Category Archives: Social Security SSD/SSI

What are the best doctor opinions for purposes of getting social security disability?

SSR Rulings on Doctor’s Opinions:

The Social Security Administration periodically issues “Social Security Rulings.” A Social Security Ruling (“SSR”) is essentially a modification of the Social Security Administration’s policies and procedures, and although an SSR does not have the same effect as a law, all parts of the Social Security Administration must comply with its terms.

For instance, on August 9, 2006, the Social Security Administration issued SSR 06-03p, the stated purpose of which was “[t]o clarify how [the Social Security Administration] consider[s] opinions from sources who are not ‘acceptable medical sources’ and how [the Social Security Administration] consider[s] decisions by other governmental and nongovernmental agencies on the issue of disability or blindness.”SSR 06-03p discusses the types of evidence that the Social Security Administration evaluates to make a disability determination. This evidence “includes, but is not limited to, objective medical evidence; other evidence from medical sources, including their opinions; statements by [an applicant for disability benefits] and others about the impairment(s) and how it affects the [applicant’s] functioning; information from other ‘non-medical sources’ and decisions by other governmental and nongovernmental agencies about whether an [applicant]is disabled or blind.”

According to the ruling, “acceptable medical sources” include licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists. Sources other than “acceptable medical sources” include nurse practitioners, physician assistants,licensed clinical social workers, naturopaths, chiropractors, audiologists, therapists, educational personnel, social welfare agency personnel, and friends, family and associates of an applicant for disability benefits.The significance of the distinction between “acceptable medical sources” and other sources is that the Social Security Administration will consider only evidence providedby an acceptable medical source for purposes of establishing “the existence of a medically determinable impairment.” Among other things, this means that a medical opinion from an acceptable medical source can lead directly to a determination about whether or not an applicant for disability benefits has a qualifying disability.Although opinions from other sources might not have as much influence on an official disability determination, the evidence from other sources can be important. These opinions provide the Social Security Administration with evidence regarding the severity of an applicant’s disability, along with the extent of an applicant’s ability to function despite the disability.

If you believe that you are eligible to receive Social Security disability benefits, or if you have been denied and want to appeal, then any evidence you have from sources other than “acceptable medical sources” can be important. Talk to an attorney who focuses on Social Security disability law if you have questions about establishing your entitlement to disability benefits.  Call today 1-800-596-1533  for a free consultation.

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What are Social Security acquiescence rulings?

What are Social Security acquiescence rulings?

Recently a bankruptcy attorney working at the Nicholson Law Center mentioned that she had been searching the internet for information about Social Security and had found an “acquiescence ruling.” Although the term “acquiesence ruling” is unfamiliar to many (if not most) Social Security recipients, they can sometimes have a significant impact on the process of applying for (and being approved or denied for) Social Security benefits. The following hypothetical example illustrates what an acquiescence ruling is, and the effect that a ruling could have on the policies and procedures of the Social Security Administration.

Imagine that Augustus “Gus” Hand is 45 years old and has worked continuously for the last 10 years at an auto parts factory near Dayton, Ohio. Gus has multiple sclerosis, and until recently, he had managed his condition and remained able to work as the result of certain therapies prescribed by his doctors. Over the last several months, Gus’s condition has grown worse and forced him to stop working.

Because Gus cannot return to his factory job, and because he is now physically unable to take any other gainful employment, Gus decides to apply for Social Security Disability Insurance (“SSDI”) benefits. In order to qualify for SSDI benefits, Gus must establish: (1) that he has been employed for at least five of the last ten years; (2) that he has paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) that he is “disabled” as the Social Security Administration defines it. According to the applicable definition, Gus would be disabled if he is unable do the work that he used to do; if he is unable to adjust to other work as the result of his medical condition; and if his medical condition has lasted for a minimum of one year (or is expected to last for a minimum of one year).

Based on the Social Security Administration’s guidelines, Gus qualifies for SSDI because: (1) he was employed for all 10 of the last 10 years; (2) he was a full-time, regular employee, meaning that FICA taxes were automatically deducted from every paycheck he received; and (3) his medical condition qualifies as a disability under the rules of the Social Security Administration. Gus submits his application for SSDI benefits. He researched eligibility for SSDI before completing the application, so he fully expects that he will be approved to receive benefits.

Much to Gus’s surprise, however, his application is denied. Gus has the right to appeal the denial, however. Gus hires an attorney who focuses on Social Security law to represent him throughout the appeal process.

