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Disability Law News - September 2011


Articles in this Issue

ALJ Rules on 12.05C
September 30, 2011
In another case involving listing 12.05C, “Buffalo Bruce” Caulfield of Neighborhood Legal Services convinced an ALJ to order IQ testing before the hearing. Bruce’s client had already undergone a consultative examination, at which he was inexplicably given a TONI (Test of Nonverbal Intelligence), on which he scored an IQ of 76. Read More

Appeals Council Reverses ALJ Findings
September 30, 2011
Ellen Rita Heidrick of the Southern Tier Legal Services division of LAW-NY is celebrating her first fully favorable decision from the Appeals Council. Ellen’s client’s SSI benefits had been terminated following an age 18 review. Ellen argued at the ALJ hearing and to the Appeals Council that her client met listing 12.05C.  Read More

Benefits Awarded in Selective Mutism Case
September 30, 2011
In an unusual childhood SSI case, an ALJ recently awarded benefits based on listing 112.07 Somatoform, Eating and Tic Disorders. The ALJ found medically documented proof under Section 3.b. of that listing of “persistent nonorganic disturbance” of speech in the case of a young girl who refused to speak. Read More

HIV Listing Claim Prevails at Appeals Council
September 30, 2011
Buffalo Bruce Caulfield of Neighborhood Legal Services reports a significant victory at the Appeals Council. The Appeals Council found that his client met listing 14.08K. It relied on clear medical evidence demonstrating the claimant’s low CD-4 counts and other symptoms that the ALJ had blatantly ignored. Read More

Appeals Council Notices Misdated
September 30, 2011
Appeals Council notices – both remand and denial notices – dated July 29, 2011 through August 10, 2011, were issued erroneously. Per Patricia Jonas, Executive Director, Office of Appellate Operations, a coding error at Central Printing resulted in these notices being rejected and resent at a later date.  Read More

Online Access Available at Appeals Council
September 30, 2011
Online access to eFolders is now available for cases at the Appeals Council level, as well as the Administrative Law Judge (ALJ) level. That means that an advocate who is enrolled for online access will be able to review Appeals Council exhibit files on SSA’s secure website in cases if an Appointment of Representative (1696) is on file. Read More

Artificially Conceived Child Not a Child for SSA
September 30, 2011
In March 2011, we reported on a January 2011 decision from the Third Circuit holding that twins born by artificial insemination after the death of their biological father were entitled to Social Security survivors’ benefits on his account. Read More

Federal Court Finds Disability, Reverses, and Orders Payment
September 30, 2011
According to 2010 data from the Social Security Administration (SSA), only 4% of cases in federal district court are reversed for payment of benefits. Getting an order of reversal, therefore, is understandably cause for joy and jubilation for plaintiff’s counsel. A recent case from the N.D.N.Y. that was reversed for payment probably made Chris Cadin of Legal Services of Central New York one such very happy fellow. Read More

Medicaid Managed Care Drug Coverage Changes Loom
September 30, 2011
Beginning in October, Medicaid managed care recipients, as well as individuals getting Family Health Plus, will get their prescription drugs through their managed care plan, rather than through fee-for-service Medicaid.  This change affects approximately 3 million Medicaid and FHP recipients across New York State and may make it more difficult for your DAP clients to access their prescription drugs. Read More

What Is...Migraine Related Nausea
September 30, 2011
Many people with migraines also experience stomach problems and nausea with their headaches. In fact, migraines are the type of headache most likely to make patients nauseated. Eight out of every 10 people in the U.S. who are diagnosed with migraines report experiencing nausea. Although millions of people suffer from migraines with nausea, scientists have not yet been able to determine exactly why. Read More

TRAC Analyses of SSA Data Generate Controversy
September 30, 2011
According to an analysis conducted by TRAC (Transitional Access Records Clearinghouse), despite the SSA’s long standing goal of reducing the number of pending disability cases, very recent SSA data show that these matters continue to head in the opposite direction and climbed to 746,712 at the end of June. Read More

Hearing Listing To Be Revised?
September 30, 2011
The Social Security Administration is soliciting comments on the medical criteria used to determine when hearing loss is disabling. Although no new regulations have been proposed, SSA is apparently considering changes as part of its “ongoing effort to ensure that our criteria are effective and reflect the latest advances in medicine.” Read More

