What You Should Know About Coronavirus and Social Security Disability

What is Coronavirus?

According to the World Health Organization (WHO), the new coronavirus, named the COVID-19 virus, is a newly discovered infectious disease. This new virus strain is a new version of six other known coronavirus strains. COVID-19 is believed to have successfully mutated to a point where it crossed over from animals to humans. The disease is now easily transmitted from human to human, and has spread to many countries around the world, causing havoc to health systems and economies alike.

Medical institutions have described COVID-19 as a respiratory disease. This means that the virus primarily attacks the lungs. Some patients have, however, reported gastro-intestinal symptoms such as vomiting and diarrhea. Although clinical trials are in progress, no vaccine or cure has been identified for the disease as of April 2020. Coronaviruses have caused epidemics like the Middle East Respiratory Syndrome (MERS) outbreak in 2015 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003.

Coronavirus Precautions 

The World Health Organization and the Center for Disease Control and Prevention have recommended washing hands, and maintaining social distancing as the best measures for preventing the spread of the virus. The virus is mostly spread through respiratory droplets, which get into the air through sneezing and coughing. The droplets then find their way into the body of an uninfected person may lead to infection and symptoms. Avoiding crowded areas and maintaining distance from other individuals are thus necessary precautions that help minimize the spread of the virus.

People are also being urged to stay at home and only travel when absolutely necessary. Where possible, individuals should work from home or take paid or unpaid leave until the situation is under control. As many countries are struggling to reduce the impacts of coronavirus on their health and economic systems so governments have taken drastic measures to better protect their citizens against the pandemic. Most countries have limited their citizens travel and are enforcing quarantine of infected people.. As the global number of fatalities and infections  rise alarmingly, citizens in many places have found themselves under stringent conditions of curfews and even total lockdowns. 

According to statistics, a major portion of the global death toll is older people and they are certainly the most vulnerable group. Others who have been  severely affected are those with certain underlying medical conditions such as:

  • asthma
  • chronic lung disease
  • serious heart conditions
  • undergoing cancer treatment
  • history of smoking
  • previous bone marrow or organ transplant
  • prolonged use of corticosteroids
  • severe obesity
  • diabetes
  • chronic kidney disease
  • liver disease
  • those who are immunocompromised

Surprisingly, COVID-19 is relatively mild in children and infants. 

Coronavirus and Short-Term Disability 

If diagnosed and found sick or unable to perform their normal work duties due to coronavirus illness, people who are covered by a Short Term Disability plan are eligible for benefits. These short-term benefits may be accessed through private purchase or employers. Individuals should review their insurance coverage to see if they qualify for such benefits. In the event a policyholder acquires a medical condition or disability that prevents them from working, short term disability insurance generally provides up to 80 percent of their gross income. People  diagnosed with COVID-19 can apply for Short-Term Disability if they are not able to work because of their illness or if they are required to quarantine.. 

Coronavirus and Long-Term Disability 

In long term disability insurance, benefits are paid if and only if you have been living with a disability or medical condition for a long time. Unless you develop a chronic illness as a result of coronavirus infection, you are not likely to be eligible for long term benefits due to COVID-19. Medical quarantine also qualifies for the criteria of inability to work due to infection with the virus. It is necessary, however, to draw a line between social quarantine and medical quarantine. Working from home (social isolation) does not qualify under medical quarantine, which is recognized by insurance policies. 

Social Security Disability and Coronavirus

 The long-term health effects of COVID-19 are still unknown. However, many diseases leave people with lasting limitations in their functioning and can impact their ability to work long-term. Social Security disability benefits are available to those who are unable to work for at least 12 months because of a medically determinable impairment. If you are permanently limited by a coronavirus infection in a way that leaves you unable to work for at least twelve months, you could qualify for Social Security disability benefits. However, if your symptoms last less than 12 months you are not likely to be eligible even if you are hospitalized for an extended time.

