DISSOCIATIVE DISORDERS AND SOCIAL SECURITY DISABILITY BENEFITS PAM

DISSOCIATIVE DISORDERS AND SOCIAL SECURITY DISABILITY BENEFITS PAM NOBLITT, EDPNA RANDY NOBLITT, PHD

AN OVERVIEW OF SOCIAL SECURITY DISABILITY PROGRAMS • SOCIAL SECURITY DISABILITY INSURANCE (SSDI) PROVIDES THE FOLLOWING BENEFITS: • MONTHLY INCOME BASED ON A COMPLICATED FORMULA USING THE CLAIMANT’S EARNINGS RECORD FOR THE PRIOR 15 YEARS. • BACK-DUE BENEFITS BASED ON THE MONTHLY PAYMENT THE CLAIMANT WOULD HAVE RECEIVED HAD BENEFITS BEEN AWARDED AT THE TIME OF APPLICATION. • MEDICARE ELIGIBILITY 29 MONTHS FROM THE CLAIMANT’S ALLEGED ONSET DATE. SSDI BENEFICIARIES RECEIVE MEDICARE PART A (HOSPITALIZATION) AT NO COST BUT MEDICARE PARTS B (PROVIDER) AND D (PRESCRIPTIONS) HAS A PREMIUM DEDUCTED MONTHLY FROM THE SSDI PAYMENT.

AN OVERVIEW OF SOCIAL SECURITY DISABILITY PROGRAMS • SUPPLEMENTAL SECURITY INCOME PROVIDES THE FOLLOWING BENEFITS: • MONTHLY INCOME BASED ON THE FEDERAL BENEFIT RATE (FBR) FOR 2020 OF $783 FOR AN ELIGIBLE INDIVIDUAL AND $1, 175 FOR A COUPLE. • BACK-DUE BENEFITS BASED ON THE MONTHLY PAYMENT THE CLAIMANT WOULD HAVE RECEIVED HAD BENEFITS BEEN AWARDED AT THE TIME OF APPLICATION. • MEDICAID (OR STATE’S EQUIVALENT) AVAILABLE IMMEDIATELY UPON APPROVAL OF SSI CLAIM.

AN OVERVIEW OF SOCIAL SECURITY DISABILITY PROGRAMS SSDI CLAIMANTS WHOSE BENEFIT IS VERY LOW MAY ALSO BE ENTITLED TO SSI AND RECEIVE BOTH MEDICARE AND MEDICAID. A PROGRAM, QUALIFIED MEDICARE BENEFICIARY (QMB) MAY BE APPLICABLE. QMB PAYS THE BENEFICIARY’S PREMIUM AND CO -PAYS SO THE CLAIMANT RECEIVES MORE CASH. SSI IS AVAILABLE TO DISABLED CHILDREN AND TO ADULTS OVER THE AGE OF 65.

AN OVERVIEW OF SOCIAL SECURITY DISABILITY PROGRAMS • SOCIAL SECURITY DISABILITY INSURANCE ELIGIBILITY • PAID SOCIAL SECURITY TAXES FOR SUFFICIENT QUARTERS DURING THE PAST 15 YEARS PRIOR TO DISABILITY • NOT ENGAGED IN FULL-TIME COMPETITIVE WORK SINCE ONSET OF DISABLING CONDITION • HAVE SEVERE IMPAIRMENT THAT HAS LASTED OR IS EXPECTED TO LAST 12 MONTHS OR RESULT IN DEATH • PHYSICAL OR MENTAL LIMITATIONS PREVENTING RETURN TO PAST RELEVANT WORK (WORK PERFORMED DURING PROCEEDING 15 YEARS) • LIMITATIONS PREVENTING ANY OTHER WORK IN NATIONAL ECONOMY

