Bassett Law Firm

The Straightforward Application Process Becomes a Struggle for Benefits: Bassett Law Firm Attorney Maren Mellem Outlines Issues in the Veterans Disability Compensation Process

mthomas — Fri, 27 Apr 2012 19:26:02 +0000

Veterans are some of our most honorable and principled citizens. It is likely no surprise that when the disabled among them file with our government for benefits, they believe the process will be straightforward and fair. They assume this country—the country for which they risked their lives—will make them whole and both the military and the VA encourage this belief. Unfortunately, the “straightforward application process” all too often becomes a struggle for benefits. Claims languish in the system for years with the most basic of facts being disputed by the government. Sadly, a quick perusal of my current cases highlights these tragedies all too well.

A Gulf War Veteran who struggles with PTSD and traumatic brain injury is fighting to prove that he even left the United States. Yes, that is correct: the Veterans Administration is denying he even served overseas. This is despite documentation in the file that he should be allowed to leave the country without a passport.

Recently, I received a call from the wife of an ill veteran who was once stationed in Guam. Now the government denies he was ever even there. This dedicated woman spent hours in the library looking for an old newspaper picture of her husband at Andersen Air Force Base. She finally called us when she realized that she didn’t have time to fight the VA and care for her still ailing, disabled husband.

Unofficial VA “rules” may also hinder disability compensation claims from a medical standpoint as well. When it comes time to demonstrate the severity or cause of their disability, veterans turn to their doctors for assistance. If they’re receiving care from a VA medical center, however, the veterans will likely hit a brick wall. Many VA doctors refuse to provide veterans with any documentation that links the disability to the veteran’s time in services. As the VA requires these opinions before they will award a claim, and, just as in the practice of Social Security Disability, many veterans in a health crisis are forced to pay for medical care outside the VA system to get the documentation they need to prevail. The veterans who cannot afford to do this are often left with incomplete claims that the VA then denies.

It is important to me that veterans, and their loved ones, know they are not alone. There are organizations at the ready to assist in their struggles against the VA. Dedicated service officers with groups like the VFW, DAV and American Legion can help file initial claims. Should those claims be denied or inadequately awarded, the veteran should continue the fight by filing an appeal. An appeal protects retroactive benefits, and allows the facts to be reviewed by higher level employees of the VA, whereas a new claim resets the entire process. Attorneys trained in veterans’ law can provide valuable assistance with these appeals. Attorneys know how to obtain valuable evidence, and are trained advocates. Most importantly, they know the law—the law the VA itself must follow—and they know how to hold the VA accountable when it fails our veterans.

ABOUT THE AUTHOR: Bassett Law Firm LLC attorney, Maren E.H. Mellem, (http://www.bassettlawyers.com) has practiced law since 2001. She is the Veterans Benefits Partner of Bassett Law Firm LLC and is a member of the Missouri Bar, the National Organization of Veterans’ Advocates (NOVA), National Academy of Elder Law Attorneys (NAELA), and the National Organization of Social Security Claimants’ Representatives (NOSSCR). She welcomes comments, questions, and new clients at 800-331-1127 or at mmellem@bassettlawyers.com.

ABOUT BASSETT LAW FIRM LLC: Since 2004, Bassett Law Firm LLC (www.bassettlawyers.com) has successfully provided quality service to thousands of Social Security Disability beneficiaries, while adding two new practice areas – assistance to veterans in their pursuit of benefits from the Veterans Administration and health crisis management (Missouri only). Bassett Law Firm offers potential clients the same resources as many large law firms, without sacrificing the personalized focus and attention that comes with a boutique law firm staff.

Source: Bassett Law Firm LLC
For additional information about this author/attorney and her practice areas at Bassett Law Firm, LLC, please visit http://www.bassettlawyers.com.

Designated to Decide: How to Help a Loved One Finish Well

mthomas — Fri, 20 Apr 2012 15:24:07 +0000

In the video, “When Surrogates Override the DNR ,” a woman who was appointed to be her mother’s healthcare agent explains why she directed emergency room doctors to intubate her mother against her mother’s wishes.
It is a compelling video especially in light of the upcoming April 16th National Healthcare Decisions Day and growing discussion about aggressive healthcare at the end of life. The video is a sad story of loss that teaches important lessons about choosing and agreeing to be chosen as a healthcare agent.

