The Philadelphia Inquirer is reporting on the effects of Social Security's horrible hearing backlog. Note that the article focuses on the case of a young woman suffering from multiple sclerosis. Where I practice they seem to be turning down almost all the MS cases at the initial and reconsideration levels. Maybe ten years ago I might take on one MS case a year. Now I may take on one a month. That's me personally. I'm sure my firm takes on many more than I take on personally. The disease didn't change. The definition of disability didn't change. The agency's regulations didn't change in a way that would especially affect MS. Social Security never announced a change. However, it's clear to me that some person or persons decided to change the agency's practices and then used the secretive quality assurance process to effect the change. In the end, I win the vast majority of the MS cases but there's way too much unnecessary suffering in the meantime and too many claimants who get so discouraged that they drop their cases without ever consulting with an attorney. They don't go back to work. They just rely upon other income or on family and friends. More than a few just get poorer and poorer for years before finally becoming so desperate that they file a new claim and pursue appeals. MS isn't a rare disease but it's not so common that I should be seeing about one new MS each month. This is a terrible way to treat very sick people.
The Listing did change in 2016 with the C. Criteria focus on "Fatigue" removed.
ReplyDeleteCurrent Listing:
11.09 Multiple sclerosis, characterized by A or B:
A. Disorganization of motor function in two extremities (see 11.00D1), resulting in an extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
OR
B. Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following:
1.Understanding, remembering, or applying information (see 11.00G3b(i)); or
2.Interacting with others (see 11.00G3b(ii)); or
3.Concentrating, persisting, or maintaining pace (see 11.00G3b(iii)); or
4.Adapting or managing oneself (see 11.00G3b(iv)).
The new neurological Listings have made it easier to allow for MS. I have not seen any QA push to deny more. Maybe you are seeing more because MRIs, scans are done more frequently so it is diagnosed earlier. What do you think the criteria for MS and similar disorders should be?
ReplyDeleteMy observation after a decade and a half.
ReplyDelete1. More people are being identified earlier.
2. Treatment is providing better results.
The tricky thing with immune type disorders is the tendency to have good months and bad weeks. DDS isn't especially well equipped to deal with a person who might be capable of working 45 weeks a year and incapacitated for 7 weeks spread over the work year beyond the tolerance of an employer unwilling to accommodate.
The blogger is right. It is very hard to get approved at the initial level with MS, or any condition. Lost almost all function, and still got denied. There are some ppl in DDS who see the word MS, and they think of Montel Williams who looks perfectly fine. This bias is a problem.
ReplyDelete6:00 is on point. This coming from a former DDS Disability Specialist ("Disability Examiner" is the title in most states) who was trained on the 11.00 listings by a board certified neurologist and had SAMCs in my office regularly discussing cases. The DDS is objective MER all the way. The claimant's subjective limitations generally only matter when the objective MER is there and it's more of a "are they consistent?" analysis. If the objective MER isn't strong, the subjective limitations then they aren't worth the paper they are written on.
ReplyDeleteBut, and this is directed toward's Charles, complaining about how bad initial and reconsideration decisions are needs to be toned down. The DDS is literally why this blog exists. As my favorite ALJ likes to say, "If the DDS did their job then you and I wouldn't have a job."
"secretive quality assurance process" I am sure it was done by the "deep state." Beware of the stealth SSA helicopters monitoring you!
ReplyDeleteAs an insider attorney, admittedly only writing maybe a couple dozen MS cases, it seems like maybe one part of this problem is that a lot of people have relapsing/remitting MS and often don't have many or any obvious/super significant signs a lot of the time? I don't know, I definitely never saw any dead to rights, significant immobility, etc. MS cases at ODAR--it was always relapsing/remitting, which like I said may not look as bad, especially if treatment is sparse or the treatment notes are sparse or weak.
ReplyDeleteMost people with Multiple Sclerosis would meet a listing.
ReplyDeleteThe problem is the examiners at DDS have no medical background and probably don't even know what MS is or how it affects claimants.
They also go off of the grid which is completely irrelevant in Multiple Sclerosis as age plays no part in the disease.
It's an absolute to deny someone with MS who can't see or walk.
In the words of every dumfounded MS applicant who is denied. "WTF!?"