Ever wonder what Social Security consultative examiners – the doctors who meet with disability applications to decide if they are disabled – think of the Social Security disability process?

Writing in Guernica, Dr. Heather Kovich discusses  her experiences as a (former) Social Security disability examiner:
There is also a stereotype of the doctors who do this work: lazy and disinterested. I found the job fascinating. The more I learned about the disability system, the more I pondered its complexities: it provides a safety net but keeps people mired in poverty. Helpful services, including job retraining, are available, but aren’t advertised. And the system rests on a deeply flawed premise—that there is a way to objectively determine who is able to work and who is not.

…

This was my job, “independent medical examiner.” On the basis of a forty-minute interview and examination, I was supposed to determine how disabled an applicant or “claimant” was. 

…

I did hundreds of disability exams over the next year, and while I did meet two people who were obviously faking, for the most part the stories I heard were heartbreaking: car accidents, massive strokes, lost jobs, dead spouses. Many people who apply for disability have lived through a tragedy. But the stories also told of the inefficiencies of the disability system. That first day in Spokane I met a man who had worked in manual labor his whole life, but for years had been getting crushing chest pain after walking a few blocks. His blood pressure was dangerously high. His condition was obviously treatable, but he did not have insurance so he had not been to a doctor in years. He knew that if he qualified for permanent disability he would eventually get Medicare or Medicaid and get proper treatment. He had no idea he could go to a community health center, a federally financed clinic where he could pay on a sliding-scale basis. With the right treatment and a less strenuous job, he would probably have not needed disability. Emphasis added.
This is the catch 22 of the Social Security system: with the health insurance Social Security provides, you might not be disabled. However, without Social Security disability, you can’t get the medical care you need.

This isn’t strictly a Social Security problem, it is US health system problem.

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Here is a list of the 100 conditions (as of 10/13/11) which Social Security now considers eligible for the Compassionate Allowance program which can result in a very fast approval. Recently added conditions are in bold. An up to date list is available here.

Acute Leukemia
Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
Alexander Disease (ALX) – Neonatal and Infantile
Alstrom Syndrome
Amegakaryocytic Thrombocytopenia
Amyotrophic Lateral Sclerosis (ALS)
Anaplastic Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
Aortic Atresia
Astrocytoma – Grade III and IV
Ataxia Telangiectasia

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Social Security has regulations on which medical providers can provide evidence and opinions about an individual’s diagnosis  and limitations. For a long time, evidence from nurses, chiropractors, therapists, and psychologists was not considered by Social Security because these professionals were not considered “acceptable medical sources.”
The term “medical sources” refers to both “acceptable medical sources” and other health care providers who are not “acceptable medical sources.” See 20 CFR 404.1502 and 416.902.

Under our current regulations, “acceptable medical sources” are:

Licensed physicians (medical or osteopathic doctors);
Licensed or certified psychologists. Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only;
Licensed optometrists, for the measurement of visual acuity and visual fields (for claims under title II, we may need a report from a physician to determine other aspects of eye disease);
Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle; and
Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.

See 20 CFR 404.1513(a) and 416.913(a).
Basically, a medical provider had to have MD (or DO, or PhD) after their name to qualify as a medical source. This left nurses, therapists, chiropractors, teachers, counselors, among other providers out in the cold as far as having their evidence conisidered by Social Security.

Social Security Ruling (SSR) 06-03p changed that by creating a new class: “other sources.” 

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Thank you to everyone who writes in or comments on posts. You are reason I created this blog. You are the reason for all of this!

The one question I get asked most is:
Can I win a disability case? What do you think of my chances?
Sometime this comes with a short description of the disabilities, sometimes a long one.

I really wish I could answer this. There are ethical and liability issues limiting what I can say. There is a bigger issue though: a case is not one thing. It is *all* the evidence that Social Security considers.

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