An Inside Look at SSA
Medical Evaluations
Author Dr. David Morton has personally made
more than 50,000 disability determinations for Social Security
administration. As a Chief Medical Consultant, he hired, trained,
supervised, and evaluated the work of both medical doctors and clinical
psychologists.
Dr.
Morton reveals in his newest book how the SSA judges your claimants’ medical
data. Now you can have at your fingertips reliable guidance on:
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Documenting all
essential medical proof elements
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Overcoming
frequently-arising claim hurdles
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Guarding against
common errors by adjudicators and treating doctors
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Delivering persuasive
presentations of impairment
The
sophisticated and practical advice in this ground-breaking work is organized
by Listing, and all medical terms are defined in lay language. Also in this
book:
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Little-known and
revealing inside information that helps you take advantage of weaknesses
in SSA evaluation and adjudication
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Helpful guidance on
what symptoms, signs, and laboratory findings are required to meet a
Listing
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Detailed descriptions
of documentation challenges faced by both SSA and claimants’
representatives
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Candid assessments of
your chances of qualifying your claimant, and what additional factors
will help
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Practical advice,
based on the author’s 14 years of making disability determinations for
SSA, alert you to common errors by representatives
These insider tips are extraordinary in both detail and number. For example,
The following 12 quotes are taken from just the first 25 pages of the
125-page chapter on the Cardiovascular System and deal with one Listing
only:
Listing
4.02 Chronic heart failure while on a regimen of prescribed treatment
1. "The SSA has always
had a serious problem with treating physician diagnoses of congestive
heart failure, because it is not unusual to find that diagnosis in
medical records with little or even no evidence to support it. … The
poor longitudinal quality of many medical records makes it difficult and
sometimes impossible for the SSA to determine if heart failure ever
occurred in a claimant with that allegation." §4.02.1.a
2. "The SSA should not
cite the New York Heart Association or other classification as the
fundamental basis for denying or allowing a claim, but such Class should
be treated as opinion evidence. It should not be assumed that
improperly trained SSA adjudicators will not give undue weight to such
classification." §4.02.1.a
3. "An SSA adjudicator
might try to disregard cardiothoracic ratio findings on a chest x-ray in
a case that would otherwise be an allowance, because of
echocardiographic findings. Lacking legal regulatory authority, that
action would be improper and possibly a basis for appeal." §4.02.1.b
Residual functional
capacity issues
4. "Some SSA
adjudicators will try to use the objective cardiac performance alone to
determine RFC. There is no way an accurate RFC can be determined
without close consideration of the claimant’s symptoms as well as the
objective data." §4.02.2
5. "The claimant
should not be considered to have completed 5 METs of exertion unless he
or she completes the entire duration of the 5 MET stage of the protocol
used, usually 3 minutes and no less than 2 minutes. Careful attention
should be given this issue, because it is one in which an adjudicator
with insufficient medical knowledge in this area can easily err."
§4.02.2
6. "Some cardiologists
will not even have considered the possibility of diastolic dysfunction,
but the acknowledgment of that as a possibility can add credibility to a
claimant’s alleged symptoms. It should not be assumed that that the SSA
adjudicator, even if a medical doctor, will think of diastolic
dysfunction when reviewing a cardiac claim." §4.02.2
7. "The SSA does not
have cardiologists reviewing most heart impairment claims." §4.02.2
8. "Many claimants
with lung disease also have heart disease. The presence of significant
lung disease in a claimant who has had an episode of chronic heart
failure in the past due to chronic heart disease should always lower the
over-all impairment severity rating by at least one level. Failure to
recognize increased severity as a result of the inter-dependence of
cardiac and pulmonary impairments is a major source of error by SSA
adjudicators, despite federal regulations requiring consideration of the
combined effect of impairments (20 CFR §§404.1522(b), 416.922(b))."
§4.02.2
9. "It should be
remembered that many activities can be slowly completed that could not
be done at a normal pace; that does not mean such functional capacity is
an effective work-related ability. So, activity completion durations
are important in all forms of heart disease." §4.02.2
10. "Medical
conditions are not static in their effects on people; a person might be
able to perform at a certain activity level one day but not other days.
A person can perform a number of activities such as shopping and cooking
but be exhausted for several days afterward. Even the quality of sleep
can make a big difference in function the next day; medications and the
development of transient pulmonary edema at night can easily ruin a
night’s rest." §4.02.2
11. "Most claimants do
not understand how to complete daily activity forms given to them by the
SSA; the responses are too brief and vague. Unfortunately, this can get
a deserving claimant denied, because critical functional details were
not given to the SSA." §4.02.2
Other issues
12. "When trying to
understand medical evidence in heart failure or other cardiac impairment
cases, it is useful to keep in mind that the treatment given by
physicians is not a reliable indicator of the nature or severity of the
underlying disease." §4.02.3
Most
important, the book explains the impairment factors that determine residual
functional capacity. Common adjudicator errors in assigning RFCs are
highlighted.
The
incredibly knowledgeable Dr. Morton also provides innovative approaches for
avoiding denials like his new MET Connector Equation and Multimodal RFC.
The
publication also includes a full-text searchable CD-ROM at no additional
cost.
Updated annually.
ISBN 1-58012-080-6 Book
Price: $129.00
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