Social Security has physicians review disability cases as medical consultant’s to make opinions on individual’s abilities and limitations. However, what good is the medical consultant’s opinion if they don’t have expertise in with the disability in question.

Per Nate Craig:

… you may also want to look at the Medical Consultant’s Code attached to the State Agency’s opinion. I am finding more and more reviewing physician’s making opinions outside their professional field. Recently an ALJ relied on the State Agency’s opinion where the initial decision was made by a SDM and then affirmed by a “dermatologist” MCC of 6. The AC kicked it back with the directive for another physical CE. At the remand hearing, the same ALJ entered a decision of disability back to original onset date.

Wondering if the medical consultant on your case had the necessary expertise to make an opinion? Check the consultant’s code (next to the signature on the last page) with the list the at Social Security.

Note: the consultant’s codes appear on forms from doctors who review cases, not the doctors who exam claimants at consultative examinations.

MC/PC Specialty Codes
01 Anesthesiology
02 Ambulatory Medicine
03 Audiology
04 Cardiology
05 Cardiopulmonary
06 Dermatology
07 E.E.N.T.
08 E.N.T.
09 E.T.
10 Emergency Room Medicine
11 Endocrinology
12 Family or General Practice
13 Gastroenterology
14 Geriatrics
15 Gynecology
16 Hematology
17 Industrial Medicine
18 Infectious Diseases
19 Internal Medicine
20 Neurology
21 Neuro-Ophthalmology
22 Neuro-Psychiatry
23 Neonatology
24 Nephrology
25 Obstetrics
26 Occupational Medicine
27 Oncology
28 Ophthalmology
29 Orthopedics
30 Osteopathy
31 Pathology
32 Pediatrics
33 Physiatry
34 Physical Medicine
35 Plastic Surgery
36 Preventative Medicine
37 Psychiatry
38 Psychology
39 Public Health
40 Pulmonary
41 Radiology
42 Rehabilitative Medicine
43 Rheumatology
44 Special Senses
45 Surgery
46 Urology
47 Other
48 Speech-Language Pathology
49 Child and Adolescent Psychiatry

Since Social Security has started provided encrypted Social Security exhibit CDs, many people contacting my office have not been able to access their files. The Social Security encrypted disks are keeping claimants from accessing their data.

First, you have to be running Microsoft Windows. Fortunately, some early concerns about having the encryption system only working in Windows Vista seem to be unfounded. I have been able to access the encryption system in Windows 7. However, if you are using a Mac (like I am) or Linux, you are out of luck unless you virtualize a Windows system.

Let’s go through how to get at those file!

When you open the Social Security cd in your file explorer, you will see a window like this.

Double click on the “PME” icon and you will see the following dialog:

In the first box, titled “account name,” enter “ssa”. Do not capitalize or enter the quotation marks. According to Social Security, the account name stays the same for all disks sent to claimants or attorneys.

The “password” is first 4 letters of the claimant’s first name (all lowercase), followed by a “#” and the last 4 numbers of the claimant’s Social Security Number. Make sure not to capitalize the first name!

So, for John Smith, SSN 123-45-6789, the password is john#6789

If the first name is less than four characters long, add #’s until you have 4 characters for the first name.

For Tom Jones, SSN 987-65-4321, the password is tom##4321

For Al Jackson, SSN 567-89-1234, the password is al###1234

If the password does not want to work, try the following:

1. Make sure you are not capitalizing either the account name or the password.
2. If you have to add #’s to make the first name 4 characters long, don’t forget to add the extra # which has to be between the 4 characters of the first name and the last 4 digits of the SSN.
3. If you reviewing a cd on a child’s claim, make sure you are using the child’s first name.

For attorneys, I recommend signing up for electronic access to the Social Security files through the ERE (Electronic Records Express) system. Not only can you access files instantly (including case documents which have not yet been made part of the exhibit file), you can download the file either in the web format previously available on the Social Security CDs, or as a PDF. Either format in unencrypted which means you do not have to jump through hoops to access case files, and you can review exhibit files on Mac or Linux systems.

Another nice feature is the ability to download individual files instantly. If there is a downside, it is that if you want to download the entire file (either as a zip file or a PDF) you have to request the download, which is then queued up. You are notified by when the file is available for download. In the first couple of months using the new system, files are ready in an hour or two on business days, and almost immediately on weekends. We will have to see if processing times increase as more lawyers come on line and begin to use the ERE system to access case files.

