Disabled children under age 18 can receive Social Security disability benefits under the Supplemental Security Income (SSI) program, or “Child’s SSI.” In order to qualify for children’s disability benefits, Social Security requires that the child:

Is not working at a job that Social Security considers to be substantial work; and
Has a physical or mental condition (or a combination of conditions) that results in “marked and severe functional limitations.”  This means that the condition(s) very seriously limits his or her activities; and
The condition(s) has lasted, or is expected to last, at least 1 year or is expected to result in death.

Note: some conditions result in presumptive disability decision. If your child has one of these condition, he or she may be able to be instantly approved.

However, the majority of children’s disability cases focuses on the second part, the requirement of that a condition produces “marked and severe functional limitation.” There are several ways of doing this:

Continue reading →

Sometimes when a Social Security disability case goes to hearing, the Administrative Law Judge has a brand new doctor testify (usually by telephone). This is not one of your doctors, or (usually) even one of the doctors Social Security has sent you to. These are Medical Experts (MEs) that the Judge calls for several reasons:

Establish a medically determinable impairment. In any Social Security disability case, you have to prove the existence of not only symptoms, but also an underlying cause — a diagnosis. When the records are not clear, or when different doctors have provided different diagnoses (especially over time), a Medical Expert can help clarify what the underlying conditions have been and are today.
Determine if the impairments meet or equal a listing level impairment (step 3 in the Sequential Evaluation Process). If a Medical Expert states your impairments either meet the requirements of  listing level impairment, or have the same limitations as a listing level impairment, the case may be approved very quickly.
Provide limitations from the impairment(s). In many cases, treating doctors do not want to make any kind of opinion about work-place limitations. They refuse to complete forms which often results in a gap in your evidence. Even though Social Security often has one of their own doctors review a case and determine limitations during the initial case review (before the first decision), the Medical Expert can provide a new opinion. This can be a better opinion since it is based on evidence that has been developed over the course of the case.
Establish an onset date. If the Medical Expert is supportive of the disability, they may also be asked to estimate how far back the limitations existed. This is important to establishing the correct onset date in a case.
Provide a prognosis. In order for a condition to be disabling it has to either be expected to result in death or be disabling for 12 months or longer. If a condition has not clearly been disabling for 12 months, a Medical Expert may be asked whether it is likely to continue until the durational requirement is met.

While a Medical Expert may touch on any or all of these, the make or break issues are whether the impairments meet a listing, or if not, what limitations are expected to result from the impairments.
Is having a Medical Expert good or bad?

Continue reading →

How does Social Security look at children’s disability cases based on epilepsy or other seizure disorders?

Social Security first considers the Listing of Impairments. The Listings are a set of descriptions of medical conditions which can be disabling. The Listings tell you the what kind medical evidence you need and the medical findings to prove that the condition is disabling.  While the Listings are not the only way to be found disabled, they are very important in children’s disability cases.

For seizure disorders, there are two critical Listings.

111.02 Major motor seizure disorder
111.03 Nonconvulsive epilepsy

Continue reading →

Social Security attorney Gordon Gates wrote about a Social Security Administrative Law Judge (ALJ) who only approves 11 percent of cases.

In trying to find some insight in to how this ALJ could only approve 11% of cases when most other ALJs approve somewhere between 45-60% of cases, Gordon found the following post from the ALJ on a high profile public website:
Some doctors go overboard on diagnoses and treatment because they sense the “pot of gold” in having a fairly young patient on Medicare for many years to come with a reliable source of payment for constant treatment.

Lawyers and other non-attorney representative can receive fees as a percentage of the back benefits awarded to a claimant. Once a claimant has a legal representative, one can actually track how the alleged impairments become much worse, with new impairments and symptoms added as the case matures.

A judge with some experience can almost recite verbatim the same story we hear from virtually EVERY claimant, suggesting they have received training from the national organization of the claimants attorneys. The government is complicit in this boondoggle, because the Social Security Administration actually publishes lists of symptoms for various impairments in the form of rules for judges to follow. Is it any wonder we hear those lists of symptoms at almost every hearing?
The Judge’s quote is quite lengthy and covers a number of topics.  I encourage you to read it in Gordon’s article:  The 11 Percent ALJ.

While I can agree with the Judge on several points in the longer quote, I strongly disagree with what the Judge says above.

Let’s set ‘em up and knock ‘em down!

Continue reading →