September, 2014: The Reconsideration Process While Difficult can prove Successful

Mary and Janet’s success stories serve as examples as to how a zealous, experienced lawyer can make a big difference at the reconsideration process (where there is a very high denial rate). Unfortunately, if one is denied on their initial application, chance remain high that one will need to request a hearing. I’m happy to report that Mary and Janet are part of that small minority of claimants that have prevailed in the reconsideration process.

Mary is a 49 year old woman with a prior work history as a medical technician who became disabled from working as a result of problems that include mental health issues (depression and anxiety), bleeding on the brain (which bleeding occurred a few years prior and had resolved, but which after effects included reoccurring headaches), low back and leg problems resulting from degenerative disk disease and knee difficulties which continued to bother her following knee surgery. Unfortunately, Mary had become quite discouraged over her multiple medical problems and had let lapse some of the medical treatment she had been receiving in the past. A lapse in treatment can prove quite problematic in a Social Security disability claim as one is required to show that they remain totally disabled from all forms of gainful employment for a year or longer. It is always advisable that one is treating with a specialist for any condition which they believe remains severe. The Social Security regulations require that claimants do everything possible to address their medical conditions in order to show that they are doing everything possible to avoid the need to file for Social Security disability benefits. On another note, the Social Security regulations do require that there is objective documentation and not simply subjective evidence (that is, simply the word of the claimant) of the medical conditions at issue, along with the fact that these conditions remain severe and disabling despite the treatment received. This is difficult to show if one is not in continuing, significant treatment with a specialist. Fortunately, Mary followed our recommendations quickly and it appears that it was this additional treatment (and the corresponding documentation from the treatment providers) that allowed her to receive a fully favorable decision.

Janet’s circumstances, very similar in some respects to Mary’s, again bring home the point how important it is that one remains in treatment with a specialist for any medical condition they believe is severe and disabling. Janet is a thirty-three (33) year old woman who had worked for more than 10 years as a registered nurse before becoming disabled as a result of mental health difficulties. By the time she came to our office, she had already been denied on her claim, finding that her mental health condition was not severe enough to justify a finding that she remained totally disabled from all forms of gainful employment. Unfortunately, Janet’s treatment for her mental health had been followed for years by a psychiatric nurse practitioner (who was providing her with counseling) and with her primary care physician (who was the one addressing her medication management). While appropriate treatment, the Social Security regulations do not recognize a nurse practitioner as a “treating source” entitled to controlling weight and, clearly, the primary care physician does not have the specialized knowledge with reference to psychiatric disorders that a psychiatrist would. With this in mind, we advised Janet that her mental health, being severe, should really be addressed by a psychiatrist. Janet followed our recommendations and did establish treatment with a psychiatrist, who provided additional objective documentation as to the extent to which Janet’s condition remained severe and disabling. Shortly thereafter, the Social Security Administration provided Janet with a fully favorable decision on reconsideration (providing Janet with a great sense of relief, both from a financial and mental health standpoint).

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