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Social Security Administration Tightens Rules for Disability

Getting social security disability might have gotten more difficult thanks to recent rule changes by the Social Security Administration. These rule changes will only apply to persons applying for disability after March 27, 2017. Thus, if a person has applied for social security disability before that date, even if they do not have a hearing yet, these rule changes will not apply to their case.

Treating Doctors Not Given Difference

One of the biggest rule changes to disability determinations will be how the Social Security Administration considers a disabled person's treating doctor's notes and opinions. In a social security disability case, usually an applicant has at least one and sometimes multiple doctors who have treated the disabled person and are familiar with the disabled person's health and disabilities. The Social Security Administration, meanwhile, may send the disabled person to an independent doctor, called a "consulting examination". The consulting examination may last only a few minutes and is conducted by a medical professional with no prior knowledge of the disabled person. Additionally, the consulting exam doctor is often motivated to provide opinions that disfavor approval. These doctors often do not have their own practices and are dependent on the Social Security Administration sending business their way. Thus, their opinions tend to find that disabled persons can perform work, are exaggerating their symptoms, or are otherwise not disabled. The disabled person's own treating doctor, meanwhile, usually has months if not years of experience working with the disabled person. The doctor knows her patient's disability and how it affects her ability to perform tasks. The treating doctor also almost always has a steady medical practice with hundreds of patients and is not dependent upon keeping the Social Security Administration happy when they write opinions.

The Social Security Administration, under the old rules, recognized that the treating doctor was in a better position to know her disabled patient's medical condition, symptoms, and limitations than a hired doctor who examined the disabled person for 15 minutes or less. Thus, a judge had to give the treating doctor's opinion more weight than the consulting doctor's opinion. Under the new rule, that deference is gone, and the treating doctor's opinion is not afforded any extra weight. Given that consulting exam doctors almost never find that an applicant's condition is disabling, this rule change will make it harder for disabled persons to obtain disability benefits.

Medical impairments must be established by "objective" medical evidence.

Before a disability applicant can obtain disability, she must establish that she has a medically determinable impairment (MDI). Under the old rules, this medical evidence could include an applicant's subjective claims of symptoms. For example, a disability applicant who has chronic migraine headaches and has repeatedly told her physician of the headaches and how painful and debilitating the headaches are, and the doctor has prescribed treatment for her, could demonstrate her medical impairment of migraine headaches.

Under the new rule, a disability applicant must have objective findings to prove her condition. The Social Security Administration defines these types of objective evidence as "signs, laboratory findings, or both". The new rule states that the Social Security Administration "cannot establish an MDI (medically determinable impairment) based on symptoms, a diagnosis, or medical opinion" alone.

Some disability claimants will not be affected by this new rule. For example, those disabled persons with cancer, COPD, lupus, chronic arthritis, and other medical conditions which are verifiable with laboratory testing, x-rays, or demonstrate physical signs of the condition, should have no problem documenting their disabling condition. However, for other disability applicants, those suffering from migraine headaches or fibromyalgia for example, proving their case will now be harder.

For mental disorders, which are almost never observable through laboratory or x-ray testing, the rule appears to tighten the requirements for proving a medical condition. The rule states that "signs must be shown by medically acceptable clinical diagnostic techniques" which can be "medically described and evaluated". Therefore, a schizophrenic applicant who demonstrates paranoid delusions in front of his therapist will likely have evidence of his impairment. Meanwhile, a depressed disability applicant who does not demonstrate depression while in the doctor's office but describes her symptoms may have difficulty meeting the requirements of this new rule.

Disability Decisions by other agencies are not evidence.

A third change in the rules involves how the Social Security Administration considers decisions of disability from other agencies. For example, under the old rule, if an applicant were deemed disabled by North Carolina's Medicaid program and entitled to Medicaid, the Administration had to consider North Carolina's decision as evidence in the applicant's favor. Decisions regarding disability by the Veterans Administration were also considered by the Administration.

Under the new rule, the Social Security Administration does not consider another agency's disability determination as evidence. Even though these other agencies use similar, if not identical, analysis in determining a disability case, the Social Security Administration rules now say that these prior disability determinations are not evidence. However, disability attorneys are hopeful that the Fourth Circuit Court of Appeals will require the consideration of at least Veteran's Administration decisions, as the test for disability is almost identical to the test used by the Social Security Administration.

In summary, for disabled persons who applied before March 27, 2017, these changes will have no effect. However, for disabled persons applying after this date, the new rules to the Social Security Administration's evaluation of disability cases will likely result in fewer approvals.  For more information about the changes, visit https://www.ssa.gov/disability/professionals/bluebook/revisions-rules.html.  

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