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Social Security has added Initial and Reconsideration cases to its status report in Electronic Records Express (ERE).

Here is a screenshot:

ERE Status Report

The status report now allows a Representative to quickly determine whether or not they have been associated with a particular client’s disability claim file. Previously, we would have to try to access the claimant’s electronic folder, a more time-consuming process. This new feature allows quick confirmation that you have been associated with the file. It is terrific addition to the ERE system.

A hearing with an administrative law judge (ALJ) to determine medical eligibility for Social Security disability benefits usually follows a pattern: opening remarks by the judge and then the claimant’s lawyer, the claimant’s testimony, and then testimony of a vocational witness regarding the claimant’s past relevant work, and whether or not various functional limitations would preclude that past relevant work and/or other work. Broadly speaking, this is pretty much the course of most hearings. At the close of the hearing, the judge often will say something like “Thank you for coming today. I will review the record and issue a written decision soon.”

Occasionally, at the end of the hearing the judge will announce that the claim will be granted, and that a written decision will be forthcoming. But usually applicants leave the hearing without knowing the outcome of their claim.

These hearings are completely unfamiliar to most people, and there is a great deal at stake. I want the client to return home with a fair idea of the probable result, so I always spend time after the hearing to discuss with the client how the hearing went.

There are usually clues from the hearing about the probable result. Strong clues are the vocational testimony, and the judge’s choice of hypothetical questions for the VE. The caliber of the testimony of the claimant during the hearing is also a strong clue, along with the tenor of the questioning of the claimant from the judge. My past experience in other cases with the particular judge at the hearing also informs my opinion.

As a result, I usually have a pretty good idea at the end of the hearing what the decision is going to be. And I always share that with my client.

 

New evidence for Social Security claims must be submitted 5 business days ahead of the hearing. See 20 CFR 404.935(a) and HALLEX I-2-5-13. With a typical weekend, that’s 7 days ahead of the hearing. Holidays, which are of course not business days, must be accounted for as well. So beware the 3-day holiday weekend.

The federal holidays following Christmas and New Year’s Day can sneak up on you. The Birthday of Martin Luther King, Jr. is January 15th, and Washington’s Birthday will be honored on Monday, February 19th this year. If you have a hearing during the week following one of these holidays, as I do, you must take the holiday into account when calculating filing deadlines.

New evidence includes updated medical evidence and the Representative’s brief. Everything must be filed 5 business days ahead to be timely for the hearing. While filing earlier is always best, be aware of the deadline.

Substantial Gainful Activity (SGA) is the amount of money that one can earn and still qualify for Social Security disability benefits. The amount is adjusted each year for inflation, as shown by this table. In 2023, the amount is $1,470. For 2024, the SGA amount goes up to $1,550.

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 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. And remember, SGA is based on gross pay, before payroll taxes are withheld.

If you have monthly earnings above the level of substantial gainful activity, it is problematic for your disability or SSI claim.

For 2023, the SGA amount is $1,470. Earnings over that monthly amount can present real challeges to receiving benefits. Depending upon the circumstances, you can be denied benefits or the benefits you receive can be terminated if your earnings are too high.

However, if your earnings are not way over SGA amount, there are ways to reduce the earnings counted by Social Security when determining whether or not you are working at the SGA level. These are called Impairment Related Work Expenses (IRWEs).

Impairment Related Work Expenses are unreimbursed expenses that are 1) related to your impairment and 2) help you to work. Many different expenses qualify, but the most prevalent expenses are medical and medication costs. So if you are paying for medical visits, medication or for insurance copays, these are likely to be expenses that can reduce the earnings counted for SGA income. There are many other qualifying expenses. See Social Security Ruling 84-26 for more.

Once you have ruled out your ability to perform your past relevant work at Step 4 of Social Security’s sequential disability evaluation, then at Step 5 of the evaluation Social Security considers your ability to transition to other work, that is less demanding physically or mentally (or perhaps both).

The Step 5 stage of the evaluation is the first time Social Security considers your age as a vocational factor in its analysis. Social Security treats someone age 55 or older quite differently than someone under the age of 50 at this stage of the evaluation process, due to the operation of the Medical-Vocational Guidelines.

The Medical-Vocational Guidelines make certain assumptions about a person’s ability to transition to other work, depending upon age, education, physical exertional level, and acquired job skills. Based upon those factors, the guidelines direct a finding of “disabled” or “not disabled.” If you are over the age of 55 and limited to Light exertional work, the guidelines direct a finding of “disabled” in the absence of transferable job skills or recent education allowing direct entry to skilled work. Similarly, the guidelines direct a finding of “disabled” for those over age 50 who are limited to unskilled work at the Sedentary exertional level.

However, the Medical-Vocational Guidelines operate based on physical limitations, not mental limitations. So a person unable to work due to limitations from mental health symptoms alone gets no advantage at Step 5 due to being over age 55. Common mental functional limitations assessed by Social Security, such as a limitation to simple tasks or a limitation to not interact with the general public, do not prevent use of the guidelines. A limitation to simple tasks would likely preclude the transfer of acquired job skills at Step 5, but it does not otherwise help with a finding of disability under the Medical-Vocational Guidelines.

Those over the age of 55 suffering mental rather than physical limitations effectively have a higher burden of proof at Step 5. In the absence of any physical limitations, one has to rule out a person’s ability to do any work on a full-time basis, including Medium or Heavy exertional unskilled work. That is much more difficult. I always explore physical limitations of clients over the age of 55, even for those who can no longer work primarily due to their mental health. If there is a medically determinable physical impairment that limits a person to Light or Sedentary work, then they will prevail at Step 5 (in the absence of transferable skills). It doesn’t matter that the physical impairment was not the reason the client could no longer perform their past relevant work.

