Social Security Regulations Archives

Because the Social Security Disability application and appeals process can be difficult, especially when a claimant may be suffering from multiple medical impairments, it is crucial to hire an attorney that specializes in Social Security Disability Income (SSDI) and Supplemental Security Insurance (SSI) claims.

Aline Gaba, attorney and founding partner of the San Diego Disability Law Group (SDDLG) recently participated in a webinar for the San Diego County Bar Association. In this webinar, she discussed the role of Social Security Disability Attorneys in helping their clients, along with the differences between SSDI and SSI claims. One particularly valuable focus included how medical evidence helps in achieving successful SSDI and SSI claim outcomes.

You can watch the discussion touching on the points above through the recorded 23-minute webinar published here: https://www.sdcba.org/index.cfm?pg=ssi

Below, we will review some of the main points from the webinar. If you still have questions, please feel free to call the San Diego Disability Law Group at (619) 338-9000 or contact us via email and we will do our best to get your questions answered as quickly as possible.

SSI Claims vs SSDI Claims

It is important to know the difference between a Supplemental Security Income (SSI) claim and a Social Security Disability Insurance (SSDI) claim. 

SSI is a needs based program for individuals who have a severe impairment that prevents them from being able to sustain gainful employment.  There are different financial requirements depending on your marital status; however, SSI does not require any work history or qualifying quarters. As such, an individual may qualify for SSI if they have never worked a day in their life so long as they meet the financial and medical requirements for SSI.  For this reason, SSI benefits are usually much lower than SSDI benefits.

SSDI also requires a severe impairment that prevents substantial gainful employment; however, you must also have sufficient qualifying quarters.  In other words, you must have sufficient work history as well as a medically determinable impairment in order to be eligible for SSDI.  Because SSDI is based on your earnings, these benefits are usually much higher than SSI benefits.

Why Hire an SSDI/SSI Attorney?

What does an SSDI attorney really do, and is hiring one actually necessary? A Social Security Disability attorney, like Ms. Gaba, has many years of knowledge and experience in dealing with the processes and procedures of the Social Security Administration (SSA).  You could say that we are fluent in the language that the SSA speaks, which makes us uniquely qualified to address the many problems and pitfalls that may arise during the application and appeals process. 

Attorneys who specialize in Social Security Disability, like Ms. Gaba, are well versed in the SSDI and SSI application and appeals process.  We analyze each case from start to finish, including status of the claim, pending appeals, and hundreds to thousands of pages of medical records.  Over the course of this long process, we work closely with and get to know our clients so that we can develop a comprehensive strategy to give them the best chance of winning their claim. 

The Use of Medical Evidence in an SSDI/SSI Claim

It is important to note that the role of medical evidence is critical to the successful outcome of the SSDI/SSI claims process.  An experienced Social Security Disability attorney, like Ms. Gaba, will review your entire medical file and ensure that the SSA has all of the necessary and relevant information.  Your SSDI attorney will identify and request any missing records, ask your doctors for opinion letters, and work with you to gather any additional evidence that would support your claim. 

In the webinar, Ms. Gaba also discusses the impact of the current Coronavirus pandemic situation on the processing of disability claims. Due to COVID-19 related business closures, the backlog of cases waiting to be processed by SSA quickly increased early on. However, the SSA has recently pushed though cases at a more rapid pace, which helped in reducing the claim processing delay. In addition, all of the San Diego Social Security hearings are currently being held telephonically instead of in person to comply with the related health requirements and to prevent further delays in processing claims.

SDDLG Can Help With Social Security Disability Claims

Many claimants find the Social Security Disability process daunting and discouraging due to the high rate of denials and the obscure nature of dealing with a large bureaucracy such as the SSA. However, you don’t have to go through the process alone.  Please contact the San Diego Social Security Disability lawyers for a free consultation.

You can reach the offices of The San Diego Disability Law Group by calling 619-338-9000, or contact us here.

San Diego Social Security disability lawyers regularly help applicants apply to receive benefits if they are unable to perform any easy work they have done in the past. This may seem like a simple process, but San Diego Social Security disability attorneys frequently need to guide clients through the often complicated yet necessary procedures.

