How Much Do VEs and MEs Make?

     This is from a Freedom of Information Act response that Social Security posted recently.

It's Like They Don't Want Any MEs

     Social Security has posted list of fees paid for Vocational and Medical Experts at hearings for 2018. Basically, it's $77 for the first appearance of the day and $39 for each additional appearance for VEs. It's $80 for each appearance for MEs. No wonder they can't get MEs. That's laughably low.

Trying To Put A Big Finger On The Scales Of Justice?

     From three nearly identical contracting notices posted by the Social Security Administration:

The SSA Office Disability Policy seeks to: (1) provide additional capacity for medical expertise to the Office of Disability Adjudication and Review (ODAR) and (2) conduct a small scale pilot to determine whether existing Medical Consultants' (MC) in various specialties and Psychiatric Consultants (PC) use at the hearing level will enhance the accuracy and consistency between disability determinations at the initial level and decisions at the hearing level. Towards this end, BPA number SS00-16-4C051 with [H Richard Waranch, Neal Salomon, or Homayoon Moghbeli] to provide MC/PC services in the specialty of psychology, will be modified to permit the contractor to review cases for ODAR in the capacity of a ME, provide a written response and opinions to questions and/or interrogatories, and to give oral testimony subject to cross examination.

     Enhance consistency? Will there be any pilot to try to get initial level determinations more consistent with ODAR decisions? Is the only change sought at the hearing level?
     Can anyone tell me anything about Waranch, Salomon and Meghbeli?

New Ruling On Medical Equivalence

     From Social Security Ruling 17-2p, which will be published in the Federal Register on Monday:

At the hearings level or at the AC [Appeals Council] level when the AC issues its own decision, the adjudicator is responsible for the finding of medical equivalence [to a Listing]. The adjudicator must base his or her decision about whether the individual’s impairment(s) medically equals a listing on the preponderance of the evidence in the record. To demonstrate the required support of a finding that an individual is disabled based on medical equivalence at step 3, the record must contain one of the following:

     1. A prior administrative medical finding from an MC [Medical Consultant] or PC [Psychological Consultant] from the initial or reconsideration adjudication levels supporting the medical equivalence finding, or

     2. ME [Medical Expert] evidence, which may include testimony or written responses to interrogatories, obtained at the hearings level supporting the medical equivalence finding, or

     3. A report from the AC’s medical support staff supporting the medical equivalence finding.

In Fairness To Eric Conn

     This wouldn't excuse Eric Conn, if the allegations against him are true, but does this sound familiar?

• Non-physician disability examiner whose salary is paid by Social Security completes a residual functional capacity (RFC) form. The disability examiner knows that if the claim is denied, whether rightly or wrongly that it is unlikely to be reviewed any further but that if it's allowed, it's going to be reviewed at two different levels. If the reviewers disagree with the allowance, the case is returned to the examiner. Too many returns and the examiner's job is at risk.
• Disability examiner gives the RFC form to a physician whose salary is paid by Social Security.
• The physician receives so many completed RFC forms from disability examiners that he or she has no realistic way of actually reviewing all the medical evidence in each of the cases.
• The physician signs the RFC form after a cursory review of the medical evidence or no review.
• Under Social Security Ruling 96-6p, Social Security's Administrative Law Judges (ALJ) are required to consider the RFC forms generated in this manner because they come from "highly qualified physicians and psychologists who are experts in the evaluation of the medical issues in disability claims."

     What is described above is pretty much the norm. I don't think there's any excuse for what Conn is alleged to have done, but how different is it from what Social Security does regularly? And Social Security demands that the "medical opinions" produced in this way be carefully considered. Does Social Security's Office of Inspector General (OIG) want to investigate? Does anyone in Congress want to hold a hearing?

Medical Expert Witness Handbook

     Social Security's handbook for medical expert witnesses at hearings before Administrative Law Judges is now available online. It was posted as part of a solicitation for medical expert witnesses.

Proffering

From an update to Social Security's HALLEX Manual:

HALLEX Sections I-2-5-42 Obtaining Medical Expert Opinion Through Interrogatories and I-2-5-57 Obtaining Vocational Expert Opinion Through Interrogatories are amended to reflect that administrative law judges (ALJ), attorney adjudicators, and hearing office (HO) staff (with the authority to issue interrogatories in cases not yet assigned to an ALJ under the direction of the Hearing Office Chief Administrative Law Judge (HOCALJ)) need not proffer proposed pre and posthearing medical expert (ME) and vocational expert (VE) interrogatories to claimants or representatives prior to submission to the ME or VE. After the completed interrogatories are received, they must continue to be proffered to claimants and representatives.

This is the first update for HALLEX since August 7, 2009.