In the video, a loving daughter agrees to be her mother’s healthcare agent. A thoughtful mother completes a DNR (Do Not Resuscitate) and DNI (Do Not Intubate) forms. The mother even goes so far as to wear a bracelet to alert paramedics not to resort to heroic measures to save her life. The mother also has a form on her refrigerator door alerting others of her wishes. Then the day comes which is most feared – her loved ones get a call from an emergency room. Upon arrival, they discover their beloved mother is gravely ill. Emergency room personnel tell them only support through intubation will continue her life. In light of all the mother’s preparations, the end should have come quickly as daughter and medical staff honored her explicit desire not to be intubated and then put on a respirator. Instead the mother is intubated by the emergency room physician and put on a respirator in the ICU. The family gathers and watches as the mother suffers in ICU. She dies 22 days later after what everyone agrees was a great deal of terrible suffering.

As the video plays, the daughter who was appointed healthcare agent and another daughter explain why events unfolded as they did. Their explanations illustrate the truth that documents don’t take care of people – people take care of people.
The daughter who was the appointed healthcare agent explained that when she arrived at the emergency room, her mother was hardly able to breath, not able to speak and gray in color. At one point the healthcare agent was asked, “Do you want your mother intubated?” In the video, she tells of how she allowed the emergency room doctors to intubate her mother even while her mother shook a protesting finger at her.

What was the healthcare agent’s explanation for allowing this to happen to her mother against her obvious protest? She explained she felt she “did not have time to think,” “things were happening so quickly,” and that “the doctors and family” were all so vocal and all at once. The healthcare agent also revealed that every time she visited her mother in the ICU, she felt her mother’s eyes were shouting out her displeasure at being put on life support. Despite this continual feeling, the healthcare agent did not agree to withdraw life support from her mother until three weeks later.

The other daughter defended putting her mother on life support by explaining her view that she was not convinced that the mother understood what was meant by DNR or DNI. The other daughter was not convinced that her elderly mother had received sufficient explanations of the forms that she had signed or the bracelet on her wrist or the form on her refrigerator. All of these indications of her mother’s wishes not to be place on life support were meaningless to the non healthcare agent daughter because her mother had never spoken to her about such things. In her mind, little weight could be given to choices that had not been discussed with the whole family. Also the other daughter felt it was only right to wait until all of the extended family had arrived to say whatever goodbyes were necessary. This daughter insisted that the mother would have wanted life support measures, at a minimum, to keep her alive for all of the family to be present at her bedside.

The story ends when finally they asked the mother to blink if she wanted the life support measures to end. When those blinks happened, the family authorized the withdrawal of life support measures. There was a lot of grief in that moment. There was also a lot of guilt because, in that moment, when both daughters understood and accepted their mother’s wishes, they accepted and understood their part in the mother’s suffering.

But they meant well. They had argued that they knew their mother best. They knew her better than some piece of paper that said not to intubate her or put her on life support. They knew her better than some bracelet that indicated to paramedics where to draw the line at treatment. They knew her better than some form on the refrigerator.

But they didn’t.

They acted the way they did, in part, because they did not know and, in part, because they were not prepared. Everyone’s suffering could have been lessened if they had understood their mother’s preferences better. Such an understanding would have been gained from family conversations about her wishes. As the video makes clear, no such conversations were held. Interestingly, the daughter who was appointed healthcare agent revealed her mother had “told” her that she did not want to be on life support. In a sentence or two, the mother had told her that she did not want to be put on a respirator. But “telling” others of such wishes is not necessarily the conversation needed to make sure those wishes are heard and honored.

The National Healthcare Decisions Day organization encourages families to have a “conversation” about advance care planning. This is the kind of planning needed to ensure a preferred course of healthcare is provided (or not provided) in the event of incapacity. Incapacity occurs when a person cannot speak because of illness or injury. Because incapacity can occur for many reasons that have nothing to do with advanced age, adults of all ages need to engage in such planning.

One definition of “conversation” is “the informal exchange of ideas by spoken words.” The daughter appointed to be healthcare agent “heard” her mother say not to put her on life support. The other daughter and the rest of the family never heard anything. No one ever had a “conversation” with the mother so that they would know her “ideas” about life support and her attitude toward dying. There was never an exchange of concerns, wishes or attitudes that helped the family understand whether their matriarch would have agreed to life support until the arrival of all family members.

Although the wagging of the protesting finger in the ER would have suggested otherwise. But without conversations about such matters families can often project their wishes onto their loved one. Besides, such discussions are hard ones. They are vulnerable discussions about values and intimately held (possibly not shared) beliefs.