Top photo credit: gitsul.

If you are looking at your Social Security exhibit file and you notice that all the exhibits are numbered with a letter in front, such as “B1A, B2A, B1B, B2B,” etc, this means that you are looking at the “B” file — a file for the second application for Social Security disability benefits.

In other words, the first time you file for benefits, Social Security creates an “A” file. Since this may be the only file you ever have, it is not referred to as the “A” file.  However, if you file a second application, the second file becomes the “B” file. The third application becomes part of the “C” file, and so on.

These letters are just a way to distinguish the file and quickly tell whether a file is an earlier file or a later file.

Note: this system does not always work. I have had clients with 5 or more applications and their file had either no letter or it may have only been the “B” file. So, the absence of a letter does not mean there isn’t a prior file, but if there is a letter, then there definitely is a prior file.

So, do you want it and how do you get it?

If there is Social Security information out there, I generally want it. There are exceptions of course. I do not necessarily want a file from 10 years ago, but a file that is only 2 years old may have some valuable evidence in it. It all comes down to the specific circumstances of the case. Sometimes a client tells me that a prior Social Security examiner gave the client a favorable report, or a prior hearing denial said the client was limited to light work and since the client is now 55 year old, that by itself my let the client be approved. Then, absolutely, I want to get my hands on that file!

This usually just means asking for it. I do this by addressing a request, a letter really, to the judge or the judge’s office. I request that the prior file be made available, or requested (if it is in storage) and I state my reasons for why the file may be important in the current case. I have never seen a judge refuse this request.

Then, follow up to make sure the file has been received, and either request a copy of the file on CD or schedule time to make a copy of the file the ODAR (Office of Disability Adjudication and Review) office.

Now that I know the critical dates and the medical history I review the work history. Social Security reviews cases using the 5 step sequential evaluation process. At step 4, if you are still able to do any of the jobs you performed in the last 15 years before you became disabled, you can be denied benefits. There are a couple more wrinkles to this, such as the job has to be a substantial gainful activity, but the general idea is that if you can still do a job your over the last 15 years, you can be denied.

I often start with the “Disability History – Work Report” and the “Work Background Report.” These are forms you filled out for Social Security describing the type of work you did.

There may be jobs here that you have forgotten about and these documents may provide the beginning and ending dates for the various jobs.

However, you also have to check the earnings reports:

These provide your earnings reported by your employers and are another way to make sure you have not forgotten about a job. There have also been several instances where my clients and I found that someone in another state was using their Social Security number to work because those earnings were also showing up in these reports. Going over each employer is a way of making sure that you have not forgotten any work. This goes a long way to avoiding any surprises at your hearing.

The last report also describes any unemployment benefits you received. Read the linked article for more information about how unemployment can affect your case.

What’s the next thing to review in the Social Security exhibit file after the medical records? Check these critical dates: Alleged Onset Date (AOD) & Date Last Insured (DLI)!

The E section usually contains for two documents that provide this information:

• “Disability Report – Field Office”
• “Disability Report – Appeal”

These reports also tells you whether Social Security thinks there should be a later (or earlier) alleged onset date and Social Security also discussed whether work after the alleged onset day was an unsuccessful work activity or not a substantial gainful activity.

I have been in a number of hearings where being able to point out that Social Security previously noted a claimant’s past work as an unsuccessful work attempt made all the difference.

Let’s say you are reviewing your Social Security exhibit file before your disability hearing and you discover that some of your doctor’s (or other records) are not there. I have mentioned before that it is not unusual for the medical records in a Social Security file to be a year or more out of date.

What can you do if the records are not complete?

You can ask Social Security to update the records. If you do not have a lawyer Social Security has a higher responsibility to make sure that your hearing is fair, which includes helping you obtain sufficient records to review your case.

Be clear with your request. If you are missing records from a particular doctor, say,

Dr. Smith’s records are missing. Dr. Smith treated me for my back problem from 2001 to 2009 and performed my back surgery. Can Social Security request these records.

If Social Security only has a partial set of records, tell them:

I see you have Dr. Jones records from April 4, 2006 through September 2008, but you are missing her records after September 2008. These records are important because …. Can Social Security request these records?

It is important to tell Social Security why the missing records are important. Social Security does not require every single piece of medical evidence to decide your case. If you want Social Security to get your records, help them understand why those records are critical.

