I just took on a client whose Social Security disability claim was medically denied even though the Disability Determination Service knew he recently had a Left Ventricular Assist Device (LVAD) installed. No, this wasn't some technical denial. No, there's no date last insured issue. They just flat said he wasn't disabled. An LVAD is a partial artificial heart. In this case, it's being used as a last ditch measure to help the patient survive until a heart transplant is available. This isn't the first time I've seen this sort of thing. I had another client recently who had an LVAD installed. He didn't make it out of the hospital alive after he had it installed. It was obvious he was headed in this direction but he was still denied.
35 comments:
Very sad.
Yes it is! No sympathy or compassion whatsoever. It's time to shutdown ODAR and get the bastards out!!
I was an ALJ for 17 years and served two (2) tours on what was then referred to as a QAR detail. Essentially, QAR ALJ's reviewed the decisions of other ALJ's to determine whether the decisions were "legally sufficient and procedurally correct."
Before each assignment, the new cadre of QAR ALJ's were assembled in Falls Church where an Associate SSA Commissioner, whose name shall remain anonymous, would address the assembled QAR ALJ's and essentially give a "pep talk" on how important our duties and the project itself was to the Agency. I can remember like it was yesterday a comment he made to the effect, "Keep in mind this whole [disability) system is based on one word and that word is "no". The more times we tell a claimant "no" the more likely the person will go away and leave us alone. This strategy saves the government literally billions of dollars a year."
So you ask why so many meritorious claims are rejected? See above.
That (4:06) is complete nonsense.
I fully agree with the idea of closing down ODAR. While we're at it, eliminate ALL the entrenchingly biased OCREO components within SSA and its much-more biased staff is the best way to save taxpayers' $$$.
If you read Charles' fact pattern it was a DDS denial not ODAR. So why I agree that ODAR for sure has issues I think we can't blame them for this situation. Hopefully Charles will be successful in getting this one on someone's radar and this one can be fast tracked for an otr.
I have no doubt 4:06 is telling the truth based on my 27+ years with ODAR as a SA and AA.
I have not done it yet but I have been tempted to get client permission to send complaints to the medical board licensing some of the DDS docs making particularly awful calls. SSA and the state DDS' lack the motivation and resources to police them adequately. If you got the entire ODAR file and the Disability Determination Explanation with a medical opinion that demonstrated obvious incompetence you might get some attention by sending that to the medical board with a complaint challenging the competence of the physician...especially so with a claim decision so dumb it would make headlines if publicized.
If the Ejection Fraction or EF of the heart is less than 30%, or less the Medical Expert MUST find Impairments listing for Chronic Heart Failure to Meet the criteria set by the SSA. Now you can clearly challenge that ODAR ruling On condition that you have an Echocardiogram or angiogram to prove that the LVAD was placed due to EF less than 30%.No cardiothiracic surgeon in his right mind would implant a LVAD unless the EF is 30 or less. You can take that from a medical expert.
4.02 Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2. The required level of severity for this impairment is met when the requirements in both A and B are satisfied.
A. Medically documented presence of one of the following:
1. Systolic failure (see 4.00D1a(i)), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure)
That does seem like a questionable decision by the DDS doctor. Having said that, the doc might have seen something to make him/her believe that there would be medical improvement less than 12 months out. For example, here's a quote from Charles's LVAD wikipedia link:
"Peter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000. Since then, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and the American West, flew in an ultra-light aircraft, and traveled extensively around the world. He died of acute renal failure in 2007 at the age of 69."
Now, Mr. Houghton and Charles's claimant may have nothing in common. But it does show you that some people with LVADs can perform pretty strenuous activities. Without seeing the medical record, any consultative examinations that were performed, and the self-reported daily activities, any outrage is feigned at best.
2:24 - "It's time to shutdown ODAR and get the bastards out!!"
4:06 - "Keep in mind this whole [disability) system is based on one word and that word is "no".
5:06 - "I fully agree with the idea of closing down ODAR."
8:03 - "I have no doubt 4:06 is telling the truth"
Man, this place feels like an echo chamber sometimes. Idiots with an axe to grind feeding off each other like leeches. As noted, this story has nothing to do with ODAR.
Also, the guy who claimed he was a QAR ALJ is lying. First, unless I missed something over the last few years, there are no QARs for ALJs (unlike legal assistants and writers). There are people who do focused reviews, but that's another thing altogether. If an ALJ's decision is not "legally sufficient and procedurally correct" as 4:06 put it, the appeals council would remand it, not some QAR person. Second, the idea that an associate commissioner told a room full of ALJs that the agency exists to deny claims is laughable. On the other hand, the fact that someone actually agreed with 4:06 on that point is sad.
I can't imagine what shallow lives people posting on this blog must have to make up such horsesh*t, much less believe it.
To 12:32am- old useless dinosaurs like yourself who is a hater, arrogant, prejudice and possibly real lazy...a typical government and highly likely, a SSA tenured employee who do not like to hear criticism. Drain the swamp!!!
