Myasthenia Gravis Listing

Myasthenia Gravis is a chronic autoimmune disease that can cause severe muscle weakness and fatigue, making it difficult to work consistently or keep a regular schedule.

We recently helped a 50-year-old Portfolio Management Specialist from Brooklyn who has Myasthenia Gravis obtain Social Security Disability benefits. Her claim was approved just over three months after filing.

When Social Security evaluates a disability claim, it considers the severity of the claimant’s impairments. Its Listing of Impairments sets out the criteria a condition must meet or equal in severity for the claimant to be presumed disabled and entitled to SSD benefits.

In this case, we knew that a “Listing” letter from our client’s neurologist could help secure a quick approval. We sent the neurologist the criteria for Social Security’s Listing 11.12 for Myasthenia Gravis and explained that his letter needed to state clearly that our client met Listing 11.12 and why she met the criteria. This specificity was essential to prevent Social Security from misinterpreting the letter.  After we submitted the doctor’s Listing letter, the State Agency (“DDS”) asked our client to attend a Consultative Exam (“CE”) with one of its doctors. We immediately contacted the analyst assigned to the case and explained that a CE was unnecessary because we had already submitted the Listing letter, medical records, and a Medical Findings Summary. DDS agreed, and the claim was approved.

Every Social Security Disability case is different, and approval is never guaranteed within a specific timeframe. Some cases move quickly; others take much longer. This case shows why it is important to be proactive from the start and provide Social Security with the medical evidence needed to evaluate the claim.  It also highlights the important role treating physicians can play in a disability claim. A detailed letter from a specialist who understands the patient’s condition can strengthen the claim and help Social Security assess the severity of the impairment.

Our goal is to fully develop the record and give each client the strongest possible opportunity for a favorable decision.  If you are unable to work because of a serious medical condition, having an experienced disability attorney who knows what evidence to look for and how to develop your medical record can make an important difference.

Compassionate Allowance

A former client referred her husband to us to file a Social Security Disability claim after he was diagnosed with Stage 4 pancreatic cancer, a condition that qualifies for a Compassionate Allowance claim under Social Security guidelines. We were glad to assist with filing his claim on his behalf, even though we knew there would be no attorney fees.

Her husband, a 61-year-old mail handler from Laurinburg, North Carolina, was approved in less than two weeks. When we submitted the claim, we notified Social Security that it qualified for Compassionate Allowance treatment. Once the case reached the state agency for review, we promptly provided his pathology report, and the claim was approved

Lifelong Disability Approved

Our client is a 30-year-old woman born with Cerebral Palsy, a lifelong condition affecting her mobility, muscle control, and overall functional capacity. Despite significant limitations, she had attempted to navigate the disability process twice on her own but was denied both times. By the time she retained our office, she was understandably frustrated.

We elected to file a new application and developed the case thoroughly from the outset. Updated medical records were obtained, and we worked to ensure the evidence clearly documented not only her diagnosis, but also her limitations in standing, walking, balance, coordination, and endurance over the course of a workday. Unfortunately, the State agency denied the application at the initial and reconsideration levels. While disappointing, these denials, are not uncommon, even in cases involving longstanding impairments.

We requested a hearing before an Administrative Law Judge ("ALJ"). Prior to the hearing date, the attorney at the hearing office assigned to review the file explored the possibility of resolving the matter without a formal appearance before the ALJ. Although those discussions were constructive, the case ultimately proceeded to a hearing. As part of our pre-hearing preparation, we amended the alleged disability onset to a much earlier date. At the hearing, the ALJ observed our client directly and heard her testimony regarding her daily functioning and work-related limitations. Following the hearing, the ALJ issued a fully favorable decision.

Every disability case is unique, but this one reinforces why careful case development, strategic advocacy, and preparation for hearing can change the outcome entirely. If you are considering filing for SSD, please reach out to our office for a free consultation.

 

 

QR Increases on Approvals

It is no coincidence that all of our cases approved by the State agency at the initial and reconsideration levers are being reviewed by the Federal government's Quality Review ("QR") unit. The QR process process is supposed to select State agency decisions at random.  However, the QR unit only pulls approved cases to evaluate.  In most instances, the approvals are confirmed. 

For decades, only one or two of our cases annually would be selected for QR, and rarely overturned. We spoke to a State agency analyst who verified that almost every approved claim is currently being pulled for further examination. This new policy is counterproductive to efforts to reduce costs and spending.  Overturning approvals makes it harder for disabled people, who cannot work due to medical conditions, to receive Social Security Disability benefits. This alarming treatment of individuals with disabilities is deeply concerning.

