12.10 Autism spectrum disorder (see 12.00B8), satisfied by A and B:
A. Medical documentation of both of the following:
1. Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and
2. Significantly restricted, repetitive patterns of behavior, interests, or activities.
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4).
12.06 Anxiety and obsessive-compulsive disorders (see 12.00B5), satisfied by A and B, or A and C:
A. Medical documentation of the requirements of paragraph 1, 2, or 3:
1. Anxiety disorder, characterized by three or more of the following;
a. Restlessness;
b. Easily fatigued;
c. Difficulty concentrating;
d. Irritability;
e. Muscle tension; or
f. Sleep disturbance.
2. Panic disorder or agoraphobia, characterized by one or both:
a. Panic attacks followed by a persistent concern or worry about additional panic attacks or their consequences; or
b. Disproportionate fear or anxiety about at least two different situations (for example, using public transportation, being in a crowd, being in a line, being outside of your home, being in open spaces).
3. Obsessive-compulsive disorder, characterized by one or both:
a. Involuntary, time-consuming preoccupation with intrusive, unwanted thoughts; or
b. Repetitive behaviors aimed at reducing anxiety.
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4). OR
C. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already par t of your daily life (see 12.00G2c)
12.15 Trauma-and [so in the original] stressor-related disorders (see 12.00B11), satisfied by A and B, or A and C:
A. Medical documentation of all of the following:
1. Exposure to actual or threatened death, serious injury, or violence;
2. Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks);
3. Avoidance of external reminders of the event;
4. Disturbance in mood and behavior; and
5. Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance).
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4).
OR
C. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both
1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c).
12.04 Depressive, bipolar and related disorders (see 12.00B3), satisfied by A and B, or A and C:
A. Medical documentation of the requirements of paragraph 1 or 2:
1. Depressive disorder, characterized by five or more of the following:
a. Depressed mood;
b. Diminished interest in almost all activities;
c. Appetite disturbance with change in weight;
d. Sleep disturbance;
e. Observable psychomotor agitation or retardation;
f. Decreased energy
g. Feelings of guilt or worthlessness;
h. Difficulty concentrating or thinking; or
i. Thoughts of death or suicide.
2. Bipolar disorder, characterized by three or more of the following:
a. Pressured speech;
b. Flight of ideas;
c. Inflated self-esteem;
d. Decreased need for sleep;
e. Distractibility;
f. Involvement in activities that have a high probability of painful consequences that are not recognized;
or
g . Increase in goal-directed activity or psychomotor agitation
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4).
OR
C. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c) .
12.13 Eating disorders (see 12.00B10), satisfied by A and B:
A. Medical documentation of a persistent alteration in eating or eating-related behavior that results in a change in consumption or absorption of food and that significantly impairs physical or psychological health .
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4)
12.03 Schizophrenia spectrum and other psychotic disorders (see 12.00B2), satisfied by A and B, or A and C:
A. Medical documentation of one or more of the following:
1. Delusions or hallucinations;
2. Disorganized thinking (speech); or
3. Grossly disorganized behavior or catatonia.
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4). OR
C. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c) .
12.05 Intellectual disorder(see 12.00B4), satisfied by A or B:A. Satisfied by 1, 2, and 3 (see 12.00H):1. Significantly subaverage general intellectual functioning evident in your cognitive inability to function at a level required to participate in standardized testing of intellectual functioning; and2. Significant deficits in adaptive functioning currently manifested by your dependence upon others for personal needs (for example, toileting, eating, dressing, or bathing); and3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.B. Satisfied by 1, 2, and 3 (see 12.00H):1. Significantly subaverage general intellectual functioning evidenced by a or b:a. A full scale (or comparable) IQ score of 70 or below on an individually administered standardized test of general intelligence;orb. A full scale (or comparable) IQ score of 71-75 accompanied by a verbal or performance IQ score (or comparable part score) of 70 or below on an individually administered standardized test of general intelligence; and2. Significant deficits in adaptive functioning currently manifested by extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:a. Understand,remember, or apply information (see 12.00E1); orb. Interact with others (see 12.00E2); orc. Concentrate, persist, or maintain pace (see 12.00E3); ord. Adapt or manage oneself (see 12.00E4); and3. The evidence about your current intellectual and adaptive functioning and about the history of your disorder demonstrates or supports the conclusion that the disorder began prior to your attainment of age 22.
