Monthly Archives: September 2011

Tourette Syndrome and Social Security Disability Benefits

Tourette Syndrome is a tic disorder that is characterized by multiple motor and vocal
tics. How do you know if you have Tourette Syndrome? According to the Diagnostic and Statistical Manual of Mental Disorders, claimants with Tourette Syndrome will have the following symptoms:

• Tics occur multiple times per day, each day. The duration is for no less than one year and if the condition is intermittent it does not stop for more than 3 consecutive months.
• The onset of the condition is prior to 18 years of age.
• Motor and vocal tics are present at the same time, although they may not be concurrent.
• The condition causes impairments in occupation and social functioning.
• The condition is not caused by physiological effects of a stimulant or another type of medical condition.

If you have a mental health condition or a condition such as Tourette Syndrome, which may interfere with your ability to maintain employment, it may be a good idea to contact a disability lawyer.

Proving Disability with Tourette Syndrome

In general, the Social Security, when they evaluate mental health disorders, consider how your condition affects your ability in the following areas: (a) daily living, (b) social functioning, (c) concentration, and (d) decompensation.

• Daily Living

Activities of daily living include cooking, cleaning, and laundry. It includes getting dressed, brushing your teeth, going to the grocery store, and paying your rent on time. If you are unable to complete these tasks independently or if you need daily reminders to complete them, the SSA will consider you as having “marked restriction of activities of daily living.”

• Social Functioning

Are you able to adequately function in a social setting? If you have difficulty interacting with others in a social environment, you isolate yourself, you are unable to speak in groups, or have consistent conflicts with others, you may have marked restrictions in social functioning. This type of restriction can be evidenced by evictions, multiple firings, fear of strangers, and social isolation. The SSA will recognize that severe restrictions in social functioning can limit your ability to work.

• Concentration, persistence, or pace

All jobs require claimants to maintain schedules and complete tasks efficiently. The SSA will evaluate your ability to start and complete projects and your ability to maintain focus for a certain period of time.

• Episodes of deterioration or decompensation

Any exacerbation of your signs and symptoms is considered an “episode” and multiple episodes may interfere with your ability to work. Decompensation can be evidenced by increased need for medical intervention, medication or institutionalization and is a sure sign that you can’t function at work.
Generally, to win SSDI or SSI benefits you must prove your syndrome affects several areas of functioning. Ideally, your doctor would complete reports detailing how your condition affects your daily living, social functioning, concentration, and decompensation. It is important that the doctor includes specific examples in each of these areas.

Hiring a Social Security Disability Lawyer

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

Social Security Disability Overpayments

If you have been notified that you have a Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) and not only have your disability benefits been terminated or suspended, you OWE money to the Social Security Administration you may be shocked and you may need information about what to do next. First, let’s talk about what an overpayment is according to the Social Security Administration.

What is a Social Security Disability Overpayment?

A Social Security Disability overpayment can happen if the amount you received for your Supplemental Security Income or Social Security Disability Insurance payment is more than the amount you were due. How can this happen? According to the Social Security Administration, a disability overpayment can happen for any of the following reasons:

• Your income is higher than you estimated (SSI overpayment only)
• Your living situation has changed. (SSI overpayment only)
• Your marital status has changed (SSI overpayment only)
• You have more resources than the allowable limit (SSI overpayment only)
• You are no longer disabled and you continue to receive disability payments
• You do not report a change in your income as required
• The Social Security Administration miscalculated your payment information because incorrect or incomplete information was given to them.

If you have been overpaid, the SSA will notify you or the representative payee and the notice will explain the reason the overpayment occurred, the amount of the overpayment and the repayment options. If you do not believe the overpayment is valid, you have the right to appeal.

If you agree with the overpayment

If you acknowledge the overpayment and you are receiving SSDI, the SSA will withhold the full amount of the disability benefit payment each month until the overpayment is repaid. Some claimants may be able to request that the SSA withhold only a portion of the SSDI amount, but this request must be approved by the SSA. The repayment plan would start 30 days from the date you have been notified of the overpayment.