ALJ Reverses DDS's Denials

Obtaining Social Security Disability (“SSD”) benefits can be a long and frustrating process, especially for claimants whose disabilities are not always visible. A recent fully favorable decision for one of our clients illustrates how thorough medical documentation and effective legal representation can make a difference.

We represented a 52 year old client from West Babylon who suffered from post-concussion syndrome, cognitive disorder, chronic migraine headaches, and anxiety and depressive disorders.  These impairments caused persistent symptoms such as severe headaches, brain fog, memory problems, difficulty concentrating, fatigue, and emotional distress. Despite ongoing treatment, her condition showed little improvement.

From the outset, extensive and consistent medical evidence supported this case. Multiple treating providers documented her symptoms, limitations, and lack of meaningful improvement over several years.  Detailed records showed near-daily migraines, cognitive deficits, difficulty using computer screens, and significant mental health struggles.  Despite the strong medical support, a Social Security disability analyst from the State agency denied our client’s application at the initial and reconsideration levels.  Unfortunately, these early denials are common and often occur even when substantial evidence is present in the file. 

We requested a hearing before an Administrative Law Judge (“ALJ”).  At this stage, the case finally received the individualized attention it deserved. The ALJ carefully reviewed the medical evidence, hearing testimony, and medical opinions.  The ALJ determined our client was limited to less than a full range of light work, to only simple, routine tasks, to being off-task 15% of the workday, and to missing work two days of work each month.  Based on those limitations, the ALJissued a fully favorable decision.

This case highlights several important realities about the SSD review process.  Strong medical evidence alone is not always enough at the early stages as many valid claims are denied by the State agency analyst. Frequently, a hearing provides the best opportunity for a full and fair evaluation.

Navigating this process without guidance can be overwhelming. With our knowledgeable representation, our clients are better positioned to obtain the benefits they deserve.

Reconsideration

If an application for Social Security Disability ("SSD") benefits is denied, the next step is to request reconsideration.  Reconsideration is basically an appeal to the same State agency that made the initial decision. At reconsideration, a different analyst reviews the case for a new perspective.

We represent a 52-year-old Insurance Coordinator from Old Bethpage, who suffers from severe IBS, ADD, and hypothyroidism. Her claim was recently approved by the State agency during the reconsideration phase. The only new evidence we provided were treatment notes from her last three monthly infusions with her doctor, which have been ongoing since we filed the initial claim. Although the agency requested records that we had already submitted, we had to clarify this for them. In reality, the extensive medical evidence presented at the start should have sufficed for benefit approval. The SSD process ended up spending unnecessary resources and caused delays for a claim that should have been resolved much earlier.

Meeting A Listing

When representing a claimant seeking Social Security Disability ("SSD") benefits, we obtain medical records from each of their treating physicians. We also ask these doctors to complete a Medical Findings Summary, which is a questionnaire designed to assess a patient’s restrictions and limitations (“R&Ls”).  The Social Security Administration relies on these R&Ls when making its determination. If the R&Ls from a claimant’s medical impairment is severe, they may satisfy the requirements of one of Social Security’s “Listings.”

We represented a 41-year-old dental assistant from Melville, NY, who suffers from a significant vision impairment. We requested that her doctor to review Social Security’s Listing criteria for Visual Disorders. The physician supported our case by providing medical evidence showing our client met the Listing.  Along with a vision test requested by the State agency, we submitted this information, and our client was promptly approved during the initial application stage.

Retaining an experienced disability attorney is in your best interest if you are planning on applying for SSD benefits.  Our office, located in Melville, NY in Suffolk county, offers a free phone consultation.

Meeting SS Grid Rules

When applying for Social Security Disability (“SSD”) benefits, your likelihood of approval at the initial application stage increases significantly if you meet the criteria outlined under the “Grid Rules.”  These rules are designed to assess disability claims based on three main factors: your age, your highest level of education completed, and your past employment history.  Satisfying the Grid Rules can be crucial in securing benefits, as the Social Security Administration uses these benchmarks to determine whether a claimant can adjust to other work given their impairments.

I represent a 54 year old laborer from Port Washington, NY.   My claimant’s highest completed education was the 5th grade, and he began working as a laborer during his teenage years.  He remained in this occupation until health issues, specifically cardiovascular problems and musculoskeletal ailments, prevented him from continuing.  Social Security classifies the laborer role as an unskilled occupation, meaning it does not provide transferrable skills that could be applied to other types of work.

