Mar 20, 2021

Disability Claim Of Man In Hospice Care Denied On Grounds He Has No "Severe Impairment"

    From some television station in Florida or Georgia that wishes to be known as Firstcoast News:

Before his illness, Aaron Conner was relatively healthy and enjoying life and working as a hair stylist. Now, at age 34, he is at the opposite end of the life cycle.

"I am in the process of writing down my final wishes," Conner said.

In November, he entered hospice for a terminal illness; he is battling congestive heart failure, liver failure and other diseases. ...

Before it got to where it is today, Conner said he applied for Social Security Disability Insurance. He was denied and appealed, and on March 1, his appeal was denied.

Hospice counselors and health care providers all petitioned SSI but in vain. The agency already backlogged with claims stated in its denial, in part:

"...we have determined that your condition is not severe enough to keep you from working." ...

On Your Side reached out to the Social Security Administration office in Atlanta for answers.

Privacy laws restrict discussing the specifics of a case unless there is a written waiver from the client in hand or on file.

However, a spokesperson told On Your Side Social Security will reach out to Conner and provide assistance. ...


21 comments:

Anonymous said...

This is absolutely heartless and ridiculous, not to mention totally contrary to SSA's purported mission upon creation. There's a new article out today about SSA leadership and whistleblower complaint from an ALJ about Saul and leadership pressuring the ALJ Corp to reduce Favorable Decisions.

Anonymous said...

Did he apply for SSDI or SSI? The article is unclear.

The only possible explanation I can think of is - he didn't qualify for SSI and he applied for a Title 2 benefit, but his insured status expired before his condition became severe.

Anonymous said...

He wasn’t denied for no severe impairment. He was denied because his condition was not severe enough to keep him from working. I know (or at least hope you know) the difference between those two reasons for denial, and the post title is not misleading... it’s flat out incorrect.

Once again, a cherry picked article written out of ignorance that glosses over the previous 2-3 years and focuses on his entering hospice four months ago. No idea what evidence SSA actually has or received from various providers. Who knows what the hospice staff has done to reach out or provide information to the agency? Is it possible that SSA has every single piece of medical evidence that can be obtained and still denied someone, even of a later onset, who is terminal? Yes. Is it also possible that they only have records from 2019 aside from someone with hospice recently writing a letter stating that “Mr. Conner is in hospice right now and should be considered disabled.” Yes. Point is we don’t know.

It is not uncommon for DDS doctors at recon to copy/paste the initial doc’s without doing any analysis of any evidence obtained between the stages, and that’s garbage. It’s equally common that claimants incorrectly assume that SSA has all their records when they haven’t been notified of their existence. There can be a presumption of SSA’s omnipotence by claimants at times, and unfortunately, that’s one of SSA’s shortcomings.

Regardless, he’s obviously in a bad spot now and regardless of anything else, he should be able to get a hearing quickly as a TERI case, and assuming GA is in the same spot as the rest of the country, should be able to get a hearing on this quickly. It’s not going to make up for any lost time at this point, but since no one involved (the writer, Mr. Conner, or anyone here) knows what information has been provided or reviewed, maybe let’s hold off on the pitchforks and torches. And maybe fix the post title, too.

Hall & Rouse, P.C. said...

The article quotes the determinations saying "...we have determined that your condition is not severe enough to keep you from working."
That’s a denial on the grounds of no severe impairment.

Anonymous said...

I have seen that language in nearly every unfavorable decision the Agency produces. It is not indicative of a denial at a particular step. Your title is wrong.

Anonymous said...

No, Charles, it’s not. Open any Notice of Disapproved Claim in your cases at initial or recon that were pure denials, and you’ll see the phrase “We have determined that your condition is not severe enough to keep you from working” in almost every single one other than an IE denial where a determination can’t be made. Below that stock statement is the rationale for the denial, whether non-severe, can do past work, or can adjust to other work.

“Not severe enough to keep you from working” is not the same as “not severe.”

Anonymous said...

the standard state agency denial letter uses that language but its a step 5 denial. its not no severe impairment, its a severe impairment or impairments that are not disabling.

Anonymous said...

There's a rather large difference between a nonsevere finding (resulting in no more than minimal work-related limitations/not expected to last 12 months or result in death) and a full step 4 or step 5 finding of non-disability ("...we have determined that your condition is not severe enough to keep you from working.").

Anonymous said...

@6:23

Sorry, but it is not. One may have a "severe" impairment as defined by the Act and yet still be able to work (i.e., a fourth or fifth step denial). In that event it is severe but not "severe enough" to keep one from working. DDS's have been using this language for decades.

Jonathan Ginsberg said...