Some try to avoid the conflict or disclosure involved in such conversations by documenting their wishes in advanced directives. They figure if it is there in black and white, then they can count on their wishes being honored. But documents don’t take care of people. People take care of people. A person’s advanced directive is not going to become a flesh and blood person, materialize on the side of the road, or in the ER or in the ICU, and assert its contents. A person does that. A live feeling person with their own ideas, values and attachments does that.

Thus, the video offers a two fold lesson. First, the person engaging in advance care planning must understand that it is more about the people than the papers. When choosing a healthcare agent, a person should be sure to have a conversation with their person of choice so that they understand their wishes are not the products of deception, confusion or manipulation. It must be clear to the proposed healthcare agent that their wishes are not just the mood of the day. The healthcare agent may need multiple conversations to understand and accept choices based on the appointee’s values and attitudes about life and death. The video showed there is much to consider in choosing a healthcare agent such as their temperament, place in the family dynamics, and their own feelings about life and death. Thus, the person choosing a healthcare agent and the person being asked to be a healthcare agent, should together identify obstacles and possible sources of resistance that could be faced by the proposed healthcare agent in carrying out the advanced directives.

The second lesson is for the person who agrees to be a healthcare agent – the person designated to decide. That person needs to understand that they have two decisions before a health crisis even arises.

First, the person who is asked to be a healthcare agent must decide if they are willing to make the choices he may be asked to make. He or she needs to examine oneself to decide if they have a moral, emotional or other issue that would make it impossible to carry out the choices of the advanced directive – whether that is to withheld life support or order it. The second decision is whether one has the personality or temperament to carry out an advanced directive in the worst circumstances. In the video, the daughter who was appointed healthcare agent often said that she did not have time to decide and that they (ER) wanted a “quick” decision. Also she explained how overwhelmed she felt with the insistent voices of the medical personnel and anxious voices of family coming at her.

Resistance by family members should be considered by both the appointee and the person proposed as healthcare agent. The other daughter, who was not the healthcare agent, repeatedly said that she told the ER personnel that she “did not want to hear” anything negative about her mother’s condition. She had decided that she would be a force to be reckoned with to save her mother. This illustrates that even when the appointed healthcare agent, intellectually, morally and emotionally, agrees with the course of care that a loved one has indicated, they may be, by personality or temperament, unable to deal with family dynamics that resist such a course of care. It cannot be overemphasized that the choice of a healthcare agent or the choice to be a healthcare agent involves more than deciding who is smartest or who loves the most. Consider whether what is trusted about the proposed healthcare agent is what will stand in the worst of situations.

Yet it is important to understand that agreeing to be a healthcare agent does not always mean a heart wrenching scene in an ER or in an ICU. Healthcare agents regularly agree to far less dramatic interventions. Healthcare agents can agree to surgeries or procedures for a loved one too upset to think through even a non-life threatening situation. But because people drive through red lights, accidents happen and fatal diseases can make an ugly announcement of their presence, people who agree to be a healthcare agent need to be emotionally and intellectually ready, willing and able for anything. Being ready and able is more likely if the person choosing a healthcare agent engages that person in open and honest conversations. From a true dialogue, the person choosing a healthcare agent can gain a finish of life of their own choosing and the person chosen as the healthcare agent will gain the peace of having helped a loved one “finish well.

1-This video is found at www.geripal.com, A Geriatrics and Palliative Care Blog

Social Security Adds 52 Compassionate Allowance Listings for Disability

mthomas — Wed, 11 Apr 2012 15:32:23 +0000

Michael J. Astrue, Commissioner of Social Security, today announced 52 new Compassionate Allowances conditions, primarily involving neurological disorders, cancers and rare diseases. The Compassionate Allowances program fast-tracks disability decisions to ensure that Americans with the most serious disabilities receive their benefit decisions within days instead of months or years. Commissioner Astrue made the announcement during his remarks at the World Orphan Drug Congress near Washington, D.C.

“Social Security will continue to work with the medical community and patient organizations to add more conditions,” Commissioner Astrue said. “With our Compassionate Allowances program, we quickly approved disability benefits for nearly 61,000 people with severe disabilities in the past fiscal year, and nearly 173,000 applications since the program began.”

The Compassionate Allowances initiative identifies claims where the nature of the applicant’s disease or condition clearly meets the statutory standard for disability. With the help of sophisticated new information technology, the agency can quickly identify potential Compassionate Allowances and then quickly make decisions.

