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?

Compassionate Allowances are a way of quickly identifying diseases and other medical conditions that clearly qualify for Social Security and Supplemental Security Income disability benefits.  It allows the agency to electronically target and make speedy decisions for the most obviously disabled individuals.  In developing the expanded list of conditions, Social Security held public hearings and worked closely with the National Institutes of Health, the Alzheimer’s Association, the National Organization for Rare Disorders, and other groups.

“The diagnosis of Alzheimer’s indicates significant cognitive impairment that interferes with daily living activities, including the ability to work,” said Harry Johns, President and CEO of the Alzheimer’s Association.  “Now, individuals who are dealing with the enormous challenges of Alzheimer’s won’t also have to endure the financial and emotional toll of a long disability decision process.”

“This truly innovative program will provide invaluable assistance and support to patients and families coping with severely disabling rare diseases,” said Peter L. Saltonstall, President and CEO of the National Organization for Rare Disorders (NORD).  “On behalf of those patients and families, I want to thank Commissioner Astrue and his enthusiastic team for creating and now expanding a program that will have a direct impact on the quality of life of thousands of individuals.”

“The initiative not only assists those whose applications are quickly processed, but also assists those whose applications need more time and attention from SSA adjudicators,” said Marty Ford, Co-Chair, Social Security Task Force, Consortium for Citizens with Disabilities.  “We are pleased to see today’s expansion and look forward to working with Commissioner Astrue on further expansion of this decision-making tool and other ways to expedite determinations and decisions for disability claims.”

“We will continue to hold hearings and look for other diseases and conditions that can be added to our list of Compassionate Allowances,” Commissioner Astrue said.  “There can be no higher priority than getting disability benefits quickly to those Americans with these severe and life-threatening conditions.”

Social Security will begin electronically identifying these 38 new conditions March 1.

New Compassionate Allowance Conditions

1. Alstrom Syndrome
2. Amegakaryocytic Thrombocytopenia
3. Ataxia Spinocerebellar
4. Ataxia Telangiectasia
5. Batten Disease
6. Bilateral Retinoblastoma
7. Cri du Chat Syndrome
8. Degos Disease
9. Early-Onset Alzheimer’s Disease
10. Edwards Syndrome
11. Fibrodysplasia Ossificans Progressiva
12. Fukuyama Congenital Muscular Dystrophy
13. Glutaric Acidemia Type II
14. Hemophagocytic Lymphohistiocytosis (HLH), Familial Type
15. Hurler Syndrome, Type IH
16. Hunter Syndrome, Type II
17. Idiopathic Pulmonary Fibrosis
18. Junctional Epidermolysis Bullosa, Lethal Type
19. Late Infantile Neuronal Ceroid Lipofuscinoses
20. Leigh’s Disease
21. Maple Syrup Urine Disease
22. Merosin Deficient Congenital Muscular Dystrophy
23. Mixed Dementia
24. Mucosal Malignant Melanoma
25. Neonatal Adrenoleukodystrophy
26. Neuronal Ceroid Lipofuscinoses, Infantile Type
27. Niemann-Pick Type C
28. Patau Syndrome
29. Primary Progressive Aphasia
30. Progressive Multifocal Leukoencephalopathy
31. Sanfilippo Syndrome
32. Subacute Sclerosis Panencephalitis
33. Tay Sachs Disease
34. Thanatophoric Dysplasia, Type 1
35. Ullrich Congenital Muscular Dystrophy
36. Walker Warburg Syndrome
37. Wolman Disease
38. Zellweger Syndrome

Here is the list of the previously announced conditions.

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…..”

“We apologize for the inconvenience and confusion these incorrect notices will cause,” said Michael J. Astrue, Commissioner of Social Security.  “The problem was caused by an unfortunate human error.  We are correcting the misinformation as quickly as possible, and we are reviewing our processes closely to prevent this type of mistake from happening in the future.  People receiving Social Security benefits in January 2010 should know that their payment will arrive on the same payment day that it has arrived in the past.”

I encourage my disabled clients to stop and celebrate the blessings in their life on a regular basis. It is easy to get mired down in the negative things that are going on in our lives. This is especially true when you are ill and disabled. You never thought that you would not be able at this point in your life to do the “normal” things that are now impossible to do. It is very easy to only focus on the things in your life that you have lost. This “stinkin’ thinking”, as Zig Zigler calls it, will eventually pull us down. If you are ill and disabled, please stop on a weekly basis to count your blessings and give thanks for them. By focusing on the “good” in your life, it will be just a little bit easier to continue to in your daily life. Even if you can not have the Thanksgiving Day you would like today, look for the good and you will find something that you can give thanks about. It will be good medicine for you.