AN OVERVIEW OF SOCIAL SECURITY DISABILITY PROGRAMS • SUPPLEMENTAL SECURITY INCOME ELIGIBILITY • NOT ENGAGED IN FULL-TIME COMPETITIVE WORK SINCE ONSET OF DISABLING CONDITION • HAVE SEVERE IMPAIRMENT THAT HAS LASTED OR IS EXPECTED TO LAST 12 MONTHS OR RESULT IN DEATH • PHYSICAL OR MENTAL LIMITATIONS PREVENTING RETURN TO PAST RELEVANT WORK (WORK PERFORMED DURING PROCEEDING 15 YEARS) • LIMITATIONS PREVENTING ANY OTHER WORK IN NATIONAL ECONOMY • MEETING SSI FINANCIAL CRITERIA

WHAT IS DISABILITY ACCORDING TO THE SOCIAL SECURITY ADMINISTRATION? • THE SSA DEFINES DISABILITY AS A MEDICALLY DETERMINABLE PHYSICAL OR MENTAL IMPAIRMENT THAT IS SO SEVERE IT PREVENTS AN INDIVIDUAL FROM ENGAGING IN FULL-TIME WORK IN A COMPETITIVE WORK SETTING AT ANY JOB WITHIN THE NATIONAL ECONOMY AND WHERE PAYMENT FOR SUCH EMPLOYMENT WILL AVERAGE AT LEAST $1260 SUBSTANTIAL GAINFUL ACTIVITY, SGA) FOR NON-BLIND INDIVIDUALS IN 2020. FOR BLIND INDIVIDUALS, THE SGA IS $2, 110.

This definition is foundational in Social Security disability determination. Impairments that significantly limit an individual’s strength, endurance, mobility, intelligence, cognition, concentration, attention, persistence, and pace of performance would affect that person’s ability to perform any work. Furthermore, Social Security’s definition of disability requires that the impairment must have lasted or be expected to last at least 12 months or result in death.

HOW IS DISABILITY DEFINED FOR CHILDREN? • SINCE MOST CHILDREN DO NOT WORK, THE IMPACT OF THEIR SEVERE PHYSICAL OR MENTAL IMPAIRMENTS IS CONSIDERED RELATIVE TO SCHOOL PERFORMANCE AT GRADE OR AGE LEVEL, BEHAVIORAL AND SOCIAL ADAPTATION, AND MEETING DEVELOPMENTAL MILESTONES APPROPRIATELY AND TIMELY.

HOW IS DISABILITY PROVEN? • DOCUMENTARY EVIDENCE • OPINION • TESTIMONY

HOW IS DISABILITY PROVEN? • DOCUMENTARY EVIDENCE • TREATMENT NOTES • OPERATIVE NOTES • DIAGNOSTIC TESTING • SCHOOL RECORDS FOR CHILDREN AND ADULTS WITH INTELLECTUAL CHALLENGES OR LIFELONG BEHAVIORAL, EMOTIONAL, COGNITIVE CHALLENGES.

HOW IS DISABILITY PROVEN? • OPINIONS BY ACCEPTABLE TREATING SOURCES • OPINIONS BY EXAMINING ACCEPTABLE TREATING SOURCES (CONSULTATIVE EXAMINER AND INDEPENDENT OR QUALIFIED MEDICAL EXAMINER) • OPINIONS BY NON-EXAMINING ACCEPTABLE TREATING SOURCES (MEDICAL EXPERT , SOCIAL SECURITY, AND DEPARTMENT OR DISABILITY DETERMINATION)

HOW IS DISABILITY PROVEN? • TESTIMONY OF MEDICAL EXPERT • TESTIMONY OF VOCATIONAL EXPERT • TESTIMONY OF TREATING CLINICIAN • TESTIMONY OF CLAIMANT • TESTIMONY OF 3 RD PARTY

SSDI AND SSI CLAIMS PROCESS • CLAIMANT MAKES INITIAL APPLICATION. RESPONSE RECEIVED IN 60 -90 DAYS. ABOUT 34% OF INITIAL APPLICATIONS RESULT IN AN AWARD. • CLAIMANT APPEALS UNFAVORABLE DECISION FOR RECONSIDERATION. RESPONSE RECEIVED IN 60 -90 DAYS. ABOUT 12% OF RECONSIDERATION APPLICATIONS ARE APPROVED. • CLAIMANT REQUESTS HEARING WITH AN ADMINISTRATIVE LAW JUDGE. HEARING SCHEDULED IN APPROXIMATELY ONE YEAR. RESPONSE RECEIVED IN 60 -90 DAYS. ABOUT 46% OF CLAIMS RESOLVED BY AN ALJ ARE AWARDED. • DISAPPROVED CLAIMS CAN BE APPEALED TO APPEALS COUNCIL, BUT ONLY 12% AWARDED.

