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There is an excellent recent NY Times Magazine article by Jennifer Kahn, entitled Chronic Pain is a Hidden Epidemic. It’s time for a Revolution. (the link will take you through the paywall).

Many of my clients experience chronic pain. It is good to see the issue starting to get the attention it deserves from the medical and scientific community.

The article states that pain was traditionally considered part of the healing process, and expected to disappear after an injury healed. Doctors were mystified by persistent pain. Contributing to the problem is the fact that there is no way to observe a patient’s pain or objectively measure it. So patients were often not taken seriously when they complained of chronic pain.

Researches are now beginning to understand that chronic pain can be a disorder of the central nervous system, and can be triggered anywhere along the pain-signaling nerve chain that runs to the brain. That is a big shift in thinking, and offers hope through targeting medications for those experiencing chronic pain. That’s the good news.

The bad news for those applying for disability due to chronic pain is that the Social Security disability system is an inherently skeptical system. Particularly at the DDS levels of initial and reconsideration review, chronic pain is not given enough weight – even when the cause of the pain is apparent. In cases where the reported pain is disproportionate to the perceived cause, or the precise cause is unknown, the chronic pain is often discounted altogether. The problem is compounded by the fact that there is no objective way to measure a person’s pain level.

The situation usually improves at the hearing level, when an administrative law judge will listen to your testimony and make a decision.

Social Security has issued Ruling 24-3p, entitled: Titles II and XVI: Use of Occupational Information and Vocational Specialist and Vocational Expert Evidence in Disability Determinations and Decisions. The Ruling became effective January 6, 2025.

The new Ruling rescinds and replaces Ruling 00-4p. The new Ruling follows two emergency messages from last year, addressing certain outdated occupations in the Dictionary of Occupational Titles.

The HALLEX has also been updated. See “Testimony of a Vocational Expert” HALLEX I-2-6-74.

Substantial Gainful Activity (SGA) is the amount of money that one can earn monthly and still qualify for Social Security disability benefits. The amount is adjusted each year for cost of living, as shown by this table. In 2024, the amount was $1,550 per month. This year, it rises to $1,620. SGA is based on gross pay, before payroll taxes are withheld.

The SGA amount is important for two groups of people:

  • A person applying for disability benefits must have (or be expected to have) a period of 12 consecutive months with wages below SGA (subject, of course, to the rules for unsuccessful work attempts and Impairment Related Work Expenses).
  • A person receiving Title II disability benefits can earn up to the SGA amount and still receive benefits (be sure to also take a look at the trial work rules).

For those receiving Title II disability benefits and working part-time, it is your responsibility to keep track of your monthly earnings and make sure they remain below the level of SGA.

Here in Maine and New Hampshire, where I attend Social Security disability hearings with administrative law judges, the hearing offices have caught up. Hearings are being scheduled promptly, with 75+ days notice, after the hearing request is processed. Many years ago, when I started handling these cases, the hearing offices had a large backlog of cases, and hearing delays were well over a year, sometimes 2 years. That was a long time to wait for a person unable to work to earn an income.

Social Security committed resources to improve the situation. Technology and the electronic claim file have certainly helped. It is terrific to see these cases move expeditiously now at the hearing level.

At the initial and reconsideration levels of review, however, delays have gotten worse. There seem to be enough disability adjudicators making determinations. And again, technology and the electronic claim file have helped, because claims can easily be transmitted to offices that have available capacity.

The problem is that each disability claim must go through a medical review, and there are simply not enough doctors reviewing these claims. After a disability adjudicator has gathered the medical records, a completed Work History Report, and an Adult Function Report, the claim goes into a queue for medical review. And it may sit in the queue for months before it is assigned to a doctor to review the claim and assess a residual functional capacity. Sometimes that in-house doctor will not have sufficient evidence, and a consultative exam is scheduled. That can add another 1-2 months to a claim, because there are a limited number of doctors conducting those examinations. As a result, some initial claims are taking 8-9 months for a determination. That is longer than it should be.

On this day in 2008, I published a post on this blog titled “Disability is Functionality.” All these years later, it remains true.

Claimants often are surprised to learn that their disability applications were denied even though their doctors provided a letter stating that their patient is disabled, or their medical records show that they have a severe medical condition. However, disability decisions are primarily based upon an individual’s functional capacity rather than a diagnosis.

To establish disability, a person must establish the functional limitations they experience due their diagnosed conditions, and that those limitations prevent ongoing work. Social Security will not connect the dots between a particular diagnosis and the ability to work. It is the claimant’s burden to prove.

The new fee cap, announced back in March, is now in effect. The relevant date for the fee cap is the date of the approval fee agreement. So if the fee agreement was approved prior to November 30, 2024 but is still unpaid, the previous cap of $7,200 applies. Social Security has announced that, in the future, the cap will be adjusted annually for inflation/cost of living.

Social Security has a new form 1693 reflecting the change. The new form does not reflect the specific cap amount (since it will be adjusted annually), but just limits the fee to “25 percent of your past-due (retroactive) benefits or a maximum dollar amount we set, whichever is less.”

The fee cap applies to fees approved via a fee agreement. It does not apply to fees charged via a fee petition.

Updated: 12/09/2024

Social Security is now using an updated version of its Work History Report, form SSA-3369-BK.

Of course, a new Work History form was necessary when the period of time for past relevant work was changed from 15 years to 5 years, streamlining the disability process. But Social Security took the opportunity to redesign the form as well, and to me the new form is much better than the previous version, and much more intuitive to complete.

A person’s mental health is often the basis of a disability claim. That person’s past relevant work (PRW) is often precluded by their mental health symptoms at Step 4 of the Social Security’s sequential evaluation. Frequently assessed functional limitations due to mental health symptoms, such as a limitations to “simple tasks” or “no interaction with the general public” are enough to eliminate that person’s ability to perform their PRW.

However, those limitations do not help much when considering the person’s ability to perform other work at Step 5 of the sequential evaluation. Limitations to “simple tasks” or “no interaction with the general public” do not prevent application of the Medical-Vocational guidelines at Step 5. A person with those mental health limitations alone will not be found disabled at Step 5 in the absence of physical impairments.

That is why I always explore physical issues in mental health claims, even when the client says that the reason they can’t work is their mental health. Their physical limitations can have an oversized effect in proving that they can’t perform other work at Step 5, due the the Medical-Vocational Guidelines, which use physical limitations and age as the primary vocational factors.

For those over the age of 55, that means a limitations to Light exertional work will direct a finding of “disabled.” The limitation to “simple tasks” due to mental health symptoms plays a role here as well, because a limitations to simple tasks precludes the transfer of acquired job skills. That combination of impairments is a winning combination for those over 55.