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State Agency Medical Consultants

At the initial stages of the Social Security Disability (“SSD”) application process, the Social Security Administration relies on doctors who work for each State’s disability determination services (“DDS”) to evaluate the medical evidence.  The DDS doctors, also known as State agency medical consultants, do not examine claimants.  Consultative examiners (“CEs”), who are from private companies that contract with DDS, examine claimants.

DDS doctors usually disregard what claimants’ doctors say, and just focus on what the CEs say, when evaluating SSD claims.  If an SSD application is denied based upon the conclusion of a DDS doctor, then a claimant typically has to wait a couple of years before an administrative law judge (“ALJ”) can hold a hearing on the denied application.  During that delay, claimants can continue to submit updated medical information.  By the time an ALJ has to decide a case, it is likely that the opinion of a DDS doctor has become stale, which is especially true if the claimant provided additional medical evidence during the wait for a hearing.  

We were retained to represent a 52 year old former attorney from Rockville Centre with multiple medical impairments after his SSD application had been denied based on the opinions of the DDS doctors.  We supplied a substantial amount of medical evidence while the claimant awaited his hearing with ALJ Alan Berkowitz, who approved the claimant’s SSD application today.  Notably, ALJ Berkowitz stated that the opinions of the DDS doctors were unpersuasive because they did not review the updated medical evidence

This is an example of why it is so important to retain an attorney who specializes in disability, if you decide to apply for Social Security Disability benefits.   Please call my office for a free phone consultation.  Our Long Island offices are conveniently located in both Nassau and Suffolk counties.

ALJ Berkowitz Reversed Second Time

We represent a claimant from Uniondale with Protein S Deficiency that causes clotting problems, and requires her to elevate her legs most of the day to prevent additional deep vein thromboses from developing.

We filed the claimant’s Social Security Disability (“SSD”) application in 2013, which administrative law judge (“ALJ”) Alan Berkowitz denied.  After the Appeals Council denied review, we appealed to federal court, where we got the ALJ’s decision reversed for a second hearing.  However, the ALJ denied the SSD application at the new hearing by repeating the same mistakes that he made at the first hearing.  This time though, the Appeals Council reversed the ALJ, and ordered yet another hearing.

Fortunately, the Appeals Council determined that it would be unfair to subject the claimant to a third hearing with the same ALJ, and ordered that the case be reassigned to another ALJ.

We are a full service SSD office, and represent claimants at all levels of the application and appeal process.  If you find yourself unable Please call us for a free phone consultation.  We have offices conveniently located on Long Island in both Nassau and Suffolk counties.

Some Good News

When someone is approved for Social Security Disability (“SSD”) benefits, or Supplemental Income benefits (“SSI”), accompanying the decision is a guideline for when the claimant’s case should be reviewed.  SSD and SSI are considered temporary disabilities, unless a person has a condition that is expected to end in death within 14 months from the time they stop working.  A review requires the beneficiary to complete paperwork with updated medical information, and to get updated records from their treating doctors to support that they are still disabled, and unable to work full time.  Typically, the older a person is, or the lesser the likelihood of their condition improving, the longer the length of time there is between reviews.  However, under the Trump administration, a new rule was passed to require more frequent reviews, no matter what the age or medical condition of the beneficiary was.  President Biden has withdrawn that rule, which will provide much relief for people who are receiving disability.  There will still be reviews, but not at the ramped up rate that the Trump administration had wanted, which was just another excuse to hurt and disgrace those people who are truly disabled and rely on the little amount of money they received for disability, because they’re medical condition(s) prevent them from being able to work full time.

ALJ Smith Reversed Again

We represent a 23 year old claimant from Huntington with disruptive mood dysregulation disorder whose application for social security disability (“SSD”) insurance benefits was denied by Administrative Law Judge (“ALJ”) Susan G. Smith.  The Appeals Council remanded the case to another ALJ after because Smith had failed to conduct a fair hearing.

