I know that this blog is read by Congressional staffers who have never been involved in disability determination work at all as well as by upper level Social Security employees who also lack that experience. It's easy when you don't have this experience to develop attitudes towards disability claimants that have far more to do with your general political and social views than with the reality of disability claims. I thought I would reproduce here a portion of one consultative examination (that is an exam purchased by Social Security) on one of my clients, after having been careful to remove anything that could identify the individual. It may give you a peek at what goes on in these cases.
This is a man who was 60 at the time of the exam. He has a high school education. He's done fairly heavy work.
You'll have to trust me that there's nothing in the rest of this man's file that detracts one bit from the information given in this excerpt. In fact, the rest of the medical records only make the case seem stronger.
This man's case is quite strong but not unusual. I've picked it mostly because it's not that difficult for a novice to appreciate.
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Let my explain a few things from this report.
- "Glucometer 399". This means his blood sugar was quite high the day he was seen. He's a diabetic.
- "Degenerative changes greatest at the L4-5, L5-S1." He's got arthritis in is low back. That's actually fairly normal in a man of his age but it still hurts.
- "He does seem to have a bit of peripheral lateral deficit on the right eye." You expect vision problems in an older diabetic. It's part of the damage that diabetes does to the body. However, this deficit could have some other cause.
- "He has quite a bit of peripheral edema bilaterally very hard, woody type edema." Edema is swelling. Peripheral means it's in his lower legs. "Hard, woody type edema" sounds bad and is bad. It's a sign of poor blood circulation. This man's obesity is also contributing to the problem.
- "He has numbness to his fingertips, numbness to the plantar aspect of both feet and the dorsum of both feet and basically the entirety of both legs ..." Diabetics typically develop peripheral neuropathy, that is nerve damage in the lower legs and sometimes their hands. It's a serious matter. Diabetics can't feel their feet very well which can lead to poor balance. Our feet are supposed to be constantly feeling the ground beneath them. Take away that feedback and you're more likely to fall. You're also more likely to injure your feet without knowing it. Other medical records show that the numbness in this man's hands is mostly due to carpal tunnel syndrome.
- "Hypersensitivity and numbness to the lower legs." It's weird but with peripheral neuropathy, your legs can be exquisitely sensitive to touch yet numb at the same time. Just a light touch can be painful even though you can hardly feel it.
- "Tandem gait is definitely abnormal." Tandem gait is where a physician asks a patient to try to walk while placing one foot immediately in front of the other. This man's balance is poor so he has a hard time doing it.
- "A stent to his LAD years ago." LAD is the Left Anterior Descending coronary artery. Stents are great. They help keep a diseased artery open. In this case it was an important artery supplying blood to the heart itself. A stent has helped this man for many years but he's still got heart disease and it's almost certainly getting worse over time.
I guess my point here is to explain why Social Security Administrative Law Judges (ALJs) approve almost half the cases they hear. It's because the claimants whose cases they're hearing mostly have fairly serious health problems. Most aren't as serious as this man's but they're still serious.
If you have no real experience with these cases, you can say things like "There's something else he can do." However, when you actually have to face a 60+ year old man who's never done anything that didn't involve a lot of exertion that doesn't seem to make much sense, especially when the man doesn't have much education and his health is rapidly deteriorating.
What I'm saying here is that even if you're a Republican Congressional staffer and you're a true believer in personal responsibility and you just know that Social Security approves too many disability claims, if you were a Social Security ALJ you'd still probably approve 40% or more of the cases you heard because it wouldn't be theory anymore. It would be flesh and blood people and you'd have a solemn responsibility to fairly judge the cases.