In 2018 the House Social Security Subcommittee requested that the Social Security Advisory Board (SSAB) examine Social Security's reinstatement of the reconsideration stage of appeal in disability claims and to recommend improvements at the initial and reconsideration stages. SSAB is only now getting back to the Subcommittee with a full report.
SSAB assembled five panels to discuss possible improvements. What the panels recommended mostly seems vague to me. For instance, one recommendation is "Simplify SSI eligibility for children." That's certainly a worthy goal but if you know any history of SSI child disability, you know that if you want "simplification" you'd better say exactly what you have in mind -- and then duck because whatever you have in mind will be extremely controversial. Recommendations that are more specific, such as "Simplify the SSI program by eliminating the living arrangement eligibility requirement, windfall offset, dedicated accounts, and in-kind support and maintenance" can only happen if there are major changes in the political environment. We'll see about that after November 3.
Definitely get rid of dedicated accounts. Nearly impossible to administer per policy. It is a law with no teeth, no down side for ignoring. ISM is too complicated and too much work for too little impact on payments.
ReplyDeleteBut getting rid of windfall offset would result in much more money being paid out. In the SDW (Special Disability Workload) cadre days, using protective filing dates, the T2 CR's were frequently creating underpayments in the six figure range, JUST BECAUSE OF SSI. Why should someone be paid $100,000 more than they would have gotten had they been paid on time? They were paid the SSI money. Why should they also get SSDI ON TOP OF IT that they would not get if paid on time? Fast track to bankrupting the 'trust funds'.
Getting rid of the federal benefit marriage penalty is a good idea. Increasing the earned income exclusion is a good idea.
I read the whole document linked. I must say, DDS does NOT allow enough time for medical records to arrive. I applied, went through all the requirements, then they denied me for lack of medical records in 30 days. I got a lawyer, and filed for a reconsideration. It's odd how lawyers can get medical records REALLY fast, send out a letter, and then have the claimant approved. Then, I had to pay the lawyer. So, I received SSDI on a reconsideration because DDS did not wait for my records that the lawyer was able to get really quickly. Without a lawyer, I would not have gotten SSDI on a reconsideration, I do not believe. DDS needs to wait for all records before making a determination. It causes hardship on the claimant when they do not.
ReplyDeleteI see one of their recommendations is reversing the 2017 revision to the treating physician rule. It seems to me, with our without the rule, anyone with any common sense would realize a treating physician's opinion should be given significant consideration and not simply dismissed for reliance on the DDS quacks.
ReplyDelete@ 7:27
ReplyDelete"It's odd how lawyers can get medical records REALLY fast, send out a letter, and then have the claimant approved."
Wish it was that easy.
@4:42pm - So Do I....So do I. That was just my experience. The best thing to do is be persistent and don't take no for an answer. It was an obvious case, so, like I said, that was my experience. Best of luck to everyone out there having problems with this, because, yes, it is a problem. I was lucky, and persistent on DDS not waiting for my medical records. It was quite the put-off to say the absolute least. Mind you, this was in 2003. I see not much has changed.
ReplyDelete@727 I'd guess that DDS has time guidelines, like SSA does, and if there's nothing received in some amount of time they are forced to make a decision.
ReplyDeleteThe internet unit in my office gives 30 days from the date the claim is submitted online until they deny if there is no 3368 (Disability Report) received. The thought being if you can't get it completed in a month, you may never get it completed and that is usually the case. The few that are submitted after denial are reopened but the vast majority of denials for no medical info/medical release are not reopened.
It is the Claimant that is to provide the evidence. Being lazy and blaming DDS or SSA is just another excuse. You want the dough you can call for your own records, not rocket surgery.
ReplyDelete@8:44 You're absolutely right. I've seen claimants pay doctors to actually bring them in physically to SSA so that they aren't just denied. One must be very diligent in getting their records to DDS in time, however, it should not be that way. They should wait without time constraints. Claimants shouldn't have to gather their own medical records, especially if they are in a crisis. Unfortunately, it's how the system works. But yes, you are right 8:44, it is on the claimant, but what if the claimant is not able to do those things? They then have to hire a lawyer. So, though you are right, DDS need to wait for medical records for as long as it takes.
ReplyDelete@8:44
ReplyDelete20 CFR § 404.1512(b) disagrees with you.
It can cost hundreds of dollars in some places to get copies of all the medical records. SSI disability applicants often cannot afford that. By law most providers have at least 30 days before they must respond to a medical record request, and as a practical matter they often take longer. Giving up on medical records after 10 or 20 days in order to make a decision makes no sense in light of that.
ReplyDelete7:27 AM/5:25 PM Unfortunately, what is obvious to some is much less obvious to others. I had 2 hearings with ALJs. The first was somewhat like Savannah Guthrie was to Trump...the other was more like George Stephanopoulos was to Biden. My symptoms and records were very basically the same. But, if you read the two decisions, it sounds like two completely different people where being described. If I used the job titles, descriptions, and skills from the first VE and put them on a resume, anyone who later noticed it would certainty terminate "for lying on a resume. A Federal Judge AND a Circuit Court said this was acceptable! If anything, the second VE downplayed the same job's description and skills.
ReplyDelete@Tim
ReplyDeleteIf it's any comfort, the Supreme Court basically said in Biestek v. Berryhill a VE can say whatever and it's good enough. So that fact that in your claims, 2 VEs said inconsistent things is not that surprising.