In Ohio, the first step in the SSDI appeal process is a review by the Bureau of Disability Determinations (“BDD”). BDD analyzes the medical documentation that Gus provided with his application and, in this case, instructs Gus to have an independent physical examination. In Gus’s case, BDD decides that the initial denial was correct. Gus decides to proceed with the next step, the “Reconsideration”.

In the second step, Gus and his attorney appear at a hearing before an administrative law judge. The administrative law judge is an employee of the Social Security Administration with detailed knowledge of the applicable laws and regulations. Gus’s attorney argues his case before the judge, explaining that Gus is entitled to receive SSDI benefits under the official guidelines. A representative of the Social Security Administration also appears at the hearing to argue in favor of BDD’s decision. As happens in many cases, the administrative law judge upholds the determination of BDD and denies Gus’s claim for benefits. Gus refuses to give up, however, and continues his appeal to the next step.

In the third step, Gus’s attorney submits a legal brief on Gus’s behalf to the Social Security Appeal Council. Likewise, the Social Security Administration submits a brief in support of the administrative law judge’s decision. The Appeal Council reviews the briefs submitted by both sides and issues an opinion upholding the administrative law judge’s decision.

At this point, Gus can accept the Appeal Council’s decision, or he can appeal to the U.S. District Court for the Southern District of Ohio, which is the federal trial court responsible for hearing cases in the part of Ohio where Gus lives. Gus decides to take his case to court.

In the U.S. District Court, Gus’s attorney argues Gus’s case to a federal judge. The attorney explains that the Social Security Administration’s own rules, along with applicable federal laws and regulations, indicate that Gus is entitled to SSDI benefits. A lawyer for the Social Security Administration also presents his case to the judge, arguing that the Appeal Council reached the correct decision. The federal judge rules in favor of the Social Security Administration, so Gus appeals his case to the U.S. Court of Appeals for the Sixth Circuit, which is the federal appeals court responsible for reviewing the decisions of a group of federal courts that includes the U.S. District Court for the Southern District of Ohio.

The proceedings in the Sixth Circuit Court of Appeals are similar to those in the District Court, except that a panel of three judges hears the arguments and issues a decision. Finally, Gus prevails, and the Sixth Circuit issues a decision stating that Gus is entitled to receive SSDI benefits. In its decision, the Sixth Circuit also makes a modification to one of the guidelines applicable to BDD’s evaluation of claims for SSDI benefits.

As the result of the outcome of Gus’s case before the Sixth Circuit Court of Appeals, the Social Security Administration sends instructions to BDD that explain what BDD must do in order to comply with the Sixth Circuit’s decision. Basically, these instructions are an “acquiescence ruling.”

Of course, very few SSDI appeals last as long as the example. Most applications for SSDI benefits are denied, and BDD only rarely overturns an initial denial. As a result, many appeals reach an administrative law judge. If your application for SSDI benefits has been denied and you want to exercise your legal right to appeal that denial, then talk with an attorney, like John T. Nicholson, who practices Social Security law.

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Does my income affect my child’s ability to qualify for Social Security Benefits?

How much income can parents have before their children no longer qualify for Supplemental Security Income benefits?

Disabled children can qualify for benefits under the Supplemental Security Income (“SSI”) program, which is administered by the Social Security Administration, depending: (1) on the nature of their disabilities; (2) on how much income they have (if any); and (3) on their available resources. Children’s “available resources” include the income (and assets) of their parents and guardians. Therefore, many parents and guardians of disabled children wonder how much income they can have before their children no longer qualify for SSI benefits.

The Social Security Administration (“SSA”) defines a child as someone who is not married; is not head of a household; and is under age 18, or is under age 22 and regularly attending school. This discussion only applies to SSI benefits for disabled children, as the SSA defines the terms “disabled” and “children.”

1. Nature of disability. According to the definition established by the applicable laws and regulations, a child is “disabled” if the child “has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” In other words, a child is disabled for purposes of SSI benefits if the child has a very serious medical condition that will last (or has lasted) for at least one year. For example, a child who suffers from cystic fibrosis could qualify for SSI benefits. A child with a minor broken leg, but who did not otherwise have a serious medical condition, would probably not qualify.

2. Child’s income (if any). In terms of a child’s income, a child may not earn more than $1,000.00 per month from employment and still qualify to receive SSI benefits (in 2011; the limit on a child’s total monthly income changes every year). On the other hand, a child who is unemployed, or who is employed but earns less than $1,000.00 per month (in 2011), would meet the income limit.