Social Security launched the Compassionate Allowances program in 2008 with a list of 50 diseases and conditions. The announcement of 52 new conditions, effective in August, will increase the total number of Compassionate Allowances conditions to 165. The conditions include certain cancers, adult brain disorders, a number of rare genetic disorders of children, early-onset Alzheimer’s disease, immune system conditions, and other disorders. In his speech that opened the Congress, Commissioner Astrue thanked the National Institutes of Health for research they conducted which helped identify many of the conditions added to the list.

The agency also is improving its online disability application process, which is already substantially shorter than the standard paper application. Starting April 21, 2012, adults who file for benefits online will have the option to electronically sign and submit their Authorization to Disclose Information to the Social Security Administration (Form SSA-827). This improvement allows applicants to complete disability applications in a streamlined online session, rather than printing, signing, and mailing paper authorization forms to Social Security offices.

In March, Social Security approved eight research projects through its Disability Determination Process Small Grant Program. This new program aims to improve the disability process through innovative research by graduate students focusing on topics such as the Compassionate Allowances program, Wounded Warriors initiative, homelessness and SSI, and disability enrollment issues.

For more information on the Compassionate Allowances initiative, please visit www.socialsecurity.gov/compassionateallowances or contact Melissa Thomas at Bassett Law Firm LLC at mthomas@bassettsslaw.com

Social Security Disability and Unemployment Benefits: Unable vs Able

mthomas — Fri, 23 Mar 2012 18:54:14 +0000

Applying for or receiving unemployment benefits can be a problem if you have a claim for Social Security Disability or SSI. In doing so, you are making two inconsistent statements.

In filing for unemployment benefits, you are claiming that you are able to work, but you cannot find a job.
In filing for Social Security disability benefits, you are claiming that you cannot perform any type of work.
Therefore, you are saying that you are ABLE and UNABLE to work at the same time.

See the case of Ricky Arnaz Crawford. Crawford received unemployment benefits prior to a favorable determination by Social Security. Now, the MO Division of Employment Security is pursuing Crawford for $3,000 – the amount it says he was overpaid while collecting unemployment in 2009-10.

Read more by visiting the St. Louis Post Dispatch.

Government Involvement in Healthcare Reform

mthomas — Wed, 07 Mar 2012 19:30:50 +0000

From Alisa M. Dotson, Esq. – who heads our Health Crisis Management practice area:

As others have, I have spent time reading and listening to debates on health care reform. The arguments I struggle with the most are the ones that object to a government solution.

Government has had to step up to the plate because churches, families or communities cannot or will not. In our country’s history, adult protective services and child protective services sprung up, in part, because churches, families and communities, as moral and social institutions, were unwilling (in part) and unable (in larger part) to provide an adequate safety net. There are a lot of reasons that this is happening. But the solution is not to bemoan the myriad of social, political and economic reasons but to do something about their effects. I do not understand those who oppose “Obamacare” on the argument that government should not interfere. They say let the market do it. This is said without regard to the fact that the market has not done it so far. Too many buyers are left out of the market – hence the crisis.

Even more troublesome are those who feel access to health care is a not a right. There are those who would argue that if you cannot provide healthcare for yourself then you are not entitled to it. Or some who argue that it is the church that should take care of its own and the community. But ask yourselves whether your church is so involved in the community that you don’t need the government to help the people you serve – can and does your church and community pay for it all yourselves? I have heard the argument that each family should take care of its own. But I seriously doubt that those who feel that way are as “independent” and “self-reliant” as they appear to themselves. Too often I have witnessed those who decry government solutions seek and be sustained by the government benefits of Medicaid and Medicare. Too many people, even if they do not receive government benefits, enjoy the collective and shared pool of risk known as “insurance.” Yet for too many, the argument has to do with standing on one’s own and letting others fend for themselves. As I see it, we as a nation have moved from the pioneer frontier notion of self-reliance and independence to an ungodly, indefensible promotion of selfishness and an unscriptural contempt of the poor and the weak.

Even if a person is not of faith, there are purely secular reasons that it must be one for all and all for one. On the most basic level, any society stands or falls on its weakest link. The “weaker” these links are the weaker we are as a whole. If one is to be unapologetically selfish about it, think of it this way: it is simply unsafe for the rest of us when some of us are allowed to fall victim to disease and poverty. We cannot let diseases go unchecked among those who cannot afford treatment. Disease among a minority of people can spread among a majority of people – anything from the flu to AIDS. On an economic ground, people using ERs for primary care raises everyone’s healthcare costs. When hospitals lose money on those who cannot pay, then the costs for those who can simply go up. Despite what most Americans think, the healthcare industry is a business in which the bottom line is always being closely watched. What one does not pay, others make up for – always and without exception. And for those who are purely secular at heart, the bottom line is this: an unhealthy population is an unproductive population. Fewer healthy adults working means fewer goods and services.

