Monthly Archives: August 2011

Coronary Heart Disease and SSD Benefits

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Obesity, diabetes, high blood pressure, smoking, lack of exercise, and chronic kidney disease can all contribute to an increased risk of heart disease.

Claimants who have coronary heart disease may experience a variety of symptoms including chest pain, pressure in their chest, breast bone, neck, stomach, arms or upper back, difficulty breathing and fatigue.

Treatment for heart disease will vary for claimants, depending on the severity of the condition, but can consist of ACE inhibitors to lower blood pressure and protect your heart and kidneys, aspirin, diuretics, nitrates, statins, and beta blockers.

If you have a disabling health condition that is expected to last for 12 continuous months and your impairment is so severe that you are unable to perform substantial work (making more than $1000 per month) you may qualify for one of two disability programs offered by the Federal Government and administered by the Social Security Administration. These programs are the Social Security Disability Insurance program (SSDI) or Supplemental Security Income program (SSI).

To qualify for Social Security Disability Insurance (SSDI) you must also have worked long enough and paid enough taxes to be considered “insured”. To determine if you are insured you can contact the SSA at 1-800-772-1213 or you can preview your most recent SSA statement of earnings. The statement of earnings will also outline your estimated Social Security Disability Insurance payment amount if you do qualify for earnings. If you do not have your most recent statement you can contact the SSA at 1-800-772-1213 and they can give you an estimated payment amount.

Claimants who have not worked or have worked and not paid taxes may qualify for Supplemental Security Income (SSI) which is offered to the blind, disabled, or aged (65 years or older) who are unable to perform substantial work for at least 12 continuous months and who have VERY limited income and resources.

Do you qualify for SSDI or SSI for Coronary Heart Disease?

Claimants may qualify for either SSI or SSDI either by “meeting a listing” (having a condition which is listed on the SSA Listing of Impairments) or proving their heart condition is so severe they cannot work.

Meeting a Listing for Coronary Heart Disease

The SSA has several listings for the cardiovascular system which consider disabling including chronic heart failure, ischemic heart disease, and cardiomyopathy. Claimants will need medical evidence of their condition including angiograms, echocardiography, and electrocardiography to assess the severity of the heart disease.

Claimants whose condition does not meet a listing can attempt to prove their condition is so severe they are unable to perform their current job, past relevant work or retrain for new employment. The SSA will review the age, education, work experience, and health condition of the claimant to determine if they could find new employment. The SSA has rules called medical vocational rules that they use to assist with this decision.

If you would like an attorney to review your claim you can fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now. 

How long will I have to wait for SSDI Benefits?

Many Social Security Disability claimants have heard that the SSA immediately denies all first time Social Security Disability Insurance (SSDI) applications. Other claimants have heard that it could take two years to get SSDI. It is no wonder that many SSDI claimants are confused about the disability process and how long they will have to wait for their first SSDI payment.

According to the Fiscal Times, there has been a rapidly increasing number of disability applicants. Last year alone it is estimated there were 3 million disability applicants. Thomas Foley, deputy director of the World Institute on Disability in California, described the crisis facing many disabled people as, “A perfect storm of the baby boom bubble, the economic downturn and the housing market collapse.”

What does this mean for you? Unless you have a condition that automatically meets a listing on the Social Security Administration’s Listing of Medical Impairments or Blue Book (which is a list maintained by the SSA of conditions that they believe are automatically disabling). Your Social Security Disability Insurance application may be placed in a long line with hundreds of thousands of applications that have to be reviewed by a limited number of SSA disability examiners.

What is the Social Security disability process and why does it take so long?

SSDI applicants can file for disability either online, on the phone or in person at a local Social Security Administration office. The SSA office will review the SSDI application and make sure the claimant meets all of the non-medical requirements. This will include reviewing the whether a claimant is considered “insured” and whether they have worked and paid enough taxes to qualify for SSDI.

If the claimant is not insured, they will be denied SSDI benefits, regardless of the severity of their condition. The SSA will not pull any medical records and review their mental or physical health condition is they do not meet the non-medical requirements.

If the SSDI claimant has met the non-medical requirements, their SSDI application is sent to the appropriate Disability Determinations Services Offices (DDS) for review. It can take 90 to 120 days for the Disability Determinations Services Office to review the claim and make a disability determination. Up to 70% of initial disability applications are denied.

