From a recent report by the Government Accountability Office (GAO):
Allowance rates—the rate at which Social Security Administration (SSA) administrative law judges allowed disability benefits to be paid when claimants appealed—varied across judges, even after holding constant certain characteristics of claimants, judges, hearing offices, and other factors that could otherwise explain differences in allowance rates. Specifically, GAO estimated that the allowance rate could vary by as much as 46 percentage points if different judges heard a typical claim (one that was average in all other factors GAO analyzed). SSA officials said that this level of variation is not surprising, given the complexity of appeals and judicial discretion. Nonetheless, the variation declined by 5 percentage points between fiscal years 2007 and 2015 (see figure), a change officials attributed to enhanced quality assurance efforts and training for judges. GAO also identified various factors that were associated with a greater chance that a claimant would be allowed benefits. In addition to characteristics related to disability criteria, such as the claimant's impairment and age, GAO found that claimants who had representatives, such as an attorney or family member, were allowed benefits at a rate nearly 3 times higher than those without representatives. Other factors did not appear related to allowance rates, such as the percentage of backlogged claims in a hearing office. ...
From fiscal years 2007 through 2015, most claimants (77 percent) had an attorney representative, and 12 percent had a nonattorney representative. ...
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| Note the high approval rate in MS cases. I was just talking about MS cases recently. I've also talked about intellectual deficiency cases a lot also. |
Not surprising. Intellectual disability and multiple sclerosis are usually pretty cut and dry to prove.
ReplyDeleteThe fibromyalgia jumped out as pretty low. There is a huge variation in ALJs opinions on this disorder. Some buy it, a lot don't.
I suppose it makes sense that there is wide variation in approvals based on fibromyalgia because there is wide variation in how the medical community deals with it.
ReplyDeleteIf your doctor is telling you to exercise, take vitamin D and magnesium and prescribes muscle relaxers, chances are you aren't getting approved.
If your doctor is giving you neurotin or lyrica and has you taking four opioid pills a day I suspect the chances of approval rise.
I have inflammatory arthritis (Ankylosing Spondylitis), Fibromyalgia, etc. and was still denied. I have taken Neurontin, then Lyrica (and Cymbalta).The Cymbalta helped my back, but not enough. The other two? The opioid I was given... is like taking 10-15 ibuprofen a day, which I stopped taking when I could no longer tell that I was taking them (i.e. No appreciable effect.) The Fibromyalgia basically intensifies drastically the AS. None of these improved my shoulder, hand and knee pain. I also have migraines from dry eye syndrome...
ReplyDeleteI should note that the Rheumatologist I had said upon another's diagnosis of Fibromyalgia, "Oh, I don't believe in Fibromyalgia!"