Social Security Operations During the Pandemic

The effects of coronavirus are far-reaching and can be felt in almost every aspect of our lives. Millions of American businesses have been forced to close their doors, and citizens asked to stay at home. With the economy at such a standstill, many elderly and disabled citizens depend on Social Security benefits to make ends meet. Fortunately, the Social Security Administration (SSA) has indicated that it will continue operating normally amidst the epidemic. While many employees are working from home, the Social Security Administration is still processing new applications, disability appeals, and issuing checks, among its other normal operations. While things are moving more slowly, Social Security is still working.

Retirees and those on disability will receive their normal benefit amounts at their normal payment intervals. However, SSA has said that people should contact the agency through its online resources at www.ssa.gov or by telephone because its field offices are closed to reduce the spread of COVID-19. Also, the SSA has extended submission deadlines, and several other services have been postponed. Hopefully, SSA will be back to normal operations soon, but in the meantime, follow the recommendations for social distancing and stay healthy.


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Is Depression a Disability for Purposes of Social Security Disability Benefits?

Depression is a mental health disorder that causes individuals to feel a loss of self-worth and happiness, resulting in feeling overwhelmingly sad, unmotivated, or lost. Unfortunately, depression can be severe and affects millions of people of all ages. If you suffer from depression you may be considering the option of applying for Social Security Disability benefits. Understanding what Social Security requires to document depression and how you can qualify for benefits can help you on your road to maintaining stability and seeking recovery. 

What Is Depression?

Depression is classified as feeling sad, hopeless, discouraged,  or “down in the dumps,” for an extended period of time. While depression is common for most people to feel at some point in their lives, serious episodes of depression, or clinical depression, can lead to the loss of relationships, employment, homes, suicide, and more.

What Is Clinical Depression? 

Clinical depression is severe depression that has been diagnosed by a medical professional, most often a general practitioner, a psychiatrist, or a psychologist. If you are suffering from extended bouts of feeling depressed that are not due to everyday events, tragic occurrences, or circumstances, speak with your doctor to determine the best course of action that is right for you.

Signs and Symptoms of Depression 

The signs and symptoms of depression vary, as no one individual experiences life and pain in the same manner. However, there are common signs and symptoms that typically manifest in those who struggle with ongoing clinical depression or depressive episodes due to another mood disorder or mental illness. Some of the mental and emotional signs of depression include:

  • Loss of focus and concentration
  • Despondent attitude and behavior
  • Social withdrawal
  • Loss of joy in activities that were once a source of fun and pleasure
  • Insomnia
  • Oversleeping
  • Lack of care for responsibilities and relationships
  • Poor hygiene routines
  • Thoughts of suicide
  • Discussions of suicide 

In addition to the mental and emotional signs that manifest in those who suffer from depression, physical signs and symptoms may also present themselves. Some of the more common physical signs of ongoing clinical depression may include:

  • Anemia and bruising
  • Loss of appetite
  • Nausea/vomiting
  • Diarrhea
  • Constipation
  • Hair loss
  • Tooth issues
  • Malnutrition 

Is Depression a Disability? 

Clinical depression is classified as a disability because it interferes with daily activities, work, relationships, concentration and focus, and other basic tassk. Individuals who suffer from chronic, manic, or ongoing depressive episodes may qualify for Social Security Disability benefits if their symptoms are severe enough to keep them from working on a full-time sustained basis..

How to Apply for Social Security Disability Benefits for Depression

Applying for Social Security Disability in the state of Utah is possible by visiting your nearest Social Security office or by doing so online. You have the ability to apply for Social Security Disability benefits independently and without legal representation, though many people recommend working with an attorney. 