But the strongest secular argument against those who think everyone should bear their own healthcare costs and that the health of others is not a topic of “public” concern and should not be line item of “public” expenditures boils down to this fact: no man is an island unto himself.

No one but the extremely rich can afford healthcare. Most of us do it through the “pooled risk” and the “collective” resources of insurance. We pool our money together and through insurance policies we take care of health care costs, natural disasters, automobile accidents and many of the unfortunate incidents of life. Medicare and Social Security recipients, despite the common perception, are not pulling out the money they paid in. They are pulling out the money that others, who have never heard of them, are paying in. Middle class families who do not want to watch a lifetime of savings taken by nursing home care seek out professional help to qualify for Medicaid. Medicaid planning is necessary because almost no one can pay long term costs without turning to someone or something else. The fact is no one can bear the cost of modern life alone.

None of us can do this 21st century life by ourselves. We do not grow our own food, sew our own clothes, or build our own homes. We rely on strangers to light our homes, make gasoline for our cars, manufacture the medicine we take, build the roads we drive on, connect us with cables, wires and invisible signals and provide us with an opportunity to make a living. The idea that if you cannot do it yourself then you have no right to it ignores the interdependence required when you don’t live “A Little House on the Prairie” existence. The complexities and structure of modern life require that we deal with each other and deal with the consequences of choices of people whom we have no access to and no control (Remember Enron, remember the BP Gulf oil spill or the shenanigans of Wall Street bankers?) So for me the call to make people stand on their own two feet, fend for themselves and reject government sponsored solutions ignore 21st century realities.

Sadly, the “health crisis” in America is a reflection of a larger moral crisis in America. The debate seems is to be an unprincipled one and one that forgets our history. We live in the greatest country on earth. We are different because not only of what we have but who we are. We are a community of citizens who believe that our sum is as great as our parts. We are a community of citizens whose pledge of allegiance is our manifesto:

I pledge allegiance to the flag of the United States of America, and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all.

Much of the health care debate forgets the values and morals reflected in this pledge. There are too many people who don’t know what “indivisible” means and don’t understand that liberty and justice cannot be enjoyed without a modicum of good health. “Obamacare” will fail because it fails to address the root of the problem it is trying to solve: healthcare costs. Instead of addressing those costs, it avoids the issue by trying to come up with insurance options that will help everyone pay ever growing and eventually unsustainable health care costs. Blame it for that. Don’t blame it for being a government solution. Don’t blame the government if you are not willing or able to pay for the health costs of others even in your own family, church, or community. Unless you have a better idea or deeper pockets, then let the rest of us do what we can to take care of each other as a community of citizens should. Unless you are willing to step up to the plate yourself on healthcare, then let the rest of us do what the Good Book says to do: Do unto others as we would have others to do unto us.

We are all in this together. This is the economical and moral truth. It is this truth that must drive any solution.

Delaware Online Story on SSDI Judges

mthomas — Fri, 02 Mar 2012 18:17:06 +0000

Life isn’t fair. But, if you’re applying for SSDI in Delaware, find yourself at the hearing level, and your claim is assigned to ALJs Showalter, Benitz or Powell – well, according to Delaware Online, your claim will most likely be denied. But, don’t be mislead. You could encounter bias in any one of the other 49 states, in over 170 hearing offices.
If you’re disabled, call us. We have experience in most of the hearing offices nationwide. We will help you navigate the system and fight for your rights as a disabled individual seeking the SSDI benefits you so rightly deserve.
http://www.delawareonline.com/article/20120301/NEWS/203010324?nclick_check=1

COMING SOON! New Electronic Signature Process for the SSA-827

mthomas — Thu, 01 Mar 2012 15:29:00 +0000

Beginning in April 2012, adults filing online for Social Security Disability benefits will be able to electronically sign and submit their medical release form, Authorization to Disclose Information to the Social Security Administration (SSA-827).

When you file online (sometime this April) SSA says that you will soon have the opportunity to read the SSA-827 and electronically sign the form as part of your disability application. By electronically signing the SSA-827, you will not have to print, sign, and mail or deliver a paper copy of the form to a Social Security office. This means that SSA can begin processing your disability claim sooner. Social Security anticipates that, on average, this will reduce disability application processing time by nine days on some cases, which can result in applicants receiving much needed medical insurance coverage and cash benefits sooner. Applicants will also benefit from a streamlined process that allows for the electronic, online submission of all parts of their disability application.

