An Atlanta television station is reporting on one vet's struggle to get Social Security disability benefits. You must multiply this story by a million to begin to get a picture of what goes on at Social Security.
14 comments:
Anonymous
said...
He's a vet but that has nothing to do with his current disability. He's just another person waiting to be approved for disability. Hopefully he can be approved by the ALJ but a doctor saying someone can't work is not medical evidence that will get him disability. He may not be able to work at his old job but may be able to do something else. Or perhaps not.
Hopefully that doctor will be considerate enough to complete a detailed source statement and hopefully his treatment records are detailed enough. I'm seeing ALJ's now that are becoming almost fanatical in their demands for detail in medical records. At some point nobody's treatment records will pass muster. Also, I think there is an unwritten rule in SSA that works against veterans based on the belief that they will be "double dipping" federal payments and that they are already being payed out of scarce resources. Why not just come out in the open and propose that someone receiving over a certain amount in VA should be ineligible for social security,
You point out one of the great fallacies that many unfavorable disability decisions are based on. "The medical opinion is given little weight because it is inconsistent with the treating source medical records." Don't get me wrong. There are some claims where that is true and claims are legitimately denied on those grounds.
In a lot of cases however, something else entirely is happening that is not hard to document or understand. If you ask a lot of doctors what they document in medical records about symptoms and limitations, most will tell you that they simply document what's necessary for the diagnosis and treatment of their patient's condition. That does not include incessantly repeated detail about the exact frequency, severity and duration of each symptom producing functional limitations, especially those already well known by the treating source (with the possible exception of physiatrists and physical therapists whose job it is to document such things). Yet, that degree of repetitious detail is what some adjudicators require before they will credit most treating source opinions about potentially disabling functional limitations. Think of it as a straw man on a pedestal.
9:39 AM. So, what you are saying is SSA and ALJ's have unreasonable expectations of what should be in medical records. My experience is if you tell a doctor 7-10 symptoms, such as dizziness, lightheadedness, tingling, numbness, pain, spasms, fatigue, stiffness, etc. you might see 2-4 of these in the record if your lucky. Some doctors are horrible record keepers. I once started to get up, became really dizzy and went down on one knee and knealt there for 2-3 minutes in front of the doctor. I would describe if as borderline vertigo, perhaps even brief vertigo, which I have had 3-4 tines before, but more intensive. The doctor WITNESSED this, but didn't include it in her records. However, if you look collectively at my medical record, these symptoms and others. I think this boils down to how you look at medical records. If you put it together, does it fit with what the claimant says? Or, do you look at as, "Well, this doctor only shows these symptoms, and that doctor only shows these symptoms... So, neither must be true." If SSA is hiring prosecutors, are they only hiring the bad ones? Or, do they perceive claimants like defendants? Do they start with a bias against the claimants? An, ALJ's duty is to find the truth and proof is preponderance of the evidence. Part of that is knowing that many doctors don't put everything in the record. Dobwe really want to decide ssdi cases based upon the quality of record keeping?
There's a wide gulf between what some 27-year-old reporter taking a story on a tip from Allsup believes, and what really goes on inside SSA/OHO.
There no unwritten bias against vets; not from the recent quarterly OCEP training video on adjudicating vet claims, and not from any HOCALJ or RCALJ or HOD that I've ever worked almost. Management judges want to weed out low producers and HODs want to be able to afford staplers and get their SCTs off telework. They're not micro managing pay rates.
As for fanatical demands for detail... Well, SSA/OHO adjudication is based on scientific method, innit? Disability Is more than just someone saying "I'm disabled". The proof is in the SOAP notes. That's literally how you verify someone's story. An ALJ gets 2.5 hours to decide a case, not 40 hours plus home surveillance footage.
S: a person who repeatedly tells their doctor "No complaints" or "feels fine" is going to look odd saying one thing to the person who prescribes medicine, but another to the person authorizing the SSD check.
O: Abnormal clinical exam findings or diagnostic imaging results are kinda necessary under the regs. If you allege crippling back pain but have full range of motion and no spasm, it doesn't matter that you served with distinction as a supply sergeant in Germany in the mid '90s.
A: Your doctor should be diagnosing you with the condition you tell the judge you have, no?
P: Physical therapy, ibuprofen 800, and amlodipine and atorvastatin, if that's all you're on, doesn't scream "This person needs my help!" to the reasonable ALJ, no?
Do the reporters understand that there is more to winning an SSD claim than simply filing an SSD claim?
While doing Dib representation before I retired, the lack of detail in medical records drove me nuts! What the above commentators have said is true. The typical M.D. writes of a severe diabetic, "peripheral neuropathy," and the lab results show blood glucose and AlC levels, but no further description of functional limitations. I always told my clients to inform their docs that they needed to document how far up the extremity the numbness extended, and best of all, the results of pin-prick testing. The same is true for many other conditions.
