Compassionate Allowance

Social Security's Compassionate Allowances Program allows for a quick approval for people who have a critically severe illness, such as Stage 4 cancer or a brain disorder.  When an application for Social Security Disability ("SSD") benefits is filed as a Compassionate Allowance claim, the local office is supposed to determine if the claim satisfies the criteria for a compassionate allowance.  If it does, the local office is supposed to send the claim to the State agency as a flagged claim.  The analyst at the State agency assigned to the case is supposed to expedite the claim, so instead of taking months or years to make a decision, the claimant can expect a decision within a matter of a few short weeks.

We represent two claimants with Stage 4 cancers, who were approved within weeks of filing their application.  We knew when we took their cases, we would not be collecting a fee because our fee is a percentage of a claimant's past due benefits, and there would be no past due benefits because their claims would be approved so quickly.  We could have told the claimants to apply on their own, knowing they would be approved right away, like some other lawyers would have done.  But we are not those kinds of attorneys.  We wanted to take the burden of applying for SSD off their shoulders and their families', and help in any way we could.  The last thing they needed was to be stressed and worried about applying for SSD.

 

SSD and Retirement

One of the most common questions we get asked from clients and potential clients is what happens to my Social Security Disability ("SSD") benefits when I reach my full retirement age ("FRA").  The simple answer is that when you reach your FRA, which is between 66 and 67 years old depending on when you were born, your SSD benefits automatically convert to retirement benefits.  The amount will most likely stay the same, but it cannot be less than what you were already getting for SSD.

Consistency and Persuasiveness

When the Social Security Administration (“SSA”) evaluates medical opinions, the two most important factors are supportability and consistency.  The more consistent a medical opinion is with the evidence from other medical sources and nonmedical sources, the more persuasive the medical opinion will be.  Evidence from nonmedical sources should not be overlooked.

We represent a 47 year old nurse from Bethpage with polycythemia and mental impairments.  In connection with the claimant’s Social Security Disability (“SSD”) application, we submitted letters from his friends and relatives, which described their observations about the way his impairments progressively restricted his ability to function.  The administrative law judge (“ALJ”) found their opinions “somewhat persuasive” because they were consistent with the treatment reports of the claimant’s treating sources.

The ALJ found the opinions of the state agency medical consultants regarding the claimant’s physical and mental functioning abilities “not Persuasive” because additional evidence was provided after their reviews. The ALJ found the opinion of the treating physician to be the most persuasive because, among other things, it was the most consistent with the record as a whole.

Providing detailed descriptions from third parties concerning how a claimant’s affect their ability to do things, and how their behavior has evolved, adds strength to the argument that the treating doctor’s opinion should be considered persuasive.

If you are planning on applying for Social Security Disability benefits, it is in your best interest to retain an attorney who specializes in disability.  Please call our office for a free phone consultation.  Our offices are conveniently located in both Nassau and Suffolk counties on Long Island.

 

Multiple Sclerosis

MS is a chronic neurological and eventually disabling disease that attacks the brain, spinal cord, and optic nerves. Symptoms include overwhelming fatigue, pain, numbness, and poor coordination.

The Social Security Administration (“SSA”) made it near impossible to meet the listing for MS.  Consequently, the key to obtaining benefits is explaining why the symptoms from MS credibly result in functional limitations that preclude the ability to perform full time work consistently.

I represent a 41 year old from Oceanside with MS who worked as a property manager.  The objective diagnostic tests established the MS diagnosis, which explained the presence of her symptoms.  However, the State agency denied her SSD application because it refused to believe that the claimant’s symptoms were severe enough to preclude all work.

The claimant had a hearing with ALJ Berkowitz, who immediately zoned in on the obvious.  The claimant had been earning around $200,000 annually, and the ALJ asked the claimant if she knew how much SSD she would receive.  Common sense dictated that the claimant would not forgo a job that she held for over two decades because she wanted to receive SSD benefits equal to less than 20% of her former income, and that provided credible support for the severity of her symptoms.

It seemed clear to the ALJ that the claimant was unable to work, and entitled to SSD benefits.  It seems incomprehensible that it wasn’t equally evident to the State agency that the claimant could not work on a full time basis.

Wasteful & Inequitable CEs

We represent a 53 year old business owner from New Rochelle with physical and mental impairments, whose Social Security Disability (“SSD”) application was approved today.  Last month, the claimant was warned that his failure to attend a consultative examination (“CE”) with IMA could result in his application being denied.  Due to COVID I had advised the claimant not to attend the CE.  It seemed hypocritical to me that Social Security district and hearing offices were closed due to COVID, yet the State agency wanted claimants to be physically examined at IMA offices.

Three non-for-profit institutions just published a position paper about their investigation into CEs that IMA performs.  The position paper discusses the various complaints that I have been posting about for many years now.  The position paper can be found on my Resources tab, and I would encourage anyone applying for SSD benefits to read it

Overwhelming Opinions

For various reasons, OTR decisions are written far less frequently compared to past years.  If a claimant is under 50 years old, and does not meet a listing or compassionate allowance , it is highly unlikely that an OTR will now be approved.  Today represents an exception to the recent rule.

We represent a 46 year old teacher who applied for Social Security Disability (“SSD”) benefits over a year ago due to orthopedic and mental impairments.  Even though the claimant submitted well over 1,000 pages of medical records and reports, the State agency denied her SSD application because she refused to attend a consultative examination because of COVID-19 concerns.

Even before the ALJ could review the file, the National center pulled her file and approved SSD benefits.  What made this case different is that we were able to obtain supporting functional assessments from nine (9) medical sources representing different medical specialties.  While so many reports may seem like gilding the lily, that is what it takes these days for a younger person to obtain an OTR decision.  T. Cotman, the State agency reviewer, obviously had a strong anti-claimant bias to have denied the claimant’s SSD application.

Applying for SSD can be overwhelming, time consuming, and frustrating.  While you might think it should be obvious that your medical condition(s) render you disabled, and that you should be approved for SSD benefits, you cannot assume you will be approved. It is in your best interest to retain an attorney who specializes in disability.  The road to being approved for SSD is not a straight one, and you would need an attorney to navigate it for you, to get the outcome you deserve.  If you are thinking about applying for SSD, you can call our offices for a free phone consultation.  Our offices are located on Long Island in both Nassau and Suffolk counties.