In this case, the client’s doctors provided substantial support by completing questionnaires that clearly detailed the patient’s restrictions and limitations.  These medical opinions, combined with the client’s age, limited education, and unskilled work history, created a compelling record that led to his approval at the initial application stage.  Although the State agency attempted to delay the decision by requesting a Consultative Exam (“CE”), the evidence provided from the client’s treating physicians was so strong and conclusive that the CE was ultimately canceled. The approval was granted based solely on the evidence already in the file.

Obtaining a favorable decision from the Disability Determination Services (“DDS”) has become increasingly difficult. Rather than thoroughly reviewing claimants’ files, DDS analysts often overlook submitted evidence.  In many cases, it falls upon us to identify and direct the analyst to the relevant documentation within the file.  Effectively, this means doing both our job and part of the analyst’s job to ensure the claim is properly considered.

This case underscores the importance of retaining an experienced disability attorney when applying for SSD benefits.  An attorney can ensure that all necessary evidence is submitted and highlighted for review, increasing the chances of a favorable and expeditious decision.  For those considering an application, my office, located in Melville, NY in Suffolk County, offers a free phone consultation to assist with the process and answer any questions.

Strokes

According to the CDC, approximately 800,000 people in the United States have a stroke every year, causing many of them to be paralyzed.

We represent a 41 year old physician's assistant from Wading River who suffered a stroke, leaving him with left sided hemiparesis, vision loss, and post stroke epilepsy.  We provided the State agency with supportive medical evidence from our claimant's treating providers, yet they still "needed" to send our client to a Consultative Exam ("CE").  We asked the State agency to send us in writing what information they contended was missing so we could request that information from our client's doctor, who Social Security cites as the "preferred" sources for information.

Once the State agency received the requested information, they approved our client's application, proving once again, that the CE was not needed.  Our client was very appreciative that we avoided the necessity for him to have to go for the CE.

Long Covid

COVID pandemic may be over for most of us, but it's not over for those people suffering from Long COVID.  According to the Mayo Clinic, common symptoms of long COVID include extreme fatigue, problems with memory, lightheadedness or dizziness, sleep problems, shortness of breath and headaches.  These symptoms can last weeks, months, and in many cases years.

We represent a 48 year old Underwriting Analyst from Williston Park, whose Social Security Disability ("SSD") benefits were approved by ALJ Linda Stagno, On The Record "OTR".  After reviewing the same medical records that the State agency doctors reviewed, ALJ Stagno recognized the obvious severity of our client's condition and approved the OTR.  This illustrates the waste of time spent by the Stage agency, whose doctors continue to deny people who have sufficient supportive medical evidence to be approved.

It may seem obvious to a claimant that their medical condition renders them disabled from working a fulltime job.  However, it is not so obvious to Social Security, which is why you should retain an experienced disability attorney who understands exactly what is needed to obtain a successful outcome.  Our office in Melville, Long Island offers free phone consultations for anyone considering applying for disability benefits.

Veteran Approved for SSD

When a veteran applies for disability through the Veteran's Affairs ("VA") Department, when they are approved, they get a disability rating based on the severity of their medical condition.

We represent a 50 year old former electrician from Manhasset, NY, who suffers from severe PTSD, major depressive disorder, acute stress disorder, and back problems.  The VA gave him a rating of 100% disability based on the severity of his conditions.

It would seem obvious that Social Security would find him disabled based on the VA's rating.  However, the State agency denied him both at the initial application and at the reconsideration level, even though he had strong support from his doctors, and we provided them with his VA disability approval.

Today, administrative law judge ("ALJ") Michelle Allen issued a Fully Favorable decision, finding all the evidence we submitted from his doctors and the VA supported finding him disabled.

Even though to many people applying for disability, it seems obvious that they qualify for Social Security Disability ("SSD") benefits and should be approved, their outcome is not always favorable.  It is imperative to retain an experienced, knowledgeable disability attorney who knows what medical evidence is needed for a favorable outcome.  Medical records alone are not enough to win an approval for SSD benefits.

Our Melville, NY office offers free phone consultations for anyone considering applying for SSD benefits.  We will discuss our strategy to provide you with what information you would need to have a strong, successful claim to win your case.

  

Rare OTR

It has become increasingly rare for an Administrative Law Judge ("ALJ") to approve an on the record ("OTR") request, and when they do, it typically is for individuals over 50 years of age.  Social Security recognizes that people over 50 may have difficulty adapting to new job requirements, and possess fewer transferable skills, which is why approval of OTRs are more likely if the claimant is older than 50.

We represent a 48-year-old claimant from Williston Park, NY, who suffers from Long Covid. Her symptoms include severe migraines, brain fog, chronic joint pain, and pulmonary problems. The claimant's physicians provided detailed medical records and impairment questionnaires to support her claim. Although her case was very strong, it was denied at the initial application and reconsideration levels by the State agency.