1:50 PM. I asked a doctor to do that for me. She said, "I write my notes for me, not Social Security!" Rule SSR 96-7p (replaced by 16-3 in 2016) states "after they find that the individual has a medically determinable impairment(s) that could reasonably be expected to produce those symptoms." If this rule meant anything, shouldn't the diagnosis be enough? Isn't a diagnosis enough for ALS? It is not just that doctor's are often poor record keepers, they are often "overconfident" in their treatments. The doctor asks how the treatment is working. You say, "Well, it's a little better than without the new medication." What you mean is, "It is like putting on a bandaid when you need a tourniquet." The doctor writes, "Patient is doing much better." So, you call to move up your next appointment. The doctor wonders why. You tell them the medication isn't helping. So, the doctor tries something else. The process repeats. The doctor gives you a mild opiate. Does nothing for you. But, they don't want to give you anything stronger... ALJ states, "You aren't taking NSAIDS or stronger for pain."
10:01 PM, a diagnosis of ALS is literally all you need to meet a Listing; that was made law about 15 years ago. But that's a fatal diagnosis. Other diagnoses have a wide range of outcomes. Diabetes, lumbar herniated disc, dysthymic disorder. This is why SSA is concerned with functionality. And, since the program requires more than just a claimant's say-so, a doctor's notes is one of the places you turn to, in order to assess functionality. If you're going to your doctor frequently, receive escalating treatment, and don't get better, the reasonable ALJ should grasp that.
Something to remember about the original post is that the veteran in question hasn't had his hearing yet -- his two denials came through DDS, which is historically much more conservative and short-sighted than the ALJ corps.
you've hit on something too many ALJs, especially the ones that were prosecutors!, can't quite grasp. You are absolutely correct that once a claimant establishes the presence of an MDI, as long as their reported symptoms are of a type reasonably caused by that impairment, we should believe the claimant's assertions regarding the nature and extent of those symptoms. Yes, we have to look at all the evidence, and if that evidence is just not consistent with those allegations at all, sure, discount and disbelieve the claimant.
But that doesn't mean every shred of evidence has to be consistent or supportive (ESPECIALLY considering the weaknesses of using treatment notes for our purposes, only some of which have been discussed above), and too many of these former cops-with-law-degrees seem to think the claimant's allegations are not worth anything unless and until (if and only if) every single other piece of evidence comports with those allegations perfectly.
This phenomenon probably has a lot to do with the special, fun biases prosecutors have burned in their brains after a few years working within our racist and classist criminal justice system, but that's a topic for another day.
Just ask yourself why, more than any other sworn testimony you can think of, the decision makers (judges!) so overwhelmingly do not value statements from the friggin' complaining witness/plaintiff/etc. We send people to jail for very long periods, even kill them, based solely on the allegations of not-so-credible witness testimony all the time, but at SSA, claimant's assertions might as well not even be made since so many ALJs literally give them no credence whatsoever unless the file just lines up 100% with those allegations. It's a travesty.
I get it. I know whose blog this is, but it still amazes me that stories like this, where neither Charles nor anyone else posting here, has seen the records or has any idea what is going on in this particular case. Yet a few brief statements and allegations in a news article, and it's gospel truth and an indictment on the entire system (which is under a million now, btw).
Yet the WaPo stories on desperate people in economically-depressed rural areas applying are an exaggeration, fraud stories are "gilding the lily," and stories of people adapting to and overcoming their challenging conditions are dangerous.
Why did he wait until sometime in 2017 to apply for benefits after a 2014 accident? When did he get fired and why? What did his doc actually say about working? When did his wife become his caretaker? Did DDS have any of this information? Did the family get rid of the DDE that the reporter could have looked at to see why SSA denied the claim? There is absolutely nothing in this story beyond a few subjective allegations, and any comment on this particular case absent additional information is ignorant at best.
It's like the article of the disabled vet a few months the back. The article was filled with all sorts of horrific details, many of which conflicted with his earlier statements to that same paper as well as statements on what he could and could not do to other entities.
And Tim, I will never comment on your case or your experience because I have zero knowledge of the particulars. I can only comment generally on the thousands of cases I have seen. Like some others have indicated, a condition itself is not enough to get there other than very specific conditions. Every case is taken singularly, every condition impacts people individually, every treatment works or doesn't work for each individual uniquely. You would be shocked at some of what you would see in the medical records versus what you hear at the hearings.
@ 828 AM Well when we send those folks to prison or death row we pretty much discount their statements that they didn't do it, don't we? A disabled claimant has a much greater reason to exaggerate their symptoms than an impartial witness.
