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Massachussets Bar Association
Maine state Bar

November, 2010: The Social Security Grid Rule and their Effect at Age 50

Shelly's case is another example of how Social Security's Grid rules come into play once one reaches the age of fifty (50) years old). Shelly had worked many years as a convenience store clerk: in fact, she became disabled on a trip she was provided as a reward for her efforts. She was provided a trip out to the Midwest that included horseback riding: it was while horseback riding that she sustained an upper back vertebral fracture. When getting involved initially, Shelly was quite frustrated that she was continuing to have significant back pain and nothing was being suggested for treatment. We were able to guide Shelly as to additional treatment options she could attempt (which is quite important as the Social Security Administration is looking to see that she is disabled despite prescribed treatment).

The Social Security Administration (SSA) did send Shelly to a consultative examination with an orthopedic specialist who did indicate that she was quite limited: however, when this opinion was reviewed by one of the state agency doctors who review the medical evidence in the file, they chose to ignore this opinion.  It is important to note that consultative examinations are typically set up in those circumstances when a disability claimant is alleging they are suffering from disabling circumstances as result of a condition for which they are not being followed by a physician.  This might be the circumstance where someone does not have insurance coverage in place to see a doctor, or it might simply be that the claimant has been reticent about seeking such treatment.  Consultative examinations, while they can prove helpful, they are not a substitute for treatment and the regulations do require that an individual show they remain disabled “despite prescribed treatment.” 

By guiding Shelly to advocate for herself with her primary care physician to ensure that she received the treatment she required both personally for her medical condition and for her claim, we were able to ensure that Shelly received answers as to what was going on with her back and how these problems might best be treated.  Thus, this served to help Shelly both personally and in terms of her claim, as now, a specialist was willing to comment on her behalf as to the nature and severity of her medical condition and how it was impacting her ability to function.  

Thus, while at the time of the prior state agency determinations of her claim (at the time of both the initial denial and the denial on reconsideration), SSA did not have the benefit of one of Shelly's treatment provider's opinion as to her functional limitations, at hearing there was a much different scenario.  The presiding Administrative Law Judge (ALJ) at the Portland Office of Disability Adjudication and Review now had significant additional medical documentation that was compelling.   The judge agreed at hearing with claimant's counsel that these  two assessments (the prior consultative examination opinion and that of her own treating specialist) should be given controlling weigh thereby resulting in a favorable decision for Shelly. The ALJ likewise agreed with claimant's counsel's argument that based on Shelly's age, education, past relevant work experience (which was as a convenience store clerk) and lack of transferable skills to other sedentary work that she should be found to meet a Social Security grid rule (and was therefore found disabled under Social Security's rules and entitled to benefits).

I was honored to handle the claim of such a hardworking an dedicated individual such as Shelly.  Working together as a team, that is to say, Shelly, her doctors and I, Shelly’s case went very smoothly at hearing and served to result in what has been a fully favorable decision.