On June 05, 2015, The Social Security Lawyers section for the State Bar of Michigan held its annual Grand Rapids seminar on the campus of Grand Valley State University. The seminar featured four speakers: Attorney Cliff Farrell, Dr. Natalie Wallace, Dr. Oren Mason, and Administrative Law Judge Paul W Jones. Although road construction caused problems for those attending the event, it was worth the trouble. Even the most seasoned disability attorneys were able to take away valuable information that will certainly assist their disabled clients.
Cliff Farrell is a well-known and highly regarded attorney with an extensive knowledge of Social Security disability law. He spoke about Social Security’s revised rules and regulations that are now lovingly referred to as the “all evidence rule.” It appears as if Social Security promulgated this rule in response to a few bad actors who seemingly had, or thought they had, the authority or obligation to withhold unfavorable evidence from the administrative law judge in any given matter. The new rule seems to take away any perceived wiggle room with regard to the submission of evidence. Now each representative and each claimant is obligated to inform Social Security where evidence exists that relates to a person’s claim for Social Security disability benefits. Unfortunately, the rule seems so incredibly broad that many attorneys feel that everybody is being punished for the sins of a few. Attorney Farrell noted that this recent rule change has already increased the administrative burden on his practice. The strict reading of the rule would have attorneys informing Social Security every time a client calls and says anything has changed with respect to their mental or physical conditions – because any change could broadly be interpreted to relate to that person’s claim for benefits.
Is an attorney obligated to inform Social Security if client calls and says his medication has been changed from 10 mg per day to 12 mg per day? Some would say by following the new rule, the attorney would then need to inform the Social Security Administration that there is a new source of potential evidence that relates to the individual’s claim for benefits. Alternatively, the attorney would have the ability to procure and submit that evidence to Social Security as well.
The increased burden this new policy has placed on my office is very real. And the increased burden on the Administration as a whole must be astronomical. For instance, if an individual goes to the hospital, am I obligated to request all records? Even if those records contain hundreds and hundreds of pages of nursing notes, or urine output notes, or even EKG graphs? Does the judge in any given case really want to see that stuff? As one judge recently put it, the lines go up and the lines go down but beyond that, it’s meaningless. That what summaries are for. That’s why there is a nice, big space for treating physicians to list their impressions and observations.
Dr. Natalie Wallace, a board-certified forensic psychiatrist, spoke about mental disorders, and provided in depth analysis of both positive and negative symptoms of schizophrenia. She spoke to the need for independent medical reviews to properly assess functional limitations in patients. She spoke about the signs and symptoms of schizophrenia, and how their timing and presentation can be used to forecast the severity and likely outcomes. Cases involving schizophrenia are some of the most interesting cases that I’ve had the opportunity to work on, but they are extremely difficult because a common part of the condition involves noncompliance with medication regimens (and often problems with substance abuse). As you can imagine, Social Security looks down upon individuals who “choose” not to follow their physicians’ orders to take medication as prescribed. Dr. Wallace also spoke about other common characteristics of the disease which impact an individual’s ability to work competitive, full-time employment, on a regular and continuing basis.
Dr. Oren Mason spoke about ADHD in kids and adults. One of the things I found to be most interesting about his presentation was that based on functional MRI results, attention deficit hyperactivity disorder might be more appropriately named attention absence hyperactivity disorder. Dr. Mason spoke about the past and present diagnostic criteria of the disorder. He spoke about several therapies, including medication, community assistance, and the use of incentives to get people afflicted with ADHD more in line with what society expects from its productive citizens. Sadly the data suggest that those individuals with ADHD will have a much higher rate of joblessness and divorce. The data also suggests that these individuals have shorter life expectancies, not necessarily due to the disorder, but perhaps related to the comorbid conditions. It is estimated that ADHD plays a large role in thousands of motor vehicle accidents every year. ADHD also seems to be related to over 1000 suicides per year.
Administrative Law Judge Paul W Jones spoke to section members about his views on what makes a good Social Security disability case. Judge Jones indicated his philosophy on medical opinions, and how treating sources can effectively describe their patients functional limitations. Judge Jones talk highlighted the difficulty in evaluating cases where the diagnosis is not based on objective medical evidence, but instead based on signs and symptoms and testing. Unfortunately, almost all psychological problems are based on diagnoses that are made using subjective evidence (although Dr. Wallace and Dr. Mason both referred to objective test results relating to certain mental disorders – although use of these techniques is quite rare and prohibitively expensive). Additionally, disorders like fibromyalgia, as the judge put it, are highly subjective. He indicated that an individual could, in order to get diagnosed with fibromyalgia, simply say ouch each time trigger points were tested. While I believe that’s a very cynical view of disability claimants, a practically insulting view of physicians, it is helpful to know what your judge thinks about your conditions. Judge Jones indicated his preference for early briefs and the timely submission of evidence. His thoughts about the “all evidence rule” tended to contradict the actual rule itself, because in his eyes submitting the same piece of evidence from two separate sources shows that the claimant’s rap isn’t paying attention (while a strict reading of the rule may require the submission multiple times).
On a side note, I had a client crying while she told me that I understood her ADHD better that her doctors ever have. I am sure I don't understand it better, but I am good at articulating what I know about ADHD. And I had a lot of time to spend with her while we prepared for her hearing, unlike most busy physicians. While I take her tearful statement as a compliment, I need to thank Dr. Mason for sharing that knowledge and presenting it in such a way that it really stuck with me.