Defining the Term “Disabled”

San Diego Social Security disability attorneys are aware that the Social Security Administration defines the term “disabled” in a particular way. “Disabled” applicants are those who can no longer complete any “past relevant work,” and must meet the following criteria:

  1. The applicant must have been employed in the occupation within the last 15 years or 15 years prior to the most recent disability requirement check (whichever was earlier).
  2. He or she must have performed the work for a significant period of time. (Any applicants unsure about whether their work qualifies should consult their San Diego Social Security disability lawyers.)
  3. The applicant must have earned a certain amount of money throughout the working period.

Qualifying for Benefits

San Diego Social Security disability lawyers may test whether an applicant may qualify for disability benefits by following a two-step process:

  • The San Diego Social Security disability lawyers will first conclude which occupation fits the “past relevant work” criteria and is the least strenuous.
  • Then, they may investigate why the applicant can no longer perform the occupation.

Level of Exertion Required to Perform Job Duties

An applicant will not qualify for benefits if his or her San Diego Social Security disability lawyers cannot show that he or she is unable to complete a former job of average difficulty. In addition, the Social Security Administration will ask the San Diego Social Security disability attorneys whether the applicant’s past performance corresponded to the difficulty level of each position.

Medical-Vocational Guidelines

The Social Security Administration will utilize the Medical-Vocational Guidelines to determine a candidate’s degree of disability. San Diego Social Security disability lawyers will need to prove that the applicant cannot perform any commonly available job.

Contact Us

Many candidates find the application process confusing. If you are disabled and would like to apply for benefits, consult with San Diego Social Security disability lawyers at the San Diego Disability Law Group by calling 619-338-9000, or contact us here.

Social Security Disability and Reflect Sympathetic Dystrophy

Is rsd a disability?

We presently have a client who has been diagnosed with REFLEX SYMPATHETIC DYSTROPHY (RSD) also known as COMPLEX REGIONAL PAIN SYNDROME (CRPS).  RSD is a unique clinical syndrome that may develop following trauma, severe or minor. Claimants with RSD typically report burning, aching, or searing pain that starts out at the site of the trauma and can then spread to other limbs or parts of the body. In our case, our claimant is a 30 year old women who fractured her finger playing football. She had surgery on the finger but it ever healed properly. She can’t bend it or make a fist. After the surgery her hand started to swell and tingle. She also had a burning , searing pain first in the injured hand and then in her other, non-injured hand. Thereafter she developed symptoms all over  her body including both her lower extremities. The pain and spasms are so bad that both her feet contract inward during an episode making it extremely difficult for her to walk. She certainly can no longer do her job as a certified nurses assistant.

The Disability Lawyers with the  San Diego Disability Law Group analyze each case according to the sequential evaluation process applied to all initial Social Security insurance claims and all adult SSI claims i.e. 1) Is the claimant presently engaged in substantial gainful activity; 2) Does the claimant have a severe impairment; 3) Does the impairment meet or equal a listed impairment; 4) Does the impairment prevent the claimant from performing past relevant work and 5) Does the impairment prevent the performance of other work considering the claimant’s age, education and prior work experience.

The Social Security  Administration publishes a Listing of Impairments with medical evidence requirements which, if met, are conclusive of social security disability. Sometimes however, a severe condition like REFLEX SYMPATHETIC DYSTROPHY is not listed in the Listing of Impairments but is addressed in a Social Security Policy Interpretation Ruling.  In preparing this case,  the Disability Lawyers at the San Diego Disability  Law Group referenced SSR 03-02P ” EVALUATING REFLEX SYMPATHETIC DYSTROPHY SYNDROME/COMPLEX REGIONAL PAIN SYNDROME”.

SSR 03-02P acknowledges that RSD/CRPS is a chronic pain syndrome most often resulting from trauma to a single extremity and that patients typically report persistent, burning, aching or searing pain that is initially localized to the site of the injury. The degree of pain is often out of proportion to the severity of the precipitating injury and cases have been reported to progress and spread to other limbs, or to remote parts of the body (Like in our case).

The Social Security Act defines “disability” as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be  expected to result in death or which has lasted or can be expected to last for a continuous period of not less that  12 months. The act also requires that the impairment result form anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.

SSR 03-02P states that, for purposes of Social Security disability evaluation, RSD/CRPS can be established in the presence of persistent complaints of pain that are typically out of proportion to the severity of any documented precipitant and one or more of the following clinically documented signs in the affected region at any time following the documented precipitant: 1) Swelling; 2) Autonomic instability i.e. changes in skin color or texture,changes in sweating(decreased or excessive sweating); 3) changes is skin temperature; 4)Abnormal hair or nail growth;  5) Osteoporosis; or 6) involuntary movements of the affected region of the initial injury.

