You probably would not be surprised to discover that the most common impairment cited by Social Security disability applicants involves back pain. Because disability adjudicators and judges see so many back pain cases, you cannot simply walk into a disability hearing and testify that your back really hurts and that you cannot lift very much, walk very far, or sit very long, and expect to win.
Instead, Social Security disability judges expect to see evidence in the form of diagnostic test results (such as an MRI or CT scan), treatment notes from one or more physicians – ideally specialists – dating back months or years, evidence that conservative treatment like physical therapy or epidural injections have failed, and evidence that you are either a surgical candidate or that you have been referred for long term pain management.
In addition to evidence related to your back pain, Social Security judges look at evidence about other conditions such as depression, anxiety, diabetes, heart problems, and non-medical factors like your age, education, and work history.
Because so many folks have questions about back pain disability cases, I thought it would be helpful to describe the types of musculoskeletal pain cases that are getting approved at the end of 2017 and into 2018, and which types of cases are not being approved. Continue reading →
In order to win disability benefits from Social Security, you (and your lawyer) have the burden of proving that you meet SSA’s definition of disability – that you are unable to engage in substantial gainful activity because of a medical or mental health condition that has lasted or is expected to last 12 consecutive months or result in death.
There are three (3) ways you can prove that you meet this definition:
meet a Social Security listing
fit within a “grid rule”
prove that your capacity to function at even a simple, entry-level job has been so compromised by your multiple medical issues and/or medication side effects that you would not be a reliable employee
I want to explain why you need an “elevator speech” for your Social Security disability case.
If you are not familiar with the term elevator speech, it comes from the world of job search. Imagine that you are in need of a job and you find yourself in an elevator with the CEO of a company that would be a perfect fit for your skills and education. You have a 45 second elevator ride to introduce yourself to the CEO, tell him (or her) who you are, and how you would be the ideal candidate for a job at his company.
45 seconds is not a lot of time – you need to cut out the fluff and convince this busy CEO why you would be a benefit to his company.
You should use this same approach when you are communicating with Social Security and especially when you are testifying to a judge. They have something you want – the power to award you life changing disability benefits. So it stands to reason that you need to make the claims adjudicator or the judge’s life easy by demonstrating how you fit SSA’s definition of disability.
Focus on Social Security’s Definition of Disability
Fortunately, you don’t have to guess about what they need – Social Security tells us in clear terms that in order to qualify for disability you have to prove that you are unable to reliably perform the duties of even a simple, entry-level job because of a medically determinable condition. You also have to prove that your job limiting condition has lasted or is expected to law at least 12 consecutive months or result in death. Continue reading →
WXIA TV in Atlanta recently ran a story about a 53 year old U.S. Navy veteran who was approved for VA benefits but denied for Social Security. Retired Navy vet Daniel Norfleat from Covington, Georgia was deemed 90% disabled and unemployable by the VA for PTSD, a heart attack, a stroke and knee surgeries. Mr. Norfleat applied for Social Security disability and was approved, but SSA changed his onset date.
Norfleat appealed and his case went before a Social Security administrative law judge. The ALJ not only refused to change the onset date but she reversed the finding of disability entirely and ruled that Mr. Norfleat has the capacity to work at a full time job. This despite opinions to the contrary from 15 different doctors and prescriptions for 24 pills a day for pain, depression and insomnia.
Under new rules released by Social Security, their judge no longer has to explain why she disagrees with the VA’s decision. These new rules also provide that Social Security no longer has to give controlling weight to opinions about employability issued by treating physicians. See my video here about these new evidentiary rules. Continue reading →
Can you get more money from Social Security disability if your physical or mental health condition takes a turn for the worse after you are approved for disability benefits.
Unfortunately, the answer to this question is “no.” The amount of your SSDI benefit is based on a calculation that looks to the amount of Social Security taxes you paid into the system. If you are found disabled and unable to work by Social Security, you get a monthly payment based on SSA’s formula. A deterioration of your medical condition will not cause your monthly benefit to increase.
If your medical or mental health condition improves to the point where Social Security concludes that you can perform the duties of a simple, entry-level job, SSA can cut you off, and the termination impacts your total monthly check – there is no partial disability in the Social Security disability system. Continue reading →
What should you do if you receive a notice from Social Security that they have reviewed your case and determined that your medical condition has improved such that you are no longer disabled, and that your benefits will be cut off as of a certain date?
This type of termination is being processed under something called a continuing disability review (CDR) and we are seeing more and more of these CDR termination notices.