14 comments:
He's a vet but that has nothing to do with his current disability. He's just another person waiting to be approved for disability. Hopefully he can be approved by the ALJ but a doctor saying someone can't work is not medical evidence that will get him disability. He may not be able to work at his old job but may be able to do something else. Or perhaps not.
Hopefully that doctor will be considerate enough to complete a detailed source statement and hopefully his treatment records are detailed enough. I'm seeing ALJ's now that are becoming almost fanatical in their demands for detail in medical records. At some point nobody's treatment records will pass muster. Also, I think there is an unwritten rule in SSA that works against veterans based on the belief that they will be "double dipping" federal payments and that they are already being payed out of scarce resources. Why not just come out in the open and propose that someone receiving over a certain amount in VA should be ineligible for social security,
@8:12
You point out one of the great fallacies that many unfavorable disability decisions are based on. "The medical opinion is given little weight because it is inconsistent with the treating source medical records." Don't get me wrong. There are some claims where that is true and claims are legitimately denied on those grounds.
In a lot of cases however, something else entirely is happening that is not hard to document or understand. If you ask a lot of doctors what they document in medical records about symptoms and limitations, most will tell you that they simply document what's necessary for the diagnosis and treatment of their patient's condition. That does not include incessantly repeated detail about the exact frequency, severity and duration of each symptom producing functional limitations, especially those already well known by the treating source (with the possible exception of physiatrists and physical therapists whose job it is to document such things). Yet, that degree of repetitious detail is what some adjudicators require before they will credit most treating source opinions about potentially disabling functional limitations. Think of it as a straw man on a pedestal.
9:39 AM. So, what you are saying is SSA and ALJ's have unreasonable expectations of what should be in medical records. My experience is if you tell a doctor 7-10 symptoms, such as dizziness, lightheadedness, tingling, numbness, pain, spasms, fatigue, stiffness, etc. you might see 2-4 of these in the record if your lucky. Some doctors are horrible record keepers. I once started to get up, became really dizzy and went down on one knee and knealt there for 2-3 minutes in front of the doctor. I would describe if as borderline vertigo, perhaps even brief vertigo, which I have had 3-4 tines before, but more intensive. The doctor WITNESSED this, but didn't include it in her records. However, if you look collectively at my medical record, these symptoms and others. I think this boils down to how you look at medical records. If you put it together, does it fit with what the claimant says? Or, do you look at as, "Well, this doctor only shows these symptoms, and that doctor only shows these symptoms... So, neither must be true." If SSA is hiring prosecutors, are they only hiring the bad ones? Or, do they perceive claimants like defendants? Do they start with a bias against the claimants? An, ALJ's duty is to find the truth and proof is preponderance of the evidence. Part of that is knowing that many doctors don't put everything in the record. Dobwe really want to decide ssdi cases based upon the quality of record keeping?
There's a wide gulf between what some 27-year-old reporter taking a story on a tip from Allsup believes, and what really goes on inside SSA/OHO.
There no unwritten bias against vets; not from the recent quarterly OCEP training video on adjudicating vet claims, and not from any HOCALJ or RCALJ or HOD that I've ever worked almost. Management judges want to weed out low producers and HODs want to be able to afford staplers and get their SCTs off telework. They're not micro managing pay rates.
As for fanatical demands for detail... Well, SSA/OHO adjudication is based on scientific method, innit? Disability Is more than just someone saying "I'm disabled". The proof is in the SOAP notes. That's literally how you verify someone's story. An ALJ gets 2.5 hours to decide a case, not 40 hours plus home surveillance footage.
S: a person who repeatedly tells their doctor "No complaints" or "feels fine" is going to look odd saying one thing to the person who prescribes medicine, but another to the person authorizing the SSD check.
O: Abnormal clinical exam findings or diagnostic imaging results are kinda necessary under the regs. If you allege crippling back pain but have full range of motion and no spasm, it doesn't matter that you served with distinction as a supply sergeant in Germany in the mid '90s.
A: Your doctor should be diagnosing you with the condition you tell the judge you have, no?
P: Physical therapy, ibuprofen 800, and amlodipine and atorvastatin, if that's all you're on, doesn't scream "This person needs my help!" to the reasonable ALJ, no?
Do the reporters understand that there is more to winning an SSD claim than simply filing an SSD claim?
12:54 mic drop!!!
While doing Dib representation before I retired, the lack of detail in medical records drove me nuts! What the above commentators have said is true. The typical M.D. writes of a severe diabetic, "peripheral neuropathy," and the lab results show blood glucose and AlC levels, but no further description of functional limitations. I always told my clients to inform their docs that they needed to document how far up the extremity the numbness extended, and best of all, the results of pin-prick testing. The same is true for many other conditions.
