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August, 2017: Sharon’s Maine Social Security Fully Favorable Decision out of Lawrence, MA ODAR

Sharon’s favorable decision out of the Rockland, Maine Social Security District Office and the Lawrence, MA Office of Disability Adjudication and Review provides a good example as to how having Maine Social Security lawyer involved in your case can ultimately make all of the difference in your claim. It’s not only important to have a Social Security lawyer involved as soon as possible from the standpoint that they will be aware of the particular rules and regulations that might be applied to your particular case, but they will have an inside knowledge of the workings so as to ensure that proper consideration is being given to your case.

Sharon is in her mid-fifties and was noted to have a consistent work history that included work as a cafeteria worker, cleaner, clerk for UPS, home health care provider and as a prep cook in a restaurant. Certainly, Sharon was not afraid of hard work, and had been pushing herself for a great many years to keep working given the number of medical problems she had been experience. She was having problems with her hips, knees, shoulders, hands, back and chest (in terms of pain), along with issues of fatigue, breathlessness, anxiety and depression. However, when applying for disability, it is important to understand that the Social Security Administration must first determine that you are suffering from a medically determinable impairment (MDI) that is severe, before they can consider the symptoms that go along with that impairment.

The problem with Sharon’s case is that she was suffering from a great deal of pain that was being addressed as chronic pain syndrome and Fibromyalgia. Proving that one suffers from these conditions is not easy, and the Social Security Administration has adopted rules for addressing how pain should be considered as part of their sequential process and, in addition, how conditions such as Fibromyalgia should be evaluated. See Social Security Ruling 16-3P (evaluation of symptoms in disability claims) and Social Security Ruling 12-2 (Evaluation of Fibromyalgia). These are rather complex rules that address the types of evidence that will be considered, and having knowledge of these rules assists Social Security disability lawyers in establishing one’s case.

However, as Sharon’s case made clear, things don’t always go as planned. By being able to look into her electronic file, we were able to see that at one point in time the agency had recommended a favorable decision, only for the case to be picked up by Boston Quality Review (that many times will pick up recommended favorable determinations to check and see whether there is agreement with the recommended disposition) and then turned back to Augusta, Maine Disability Determination Services with instructions that ultimately led to the denial of her claim. However, findings contained in the initial decision did serve as a good basis for arguing at hearing that indeed the Agency had the correct decision when they did initially evaluate the case.

That being said, at the reconsideration level, we were able to provide additional evidence from her treatment providers in the form of medical questionnaires from her physiatrist, psychiatrist and primary care provider. What became apparently, however, is that while the state agency had these files at the time of the reconsideration decision, they did not provide them with any consideration whatsoever.

At the hearing level, the Administrative Law Judge was able to see how this additional documentation should have caused a much different determination at the reconsideration level (especially in light of the fact that an earlier recommendation, without these helpful questionnaires present), had caused the Agency to recommend initially a favorable decision.

Needless to say, Sharon is resting much easier after what was a very lengthy appeals process for her. If you or someone you love has been pursuing a Social Security disability claim that is simply being overlooked by the SSA, ensure they have competent legal representation with a lawyer that has been handling matters for many years. Contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 for an expert opinion as what to do next. Perhaps we can help turn things around for you as with Sharon’s case.