OIG Report On Allegations Of Medical Consultant Irregularities

From a report of Social Security's Office of Inspector General (OIG) produced in response to a Congressional request:

On March 25, 2009, your staff asked that we review allegations by the American Association of Social Security Disability Consultants (AASSDC) that (1) medical consultant (MC) assessments were altered and/or destroyed in the disability determination services, (2) MCs were pressured to produce specific assessments, and (3) disability examiners were seeking certain MCs to obtain specific assessments. ...

Of the two MCs who indicated an assessment was altered, each described one-time occurrences. In one of these cases, the MC prepared a complex assessment not taken into consideration when making the final disability determination. This occurred in a DDS with SDM authority and a supervisor noted that they did not consider the MC’s assessment. In the other instance, the MC did not give details other than it occurred over 2 years ago. ...

Of the 189 MCs who participated in our review,

• 182 indicated assessments were not deleted, and

• 7 indicated assessments were deleted.

Of the seven MCs who indicated an assessment was deleted, six reported
it was a one time occurrence. For example, an MC indicated an assessment was deleted because a more experienced consultant provided another assessment. The MC was notified and made aware of why the DE removed his assessment from the disability folder.

Are MEs Paid Enough?

Below is an e-mail that I have received that I am posting here with the writer's permission. One detail that might help identify the writer is omitted. The ellipses are in the original. I think there are others who feel the same as this writer.

Greetings,
Having been a follower of your blog for some long while, I've often thought of writing you.

By way of introduction, I am a Ph.D. psychologist in private practice...I've worked at least part-time since 1994 in the SSA [Social Security Administration] system, first at DDS [Disability Determination Services] as a consultant, and now doing ME work for ODAR [Office of Disability Adjudication and Review]. Unlike many MEs [Medical Expert witness at Social Security disability hearing], I am not an elderly retiree, doing this work as supplementary income. I consider it very important work, and I try to bring my varied clinical experiences to bear on the disability cases I read. I work for 7 different ODAR offices in __________, when they call.

What 'pushed me over the edge' to write to you now was a recent case I was asked to review in an interrogatory form. The case involved well over 1200 pages of records relevant to mental health issues, as well as Appeals Council and District Court opinions. I don't mean to sound self-righteous, but I read every page of the case...all the while processing other thoughts....For one, no ME had ever been involved before in this case, though years of back and forth had occurred. For another, I could not do anything but despair about the time I had to invest in it...11 hours including the reading and then writing of an opinion. I could have spent even more time. For this, I will be paid $130. If my forensic colleagues were to take on a case such as this, their fees would approach $2000!

I have very little interaction with other MEs (partly because of the way the ME system is arranged). I have many other concerns..especially the capricious nature of how the case work comes to me...how different judges work so very differently, ..and on. Do other MEs correspond with you? Is there a "lobby" for us? How could I impact the fee structure (unchanged in the time I have worked for OHA [Office of Hearings and Appeals, the former name for ODAR]/ODAR)? So, I am curious about your thoughts...

I look forward to hearing from you...
thanks much,

Astrue Speaks At NADR Conference

Commissioner Astrue spoke at the convention of the National Association of Disability Representatives (NADR) yesterday. I am told that he announced:

• The fees paid to Vocational Experts for testifying at Social Security hearings will rise by 10%.
  
• Fees paid to Medical Expert witnesses for their testimony are under review.
• The current process by which those who represent Social Security claimants notify the agency of their identifying information using form 1695 will be phased out. Apparently, Astrue did not discuss what will replace it.
• Astrue expects that sometime next year Social Security will adopt regulations which will recognize entities as representatives of claimants.
• New hearing offices will open this year. A new office for Fayetteville, NC is to be in the second round of office openings, but is still likely to open this year.
  

An Oldie But A Goodie On ME Usage

Attorneys who represent claimants before the Social Security Administration and who wonder about how Medical Experts (MEs) are selected for hearings may want to take a look at an old report from GAO (General Accounting Office at that time, now called the Government Accountability Office) entitled "Action Needed to Improve Use of Medical Experts at Hearings." Interesting reading. I think that there may be many instances across the country where the agency is not in compliance with the standards suggested by this report.

Social Security Medical Experts

I took a look recently at the documents connected with Social Security's process for hiring physicians as Medical Experts (ME). This caught my eye:

The ME shall maintain a satisfactory quality level of performance when reviewing disability case files. The ME’s level of performance shall be identified through the Office of Medical and Vocational Expertise (OMVE) quality assurance program and its policies and procedures. OMVE will randomly sample 1 or 2 completed work products per ME per month. The work will be reviewed by OMVE full time staff for compliance with SSA policy and procedures, completeness, and accuracy of medical assessment of severity and functional ability. Feedback documentation will be provided to the ME. The ME will have the opportunity to discuss any noted deficiency with OMVE staff and will make the agreed upon corrections to the appropriate documents.

The announcement appears to cover both MEs who testify at hearings before Social Security Administrative Law Judges (ALJs) as well as those who work for Social Security's regional and central offices. I hope these quality assurance reviews do not apply now and are not intended to ever apply to MEs testifying before ALJs.