A young disabled Knoxville woman has lost her Social Security disability and Medicare assistance. She has epilepsy and until a year ago, had uncontrollable seizures. ...
Over the last 15 months, Amy Schnelle’s mom says her daughter’s health improved dramatically with the help of anti-seizure medications. Now, however, Amy Schnelle’s Medicare is ending and she can’t afford to buy the pills. Everything changed when Social Security sent a letter in May of this year saying her $1,200 a month check would be ending. ...
The Schnelles say what Social Security didn’t take into account is once her disability was dropped, she no longer can get the medications needed to control her condition. ...
§ 404.1503b Evidence from excluded medical sources of evidence.
(a) General. We will not consider evidence from the following medical sources excluded under section 223(d)(5)(C) (i) of the Social Security Act (Act), as amended, unless we find good cause under paragraph (b) of this section:
(1) Any medical source that has been convicted of a felony under section 208 or under section 1632 of the Act;
(2) Any medical source that has been excluded from participation in any Federal health care program under section 1128 of the Act; or
(3) Any medical source that has received a final decision imposing a civil monetary penalty or assessment, or both, for submitting false evidence under section 1129 of the Act.
(b) Good cause. We may find good cause to consider evidence from a n excluded medical source of evidence under section 223(d)(5)(C) (i) of the Act, as amended, if:
(1) The evidence from the medical source consists of evidence of treatment that occurred before the date the source was convicted of a felony under section 208 or under section 1632 of the Act;
(2) The evidence from the medical source consists of evidence of treatment that occurred during a period in which the source was not excluded from participation in any Federal health care program under section 1128 of the Act;
(3) The evidence from the medical source consists of evidence of treatment that occurred before the date the source received a final decision imposing a civil monetary penalty or assessment, or both, for submitting false evidence under section 1129 of the Act;
(4) The sole basis for the medical source’s exclusion under section 223(d)(5)(C) (i) of the Act, as amended, is that the source cannot participate in any Federal health care program under section 1128 of the Act, but the Office of Inspector General of the Department of Health and Hum an Services granted a waiver of the section 1128 exclusion; or
(5) The evidence is a laboratory finding about a physical impairment and there is no indication that the finding is unreliable.
A new Public Policy Polling survey covering 5 key Senate battlegrounds finds that voters are strongly opposed to a number of changes that Republicans might pursue to Social Security if they get total control of the government after this fall. 69% of voters say they’re concerned about the changes Republicans might make to Social Security, and by a 33 point margin they say they’re less likely to vote GOP this fall if they’re informed about what changes Republican control could bring to the program. In this closely contested election Democrats should be talking more about Social Security, which could be a winning issue for them in these pivotal states.
Key findings of the survey which included voters in Florida, Nevada, Ohio, Pennsylvania, and Wisconsin include:
- Only 20% of voters would support privatizing Social Security by investing benefits in the stock market, to 68% who are opposed to that. There’s bipartisan agreement with Democrats (13/83), independents (24/64), and Republicans (27/53) all strongly opposed to privatization. By a 48 point margin voters say they’d be less likely to vote for a candidate who supported that - 63% would be less likely to, compared to only 15% who would be more likely to.
- Only 5% of voters support making any cuts to Social Security benefits, to 88% who are opposed to them. You’d be hard pressed to find any issue that Americans are in such strong agreement about. There’s more than 80% opposition from independents (5/91), Democrats (6/90), and Republicans (4/84) alike. 80% of voters say they’d be less likely to support someone who would cut Social Security benefits, to only 5% who’d be more likely to vote for someone wanting to do that.