You will need to prove that you have a valid diagnosis of depression or a related disorder and that diagnosis needs to be made by someone who is qualified to make it. To meet the severity requirements, your depression must interfere with basic functioning in at least two of four fundamental areas of functioning: understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and, adapting or managing.. If your activities of daily living and social functioning have been severely impaired, you may qualify for SSDI benefits. If your ability to maintain focus and concentration and your ability to maintain basic daily functioning have been severely impaired, you may also qualify for SSDI benefits. . You will require medical documentation and proof of your depression in order to prove the severity of your depression and how it is negatively impacting your daily life and ability to sustain yourself. Just taking medications or going to regular counseling is not sufficient. You will need to establish that nearly every aspect of your life is worse because of depression.

When working with medical professionals and attorneys, it is best to be open, honest, and upfront about how depression has affected your life. With the proper support from your legal counsel and doctors, you can be successful applying for the SSDI benefits you need.

What is Social Security Disability?

Social Security Disability or SSDI benefits provide you with a monthly income after you have been unable to work for 12 months. The crucial difference between SSDI and SSI relates to the number of years you worked full-time for five of the last 10 years. If you had FICA taxes withheld for five years during that ten-year span, you can apply to qualify for SSDI funds. If you weren’t able to work for that span at a W-2 job, you can still qualify for SSI or Supplemental Security Income, as well as state benefits depending on laws in your state. 

Qualifications

To qualify for SSDI, you must be facing severe, long-term, total disability. Total disability means that you can’t hold a full-time job. Long-term means that the condition is expected to last for at least a year. Anything you’re currently earning will need to be reported. In 2020, if your income is more than $1,260 per month for sighted people and $2,110 for non-sighted (statutory blindness) people, your application will not be accepted.

How Do I Apply?

You can make your Social Security disability application online. You’ll also send in a Medical Release Form so that SSA can collect your medical records. Take care to review the Adult Disability Checklist to make sure you have all your documentation in order. Finally, if you’re not comfortable working on the computer, you can apply via telephone or TTY. You can also visit your local Social Security office in person to ask for application help. It’s a good idea to call and set up an appointment for this assistance. What you put on the application is important. You may think that you have a slam dunk case for disability but more than 65% of initial claims are denied. You should consider hiring a Social Security disability attorney before you decide to file the application.

How Long Must I Wait?

The initial decision usually takes between four and six months. The process can take longer if Social Security needs additional information and sometimes they wait to see how well your treatment works to make sure your condition will last at least 12 months before making a decision. Once approved, you may receive a back payment of benefits and ultimately a monthly payment. For SSDI there is a 5 month waiting period that begins the month after the month you were found disabled and you can be paid nor more than 12 months prior to the day you applied. For SSI benefits generally begin with month you applied. Be aware that if you are disabled, any income you make and the income of your spouse may raise your income high enough that you have to pay taxes on your SSDI income. Once you apply for SSDI, be ready to apply for state benefits as well to make sure that you have some cash coming in to help you stay afloat.

What If I’m Denied?

There are four levels of appeal after a denial. After the first denial, you can request a reconsideration of your application. You are allowed to submit new evidence to show that the initial decision was not correct. If you are denied at reconsideration, you can then ask an administrative law judge to hold a hearing on your disability application. Hearings are complicated legal proceedings and it is generally advisable that you have an attorney help you with the hearing. If the judge denies your claim you can appeal to the appeals council. The appeals council will review the judge’s decision to see if any mistakes were made. If the appeals council decides not to review your claim you can then file a lawsuit against the Social Security Administration in the United States Federal District Court. Understand that none of these are fast and that you may have to wait for years for your disability benefits. For example, just getting in front of an administrative law judge takes about two years or more.

What Does a Denial Mean? 

Many first-time applications are denied. Don’t be defeated by a denial. Be ready to connect with someone at the Social Security office to help you make another submittal and pick up any new information you may have omitted in your first submittal. Understand that the Social Security Administration wins if you give up on benefits you’re entitled to. Keep fighting.

How Can a Lawyer Help? 