Reconsideration Appeal Process for SSDI

Reconsideration is the first step in the disability appeals process for the Social Security Disability Insurance denial and must be made within 60 days from the date of the initial application denial letter.

Do claimants win benefits at reconsideration? Yes, approximately 20% win SSDI benefits at this level. Unfortunately, reconsideration is simply a second review of the claimants SSDI application by another examiner in the DDS office who was not involved in the first SSDI disability evaluation.

The second DDS examiner will use the same criteria to evaluate the SSDI claim and generally will have the same medical documentation, unless the claimant has proactively acquired more information and sent it to the SSA.

Up to 80% of reconsiderations will be denied, and the SSA will notify the claimant of their denial decision within 30 to 90 days.

Administrative Hearing for SSDI

What if you are denied for SSDI at reconsideration? Claimants have 60 days to request an appeal for an administrative hearing before an Administrative Law Judge. Most claimants who have not hired a SSDI disability lawyer will choose to do so at this step.

Do you have to have a SSDI disability lawyer for the SSDI disability hearing? No, but unless you fully understand how the SSA determines you are disabled and you are ready to argue why you have little residual functional capacity to work jobs which are suggested by a vocational expert at your court hearing, it is a good idea to consult with a disability attorney.

Most of the waiting in the appeals process happens at the administrative hearing level.

If the disability claimant requests a hearing the Social Security Disability claim is sent to the appropriate Office of Disability Adjudication and Review (ODAR) for the region.

Administrative hearing case loads can number in the hundreds and wait times vary widely by district. Some courts may have 5 to 10 Administrative Law Judges who are scheduled to perform the SSDI administrative hearings. It is not unusual for SSDI disability claimants to wait 12-14 months for a Social Security Administrative Hearing to be held.

What if I win at the Reconsideration or Administrative Hearing Level?

What if you are approved at either the reconsideration or the hearing level? How long do you have to wait to receive your SSDI benefits? Estimates can vary widely. The SSA estimates a 30 to 90 day waiting period to receive SSDI benefits, but they will send out a letter detailing the estimated payment amount and date of payment. Keep in mind, in many parts of the country the wait could be much longer.

When we are asked how long it could take to get SSDI benefits we say 60 days to 2 years. Claimants who immediately meet a listing or who have a condition that allows their SSDI benefits to be expedited will receive their SSDI benefits fairly quickly. If a claimant has to appeal their SSDI denial all the way to an Administrative Law Judge the wait could be as long as two years.

Hiring a SSDI Lawyer

There is good news; the SSA has implemented some good programs to identify claims that should be immediately approved. Talk to your disability lawyer about whether or not your condition makes you eligible for an expedited SSDI payment. The bad news is there are more people applying for disability than have ever applied before.

If you would like a disability attorney to review your Social Security Disability Insurance claim you can fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now.

Can I get Social Security Disability with a Mental Illness?

There are a variety of mental health disorders that the Social Security Administration will consider disabling. Claimants may be able to win Social Security Disability benefits either by “meeting a listing”, which means their condition is listed in the Social Security Administration’s Listing of Impairment or Blue Book (a list of conditions the SSA automatically considers disabling) or by proving their mental health condition is so severe they are unable to perform substantial gainful activity for at least 12 continuous months through a medical vocational allowance.

So what types of mental health disorders does the Social Security Administration have listed in their SSA Listing of Impairments or Blue Book?

Common disabling mental health conditions and their corresponding listing number are below.

  • Organic mental disorders (12.02)
  • Schizophrenic
  • Paranoid and other psychotic disorders (12.03)
  •  Affective disorders (12.04)
  • Mental retardation (12.05)
  • Anxiety-related disorders (12.06)
  • Somatoform disorders (12.07)
  • Personality disorders (12.08)
  • Substance addiction disorders (12.09)
  • Autistic disorder and other pervasive developmental disorders (12.10)

Keep in mind, to meet a listing your condition not only has to be listed, you also have to have symptoms or limitations which are as severe as the ones listed in the Blue Book. Having the condition may be insufficient if your condition is not serious. For instance, claimants who claim to be “depressed” may experience mild mood swings or loss of interest in activities or they may be suicidal.