- Only 28% of voters support raising the retirement age, to 62% who are opposed to doing that. Once again there’s bipartisan opposition with Democrats (18/74), Republicans (34/54), and independents (40/47) all firmly opposed to raising the retirement age. By a 44 point spread voters are less likely to support a candidate who would raise it - 58% say they’d be less inclined to vote for someone who wanted to do that, to only 14% who would be more likely to vote for them.
- Only 14% of voters support changing the formula that increases benefits for inflation, to 62% who would oppose doing that. Democrats (11/69), independents (14/69), and Republicans (19/52) all stand together in opposing such changes.
- When informed about the possibility that Republicans might pursue some of these policy changes if they end up with control of the White House, Senate, and House after the election 53% of voters say that makes them less likely to vote for the GOP in November, to only 20% who say it makes them more likely to support the party’s candidates. Particularly notable is that among pivotal independent voters, 50% say possible Republican changes to Social Security would make them less likely to vote for the party to just 22% who would be more likely to do so.
A Benton Harbor woman who stole Social Security benefits meant for disabled people was sentenced Monday to 2-5 years in prison.
Jill Mae Williams was also ordered by Berrien County Trial Court Judge Arthur Cotter to pay $260,089 in restitution to the Social Security Administration and $25,185 to the Michigan Department of Health and Human Services. ...
According to [prosecutor Jane] Wainwright, Williams had arranged for herself to become the “payee” for Social Security benefits for 10 vulnerable adults in Benton Harbor and was taking much of the money for her own use. ...
The people she was charged with stealing from were disabled and/or could not read and write. ...
In May 2013, an estimated 15 percent of the 7.2 million households with blind, aged, and disabled individuals receiving Supplemental Security Income (SSI) cash benefits included more than one SSI recipient, according to GAO’s data analysis. Of the estimated 1.1 million households with multiple SSI recipients, most included two recipients (953, 000) and at least one adult recipient between ages 18 and 64 (695,000). Most households with multiple recipients did not have any child recipients, though an estimated 190,000 had one child recipient, 111,000 had two, and 3 0,000 had three or more. Few households reported having married couple recipients (an estimated 90,000). Most multiple recipient households reported that members of one family — those related by birth, marriage, or adoption —lived in the household (an estimated 941,000). GAO was unable to determine the specific relationships of recipients in these households.
The Social Security Administration (SSA) provided households with multiple SSI recipients almost 30 percent, or an estimated $1.2 billion , of the total $4.3 billion paid in SSI benefits in May 2013, according to GAO’s data analysis. In that month, multiple recipient households received an estimated average of $1,131 in SSI benefits, compared to $507 for single recipient households. Further, consistent with federal law that applies a lower maximum benefit rate to married couple recipients, GAO’s analysis found that households with nonmarried multiple recipients received a higher estimated average monthly benefit payment than married recipient households. ...
[A]ccording to SSA staff, SSA’s claims management system lacks the ability to automatically connect and adjust claim records of those living in households with other SSI recipients, as it is structured around providing benefits to individuals. For example, if a mother lives with two of her children who are both SSI recipients, and the mother reports changes to her income, SSA’s system does not automatically adjust both children’s benefit amounts to account for this change in income. In addition, the system is unable to automatically process claims when two SSI recipients marry or separate, so staff must manually complete forms and calculate benefits outside the claims management system, which is time consuming and error prone, according to staff GAO spoke with in three of five selected field offices . SSA officials said the agency has not assessed the risks associated with the system’s limited ability to automatically process claims for multiple recipient households, and has no plans to improve the claims management system to address related issues. ...To be sure, there are some issues with households with multiple SSI recipients but the Republican interest in the subject seems to harken back to Ronald Reagan's fables (and they were fables with little basis is fact) about "welfare queens." Households with more than one SSI recipient are hardly living large on $1,131 per month. There's almost never a sinister explanation for why there is more than one SSI recipient in a household. Usually, it has to do with factors such as people who are mentally ill associating with each other (because that's who will associate with them) and families with more than one child suffering from the same congenital abnormality.
