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Facing the Reality of the Social Security Disability System

Like any other federal agency, there are supposed to be rules in place which give little room for wide variations in interpretation, keeping the majority of decisions uniform. However, one only needs to dip his or her little toe into the disability pool, to know the above statement is completely false. In fact, the reality is, that depending upon who is the decision maker for any case for disability benefits, can make a difference between approval and denial.

If the statement rings true to you and your past history with the Administration, here are some other things to show how inconsistent the Administration is with individual cases. These are just my own experiences, but you may have also experienced these as well.

1. Depending upon the medical doctor at the initial application phase and reconsideration, you will either be denied or approved.

There is no doubt, if you file a claim for headaches and you have no other medical impairments, and there is no medical evidence to substantiate your symptoms other than your own subjective complaints, no matter who reviews your case, you are going to be denied.

However, there are many claims with extremely similar symptoms in which one DDS doctor will approve the claim and another will deny. Again, because there are rules in place to curb this kind of deviation, but ultimately it still comes down to some medical expert with enough leeway in interpreting the medical evidence to make a decision. While some would argue there is no way this can he changed or helped, they may be completely correct. However, the disgust most people would have with this issue is that they often wait many months or even a year or more at the hearing level to correct a possible mistake. There is nothing wrong with discretion, but when the solution to correct and incorrect determination takes a year or more, then either the discretion needs to be addressed or the system needs to adapt accordingly. Simple put, many claimants are financially damaged and their conditions often grow worse while waiting for a chance to appeal their past decisions.

2. If you are at the hearing level, it is extremely important which judge you draw to hear your case.

Ask any seasoned disability attorney and he or she will tell you whether you have a chance of winning benefits or no chance at all, depending upon the ALJ chosen to hear the case. Consider this, we all make decisions in our life based on past experience. It defines how we view the world and other people in it. However, there is too great of a discrepancy between judges' decisions within the hearing phase. While most are within a high 30% to low 40% approval rate, there are still outliers with approval rates in the abysmal teens. If you know the system, this is almost an impossibility, if the rules are being followed accordingly. This also means that even when the rules direct a finding of disabled, the same judges are ruling against the claimants.

3. The use of vocational experts needs to be used only as a guideline and not the sole reason for disapproval of a claim.

If you have ever been in a hearing, you know too well that strange person sitting in your hearing advising the judge on what jobs you are still capable of performing. While this alone is actually a good idea, the problem is that most or many judges use the experts' testimony as a reason to deny a claim without using independent judgment. Also, there are oftentimes identification of jobs within the national economy with inflated numbers of availability. Second, since the judges have discretion to determine a person's mental or physical capabilities to work, the experts are often nothing more than a sounding board to reinforce the judge's predetermined decision. Again, ask any seasoned disability attorney and he or she will be able to tell you before the hearing ever begins whether there will be an approval or denial. Further, the determination of what constitutes transferable work skills varies wildly between experts. Many times, instead of the judge drawn for the case to determine an approval or denial, what constitutes the definition of a transferable work skill varies greatly between the vocational experts.

4. If you are under the age of 50, there is almost always a predetermination you can return to some other kind of work.

Yes, if you are over the age of 50, the rules favor you being approved. If you are under the age of 50, you are likely to lose your case more than having a chance at approval. Yes again, there is an understanding that as a person ages, there are fewer jobs within the national economy he or she can perform. But, just because a person is under the age of 50, should not necessarily predetermine he or she can at least perform sedentary work. Oftentimes, the burden of proving otherwise, especially at the hearing stage, is almost insurmountable. Yet again, ask any seasoned disability attorney and he or she will tell you if you are under the age of 50, you often have little chance of being approved. This is also true even where the claimant has multiple severe physical impairments.

5. The doing away with the Treating Source Rule only made matters worse.

The way it used to be, was that if a claimant had a long period of treatment with a physician, the doctor was given controlling weight in determining a person's ability to do basic work activities. As it stands now, this decision has been given to the individual judges that listen to the cases at the hearing level. So, instead of an actual medical professional with a long history with his or her patient being given controlling weight, now a person with no medical background is allowed to determine a person's ability to complete basic work activities.

This doesn't even make sense. On one hand, the Administration is allowing a vocational expert's opinion to determine a person's case, but on the other, there is denial to a trained medical professional to also determine what basic work activities a person may possibly be able to achieve. It places the claimant at an unfair advantage, and I hope one day this is challenged in federal court.

We help claimants throughout Texas and now Oklahoma fighting for their Social Security disability benefits. If you need help, please always feel free to contact our office at: (888) 780-9125.

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