So what types of issues does the Social Security Administration assess for a mental health disorder? The SSA will review a variety of factors including how the mental health disorder affects the following:

  • The impact on the claimant’s daily living and social functioning
  • The ability of the claimant to maintain concentration, pace, persistence in a work environment
  • The amount and duration of their episodes of decompensation, including increases in the claimant’s medications or psychological support system or increased hospitalizations. (Episodes of decompensation generally are three episodes within 1 year, or an average of once every 4 months, each lasting for at least 2 weeks).

If your condition does not meet a listing, you may be able to qualify for SSDI or SSI benefits, but it will be more difficult.  The Social Security Administration may concede you have a serious health condition but you will have to work a little harder to convince them that you are unable to work due to your mental health condition.

So, how do you prove that you cannot work? First it is important to understand what you need to prove. If you have been seeing a mental health specialist your medical records probably prove that you have a mental health disorder, but do they prove that you cannot work (perform substantial activity) or explicitly outline your residual functional capacity to work?

If your condition does not meet a listing, the SSA will complete several additional disability evaluation steps (which are part of their Five Step Sequential Evaluation) and see if you can qualify for disability under a medical vocational allowance. The SSA will answer two questions. 

  • Can you perform the work you performed in the past?

Many claimants can prove that their condition is so severe that they cannot work their current job, unfortunately, this will not be enough to win SSD benefits. If you cannot work your previous job, the SSA proceeds to the next question.  

  • Can you be retrained for new work?

Under this step the SSA will determine if you could be retrained for new work. To make this determination, the SSA will review your education, work history and transferable work skills, your age, and your residual capacity to work. If the SSA determines you could not retrain or adjust to other work, they will award SSD benefits. If they determine you could retrain for new employment, they will deny SSD benefits.

What does the SSA need to find you disabled?

The Social Security Administration asks claimants to list the names of their doctor’s addresses, phone numbers and dates of treatment. This information is used to gather medical evidence from all of your medical sources. Make sure this information is complete or this could add weeks to the disability evaluation process.

After the SSA has gathered all of your medical records the Disability of Determination Services (DDS) Offices will evaluate your medical record. The DDS will review your medical files, your diagnosis, your residual functional capacity to work, and determine if you meet mental or physical health condition meets their definition of disabled as determined by the sequential evaluation process.

Hiring a Disability Lawyer

What is the most important thing you can do to improve your chances of winning disability for a mental health condition? Get great medical help, consistently see a doctor, take your medication and make sure your medical file clearly states why you cannot work.

If you would like a disability attorney to review your claim you can fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now.

Should you go to the SSA doctors?

The first mistake claimants make is to assume if they are required to see a consultative examiner that they are seeing a “SSA doctor.” The CE or consultative doctor is an independent contractor. They are not a government employee, and they are required to give an objective opinion about a claimant’s mental or physical health conditions.

When will the Social Security Administration (SSA) request that a claimant go to see a consultative examiner? A consultative examination will only be required if the SSA does not have enough information to make a disability determination for a claimant. This could happen if the treating physicians have not sent the patient’s medical records to the SSA as requested, the claimant has not seen the appropriate specialists, or the patient does not have sufficient medical evidence to support their claim of disability and the SSA disability examiner needs more information to make a disability determination.

One of the biggest mistakes Social Security Disability claimants make is to assume that they can use the consultative examination to prove their claim and they do not have to go see their own doctor or worry about their medical file.

The consultative examiner is not providing medical care. They are only tasked with evaluating a claimant’s mental or physical health status and documenting the claimant’s functional limitations which may hinder their ability to perform substantial gainful activity.

Do these consultative examinations generally support the claimant’s claim for disability? No, they do not.  The consultative examination generally does not offer sufficient medical evidence to prove disability and should not be used as a substitute for an on-going doctor/patient relationship.

Many claimants, in fact, complain about the CE examinations which can last as little as 5 to 10 minutes. This is not enough time to accurately examine and diagnosis a patient, regardless of their mental or physical health condition.

What should you do at a Consultative Examination? 