If you are receiving Supplemental Security Income the SSA will withhold 10% of the maximum Federal Benefit Rate unless you request that less be subtracted each month. You may also ask to repay the back pay at a higher rate each month. SSI overpayments will be made 60 days after notification.

If you disagree with the overpayment amount

What if you do not believe you have received an overpayment? The SSA allows you to file a SSA-561 form to contest the overpayment. The form can be downloaded from the SSA website or you can call the SSA at 1-800-772-1213.

All appeals must clearly state why you do not think you have been overpaid. Appeals must be made within 60 days from the date of the overpayment notice.

You may be able to win your overpayment appeal if you can prove:

1. The overpayment was not your fault.
2. Paying the overpayment would cause you severe financial hardship.

The Social Security Administration may request proof of your income and expenses.

Hiring a Social Security Disability Lawyer

If you would like a Social Security Disability attorney to review your Supplemental Security Income or Social Security Disability Insurance overpayment, 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.

Social Security Disability Benefits and Low IQ

The Social Security Administration does consider a low I.Q. or mental retardation as disabling, although proving disability will require medical documentation which outlines the claimant’s decreased mental functioning.

The claimant must also have seen the proper medical doctors and taken the appropriate tests to prove they have difficulty performing routine, simple and repetitive tasks.

According to the Social Security Administration’s Listing of Impairments or Blue Book, Mental Retardation is found under section 12.05 Mental Retardation.

12.05 Mental retardation:

Mental retardation refers to significantly below average general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period. The evidence demonstrates or supports onset of the impairment before age 22.

The required level of severity for this disorder is met when the requirements in A, B, C, or D are satisfied.

A. Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, or bathing) and inability to follow directions, such that the use of standardized measures of intellectual functioning is precluded;

OR

B. A valid verbal, performance, or full scale IQ of 59 or less;

OR

C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function;

OR

D. A valid verbal, performance, or full scale IQ of 60 through 70, resulting in at least two of the following:

1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.

Keep in mind, meeting this listing will require proof that your mental retardation existed prior to the age of 22. This can be done with IQ exams, evidence of attendance in special education classes or school records.

If you do not meet this listing you may be able to prove that your IQ is very low and that, combined with other mental health conditions, it severely limits your ability to work. For example, if you have a very low IQ and a very limiting physical condition, this may severely limit your ability to work.

Additionally, the listing above only relates to mental retardation, the SSA does have other listings that may more clearly define your mental health disorder.

Hiring a Social Security Disability Lawyer

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

How Do I know if I am Disabled according to the SSA?

Many Social Security Disability claimants want to know if the Social Security Administration has a list of mental and physical health conditions or diseases which they consider automatically disabling. Yes, they do.

What is this list? It was a book that the Social Security Administration published which they called “Disability Evaluation under Social Security.” The book is also more informally called the “Blue Book” because it is actually blue.

Who uses the book? Claimants are allowed to preview the book online (Google SSA Blue Book), but it is primarily intended for disability examiners who make decisions at the initial application level and the reconsideration level, and Administrative Law Judges who preside over the Social Security Administrative Hearings.

How is the Blue Book organized?

The book has many sections, but claimants will be most interested in the sections for the disabling diseases and health conditions. In these sections the SSA lists the specific diagnosis and symptoms that a claimant needs to have to be considered automatically disabled and unable to work for at least 12 continuous months.

The Social Security Administration divides the listings into categories. There is an adult section and a child’s section. In the adult section there are the following categories: Musculoskeletal System (1.00), Special Senses and Speech (2.00), Respirator System (3.00), Cardiovascular System (4.00), Digestive System (5.00), Genitourinary Impairments (6.00), Hematological Disorders (7.00), Skin Disorders (8.00), Endocrine Disorders (9.00), Impairments that affect Multiple Body Systems (10.00), Neurological (11.00), Mental Disorders (12.00), Malignant Neoplastic Diseases (13.00), and Immune System Disorders (14.00).

One of the biggest criticisms of the SSA Listing of Impairments is that there are many conditions that do not appear in the listing which can be very debilitating. Others are listed but they are simply grouped with other listings.

