Persistence is Key

When it comes to applying for Social Security Disability (SSD) benefits, many applicants face roadblocks along the way—especially when the evidence is clear,  but still gets overlooked by the Social Security Administration (SSA). This was the case for our client, a 42-year-old ophthalmic technician from Hicksville, who suffered from severe mental health conditions. Despite having strong support from her doctors and submitting their expert opinions, her claim was repeatedly denied. However, after persevering and bringing the case before an administrative law judge (ALJ), we were finally able to get her SSD claim approved.

Our client had a long history of mental health conditions, including severe anxiety and depression. Although her treating doctors were fully supportive of her disability claim, their expert opinions were repeatedly rejected by the SSA during the Disability Determination Services (DDS) review process.

The district courts in New York continue to hold that the opinions of the claimant’s treating doctors should be found more persuasive than SSA doctors, even if they are no longer required to be given controlling weight under the regulations, because the former are the most familiar with the patient's condition and treatment history. However, in this case, the DDS analysts repeatedly disregarded the expert testimony and supporting documentation provided by our client’s doctors. Despite their detailed, professional assessments and consistent backing of her claim, the SSA denied her initial claim as well as the reconsideration.

At this point our client’s case was sent to an ALJ for a hearing.  At the hearing level an ALJ reviews the evidence in person and makes the final decision. The ALJ was presented with a full range of medical records, including detailed opinions from our client’s treating doctors. The ALJ also had the opportunity to hear our client’s testimony about how her mental health conditions had prevented her from being able to work. Without any contradictory opinions or expert analysis from the SSA to challenge the treating doctors’ assessments, the ALJ approved the claim.

For anyone struggling with a denied SSD claim, particularly for mental health conditions, this case shows that persistence is key. Even if the SSA denies your claim or ignores important medical evidence, you have the right to take your case further, and an ALJ might be more likely to understand your situation.

Having a lawyer who knows how to navigate these challenges can significantly increase your chances of success. We’re here to help guide you through the SSD process and fight for the benefits you deserve.  Our office, located in Melville, NY, offers a free phone consultation.

Impairment-Related Work Expenses

Impairment-Related Work Expenses (IRWE), as defined by the Social Security Administration (SSA), are "costs for items or services that you need in order to work because of your disability. Social Security will deduct the costs of an IRWE from your countable income when determining your eligibility for Social Security disability benefits."

We represent a 36-year-old claimant from Brooklyn who suffers from schizoaffective disorder, bipolar disorder, cognitive decline, and hypersomnia. He met the criteria for an IRWE because he was paying out-of-pocket for his medical costs, which enabled him to continue seeking treatment with his longtime psychiatrist, without being reimbursed by an insurance carrier. He could not work at all without receiving his medications and treatment from his doctor. The costs were reasonable, which met other criteria of the IRWE.

The claimant was working with accommodations, provided as a favor to his father, who worked for the same company, enabling our client to work part-time. We had to submit all of our client's earnings to his local SSA office, including pay stubs and tax returns, so that the local field office could calculate how much his medical expenses offset his salary. We also submitted a statement from his employer confirming his accommodations and salary.

The State agency approved the medical portion of our client's disability claim based on the information we submitted from the treating doctor. Ms. Kircher, at the Borough Hall field office in Brooklyn, undertook the complicated project and determined that our client's income fell below SS's Substantial Gainful Activity threshold, approving the non-medical portion of the claim.

Overcoming SSD Denial

Dealing with a disability claim can be a long and often frustrating process. Many applicants face challenges in getting their claims approved, even when their medical conditions are severe. This was the case for one of our clients who had been living with rheumatoid arthritis, lupus, and several orthopedic issues. Despite the gravity of their conditions, their initial Social Security Disability (“SSD”) claim was denied. However, with perseverance and the right approach, we were able to get their claim approved on reconsideration.

It is not uncommon for SSD claims to be rejected, especially when the medical documentation provided doesn’t align perfectly with the Social Security Administration’s (SSA) criteria for proving disability. In many cases, the issue lies not in the severity of the condition, but in how the evidence is presented.

We represent a 54 year old USPC worker from White Plains, NY with rheumatoid arthritis and Lupus.  After she was initially denial, we requested a reconsideration of her claim. The reconsideration process allows applicants another chance to have their case reviewed, by a different analyst. This time the new analyst gave us specific information that was needed by the SSA doctors. These details, which hadn’t been part of the initial claim, were critical in strengthening the case. To meet these specific requirements, we reached out to our client’s doctors to request additional, more detailed documentation.

After we submitted the updated, more comprehensive medical documentation, the SSA reassessed the claim. This time, the application was approved on reconsideration. Our client was granted the SSD benefits they rightfully deserved. This outcome shows how crucial it is to have the right medical evidence to meet the requirements to meet the SSA’s disability criteria.

While the process can be lengthy and complex, persistence and attention to detail are crucial. Having a lawyer who knows how to navigate these challenges can significantly increase your chances of success. We’re here to help guide you through the process and fight for the benefits you deserve. My office, located in Melville, NY, offers a free phone consultation.  Please feel free to reach out if you are applying for SSD benefits.

Rare Decision

In June of 2022, we appealed a decision of ALJ Suarez to the Second Circuit after Magistrate Judge Davidson upheld Suarez’s denial in district court.  Last September, the Second Circuit rejected Suarez’s decision, and remanded it to the district court to send the case for a new hearing with the Social Security Administration (“SSA”).

Last January, the district court sent the case back to the SSA.  Specifically, the case was sent to the Appeals Council, which normally prepares a remand order with instructions for the ALJ.