Your Social Security disability application can be filed with the help of an attorney. If you get a denial and you don’t have an attorney you can hire an attorney who can help you appeal the denial. Attorneys help with getting the best information to the Social Security Administration and with building the best case possible.

The attorneys for Social Security disability at Barnes Disability Advocates help clients file applications and appeal denials. We have an experienced team of professionals that can assist you through every part of the disability process, from applying for benefits, to conducting a hearing before an Administrative Law Judge, to appeals to the Appeals Council and in the Federal Courts.

We can assist clients with all types of disabilities, including disorders like depression, anxiety, bi-polar disorder, PTSD, schizophrenia, and intellectual disability and physical disabilities like back pain, breathing disorders, heart conditions, cancer, arthritis, headaches, neck pain, COPD, skin disorders, and seizures. We even help with more difficult conditions like fibromyalgia, chronic fatigue syndrome, and rare or unusual diseases and conditions.

Can My Doctor Help?

Your doctor can assess your Residual Functional Capacity to determine whether or not you can hold a job. This assessment is critical in qualifying for your Social Security disability benefits because it establishes your specific work-related limitations in basic work activities. Your Social Security disability application will need to demonstrate that you are incapable of maintaining any form of employment moving forward. 

Working with a Social Security disability attorney during the initial application process can lessen your chance of being declined and having to fight through an appeal. However, even with a Social Security disability lawyer, your application might be rejected. However, this shouldn’t mean you should give up. With the right guidance, you can get your application reviewed and approved to help you support yourself and your family.

Get results with Barnes Disability Advocates starting today!

How To Find Out How Much Your Disability Benefits Will Be…

How much is your benefit?
How much you are eligible for in Social Security disability benefits?

 

One of the questions we are as frequently is “how much will I get if my claim is approved.” The answer to this question, like most things in the Social Security disability world, is more complicated than it would first appear.

The first thing to realize is that the amount of a disability payment varies from person to person and depends on the type of claim that you have. Most people who file for disability qualify for Title II benefits, otherwise known as Disability Insurance Benefits. The amount of benefit depends upon how much you have paid into Social Security through your payroll taxes. The national average benefit is about $1,100. Social Security provides several ways for you to find out what you would be eligible for.

The best way is to create a my Social Security account online. After creating an account, you can verify your earnings and get your Social Security Statement. Social Security mails Social Security Statements annually to workers who are age 60 and over, aren’t currently receiving Social Security benefits and don’t have a my Social Security account. Social Security also provides several calculators you can use to determine your own benefit based on different scenarios.

Once you have your statement or have logged in to your online account you want to look for the line that tells you whether you have earned enough credits to qualify for disability and provide the amount. That amount is the best estimate for what you would receive if you are approved for disability benefits.

We are often asked what effect other assets or income will have on your disability benefit. With Title II benefits other assets or income do not affect the amount of your benefit as long as those assets or income are not from earned income related to your work activity. For example, if you receive $100 a month from an annuity it will not affect the amount of your disability payment.

If you are filing for Supplemental Security Income (“SSI”) things are a bit different. SSI is designed to help individuals who have little or no income, few resources, and are aged, blind, or disabled. The federal maximum SSI benefit is adjusted annually. For 2018 it is $750 and the maximum couple benefit is $1,125. Therefore, any assets or income available to the individual receiving the SSI benefits will be counted against the SSI the person receives. The rules for calculation of the SSI amount get quite complicated and are beyond the scope of this article. Just realize that SSI benefits get offset by any resources the individual receiving the benefit might have access to including land, vehicles, cash whether in bank accounts or at home, gold, or any other assets that can be turned into cash. Social Security also imputes income from other family members such as a spouse or parent, so a person’s eligibility for SSI can be reduced or eliminated if a spouse’s income is too high. The one major exception to this rule is that Social Security will exclude one house (if you live in it) and one car, no matter their value, from this resources reduction.