First of all, do not panic. Under Social Security’s rules you will have an opportunity to contest SSA’s termination decision. You can also choose to continue receiving your benefits while the CDR evaluation process drags on – this can take a year or longer. Continue reading →
Effective March 27, 2017, Social Security has changed its long-standing policy about how it treats medical records and opinion evidence form your treating physician. Prior to March 27, 2017, evidence from your treating physicians would be given “controlling weight” by a Social Security adjudicator or judge.
Now, records and opinions from your long time treating doctors will be given no special weight. Instead, medical opinions from your treating doctor, consultative doctors and even non-examining medical consultants will be evaluated equally based on “persuasiveness.”
What does this change mean to you?
At first glance, this rule change seems to make no sense at all. Clearly a physician who has treated you for 10 years would have a more educated opinion about your capacity for work than a consultative doctor who met you once 2 years ago for 45 minutes, or a Social Security in house doctor who only knows you through his review of your medical records.
And, yes, there is a danger that a judge who has made up his mind not to approve your case will now have an easier time justifying a denial of your case. Continue reading →
I have changed how I prepare PTSD disability claims involving combat veterans. Over the past few years I have represented dozens of “wounded warriors” – men and women who have served our country in Iraq, Afghanistan and elsewhere in the middle east. Perhaps you or a loved one find yourself applying for disability based on PTSD along with other degenerative physical issues such as chronic back or knee pain.
Many of the soldiers I represent served multiple tours of duty – often I represent retired military clients who served on active duty for 5, 8, 10 years or more.
In the past, an ex-military Social Security disability claimant who had served in combat duty, with a PTSD diagnosis from the VA and a 90% or 100% VA disability rating was almost certain to qualify for SSDI. For a variety of reasons, disability claimants meeting this profile are being questioned more by SSD judges and are getting turned down more often than before.
I think I understand why combat veteran PTSD claims are being denied and I have changed how I prepare my clients for their hearings.
First, judges are seeing more of these claims, so the stories they hear are less “shocking.” I’m not exactly sure how eyewitness reports of seeing your best friend’s body could become anything less than horrifying, but that is what is happening.
I also sense that SSD judges believe that the VA hands out 100% service connected disability awards based on PTSD to pretty much any combat veteran. I don’t necessary think this is true but I have seen a significant increase in 90-100% VA disability ratings. VA disability ratings are not binding on Social Security. Continue reading →
Over the last few months, I have represented ten different clients claiming disability based on irritable bowel or inflammatory bowel diseases and every one of these cases was approved. My experience has been that disability judges recognize how IBS or IBD can significantly impact your ability get through a workday and thus preclude reliable work.
Since the main issue in any SSDI or SSI claim asks whether you have the capacity to reliably perform even a simple, entry-level job, medical issues that impact reliability will be considered disabling.
In irritable bowel or inflammatory bowel diseases like Crohn’s disease, ulcerative colitis, schistosomiasis, and amebic colitis cause work performance problems such as:
need to take frequent unscheduled restroom breaks
unscheduled time away from work station to use the restroomneed for a work station near and always open restroom
gastric pain that interferes with attention and concentration
There is no question that Social Security has made it much more difficult to qualify for disability benefits. Statistically, hearing approval rates have dropped from 62% in 2010 to 45% in 2015, which is a significant drop. There is one hopeful sign: approval rates by judges nationally in 2014 were also 45% which suggests that the trend is not getting worse.
No doubt our elected representatives in Washington, D.C. have been putting pressure on Social Security officials to keep approval rates down. The disability trust fund came close to running out of money in 2016, but at the last minute was shored up when Congress transferred funds into the disability funds from other accounts. There is also a widespread perception that judges have been too lenient in approving claims, and there have been a few high profile cases of outright fraud (although these cases capture a lot of attention they represent only a tiny fraction of awards).
In my practice I definitely sense that administrative law judges give much more scrutiny to claims of younger individuals – Social Security defines “younger individual” as anyone under the age of 50. No doubt, SSA administrators regularly remind judges that a 30 year old approved claimant will be drawing on the trust fund for another 30 years, whereas a 55 year old claimant will likely draw on the fund for only 7 or 8 years.
So, if you are under the age of 50, you will have more of an uphill battle. However, disability judges regularly approve younger claimants if the medical and other evidence directs a finding of disability. Here the most important factors that I consider when evaluating a claim by a younger individual: Continue reading →