  1. If the Social Security Administration asks you to go to a consultative examination, it is important that you attend. Claimants who repeatedly refuse to attend their consultative examinations may be denied Social Security Disability Insurance or Supplemental Security Income benefits. The C.E. is supposed to provide an objective opinion to the SSA.
  2. If you are unable to attend your consultative examination, reschedule as soon as possible. If you have hired a disability lawyer, they can work with the SSA to help you reschedule your examination. If you are at the application level, call the Social Security Administration and talk to a disability examiner.
  3. Do not keep the consultative examiner waiting. Be on time and be courteous. Remember, the doctor is trying to do their job, and it is important to make their job as easy as possible. Do not give them any reason to give you a bad review.
  4. Keep notes about the visit. How long was the visit? What did the C.E. ask you? Did you think the examination was thorough? Was the C.E. rude or condescending? Detailed records may be presented at the Administrative Hearing if necessary to prove that the C.E. did not spend enough time with you to accurately diagnose your medical issues.

What not to do at a Consultative Examination 

  1. Do not overstate or try to convince the doctor that you are disabled. Do not intentionally try to fail any type of test. The C.E. will document if they believe you intentionally failed or overstated your conditions and this information will be permanently attached to your Social Security Disability file, potentially making all of your statements seem potentially false.
  2. Do not hide any physical or mental limitations or pain. This is not the time to push through or try to be a hero. If you feel pain, let the C.E. know. Always be honest about your conditions and your resulting symptoms.
  3. We all know doctors are overscheduled. The C.E. may have a busy schedule and you may have to wait awhile to see them. Give yourself enough time for the visit and expect to wait. Understand that the doctor may spend very little time evaluating your condition and do not rely on their evaluation. This is why you have your own primary care doctor who has provided their own assessment of your ability to work.  

How do you avoid the consultative examination? Review your medical records. Are they clear? Do they provide specific information about your diagnosis, your symptoms and the job responsibilities that you cannot perform? Have you found a good doctor and specialists who are on your side and willing to help you win disability benefits?

If your doctor is not supportive or refuses to provide any help or if they have stated either verbally or in your medical record that you are not disabled, it may be time to find another doctor.

One of the most common questions on our Social Security Disability forum is about a claimant’s inability to afford medical care. Many claimants have been out of work for months and do not have medical insurance. How do you get the medical records you need to win a Social Security Disability claim if you cannot see a doctor?

This is a great question and for some claimants their only hope will be the consultative examiner and convincing them they are disabled.

If you would like a disability attorney to review your claim you can fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now. 

 

 

 

 

 

 

When will the SSA send me to the doctor for a disability evaluation?

Many Social Security Disability insurance (SSDI) or Supplemental Security Income (SSI) claimants want to know if or when the Social Security Administration will send them to a doctor.

If the Social Security Administration does not have enough medical evidence to make a Social Security Disability decision for a SSDI or SSI claimant, their primary care doctor has not sent the requested medical files to the Social Security Administration, or their treating physician is not a specialist in their medical condition, the Social Security Administration may send them to a Consultative Examiner (CE) who will perform a cursory mental or physical health review and make a disability determination for either Supplemental Security Income or Social Security Disability Insurance benefits.

Many disability claimants assume that a consultative examiner or CE works for the Social Security Administration, but they do not. They are an objective,  non-governmental, medical professional who reviews a claimant’s medical records and performs a cursory medical evaluation. They are also responsible for completing documentation from the exam and reporting back to the Social Security Administration.

If you have not seen a doctor for your mental or physical health condition and you are waiting for the SSA to send you to the doctor, stop waiting. It is not the responsibility of the Social Security Administration to send you to a doctor.

If a consultative examination is needed, this generally means your medical records are not sufficient to decide your Social Security Disability claim, and unfortunately, these examines are generally not helpful to a claimant’s Social Security Disability case. Consultation examiners are not a very good substitute for an ongoing relationship with a doctor who is sympathetic to your situation and who is familiar with the mental or physical limitations you may have to complete work.

According to Social Security Administration’s policy, they must consider your treating physician as the primary source of information about your disabling mental or physical health condition. With this in mind, you may be able to request that your physician perform the consultative medical examination. Many physicians will not do these exams, however, because the SSA requires extensive paperwork and does not reimburse much money for the examination.

If you have been waiting for the Social Security Administration to send you to the doctor, it is time to stop waiting and get the medical documentation you need to win your SSI or SSDI claim.

If you would like a Social Security Disability attorney to review your disability claim, fill out the FREE evaluation form and a disability advocate will call you to review your claim or you can call our office at 1-800-641-3759 to talk to someone now.