2013 Appeals Council Statistics

In fiscal year 2013, the Appeals Council took approximately one year to process requests for review. Almost 77% of the requests were denied by the Appeals Council.  In other words, the Appeals Council refused to review almost 80% of the requests filed. Approximately 17% of the requests resulted in a remand. About 1% of the requests for review by the Appeals Council resulted in a favorable decision.

If the claimant is denied, the decision on whether to re-file for benefits or appeal the decision to the Appeals Council is very difficult.  If you decide to appeal to the appeals council, it will probably take at least a year to get a decision, and about 80% of those requests will not even be reviewed.  If you decide to appeal your claim to the Appeals Council, make sure your attorney or representative is able and willing to consider taking the case to Federal Court.

Child Support and Social Security Disability

“It is well settled in Tennessee that SSI benefits are not subject to legal process for payment of court-ordered child support.”  In re Jordan H. (Tenn.Ct.App. March 25, 2014).  SSDI benefits, on the other hand, can be garnished. 

Evaluating Medical opinions

The regulations require an ALJ to evaluate every medical opinion. 20 CFR 404.1527(b): “we will evaluate every medical opinion we receive.”  The evaluation must comply with 20 CFR 404.1527(d).  Remember, a treating source opinion should not be rejected absent “good reasons.”  Id.

Headaches and Disability

A common problem I see in disability claims is the evaluation of headaches.  So long as there is evidence to support the presence of possibly disabling headaches, the ALJ must address the issue.  2014 U.S. Dist. Lexis 8450

 

Consideration of VA benefits in an SSDI claim

A recent case from a local district court that resulted in remand addressed a number of important issues, including the issue of a VA disability determination in the context of a SSDI claim.

According to the Commissioner’s own rules and regulations, a decision by any governmental agency about whether an individual is disabled must be considered evidence. 20 C.F.R. § 404.1504. While such evidence may not be binding on the Administration, various Circuit Courts, including the Sixth Circuit, have held that the Commissioner must give the decisions of other agencies evidentiary weight.

. . . .  Furthermore, the Fourth, Fifth, Ninth, and Eleventh Circuit Courts have held that a VA ratings decision was entitled to “great weight.” . . . .

Reynolds v. Colvin, 2014 U.S. Dist. Lexis 8450 (E.D.Tenn. Jan. 3, 2014)

GAF Scores must be properly considered by the ALJ

A recent case from the Eastern District of Tennessee resulted in a remand on a number of important issues. The first issue discussed in this post concerns GAF scores:

The ALJ rejected the Global Assessment of Functioning (“GAF”) scores. The ALJ reasoned that GAF scores “are not based on standardized norms and admittedly provide only a snapshot impression of an individual’s psychological status. . . .” (Tr. 16). The ALJ further stated that “detailed observations and descriptions in a provider’s notes are a vastly superior reflection of an individual’s true functional abilities than a shorthand GAF score. . . .” (Id.). As Plaintiff notes however, the ALJ does not cite to any observations and descriptions from treating providers to contradict the assigned GAF scores. Plaintiff argues the ALJ rejected the numerous GAF scores in the record that would support a finding of severe social and occupational impairment (Tr. 16). A review of the record shows that from the time of Plaintiff’s alleged onset date through the date of the hearing in this matter, treating psychologists and psychiatrists at the VA, almost without exception, rated Plaintiff’s GAF at 50 and on one occasion 45. (See, e.g., Tr. 763, 780, 783, 790, 1044 and 1068). In light of the multiple GAF scores in this range, I conclude a fuller explanation of the reason for their rejection is required. I note that the GAF scale shows 41 to 50 as serious symptoms but the range of 51 to 60 reflects moderate symptoms. There may be reasons why the ALJ concluded the scores  did not reflect serious symptoms but the articulation of those reasons is for the ALJ and not this court.

Reynolds v. Colvin, 2014 U.S. Dist. Lexis 8450 (E.D.Tenn. Jan. 3, 2014)

Denial and Allowance Rates

A Statement by the Deputy Commissioner of ODAR to the House of Representatives on November 19, 2013, contains some interesting comments with regard to denial and allowance rates by administrative law judges.  The Statement provides, “we have no targets or goals regarding these rates.”  However, the Deputy Commissioner goes on to state that an ALJ with a “very high or very low allowance rate may raise a quality red flag.”  Although the Deputy Commissioner states there are no targets or goals, it is obvious from the Statement that Judges who deny a certain percentage or approve a certain percentage raise a “red flag.”  Apparently, a “high” approval rate is 85% or above, while a “low” approval rate is 20% or less.  The Statement outlines and explains why ALJs are expected to decide 500-700 cases per year, with a limit of 840 per year.  The Statement is worthy of careful consideration by anyone representing disabled individuals.

Follow

Get every new post delivered to your Inbox.