FIVE-STEP SEQUENTIAL EVALUATION PROCESS • AT THE FIRST STEP, SOCIAL SECURITY CONSIDERS THE CLAIMANT’S WORK HISTORY, IF ANY. IF THE CLAIMANT IS PERFORMING SUBSTANTIAL GAINFUL ACTIVITY, SOCIAL SECURITY WILL FIND THE CLAIMANT IS NOT DISABLED. • THE MEDICAL SEVERITY OF THE IMPAIRMENT(S) IS THEN CONSIDERED. IF THE IMPAIRMENTS DO NOT CONSTITUTE A SEVERE, MEDICALLY DETERMINABLE PHYSICAL OR MENTAL IMPAIRMENT THAT MEETS THE DURATION REQUIREMENT, OR A COMBINATION OF IMPAIRMENTS THAT IS SEVERE AND MEETS THE DURATION REQUIREMENT, A FINDING OF NOT DISABLED WILL BE MADE.

At the third step, consideration is made regarding the medical severity of the impairment(s) and whether the impairment meets or equals one of the listings of this subpart and meets the duration requirement. If the impairment meets or equals a listing and the duration requirement, a finding of disability will be rendered.

At step 4, the claimant’s residual functional capacity and past relevant work are evaluated. If the claimant can still perform past relevant work, Social Security will find the claimant not disabled.

At the last step, Social Security considers its assessment of the claimant’s residual functional capacity, age, education, and work experience to see if the claimant can reasonably make an adjustment to other work. If the claimant can make an adjustment to other work, Social Security will find the claimant not disabled. If an adjustment to other work cannot be made, Social Security will find the claimant disabled. Evaluation of Disability in General, 20 C. F. R. § 404. 1520.

WHAT IS WORK? • WORK CONSISTS OF COMBINED MENTAL EFFORT (NONEXERTIONAL) AND PHYSICAL ACTIVITY (EXERTIONAL) RESULTING IN AN INTELLECTUAL OR TANGIBLE PRODUCT. ALL WORK IS COMPOSED OF EXERTIONAL AND NON-EXERTIONAL ACTIVITIES.

WHAT IS A COMPETITIVE WORK SETTING? • HAS STRUCTURE THAT WORKERS ARE OBLIGATED TO MAINTAIN WITHIN CUSTOMARY TOLERANCES, • WORKING COOPERATIVELY AND IN COORDINATION WITH COWORKERS. • MEETING QUOTAS AND DEADLINES, • RESPONDING APPROPRIATELY TO SUPERVISORS, COWORKERS AND THE PUBLIC, • PERFORMING WITHOUT SPECIAL ACCOMMODATIONS.

WORKERS ARE EXPECTED TO BE • ABSENT 1 DAY OR LESS PER MONTH CONSISTENTLY, • OFF-TASK LESS THAN 10% OF THE WORKDAY ON A SUSTAINED BASIS, • MAINTAIN CONCENTRATION, ATTENTION, PERSISTENCE AND PACE. THROUGHOUT THE WORKDAY

SOCIAL SECURITY DISABILITY BENEFITS AND DISSOCIATIVE DISORDERS • SOCIAL SECURITY LISTS CATEGORIES OF IMPAIRMENTS FOR ADULTS AND CHILDREN. THESE LISTINGS SPECIFY MEDICAL OR MENTAL CONDITIONS THAT ARE CONSIDERED DISABLING. ALTHOUGH DISSOCIATIVE DISORDERS ARE NOT AMONG THE LISTINGS FOR MENTAL IMPAIRMENTS, OTHER LISTINGS MAY BE CONSISTENT WITH THE PATIENT’S OR CLIENT’S TREATMENT RECORDS.

