical records, there may be a cost, so be prepared.

In addition to the medical records that already exist in your file, it is IMPORTANT that you continue to supplement your file EACH TIME that you visit a doctor, specialist, counselor, etc. Remember, even if you receive aupdate your medical records denial on your application, continue to supplement your record while you go through the appeals process. A good practice is always to request a copy of your medical records immediately at the conclusion of your doctor’s visit. Politely explain that you are in the process of applying for disability and that you need your medical records in order to supplement your file. Some individuals request their medical records once a month if they visit the same doctor weekly or bi-weekly. When receiving your medical records from any source, always make at least two (2) copies. This will allow your representative to have a copy to work from as well as provide you with an additional copy. By having an extra copy available, you will prevent incurring additional costs in the event that you need copies later.

Q & A: What Rules Govern the Confidentiality of MY Medical Records?

Hello and welcome to the 5th 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 answer a question regarding the confidentiality of a Social Security Disability claimant’s medical records.

Question:

I recently received a denial following my initial disability application. I would like to review all of the evidence, both medical and other, that was considered in determining my claim. Is this a possibility? Further, is this information available to the public for review and dissemination? In essence, what rules govern confidentiality of SSA disability records?

My answer:

To begin with, I am here to tell you that you can feel at ease about your SSA records. Any information that was provided by you, as well as any additional information obtained by the SSA that is part of your claim, is protected under the Privacy Act, one of two separate and distinct laws that govern Federal agencies.

Under the Freedom of Information Act (FOIA), Federal agencies are required to provide the public with access to their files and records. However, this particular Act (FOIA) is not applicable to records maintained by the SSA. The second law, the Privacy Act, governs records such as medical evidence and other supporting documents retained by the SSA during your claim. The Privacy Act permits you only or your designated representative the opportunity to examine all records pertaining to you. This means that youConfidential SSA Records may request to review all the medical documentation or other evidence that was used to evaluate your claim for disability. While you and/or your representative are provided with this opportunity, members of the public are not. Simply stated, your information is not available to the public for any type of review or dissemination.

It is important to note, however, that the SSA does reserve the right to determine whether the release of information could potentially have an adverse effect on you. If it is determined that the potential negative effects outweigh any probative value, the information requested will only be released to your authorized representative, that individual you designated in your initial application or later in writing. This is rare, however, and only applies in extreme circumstances.

One final note: Now that the SSA has converted most it’s disability case files into electronic format, it is likely that you will be sent a CD containing your information/records once you request access to your records.  Here at my Social Security CDpractice, we receive CDs containing our clients’ case files a few weeks or months prior to the hearing. We are now able to see everything in our clients’ files just by referring to the CD, and this is saving us from having to finger through large files to find what we need! Hopefully you will find this convenient as well, in the event that you end up requesting that SSA furnish you with your claim records.

The CD format for managing medical records is intended as a stopgap until SSA manages to establish a secure online system that attorneys and perhaps even claimants can use to access their claims files online.  Currently Social Security judges have access to records online but not attorneys.   In my view the CD format is probably less secure than the old paper format because claimants, attorneys and even Social Security personnel tend to get sloppy about leaving CD’s lying around.  Almost every time I appear at a hearing office, I will see CD’s containing someone else’s personal medical records, Social Security numbers and Social Security claims file lying around.  If your file is on on CD, make sure to verify after your hearing your lawyer removes the CD from the hearing room computer.

Happy Friday, be sure to tune in next week for Installment 6 of my Q & A Series.

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