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.

Mental Health Approval

Social Security Disability (“SSD”) benefits are not only for older individuals or those with physical impairments. Serious mental health conditions can be just as disabling. Unfortunately, younger applicants often face greater challenges because Social Security frequently believes they can adjust to other types of work even if they cannot perform their past work. Our client’s case shows how proper legal representation can make a critical difference when seeking SSD benefits.

We represent a 36-year-old woman from Huntington with a long history of mental health conditions, including PTSD, panic disorder, generalized anxiety disorder, chronic depression, PMS disorder, and ADHD. After she applied for SSD benefits on her own and was denied, she contacted our office to take over her case. We strengthened the medical and vocational evidence, and secured confirmation from her doctors that she was significantly limited in her ability to function in a work setting, which became a key part of her case.

Ultimately, we requested a hearing before an Administrative Law Judge (“ALJ”). At the hearing, a vocational expert evaluated whether jobs existed in the national economy that our client could perform. Based on the mental health limitations, the expert testified that there were no jobs our client could perform on a sustained, full-time basis. After reviewing the evidence and testimony, the ALJ approved her application for SSD benefits. This case exemplified the difficulty that younger individuals with mental health conditions face with the disability process. With our experienced representation, recognizing the type of medical support needed, and careful preparation, our client was able to secure the SSD benefits she deserved.

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.

SS Delays Worsening

The Social Security Administration (SSA) has been facing challenges for years due to understaffing, underfunding, and an outdated infrastructure that has impacted millions of Americans. In January 2025, President Trump authorized Elon Musk to establish DOGE, which granted considerable authority to reduce funding for government agencies, with the intent of curbing federal spending and minimizing inefficiency. DOGE’s stated objectives included modernizing information technology, enhancing productivity, and reducing excessive regulation and expenditures. However, budget reductions have compounded difficulties for agencies already facing operational struggles, and in particular, the SSA.

According to The Washington Post, delays at the SSA have intensified as a result of DOGE's measures, such as workforce reductions, early retirements, and office closures. These changes have had far-reaching consequences for individuals nationwide. While the Trump Administration has claimed improvements, such as shorter wait times to reach customer service representatives, the experiences and data reported by both claimants and the SSA employees differ significantly. Although telephone wait times may have decreased, callers are now routed to offices outside their local area, which can prevent access to complete and relevant information. This shift frequently results in inefficiencies, as representatives may lack the necessary knowledge or training to resolve specific inquiries.

Additionally, reduced staffing has led to increased wait times for hearings, decisions, and benefit disbursements. The expedited claims process, previously available for individuals facing urgent financial hardship, no longer moves as swiftly as before. For example, some clients experiencing homelessness continue to face extended waiting periods for hearings, even when their cases are designated as expedited, such as our client, who has been living in his car for months.  Even worse, thousands of claimants die waiting for their claims to be processed completely.

While DOGE initiatives may have achieved cost savings, they exacerbated many existing issues within the SSA. Potential solutions could include rehiring experienced staff to address the backlog and streamlining administrative procedures, such as reducing redundant paperwork, to improve efficiency without compromising service quality.

 

 

Listing Approval

Typically, Social Security processes disability benefit applications very slowly, and the government shutdown has made the wait even longer.

We represented a 45-year-old Patent Examiner from Freeport, New York, who struggled with several severe mental health conditions. Over the past 20 years, she had been hospitalized more than eight times. Her difficult childhood contributed to diagnoses including severe PTSD, schizophrenia, bipolar disorder, depressive disorder, along with hallucinations and panic attacks.

After being denied benefits at both the initial and reconsideration stages, our client retained us when her case was sent to the hearing office. We collected all her medical records, including each hospitalization. We also secured detailed questionnaires and letters from her treating physicians, one of which confirmed that she met Social Security’s criteria for Listing12.03. To reinforce our case, we compiled a chart comparing her symptoms, as documented in her medical records, directly to the listing requirements, clearly demonstrating to the administrative law judge ("ALJ") that she was unable to work in any capacity.

Just three days after the hearing, the ALJ who rarely approves mental health cases, issued a favorable decision.  The strength of the evidence we submitted convincingly established our client’s inability to work, and the medical expert had no choice but to concur with the opinions of the treating specialists.

Compassion v. Calculation

We recently handled a difficult, yet unfortunately common, case that perfectly illustrates a critical flaw in the Social Security Disability ("SSD") Insurance system.  Our client, a 57-year-old golf cart technician from Port St. Lucie, Florida, was recently diagnosed with Stage 4 Pancreatic Cancer. This devastating diagnosis immediately met the criteria for a Compassionate Allowance.  The good news is that the Compassionate Allowance designation worked as intended: his claim was approved in just three weeks. In a time of unimaginable stress, this rapid decision was a small victory, lifting the burden of uncertainty from his family.  However, this victory was overshadowed by a hard reality: the mandatory five-month waiting period for SSD benefits.

By law, an applicant cannot receive their first SSD benefit payment until up to six months after their established onset date when they became unable to work.  Our client stopped working last month.  This means that despite his terminal diagnosis and rapid SSD approval, his first payment will not be due for about six months from the onset date.  The cruel irony is undeniable. Our client, with a terminal illness recognized by Social Security as immediately disabling, may not survive long enough to ever receive the benefits he and his family desperately need and deserve.  Common sense would suggest that when a disability is recognized as terminal, this five to six month waiting period should be inapplicable. Unfortunately, the delay from the waiting rules runs counter contrary to the issuance of a a Compassionate Allowance.

As experienced disability advocates, we knew going into this case that a quick approval meant we would not receive a fee.  We were happy to help our client and his wife navigate the complexities of the SSD application process during this excruciating time.  Our priority was to shoulder the stress of the paperwork and give them back precious time to focus on what truly matters.

This case is a stark reminder that while the Compassionate Allowances program speeds up the approval process, a necessary reform is still needed to bring true compassion to the payment schedule for those with terminal conditions.

 

Quality Review Increases

The Social Security Administration pulls disability claims for review that have been decided by the Stage agency at the initial application.  Social Security Disability claims selected for Federal Quality Review are said to be chosen at random, including both approved and denied cases. However, in my three decades as a disability attorney, only approved claims have been reviewed. Each time we check with the local office, only approved claims have been pulled, which shows the process is not random.  Since the beginning of this year, every one of our cases that have been approved at the initial application were pulled by Quality Review.