January, 2011: Application of Social Security’s Grid Rules

Denise's successful claim (which has been a long time coming: that is, 5 years) is a classic example of how the Grid rules can make a difference in the analysis undertaken by the Administrative Law Judge presiding over the case. Denise initially filed in 2005 and, following initial and reconsideration denials, went for a hearing at the Boston, Massachusetts Office of Disability Adjudication and Review in 2007. Denise was denied at the hearing level despite very telling residual functional capacity questionnaires that were undertaken by her primary care physician as well as her rheumatologist. At the time of hearing, the vocational expert provided very questionable testimony concerning what jobs would be available for Denise given the hypothetical residual functional capacity presented by the judge. The presiding ALJ used this testimony as the basis for providing an unfavorable decision. Subsequent to the unfavorable decision, I filed an appeal (and appeals brief) to the Appeals Council in Virginia appealing the judge's unfavorable decision. Unfortunately, the Appeals Council process has been taking more than 2 years on average to make a decision (and in Denise's circumstances, the Appeals Council took this long to agree with my arguments and return the case to the judge: it then took an additional year for the judge to reschedule the matter for additional hearing). Upon review of my arguments, the Appeals Council was in agreement that the vocational expert's testimony raised concerns which required the administrative law judge to undertake further analysis of Denise's claim. Needless to say, Denise had become quite frustrated at both her condition and with the administrative review process and was very wary about going back in front of this judge. Fortunately, Denise agreed to hang in there and go to an additional hearing. I explained to Denise that a few additional factors would now work in her favor: first, she had turned 55 years old just after the judge's unfavorable decision (meaning that she would now be evaluated under the Grid Rules as being of advanced age). The other favorable condition working for Denise would be the fact that she had a limited education and had not graduated high school. Unknown to the judge and to me at the time of the prior hearing, she had indicated that she was a high school graduate when in fact she had dropped out in the 10th grade given she was embarrassed to admit that she had not graduated high school. These additional factors were presented to the presiding judge in a pre-hearing brief and, as a result, the judge called me in for a pre-hearing meeting and notified me that he was in agreement with my brief: that is to say, he was willing to find that based on the additional evidence provided at least a partially favorable decision was warranted, finding Denise disabled (pursuant to the Grid rules) as of her 55th birthday. Denise chose to accept the ALJ's offer of a partially favorable decision, which served to provide her with three (3) years of back benefits and an ongoing check. Denise walked away that day very happy that she stayed the course.