Social Security has published proposed regulations in the Federal Register requiring disability claimants and their attorneys or other representatives to notify the agency or submit all medical records concerning a Social Security disability claim.
This proposal includes a statement that "When you submit evidence from another source, you must submit that evidence in its entirety." I don't know how to interpret this other than to mean that if I request a hospital record, I must request and submit the whole thing, which can easily run over 1,000 pages on a single hospitalization. Even an overnight hospitalization will result in hundreds of pages of records. The proposal says explicitly that Social Security intends to simplify matters by removing all discretion from the claimant and attorney. I could, in the alternative, simplify notify Social Security that the claimant was in the hospital but these days it's unlikely that an ALJ would, on his or her own, request the hospital record. In terms of outpatient records, if the claimant has been going to the same physician for 20 years, if I'm going to obtain and submit the record, I don't see how I can limit it to a particular time period. I would have to request the entire record. Social Security says that I have no discretion. Also, I don't see how I can not request lab reports, x-ray reports and other documents contained in the physician's records. I would have no discretion.
By the way, if I, as an attorney representing a Social Security disability claimant, has no discretion to not request the entirety of any medical record, why should Social Security?
I think that Social Security means well but this is unworkable. On its face, it wouldn't increase the quantity of medical records that claimants and their attorneys submit; it would reduce it by making it impractical for an attorney to obtain and submit many records.
In agreement, I think the complete record should be sent out to any CE's that the Agency requests. Instead of picking 25-40 pages to sent out the whole enchilada should go and be reviewed by the CE.
ReplyDeleteSend it all. Its our job to determine what's relevant, not the reps. No more withholding bad evidence for you!!!
ReplyDeletenot sure how this is "unworkable."
ReplyDeleteStep 1. Request records.
Step 2. Scan to e-file.
Step 3. Done.
What part is "unworkable"?
If anything, this benefits you. The likelihood of an opinion being missed and therefore open for remand just increases.
The rule says you must inform SSA of any records,not that you must obtain them. If there is a 1000 page record for a hospitalization, I will submit what I think is relevant and inform SSA that they can get the rest if they wish. The rule says inform OR submit. If a claimant has gone to a doctor for 20 years, I will inform SSA of that fact and submit medical records of the relevant period. I think that complies with the rule, based on a cursory reading.
ReplyDelete@ 11:43 - It is unreasonable to think a CE provider is going to read hundreds of pages. Doing so guarantees that the CE physician will not read any of the background material.
ReplyDeleteAs an "insider", who leans toward looking out for the claimant, the public we serve, I must add that SSA itself does not "submit" the entire record when it Exhibits a case, especially non-medical cases (e.g. overpayments, SGA ccessations, etc.). They tend to exhibit what supports the prior determination, or what they perceive addresses the "issue" as they see it. The newish process of preparing folders before sending along to the hearing office actually includes instructions to inlcude all documents that support the prior adverse determination. There is no encouragement to inlcude any mitigating evidence. ALJ's who accept what they are given in this process do not have a full picture, and cannot possibly advocate for the truth, which is job #1, in this writer's opinion.
ReplyDelete@8:24,
ReplyDeleteThank you! Now I understand why so many cases over the last 24 years which arrived at ODAR from Disability Determination Services have lacked very relevant MRIs or other strong evidence which should have been received from treatment providers. When I reviewed my client's ODAR files and didn't find these (in the days of paper files), I naively figured that a reviewer had pulled that page for special examination and carelessly misplaced it. This happens more frequently than one would suspect. Now I know why!
12:42 and 1:29
ReplyDeleteOk, I'll be glad to comply with the rules and let you decide what is relevant in 1000 pages of nursing notes. If that's not unworkable for you, you have a lot more time on your hands than you should and the tax payers are paying you way too much. Have fun!
The proposed rule requires you to submit all evidence related to the disability claim. If you have been seeing Dr. Bob for twenty years, but your disabling condition only arose three years ago, you only need the records for those three years.
ReplyDeleteIf the hospitalization results in 500 pages, most of which are worthless, you have to submit all 500 and I have to look through all 500; however, you could arrange the records so that the discharge summary and pertinent test results are near the top or you could identify the page numbers of the most important information to help focus the review.
The purpose of this proposed change is to prevent representatives from withholding records that are unfavorable to their clients (as a particular national disability firm has been known to do) and to prevent the habit of some representatives from holding onto a medical opinion or recent medical record so that if the case is denied, they can submit the "new" evidence to the AC and get a remand. Thankfully, there are only a few representatives in my area that pull this type of shenanigan; most representatives try to submit all records they know about.
SSA does not hide records; if records are not exhibited in a disability claim it is probably because the case technician was not careful during workup; the typical file contains more exhibited material than necessary -- i.e. duplicates, CE payment vouchers or appointment notices, etc.
As for nondisability cases, the poor workup is a result of poor training regarding what documents are necessary/relevant, the fact that documents are often not all gathered in one location, and the fact that ODAR does not have access to some of the databases the DO and Payment Center has and getting those entities to share their information is not always easy.
I won't go as far as to call this "hiding" evidence, but there is at least one important document or set of documents missing from every case I've seen. The record is supposed to contain all communications between the SSA and the ALJs to CE's and ME's. I have yet to see a document from DDS or ODAR to a CE or ME listing what records are sent to them or, in the alternative, a reproduction of the records sent to them.
ReplyDeleteAt least in my area, the CE Reports often identify what exhibits DDS sent to them.
ReplyDeleteAs for medical experts, if you want to know what they were sent, just look in the "F" section of the disability file.
And the ALJs, who are expected and told to spend about 2 hours per case (total, including hearing time), will never review all these records. The disabled applicants will be the ones hurt, since the ALJ decisions will be based on an even smaller sampling of the records. Talk about throwing the baby out with the bathwater!
ReplyDelete