1:50 PM. I asked a doctor to do that for me. She said, "I write my notes for me, not Social Security!" Rule SSR 96-7p (replaced by 16-3 in 2016) states "after they find that the individual has a medically determinable impairment(s) that could reasonably be expected to produce those symptoms." If this rule meant anything, shouldn't the diagnosis be enough? Isn't a diagnosis enough for ALS? It is not just that doctor's are often poor record keepers, they are often "overconfident" in their treatments. The doctor asks how the treatment is working. You say, "Well, it's a little better than without the new medication." What you mean is, "It is like putting on a bandaid when you need a tourniquet." The doctor writes, "Patient is doing much better." So, you call to move up your next appointment. The doctor wonders why. You tell them the medication isn't helping. So, the doctor tries something else. The process repeats. The doctor gives you a mild opiate. Does nothing for you. But, they don't want to give you anything stronger... ALJ states, "You aren't taking NSAIDS or stronger for pain."
10:01 PM, a diagnosis of ALS is literally all you need to meet a Listing; that was made law about 15 years ago. But that's a fatal diagnosis. Other diagnoses have a wide range of outcomes. Diabetes, lumbar herniated disc, dysthymic disorder. This is why SSA is concerned with functionality. And, since the program requires more than just a claimant's say-so, a doctor's notes is one of the places you turn to, in order to assess functionality. If you're going to your doctor frequently, receive escalating treatment, and don't get better, the reasonable ALJ should grasp that.
Something to remember about the original post is that the veteran in question hasn't had his hearing yet -- his two denials came through DDS, which is historically much more conservative and short-sighted than the ALJ corps.
@ 10:01
you've hit on something too many ALJs, especially the ones that were prosecutors!, can't quite grasp. You are absolutely correct that once a claimant establishes the presence of an MDI, as long as their reported symptoms are of a type reasonably caused by that impairment, we should believe the claimant's assertions regarding the nature and extent of those symptoms. Yes, we have to look at all the evidence, and if that evidence is just not consistent with those allegations at all, sure, discount and disbelieve the claimant.
But that doesn't mean every shred of evidence has to be consistent or supportive (ESPECIALLY considering the weaknesses of using treatment notes for our purposes, only some of which have been discussed above), and too many of these former cops-with-law-degrees seem to think the claimant's allegations are not worth anything unless and until (if and only if) every single other piece of evidence comports with those allegations perfectly.
This phenomenon probably has a lot to do with the special, fun biases prosecutors have burned in their brains after a few years working within our racist and classist criminal justice system, but that's a topic for another day.
Just ask yourself why, more than any other sworn testimony you can think of, the decision makers (judges!) so overwhelmingly do not value statements from the friggin' complaining witness/plaintiff/etc. We send people to jail for very long periods, even kill them, based solely on the allegations of not-so-credible witness testimony all the time, but at SSA, claimant's assertions might as well not even be made since so many ALJs literally give them no credence whatsoever unless the file just lines up 100% with those allegations. It's a travesty.
I get it. I know whose blog this is, but it still amazes me that stories like this, where neither Charles nor anyone else posting here, has seen the records or has any idea what is going on in this particular case. Yet a few brief statements and allegations in a news article, and it's gospel truth and an indictment on the entire system (which is under a million now, btw).
Yet the WaPo stories on desperate people in economically-depressed rural areas applying are an exaggeration, fraud stories are "gilding the lily," and stories of people adapting to and overcoming their challenging conditions are dangerous.
Why did he wait until sometime in 2017 to apply for benefits after a 2014 accident? When did he get fired and why? What did his doc actually say about working? When did his wife become his caretaker? Did DDS have any of this information? Did the family get rid of the DDE that the reporter could have looked at to see why SSA denied the claim? There is absolutely nothing in this story beyond a few subjective allegations, and any comment on this particular case absent additional information is ignorant at best.
It's like the article of the disabled vet a few months the back. The article was filled with all sorts of horrific details, many of which conflicted with his earlier statements to that same paper as well as statements on what he could and could not do to other entities.
And Tim, I will never comment on your case or your experience because I have zero knowledge of the particulars. I can only comment generally on the thousands of cases I have seen. Like some others have indicated, a condition itself is not enough to get there other than very specific conditions. Every case is taken singularly, every condition impacts people individually, every treatment works or doesn't work for each individual uniquely. You would be shocked at some of what you would see in the medical records versus what you hear at the hearings.
Well stated 8:56!!!!
8:56, second mic drop of the thread!
@ 828 AM Well when we send those folks to prison or death row we pretty much discount their statements that they didn't do it, don't we? A disabled claimant has a much greater reason to exaggerate their symptoms than an impartial witness.
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