In summary, a person who can no longer perform their highly skilled past work at Step 4 due to their mental health could be denied benefits at Step 5 in the absence of severe physical impairments, because they could theoretically work as an unskilled laborer, even if the unskilled job pays a fraction of the highly skilled work that the person used to perform.

That is why for those over 55, there is an easy way and a hard way to win your case.

Social Security has published a proposed rule that shortens the lookback period for past relevant work (PRW) from the current 15 years to a 5 year period. The proposed rule would recognize that claimants often do not remember the details of a job held 15 years ago. Further, that past job has limited relevance to a claimant’s ability currently to perform that work, because the workplace has changed significantly.  Similarly, job skills acquired 15 years ago are unlikely to be readily transferable to a significant range of semi-skilled or skilled jobs in the current workplace.

The comment period for the rule closes in a week, on November 28th (which is 60 days after the date the proposed rule was published). It has been interesting reading the public comments to the proposed rule. Of the 50+ comments made to date, there are a few stray comments that oppose the proposed rule. The overwhelming majority of the comments, including mine, are strongly supportive of the rule change.

One comment in particular caught my eye. Submitted by Social Security disability lawyer Andrew Kinney, the comment suggests that the new 5-year rule should from the date of adjudication ONLY, and not from the date last insured (DLI), if the DLI is earlier. It is a very good point.

The current rule looks back 15 years from the date of adjudication, or from the date “when the disability insured status requirement was last met, if earlier”. See 20 C.F.R. 404.1565(a).

However, using only the date of adjucation for the PRW period would make sense, for all the reasons underlying the proposed rule change. As Mr. Kinney stated at the end of his comment, “Relying solely on the date of adjudication to calculate PRW in all cases would eliminate the issues you cite surrounding memory and erosion of skills that arise when evaluating PRW in remote DLI situations.” Mr. Kinney is right. Social Security should use the date of adjudication only to define the new 5-year PRW period.

11/27/2023 Update: NOSSCR has submitted its comment, providing reasoned arguments in support of the proposed rule, and urging the SSA to swiftly enact it.

11/29/2023 Update: The comment period has ended. A total of 89 comments were received.

Today Social Security gave notice of Ruling 23-1p, “Titles II and XVI: Duration Requirement for Disability.”

The new Ruling rescinds and replaces SSR 82–52: Titles II and XVI: Duration of the Impairment.

Charles Hall made the following comment in his blog post about the new Ruling:

One thing I really don’t like about this is that it perpetuates the existing problem with situations where you need to combine two impairments to make up the one year duration requirement. As an example, a claimant is in chemotherapy for lung cancer and having a hard time of it for eight months. Before the chemo ends, the claimant is in an automobile accident and suffers a bad femur fracture that takes six months to heal. The claimant is out of work for more than a year due to the health problems but Social Security has examined the definition of disability with a microscope to find some tortured argument for denying such claims. Each disability must itself last at least a year. This only comes up rarely and usually when it does the decision makers involved are unaware of agency policy. Still, it’s unnecessary and cruel.

I totally agree.

NOSSCR developed a “Hearing Format Election Statement,” which is an excellent one-page, fillable form that contains all four types of hearing modalities (in-person, VTC from the hearing office, telephone, and online video) and allows for a simple way to notify the hearing office of how the claimant wants to appear at their hearing.

Using NOSSCR’s form, this information can be communicated to the hearing office on a single, straightforward form. It avoids using SSA’s forms (the HA-55 and the COVID-19 Remote Hearing Agreement Form), which claimant’s often find confusing.

I wrote about this form back in March, but it is worth mentioning again. I use this form regularly to respond to the hearing acknowledgement letter and the remote hearing options letter, which are sent routinely by the hearing office after a hearing request is processed.

11/07/2023 update: Social Security has (finally) added the document type “Objection to Video Hearing” to the dropdown list on the Electronic Records Express (ERE). It can be found at the bottom of the dropdown list. You can now upload the hearing format form electronically and it will be placed in the B section of the electronic folder.

Social security has published a proposed rule which would reduce the period for past relevant work (PRW) from 15 to 5 years. The proposal is the result of a great deal of research by Social Security, and it presents a practical improvement to the disability adjudication process.

The proposed rule is currently in the comment period. Below is the comment I submitted to the Social Security Administration.

As a claimant’s representative, I support the proposed rule.

Limiting PRW to 5 years would help to streamline the disability adjudication process. A great deal of time and effort is spent cataloguing and evaluating jobs going back 15 years. It would save significant time and effort by claimants, representatives, disability examiners, judges and staff.

The proposed rule recognizes that a job held 10-15 years ago has limited relevance to a claimant’s ability currently to perform that past work, because the workplace has changed significantly. This is particularly true of technology jobs (as some commenters have noted), which constantly require new knowledge and skills as software and systems evolve. But it is also true of general office work, which now relies heavily on technology (computers, software, scanners) in a way that office work did not even 10 years ago.

Likewise, job skills acquired 10-15 years ago are unlikely to be readily transferable to a significant range of semi-skilled or skilled jobs in the current workplace.

The proposed rule could be implemented quickly, so that the rule is effective as soon as possible. While a great deal of thought and preparation have gone into the proposed rule, it would only require a simple change to the regulations. Please finalize and implement the rule with all deliberate speed.

The comment period for the proposed rule is open until November 28, 2023. Let’s hope that SSA adopts the proposed rule early in 2024.