My Condition is not listed in the SSA Blue Book

Many claimants peruse the listing and do not find their conditions or they realize their condition is not as severe as the condition listed. Many claimants have multiple health conditions which may not be listed but may, in their entirety, be so disabling that the claimant does not have the residual functional capacity to work.

If your condition is not on the list are you automatically determined “not disabled”. No, the Social Security Administration can also find you disabled using what they term a medical vocational allowance.

Determining Disability through a Medical Vocational Allowance

How is the medical vocational allowance decision made? First, the disability examiner will review the claimant’s medical records to determine if their condition is on the SSA Listing of Impairments. If it is not, the disability examiner will determine the claimant’s functional limitations to work. All of the information gathered by the DDS examiner is recorded on a residual capacity form.

The DDS examiner will then evaluate the work responsibilities the claimant had at their previous and current job and determine if they have enough residual functional capacity to do these jobs. If they do, the DDS examiner will deny their application. If they do not, the DDS examiner will evaluate whether the claimant could be retrained for new work based on their on their age, their education, and their job skills. If they are unable to retrain for new work they will be awarded either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). This is called a medical vocational allowance.

Hiring a Social Security Disability Lawyer

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

What is a Consultative Examination and what is in a Consultative Report?

Many Social Security Disability claimants want to know if the Social Security Administration has asked them to see a Consultative Examiner, what this means for their Social Security Disability Insurance or Supplemental Security Income Case.

If the Social Security Administration has requested that you see a C.E. or consultative examiner this means they do not have enough medical evidence (from the medical sources you provided) to prove that you are disabled, and they need additional information to make either the Social Security Disability Insurance or Supplemental Security Income disability determination.

According to the Social Security Administration, the claimant’s treating physician can provide the consultative examination if they are “qualified, equipped and willing to perform the additional examination or tests for the fee schedule payment and generally furnishes complete and timely reports.”

What if the primary doctor is not willing to perform the consultative examination? The Social Security Administration will use an independent source if the following conditions are met:

• The treating doctor does not want to do the consultative examination.
• There are conflicts or inconsistencies in the file that cannot be resolved
by going back to the treating source
• The claimant prefers another doctor to review their case and they good reason for their preference
• The SSA determines the treating source may not be a “productive source”

What type of tests can the consultative examiner request? It will depend on the type of additional evidence needed by the Social Security Administration to make their disability decision. Prior to completing any additional testing (such as X-ray, PFS or EKG), the medical source should contact the Disability Determination Services office and request approval.

How does the Social Security Administration select a Consultative Examination Source?

The Disability Determination Services office must purchase consultative examinations from “qualified medical sources.” As mentioned before, this can include the claimant’s treating physician or psychologist.

The consultative examiner must be “qualified”, which the SSA defines as a “currently licensed in the State and have the training and experience to perform the type of examination that they request.”

The consultative examiner must also have a good understanding of the Social Security Administration’s procedures and processes, they must understand how the SSA makes their disability determination, and they must be willing to provide the evidence and reports requested by the SSA.

How does the Social Security Administration choose who will perform the consultative examination? The Social Security Administration will make their decision based on what C.E. is available, how far the office is from the claimant and whether or not the C.E. can perform the exam and tests required by the SSA.

What is a Consultative Examination Report?

The Social Security Administration has established reporting procedures which each consultative examiner should follow. Reports should include the claimant’s claim number and a physical description of the claimant.

What is the purpose of the report? The Disability Determination Services examiner must be able to read the report and understand the nature, the duration, and the severity of the claimant’s health condition. If the claimant is an adult, the SSA should be able to determine if the worker’s condition allows them to continue to perform basic work functions.

The DDS is also validating that the report is consistent and all of the diseases, the physical and mental health impairments and the claimant’s complaints, which they outlined in their application, are adequately addressed and reported.

The DDS will also ensure that the C.E. report does not fail to mention other pieces of information and complaints that were evidenced in the claimant’s SSD file.
What does the report NOT include? The report, according to the SSA, should not include the consultative examiner’s opinion about whether or not the claimant is disabled, according to the definition outlined by the Social Security Administration.

Hiring a Social Security Disability Lawyer

If you would like a Social Security Disability attorney to review your Social Security Disability 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.