Welcome! This site is written for Social Security disability claimants, for their legal representatives, and for the network of people involved in the Social Security disability claim process. I hope you find it helpful.
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When a concurrent Title II and Title XVI case is awarded, the claim goes to the local Field Office for a determination of SSI benefits. This process takes some time, because the claim specialist at the field office needs to make an appointment to call the claimant to document the claimant’s income and assets to determine financial eligibility (SSI is a need-based program). Then the claim gets sent to the Payment Center, where Title II benefits are calculated, and then the SSI benefits offset the Title II benefits. Therefore, concurrent cases typically take several weeks longer to get paid than straight Title II-only disability claims. This is frustrating, because the SSI claimants are the ones who often need to money the most.

The monthly Title II disability benefit (PIA) is usually greater than the monthly Title XVI SSI amount. And while the SSI benefits begin to accrue on the filing date of the claim, the disability benefit is not paid until after the 5-month waiting period after the onset date. To evaluate these payment issues, you need to compare the filing date with the onset date, and know that the eligibility date for Title II is 5 full calendar months after the onset date.

Continue Reading Title II Offset When a Representative Fee is Involved

When one of my clients is awarded disability benefits, I like to write a short letter to the local Social Security field office, asking them to quickly process the disability claim. I want the local office to send the claim promptly to the Social Security Payment Center for payment.

When the person  awarded Social Security disability benefits is a parent of a minor child (or children), that minor child is entitled to auxiliary benefits. I always provide the child’s name, date of birth, and Social Security number in my letter, to assist the processing of the auxiliary benefits claim.

Represesentation does not end once your client is awarded disability benefits. Making sure that they are paid correctly, and as promptly as possible, is part of the job.

There is article in a national magazine enititled Inside the Kafkaesque Process for Determining Who Gets Federal Disability Benefits. It is most definitely worth reading.

The article begins by describing a (fairly typical) hearing before an Administrative Law Judge, and concludes: “A disability appeal hearing can seem surreal to an outsider.”

Fact check: True

The Social Security Processing Centers calculate and pay a claimant’s disability benefits, once a favorable decision or determination has been made.

The SSA has posted on its site the telephone numbers for the various processing centers. These numbers are for attorney and non-attorney Representatives to call, rather than individual disability claimants.

Disability cases are broken up into two different groups for processing: claimants under age 54 and claimants age 54 and over. From there, you can find the phone number for the correct processing center with the claimant’s Social Security number.

The numbers are invaluable when tracking down a retroactive payment for a client or a Representative’s fee that is overdue.

I frequently talk with people who have applied for Social Security disability. When I ask them why they are unable to work, they often respond “I have been diagnosed with _____.”

Sometimes the diagnosis is just a quick answer to my question. But often, as the conversation continues, there is a belief that, given the diagnosis, it is self-evident that they have symptoms preventing ongoing employment.

But that is not at all how a Social Security disability claim works. Social Security will not “connect the dots” from your diagnosis, to your symptoms, to your functional limitations.

The person claiming disability benefits has the burden to prove the links between the diagnosis, the symptoms, and the resultant functional limitations that prevent employment.

Each element (diagnosis, symptoms, limitations), must be proved.

A client with long-haul COVID symptoms was recently awarded Social Security disability benefits at the initial stage of review. That was great news. But when Social Security allows a disability claim at the initial or reconsideration level of review, they don’t tell you why; they just pay the disability benefits.

I wanted to know why the claim was granted. Specifically, I wanted to know how the claim was analyzed by the disability examiner and the medical reviewer, so that I could use that information in future cases. I requested a copy of the Disability Determination Explanation from the local field office. It just arrived.

This particulary client was 61 years old at the time of his application, with past relevant work at the Medium exertional level. His long COVID symptoms included chronic fatigue, joint pain, and severe, near-daily headaches.

Social Security issued an Emergency Message last year, entitled “Evaluating Cases with Coronavirus Disease 2019 (COVID-19).” The emergency message was recently revised (see EM 21032 REV). If you have a client with long-haul COVID, that Emergency Message is a good starting place when putting your case together.

I was wondering if, due to the my client’s long COVID symptoms, DDS had assessed an RFC for complete inability to do sustained work-related activity (see POMS section DI 24510.057B.2.b). To me, that would be the most appropriate resolution of the claim, and a similar finding could be made in most long-COVID cases.