One common situation is for someone to receive both SSI and Title II benefits at the same time. This can only happen if the amount of your Title II benefit is less than the federal maximum SSI benefit because there is a dollar for dollar offset. For example, if you receive $349 in Title II benefits you can receive up to $401 in SSI benefits. Thus, if your Title II exceeds $750, you will not be eligible for ongoing SSI benefits.

This explanation of the benefit amounts and the rules affecting those amounts is very simplified. Specific situations will be different for each individual and can fluctuate from month to month. However, this should provide you with a good understanding of the amount you may be eligible for.

Introduction to Supplemental Security Income (SSI)

There are a few different types of disability payments managed by the Social Security Administration. Many times, people refer to all these types of disability as SSI. However, SSI refers to a specific program called Supplemental Security Income or Title XVI benefits.

The Supplemental Security Income (SSI) program is a Federal income supplement program funded by general tax revenues, not Social Security taxes. It is designed to help individuals who have little or no income, few resources, and are aged, blind, or disabled. Those who are potentially eligible for SSI include those of retirement age who do not have sufficient quarters to qualify for regular Social Security retirement, children with severe disabilities, and disabled adults who have low income and resources and don’t qualify for disability insurance.

SSI has specific provisions for children who are under the age of 18, or under the age of 22 and still regularly attending primary or secondary school. To be eligible the child must be either blind or disabled. There is no minimum age requirement, but childhood disability benefits and when the child turns 18 or 22 if the child is still in school. Social Security has a specific set of regulations for determining whether a child is blind or disabled. These requirements are not the same as they are for an adult. The test for disability for adults under the Supplemental Security Income program is the same as it is under the Disability Insurance Benefits program.

The maximum Federal SSI benefit changes yearly based on the Consumer Price Index. For 2018, the maximum individual benefit is $750 and the maximum couple benefit is $1,125. Some states, including Utah, have supplement programs that provide additional payments to the Federal SSI. These amounts vary by state. You can find out if your state offers such a supplement program here. At last report, the supplement for Utahns on SSI was minimal.

The maximum Federal SSI benefit is reduced by countable income. Countable income includes things like cash, bank accounts, stocks, land, personal property, vehicles, and anything else you own that can be changed to cash and used for food and shelter. It also includes deemed resources, which refers to resources earned or received by someone else in your household.

It is possible for an individual to receive both SSI and disability benefits as long as the individual’s insurance disability benefit does not exceed the maximum Federal SSI benefit. For example, if an individual receives $500 per month in disability insurance benefits, that individual in 2018 may be eligible for up to $250 in SSI benefits.

Although SSI benefits are minimal, individuals who qualify for SSI also often qualify for other types of government assistance such as housing assistance, food stamps, and Medicaid. The Supplemental Security Income program provides essential benefits for individuals, including children, who are in severe need of assistance. Although it can be difficult to qualify for these benefits, they provide sufficient relief to allow people to support themselves when they otherwise wouldn’t be able to.

Social Security Disability Defined

Social Security does not define disability in the same way that many of us think about disability. For Social Security, the only kind of disability that matters is a disability that leaves you unable to perform any work activity. This definition is one of the most strict definitions of disability in American law.

The law specifically states that an individual must be not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.

Social Security’s definition of disability is really a hypothetical definition. Rather than focusing on whether work exists in your area that you could perform and actually be hired for, the definition requires Social Security to look at whether jobs exist in the national economy. It is possible to be found not disabled because Social Security believes there are certain jobs available in the national economy, even though those jobs do not exist in your community, state, or region.

Many people who live in rural areas or who have a limited ability to travel ask what does Social Security expect a person to do? The answer is that Social Security does not have any expectation. Instead, Social Security simply requires that you meet its definition of disability to be eligible for disability benefits.

