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New Strategy for Winning PTSD Disability Claims

Under pressureI 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 →

Why Irritable Bowel and Inflammatory Bowel Claims are Usually Approved by Social Security Disability Judges

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
  • excessive missed days from work due to symptoms
  • medication side effects

Continue reading →

Social Security Disability Claims for Applicants Under Age 50: is there Hope for Approval?

 

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 →

Musculoskeletal Injuries: How Severely Impaired Must I Be?

Intentionally or not, the Social Security Administration has done a good job selling the idea that winning disability benefits is extremely hard. Bloggers (including me) write about the long delays and the arbitrary nature of decisions and the possibility of drawing a judge who would not approve a deathbed claimant.

Clearly, claimants without compelling medical evidence are having an increasingly difficult time winning. Ten years ago, judges were much more likely to accept your testimony about your work activity limitations – now, judges are looking for extensive medical evidence.

I often hear from, or end up representing disability claimants who have been denied at the administrative (initial application or reconsideration) and who are about ready to give up. Ironically, many of these claimants have cases that are likely to be approved because the medical evidence is so compelling.

Recently, I received an email from a gentleman named Kevin who was turned down at reconsideration, and wants to know what I think about his chances. I don’t have access to his specific medical records but, after reading his case summary, I would be shocked if he was denied. I would guess that 95% + of judges that I might see would approve this case after submission of a brief or after a brief hearing.

As I have discussed before in writing and on video, the state agency adjudicators are not judges and they do not have the experience or authority to make value judgments. Adjudicators are looking for listing level impairments without any reservations. Continue reading →

Unconventional, Non-Medical Evidence That Can Help You Win

With approval rates on the decline at hearing offices throughout the country, disability lawyers and their clients have to find creative and compelling evidence to make their cases stand out.

In my practice I regularly look for evidence beyond medical records and medical source statements. Often times you can find very convincing evidence in the form of employee files, school records, statements from former co-workers and supervisors and claimant maintained pain diaries.

Now, to be sure, judges are most concerned about your medical record and how your medical issues impact your capacity to work. However your doctor’s main concern when keeping medical records tends to focus on medical issues alone – rarely will medical records contain the specific vocational capacity observations or opinions that judges rely upon.

We can ask your doctor complete a functional capacity evaluation or narrative report (often at a cost of several hundred dollars) but some doctors do not wish to get involved in disability matters and others don’t feel equipped to make vocational capacity conclusions.

This is where unconventional evidence comes in. Continue reading →

Part Time Work Before and After Your SSD Award

This month I received two questions via the Speakpipe app on my blog about outside earnings and Social Security disability. The first gentleman is applying for disability and wants to know how much he can earn without jeopardizing his case, while the second gentlemen wanted to know how much an approved claimant (his son) could earn without jeopardizing his SSDI award.

Neither gentleman left an email for personal reply so I am using my blog to respond.

The raw number that applies to both of these questions is the current SGA (substantial gainful activity) figure. For 2015, the figure is $1,090 per month. For 2014, the SGA number was $1,070 per month. This number will change every year. Here is the current link to the page on SSA’s web site which shows the current SGA figure. If this link changes you can search “SGA and Social Security disability” to find the current number.

So now you know that the earnings limit for both disability applicants and approved disability claimants is the same – the current SGA number. However, that is not the end of the story. My experience has been that SSA treats disability applicants quite differently from approved disability claimants. Here’s what I have observed: Continue reading →

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 →

How to Testify Credibly About Sexual, Emotional or Physical Abuse in a Social Security Hearing

abuse and PTSD or depressionOne of the more troubling parts about practicing Social Security disability law involves hearing stories of how my clients suffered horrific abuse.  I would estimate that at least 75% of my cases involving mental illness also include a history of abuse.  It is no surprise to me that anyone who was abused by a parent or authority figure, or by a person physically stronger would continue to suffer physical and emotional wounds for years to come.

Because a claimant’s history of abuse helps explain current symptoms – depression, social phobia, anxiety, etc. – I think it is necessary to question my client about the abuse he or she experienced during that client’s disability hearing.  Obviously this is a difficult and uncomfortable task – I have no desire to dredge up bad memories or to make my client relive a terrifying experience – but I have to bring this information about in testimony so the judge can better understand what my client is going through.

In preparing my clients for testimony about prior abuse, I suggest one of two ways to present this evidence. Continue reading →

Functional Capacity Evaluations: Helpful or Hurtful?

Social Security FCEHere is a question I received from a blog reader:

I have been told I should qualify for disability because of my permanent restrictions set by my FCE. I was put in a light category. What do you think?

Here is my response:

First, let’s clarify what a functional capacity evaluation is and why it is important to Social Security.  Functional capacity evaluations (abbreviated FCE) are a set of tests and evalautions designed to objectively determine your capacity to perform the physical demands of work [1. Here is Wikipedia’s definition of an FCE].  A physical FCE will categorize you as:

  • able to perform heavy work
  • able to perform medium work
  • able to perform light work
  • able to perform sedentary work
  • unable to perform sedentary work

Social Security has defined each of these terms – click here for the definitions.

An FCE can be preformed by a rehabilitation supplier, a physical therapist or a physician.  A formal FCE may involve one or two days of testing along with interpretation by a trained health care provider.  An informal FCE may involve a checklist form completed by your doctor. Continue reading →

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