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Oxford, NC Social Security Disability Attorney

Social Security Disability

Social Security Disability is awarded to those who are disabled from medically determinable conditions that prevent them from performing "substantial gainful employment" and this disability will continue for at least 12 months or permanently. Substantial gainful employment is essentially the ability to work in a competitive, non-accommodated position 5 days a week, 8 hours per day.

The days when a prescription pad note that "the patient is disabled" was sufficient have been over for years. But, by regulation, the Social Security Administration defers to the opinions of treating physicians and providers.

Social Security is awarded in one of two ways. First, if the patient’s medical conditions or combination of conditions is so severe that it meets or equals (is equivalent to) an Impairment Listing, the person will be deemed disabled. For some judges, this is considered a legal determination, but the fact remains the evidence is almost entirely medical. The Listings are a catalog of conditions of each major body system from orthopedic to mental to cancer or AIDS. The second way the people obtain benefits is when they have one or more severe medical conditions which, when combined with their age, education and prior work experience, makes them unable to work. Most people do not have the medical evidence in hand when applying to show medical equivalents and so this second approach usually applies.

Residual Functional Capacity

What Social Security looks at is Residual Functional Capacity or the physical and mental vocational capacity a patient may retain despite his or her conditions. There are two basic types of limitations:

  1. Exertional limitations and those affecting physical abilities to walk, carry, stand, lift, balance, sit, stoop, bend, reach, etc. The inability to ambulate effectively or with the use of assistive devices is important.
  2. Non-exertional limitations are those such as pain, drowsiness, loss of concentration and memory, medication side effects, depression, psychiatric conditions and mental impairments. Although these are hard to objectify, they usually have to be supported by some objective findings, testing or observations that make these consistent and credible.

The Social Security disability process is lengthy. The first step is an application at the local office which can take two to three months for approval or disapproval. Usually the claims are disapproved and the claimant, rather than give up, should apply for Reconsideration after the denial. Reconsideration allows review by physicians or other personnel at the Office of Disability Determination in Raleigh, but depending on the medical proof at that point, normally results in a denial. Rather than give up and quit, the claimant should then appeal for review before an Administrative Law Judge in Raleigh or at one of the satellite hearing facilities. By this time, the Judge will have had time to digest the full record, review the law provided by a representative and make a decision after a hearing. These Judges work very hard with many, many cases and it can take as long as two years for a hearing date.

Most representatives and counsel like to have relevant medical opinions as soon as possible with the appeal process to expedite determination.

Elements of an effective medical report:

  1. Area of practice and position of employment with a copy of the curriculum vitae attached.
  2. The physician’s direct experience with the patient and a short history and description of the disabling condition or conditions.
  3. Whenever possible laboratory findings/imaging and observations should be noted with the symptoms or subjective complaints.
  4. Course of treatment and response to treatment.
  5. That in my professional opinion or to reasonable medical certainty patient X’s condition or conditions meets or equals Impairment Listing under the Social Security Disability regulations. My opinion is based on the patient’s history and is supported by XYZ findings, response to treatment, imaging, etc. From a physical standpoint, I would expect he/she to be limited in activities of daily living/physical activities (exertional). Further, the pain and medications may impair memory, attention and pace, etc. OR, if not equivalent.
  6. My professional opinion, or to reasonable medical certainty, patient has severe medical conditions which would render him or her unable to perform gainful employment. These conditions would physically affect the patient’s abilities to: walk, stand, lift, carry, work without breaks, etc. Non-physical limitations (non-exertional limitations) would include the effects of pain, periodic swelling, drowsiness, loss of concentration and memory, medication side effects, depression, psychiatric conditions and mental impairments.
  7. Further factors: If known, reference to the patient’s limited education, physical job demands and limited job experience are helpful. Certainly, if the patient cannot perform his or her previous employment, this would be important. Also, age is an important consideration. Although doctors are not vocational experts, all of us know that the axiom that one cannot teach an old dog new tricks applies even more to people with obsolete schooling and no computer skills.

This overview is not intended as a legal authority, but merely a guideline for looking at patients who may need disability. Medicare is one of the most important needs, but typically will not be available for two years and five months from the disability date. For those who are not Medicaid eligible, this means that private insurance may be exhausted or unavailable before all medical proof can be obtained.

Updated regulations and Impairment Listings are available on-line at the Social Security Administration’s website. Physicians in specific areas can easily maintain a familiarity with the applicable Impairment Listings in a particular field.

For more information, contact a Social Security Disability attorney at Watson Law, P.C.

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