The law does require that Social Security consider all of your impairments in combination. And impairment refers to a limitation on your ability to perform basic work activity. Basic work activity includes things like sitting, standing, walking, bending, pushing, pulling, lifting, and carrying four physical impairments and things like following instructions both written and oral, getting along with coworkers and supervisors, maintaining attention, maintaining concentration, maintaining appropriate pace, working independently, maintaining appropriate appearance, and maintaining regular schedules for mental impairments. If your conditions do not impair your ability to do these basic work activities Social Security will consider you not disabled.

What does this mean for how Social Security evaluates your case and what you can do to help prove your disability? Social Security looks first to the medical records to determine how your conditions impair your ability to perform basic work activity. The best way to make Social Security aware of how your conditions impair your abilities is to discuss those impairments with your medical provider. It is also important to ask your medical provider to document those impairments, because such documentation is usually not part of the normal medical documentation process. If you don’t document your impairments, Social Security will be left to guess at what those impairments are.

Although Social Security’s definition of disability is very strict, if your condition significantly impairs your ability to perform work activity and you have been, or will be, unable to work for a significant period of time, you should consider filing for disability.

Proposed Budget Harms and Further Impoverishes the Disabled

The President promised many times during the campaign not to make cuts to the Social Security program. Now, his proposed budget breaks that promise on a massive scale. Some of the most significant cuts to the SSI and SSDI Social Security Disability programs include:

  • Reducing SSDI retroactive payments to six months rather than 12 months before the protected filing date. This will take an estimated $9.9 billion over the next ten years from people with disabilities.
  • Reinstating reconsideration in ten “prototype” states This is expected to result in more claimants being denied and some dying or becoming discouraged without appealing.
  • Creating an “expert panel” to recommend program changes to SSI and SSDI, with the goal of a 5% reduction in benefits by 2027. The budget proposal suggests requiring claimants to receive specific medical treatments or prove they looked for work, or limiting the amount of time beneficiaries can receive benefits, among the possible changes.
  • Reducing SSDI benefits when an individual attempts to work, is laid off, and then receives unemployment benefits. This disincentives people with disabilities from trying to work.
  • Changing workers’ compensation laws to save the DI trust funds money at the expense of state workers’ compensation programs.
  • Establishing a one-year probationary period for new ALJs, which could interfere with their decisional independence.
  • Limiting SSI payments for individuals living with other SSI recipients. This would interfere with families’ choices about living arrangements, add complexity to the SSI program (increasing overpayments), and increase poverty.
  • Excluding Social Security overpayments from discharge in bankruptcy proceedings, and increasing the minimum withholding to repay overpayments from $10 a month to 10% of benefits.

I frequently meet with people who wonder, even after they have endured the lengthy, often years long, process to get disability benefits, how they will be able to survive on their benefit amount. They lose homes, assets, marriages, and suffer further declines in thier health because of the stress.

These proposed cuts to Social Security will amount to $72 billion over the next ten years. That is $72 billion less for people with disabilities to use for basic needs like food and shelter. When combined with reductions in Medicaid, Food Stamps (SNAP), TANF, and other critical programs, many people with disabilities will not be able to meet their basic needs.

I urge you to write or phone your senators (https://www.senate.gov) and representatives (https://www.house.gov) to oppose these cuts.

Sincerely,

Jay Barnes, Esq.

 

Social Security and Machine Driven Disability Determinations

Why is it so hard to get disability benefits nowadays? Social Security has not substantively changed any of its rules and there has been no change in the definition of disability. Yet, approval rates have plummeted to record lows over the last few years, even while Social Security continues to claim that its decisions are more accurate than ever. The answer to that question is probably very complicated but I believe it starts with SSA’s use of computer algorithms to evaluate claims and decisions.

There is a graph based on the 2015 SSA statistical report in the November 2016 NOSSCR Forum I found very interesting. It categorizes the reasons people win their disability claim into four categories: Meets level of severity of listings; equals level of severity of listings; medical and vocational factors considered; and other.

“Meets level of the severity of listings” refers to a set of regulatory criteria SSA has published for specific conditions. If a person meets those criteria they are automatically found disabled. Those criteria are commonly called the Listings.