There’s one more thing: even though Social Security has a greater obligation to unrepresented claimant’s (that’s you), it is not Social Security’s duty to obtain evidence. You have the duty to provide evidence to prove your disability.

So, don’t go demanding that Social Security get this or get that, or get all your records for the last 30 years. It won’t get you anywhere.

Be respectful, explain why the records are critical in a fair evaluation of your case and ask for help.

How do you begin to review your Social Security exhibit file? Here is a quick guide to finding the really important parts.

Start with the “F” section to review the medical records.

If you do not review anything else in the file, you need to know what medical records are there (and what records are missing).

Here is what I look for:

• Are all the doctors and hospitals listed? If the doctor or hospital is not listed, it is a safe bet that those records are not in the file. There are some exceptions to this. Occasionally, records are commingled, with more than one doctor’s records in one exhibit, but that is usually straightened out as the Office of Disability Adjudication and Review (ODAR) gets your exhibit file ready for the hearing.
• Are all all the dates of service complete? In the image above the records cover August 19, 2003 through November 13, 2003. If you know you treated with that doctor in 2004, you know the records are not complete.
• Do the number of pages look right? If you were treating with the same doctor for years and years, but Social Security only shows 12 pages, the records are probably not complete.

Then, start to review the actual records. While a review of the exhibit list can help you quickly spot missing records or other problems, you really have to examine the records to find out what Social Security has (and what might be missing).

The F section of the file also has all the reports from any doctors Social Security sent you to. If you want to see what the consultative examiner had to say, now is your chance to find out!

You will also find the forms from the Social Security technicians describing what limitations they think you have. Social Security often uses this information in deciding your case, so you need to know what they are saying.

Just before your Social Security hearing, you will be given a cd and pointed at a computer. If you ask, someone may help you load up the disk and get you to a screen that looks like this:

Ok, now what?

What is all this stuff and what do I do with it?

Social Security uses electronic case files. The image above is the “Exhibit List Index” which may automatically come up when you insert the disk into the computer (if it does not, you may have to browse to your cd and double click “index.html” If in doubt, just ask your kids.

The Exhibit List Index is a “table of contents” for the documents in the file.

In the above image, you can see there are 4 exhibits in the “B” part of the file.  The first one, 1B is a request for hearing and that document is 5 pages long. By clicking on any link (blue underlined text) you will be taken to that exhibit.

I know how to move around in the exhibit file, but I don’t know what I am looking at!

Ok. The file is divided into different sections, labeled A through F. Here is what you can find inside each section.

• Section “A” contains the transmittal sheets, which provide a quick overview of your case. These are pretty cryptic if you are not familiar with them. However, they do provide one critical piece of information: right at the top to the left of your Social Security Number there is a block for your “Filing Date.”  This is your Protected Filing Date.
• Section “B” covers the decisions on the case, or more importantly the denials. If you need to find the official documents in the case (denials, requests for hearing, fee agreements, appointment of representative forms, notice of hearings etc) this is where they are.
• Section “D” covers most of the forms that your filled out for Social Security and the non-medical evidence. This includes all the forms Social Security has you fill out, and your earnings records. This also includes school records such as grades, IEPs, 504 plans, teacher questionnaires, and all other school records.
• Section “F” has all of the medical records in your case. This includes the reports of the doctors Social Security sent you to (you really need to review this) and the reports from any technicians who completed forms describing what you can and cannot do.

What do you do with all of this … stuff? Well, you read it. Personally, I like to do a cover-to-cover review of the file.

However, if you have never read a file before, you may give up before you get to the critical stuff (like the medical records all the way in the back of the file). My next series of articles will deal with how to review a Social Security exhibit file.

Keep in mind that there are some regional differences in how Social Security organizes the files. I have seen files from other states that had records in different places. Some states try to speed up the processing of cases by putting all the medical records into just one “F” exhibit. You end up with just a single description, “1F Medical Records 608 pages.” This is fairly useless and requires going through the exhibit and figuring out exactly what records are there.

It surprises my clients to learn that, most of the time, Social Security does not update medical records after the initial denial.

With wait times of a year or more, this can mean that by the time your case gets in front of a judge, the records in your file may be a year (or more) old, and your recent treatment may not be in the file at all.

This is not the way the system is supposed to work.