In a February 13, 2015 letter to the Inspector General, Sam Johnson, Chairman of the Subcommittee on Social Security, House Committee on Ways and Means, expressed his continued concerns regarding the development of DCPS [Disabilty Case Processing System]. Specifically, Chairman Johnson requested that we provide regular reports to keep the Subcommittee informed of SSA’s DCPS-related efforts. This report is one in a series of reports that examines SSA’s progress in developing and implementing DCPS. ...
We concluded that SSA’s reported costs of $356 million for the DCPS project for the 8-year period ended September 30, 2015 were reasonably accurate. However, we noted issues with SSA’s processes for capturing and reporting contractor and labor costs. While we did not consider these issues to be sufficiently significant to materially affect the overall DCPS cost figure, we believe they warrant SSA’s attention....
U.S. Sen. Sherrod Brown has asked the General Services Administration to investigate an incident in which some Social Security Administration employees who work in downtown Cleveland said they became ill after their office was sprayed for a bed bug infestation.
Furniture from that office later was donated to Catholic Charities. ...
The spraying took place in February at the Social Security Administration office on the seventh floor of the Celebrezze building. After the spraying, workers complained of a chemical smell when they returned to their office.
A worker told Fox8 that she suffered from vomiting, dizziness and tremors in her arms and legs.
Brown's letter cites a recently released investigation by the Ohio Department to Agriculture that suggests pesticides intended for outdoor use only were used in the office.
House Ways and Means Social Security Subcommittee Chairman Sam Johnson (R-TX) announced today that the Subcommittee will hold a hearing on “Understanding Social Security’s Solvency Challenge.” The hearing will focus on the difference between the Social Security solvency projections of the Congressional Budget Office and the Social Security Board of Trustees, the causes of the difference, and what this means for Social Security’s long-term solvency. The hearing will take place on Wednesday, September 21, 2016 in B-318 Rayburn House Office Building, beginning at 10:00 AM.
A short video about lesbian, gay, transgender and bisexual diversity may bring an abrupt end to a federal employee’s 14-year career with the Social Security Administration. David Hall, who works in information technology at the agency’s office in Champaign, Ill., refused to watch the 17-minute video on several occasions.
Hall told the News-Gazette that the mandate to watch the video first came in April, when the national office sent out an email memo regarding LGBT diversity and inclusivity training. ...
For Hall, that premise was too sinful. The 42-year-old, who identifies as Christian, said he does not believe God would have wanted him to watch the video. Signing a statement he had watched such a video, moreover, was equal to endorsing “an abomination,” he told WCIA. “I’m not going to certify sin.” ...
On two occasions in June, Hall’s boss told him to watch the video. When Hall declined, he was reprimanded. He later received a two-day suspension, in August, without pay. ...
Hall is willing to lose his job — he admits it is likely, in fact — and he sees his stance as a call to other Christians. ...
Jack and I have spoken with many of you over the last few months and know that you share ODAR’s commitment to public service by providing claimants with timely and policy compliant dispositions. You also have shared some of the challenges you face in doing so. We are aware of the challenges you have been facing, even more so now with the hiring freeze. We are working on many initiatives to help support you, such as new regulations, pre-hearing conferences and case summaries of large files.