“Equals level of severity of the listings” refers to conditions that may not specifically meet the criteria but are so similar that they can be found equivalent to a listed impairment. For example, SSA states that it will find that migraine headaches will be found to equal the listing for epilepsy in certain circumstances.

“Medical vocational factors considered” refers to what are commonly called the grid rules. The grid rules direct a finding of disabled or not disabled using age, education, and work skill attainment along with a person’s limitations. They generally apply only to people over the age of 50.

Both the listings and the grid rules have very specific requirements that are easy to evaluate for professionals familiar with Social Security’s rules and policies.

“Other” is not well defined in the statistical report but appears to refer to step 5 of the disability evaluation process. At this stage SSA is supposed to consider all of your conditions, whether severe or not, to determine your ability to do any work that may be available in the national economy. Decision making at this step necessarily involves a lot of judgement and generally requires the input of a vocational expert. It also requires an assessment of the consistency of a claimant’s description of limitations with the medical record as a whole. This is significant because the “other” category is the one that has seen the most change in recent years.

The numbers from the statistical chart go along pretty flat until 2012, when there are some very big changes. During this same period, SSA’s disability approval rate has dropped to historically low levels. To my knowledge, SSA has never offered an explanation for these drastic changes. There have not been any significant regulatory changes, policy changes, or personnel changes, that could account for such a drastic change. Most of us who practice Social Security law have been left scrambling to deal with the changes and to figure out why they may be occurring..

The data from the statistical report shows that the percentage of favorable decisions due to application of the medical/vocational factors has increased from a little over 40% to 55%; the percentage of favorable decisions attributable to meeting a listing has a very similar increase, from a little over 20% to 35%. That means 90% of all favorable decisions are attributable to either meeting a grid rule that directs disability or meeting a listing.

At the same time the other category had dropped from about 30% to about 5%.

Another chart that was included shows unsurprisingly that the primary reason why claimants are denied is that they are found “able to do other types of work,” a step 5 denial. But the percentage of cases with that finding has increased from a little over 30% to just under 40%. Interestingly, the big jump in these charts happened in 2011.

I think that is pretty much all you need to know if you want to know why SSA approvals have declined so much. SSA has basically eliminated step 5.

How did SSA accomplish such a thing?

I remember in about 2009 (maybe it was 2010) attending a NOSSCR conference where someone from SSA mentioned that they had a contract with IBM to develop a decision evaluation algorithm. The idea was that you could feed the computer data and a decision model to have it identify decisions that may have problems and then spend your time looking at those. Computers are really good at identifying specific rule applications like the grid rules and listings. I could easily imagine a computer that could read a set of medical records and find information relative to meeting a listing and then determine the likelihood the listing was met based on whether all the factors were discussed and how frequently. However, SSA has refused multiple requests by different parties to identify how the algorithm works, saying they don’t want to give anyone the tools to game the program. The program isn’t making decisions, just checking the work of the humans and providing training.

Gerald Ray, Deputy Executive Director, Office of Appellate Operations, discussed the program in detail in a pod cast in 2015. Mr. Ray takes issue with the premise that Social Security judges are experts. He sees the application of big data as a tool to refine not only the accuracy of the decisions but also sub-regulatory policy and training and instruction. He describes the process he took SSA through to develop a set of decision evaluation criteria and then to use those criteria to “train” decision makers to issue “better” decisions.  He says that SSA used over 2,000 data points to develop the model. SSA has not released those data points so we don’t know what they are, but it has stated the data is used to create a feed back loop so that decisions will be made to more closely match the model. In other words decision accuracy is determined by how closely a decision matches with a computer model of what a good decision is. The human element, the element most prominent at step 5 and in many cases most important to disability, has been removed. What once required judgement, is now simply a mechanical application of a secret computer algorithm. The closer you get to the algorithm the better your evaluations will be.