When you appeal the initial denial, you provide a list of your current doctors, dates of treatment, tests performed, and medications as part of the appeal.  You also provide an authorization letting Social Security get updated records. Your appeal will be rejected if you do not do this.

There are also regulation instructing Judges to assist un-represented claimants (people applying for Social Security) with obtaining relevant evidence in their case.

BUT, when I get a call from someone whose hearing has just been set, or continued, I often see that NONE of the records have been updated since the denial.

Think about the waiting times in your area.  In Colorado, the typical wait is a bit over a year (although the times in the Pueblo area are sometimes over 2 years). Do you want a Judge deciding your case with out-of-date records?

This is why you need to review your file early to figure out just what records Social Security has, what records are incomplete, and what records are just plain missing. That means you have to know how to review your file.

Personally, I encourage you to work with an attorney to make sure the necessary records are in your file. However, if you decide to brave this process alone, make sure you know what is in your file and keep it up to date!

My last article talked about why it is so important to review your Social Security exhibit file.

But how do I get a copy of my Social Security file?

If you already have a hearing scheduled, Social Security will tell you in the Notice of Hearing that you should arrive thirty minutes before your hearing and you will then have a chance to review your file.

However, 30 minutes is NOT enough time to review your file. If you are like most people, you have never seen a Social Security file. If you simply start at the beginning of your file, your case may be called before you even get to your medical records.

Hint: the medical records are kept in the very back of the exhibit file in the “F” section.

Instead of a paper file, your case may be kept in an electronic format. If so, you will be handed a cd and pointed at a computer.

There is a better way to review your file.

Whether you have a paper file or an electronic file, you can request to review your file before your hearing. I, personally, recommend reviewing your file once your have appealed the initial denial and your file has been transferred to the Office of Disability Adjudication and Review (ODAR).

Once your file is transferred to an ODAR, you will receive a letter confirming the receipt of your appeal. This is the letter that tells you that you will notified 20 days before the hearing.

Usually in the top right corner you will find the ODAR address and telephone number. Just call the number and ask the receptionist how you can either get a copy of your file, or how your can review your file at the ODAR office.

If you have a paper file, the ODAR staff will schedule a time when you can come in and either review or photocopy the file.

Tip: if you request to copy the file, it is a good idea to bring your own copy paper, two reams should be enough. Some offices will tell you this. If they forget and they do not have any paper (and you did not bring your own), you may need to reschedule your appointment.

Note: if the file has been permanently moved to an out-of-state ODAR office, that office should be willing to copy your file and mail it to you. After all, how are you supposed to prove your case, if you do not have a chance to see what Social Security has in your file?

If your case is an electronic case file, ODAR will probably send you a copy of your file on CD. The CD contains an electronic version of everything in your case file. If you have a computer, viewing the exhibit file may be as simple as putting the disk in your computer. An internet browser should pop up displaying all the sections of the case file. You can then click on each exhibit to see what it contains.

Note: Even though you view the exhibit file through an internet browser, you do not need internet access to view the exhibit file.

If you do not have a computer, you may be able to view the file at your local library, or you can schedule time to view the file at the ODAR office on one of their public computers.

Make sure to give yourself plenty of time to review the file and bring a notepad to jot down any questions you have.

Wouldn’t you like to know what Social Security really thinks about your claim? The best way to find out is to review your Social Security exhibit file.

Everything Social Security has on your claim for disability benefits is contained in the “exhibit file.” This includes medical records, statements of limitations, notes from Social Security’s technicians, reports from any doctors Social Security sent you to, and any opinions Social Security based on the evidence in your file. Plus, you may even see post it notes flagging what Social Security thought was particularly important.

“But, wait there’s more…” The exhibit file also contains income summaries and earnings reports, as well as every form you filled out during your application, and possibly your prior files as well.

Why is this important?

If you want to know why you were denied (something more substantial than what Social Security told you in their denial), and what your chances are at hearing, you need to review your Social Security file.

Keep in mind, there is a lot of technical data in the file. There are a number of cryptic forms and abbreviations fly fast and furious. It really is helpful to review the file with an attorney who can help you spot the critical issues and translate the Social Security-isms.

However, even if you do not have an attorney [although you really should get one], reviewing the Social Security’s medical reports, and Residual Functional Capacity forms (the ones where Social Security says what it thinks you can and cannot do), will give you insight into how Social Security views your case. This will let you know what you will be up against when you go to the hearing.