When you apply for disability, your claim is sent to a state agency that SSA hires to made the medical determination of  whether you are disabled. In many states this is called the Disability Determination Service,  DDS, while in Indiana the current name is the Disability Determination Bureau, DDB. It is these State workers that decide your claim.

The National Association of Disability Examiners, NADE, describes itself as:

a professional association whose purpose is to promote the art and science of disability evaluation. The majority of our members work in the state Disability Determination Service (DDS) agencies where 15,000+ employees adjudicate claims for Social Security and/or Supplemental Security Income (SSI) disability benefits. As such, our members constitute the “front lines” of disability evaluation.

A recent issue of The NADE Advocate, Volume 26, Number 1,  provides insight into why SSA may make the wrong decision in your case.

The growing complexity of the Social Security and SSI Disability Programs, coupled with the need to produce a huge volume of work, justifies even more the need for adequate resources in order to provide the service that the American public has come to expect and deserve from SSA. It takes an average of two years for a newly hired disability examiner to become fully trained and proficient to the point they can function independently and contribute to the process of making timely and accurate disability decisions. Thus, decisions not to replace productive personnel when they leave can take two or more years to correct even after new hires are made. NADE has long maintained that it is critical for SSA to be provided with the resources needed to hire and train new staff that can perform these duties. Low salaries, hiring restrictions and the stress of the job have contributed to high attrition (12.3%) in the DDSs. (Emphasis added)

Constantly having to replace 12.3% of the workforce and it taking two years before they can function independently, plus the stress of the job to get the work out fast, combined with low pay, may be a reason that DDB makes the wrong decision so many times.

The important point for you is that you should not be discouraged when your claim is turned down at the initial or reconsideration stages. With approximately 65% turned down on initial application and approximately  93%  turned down at Reconsideration,  you should take the steps necessary to increase your odds of winning. You will need an experienced attorney in Social Security claims to help you increase your odds in what NADE calls a “growing complexity of the Social Security and SSI Disability Programs.”

Unlike many attorneys, I will begin to help you with your case before your file your claim.  Read When Should I Hire An Attorney For My Disability Case? for my reasons why. What are you doing to increase your odds of winning?

When you apply for Social Security Disability, you are stating that you cannot do an 8 hour a day job 5 days a week. If you have posted your resume seeking work, some might conclude that you really think you can work. The old adage “you cannot have your cake and eat it too” comes to mind. Some will conclude that you really are not disabled and you are only using the Social Security Disability system to provide you a means of support while you are looking for work. After all, if you cannot work, why would you be posting your resume seeking work?

Perhaps you posted a resume on line shortly before you became disabled. Have you forgotten about it? Did you remember to remove it from the site when you became unable to work? Even if you did, can it still be retrieved from the web?

Much has also been made in the news media about potential employers looking at social media sites such as Facebook and MySpace to see what they can learn. If someone might research you, what might they learn about you at these sites? If you participate in an online chat group, how might your comments be misconstrued? Also, if you are posting all the time, what might that say about your computer skills and your ability to concentrate? Do not assume that the postings are private because it is a disease support group web site. Who knows, your ALJ may actually belong to the support group and be reading about you.

There used to be an ALJ in Indianapolis that would state that he got on the SSA system the day before the hearing and personally ran the earnings records to see what it showed. He would then ask the claimant pointed questions about the latest findings. You need to be prepared to answer the ALJ’s questions about what the internet reveals about you. You may hear the ALJ begin a question with “I see on the web that…..”

Most people tell me that they have heard that ‘everyone gets turned down twice,’ but they always think it will not happen to them. With odds like these, year after year, you have to know the rules . You need to know when to hire an attorney to represent you.

Just because your doctor told you six months ago that there was nothing more the doctor could do for you – this is as good as it gets – does not mean that you can stop going to the doctor. If you do not have medical records (that third party verification) for those six months, the judge can say that there is no proof that your medical condition did not improve during that time or that it stayed the same, therefore you have not proved that your medical condition prevented you from working those six months. This could result in a complete loss of benefits. If you have seen the doctor in that time, then the medical records can document that you did not improve. Also, the doctor may document some facts that the doctor did not previously document. These facts may be what convince the judge that you can not work.

Another problem is that most doctors do not put in their medical records that they told you that this is as good as it gets. When you tell the judge that is what the doctor says, there is no way to verify this in the medical records. In preparing your case to win, you must assume that without third party verification of what you say that the judge will not believe you. Otherwise you are gambling that maybe you will be lucky and the judge will believe you. Why would you want to gamble on winning when you can continue to see the doctor and generate the third party evidence (medical records) that will show what your medical condition was?

A new client informed me that Paul Harvey had died. Why was I talking to my new client about Paul Harvey when we were discussing her disability case? I knew that if she had heard radio legend Paul Harvey’s show, The Rest of the Story, she could learn and understand an important lesson about her disability case. Like so many others, she was not telling The Rest of the Story.

Paul Harvey’s radio show always had a spot he called “The Rest of the Story”. Paul always had an interesting story that he would begin to tell. He would let you know how the story would end and give you some facts up to the commercial. When you heard the facts that he told you up to the commercial, the story did not make any sense because you just could not understand how given those facts there could be the end he had told you about. In fact, many times, I thought it was impossible!