LISTINGS THAT MAY BE APPROPRIATE FOR DISSOCIATIVE IDENTITY DISORDER • 12. 03 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS • 12. 04 DEPRESSIVE, BIPOLAR AND RELATED DISORDERS • 12. 06 ANXIETY AND OBSESSIVE-COMPULSIVE DISORDERS • 12. 08 PERSONALITY AND IMPULSE CONTROL DISORDERS • 12. 13 EATING DISORDERS • 12. 15 TRAUMA AND STRESSOR-RELATED DISORDERS

DOCUMENTING DISABILITY • DISABILITY IS DETERMINED BASED ON EVIDENCE WHICH INCLUDES: • DIAGNOSIS • SYMPTOMS • TREATMENT • LIMITATIONS • MEETING OF ONE OR MORE OF THE LISTINGS OF IMPAIRMENTS • PROFESSIONAL OPINIONS • CLAIMANT TESTIMONY • THIRD-PARTY TESTIMONY

OBJECTIVE MEDICAL EVIDENCE FROM ACCEPTED MEDICAL SOURCES • MEDICALLY DETERMINABLE IMPAIRMENT • A PHYSICAL OR MENTAL CONDITION DEMONSTRATED BY OBJECTIVE MEDICAL EVIDENCE (SIGNS, LABORATORY FINDINGS, OR BOTH), MEDICAL OPINIONS, OR OTHER MEDICAL EVIDENCE. • HAS LASTED OR IS EXPECTED TO LAST AT LEAST 12 MONTHS OR RESULT IN DEATH.

ACCEPTED MEDICAL SOURCES • LICENSED PHYSICIANS (INCLUDING MD AND DO) • LICENSED OR CERTIFIED PSYCHOLOGISTS AT INDEPENDENT PRACTICE LEVEL (PH. D. AND PSY. D. ) • SCHOOL PSYCHOLOGISTS, OR OTHER LICENSED OR CERTIFIED INDIVIDUALS WITH OTHER TITLES WHO PERFORM THE SAME FUNCTION AS A SCHOOL PSYCHOLOGIST IN A SCHOOL SETTING, ARE AMSS FOR IMPAIRMENTS OF INTELLECTUAL DISABILITY, LEARNING DISABILITIES, AND BORDERLINE INTELLECTUAL FUNCTIONING ONLY.

OTHER ACCEPTED MEDICAL SOURCES • LICENSED OPTOMETRISTS FOR IMPAIRMENTS OF VISUAL DISORDERS, OR MEASUREMENT OF VISUAL ACUITY AND VISUAL FIELDS ONLY, DEPENDING ON THE SCOPE OF PRACTICE IN THE STATE IN WHICH THE OPTOMETRIST PRACTICES. • LICENSED PODIATRISTS FOR IMPAIRMENTS OF THE FOOT, OR FOOT AND ANKLE ONLY, DEPENDING ON WHETHER THE STATE IN WHICH THE PODIATRIST PRACTICES PERMITS THE PRACTICE OF PODIATRY ON THE FOOT ONLY, OR THE FOOT AND ANKLE. • QUALIFIED SPEECH-LANGUAGE PATHOLOGISTS (SLPS) FOR SPEECH OR LANGUAGE IMPAIRMENTS ONLY. FOR THIS SOURCE, “QUALIFIED” MEANS THAT THE SLP MUST BE LICENSED BY THE STATE PROFESSIONAL LICENSING AGENCY, OR BE FULLY CERTIFIED BY THE STATE EDUCATION AGENCY IN THE STATE THAT HE OR SHE PRACTICES, OR HOLD A CERTIFICATE OF CLINICAL COMPETENCE IN SPEECH-LANGUAGE-PATHOLOGY FROM THE AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION.

