Justia Lawyer Rating
Massachussets Bar Association
Maine state Bar

May, 2016: Carol’s Fully Favorable Decision at the Lawrence, MA ODAR

Carol’s story is yet another sad story of how someone’s life can be turned around in an instant as a result of unexpected medical circumstances: we are all just one very bad illness or injury away from being unable to work and provide for our families. Carol’s is the story of a hardworking young lady in her mid-forties who has always worked very difficult jobs in the restaurant industry until such time as her severe headaches landed her in the hospital wondering what was happening to her health. What was initially understood as migraines, later became understood as a brain aneurysm that required surgery. And yet, the story didn’t end there for Carol. Just a few months later, new symptoms that involved the loss of her balance, weakness and shakiness of her legs caused Carol to seek treatment with a neurologist and resulted in a diagnosis of a neurological disorder called Multiple Sclerosis.

Carol undertook a Social Security disability application through the Haverhill, Massachusetts Social Security Administration (SSA) just a few months after going out of work failing to understand that she would need to prove that she will remain totally disabled from all forms of gainful employment for a year or longer. She was consequently denied on her initial application. She subsequently filed a request for reconsideration on her own and Disability Determination Services out of Boston, Massachusetts subsequently denied her claim once again. It was at this point that she sought advice and assistance from our office.

Upon filing her Carol’s Request for Hearing, which caused her case to be assigned to the Lawrence, MA Office of Disability Adjudication and Review (ODAR), we began the work of seeking the additional evidence necessary to prove her case. We saw that while her treating neurologist was quite supportive of her claim, he took to writing a letter on his own as to why he felt that Carol was disabled from working. While this effort showed his empathy towards Carol’s circumstances, it actually did not serve to help her case as SSA is required to ignore any conclusions from medical providers that are simply conclusions that someone is disabled under Social Security rules or incapable of working. The Social Security regulations do not allow for doctors to draw such conclusions as they are not deemed specialists in Social Security disability law. Rather, one’s treatment providers should be asked to present evidence in the form of medical opinions as to their objective findings, including that of diagnoses, symptoms, effects of treatment and the manner in which the condition impacts an individual’s ability to undertake activities that may be necessary for a work place (which assessment is many times referred to a residual functional capacity assessment).

Given the state of her file, we went about the process of providing substantial additional medical documentation that provided objective evidence of a severe peripheral neuropathy that was impacting Carol’s ability to walk. We were able to work with Carol and the treating neurologist so as to obtain a more acceptable set of opinions from him that addressed, in a more appropriate manner, what the Social Security rules and regulations call for from doctors in order to prove the nature and severity of one’s medical conditions and the extent to which they may cause a claimant to be "disabled" under Social Security’s rules.

The additional evidence we were able to obtain, along with Carol’s compelling testimony at hearing, served to persuade the Administrative Law Judge (ALJ) conducting the hearing that indeed Carol had remained totally disabled from performing all manner of gainful employment and was indeed deserving of benefits under Social Security’s rules. Needless to say, Carol is now resting much easier now that the help she has needed has indeed arrived.