SSD for RSD

Reflex Sympathetic Dystrophy (“RSD”), which is also known as Complex Regional Pain Syndrome (CRPS), is believed to be a nervous system malfunction that develops in response to trauma, and affects so many people that the Social Security Administration (the “SSA”) promulgated a special rule for it. 

I represent a 46 year old foreman working for a boat manufacturer with RSD whose application for Social Security Disability (“SSD”) benefits was approved today without the need for a hearing. While the claimant had submitted reports that documented the medical findings and resulting functional restrictions, the SSA did not approve the SSD benefits until the claimant submitted treatment records from the his orthopedist. 

The treatment records merely corroborated the evidence that had already been submitted. It remains unclear if the records were requested for the sake of completeness, or whether the SSA was attempting to see if there was anything in the records that would contradict the supporting evidence already in the file.

State Agency Waste and Delay

The State Agency makes the initial decision when you apply for Social Security Disability (“SSD”) benefits. Unfortunately, the vast majority of the time, it is a clerk, not a doctor, who makes the decision for the State agency. As you can imagine, those clerks usually make the wrong decision. Even worse, sometimes the clerks go out of their way to avoid approving SSD applications. 

I represent a 49 year old pharmaceutical manager with depression. The State agency clerk named T. Cotman denied the application on the grounds that the claimant’s psychiatrist did not send treatment notes to substantiate her opinions about the claimant’s mental limitations. The psychologist had submitted a report that specifically identified the medical findings supporting her restrictions and limitations due to the claimant’s depression. However, Cotman purged that report from the claimant’s file. On appeal, a copy of the report, together with the Electronic Records Express receipt showing that the State agency received it on November 23, 2012 at 2:51 PM EST, was resubmitted. 

The psychologist’s report showed that the claimant met the listing for depression. Based solely upon that report, the claimant’s SSD application should have been approved. The administrative law judge (“ALJ”) approved the claimant’s SSD application today based upon that report; as the psychologist refused to produce the treatment records on confidentiality grounds. The ALJ did have a Social Security psychologist review the report, who opined it showed the claimant met the listing. 

If Cotman had asked a Social Security psychologist to review the report, instead of purging it from the file, then the claimant’s application would have been approved more than a year earlier. Moreover, it would have prevented the hearing office and ALJ from having to expend their time and resources to do precisely what the State agency was obligated to do.

Lyme Disease

Lyme Disease is an infection caused by bacteria called Borrelia burgdorferi, which can lead to chronic encephalomyelitis. There are laboratory blood test findings that can provide objective support for the diagnosis. However, whether Lyme is considered disabling is a function of the severity of its symptoms.

I represent a 48 year old woman from Virginia with Lyme Disease that worked as an engineer, whose Social Security Disability (“SSD”) application was approved today without a hearing. The key was that the claimant was treating with the right specialist, dual board certified in Infectious Disease and Internal medicine, who prepared a very detailed narrative report, which explained why the treatment, objective and subjective medical evidence, precluded the claimant from functioning in a full time capacity. 

Many disability adjudicators are predisposed to reject disability claims based upon Lyme Disease, and frequently even question the validity of the disease itself. The narrative report was expensive, but still represented less than one month’s SSD benefits.

SSD Benefits for Hearing Loss

Can you receive Social Security Disability (“SSD”) benefits if you have problems hearing but are not deaf? The answer is yes. Perhaps the tougher question is how do you establish your entitlement to SSD benefits when you have problems hearing but are not deaf. Most claimants establish their entitlement to SSD benefits by showing how their medical conditions prevent them from performing the physical or mental demands of work. For example, claimants with back or knee problems show that their conditions prevent them from being able to sit or stand long enough to work. 

Showing how a hearing problem prevents you from doing the physical or mental demands of work is very difficult. An alternative way of establishing entitlement to SSD benefits is by demonstrating you meet the criteria of a listing. There is a listing, numbered 2.10 specifically for hearing loss.

Clearly documented medical records are needed to meet the listing based on hearing loss. Listings for many impairments are inexplicably overlooked or rejected. However, because the listing for hearing loss is based on meeting test data, there is no wiggle room for rejecting that the claimant meets the listing. 

I represent an attorney whose SSD claim was approved today. I obtained a report from the claimant’s otolaryngologist detailing why the claimant met listing 2.10. Notably, SSD was awarded without the claimant even being asked to attend a consultative examination.

SSD For Landscaper

A stroke occurs when a blood clot that is blocking an artery or a blood vessel breaks, thereby interrupting blood flow to an area of the brain, which results in brain damage. A common stroke symptom is weakness to one side of the body. 

I represent a 51 year old unskilled landscaper who had to stop working because of a stroke. The claimant’s symptoms included left sided weakness. The claimant’s application for Social Security Disability (“SSD”) benefits was approved without a hearing. 

Treatment records established that the claimant had suffered a stroke causing left sided weakness, which prevented him from resuming his strenuous work as a landscaper. Social Security rules state that bilateral manual dexterity (“BMD”) is necessary for the performance of substantially all unskilled sedentary occupations. Presumably, it was obvious that the claimant could not perform his arduous past work, and SSD benefits were approved because his lack of BMD precluded sedentary work as well.

Disability Retirement Approved Without A Hearing

I filed application for Article 15 Disability Retirement with New York State for a Motor Equipment Operator, which was approved today without a hearing being required. When seeking disability retirement, I have found that including a vocational assessment (“VA”) and independent medical opinions significantly increases the chances of approval. 

The VA uses the U.S. Department of Labor’s Dictionary of Occupational Titles (the “DOT”) to determine the occupation that most closely matches the State’s job description. The DOT then provides physical and mental demands for the occupation. In addition to exam findings, test reports and restrictions and limitations (“R&Ls”) from the treating doctors, I furnish IME and peer reviews that also provide R&Ls. The VA then compares the R&Ls to the occupation’s demands to determine if the claimant has the ability to perform them. 

The cost of the VA, IME and peer review can be substantial. Nonetheless, I believe that it is an investment that more than pays off in the long run.

SSD for Cement Truck Driver

I represent a 55 year old cement truck driver with neck and back problems whose application for Social Security Disability (“SSD”) benefits was approved today without a hearing. The interesting thing about this case is that it was approved based largely on the opinion of the claimant’s primary care physician (“PCP”). 

 In general, the rules provide that the opinion of a generalist is entitled to less weight than a specialist. Many Administrative Law Judges misapply that rule, and reject the opinion of a PCP on the grounds that he or she is not a specialist. However, when a PCP’s opinion is well supported by clinical and diagnostic findings, it may be entitled to significant or even controlling weight. 

In this case, the PCP’s opinion was supported by several MRI reports as well as exam findings by numerous other orthopedic and pain management specialists. Accordingly, there was more ample grounds for approving SSD benefits based upon the PCP’s opinion. 

There have been many times where clients have neglected to provide their PCP’s information, or were reluctant to ask them to provide reports because they were not the specialist treating the disabling impairment. This case is a perfect example demonstrating why supportive information should not be disregarded just because the source is not a specialist.