If all works as it should, this is definitely a step in the right direction for SSA.

Looking for assistance in filing your SSDI application? Call Bassett Law Firm LLC today at 1-800-331-1127.

Bassett Law Firm LLC Earns Women’s Business Enterprise National Certification

mthomas — Wed, 29 Feb 2012 15:37:54 +0000

COLUMBIA, MO – February 29, 2012 – Assisting clients in a health crisis since 2004, Bassett Law Firm LLC, received national certification as a Women’s Business Enterprise by the Women’s Business Enterprise Council – Chicago, a regional certifying partner of the Women’s Business Enterprise National Council (WBENC).

WBENC’s national standard of certification implemented by the Women’s Business Council – Southwest is a meticulous process including an in-depth review of the business and site inspection. The certification process is designed to confirm the business is at least 51% owned, operated and controlled by a woman or women. Bassett Law Firm LLC is 100% owned and operated by Greta M. Bassett-Seymour.

“We are pleased to receive this important certification by WBENC and we are honored to be a part of this great organization that promotes and fosters growth for women-owned businesses,” said Greta M. Bassett-Seymour, owner and attorney of Bassett Law Firm LLC.

The WBENC certification process is comprehensive. Independent reviewers examined Bassett Law Firm’s professional, legal, and financial status, followed by an on site visit to Bassett Law Firm’s Columbia, Missouri law office.

Originally founded in 2004 with the sole focus of assisting disabled individuals with Supplemental Security Income and Social Security Disability applications and appeals, Bassett Law Firm LLC has since expanded to include the practice areas of Veterans’ disability and Health Crisis Management. Bassett Law Firm LLC develops a strategy for managing a life that can become overwhelmed with the demands that come with a catastrophic or disabling illness.

To learn more about Bassett Law Firm LLC, please visit: http://www.bassettsslaw.com.

About WBENC
The Women’s Business Enterprise National Council is the nation’s largest third party certifier of businesses owned and operated by women in the United States. WBENC is a resource for the more than 700 US companies and government agencies that rely on WBENC’s certification as an integral part of their supplier diversity programs.

By including women-owned businesses among their vendors, corporations, and government agencies demonstrate their commitment to fostering diversity and the continued development of their supplier/vendor diversity programs.

CONTACT INFORMATION:
Melissa J. Thomas
Director of Marketing and Client Relations
Bassett Law Firm, LLC
mthomas@bassettsslaw.com
800-331-1127

Medical Records Speak Louder Than Words: What It Takes to Win a Social Security Disability Claim

mthomas — Tue, 28 Feb 2012 14:40:11 +0000

From an article published by Alisa M. Dotson, Esq. of Bassett Law Firm, LLC -
_________________________________________

Sincere and passionate testimony can make great courtroom drama. Unfortunately, such testimony does not win a Social Security disability case. You can tell the Social Security Administration (SSA) that you are too sick to work. Your family and all of your friends can state under oath that you are too sick to work. Your doctor can too. However in a Social Security disability case, the most persuasive “testimony” is not offered by a person but an inanimate object – medical records. If your medical records don’t corroborate what is being said then it will be as though nothing was said at all.

SSA has its own way of looking at things. Even the way it talks about disability is different so you need to know how to speak the agency’s language.

What “Disabled” Means to SSA

First, in applying for social security disability, you need to understand what SSA means when it uses the word “disabled.” You have to prove you meet the agency’s definition of that word, not yours. Also, it is up to SSA to decide that you meet that definition. So even if your doctor thinks you are disabled, SSA reserves for itself the conclusion that whatever is wrong with you makes you “disabled.”To SSA, you are “disabled” if you have a “medically determinable impairment” which will result in death or is so “severe” that it has or will eliminate your ability to do “substantial and gainful activity” for at least twelve continuous months. Translation: you have to have something a “doctor can find” that is terminal or affects you so much that you cannot work at a job 8 hours a day, five days a week for at least 12 continuous months.

Every person applying for Social Security disability is expected to produce medical evidence. You can produce records yourself or simply give SSA all the names of the doctors, hospital and clinics that are treating the impairment you believe is making you unable to work. You may have more than one impairment, and therefore, it is important to tell SSA about all the places up go for treatment and people you see for care.

