May 17, 2016

Priority Processing At The Appeals Council -- What A List!

     This month's issue of the newsletter (not available online) of the National Organization of Social Security Claimants Representatives (NOSSCR) has an article prepared by the Social Security on priority processing at the Appeals Council, which has a huge backlog. Here's an excerpt:
A list of the Appeals Council-level cases with newly submitted evidence is generated several times a week. A group of employees has started screening the listed cases to see if they meet any of the 21 circumstances below. If so, the branch chief receives the case and assigns it for priority processing. The circumstances are:
(1) Age 55
(2) Any indication or report of death
(3) Hospice, nursing care, or claimant cannot care for personal needs
(4) Intensive care unit for more than 3 days
(5) Hospitalization for more than 7 days
(6) Transplant notes (kidney, heart, heart/lung, liver or bone marrow, etc.)
(7) Transplant waiting list
(8) Cancer with poor or no response to treatment
(9) Cancer that has spread to other areas/
(10) Coma
(11) Heart attack or myocardial infarction
(12) Stroke, or cerebral vascular accident
(13) Prescribed use of home oxygen 
(14) Prescribed use of wheelchair
(15) VA disability rating of 70% or more
(16) Letter or notice approving other forms of disability payments
(17) Medical report(s) of a terminal prognosis
(18) Dialysis or End Stage Renal Disease (ESRD)
(19) Blood transfusion(s)
(20) Bed or home confinement
(21) Very rare, unusual, or compassionate allowance diagnoses
Although attaining the age of 55 is on the list, it is not necessary to submit additional evidence of a claimant’s age as SSA also screens for this. If the claimant has died, representative correspondence to that effect is sufficient. NOSSCR is working with SSA to obtain written documentation of this practice.
To verify that the Appeals Council knows a client meets one of the 21 circumstances, call the Congressional and Public Affairs Branch at 1-877-670-2722 or fax Appeals Council Ombudsman Terry Jensen at 703-605-8691.
Cases that meet one of the 21 circumstances still should not be decided in less than 25 days unless the Appeals Council obtains permission from the claimant or representative to make a faster decision. See adjacent article on this page for more information.
     This is a far more extensive list of types of cases to be expedited than is used at the Administrative Law Judge level. Why shouldn't these cases by expedited at all levels?
     I think the existence of these lists of types of cases to be expedited demonstrates the pressures caused by backlogs at Social Security. This isn't about helping people who are hurting. They're trying to expedite the cases that would make for good newspaper or television pieces on the suffering caused by the backlog.


TruthBtold said...

How do we square this with the fact that all evidence should have been submitted at the ALJ level and the fact that the AC will not consider or exhibit post decision evidence? If any of the above things on the list are post decision, I guess all it does is get you an AC denial more quickly. I have given up on asking the AC for an exception to the no new application allowed while a Request for Review is pending.

Anonymous said...

And this is the component that will help the hearings level? With a processing time of more than a year to simply say "you can go to court" 85% of the time, isn't it time to reevaluate the need for a request for review level, particularly in light of the robust informal review that is done by OGC once a case is filed in court?

Anonymous said...

Ah yes, the old abolish the AC argument, because the federal courts are capable of handling a massive influx of 100k disability cases. It's not like they have any other cases on the dockets already.

Anonymous said...

I would really like to see Congressional hearings held on the workload/delays of the AC.

Anonymous said...

2;21 pm says that the courts would be inundated with 100K filings. I don't think that would happen. Stats show that the filing rate is a constant, regardless of backlog. There are reasons why many cases that are denied at the AC level never go to court - filing fees, adversarial process, the District Court Judge might not be happy with the case presented and thus reputations are harmed, actual work must be done on arguing the case (unlike the RR level, where a simple "my client is disabled" on the 520 is sufficient). The fear of an avalanche of cases going to court is unfounded, in my opinion. In any event, as I said in my first post, OGC and its pretty sizeable resources looks at all of the filings anyway and will get the agency to voluntarily remand the case if it is indefensible. I say pilot this and see what actually happens.