How Much is That Doggy in the Window?
September 30, 2011
SSA has updated POMS SI 01130.430 to clarify that it does not count animals or pets as resources when deciding a claimant’s eligibility for SSI. Just so you know, pets can include cats, dogs, hamsters, horses, monkeys, or snakes. Read More

New POMS Govern Collection of VA Evidence
September 30, 2011
SSA has “completely” revised POMS DI 22505.022 - Developing Medical Evidence of Record (MER) from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Medical Facilities - to reflect VA and SSA electronic business processes. According to SSA’s announcement of the revisions, the “new procedures are mandatory and reflect the VA commitment to respond to SSA and Disability Determination Services medical evidence requests in a timely, accurate, secure, and complete manner.” Read More

Regulations Allow SSA to Ban Individuals
September 30, 2011
SSA published regulations effective September 2, 2011, which allows it to ban certain individuals from entering its offices. Citing the rising number of threats of violence against SSA personnel, SSA promulgated a final rule permitting the banning of any individual who (1) uses force or threats of force against SSA personnel or offices, including sending threatening letters or other communications; (2) engages in disruptive conduct that impedes SSA personnel from performing their duties; or (3) engages in disruptive behavior that prevents members of the public from obtaining services. Read More

Social Security Ruling Affects New Applications
September 30, 2011
Social Security Ruling (SSR) 11-1p, issued and effective on July 28, 2011, precludes the filing of a subsequent application for benefits while an appeal is pending. This SSR revokes the rules that the Social Security Administration (SSA) had issued more than ten years ago, allowing a new application to proceed to the hearing level while a prior application was pending at the Appeals Council. Read More

SSA Adds Cardiac Conditions to Compassionate List
September 30, 2011
In July 2011, SSA announced 12 additional Compassionate Allowances conditions involving severe heart diseases, bringing the total number of conditions in the expedited disability process to 100. Read More

SSA Embraces the Electronic Age
September 30, 2011
Whether it is eliminating completion of paper forms, or directing advocates to use electronic access to client information or to get direct payment, SSA is taking a very 21st century approach to the wonders of technology. Read More

SSA Issues New POMS on PRW
September 30, 2011
Past relevant work is a hot topic at SSA. In addition to the proposed regulations discussed on page 6, SSA has issued new POMS covering a host of issues regarding Step four (Past Relevant Work - PRW) determinations. Read More

SSA Proposed Skipping Step 4 in Denial Cases
September 30, 2011
Under the sequential evaluation process that SSA employs in determining disability, evidence of past relevant work (PRW) is necessary at step 4 of the analysis. Only if a claimant is unable to return to PRW may SSA go on to make a step 5 determination of disability using either the grid rules or vocational expert testimony. Read More

OTDA Issues Interim Assistance INF
September 30, 2011
On September 15, OTDA/CEES (Office of Temporary Disability Assistance/Center for Employment and Economic Supports) issued 11 INF-10: “Electronic Interim Assistance Reimbursement (eIAR) Implementation Questions and Answers.” This INF contains OTDA’s “most recent set of questions and answers pertaining to the Electronic Interim Assistance Reimbursement (e-IAR) process.” Read More

End Note - September 2011
Are You Suffering from PVS?
September 30, 2011
Labor Day has come and gone, the summer is officially over and everything seems to be back in full-swing again. For some, the beginning of Fall is an invigorating time. Read More

LS-NYC Plans DAP Trainings
September 30, 2011
Legal Services NYC (LS-NYC) is sponsoring a three-day festival of DAP continuing legal education programs on October 25th, 26th, and 27th. All events will be held at LS-NYC’s central office, which is now located at 40 Worth Street, 6th Floor, New York, New York 10013. Read More

Web News - September 2011
September 30, 2011
Searching Social Security Regulations, Law and Cases Just Got Easier; GAO Study Examines Work-Related Overpayments; Website Allows National Search for Quality MDs and Hospitals; Health Care Needs for Young Adults Explored; New Diagnostic Criteria for Fibromyalgia Approved. Read More

Young Adult SSR Issued
September 30, 2011
On September 12, 2011, the Social Security Administration (SSA) published another significant Social Security Ruling: SSR 11-2p, entitled “Documenting and Evaluating Disability in Young Adults.” Read More

Bulletin Board
July 16, 2013
Astrue v. Capato; Barnhart v. Thomas; Genier v. Astrue Read More

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