Symptoms, Signs and Laboratory Findings

Second, SSA will look for medical records that support what you say is wrong with you in terms of “symptoms, signs, and laboratory findings.” Symptoms are your own descriptions of what you are experiencing regarding pain, inability to move, difficulty breathing, or other manifestations of your impairment. Although your statements about how you are feeling or what you can and cannot do will never “make” your case, they are relevant. But they are only a starting point.

For the sake of discussion, let’s use the problem of low back pain. Let’s say you feel you meet SSA’s definition of disability because of such pain. Your case could start with your statement of “symptoms” of back pain. Your symptoms could be that your back pain makes it difficult for you to sit for more than a few hours and you can only stand for a limited amount of time. Next, SSA will look for two things in your medical records: what is causing your back to interfere with your ability to sit and stand and is that problem so severe that it could cause you as many problems as you have claimed. This is where “signs and laboratory findings” come in. SSA will look for these in your medical records to see if they corroborate your description of your symptoms. “Signs” are what a doctor can observed separate from anything you say. In the example of low back pain, a “sign” would be swelling seen by your doctor or tenderness he can feel or some other abnormality that your doctor can see or feel. These are also referred to as “clinical observations.” But your doctor’s observations will only take your case so far.

SSA will look to corroborate your symptoms and your doctor’s observations by looking at “laboratory findings.” These refer to diagnostic procedures that show what is wrong with your back such as certain kinds of x-ray studies, CT scans, nerve conduction studies (EMG tests), or MRIs. Diagnostic tests are the objective standards by which SSA will judge both your symptoms and your doctor’s observations. Objective tests (e.g. imaging studies or blood tests) often dictate whether SSA concludes you have an impairment and that such impairment affects you so much that you cannot work. Thus in the case of low back pain, if objective tests don’t show a severe abnormality then it is unlikely that SSA will believe you or your doctor that you are very limited in your ability to sit and stand.

Test results that provide definitive diagnoses can save you quite a bit of time when applying for Social Security disability. SSA has a list of medical conditions that it feels are disabling, and the corresponding “required” signs, symptoms and objective findings. If your condition is on that list, then SSA will quickly find that you are disabled. But be careful because it is not always as simple as it sounds. Sometimes just having a certain diagnosis will cause SSA to find someone disabled. A good example of such a diagnosis is liver cancer. SSA generally does not need to know more than that. However, in other cases, just the diagnosis alone will not make SSA believe that a person is disabled. In other cases, it is how the diagnosis is affecting the person. One good example is Parkinson’s disease. It is a medical condition that is on SSA’s list of disabling diseases. But the agency will not find a person has “disabling” Parkinson if they do not have “significant rigidity or tremor” which results in sustained disturbance of gross and dexterous movements, or gait and station.” This means the person has to have the diagnosis of Parkinson’s disease in their records and those same records have to show that the effects that SSA’s rules say are “disabling.”

The lack of such medical records makes it very difficult to win your case. So it is important to understand that not just any medical records will do. Your medical records need to support what you are saying and even what your doctor says about you. This is why a letter from your doctor that simply says, “My patient is disabled” won’t convince SSA of anything. Such a letter will get nowhere with SSA. In fact, SSA can and will say they plan to ignore such a statement.

To SSA, the word “disabled” is not a medical term. This is the number one reason that the agency will not accept your doctor’s pronouncement that you are “disabled.” To SSA, being disabled is not a “diagnosis.” Under SSA law, the word “disabled” is an “administrative” or “agency” conclusion that it reaches based on its review of the medical evidence. How SSA reviews medical evidence and what conclusions it can draw from the medical evidence is dictated by its rules. Thus, SSA may accept your doctor’s opinion as to what is wrong with you (e.g. bulging discs) but feels free to interpret your doctor’s diagnoses in light of its rules. So never settle for a letter from your doctor that simply says that you are disabled. You need more.

How to Make Sure Your Medical Records Are Saying the Right Things About You

• Tell your doctor all your complaints. Make sure he writes down your complaints. If your complaints are not documented in your medical records, SSA is likely to think that if the complaints were not important enough for you to mention to your doctor, then they are not important enough for them to consider.
• Make sure your doctor writes down your complaints in your chart. It seems normal to most people that if they said it to his/her doctor, then the doctor wrote it down. Not necessarily. Too often people are unpleasantly surprised to find that their symptoms are not in their charts. If you spend time talking to your doctor about symptoms, it should be important enough to him or her to write it down. More to the point, SSA decisions are driven by what is in your medical records. Just as medical records can win a case, medical records can lose a case because your complaints of a bad back are not in your physician’s records. A credo of SSA is that if it is not written down then it is not true.

