Raleigh Field Office Evacuated

The Raleigh, NC Social Security field office was evacuated this morning due to a powdery white substance found enclosed in an envelope. Probably nothing to it, but they have to be careful.

Average Patient On Liver Transplant List Doesn't Come Close To Meeting Listing

The Social Security Administration adopted new digestive system listings last October. The liver is part of the digestive system and is covered in the new listings. One of the ways to meet the liver listings is something labeled as the "SSA CLD" (Social Security Administration Chronic Liver Disease) score. This is computed using a complicated formula. The SSA CLD formula is the same as what is generally known in medicine as the MELD (Model for End-Stage Liver Disease) score.

I have wondered why Social Security wanted to avoid using the term MELD. My guess is that they did not want people thinking that one had to be in "End-Stage Liver Disease" to meet the listing. That just sounds so extreme.

The listing requires a SSA CLD (or MELD) score of 22 or higher to meet the listing. A recent issue of the New England Journal of Medicine has an article on liver disease. You can only read the abstract online, but the whole article includes a table showing that the median MELD score for those on the waiting list for a liver transplant is 15. One short quote from the article: "On average, the risk of death increased by 21% ... per unit increase in the MELD score." Not only must one be in end-stage liver disease to meet the listing on the MELD score; one must be well into end-stage liver disease and at great risk of death.

Where did the listing requirement of a MELD score of 22 come from? Why not 20 or 18 or 15? Did someone try to figure out how many more people would qualify if the MELD score requirement were lower and how much that would cost? Did someone try to figure out how many more expensive liver transplants Medicare would have to pay for if a lower MELD score was used? As it is now, people in end stage liver disease under age 65 are unlikely to live long enough to qualify for Medicare. Was the Office of Management and Budget involved in setting the MELD score requirement? Was someone thinking "Oh, the hell with them. Most of them are alcoholics anyway." You have to wonder how comfortable the physicans involved in creating this listing are with the requirement of a MELD score of 22.

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New Edition Of My Book Available

West Publishing has released the 2008 edition of my book, Social Security Disability Practice. You can take a look at the table of contents online.

Debit Cards

In case you were wondering what the new debit cards through which Social Security beneficiaries can receive their benefits look like, here you go.

Updated Fee Payment Stats

The Social Security Administration has posted updated data on payments of fees to attorneys and others for representing Social Security claimants. Since the attorney and client are paid at about the same time, this is a useful analog for speedups and slowdowns in benefit payments to claimants. You can certainly see evidence in these numbers that these payments are far from steady.

Payment delays are tough for claimants. The ups and downs also make for a stomach churning ride for those who represent claimants. If you work at Social Security and have ever thought about leaving to represent Social Security claimants, take a close look at these numbers before giving up that regular paycheck. This is one of the reasons that very few Social Security Administration employees leave the agency to represent claimants.

Fee Payments
Month/Year	Volume	Amount
Jan-08	20,559	$75,368,163.45
Feb-08	26,570	$95,228,284.32
Mar-08	23,088	$83,166,027.02
Apr-08	27,296	$98,616,579.78
May-08	29,305	$104,283,373.35
June-08	25,243	$89,786,459.83
July-08	22,238	$77,346,266.77
Aug-08	33,834	$120,819,791.05

Blame The ALJs

Public Radio's Marketplace program ran a piece yesterday on Social Security's backlogs. Commissioner Astrue was interviewed. Listen to the piece online. Here are the parts of the transcript of the piece with Astrue's comments:

Judge Robert Habermann hears disability cases in Roanoke, Va., and is an officer in the judge's union. He says the Social Security Administration is pressuring judges to just ram through positive decisions.

ROBERT HABERMANN: It solves a lot of problems by just paying the case. The individual claimant is out of the system. In other words, there are no appeals.

Haberman says those positive decisions could stack up to billions of dollars in wasted taxpayer money.

MICHAEL ASTRUE: Well I've heard that as a union line, but that's just not true. ...

MICHAEL ASTRUE: We've had judges who decided no cases in a year. And we've had judges that have fairly chronically decided double digits -- 40 cases a year.

In fairness, the transcript makes it clear that Astrue also told the reporter that Social Security needed more money to hire more Administrative Law Judges (ALJs), but it appears that Astrue gave about equal weight to more money and ALJ productivity.

First Impressions

I have started looking at the proposed new regulations on representation of claimants. My first impression is generally unfavorable.

The most important thing I was looking for in the proposal is simplification of the process when an attorney leaves my firm and is replaced by another attorney. Currently, this process requires the filing of several forms which Social Security often fails to enter into its computer system. It is a mess. This proposal will not help. The same forms must be filed with the same potential for problems. If anything, the process could become more problematic. Here is Social Security's summary:

Any entity seeking direct payment of fees must maintain, and provide to us upon our request, a signed statement from each of the entity’s attorneys and eligible non-attorneys who represent claimants before us. The statement must state that the attorney or eligible non-attorney is performing representational services on behalf of the entity. The statement must also assert that any fees should be paid directly to the entity and that the representatives receive any compensation directly from the entity. Any request for direct payment of fees made by an entity must include an attestation that the entity is in possession of this signed statement from each attorney or eligible nonattorney who has performed any representational services for the claim in question.

This raises the specter of a disgruntled departing attorney withdrawing his or her "signed statement" while asserting that he or she worked on each of the firm's cases, whether that was true or not. If that happened, the firm would become ineligible for direct payment of fees for any of its cases. This would be a nightmare. There would be considerable potential for blackmail by a disgruntled departing attorney.

Without much more clarification, I would not register my firm as an "entity" with Social Security.

Here is an interesting nugget that I do support:

We propose to revise our list of prohibited actions to include three additional items: refusing to comply with any of our regulations, violating any section of the Act for which a criminal or civil monetary penalty is prescribed, and assisting another individual whom we have suspended or disqualified.

Update: Here is the link to the NPRM in the Federal Register.