Social Security divides medical sources into two categories: “acceptable medical sources” and other health care providers who are not “acceptable medical sources”. Nurse Practitioners are in the category of other health care providers who are not “acceptable medical sources”.

In Social Security Ruling 06-03, SSA explains that it makes the distinction for three  reasons: First, SSA needs evidence from “acceptable medical sources” to establish the existence of a medically determinable impairment. Second, only “acceptable medical sources” can give SSA medical opinions.  Third, only “acceptable medical sources” can be considered treating sources whose medical opinions may be entitled to controlling weight.

This means that the medical evidence from a Nurse Practitioner can not establish your medical impairment at Step 2 of the Sequential Evaluation. You must establish your medical impairment in order to win your benefits.

This means that if all of your treatment is by a Nurse Practitioner, then you have no one who can give SSA a medical opinion about how your medical impairments restrict what you can do.

In a card game, a King beats a Jack. Social Security does not even treat a Nurse Practitioner as a Jack–more like a low card. This is not good for your case!

On July 29,2009, Commissioner Astrue was joined by Marie A. Bernard, M.D., Deputy Director of the National Institute on Aging, National Institutes of Health, and other Social Security officials, to hear testimony from some of the nation’s leading experts on early-onset Alzheimer’s disease and related dementias about possible methods for identifying and implementing Compassionate Allowances for people with early-onset Alzheimer’s. Early-onset Alzheimer’s and related dementia has not yet been added to the list.

Here is the list of the first 50 impairments — 25 rare diseases and 25 cancers included in Compassionate Allowances:

1. Acute Leukemia
2. Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
3. Alexander Disease (ALX) – Neonatal and Infantile
4. Amyotrophic Lateral Sclerosis (ALS)
5. Anaplastic Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
6. Astrocytoma – Grade III and IV
7. Bladder Cancer – with distant metastases or inoperable or unresectable
8. Bone Cancer – with distant metastases or inoperable or unresectable
9. Breast Cancer – with distant metastases or inoperable or unresectable
10. Canavan Disease (CD)
11. Cerebro Oculo Facio Skeletal (COFS) Syndrome
12. Chronic Myelogenous Leukemia (CML) – Blast Phase
13. Creutzfeldt-Jakob Disease (CJD) – Adult
14. Ependymoblastoma (Child Brain Tumor)
15. Esophageal Cancer
16. Farber’s Disease (FD) – Infantile
17. Friedreichs Ataxia (FRDA)
18. Frontotemporal Dementia (FTD), Picks Disease -Type A – Adult
19. Gallbladder Cancer
20. Gaucher Disease (GD) – Type 2
21. Glioblastoma Multiforme (Brain Tumor)
22. Head and Neck Cancers – with distant metastasis or inoperable or uresectable
23. Infantile Neuroaxonal Dystrophy (INAD)
24. Inflammatory Breast Cancer (IBC)
25. Kidney Cancer – inoperable or unresectable
26. Krabbe Disease (KD) – Infantile
27. Large Intestine Cancer – with distant metastasis or inoperable, unresectable or recurrent
28. Lesch-Nyhan Syndrome (LNS)
29. Liver Cancer
30. Mantle Cell Lymphoma (MCL)
31. Metachromatic Leukodystrophy (MLD) – Late Infantile
32. Niemann-Pick Disease (NPD) – Type A
33. Non-Small Cell Lung Cancer – with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent
34. Ornithine Transcarbamylase (OTC) Deficiency
35. Osteogenesis Imperfecta (OI) – Type II
36. Ovarian Cancer – with distant metastases or inoperable or unresectable
37. Pancreatic Cancer
38. Peritoneal Mesothelioma
39. Pleural Mesothelioma
40. Pompe Disease – Infantile
41. Rett (RTT) Syndrome
42. Salivary Tumors
43. Sandhoff Disease
44. Small Cell Cancer (of the Large Intestine, Ovary, Prostate, or Uterus)
45. Small Cell Lung Cancer
46. Small Intestine Cancer – with distant metastases or inoperable, unresectable or recurrent
47. Spinal Muscular Atrophy (SMA) – Types 0 And 1
48. Stomach Cancer – with distant metastases or inoperable, unresectable or recurrent
49. Thyroid Cancer
50. Ureter Cancer – with distant metastases or inoperable, unresectable or recurrent