ALJ Smith made a mockery out of the administrative hearing process because she never intended to consider the claimant’s testimony.  The purpose of a hearing is for the ALJ to look fully into the issues and question the claimant.  A claimant’s testimony is taken when the objective evidence supposedly fails to substantiate the degree of impairment-related symptoms so the ALJ can consider the claimant’s statements about the intensity, persistence, and limiting effects of her symptoms.

After confirming the information that the claimant had already submitted about her education and past work, the ALJ only asked why the claimant stopped working.  The ALJ failed to ask the claimant anything at all about her pain, or inability to work with coworkers, supervisors or the public.  In fact, the ALJ failed to ask the claimant anything whatsoever about her physical or mental impairments.  In other words, the ALJ had predetermined to reject the claimant’s testimony concerning her symptoms regardless of what she had to say.

Prejudging is the very definition of bias.  ALJ Smith’s disregard for anything the claimant could possibly say demonstrated her prejudging.  I asked the Appeals Council to reassign the case to another ALJ if it were not remanded for a calculation of benefits.  The Appeals Council chose the latter, and the new ALJ assigned to the case issued a fully favorable decision today.

This is another example of why it is so important to retain an attorney who specializes in disability, if you decide to apply for Social Security Disability benefits.   Please call my office for a free phone consultation.  Our Long Island offices are conveniently located in both Nassau and Suffolk counties.

Survivor Benefits

Compassionate Allowance

With an eye toward reducing the number of people who can qualify for Social Security Disability (“SSD”) benefits, in 2017, the Social Security Administration (“SSA”) eliminated the treating physician rule. The Trump Administration has now asked the SSA to eliminate the “GRID rules,”  in order to make it even more difficult for the disabled to obtain SSD benefits. 

People dying from cancer will still obtain SSD benefits. We represent a 45 year old metal worker from Bayville with cancer whose SSD benefits were promptly paid after we highlighted to the claim examiners that the claimant’s application should be treated as a compassionate allowance.  Cynically, the SSA has no qualms paying a compassionate allowance because the benefits will not be paid for long. A person should not have to prove they are terminally ill in order to receive benefits, which seems to be the goal of the SSA as it keeps changing the rules and regulations in order to make it much more difficult to qualify for SSD benefits.

Unum LTD Approval

We were able to secure long term disability (“LTD”) benefits for a 47 year old Vice President of Human Resources from Glen Cove. After we took over the case, we advised Unum about the claimant’s various limitations that we were documenting due to the claimant’s rheumatoid arthritis (“RA”) and vocal cord nodules. Unum was unaware that the claimant was required to elevate her legs due to swelling from the RA, and was restricted in her speaking and needing a quiet environment to be heard due to the nodules. Rapidly developing the evidence regarding those limitations led to a quick approval, which was especially difficult in light of COVID.

Navigating LTD can be very difficult, which is why it is in your best interest to retain an attorney who specializes in disability law. If you find yourself in need of applying for your long term disability, please call my office for a free phone consultation. We have offices conveniently located on Long Island in both Nassau and Suffolk counties.

Federal Court Remand

Even though the Social Security Administration (“SSA”) agreed that the decision of administrative law judge (“ALJ”) Andrew Weiss was indefensible, it took over two years for U.S. District Judge Joan Azrack to remand the decision, which the ALJ issued over three years ago.   The complete decision is available on my website.

Form Over Substance

A 54 year old sanitation worker from North Babylon with various orthopedic impairments retained us after his Social Security Disability (“SSD”) application was denied. Nothing unusual about the case except that we filed over 2,000 pages of treatment records, much of which were hospital records.  The substance of the file was not unlike many similar claims that were denied by the State agency.  It may be that regardless of the materiality of the documentation submitted, when a very large volume of paper is filed, the State agency feels more confident about the credibility of the claim.