As to your two decisions reading very differently, that varies by circuit. Some circuits require an ALJ address a prior decision (I'm aware of the 9th and 4th, but others may as well), whereas others may not. As a matter of policy, SSA believes they don't have to.
Winning a claim is largely about developing the evidence to the point the ALJ can't justify a hypothetical question the VE can testify allows any form of work.
11:19 illustrates how arbitrary the system is. Certainly a system in which a significant percentage of claimant's chances of obtaining benefits is almost entirely depending on which judge he or she gets is unconstitutional.
ReplyDeleteHonestly, I believe the best thing to do is after the initial denial is to hire an attorney, if in fact it's an easy case. It's worth the money to pay the attorney from backpay. An attorney, too, will explain whether or not your case is winnable, or whether or not it would probably go in front of an ALJ for a hearing and a decision. Some cases are obviously valid, and are initially denied. As I said, at that point, it really is worth getting a lawyer to help, as disability is not always physical. Lawyers are the most helpful at giving advice to SSDI or SSI claimants. No.. I'm not a lawyer. I am a claimant. Yes, I got an attorney and it was WELL worth the money paid.
ReplyDelete@5:53
ReplyDeleteWe used to, as a matter of policy, not take initial cases because it felt dishonest to take a case where representing someone wouldn't be likely to add anything to the claim, it would basically just be free money.
That stopped about a decade ago, because even the best of claims were getting denied and DDS seemed to just be using the initial phase to develop the record against claimants.
@11:45
ReplyDeleteYou are correct, but only if treating sources provide reasonable opinions tethered to reality. Instead, the vast majority of MSSs provided by treating sources amount to either checking the most restrictive boxes without thought or simply having their patients or MAs do it for them before they sign it. They rarely put thought into the MSS, and they often describe people who cannot do anything when their actual treatment records reflect anything but that. They are regularly so nonsensical that when you come across one that appears to be even marginally reasonable it becomes much more persuasive.
@9:51 - the typical opinion from the DDS quacks are completely without support or analysis and frequently contradict citations the doc pulled from the other part of the DDE (cites pulled by the caseworker). We know many of those docs are not reviewing the records. So, you want to take their opinion over that of a doctor who actually knows and has examined and treated the claimant? That shows extremely poor judgment on your part. I certainly hope you are not an ALJ, but I bet you are. We see this kind of garbage all the time. You have a 2 or 3 sentence opinion along with a few one word opinions, usually "moderate" with some additional boilerplate and the ALJ elevates this opinion (sometimes saying that the DDS doctors thoroughly reviewed the record while knowing this is probably a lie) and denigrates what they refer to as a "checkbox" form that has more information than given by the DDS quack. Give me a break. You guys are not unbiased, independent adjudicators. You are just trained and manipulated shills for the agency.
ReplyDelete@11:18
ReplyDeleteOur DDS has for years concluded mental cases are "able to perform unskilled work," which is objectively a vocational opinion. And I'm not confusing the disability analyst's decision, literally the medical statement section is being written as if it's from a VE.
Here is my "theory" on how at least a large minority (if not most) DDS doctors figure out the RFC for a claimant. Quickly read through what the claimant says their symptoms are. If it insufficient to pay, agree with the claimant. If it is sufficiently restrictive, check the age and just barely recommend denial. That would take about 5 minutes a case... Which would maximize the number of cases you can do. If the person refiles after being denied by an ALJ and reaches an age that would require payment, you just have to adjust their abilities. So a 46 year old "sedentary" magically becomes a 51 year old "light duty." "Doctors don't lie!" you say? Then why have the numbers of COVID deaths dropped off the cliff since September 1St, when the Federal Government began requiring a positive test to accept the diagnosis (and therefore, the additional money). I have heard stories (and read in the news) about people dying if heart attacks, cancer, motorcycle accidents, etc that were tuled "COVID deaths" just to get the extra money they get.
ReplyDeleteSo, does anyone else know of DDS doctor "adjustments" of RFC in a subsequent application after reaching 50, 55 or 60?
11:18, I didn't say anything about DDS opinions, rate them as superior, or anything else. But awesome job pummeling that straw man.
ReplyDeleteYou are right, though. I should definitely ignore DDS over the orthopedist who says a claimant's replaced knee (and only the knee replacement) would limit their ability to reach, handle, finger, or feel to no more than 5% of an 8-hour day. Or the psychologist who says their patient has extreme limitations (no functional ability at all per the form) in understanding, remembering, or concentrating on even simple tasks despite being a single parent and raising 3yo twins on their own without familial assistance. Or the doctor that says their patient can't lift any weight or be on their feet for even 5 minutes at a time despite also noting in multiple earlier records that their patient has improved their bench press to 225 pounds and completed a Spartan race.
Yep. Those entirely logical and supported opinions should control the outcome of the case.
7:51 PM. I would agree with you that the "examples" you gave would be questionable, at best, depending on WHEN the conflicting statements were made. Have you heard of Darryl Stingley? He was a really good receiver for the Patriots who was paralyzed by Jack Tatum in 1978. Conditions change... Sometimes abruptly and other times over years.
ReplyDeleteOn the other hand, my first ALJ claimed my complaints of bilateral shoulder pain "wasn't credible," despite 17 YEARS of increasing amounts in medical and other records! Same thing with 24 years of increasing, debilitating back pain due to Ankylosing Spondylitis. Other debilitating symptoms also had AT LEAST 10 YEARS of documentation!