3. Income and resources (i.e. assets) of parents or guardians. The determination of a child’s eligibility to receive SSI benefits also takes into account

Income, in this context, comes in two varieties: “earned income” and “unearned income.” Earned income consists of “wages from employment, net earnings from self-employment, certain royalties and honoraria, and sheltered workshop payments.” Unearned income consists of money received from other sources, “such as Social Security benefits, pensions, state disability payments, unemployment benefits, interest income, and cash from friends and relatives.” Some income is exempt and does not count toward the applicable limits. The following chart illustrates the income limits currently applicable in many (but not all) circumstances.

Number of Ineligible Children in Household

All Income is Earned

All Income is Unearned

One Parent in Household

Two Parents in Household

One Parent in Household

Two Parents in Household

0

$2,821

$3,495

$1,388

$1,725

1

$3,158

$3,832

$1,725

$2,062

2

$3,495

$4,169

$2,062

$2,399

3

$3,832

$4,506

$2,399

$2,736

4

$4,169

$4,843

$2,736

$3,073

5

$4,506

$5,180

$3,073

$3,410

6

$4,843

%5,517

$3,410

$3,747

By “resources,” the SSA essentially means property. For instance, resources include bank accounts, cash, life insurance, real estate, stocks, U.S. savings bonds, vehicles and other property belonging to a child’s parents or guardians that could be exchanged for cash and used for food or shelter. Some resources, such as a home, household goods and personal effects, and money in pension funds, are exempt and do not count toward the applicable limits. Currently, the applicable resource limit (for non-exempt resources) is $2,000 for a single parent or guardian, and $3,000.00 for a couple.

To summarize: A disabled child’s eligibility for SSI benefits depends upon the nature of the child’s disability, the amount of income that the child earns (if any), and the income and resources available to the child—including resources available through parents and guardians. Regarding the resources of parents and guardians, the limits vary from case to case depending on the circumstances. The income limits listed in the foregoing chart, and the resource limits discussed above, might or might not apply in a specific situation because of the many rules and regulations, as well as exemptions, that govern SSI eligibility for disabled children. If you are the parent or guardian of a disabled child and would like to learn more about SSI eligibility, then talk with a lawyer with experience dealing with Social Security issues.

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My child has autism, can she draw social security disabled child benefits?

Can a child with autism receive Social Security disability benefits?

The parents of an autistic child recently asked me whether their child could be eligible to receive Social Security disability benefits. Generally, autism qualifies as a disability for Social Security purposes. Whether a specific child qualifies, however, depends upon the severity of the child’s condition.

The Social Security Administration’s definition of the term “disability,” for children under age 18, is “a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.” Autism, or “Autistic Disorder” as it is called by the Social Security Administration (“SSA”), appears on the SSA’s Listing of Impairments. As the SSA puts it, the Listing of Impairments “describes, for each major body system, impairments considered severe enough” to satisfy the SSA’s definition of the term “disability.”

Listing 112.10 is “Autistic Disorder and Other Pervasive Developmental Disorders,” which are described as “[c]haracterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity.” According to this entry in the Listing of Impairments, the “required level of severity” for an autistic child to qualify for disability benefits is met when the child exhibits: (a) qualitative deficits in the development of reciprocal social interaction; (b) qualitative deficits in verbal and nonverbal communication and in imaginative activity; (c) a markedly restricted repertoire of activities and interests; and (d) for “older infants and toddlers (age 1 to attainment of age 3), resulting in at least one of the appropriate age-group criteria in paragraph B1” of Listing 112.02; “or, for children (age 3 to attainment of age 18), resulting in at least two of the appropriate age-group criteria in paragraph B2 of” Listing 112.02.

The SSA applies a five-step disability analysis to make the determination of whether someone is officially disabled. Although autism appears on the Listing of Impairments, the SSA will still require that documentation be submitted as part of an application for disability benefits. Additionally, the SSA may require that an applicant receive an independent medical examination.

Parents of autistic children can encounter problems applying for Social Security disability benefits on behalf of their children, even though autism appears on the Listing of Impairments. In some cases, the SSA denies such applications. If you are the parent or guardian of an autistic child and have questions, or if the SSA has denied an application for benefits on behalf of your child, then you should talk with an attorney who focuses on Social Security disability issues.  Contact the Law Offices of John T. Nicholson today to schedule free consultation.

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