This is another example of why it is important to retain a disability attorney when you apply for SSD.  Even though it may seem obvious to you that you are disabled, you cannot get approved without support from your doctors.  An attorney who specializes in disability can discern what information is needed from your doctors to get your claim approved.  If you are thinking about applying for SSD, please call my office for a free phone consultation.  We have offices conveniently located on Long Island in both Nassau and Suffolk counties.

Superior Service at Melville

We have posted blogs about the ineptness of some of the Social Security district offices. But we also like to give credit, where credit is due. I called the Melville district office today regarding a claim that we had recently filed, and was lucky enough to reach Mrs. Craven who works there. Not only did Mrs. Craven fix the mistake that someone else made when processing our client’s claim, but she also went out of her way to correct a mistake that was made by someone at the Patchogue district office, who was incapable of correcting their mistake. This is not the first time that Mrs. Craven has helped me, and I hope it won’t be the last. She is professional, courteous, and most of all, she knows what she’s doing. Problems that pose a particular issue for other representatives she is able to fix in a few minutes. Why can’t we expect every SSA representative to perform as well as she. We greatly appreciate Mrs. Craven’s knowledge and help, and hope that others can follow her example. Thank you Mrs. Craven.

by Susan Golden

Common Sense

According to Webster’s, common sense is a sound and prudent judgment based on a simple perception of the situation or facts. It is astounding how often the State agency exhibits a lack of common sense when evaluating Social Security Disability (“SSD”) applications.

I represent a 59-year-old from Freeport, who suffered spine injuries from a motor vehicle accident (“MVA”) on October 11, 2018. The State agency said an MRI from May 19, 2019, supported the claimant’s SSD application, but only found the claimant disabled as of February 19, 2019. 

Common sense dictates that the spine injuries arose from the MVA. Even the administrative law judge was baffled by the State agency’s onset date of February 19, 2019. There was no evidence that the claimant’s condition got worse as of February 19, 2019. There was no medical opinion that could support finding that the claimant was able to work after the MVA. There was no other accident or physically traumatic events between the MVA and onset date.

Navigating Social Security can be very difficult, which is why it is in your best interest to retain an attorney who specializes in disability law.  If you find yourself in need of applying for SSD, please call my office for a free phone consultation.  We have offices conveniently located on Long Island in both Nassau and Suffolk counties.

Patchogue Ineptness Continues

We represent a veteran, who was approved in February for Social Security Disability (“SSD”) and Supplemental Security Income (“SSI”) benefits.  When a person is approved for benefits, it usually takes Social Security (“SS”) a while to process and calculate the retroactive and monthly benefits.  It can take even longer when you are approved for both SSD and SSI. However, it has been eight months since our client was approved, and yet he still has not received his retroactive benefits, which he so desperately needs, and he has just started to receive his monthly benefits. 

It would be a gross understatement to say the handling of our client’s payments by the Patchogue District office has been a comedy of errors.  Our client’s first SSI check was sent to an address where he has not lived for many years, even though SS had the updated address in his file. 

To add insult to injury, our client was supposed to have his first monthly SSD check directly deposited into his bank account on October 3, 2020, but on Friday, we learned from the Patchogue District office that the check had been mailed. We asked Patchogue how this could happen becauase we had confirmed our client’s bank account information with various people at the Patchogue office multiple times.  Patchogue said that they have two different systems for SSI and SSD, and whoever initially took the updated information, only entered it into the SSI system.  Patchogue also said that whoever updated the address into the SSD system, never updated the banking information.  So once again, we confirmed that Patchogue had the correct banking information and address, so that our client’s November check would be direct deposited.  Patchogue told us that our client would receive the check by this past Monday or Tuesday.   

Today is Wednesday.  I received a phone call from my client, who was understandably furious.  Even though we confirmed his address with Patchogue last Friday, they mailed his check to the wrong address again!  It’s like banging your head against the wall.     

Patchogue’s mishandling of this matter is utterly reprehensible, incompetent, and unprofessional.  Are they truly that inept at their jobs, or do they just not care?  I am certain that if their paychecks kept getting mailed to the wrong address, then they would be very angry.   