But no. DDS assessed a straight Light exertional RFC and made a Medical-Vocational determination, with a detailed analysis of potentially transferable skills. A younger claimant, or one with less demanding past relevant work, would have been denied.

Social Security has started sending a paper booklet along with the Notice of Award letter to those whose claims for Social Security disability benefits have been granted. The booklet is entitled “What You Need to Know When You Get Social Security Disability Benefits”

It is a good practice. People are (almost always) receiving disability benefits for the first time. They do not know what to expect, and may not understand their responsibilities when receiving disability  benefits.

Hopefully the booklet will help.

I’m not the person I used to be.

Social Security disability applicants sometimes tell me this when I meet with them to discuss their claims. At the hearing, I will ask them to explain to the judge why they are a different person today than when they were able to work. It is usually compelling testimony.

Simply losing the ability to work on an ongoing basis is a life-changing event. It leaves many people isolated, depressed, and anxious. It is a very difficult road to travel, and it can change who you are as a person.

Additionally, many clients are dealing with loss of functionality that affects their daily activities. They cannot do what they used to do. They may be dealing with chronic pain every day. It can change you.

Always tell the judge how your life has changed.

When I see that a Social Security disability case has been closed, I review the ALJ decision online long before the paper copy arrives in the mail. For unfavorable decisions, of course you are looking at the reasoning of the decision, and for flaws that would support an appeal to the Appeals Council.

But it is worth reviewing your Fully Favorable decisions as well.

One reason is to see what RFC the judge adopted, and therefore what theory of disability was accepted by the judge. It is valuable to know what was persuasive to the judge, as a reference point for future cases.

Also, when reviewing your Fully Favorable decisions, check the onset date in the decision to make sure it is correct. It almost always is. But I just had a case where the onset date was amended at the hearing. That amended alleged onset date was June 1, 2020. I confirmed that  date in a post hearing letter. When the decision was issued, however, it had the onset date listed as June 1, 2022. Yikes! That change would eliminate two years of disability benefits for the client.

It was clearly a typographical error, and it was quickly fixed with a phone call and a faxed letter to the hearing office. Fortunately I caught it on the day the decision was issued. Had I not caught it, we would not have known about the problem until the Notice of Award arrived, perhaps weeks later.

Take a few minutes to review your Fully Favorable decisions before calling your client and giving them the news.

Social Security requires a medically determinable physical or mental impairment as the basis for a finding of disability. The “medically determinable” language is part of the definition of disability in the Social Security Act itself. See 42 U.S.C. 423(d)(1)(A).

The impairment(s) must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Therefore, a physical or mental impairment must be established by objective medical evidence from an acceptable medical source. See 20 C.F.R. 404.1521.

The requirement for a medically determinable impairment (MDI) is to ensure there is a valid basis for your claim, and for the functional limitations you are asserting.

Some illnesses can be problematic in the MDI department. Social Security has had to clarify how the MDI requirement can be met for certain illnesses. For example, Social Security has issued rulings stating that post-polio sydrome, fibromyalgia, and migraines can meet the requirement for a medically determinable impairment. The rulings set forth criteria for those diagnoses, and when those criteria are met, these impairments satisfy the “medically determinable” requirement, and can support a determination of disability.

I have a two cases at DDS for “long-haul COVID,” and am wondering of we will run into MDI problems with that diagnosis. The SSA has no criteria for what “acceptable clinical and laboratory diagnostic techniques” are necessary for a diagnosis of long-haul COVID, and has issued no ruling on this topic. So if your doctors evaluate you and diagnose you with long-haul COVID, and treat you for long-haul COVID, that diagnois should not be second-guessed by the SSA.

Lastly, sometimes it takes a while for the medical evidence to catch up with the symptoms. I just received a Fully Favorable decision this month for a client with a tramautic brain injury (TBI). When that case was evaluated by Social Security at the initial and reconsideration levels, it was denied because there was no medically determinable impairment. At that time, the client was experiencing serious, disabling symptoms, but had not yet received the medical testing to support a diagnosis.

By the time of the hearing, the medical evidence had developed substantially. The client had an MRI of the brain, and also vision-tracking testing from an optometrist (TBI patients often have vision issues). Both tests produced abnormal results, and the treating neurologist gave her a TBI diagnosis. With that diagnosis, supported by objective testing, the requirement for a medically determinable impairment was satisfied. The client was quickly awarded disability benefits after the hearing.