November, 2015: Sharon’s Case: How Your Social Security Lawyer Can Make a Big Difference from the Beginning

Sharon’s case is a prime example of the difference your Social Security lawyer can make from the very beginning Sharon is a fifty-seven (57) year old woman with a high school education and a consistent work history that included jobs in light manufacturing settings. She has initially contacted our office after going out of work in the fall of 2014, which job she had left as a result of her disabling conditions. She had been suffering from back problems and diabetes, which problems included neuropathic pain in her feet.

When Sharon initially contacted our office it was clear to us that there were a number of concerns with applying this early on in the process. Sharon had previously undergone surgery for her back more than 10 years prior to contacting our office, and it was clear that she had not returned to the surgeon for additional neurosurgical evaluation. Likewise, she had yet to undertake evaluation and treatment of her condition, which included symptoms of back pain and radiculopathy, to see if additional treatment at this point would serve to make her more function. We advised her that the Social Security regulations require her to show that she remains disabled despite prescribed treatment for a period of a year or longer. Likewise, as Social Security disability insurance benefits are not payable for the first five (5) full months, there was no reason to apply so soon after going out of work.

Sharon recontacted our office approximately 6 months later, after she had remained out of work for the better part of a year, and provided us with a treatment update. She had undertaken an evaluation at that point with a neurologist, who upon EMG testing, determined that she should undertake pain management evaluation and treatment with a specialist out of Kennebunk, Maine. She underwent injection therapy and medication management which was not serving to address her significant symptomatology. Thus, we advised her at this point in time to undertake a disability application through our office.

As is our normal practice, in addition to assisting Sharon with her initial application paperwork, we pointed out to her the importance of exhausting her treatment options given the requirements of Social Security’s regulations. We advised her to return to her surgeon’s office to ensure there weren’t additional treatment options available to her, such as additional surgery. Sharon took our advice and did follow-up with the neurosurgeon, only to determine that there was nothing more that could be done surgically to address her condition. She likewise continued to treat with her pain management specialist, receiving additional injection therapy. We likewise provided Sharon with a very important Physical Residual Functional Capacity Questionnaire to be addressed by her pain management specialist. Routinely, this medical practice had addressed such forms on behalf of their clients. Unfortunately, in recent years they have initiated a practice of refusing to address such forms. I am happy to say that we were able to convince the treatment providers to address her condition, much as they had for many years for our clients, by explaining to them the importance of these questionnaires. While the providers maintain that they are not qualified to address the extent to which their patients experience functional limitations which hinder their ability to work, we were able to explain to them how Social Security obtains opinions from their own doctors, who are typically general practitioners who have never had an opportunity to meet the claimant/patient (nonetheless examine them: they are simply undertaking a paper review). Thus, if these Social Security hired doctors with fewer credentials find themselves capable of undertaking such evaluations, certainly then they (as the claimant’s/patient’s treating specialists) are capable of addressing the extent to which their patient remains limited in their ability to function.

I am happy to note that the claimant’s doctors did come through for her, and provided a rather compelling questionnaire in the nick of time that allowed for Sharon to receive a fully favorable decision on her initial application. Fortunately, Sharon received the guidance she needed to avoid what very well could have been a 2+ year appeals process, as a denial would have meant a very likely 2+ year appeals process through Maine’s reconsideration and then request for hearing processes. Instead, she received a fully favorable decision within five (5) months of her application that provided her with both the retroactive and ongoing benefits she needed to survive.