Sadly, Patchogue’s actions reflect their lack of concern and respect for their constituents, including their Veterans.  Our client became disabled in the line of duty.  Is this really how he should be treated?  I am appalled and disgusted at Patchogue’s misconduct.

By Susan Golden

Common Sense

According to Webster’s, common sense is a sound and prudent judgment based on a simple perception of the situation or facts. It is astounding how often the State agency exhibits a lack of common sense when evaluating Social Security Disability (“SSD”) applications. 

I represent a 59-year-old from Freeport, who suffered spine injuries from a motor vehicle accident (“MVA”) on October 11, 2018. The State agency said an MRI from May 19, 2019, supported the claimant’s SSD application, but only found the claimant disabled as of February 19, 2019. 

Common sense dictates that the spine injuries arose from the MVA. Even the administrative law judge was baffled by the State agency’s onset date of February 19, 2019. There was no evidence that the claimant’s condition got worse as of February 19, 2019. There was no medical opinion that could support finding that the claimant was able to work after the MVA. There was no other accident or physically traumatic events between the MVA and onset date.

Having an experienced, Social Security Disability attorney is vital when applying for SSD benefits.  Please feel free to call my office for a free phone consultation.  My offices are conveniently located in both Nassau and Suffolk counties on Long Island.

Attorney Needed

Sometimes it undeniably makes a difference having an attorney represent you in connection with your Social Security Disability (“SSD”) benefits. The Social Security Administration’s own statistics show that the percentage of claims approved is greater when a claimant is represented by an attorney. I represent a 55 year old from Speonk who worked in computer networking with physical and mental impairments, which shows why an attorney is sometimes is a must. 

After a very heated hearing with a medical and a vocational expert (“VE”), the administrative law judge (“ALJ”) indicated that he would deny the case based on the VE’s testimony. I asked the ALJ if he was relying on the VE’s testimony before or after I pointed out that he originally identified the wrong occupation as the claimant’s past work. The VE admitted that the claimant’s past work was at least a composite occupation comprised of the light one he identified and the physically demanding medium one that I suggested. 

The ALJ then said that it made no difference because the VE identified unskilled occupations that the claimant could perform. I pointed out that the medical-vocational rules would require a finding of disabled. I explained that there was no difference between being limited to unskilled work, and lacking any transferable skills. The ALJ said that if he accepted that argument, then he would approve the claim, but if he did not, then he would require additional information from the treating sources and a supplemental hearing to cross examine the VE. 

The ALJ approved the case yesterday. If I had not accessed vocational databases during the hearing to show the discrepancy in the VE’s testimony, and if I had not pointed out how there was no actual difference between being limited to unskilled work, and lacking any transferable skills, then the ALJ would have denied the case.

Having an experienced, Social Security Disability attorney is vital when applying for SSD benefits.  Please feel free to call my office for a free phone consultation.  My offices are conveniently located in both Nassau and Suffolk counties on Long Island.

The Right Decision

Most people know what strokes are, and how devastating the symptoms can be.  Due to the severe consequences of a stroke, claimants frequently get approved for Social Security Disability (“SSD”) benefits faster compared to other impairments. What do you think would happen to you if you had seven strokes?

A truck driver from Howard Beach retained me when he was denied SSD benefits after his sixth stroke. Both the claimant’s neurologist and his stroke specialist provided reports detailing how the claimant was incapable of any type of full-time work.  While waiting for his hearing, the claimant suffered a seventh stroke last December, which left him institutionalized without any ability to care for himself.

Last December, Gloria Pellegrino, the administrative law judge (“ALJ”) that was assigned to the case refused to approve an OTR.  Because the claimant lost the ability to speak, or use his arms or legs, the claimant’s partner had to testify at a hearing in April, and she described in horrifying detail the extraordinarily limited mental and physical abilities the claimant had even after his sixth stroke. 