Given the current environment, you have asked how many cases we expect every judge to schedule each month. Looking at current data, a majority of you are scheduling an average of 45-50 hearings a month and completing the work in a legally sufficient and policy compliant manner. I know that it takes dedication to manage your docket effectively and I thank each of you. I am asking EVERY judge to schedule hearings generally in the range of an average of 45-50 hearings per month. If you feel comfortable handling more cases and can maintain legal sufficiency and policy compliance in your dispositions, please continue to do, and we thank you. If are not yet scheduling an average of 45-50 cases a month, please try to increase your dockets to do so. This may mean adding a day of hearings every month or an additional hearing to each hearing day. We will continue to evaluate our scheduling expectations for all judges in the future.
For those of you who elect to telework, I am going to advise our HOCALJs that, for the October 2016 to March 2017 telework period, an average of 45-50 scheduled hearings a month generally should be considered “reasonably attainable.” I am also going to discuss again with our HOCALJs the need to consider all extenuating circumstances in considering your telework requests.
This is a crisis time for us. Even with all the headwinds in our face, the public we serve is asking us to do the most we can. I am so proud of all of you. If all judges generally can schedule an average of 45-50 hearings a month or more, hold those hearings absent good cause, and move the cases out of ALJ controlled status timely, we can make headway in reducing the wait time for a decision. I speak for your national leaders, your RCALJs and certainly your HOCALJs. All of us, ALL OF US, are appreciative of all you do. I know sometimes our messages do not always reflect that appreciation, but make no mistake - it is unwavering. Judge Allen and I are proud to be your judicial colleagues.
| Regional Office | Jurisdictions | Contact Information |
|---|---|---|
| REGION I Social Security Administration Office of Regional Counsel JFK Federal Building 15 New Sudbury Street Room 625 Boston, MA 02203-0002 |
MA, ME, MI , NH, RI | Phone: (617) 565-4277 Fax: (617) 565-4447 |
| REGION II Social Security Administration Office of Regional Counsel 26 Federal Plaza Room 3904 New York, NY 10278-0004 |
CT, NY, PR, VI, VT |
Phone: (212) 264-3650 Fax: (212) 264-6372 |
| REGION III Social Security Administration Office of Regional Counsel 300 Spring Garden Street 6th Floor Philadelphia, PA 19123-2932 |
DC, DE, PA, MD NC, NJ, SC, VA, WV | Phone: (215) 597-3300 Fax: (215) 597-4662 |
| REGION IV Social Security Administration Office of the Regional Counsel Sam Nunn Atlanta Federal Center 61 Forsyth Street, S.W. Suite 20T45 Atlanta, GA 30303-8910 |
MD AL, ND AL, FL, GA |
Phone: (404) 562-1028 Fax: (404) 562-1030 |
| REGION V Social Security Administration Office of the Regional Counsel 200 West Adams Street 30th Floor Chicago, IL 60606-5208 |
IL, IN, OH, WD KY,WI | Phone: (877) 800-7578 Fax: (312) 886-4754 |
| REGION VI Social Security Administration Office of Regional Counsel 1301 Young Street, A-702 Dallas, TX 75202-5433-5433 |
AR, IA, LA, MN, MS, NE ND, SD, TX |
Phone: (214) 767-3212 Fax: (214) 767-9189 |
| REGION VII Social Security Administration Office of Regional Counsel Richard Bolling Federal Building 601 East 12th Street Room 965 Kansas City, MO 64106-2898 |
MO, TN |
Phone: (816) 936-5750 Fax: (816) 936-5963 ||KC OGC |
| REGION VIII Social Security Administration Office of Regional Counsel 1961 Stout Street Suite 4169 Denver, CO 80202-4003 |
CO, KS, ED KY, NM, OK, UT, WY | Phone: (303) 844-0018 Fax: (303) 844-0770 |
| REGION IX Social Security Administration Office of Regional Counsel 160 Spear Street Suite 800 San Francisco, CA 94105-1545 |
CA, NV, HI, Guam, American Samoa, Northern Mariana Island | Phone: (415) 977-8943 Fax: (415) 744-0134 |
| REGION X Social Security Administration Office of Regional Counsel 701 Fifth Avenue Suite 2900, M/S 221A Seattle, WA 98104-7075 |
AK, AZ, ID, OR, WA | Phone: (206) 615-2539 Fax: (206) 615-2531 ^OGC SEA Admin |
| BALTIMORE Social Security Administration Office of the General Counsel 6401 Security Boulevard Room 617 Altmeyer Building Baltimore, MD 21235–6401 |
MD, SD AL, ED NC, WD NC | Phone: (410) 965-0600 Fax: (410) 597–1435 |
Nearly 70 employees at Lambert-St. Louis International Airport were relieved to learn they'll get to keep their Social Security benefits.