We learned today that, unbeknownst to us, last February, rather than issuing instructions, the Appeals Council issued a rare ruling that the claimant was disabled and entitled to benefits.  The Appeals Council rejected Suarez’s finding that the claimant did not meet listing 12.04.

DOGE Trying to Break SS

Former commissioner of the Social Security Administration ("SSA"), Martin O'Malley, warns US citizens about Elon Musk's mission to destroy the SSA. The SSA has been understaffed and underfunded for many years which causes long delays for people applying for benefits, and poor customer service.  Musk is exacerbating those delays and poor service, as impossible as that seems.

 

Anyone who has worked and paid into the SSA system expects to receive benefits when they are eligible for them.  If DOGE continues to interfere with the SSA, people will see even longer wait times, interruptions in receiving their checks, that they are unable to reach anyone to speak with at the SSA.  DOGE is compelling the most experienced people to resign or be fired, leaving the agency in far worse shape than when he found it.  

 

If you plan to apply for benefits, or already have a case pending, it could be years before you receive a decision.  People who are unable to work due to medical impairments could be without income for years, which in some cases, can lead to homelessness, or even death.  People who are collecting retirement as their only means of income will see their checks delayed.  

 

DOGE is serious a problem.  You are entitled to the money you have paid into the SSA trust fund if you become disabled.  Benefits are not an entitlement, and you need to fight for it.  Flood your senators and congressional representatives with phone calls to protect the SSA and your money.  Make your opinions known at the town halls where they appear.  Do not let Musk wreck the SSA. 

 

By Susan Golden  

 

 

 

 

 

 

 

Unconscionable Cuts to SS

CALL YOUR CONGRESS REPS AND SENATORS! Making cuts to an agency which is already understaffed and underbudgeted is unconscionable. These cuts are going to cause the experienced employees to retire or resign, leaving us with a lot of employees that haven't been properly trained, and don't know or care, what they are doing. This is going to affect anyone that receives Social Security Disability ("SSD") benefits, Supplemental Income ("SSI") or retirement benefits, and anyone planning on applying for them. It affects people of all ages, races and gender. If you don't have a Social Security Number, you cannot get benefits. If you do have one, you still have to meet rigid criteria to get any kind of benefits.

If DOGE wanted to save money at the SSA, then it should consider trying to reduce waste and fraud rather than firing employees.  DOGE could require eliminating Reconsideration in SSD and SSI cases.  DOGE could reduce the excessive amount of paper that is wasted by SSA constantly mailing duplicate letters and forms.  DOGE could insist on sufficient training for SSA employees to ensure they all know how to do their jobs correctly.  What agency is trying to fix the delays that  plague the SSA due to lack of staff and funds?  What agency is trying to avoid having claimants with no income, who are unable to work at a fulltime job, to lose their homes, or to die before a decision is made? DOGE is obviously making everything worse at the SSA.  What agency is trying to improve anything at the SSA?

SS Comm'r Resigns

Elon Musk's DOGE has turned its sights onto the Social Security Administration ("SSA"), prompting Michelle King, the Commission of Social Security to resign.  So many people depend on their Social Security benefits. The SSA is already understaffed and underfunded. Who wants Elon Musk to have access to their SSN's, earnings, bank account information, medical records and other sensitive information? If you are on disability, you should be extremely concerned. This is no joke.

SSD Even If Able To Work

In some circumstances you can get Social Security Disability (“SSD”) benefits even if you have the physical ability to work on a full time basis.  We received an approval today that illustrates this point.

We represent a 53 year old from Brooklyn with sleep apnea, who had made his living as a police detective, and had suffered a brain aneurysm.  The claimant’s pulmonologist provided reports with severe functional restrictions.  While the Administrative Law Judge (“ALJ”) believed the pulmonologist’s restrictions were excessive, the ALJ still determined that the claimant had the ability to perform sedentary work.

A vocational expert testified that the claimant had no transferable skills from his past work as a detective, which was classified as a light occupation.  Since the claimant had no recent education, the ALJ applied the medical vocational or “Grid” rules  to conclude the claimant was disabled, even if he were capable of performing the full range of sedentary work.

If you are thinking about applying for disability you should consider retaining an experienced disability attorney.   Our office is conveniently located on the Nassau/Suffolk county border in Melville.  Please call our office for a free phone consultation.

 

DDS v. ALJ

When an initial application is filed for Social Security Disability ("SSD") benefits, the first step is for the claim to be processed in the local office.  The claim then gets transferred to the State Agency, better known as DDS, to review and decide the initial claim.  If DDS denies the initial claim, then we appeal for reconsideration of the claim.  If DDS denies the claim again, then it goes to the hearing office to await the scheduling of a hearing.

I represent a 57 year old retired police detective, who spent a good deal of time at Ground Zero.  He suffers from pulmonary problems including sleep apnea, hypertension, severe back and shoulder problems, and had a cerebral aneurysm which affected his ability to do simple daily tasks.

We submitted a multitude of records from his treating doctors, including objective test results such as MRI's, and x-rays, to DDS at the initial application.  Today, his claim was approved by an administrative law judge ("ALJ") based on the same objective findings that DDS twice denied.  We provided the ALJ with additional information, including letters of support from friends and family, which helped obtain a Fully Favorable Decision.

It's important to know what information is needed to achieve a favorable outcome.  Not all medical records are supportive.  An experienced disability attorney can determine what evidence is supportive and should be submitted.  My office located in Melville, NY, offers a free phone consultation.  Please feel free to reach out if you are applying for SSD benefits.