Once Paul came back from the commercial, he would tell you The Rest of the Story. Paul would add one or two more facts, and the story would fall into place. Suddenly, the impossible ending was not only possible, it was required!

Based upon what my client had told me, I knew that she had left out some very important facts out of her disability story. I started talking to her about Paul Harvey’s radio show. I told her she had only gotten up to the commercial. I told her that her disability story did not make sense. She needed to tell The Rest of the Story. Once I pointed out to her the facts she had left out, she began to realize how she was not bothering to tell very important facts. She understood that she needed to tell The Rest of the Story.

Many people who have been turned down for disability do not realize that they are not telling The Rest of the Story. Paul Harvey’s radio program has been a valuable tool to help them understand how they can tell the truth, whole truth, and nothing but the truth by telling The Rest of the Story.

Paul Harvey will be missed.

I went over her case with her in preparation for the hearing the next day. We discussed our theory as to why she should be found disabled under the rules of Social Security. We discussed her past work and discussed why her medical conditions prevented her from being able to do that work. I reminded her how a Social Security hearing was different from “TV court” and from other court proceedings. When I asked her if she had any other questions about her hearing, she said she felt that she was ready. She had read our memo about testifying at her hearing and said it answered so many of her questions that she felt she was now ready for the hearing.

After she left, I prepared my questions for the vocational expert. From my past experience, I knew that her past work had been light work that had transferable skills. I knew enough that I could handle the questioning of the vocational expert without any further preparation, but I went ahead and looked up all of the details in the Dictionary of Occupational Titles. I wanted to be over prepared “just in case.”

Because of all of our preparation, the hearing went smoothly. She answered each of the judge’s questions with the whole truth. The client got the result that she wanted. As I thought, I did not really need to look up all of the details in the Dictionary of Occupational Titles. But you never know for sure how a hearing will go. I still follow the motto of the Boy Scouts that I learned so many years ago-Be Prepared. It is still the key to success.

I try to warn clients that most claims are denied at these levels because everyone thinks the ‘other guy who really does not deserve it will be denied, but I will not.’ These statistics prove that most people should be prepared to be turned down and should be prepared to go to hearing. They should not go it alone thinking they have a good change to win without someone who knows the rules . They need to know when to hire an attorney to represent them.

Next day I struggled on. Boy, is this cold annoying, I thought. On Wednesday morning, at about 10:30 (if I had looked at my watch I could tell you the exact time), both my ears suddenly ‘closed off’ and both suddenly began to hurt with that pain you get when you have a cold and fly on a jet. Ah, I thought, I will just take some decongestant when I go home tonight, and my ears should open up on their own soon. By 2:30 PM, I could not take the pain anymore and finally went home to take some decongestant. I waited for my ears to open and the pain to go away. At 1 AM, when I still could not fall asleep due to the pain, I finally wised up and took some Tylenol.

Next morning I thought the pain had gone away and debated about calling the doctor. I finally decided to let him take a look. I continued to work from home. At my appointment that afternoon, he found that both my ears did “look bad.” Double ear infections. Antibiotics were prescribed.

Did I stay home and rest the next day? No. Stubborn me, I went to work for a while, until I finally recognized that I was worthless. Did I stay home on Monday to get well? Nope. I thought I was doing so much better. I could work. Stephanie commented that I looked tired. I finally went home. I will not bore you with the details of how I continued to go into work when I should have stayed home and gotten well because I did not realize how sick I was.

I should have known better. Stephanie has worked for me for several years. She knows me. When she told me I looked pale, I should have remembered that the last time she commented about how I looked pale, I finally went to the doctor to discover I had severe bronchitis/walking pneumonia and was sick for three weeks. When Stephanie tells me I look pale, I should know that means ‘you need to see a doctor immediately because you are really sick.’ I did not get the hint. But both times, I did not want to believe that I was that sick, I did not think I felt that sick, and it never registered to me how sick I really was. I thought I was capable of doing much more than I could.

I see this all the time. My disabled clients want to believe that they can do more than they really can. I remember the man who came in with his family. They had finally gotten him to come in and begin to think about applying for his Social Security Disability. He and his wife sat in the first row and his grown kids were in the second row. I asked him to tell me what he could still do. While he was telling me, his kids were shaking their heads “NO!” until one finally said: “Dad, you have not been able to do that for three years.” He turned around and looked at his child. The other ones all shook their heads in agreement. Dad, like me, did not think he was that bad off and it had never registered with him what he could not do. Both of us were not good ‘eye witnesses’ about ourselves. We needed those that really knew us to tell us the truth about how we really were. Neither of us invited the assessment. We just assumed that we knew what we could do. Neither of us decoded the hints that were given to us.

I advise client’s to invite their loved ones to give them an honest, blunt, no holds barred assessment of what they can and can not do. Pick a good day when you can take it, and give them permission to tell you what they see. Go to your doctor and find out what he or she really thinks you can do. Evaluate what they say. Test it out. You may find out that like me, you are a really bad ‘eye witness’ for yourself when you do not have this information.

When you talk to Social Security about your medical conditions, you want to tell the truth, the whole truth, and nothing but the truth. Don’t be a bad witness for yourself. Test your assessment against what your family and your doctor sees. See if you need to ‘wake up and smell the coffee’ like I needed to. Don’t let you fool yourself into thinking you can do more or less than you can. Take the steps to become a good witness for yourself by figuring out what you used to be able to do before your medical impairments and what you can do now.