In May, the airport workers were informed that despite paying into the Social Security system that they were ineligible to receive those benefits because of a decades-old agreement between the state of Missouri and the Social Security Administration.
On Wednesday, Senator Claire McCaskill helped police, city, union, and Social Security officials reach an agreement allowing the workers to keep their benefits. ...This reminds me of a case in North Carolina. A new interstate agency was formed that included employees from North Carolina and Virginia, if I remember correctly. Several employees of the state of North Carolina transferred to work at the new interstate agency. Before doing so they received written assurance from the agency that administers pensions for NC state employees that they would continue to be covered by the NC state employee pension plan. Some years later, when the first of these employees retired, he was told, sorry, we made a mistake. Employees of intergovernmental agencies aren't covered by the N.C. government employees pension plan. Here's your contributions back. Goodbye. When they complained it wasn't fair, they were told that the courts had refused to recognize estoppel against the state of North Carolina so, in effect, shut up and go away. If estoppel were applied, the state couldn't argue that the interstate employees weren't covered by the pension plan since the state had told the employees years earlier that they were covered and the employees had relied on this promise. The employees took the case to court and won. The N. C. courts held that estoppel would be applied. The moral of this is that if you're a government agency, don't rely too much on old precedent. If the courts think you're really trying to screw over people, they'll find a way to give those people relief.
On September 8, 2016, the Court held a telephone conference to schedule and to prepare for oral argument on the Social Security Administration (SSA)’s motions to dismiss. Ned Pillersdorf, Francis E. Budde, and Kelly Lynn Ward Wallen represented the plaintiffs, with Mr. Pillersdorf speaking for that side. Amanda B. Gilman, John S. Osborne, III, and Laura Ridgell - Boltz represented the SSA, with Ms. Gilman speaking for that side. ...
Although the plaintiffs have brought a number of claims against the SSA, the Court is focused on one at the moment: whether the SSA’s redetermination procedures violated the Due Process Clause. That question involves many smaller — but nevertheless difficult — ones, some of which are listed below. As it tries to figure those question s out, the Court would benefit from further briefing and an oral argument. The parties agreed that an in-person argument would work the best. That argument is set for Wednesday, September 21, 2 2016, at 11:00 a.m., at the United States District Courthouse in Pikeville, Kentucky. The parties will submit further briefing by Friday, September 16, 2016.
In preparing their briefs and arguments, the parties should keep a few things in mind. First , at this stage, the Court is primarily concerned with the plaintiffs’ argument that the SSA failed to afford them due process. The plaintiffs also argue that the SSA applied its redetermination procedures in a prejudicial way — specifically, by initiating those procedures many years too late . To decide that claim, however, the Court first needs to know whether the procedures are constitutional to begin with.
Second , the Court will construe the parties’ new briefs as cross - motions for summary judgment. The parties agree that the due - process issue depends largely on questions of law that can be resolved through briefing and argument. Plus, the SSA has attached affidavits to its motions to dismiss — when a party has presented such “matters outside the pleadings,” Rule 12 requires the Court to t reat the motion to dismiss as a motion for summary judgment. Fed. R. Civ. P. 12(d). This way, the Court can decide the due - process issue once and for all .