@8:18AM
Exactly. #Garmon, and other members of Senior Management who are just like him.
I recall that there are some attorneys in Texas who were studying dds doctors and how their decisions are made. Does anyone know more about that?
As I recall there was a presentation made at one of the NOSSCR conferences about DDS doctors in Texas. The presenters had used the state's freedom of information law to get stats on work loads and show that the DDS doctors spent almost no time on the reviews as they couldn't not do the volume of cases they had if they did a good job. Or even a marginally bad job. I am doing this from memory and one problem is that DDS, being state agencies, can only be investigated using state law, not the federal FOIA law. States vary a lot it what they will provide and what they will admit they have.
OTR. I remember those. Havent seen one in a long time. Used to be a few a month, now one or two a year. Usually two days prior to the hearing when somebody actually looks at the file
Although this particular fact pattern deals with DDS, those who have remarked about ODAR are not off base, because the post itself speaks to a more broad SSA Disability Agency culture of "deny" or "no."
I've been an ALJ for several years, and worked in several offices as both a line judge and HOCALJ. I've been to numerous trainings, participated in countless management calls, viewed dozens of VODs. The alleged agency culture - at least within ODAR - of "deny" or "no" (or for that matter, "approve" or "yes") is fiction. To be clear: it does not exist.
Find another conspiratorial fantasy to get worked up over.
My understanding is disability claims are almost always rejected. Then the claimant has to file once more and again and so on until they get approved.
This keeps the SSA people employed. If the SSA approved everybody, they would quickly run out of work. It's self-preservation of the dinosaur.
It's the same reason doctors won't diagnose you correctly: to keep you coming back for more visits. Self-preservation.
4:45 Your understanding is limited. In fact, DDSs allow many initial claims. You just don't hear complaints from those claimants. DDSs and ODAR offices are filled with many people working very hard to do the right thing. Unfortunately, due to vast caseloads and human error, mistakes do happen.
"My understanding is disability claims are almost always rejected. Then the claimant has to file once more and again and so on until they get approved.
This keeps the SSA people employed. If the SSA approved everybody, they would quickly run out of work. It's self-preservation of the dinosaur."
I think that the entire DDS system is a joke, with extremely weak medical reviews and many, many useless, unhelpful consultative examinations.
That being said, you have precisely no idea what you are talking about and clearly do not understand DDS. You also have precisely no understanding of the ODAR/ALJ adjudication system and SSA's incredibly sophisticated, sometimes self-defeating, bureaucratic internal logic.
The point of Charles's post is that this is an idiotic listing-level DDS denial that has no business being denied.
*Completely Obvious* disability cases are normally actually approved by DDS. DDS does a pretty good job of approving cases that actually cannot be denied.
Sometimes, this requires a reconsideration because the first reviewer was completely incompetent, but normally you don't end up in front of an ALJ.
As a private practice attorney, these (physical impairment) cases are absolutely horrible to deal with, because you have people who are terrified about what is going to happen to their spouse/children because of true imminent death/incapacity and who are blaming *you* for incompetence because the case really is that obvious and DDS decided to blame the attorney for not "getting more records".
Somehow, I've always been able to fix almost all of these during the reconsideration stage.
I only ever had to go to one hearing on a true blindingly obvious case where DDS failed and the OTR was rejected.
In this situation, the ALJ (who is neither a fan of listings or approving young people under 50 for physical impairments) essentially took one look my client, immediately paid the case, then took me aside and told me that the surgeon responsible for the condition of my client needed to be sued for malpractice.
These are the cases that Charles is talking about here.
I could not disagree more with you concerning the Agency culture of "deny," or "no." It has not always been this way, mind you, but statistics repeatedly reported on this blog alone in recent years, especially since the Huntington debacle, confirm this. There are rarely O-T-R's anymore, and the SA Program has been gutted for all practical purposes. I also believe there is a correlation between this Agency culture, and the rise of ultra conservative Republicans.
Without seeing the actual medical record there is no way of saying why this claim was denied. The records may be unclear, there may be other issues not mentioned. Or it could be much more sinister and part of the Putin/Garmon conspiracy, Garmon controls the WORLD!
@10:17
Your attempt to humorously put down and discredit what I. SA-27, have correctly pointed out about Garmon, reveals you obviously do not care about corruption, organizational discrimination, (where top managers are treated differently than everyone else), or waste, fraud, or abuse of taxpayer money. I have clearly delineated in detail the specific circumstances which pertain to Garmon in this respect. Moreover, I have never made any remarks equating Garmon with Putin. Those headlines pertain to the Trump campaign and have nothing to do with Garmon. Although I suspect you are not affiliated with SSA in any way, regardless, what's important is the Senate Finance Committee knew what was going on with Colvin, certain SSA Senior Managers, etc., during the Eanes confirmation hearings, and easily saw through the sweet Garmon deals which quickly rose thereafter. The same is true with several journalists and watchdog groups.