The Disability Attorneys with the San Diego Disability  Law Group know that it is important in RSD/CRPS cases to present longitudinal treatment records which document the above referenced criteria in order to make the strongest case possible for RSD/CRPS claimants.

As a claimant with  RSD/CRPS it is extremely important for you to continually tell you treating doctors about your symptoms and the effect that your symptoms have on your activities of daily living and your ability to function. Develop a longitudinal medical record that clearly documents your RSD/CRPS symptoms. Documenting your symptoms will enable your Disability Lawyer to present the best claim possible.

If you or any friend or family member has a Social Security Disability claim or question, contact the Disability Attorneys at the San Diego Disability Law Group for a free consultation at 619-238-9000.

All is not necessarily lost if you don’t get your Social Security Disability appeal filed on time. The Social Security Administration (SSA) regulations recognize several excuses as “good cause” for missing the appeal deadline. An experienced San Diego Social Security attorney can help you establish good cause, or, even better, help you meet the time requirement in the first place.

Procedure for Raising Excuse

The first thing you need to do with a late appeal is get it filed. If it has clearly missed the deadline, you’ll need to include a detailed letter telling the SSA exactly why you are filing late.

If the SSA finds that your explanation amounts to “good cause,” it extends the deadline, magically making your late appeal a timely appeal.

Who Determines “Good Cause”

The SSA’s lengthy Program Operations Manual System gives the authority to decide if there is “good cause” to the “individual from the component that has the authority to adjudicate the appeal being filed.” In practical terms, this means that the official who determines good cause depends on which filing is late:

  • If the Request for Hearing is late an administrative law judge (ALJ) determines good cause
  • If the Request for Review of Hearing Decision is late, the Appeals Council determines good cause
  • If the deadline to file in federal court was missed, the Appeals Council again determines good cause

What Excuses Amount to “Good Cause”

There are SSA regulations describing, at general level, what amount to “good cause”:

  • The specific circumstances which led to the untimely filing
  • Whether the claimant was misled by any action of the SSA
  • Whether the claimant understood the time requirement

A more specific regulation provides that SSA will consider whether the claimant had any physical, mental, educational, or linguistic limitations—including any lack of facility with the English language–which prevented a timely filing, or which prevented the claimant from understanding or knowing about the need to file a timely request for review.

SSA has issued a Ruling on the lack of mental capacity, which states that tardiness will be excused when claimants lack the capacity to understand the procedures for requesting review, and had no one legally responsible for prosecuting the claim, such as “a parent of a claimant who is a minor, legal guardian, attorney, or other legal representative.” In applying this standard of mental incapacity, it doesn’t matter how much time has passed since the decision the claimant wants to appeal.

Reasonable doubt about the claimant’s capacity is resolved in favor of the claimant.

Get Social Security Disability Help

Establishing good cause is something best left to an experienced disability attorney in San Diego. Get the help you need to protect your right to benefits; if you need a lawyer for ssi appeals, call George Heppner and Aline Gaba at (619) 338-9000.

The San Diego Disability Law Group Explains the Nature of Your SSD Hearing

If you have to appeal your denial for Social Security disability benefits in a hearing before an administrative law judge, you may be anxious about your hearing and curious as to what you should expect.

All that each judge is required to do according to Social Security regulations is look fully into the issues at hand, question you and any witnesses you bring, and accept into evidence any materials you bring that help prove your case. The Social Security Administration also has a manual called HALLEX that outlines some of broad procedures. However, there is not a strict procedure for administrative law judge hearings. Outside the broad HALLEX guidelines, most of the details are left to each individual judge’s discretion.

Beyond that, however, hearing procedures can vary wildly. Some administrative law judges prefer to ask witnesses many specific questions, while some will ask only a few open ended questions and expect your Social Security disability representative to direct witness testimony with follow up questions. The length and scope of the administrative law judge’s opening statement can also vary wildly. Administrative law judges may ask witnesses to remain in the waiting room until it is their turn to testify, or they may allow all the witnesses into the room.

You should not let this worry you, however. With a knowledgeable Social Security disability representative in San Diego by your side, you will enter that hearing prepared, regardless of how it is structured.

If you have been denied benefits, call the experienced Social Security disability representatives, Aline Gaba and George Heppner, at the San Diego Disability Law Group, for a free consultation.