We appealed her claim, and a hearing was eventually scheduled with ALJ Linda Stagno at the Long Island hearing office. Despite the claimant being 46 years old at her onset date, we submitted an OTR due to the substantial medical evidence from her doctors.

ALJ Stagno approved the OTR, and issued a Fully Favorable decision. Our client was overwhelmed with gratitude. The favorable outcome of this claim underscores the importance of retaining an experienced disability attorney if you are planning on applying for Social Security Disability (“SSD”) benefits. Our office in Melville, NY offers free phone consultations. Our primary goal is obtaining approvals for our clients while also alleviating the stress associated with applying for SSD benefits independently.

DDS Wastes ALJ's Time

The analysts at the State agency deny too many cases when there is more than enough medical evidence to approve a Social Security Disability ("SSD") claim.  Sometimes, the State agency, known as Disability Determination Services ("DDS"), will issue a partially, favorable decision, which means they find the claimant disabled after the date when the claimant maintains they became disabled.  This was the case for one of our clients.

We represent a 61 year old police officer from Glenwood Landing, who worked at Ground Zero.  Due to PTSD from the work he did at Ground Zero, our client took a job as a handyman.  After performing that work for several years, he had to stop because his PTSD, depression and anxiety worsened.  He also suffers from musculoskeletal conditions.  The treating doctors were very supportive, and we submitted objective and subjective  medical evidence to the State agency.   The DDS issued only a partially favorable decision.  We filed an appeal for reconsideration with DDS, but they denied him again.

 

Our claimant had a hearing scheduled with the hearing office on Long Island.  I submitted an on the record ("OTR") request, explaining that there was no need for a hearing to approve the claimant for the additional benefits.  ALJ Allen agreed with my OTR request that no hearing was necessary, and issued a fully favorable decision today.

 

It is important to retain an experienced, disability attorney who knows what medical information you need from your doctors, to support that you are unable to work a fulltime job based on the restrictions you have from your medical conditions.  You need someone to fight for you.  Our office, located in Melville, Long Island, offers a free phone consultation.  We will fight for you.

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.

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.

 

SS Delays

It seems that every day we are reminded that the local Social Security offices and the State agencies are experiencing delays due to "backlogs."

We represent a 62 year old Ultrasound Technician from Longwood, Florida.  We filed her application for Social Security Disability ("SSD") benefits on January 8, 2024.  We contacted her local office in Florida repeatedly to discover why her case had not been transferred to the State agency.  We finally had to ask Public Affairs to get involved.

Ms. Love, from Public Affairs, told us that the average wait time in Florida for a claim to get assigned to an analyst at the State agency was 230 days.  With Ms. Love's diligence and help, she was able to get our client's case transferred to an analyst in October.  We submitted all of the supporting medical evidence we had been collecting, and the claimant was approved 2 months later.

It is a long and arduous process to apply for SSD benefits.  We are here to help.  Our office, located in Melville, Long Island, offers free phone consultations.  Please feel free to reach out if you are planning on applying for SSD benefits.

OTRs

Most times, a request for an on-the-record (“OTR”) decision is not considered until a couple of days before a hearing is scheduled to take place. Nonetheless, an OTR should still be pursued because it avoids the stress a claimant experiences when having to attend the hearing with an ALJ. Also, ALJs appreciate OTRs because they allow ALJs to devote more time to more complicated claims.

We represent a 57 year old security guard from Jamaica, who stopped working due to pain from various musculoskeletal impairments. The State agency medical consultants found the severity of the claimant’s pain to be credible. However, those consultants denied Social Security Disability (“SSD”) benefits twice because the claimant had no doctor providing functional limitations.

Since the claimant had to stop working because of pain, we referred the claimant to a pain management specialist, who supplied the requisite opinion. Based on that opinion, we submitted a brief explaining why the medical and vocational evidence in the file supported finding the claimant disabled under the Social Security rules and regulations. The ALJ agreed.

Retaining a disability attorney who has years of experience handling SSD claims is in your best interest. We have an encyclopedic of knowledge of the ins and outs of the SSA, from the initial application with the local office, to working with the State agency, the ALJ’s, and if necessary, the Appeals Council and Federal Court. If you want to greatly increase your chances of receiving a favorable outcome to your SSD claim, please contact our Melville, Long Island office for a free phone consultation.