ACCEPTED MEDICAL SOURCES IN CLAIMS WITH A FILING DATE ON OR AFTER MARCH 27, 2017 • LICENSED PHYSICIAN ASSISTANTS FOR IMPAIRMENTS WITHIN THE LICENSED SCOPE OF PRACTICE ONLY. • LICENSED AUDIOLOGISTS FOR IMPAIRMENTS OF HEARING LOSS, AUDITORY PROCESSING DISORDERS, AND BALANCE DISORDERS WITHIN THE LICENSED SCOPE OF PRACTICE ONLY. NOTE: AUDIOLOGISTS’ SCOPE OF PRACTICE GENERALLY INCLUDES EVALUATION, EXAMINATION, AND TREATMENT OF CERTAIN BALANCE IMPAIRMENTS THAT RESULT FROM THE AUDIO-VESTIBULAR SYSTEM. HOWEVER, SOME IMPAIRMENTS INVOLVING BALANCE INVOLVE SEVERAL DIFFERENT BODY SYSTEMS THAT ARE OUTSIDE THE SCOPE OF PRACTICE FOR AUDIOLOGISTS, SUCH AS THOSE INVOLVING MUSCLES, BONES, JOINTS, VISION, NERVES, HEART AND BLOOD VESSELS.

ACCEPTED MEDICAL SOURCES IN CLAIMS WITH A FILING DATE ON OR AFTER MARCH 27, 2017 • LICENSED AUDIOLOGISTS FOR IMPAIRMENTS OF HEARING LOSS, AUDITORY PROCESSING DISORDERS, AND BALANCE DISORDERS WITHIN THE LICENSED SCOPE OF PRACTICE ONLY. NOTE: AUDIOLOGISTS’ SCOPE OF PRACTICE GENERALLY INCLUDES EVALUATION, EXAMINATION, AND TREATMENT OF CERTAIN BALANCE IMPAIRMENTS THAT RESULT FROM THE AUDIO-VESTIBULAR SYSTEM. HOWEVER, SOME IMPAIRMENTS INVOLVING BALANCE INVOLVE SEVERAL DIFFERENT BODY SYSTEMS THAT ARE OUTSIDE THE SCOPE OF PRACTICE FOR AUDIOLOGISTS, SUCH AS THOSE INVOLVING MUSCLES, BONES, JOINTS, VISION, NERVES, HEART AND BLOOD VESSELS.

ACCEPTED MEDICAL SOURCES IN CLAIMS WITH A FILING DATE ON OR AFTER MARCH 27, 2017 • LICENSED ADVANCED PRACTICE REGISTERED NURSES (APRN), ALSO KNOWN IN SOME STATES AS ADVANCED PRACTICE NURSE (APN), AND ADVANCED REGISTERED NURSE PRACTITIONER (ARNP) FOR IMPAIRMENTS WITHIN HIS OR HER LICENSED SCOPE OF PRACTICE. • THERE ARE FOUR TYPES OF APRNS WITH A HANDFUL OF STATE VARIATIONS: 1. CERTIFIED NURSE MIDWIFE (CNM); 2. NURSE PRACTITIONER (NP); 3. CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA); AND 4. CLINICAL NURSE SPECIALIST (CNS).

CHIROPRACTORS ARE NOT AN ACCEPTABLE MEDICAL SOURCE UNLESS THEY ARE AFFILIATED WITH AND SUPERVISED WITHIN AN ORTHOPEDIC PRACTICE

ONCE A MEDICALLY DETERMINABLE IMPAIRMENT HAS BEEN ESTABLISHED, OTHER MEDICAL AND NON-MEDICAL SOURCES MAY PROVIDE SUBSTANTIATING EVIDENCE OF DISABILITY • A. MEDICAL SOURCES WHO ARE NOT AMSS BUT ARE LEGALLY PERMITTED TO PROVIDE HEALTHCARE, SUCH AS NATUROPATHS, CHIROPRACTORS, AND THERAPISTS; • B. NONMEDICAL SOURCES SUCH AS: • EDUCATIONAL PERSONNEL (FOR EXAMPLE, SCHOOL TEACHERS, COUNSELORS, EARLY INTERVENTION TEAM MEMBERS, DEVELOPMENTAL CENTER WORKERS, AND DAYCARE CENTER WORKERS); • PUBLIC AND PRIVATE SOCIAL WELFARE AGENCY PERSONNEL; AND • RELATIVES (SPOUSES, PARENTS, SIBLINGS, ETC. ), CAREGIVERS, FRIENDS, NEIGHBORS, PAST EMPLOYERS, AND CLERGY.

