Thursday, October 18, 2012

SSD Claimants Need To Review Their Efolders

I represent a 49 year old nurse, whose Social Security Disability (“SSD”) application was approved today. The good news is that a Senior Staff Attorney at the hearing office approved the OTR that I submitted, so the claimant will receive SSD benefits without having to attend a hearing. The bad news is that the claimant’s application had been denied by the State Agency because it had purged the disability reports of the claimant’s two medical specialists from the file. 

The reports of the claimant’s pain management specialist and family doctor each prepared detailed reports explaining why the claimant’s fibromyalgia was disabling. Both reports stated that the claimant met the American College of Rheumatology criteria for fibromyalgia, and identified the clinical signs that support the diagnosis. Both reports provided for a less than sedentary work capacity, and concluded that the claimant could not work because she was completely disabled due to severe pain. 

The State agency, as it has done on previous occasions, mysteriously excluded the treating doctors’ reports from the claimant’s file. Curiously, it seems that whenever a submitted document is missing from a claimant’s folder while being reviewed by the State agency, the document is always one that includes a doctor’s opinion that a claimant lacks the functional capacity to work. 

Once a State agency denial is appealed to the Social Security Administration (“SSA”) hearing office, I can access the efolder. When I reviewed the nurse’s efolder and learned the disability reports were missing, I immediately resubmitted them, together with the Electronic Records Express receipt for showing that the State agency had received those reports on July 12, 2011 at 3:51 and 3:55 PM EST. Fortunately, the SSA Staff Attorney then approved the SSD application promptly without the need for a hearing, after I supplied him with an updated report that he had requested. Unfortunately, the State agency unnecessarily delayed the approval of the claimant’s benefits for a year.

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