The ALJ terminated the hearing when the vocational expert (“VE”) started providing testimony that supported the claimant’s position regarding how certain occupations from the Department of Labor (“DOL”) Dictionary of Occupational Titles (“DOT”) were currently performed according to the latest DOL information from O*Net.

Despite the overwhelmingly supportive objective medical evidence and opinions from the claimant’s specialists, the ALJ refused to approve the claimant’s SSD benefits and scheduled a second hearing.

The second hearing took place July 13th, and this time a different VE testified.  The VE also identified certain occupations from the DOT in response to a hypothetical question from the ALJ.  When I insisted that the VE describe how he calculated the number of jobs he said existed for those occupations, he said they were from Job Browser.  When I said that told me the source of his numbers, but not how that magic box derived those numbers, the VE could not answer. 

Next, I had the VE testify that the occupational descriptions from the DOT that he identified were 40 years old.  After I started questioning the new VE about how those occupations were currently performed according to the latest DOL information from O*Net, the ALJ once again suddenly terminated the hearing.  The VE testified that the O*Net was reliable and current.  The ALJ still refused to approve the claimant’s SSD benefits and directed me to submit a brief regarding my vocational contentions.

On July 16^th, I submitted a nine-page brief that detailed the legal and vocational reasons why the ALJ’s reliance on the VE’s testimony was unreliable.  The two primary reasons were the current DOL information showed the occupations the VE identified were no longer performed as unskilled work, and that the VE failed to explain how he calculated his job numbers.  The ALJ still refused to approve the claimant’s SSD benefits.

A month ago, I submitted another brief based on Brace v. Saul, 2020 WL 4727345 (7th Cir. 08/14/2020), which held that an ALJ could not accept VE testimony that failed to explain the methodology for job numbers.

Today, ALJ Pellegrino approved the claimant’s SSD benefits and claimed that she rejected all of the arguments in my briefs because the treating specialist stated that the claimant would be off-task more than 10% of the time.  If that were true, then the ALJ would have and should have, approved the OTR last December.

Having an experienced, Social Security Disability attorney is vital when applying for SSD benefits.  Please feel free to call my office for a free phone consultation.  My offices are conveniently located in both Nassau and Suffolk counties on Long Island.

Coincidence or Trend?

I represent a 50-year-old computer programmer from Fairlawn NJ with neuropathy in his extremities in connection with his claim for Social Security Disability (“SSD”) benefits. The State agency applied the grid rules to issue a partially favorable decision because a transferable skill analysis did not find three jobs to which the claimant’s skills could transfer. Yesterday, the Administrative Law Judge agreed that the claimant was entitled to the remainder of the SSD benefits OTR.

Under the grid rules, a claimant is disabled if they cannot perform a significant range of work. Last week, the Ninth Circuit reversed a denial of SSD benefits when it ruled that two occupations do not
constitute a “significant range of work.”

It is unclear if the two approvals represent a haphazard convergence of favorable outcomes or an increased focus on that particular vocational factor. 

Please feel free to contact my office for free phone consultation if you are looking for an attorney who specializes in disability.  We have offices on Long Island conveniently located in both Nassau and Suffolk counties.

Federal Court Win

Yesterday, District Court Judge Ann Donnelly rejected the decision of administrative law judge (“ALJ”) Sommattie Ramrup, who had denied Social Security Disability (“SSD”) benefits to my client, who was a petition clerk from Brooklyn, and who suffers from depression. 

Judge Donnelly concluded that ALJ Ramrup had cherry-picked medical findings as an excuse to substitute her judgment for the opinions of the claimant’s psychiatrists. Judge Donnelly indicated that the claimant met listing12.04, but remanded the case anyway so the ALJ can “re-evaluate” the treating psychiatrists’ opinions. Judge Donnelly also indicated that if ALJ Ramrup does not find that the claimant meets listing 12.04, then she must ensure that the hypothetical question she poses to a vocational expert reflects the claimant’s actual limitations. 