• Be sure the symptoms your doctor writes down are the symptoms you feel make you unable to work. You may tell your doctor about a lot of problems. But be sure the problem that you feel disables you is the problem that he has written down. SSA takes back pain that interferes with the ability to sit and stand very seriously. If you have those problems, it does not help you if your medical records show your back pain causes you to have a headache or lose your appetite. Make sure that your records show that you are experiencing problems sitting and standing. Tie your symptoms to the kind of things that would stop you from working and make sure those symptoms are recorded in your chart.

• Make sure that your doctor responds to your specific complaint(s). SSA will not pay attention to the symptoms listed in your medical records if your doctor did not respond to them by doing such things as performing examinations, running tests, offering treatment, or explaining why no treatment is available. This is necessary because any disease or health condition that is going to convince SSA that it stops you from working, will be one that merits a response from a healthcare professional.

• Make sure that your doctor performs examinations and orders tests that are relevant to your complaint. Your doctor can be your biggest ally but only if he gives you the right kind of help. Here, the “right” kind of help means having “relevant” tests to support the diagnosis. For example if your doctor thinks you have rheumatoid arthritis, SSA will only be convinced of the diagnosis if your doctor has ordered certain diagnostic tests that are generally recognized to show the presence of rheumatoid arthritis. SSA will then look at the results of those tests to see if they are true indications of rheumatoid arthritis. Another example is if you say that you have a respiratory condition that interferes too much with your ability to breath. If this is the case, then you want to make sure that tests that measure your ability to breath are in your medical records.

• Make sure that all treatment attempts are in your medical records.
SSA will want to know that you have tried to make your symptoms better. It is important that SSA sees you have tried to get better. It is equally important for SSA to see that despite many attempts using various therapies, nothing has helped you get improve to the point that you could work a full time job.

Your Medical Records Should Say the Right Things About Your Doctor.

Who your doctor is counts to SSA. The SSA will learn a lot about your doctor (and therefore how much weight they should give to his medical records) through the records themselves. First, SSA will only give weight to healthcare professionals who they deem as “acceptable medical sources.” This generally means licensed doctors. So if an acupuncturist or herbalist has “treated” you, his medical records won’t be accepted as “medical evidence” by SSA. Second, the longer your doctor has seen you, the better. Rightfully, SSA thinks a doctor who has treated you for five years has more credibility than one who has seen you for only three weeks. Finally, it is extremely helpful to get records from a doctor whose specialty is in the area of your impairment. For example, if you feel rheumatoid arthritis is keeping you from working, SSA will listen to your primary care physician but it will really listen to a doctor who specializes in such a condition – a rheumatologist.

The horror stories that you may have heard that it can take years to win a Social Security disability case are often quite true. But the journey to an award can be shortened by starting with the right records because, in the end, medical records speak louder than your words.
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Medically determinable generally means your medical condition has to be something that a doctor can find or identify with a diagnosis. 42 U.S.C 423(d)(1)(A)
“Severe” generally refers to what activities of daily living your impairment will affect and whether such affect will last for at least 12 months. 20 CFR 404.1520
Substantial and gainful activity generally work that grosses $1000 or more a month. 20 CFR Section 404.1508, 404.1529
20 CFR 416.928 (b)
20 CFR 416.928(c)
Listing at 11.06
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To learn more, visit Alisa Dotson’s profile on this site. Ms. Dotson focuses her practice on Social Security disability representation and health crisis management. She is a member of the Missouri Bar, the American Bar Association, NAELA, and NOSSCR.

The VA’s Plan of Attack on the Claims Backlog

mthomas — Mon, 27 Feb 2012 17:18:27 +0000

Veterans are claiming many more disabilities. Iraq and Afghanistan Veterans are claiming an average of 8.5 disabilities per claim – more than double the number of disabilities claimed by Veterans of earlier eras. As more than one million troops leave service over the next 5 years, the VA expects claims workload to continue to rise for the foreseeable future. In 2013, the goal is to ensure that no more than 40 percent of the compensation and pension claims in the pending inventory are more than 125 days old.

This year, the VA is also beginning national implementation of the new paperless processing system, the Veterans Benefits Management System (VBMS). The VA is implementing VBMS using a phased approach that will have all regional offices on the new system by the end of 2013.

The VA has experienced a 48 percent increase in claims receipts since 2008, and expect that the incoming claims volume will continue to increase by 4.2 percent in 2013, to 1,250,000 claims.

Read the transcipt of the House Veterans’ Affairs Committee Hearing at: http://tinyurl.com/VA-Backlog