Tim said...

Age 55 is considered a priority, along with comas, cancers, stroke, etc.? I don't understand how someone with a RFC of light duty who doesn't know english at age 55 is disabled!

Anonymous said...

Don’t see Stat blindness, Florid Psychosis, C1 Paralysis wheelchair bound or Morbid obesity with respiratory failure requiring oxygen on the list. Might have helped the clients I have had in their appeals, but then again it is a roll of the dice. I have started sending AC statistics to my congressman with comparative charts to 5 years ago and the OIG study noting the AC doesn’t offer quality statistics. I shudder to think the AC gang will be actually hearing cases. SSA’s management of the disability program is in an unprecedented downward spiral.

Anonymous said...

the complaints on this blog are hypocritical at best...imagine if the AC didn't prioritize these types of issues. Then you would be complaining and asking why not.

SSA is an administrative agency. At some point you have to accept how the system is administered and learn to work within the system. Do I like everything the agency does...of course not, but complaining about every decision they make gets old.

Anonymous said...


You are far too optimistic and obviously have not been with the Agency long enough to appreciate the very serious trouble it, i.e., the Hearings Process, in particular, is in. As @9:29AM stated, "SSA’s management of the disability program is in an unprecedented downward spiral." Clearly, it is the worse I have ever seen in my 30+ years with the Agency.

To overly optimistic commenter @ 11:15AM, I say, "Do you think those of us who have been with the Agency for many, many years fail to recognize SSA is an administrative agency, that we have not tried to accept how the Agency is operated and learn to work within the system, and most important, that we are not complaining about, "every little decision," but at an egregious and very serious situation which has caused the worst downward spiral we have never witnessed?" Give us some credit, man.

We are not a bunch of idiots out here, "Complaining about every little decision." I suspect you have not been around long enough to recognize the corruption, cover-up, abusive management practices, non-attorneys in the most powerful positions making crucial decisions for a Hearings Office which they are not qualified to make, top Agency Heads who are either political appointees, or in keeping with Agency history, were more than likely promoted through the ranks ahead of more qualified candidates via a Management team who thinks nothing of engaging in Prohibited Personnel Practices. We have witnessed this first hand. In my case, over 3 decades.

It is because WE CARE about the Agency that we are desperately trying to bring these issues to the forefront before the Agency completely disintegrates into chaos. We have been in your optimistic shoes for many years and acted just as you suggest. The trouble is this not only did not work, but our choice to be passive and work within the system, primarily because we were scared our careers would be destroyed by The Powers That Be if we did not, contributed to the horrendous mess the Agency, and the Hearings Process, in particular, is in. Our heads were chopped off, careers and reputations illegally destroyed by The Powers That Be anyway, so if we had it to do over, many of us wish we would have spoken up loudly and publicly until corrupt Top Agency Heads and Officials were held accountable long ago, the downward Agency spiral stopped, and we were vindicated.

Guess what, we're not going away now, and shutting up is the last thing we intend to do until these corrupt/inept Agency officials are held accountable, and the Power House is cleaned at the top and replaced with qualified legal, managerial, and HR scholars who actually know what they are doing and run the Agency as it should be.

Anonymous said...

@2:48 PM

Paranoid much? I think you need to get some fresh air or have a cocktail maybe Netflix and chill.

Show me any public agency, in any country that is run solely by “qualified legal, managerial, and HR scholars”.

Anonymous said...


So, this is the best excuse you, (suspect management), have to offer,e.g., that no public Agency in any country is competently run and managed. Surely, you can do better than this.

Your comment intimates you are not passionate about solving the worst situation the Agency has ever been, or the millions of claimants whose cases are not being heard because of your obstinate refusal to recognize and deal with this horrific situation.

Your suggestion your long term employees are CRAZY by intimating they must be Paranoid, is a perfect example of the abusive Management practices to which they refer.

You, and those like you, ARE THE PROBLEM.

Anonymous said...

AMEN 722, they most certainly are the problem and they are wrecking (have already wrecked?) the Agency.