 

 

 

 

The Truth about Immigrants and Social Security

by Susan Golden

It is no secret that getting approved for Social Security Disability ("SSD") benefits is a battle.  To be entitled to SSD benefits, a person must have worked and paid into Social Security long enough to earn at least 40 work credits.  If you don't have enough work credits, you might be eligible for Supplemental Security Income ("SSI").  You must meet the same medical criteria, but you also have to meet the financial criteria.

Before filing a claim, we make certain that our clients have current treating doctors who support their inability to work fulltime due to their medical condition(s).  After their application is filed, it is processed by their local Social Security office and then sent to the State agency ("DDS") for review.  But even when we submit supporting medical evidence to DDS, mostly due to the incompetence of their analysts, our client is denied.  More than half of the time, claimants are denied at the initial application, and at the first level of appeal, reconsideration.  As we've discussed so much over the years, the State agency analysts are civil service workers, not doctors or lawyers, and they deny claimants erroneously all of the time.  Claimants have a much better chance of getting approved at the hearing level simply because there are actual attorneys reviewing the claims and experienced Judges presiding at the hearing, if one is needed.  We've had quite a few of our claimant's cases approved On The Record over the past few months, because we have decades of experience handling SSD claims.

We receive a lot of phone calls from people who have applied on their own and have been denied.  They've realized that this is not an easy process, they cannot do this on their own and they are ready to retain us to take over their claim for them.

It has come to our attention that vice presidential candidate J.D. Vance, has been making false claims stating that, "Social Security and Medicare are facing a “massive fraud problem” because of undocumented immigrants who are collecting benefits, citing what he said were incidents of fraud related to him by some of his constituents and friends."   As we stated above, it is difficult to get approved for Social Security even when you meet the eligibility requirements.  You cannot collect benefits if you do not have a Social Security number.  If an immigrant has a Social Security number, and they have enough work credits and a disabling condition that prevents them from working full-time, they will be eligible to apply for benefits, and are entitled to them, just as any U.S. citizen with the same criteria is.

We want to make it perfectly clear that you will not be eligible for SSD benefits if you do not have a Social Security number and if you do not have enough work credits.  If someone tells you that immigrants are taking away your Social Security benefits, they  are dangerously misinformed and do not know what they are talking about.

 

 

"Let's Get Loud" Series - Mental Health Records

by Susan Golden

Claimant 6 – Veteran Rating 100% Disabled and SSA Rules on Mental Health Records

The State Agency denied Mr. C’s case without considering more than half the evidence we submitted.  The denial letter only referred to Mr. C's therapist, and the State Agency’s inability to obtain records from the therapist.  The truth is that we submitted a Medical Findings Summary from the therapist, along with a narrative report from her in lieu of sending her records, per Social Security's own website.  We also had submitted a Medical Findings Summary from the claimant's psychiatrist along with her records.  Furthermore, we submitted a letter from the VA rating Mr. C's disability at 100%.  There was no mention of any of these documents in the denial letter at all.  The continuous denial of claims based on falsehoods at DDS has reached an intolerable point of intentional laziness, disrespect and uncaring.  

 

OTR Efficiency

An on-the-record (“OTR”) decision saves a claimant time by receiving an approval before a hearing with an Administrative Law Judge (“ALJ”) takes place.  An OTR can also save a claimant money.  Since attorney fees grow each month before a claim is approved, by receiving an OTR well in advance of the hearing, there are fewer fees to pay. Unfortunately, most ALJs will not look at a brief requesting an OTR until a couple of days before the scheduled hearing.

An OTR also avoids the stress a claimant experiences when having to attend a hearing with an ALJ.  Hearings can last for a couple of hours if there are experts, and hearings usually do not start on time.  If the case is strong, ALJs like OTRs because they free up time and resources for more complicated claims.

We represent a 55 year old claimant from Franklin Square with physical and mental impairments, who worked as a teacher’s aide and an administrative clerk.  Those occupations are considered light, i.e., more strenuous than sedentary work.  I submitted a brief showing how Vocational Experts had testified that both occupations provide no skills that transfer to sedentary work.

FI showed that five treating doctors explained why the claimant could not even perform sedentary work.  The State agency medical consultant, whose credentials could not be determined because the State refused to disclose the full name, was the only doctor who believed the claimant could work.  The State consultant never saw the claimant, and failed to review most of the medical records.

Given the above facts, I maintained that the claimant should be found disabled under the Grid rules, even if she were capable of full time sedentary work.  Consequently, I asked the ALJ to issue an OTR.  The ALJ agreed that an OTR would be appropriate, which eliminated the need for the claimant to attend the hearing.

This is a perfect example of why retaining an experienced, knowledgable disability attorney is in your best interest if you intent on applying for SSD benefits.  Please call my Long Island office for a free phone consultation.