The bottom line is Garmon does not deserve to be moved to higher management in Falls Church after being booted out of his Atlanta ROCALJ position for a track record of labor management violations, let alone being placed as a top executive with the Office of Labor Management and Employee Relations. But, it does not even end there. An entire ODAR Hearings Office is relocated near his home NW of Atlanta st his request, even though this is a horrible location for an ODAR Hearings Office, This was done at cost of millions of dollars in taxpayer money, with the SOLE reason to placate Garmon because he kicked, screamed, and cried about being removed from his ROCALJ position. Further, he had first choice of offices in this relocated building, even though he is not regularly holding hearings there, and this deprives an ALJ who is holding hearings there of an office.
But folks, it doesn't even end there. Garmon was recently promoted yet again to Associate Chiel ALJ! Thus, a higher salary, potential for more ridiculous bonuses down the road, etc.
What I am doing is crying foul. The choice of Senior Management to treat Garmon like a King after purporting to discipline him from removing him from his ROCALJ position is not only counter productive, a tremendous waste of taxpayer money, but what any reasonable person with half a brain can easily see is insane, idiotic, and senseless. What does this tell you about SSA/ODAR Senior Management.
For you naysayers, let me remind you I graduated Summa Cum Laude; earned a JD Degree and am a licensed Attorney; and I successfully worked as a SA for ODAR for 27+ years. I was also hired by the FBI right out of law school, before SSA came along. The FBI told me I had one of the highest scores ever on their written exam. Umm ...
Fortunately not a life and death situation like the one you describe above, but I recently had a client denied at initial level who CLEARLY met listing for hearing loss. Most recent audiology exam showed word recognition score of 24% in the better ear (20% in worse ear). This was pointed out clearly in disability report. Still no mention whatsoever of this exam or scores in the denial (DDS explanation), which was done solely by an SDM. Hope your client can get the help they deserve soon.
It is amazing sometimes what they reject. Years ago, my dad was dying from Grade IV astrocytoma (brain cancer). He clearly met the listings. I had submitted the MRI and biopsy results with the application and given SSA the address for the hospital where he spent most of the last year of his life. We then received notice that he needed to appear for medical eval. I called the field office, explained that my father who was paralyzed except for his left arm would not be able to attend and cited to them all the evidence they had to find that he was disabled (and the exact listing).
I was informed that my father would be denied if he did not attend the evaluation. Told her to go ahead and deny. She did. He died before the recon was filed. Through out my career I have dealt with many great SSA and ODAR employees. This clerk is one I will always remember for her stupidity and callousness.
And we have our Monday morning Duncan sighting!!
what if the decreased pay rate at ODAR is a combination of:
1) so many veterans (a largely conservative group relative to the population at large) are recently hired ALJs
2) A good number of ALJs that paid at the 75, 80+ rate and did 800+ dispositions a year (i.e., a block of folks who significantly upped the overall pay rate) retired in recent years
3) and (this is the only one that speaks to the "no" culture in any way) ALJs are going to err on the side of caution on close calls since the dead horse that is the Huntington fiasco has been beaten within the walls of ODAR so much.
I'm an insider who has been privy to rather high level meetings, trainings, emails, etc. and there really is no pressure to deny.
Our budget has nothing to do with benefit expenditures and I have literally never, ever, ever heard top brass even mention benefit payments aside from the boring reports we issue that describe that data.
You guys are full of it, there is no pressure from the top on ALJs to do anything but actually follow the biggest pieces of the law (like give an RFC and don't grid out 45 year olds at medium) and issue 500+ dispositions a year. That's it. Take the tin foil hats off.
hey SAA 27+
You also managed to get fired for working too slowly despite senior attorneys having no production metric/standard and being nearly impossible to discipline--let alone fire--for low output. Congratulations.
2:30 Thanks for the reality check!!!
I'm not stunned but I'm saddened. Based on what you've said it should have met a listing and not even made it to an ALJ, but sometimes DDS and ALJ's miss those obvious ones. The crazy thing is there are ALJs who could practically practice medicine because of what they have picked up yet there is a small group who really think there are three cases. Bad back, mentally ill, and mentally ill but drug addict and don't have a clue how to even ask questions on other conditions.
2:30 PM Your assessment of "erroring on the side of caution" because of Huntington has the effect of "We'd rather have 10 disabled get screwed then allow one "undeserving" person to get benefits."
Right on!! This agency has now transformed itself into a racist gutter for all types of coming-out-closet ultra nationalist and Regional lead bigots. Even the CREO staff are into the action with their personal agendas while many affected employees are now suffered...beyond shame!
ODAR"s biggest problem is that there are way too many lazy ALJ's and senior attorneys. My understanding is that the senior attorneys have no productivity standard. I would guess that factors into the lack of productivity by the senior attorneys. And, that's sad.
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