Social Security adopted the grid rules to streamline disability benefits for individuals who are at least 50 years old. After 50, and especially starting at 55, the grids combine medical-vocational factors like age, education, past relevant work, transferable skills, and residual functional capacity to quickly determine if a claimant qualifies for disability benefits.
These guidelines should often make hearings unnecessary and approve claimants of advanced age who can no longer perform their past work due to a medical impairment.
However, Social Security too often ignores their own rules.
We see the "state agencies," referring to the Disability Determination Service (DDS) of the state, deny claims that should have been paid. When this happens, a hearing is inevitable and benefits are delayed for months, sometimes years, while we fight the government in court.
It's my experience that sometimes the state examiner just ignored the grid rules. But it is more likely that a mistake was made in one of the following specific areas:
1. Past Jobs Were Not Properly Classified. The easier the past work was, the more difficult to win under the grid rules. For example, a claimant who had jobs at the sedentary exertion level (performed mostly seated) will have a hard time qualifying under the grids. A person with past work at the light level will have it easier, and a claimant who worked at the medium or heavy level will have the best odds.
2. The Disability Examiner Didn't Assign the Proper Residual Functional Capacity or RFC. This term simply means the most that a person is able to do in terms of work-like activity. From easiest to hardest, the exertion levels are: sedentary, light, medium, heavy or very heavy. If your past work is classified as light, when it was really performed at the medium level, the grid rules won't do their job. The RFC is based on the claimant's medical records. Thus, failing to get all of the medical records results in the wrong RFC. Failing to get a treating doctor's opinion of the claimant's RFC will also hurt the case because it leaves Social Security free to make up their own RFC.
Contrary to what most claimants believe, there are many technical factors in a Social Security disability claim. We've just discussed two of them: past relevant work and residual functional capacity.
I ask claimants who call me for advice: "What do you feel your residual functional capacity is?" Or, "Which of the medical-vocational guidelines do you feel may direct Social Security toward paying your claim?" I cringe when I hear, "I have no idea what you're talking about."
These 2 areas will be ground zero in both the initial determination and the appeal hearing.
Transferable skills may also cause your problems, even at advanced age (55 or over). Here's an example: Adam worked for 34 years as an instructor in the aviation industry. That's light work but requires standing at least 6 hours per 8-hour day. His spinal disorder won't let him do the standing required of this work; however, he could work at a sedentary level, sitting most of the time. Adam hopes to grid because he is 57 years old (advanced age), has a high school education and can't perform his past work. However, Social Security finds that he as acquired skills transferable to sedentary work, so the grid rules won't work for him.
He may have a chance, but the rules have just changed. Adam must now prove that he can't perform any sedentary work, the easiest of all work. In other words, his burden is now to prove that he cannot perform any full time job which exists in the nation.
If you get into this unenviable position at your hearing, your attorney-representative will have prepared for the problem and will be ready to argue appropriately.
Comments
Post a Comment