Whether you are thinking of applying for SSD or have applied on your own and realize you need an attorney who specializes in disability, please feel free to call my office for a free telephone consultation.  We are conveniently located on Long Island in both Nassau and Suffolk counties. 

Waiting for SSD

It seems to be common knowledge that applying for Social Security Disability (“SSD”), and then waiting for a decision, is a very slow process. On a daily basis, clients ask us how are they supposed to support themselves and pay their bills while waiting for a decision from Social Security? Unfortunately, there is no good answer. The more you work, the more Social Security (“SS”) will argue that you are not disabled. But even more heart wrenching, and less commonly known, is the amount of people that pass away while awaiting a decision from SSD. Over the years, we have had clients pass away while waiting for their hearing or decision. As we work very closely with our clients, and develop a relationship with them and some of their family members, it is very difficult and frustrating for us when a client passes away. 

The system is broken in so many ways, and has only gotten worse over the last several years. We have no choice, but to continue to wait and hope that SS gets the help and funding it needs, so people’s lives are not ruined while they wait for a decision from SS.

State Agency Employee Fraud

HALLEX I-1-3-9 requires an Administrative Law Judge (“ALJ”) to refer a State agency adjudicator suspected of fraud to refer the matter to the Office of Inspector General (“OIG”).

We represent a Social Security Disability (“SSD”) claimant from East Meadow with spine problems. Reports from adjudicators named M. Jackson and M. Censor said the treating physicians were not allowed to do the claimant’s consultative examination (“CE”) because “Prior experience raises a question as to the objectivity, accuracy, or validity of the evidence from the source(s).” 

The adjudicators conspicuously failed to identify the actual name of the medical source or sources whose prior experience was questioned. We contacted the claimant’s medical sources about their prior experience with the State agency, and none of them stated that they have had any prior experience with it. 

Knowingly making a false boilerplate assertion in order to prevent a treating doctor from performing a CE is a fraud. I asked the ALJ to issue a subpoena for the attendance of the adjudicator at the claimant’s hearing for cross-examination. Additionally, I asked the ALJ to notify the OIG about the potential misconduct, especially since was no reason to suspect that it had been limited to this one case. 

The ALJ did not make the adjudicator available for cross-examination, and it is unclear if the ALJ referred the matter to the OIG. If anyone waiting for a hearing has a file with similar boilerplate language from an adjudicator, then request that the matter be referred to OIG. Such misconduct should not be overlooked or condoned. 

If you are looking for an attorney on Long Island who specializes in disability claims, please call my office for a free phone consultation.

Judging Disabilities

It is not uncommon for a potential client to say to me, “there’s nothing wrong with my neighbor and he’s getting disability,” or “I know so many people who look fine, and are getting disability.” Many people are disabled from diseases that are invisible to others, like mental health disorders, autoimmune diseases, and even certain types of cancers. Social Security (“SS”) has a strict definition of disability. Typically, for SS to find you disabled, your doctors need to support that you are unable to work for 8 hours a day at any job, not just your own job. SS decides if you cannot adjust to other work because of your medical conditions, and if your disability has lasted or is expected to last for at least one year or to result in death. To compound matters, their determination is not only based on information that they receive from your treating doctors regarding your limitations and restrictions resulting from your illness, but also from their doctors, who usually default to finding an ability to work. 

You also must have enough work credits to apply for Social Security Disability (“SSD”) benefits. If you do not, then you may qualify for Supplemental Security Income (“SSI”), which follows the same medical requirements as SSD, but requires you to meet certain financial criteria to be eligible. 

The bottom line is, just because a person does not look like what you think a disabled person should look like, does not mean that they are not disabled under SS’s definition. It is not easy to get approved for SSD or SSI. That is why it is highly recommended that you retain an attorney who specializes in disability and has experience with SS, and statistics show legal representation results in a significantly higher approval rate. Our office offers free phone consultations, and we have offices on Long Island in Nassau and Suffolk counties.

By Susan Golden