Articles Posted in Social Security Disability

Earlier this year, the Social Security Administration issued a Policy Interpretation Ruling for claimants seeking reconsideration of a decision made in the review process. The agency specifically addressed how the federal regulations for reopening a claim should be used when a decision hinges on a federal law that is later determined to be unconstitutional. The need for this Policy Interpretation came about following two Supreme Court decisions, Defense of Marriage Act in United States v. Windsor, 133 S. Ct. 2675 (2013) and Obergefell v. Hodges, 135 S. Ct. 2584 (2015). It may have an impact on Massachusetts Social Security claimants.

The two main programs of the Social Security Administration (SSA) are Title II and Title XVI. Title II benefits are ones from the Social Security Disability Insurance program, paid to individuals insured under the Social Security Act based on their payments into the system through the tax on their earnings. These payments can also be made to a particular set of disabled dependents. Title XVI benefits are better known as SSI, or Supplemental Security Income, and they are paid to disabled people who have limited income and resources. Much of the focus on whether an individual qualifies for Social Security benefits centers around whether or not she or he meets the medical criteria to be considered disabled. However, a claimant must also fall into the categories set by the SSA. The two Supreme Court cases above allow a greater amount of individuals to qualify as a disabled widow or widower, or as a dependent of a deceased insured parent.

Normally, if the claimant objects to the decision or determination of the agency, she or he can lose the right to another review if the appeal is not made within the listed time period. The decision or determination is then final. Exceptions to finality exist, and cases may be reopened under limited circumstances. The cases can be reopened for “good cause” at the agency’s initiative or by request of the party for revision. Agency regulations guide the grounds for reopening and whether or not there are deadlines to follow.

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Whether state court or federal court, the civil justice system relies upon due process to ensure all parties are fairly heard and considered. Part of due process is the statute of limitations, which provides deadlines for parties for many parts of the litigation, including filing, responding, requesting evidence, and providing evidence. If deadlines are missed, the party missing the deadline can potentially be precluded from either moving forward with the litigation as the plaintiff, or maintaining an affirmative defense as the defendant. The First Circuit Court of Appeals addressed the effect of a missed deadline in a Massachusetts Social Security Disability appeal for benefits in a recent case (No. 16-2188).

The SSI claimant filed for Social Security Disability Insurance benefits (SSDI) in 2012, which were denied three months later and on reconsideration three months after that. A hearing was held 14 months later, ultimately concluding in an unfavorable decision for the claimant. The ALJ found he was not disabled and was ineligible for SSDI. The claimant then asked the agency’s Appeals Council to review the administrative law judge’s determination. The council denied the request, finalizing the ALJ’s denial of benefits.

The council’s denial included a notice that the claimant has 60 days to file a civil action or ask a federal court for a review. The notice specifically stated that the 60 days start the day after the claimant receives the letter and that it is assumed the letter was received within five days after the date stamped on the Notice, unless the claimant can show otherwise. The notice also advises that if the claimant is unable to file for a review within 60 days, an extension is available as long as there is a good reason for waiting more than 60 days to ask for a court review. This request for an extension must be in writing.

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If you are seeking Social Security Disability in Massachusetts, it helps to understand the process and requirements. In any determination for Social Security Disability, a decision-maker must review and make findings based on the medical evidence presented by the applicant. The Social Security Administration (SSA) recently released a new ruling (SSR 17-2p) on the evidence that is needed by a consultant or adjudicator to find medical equivalence. This Ruling provides insights for consultants, adjudicators, attorneys, and applicants on what must be presented for a successful ruling.

An SSI claim goes through the five-step Sequential Evaluation Process. If disability is determined at any step, the process is considered complete. During the third step of the evaluation, a medical assessment is conducted that looks at whether or not the applicant’s impairment(s) lines up with the ones on the formal Listing of Impairments. Generally, the applicant must meet all of the requirements of one of the listings in order to qualify for SSI, but the decision-maker may still find an individual is disabled if her or his impairment medically equals a listed impairment.

The SSA considers an impairment to be medically equivalent if it is equal in severity and duration to the criteria of the listed impairment. Medical equivalence can be found in three ways. The first possible scenario is when an applicant has an impairment that is described but does not exhibit a specific finding in the listing, or meets all of the findings of the listing but not the severity. The second is when the impairment is not described in the listing but provides findings that are similar to one or more of the listed impairments. The findings must be equal to the medical significance of a listed impairment. The third is when an applicant has a combination of impairments, and none of them meets a listing. The SSA allows the decision-maker to compare the findings as a collective to see if it is analogous to listed impairments. Similar to the second scenario, the findings must be equal to the medical significance of a listed impairment.

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At an administrative hearing for Social Security Disability, the administrative law judge (ALJ) may hear from a vocational expert (VE) to help determine whether or not the applicant qualifies for SSDI benefits. The vocational expert provides impartial expert opinion evidence that gives insight on the physical and mental demands of a job, the work setting, the type of labor performed in a certain job, and whether certain skill sets are transferable. The Eighth Circuit Court of Appeals case Gieseke v. Colvin (No. 14-1395) reveals the effect a VE’s opinion can have on an SSDI claim.

In Gieseke, the claimant suffered a long history of low back pain, which worsened following a work injury. The claimant went to physical therapy and returned to work with restrictions for several more months. He applied for disability, citing the lower back issues, leg problems, and dizziness as reasons he could not work. At the hearing, the ALJ found that he had a history of degenerative disc disease of the lumbar spine, obesity, and a history of substance abuse. Regarding his physical abilities, the judge found that while he was unable to perform his past relevant duties, his residual functional capacity (RFC) showed he had the ability to perform light work. The ALJ made these determinations based on the VE’s testimony and found that the claimant could work as a cashier, security guard, or usher. Since the claimant had the ability to work, his SSDI benefits were denied.

On appeal, the claimant argued that the ALJ did not give enough weight to the testimony of the claimant’s treating physician. The claimant’s physician testified that he was limited to lifting less than 10 pounds occasionally or frequently, standing for less than two hours a workday, frequently changing seated positions during the workday, and never climbing, crouching, stooping, crawling, or kneeling. This contrasted with the ALJ’s finding he could lift and carry 20 pounds occasionally, lift and carry 10 pounds frequently, stand and sit for six hours a day, and sometimes balance, stoop, crawl, kneel, or crouch. The treating physician’s assessment would have limited the claimant’s ability to do almost any type of sedentary work.

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You may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) if you have become incapacitated in a way that would prevent you from maintaining employment. To obtain these benefits, you must be unable to work as a result of a medical condition that will last more than a year or result in death. The condition does not have to be work-related. In order to qualify for SSDI, you must have worked, but employment history is not necessary for SSI.

The United District Court of Massachusetts issued an opinion in Burgos v. Mastroianni regarding the final decision by the Commissioner of the Social Security Administration in denying a woman’s application for SSI benefits. In any review of a decision to deny benefits, the District Court is obligated to uphold the decision if the ruling is supported by substantial evidence that a reasonable mind would find adequate.
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