There is a difference between being disabled and producing evidence that proves disability in SSD terms. I had a case like this last year - claimant was 59, with long work history, work within past 12 months, but rapidly worsening terminal cancer diagnosis. I created a form that tracked the exact language of the listing and added several questions to address the duration requirement.

I submitted the form along with associated medical records and noted at several places that this claimant meets listing 13.13 and that it should be approved as a TERI case. Fortunately someone actually read the application and the case was approved. Without the form and the specific reference to TERI and a particular listing, who knows? That may be what's going on here. Not to excuse the adjudicator or the medical consultant but perhaps the hospice staff and medical providers do not speak SSA's language.

Anonymous said...

It appears he is not in a hospice now but living with his brother. According to the article he had developed alcohol abuse which led to liver disease which led to CHF. He does not qualify for liver transplant per article and had applied for SSI. Both liver disease and CHF require findings over a period of months to meet most of the relevant listings. .. Usually 5 in the case of liver disease. Liver disease often improves in the absence of alcohol and CHF also remits with treatment. . The actual findings throughout the period are needed. In this case we do not know from the article what is going on. It seemed odd for him to be in a hospice indicating no further care other than palliative would be given.

Anonymous said...

The SSA defenses on here are all great and split all the right damn hairs. This agency has not run great in several years but it literally had a heart attack itself during the last administration and almost functionally collapsed. Initial claims are sitting for months, communication has become like trying to read distant smoke signals and when denials get sent they very seldom make it to a claimant's representative. Also, SSA is still stuck in the Dark Ages on psychological problems and the substance abuse issue that usually go with them. Also nothing has less worth in SSA eyes than a minority female, particularly one that can only use the SSI program.

Anonymous said...

1:08 drops a bunch of facts.

Anonymous said...

Inconsistency! That is the hallmark of the SSA disability program. You can speculate as to the facts of this case all day long and what happened. The big problem is, the program is so arbitrary and capricious that often, it just depends on who looks at the case and what mood they are in that day. And, the regulations and policies are written to leave so much discretion and vagueness that almost any decision can be justified on almost any case. Often, it just depends on which particular facts are emphasized. The system is, without a doubt, unconstitutional.

Anonymous said...

@7:25

Hey, maybe don't use "stock rationale" and it wouldn't cause SSA to constantly look like they are just rubberstamping denials at the first two levels. Just a thought.

Anonymous said...

Maybe this was a step 2 denial. In my experience, step 2 denials are almost always remanded by the AC. It is not hard to prove there was a severe impairment. Getting around Step 4 (past relevant work) and step 5 (other work) is the hard part.

So something is fishy. Maybe his condition suddenly got terminal in the last 4 months. Prior to that, maybe it was not as bad. I find it very unlikely there was no severe impairment especially considering the severity of the heart and liver failure.

Tim said...

The state of "journalism" today... Where getting a factual, unbiased piece that gives the reader/viewer everything they need to know is so rare... Instead, we get Hitchcock like sensationalism (and tear jerkers) or pieces that paint a distorted picture of who SSDI/SSI applicants are (a 2014 Washington Post story about a substance abuser having trouble keeping employed in Alabama with no chance of qualifying comes to mind). That aside...

I was approved by an ALJ about 2 1/2 years after another ALJ denied me. Both cases were largely decided on the same facts, conditions, evidence, etc. Of my disabling conditions, most had a 15-20 year medical history. Others had about 10 years. The most debilitating, Ankylosing Spondylitis, I had been suffering from for over 30 years at the time of the first decision. What I found most confusing and, frankly, frustrating, was that the two decisions read as if they were describing 2 completely different people. My actual ability (or lack thereof) to work was the same. The severity and symptoms was the same. Only the decision was different. That feels very arbitrary to me!

Anonymous said...

Tim, that is a great illustration of how arbitrary the system is. Same facts, two different judges, two completely different decision. Another good illustration of the arbitrariness is when you have a claimant who is between 50 and 54 and a judge finds he or she can only do light work. Then, when she applies again and is 55, suddenly she has improved to the point she can do medium work (even though the evidence actually shows her condition has worsened). And, the worst of it, the agency defends that type of thing by simply saying res judicata doesn't apply because its a different time period.

Anonymous said...

@8:52

Acquiescence Rulings in 9th and 4th circuits make that sort of thing more difficult, but it's still pretty absurd.

Also, not a lot of ALJs realize how the ARs apply.

Anonymous said...

Dont read the article, just start spouting off about how unfair the system is.

Anonymous said...

8:52, if you want to take out the human element, which necessarily entails different judgment calls that different ALJs will make, I suggest you advocate for a simple AI-based flowchart. Of course, that will depend on the PsTB. Let's see how that works out for your clients.