Medical Record Accuracy

Social Security is increasingly relying on computer systems to evaluate disability. These systems both check the accuracy of decisions and try to identify claims that can be approved earlier in the process. However, they rely intensively on natural language searches of the medical records as well as coding done by SSA employees. Recent proposed rule changes will make SSA even more reliant on medical records for disability assessment, as opposed to opinions from your doctors. With this in mind it is extremely important for you to be aware of problems with the accuracy of medical records and to know what needs to be documented in your records.

Most people assume both that their doctors write down the necessary elements to establish symptoms and diagnosis and that they write those things down accurately. Multiple studies of medical record accuracy have established that this is simply not true. For example, one study found that that emergency room doctors failed to diagnose mild traumatic brain injury when the elements were present 56% of the time. Powell, Janet M., et al. “Accuracy of mild traumatic brain injury diagnosis.” Archives of physical medicine and rehabilitation 89.8 (2008): 1550-1555. Another study found that medical providers were particularly poor at documenting symptoms and medication side effects in schizophrenia patients, especially when those patients were severely ill, black, or perceived as non-compliant (meaning that the patient did not follow the medical provider’s recommendations for treatment). Cradock, Julie, Alexander S. Young, and Greer Sullivan. “The accuracy of medical record documentation in schizophrenia.” The journal of behavioral health services & research 28.4 (2001): 456-465. The problems with accurately documenting medication side effects, dosage, and drug allergies have been documented in multiple studies. A study from 1989 found that “Medical records are being distorted and fashioned to keep clinically important but sensitive personal information about patients from public view. To comply with standards of care and a reimbursement system blind to biologic diversity, medical records are being forced to address only the technical side of care.” Burnum, John F. “The misinformation era: the fall of the medical record.” Annals of Internal Medicine 110.6 (1989): 482-484. This study cautioned against what has now become a reality of modern life, over-dependence on medical records for legal determinations such as eligibility for disability benefits.

The problems shown by these and other studies are particularly relevant to those seeking disability benefits because the disabled are generally very poor and have a difficult time complying with treatment recommendations.

So, what can you do to improve your own medical records.

The first thing to do is have a conversation with your doctor to let him or her know that you are applying for disability and that as a result you will need complete and accurate documentation of your symptoms and documentation. Social Security has very specific requirements for diagnostic documentation and the only way for those requirements to be met is for your doctor to make sure they appear in the medical records. You will also need to have your doctor document the extent and nature of your disability with specific descriptions of your functional, especially work-related, limitations. For example, if you have a back condition it is essential that your doctor describe any difficulties you have with activities such as walking, standing, sitting, lifting, carrying, concentration problems due to pain, etc.

The next thing to do is to be open and honest with your doctor about your symptoms every time you go. Many people will assume that since they have told their doctor once they don’t need to do so again. The problem is that Social Security needs to see how your condition affects you over a long period of time. If your limitations are not documented consistently throughout your record, Social Security is very likely to find that your condition is not as severe as you say it is.

Next, help your doctor by documenting your symptoms yourself. For example, you can keep a journal or calendar that keeps track of both how often you have symptoms and how severe they are. If you have depression it is a good idea to document those periods when you have severe depression that keeps you from functioning. Then you can take that documentation with you to your doctor’s visits to make sure they are aware of how limiting your depression is. Often times Social Security judges will think you are lying if you tell them you have very severe symptoms despite taking medications or seeing a doctor regularly. They think the doctor would take further action like changing your medication if you were really that bad off.

Lastly, make sure you document any difficulties you have obtaining medical care. If your doctor prescribes a medication that you can’t afford, make sure to let the doctor know you can’t afford it and have the doctor write that down in your records. The same is true for any other medical treatment such as a surgery or a recommendation for physical therapy, and any other reason you don’t get treatment such as unacceptable side effects or transportation problems.

Taking these steps will not guarantee that you will be approved for benefits, but they will go a long way to helping you prove your claim.