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April, 2017: Hillary’s Social Security Claim out of East Falmouth, MA SSA DO and Boston, MA ODAR

Hillary’s claim is a very unusual example as to how winning one’s Social Security disability claim at the hearing level even without the assistance of a MA Social Security Lawyer doesn’t necessary mean the end of the story and payment of benefits. In the small print in every favorable decision, whether you have undergone a Hearing before an Administrative Law Judge (ALJ) in Maine, Massachusetts or New Hampshire, is language that the Appeals Council has a right to pick up and review any claim on its own (favorable or unfavorable). In Hillary’s case, this is exactly what happened notwithstanding the ALJ’s favorable decision following hearing. And so Hillary, faced with the prospect of having her case returned to the ALJ for a rehearing before him, opted to hire our office to assist her with presenting her claim once again to the judge.

Hillary had initially filed her disability insurance benefit claim 2 years prior out of East Falmouth, MA Social Security disability claims office and, upon denial, did request reconsideration of her claim on her own. She was subsequently denied on reconsideration and undertook a request for hearing on her own, which caused her claim to be transferred to the Boston, MA Office of Disability Adjudication and Review. Unfortunately, without the benefit of a Social Security attorney, it was unclear to Hillary what additional evidence she needed to present at hearing. She had been suffering from a number of serious illnesses, including PTSD, migraines, Irritable Bowel Syndrome, Anxiety and Depression. When she finally did appear at hearing, it remained unclear to Hillary that the hearing office was in fact missing substantial medical documentation from her specialists for these conditions (and this is something that was probably not even apparent to the presiding ALJ at the time of hearing). What became clear to our office from a review of the file at the hearing level is that all of the treating psychiatrist’s treatment records were missing, as were the counseling records for 6 years, and the treating neurologist’s treatment records for the 6 months leading up to the hearing. While the hearing office does have an obligation to develop the hearing record, it would appear that they had failed to do so (and, obviously, there was no attorney on board to ensure the record was complete for the judge).

Likewise, the ALJ was presented with letters from her specialists (neurologist, counselor and psychiatrist) that meant to address the severity of her conditions and the extent to which she was disabled from work. However, the Social Security regulations at 20 C.F.R. §404.1512(b)(viii) provides that the hearing judge may not consider as evidence any statements from her physicians or from those physicians consulted by SSA any statements as to “the ultimate determination about whether or not you are disabled…” Thus, the letters that had been provided could not be taken into account by the ALJ in coming to his favorable determination.

At the time we initiated our involvement, Hillary was less than two (2) months away from the rehearing of her claim. In that time, we were able to review her file and determine the extent to which medical records were missing, retrieve those additional records from the providers and obtain appropriate questionnaires from her treatment specialists that spelled out the extent to which her conditions were impacting her ability to undertake functions necessary for a work environment (that is to say, reflected her residual functional capacity), both from a mental health and a physical standpoint. Upon receipt of the additional evidence, all appropriate to be considered, we were able to argue to the ALJ successfully that armed with a complete medical record at that time and appropriate statements from her providers as to how impaired she had become as a result of her condition (which opinions were in turn corroborated by the missing treatment records) that a fully favorable decision was indeed warranted.

We were in this way able to avoid not only a need for a rescheduling of Hillary’s hearing dated (even though our involvement was only 2 months away) but also a need for Hillary to show up to hearing at all. The ALJ saw fit to provide Hillary with a fully favorable decision without the need for her to reappear in front of him.

Hillary’s case is a good example of how having an attorney up front, prior to going to hearing, can avoid potential delays and headaches (and, in many circumstances, assist you in obtaining the benefits you need and deserve sooner rather than later).

If you or someone you love is feeling frustrated and alone, struggling through the Social security disability process, contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 to see how we can assist you with this process.