DOCUMENTING FOR DISABILITY

PROGRESS NOTES AS EVIDENCE OF DISABILITY • SHOULD INCLUDE ALL DIAGNOSES AND PROGNOSES • SYMPTOMS • PRESCRIBED MEDICATIONS AND DOSAGES • LIMITATIONS SECONDARY TO SYMPTOMS AND MEDICATION SIDE-EFFECTS

PROGRESS NOTES AS EVIDENCE OF DISABILITY • SHOULD INCLUDE ALL DIAGNOSES AND PROGNOSES • SYMPTOMS • PRESCRIBED MEDICATIONS AND DOSAGES • LIMITATIONS SECONDARY TO SYMPTOMS AND MEDICATION SIDE-EFFECTS

EXERTIONAL LIMITATIONS REFERS TO MOBILITY AND PHYSICAL STRENGTH SUCH AS THE ABILITY TO SIT, STAND, WALK, BEND, STOOP, KNEEL, CLIMB, CRAWL, LIFT, CARRY, REACH, PUSH, PULL, MANIPULATE, GRIP, GRASP, AND PERFORM GROSS AND/OR FINE MOTOR SKILLS. EXERTIONAL LIMITATIONS MAY BE CONSISTENT WITH THE DIAGNOSIS ITSELF SUCH AS PAIN DUE TO INJURY OR DISEASE OR TO THE EFFECTS OF TREATMENT SUCH AS ADVERSE REACTIONS TO PRESCRIBED MEDICATIONS OR ARTIFACTS OF SURGICAL INTERVENTIONS, CHEMOTHERAPY, OR RADIATION THERAPY.

NON-EXERTIONAL LIMITATIONS • NON-EXERTIONAL LIMITATIONS REFERS TO COGNITIONS: THINKING, CONCENTRATING, REMEMBERING, ATTENDING, AND PERSISTING AND TO THE CAPACITY FOR PERFORMING ACTIVITIES AT A PACE CONSISTENT WITH WORK SCHEDULES, QUOTAS, AND THE PERFORMANCE OF CO-WORKERS. • NON-EXERTIONAL LIMITATIONS ARE ASSOCIATED WITH MENTAL IMPAIRMENTS AS WELL AS FROM NEUROLOGIC OR CARDIOVASCULAR IMPAIRMENTS SUCH AS EPILEPSY OR STROKE AS WELL AS FROM PRESCRIBED MEDICATIONS AND TREATMENTS.

PATHWAYS TO A SUCCESSFUL OUTCOME TO AN SSDI OR SSI CLAIM • CLAIMANT MEETS OR EQUALS ONE OR MORE OF THE LISTINGS OF IMPAIRMENTS • CLAIMANT HAS ONE OR MORE SEVERE IMPAIRMENTS AND MEETS THE GRIDS RULES (LIMITATIONS SECONDARY EDUCATION AND ENGLISH FLUENCY OR CLAIMANT IS APPROACHING ADVANCED AGE OR IS OF ADVANCED AGE AND IT WOULD REPRESENT A MORE THAN MINIMUM ADJUSTMENT TO LEARN NEW WORK) • CLAIMANT HAS ONE OR MORE SEVERE IMPAIRMENTS THAT PREVENT FULLTIME COMPETITIVE WORK, EITHER PAST WORK OR ANY OTHER WORK IN THE NATIONAL ECONOMY WITHOUT MEETING A LISTING

OBSTACLES TO SUCCESSFUL SSDI OR SSI CLAIM • LIMITED OR NO EVIDENCE • LACK OF TREATING CLINICIAN SUPPORT • HISTORY OF DRUG OR ALCOHOL ABUSE/DEPENDENCE • NON-COMPLIANCE WITH MEDICAL ADVICE • MALINGERING • CREDIBILITY • YOUTH

CONTACT THE PRESENTERS • PAMELA PERSKIN NOBLITT, EDPNA ADVOCATESSD@AOL. COM • RANDY NOBLITT, PH. D. RANDYNOBLITT 48@AOL. COM