Third, and finally, the Court would appreciate briefs addressing the specific questions that are currently troubling it. As promised at the conference, those questions are listed here:
(1) How exactly, under 42 U.S.C. § 405(u), does the redetermination process work?
a. Where, in the text of the statute, does Congress create the “evidentiary rule” that when the Office of the Inspector General (OIG) finds fraud, parties cannot challenge the finding ?
b. Does Congress even have the power to dictate what evidence an administrative law judge may and may not consider?
c. Assuming that Congress has that power — and used it in § 405(u) — does the Due Process Clause nevertheless require that parties get a chance to challenge agency evidentiary decisions?
d. What parts of the redetermination process are judicially reviewable?
(2) How did the redetermination process work in the plaintiffs’ cases specifically ?
a. Did the SSA follow §405(u) ?
b. When the OIG alerted the SSA about the fraud, did the SSA take as given that fraud had occurred in every case Eric Conn touched, or did it decide for itself whether fraud occurred in each case?
(3) Assuming that the SSA followed §405 (u), and assuming that under that section the OIG ’s fraud findings are unchallengeable , does the redetermination process violate Goldberg v. Kelly, 397 U.S. 254 (1970)?
a. Did the plaintiffs get a chance to challenge the OIG finding?
b. If they did not, why don’t they deserve one?
(4) If the redetermination process violated the plaintiffs’ due-process rights, what is the proper remedy?
This list is not necessarily exhaustive. Other issues will certainly arise, and the Court will be grateful for the parties’ efforts to anticipate and address them. At the end of the day, however, the problem on the Court’s mind is whether the redetermination process afforded the plaintiffs due process, and if not, what to do about it.
Thousands of people nationwide seeking disability assistance are waiting months, or even years, for Social Security to hear their cases.
The Charlotte review office has the biggest backlog of all the 170 offices across the nation.
The latest numbers show that Charlotte has 14,456 pending cases. People wait an average of 622 days for their appeals to be heard, almost 100 days more than the national average.
Randy van Hoosan's wife has multiple sclerosis and said that four years ago she realized she couldn't work anymore.
When she applied for disability, she was denied. He said she appealed in October 2014, but almost two years later she's still waiting for her appeal to be heard.
The couple filed bankruptcy in December. They said they lost their house, a car and "just live day to day." ...
They contacted U.S. Sen. Richard Burr's office and got a letter back last month, saying they should expect to wait another 18 to 24 month. ...
Administrative law judge John H. Pleuss has been removed from the list of judges within the computer system at the Social Security’s Madison Office of Adjudication and Review, and all of his 60 cases through the end of 2016 have been reassigned, according to two whistle-blowers from the administration and a copy of the list provided to the Milwaukee Journal Sentinel. ...
Pleuss described disability claimants in his notes using shorthand phrases such as "very black, African looking woman (actually a gorilla-like appearance),” “buxom,” and "attractive; looks innocent,” the Milwaukee Journal Sentinel and a conservative website, Wisconsin Watchdog, have reported. ...
Although Pleuss remains at the Madison office in some capacity, office director Laura Hodorowicz and group supervisor Wayne Gentz have both been removed from the hearing office and its directory, according to Holland, lead case technician Machelle Keller and a copy of the directory provided to the Journal Sentinel. ...Pleuss was approving 55% of the cases he heard.
1. Creating an arbitrary deadline for the submission of evidence is inconsistent with the statutory and regulatory duties of the Commissioner to fully develop the record and inconsistent with the duties of claimants to submit all evidence as required in 20 C.F.R. §404.1512 and §416.912.
2. Excluding material evidence is administratively inefficient and will increase appeals to the Appeals Council and to federal court.
3. The proposed rule ignores the reality that testimony, and sometimes new evidence, is routinely introduced at or after ALJ hearings, and claimants and representatives need the opportunity to respond.
4. Serious problems and inconsistencies exist with the implementation of the 5 business day rule in Region I.
