SSA Adds New Compassionate Allowances

Recently the commissioner of Social Security, Michael Astrue, announced that starting August 13, 2012, 52 new diseases and conditions will be added to the list of Compassionate Allowances (CAL). This brings the total number of diseases and conditions that qualify for CAL from 113 to 165.

Social Security defines Compassionate Allowance as:

Compassionate Allowances (CAL) are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

SSA started this program back in 2008 with a list of 50 diseases and conditions. So how does SSA determine if a disease or condition qualifies for CAL? A couple different methods are utilized, such as public outreach hearings focused on conditions like early-onset Alzheimer’s disease, cardiovascular diseases and traumatic brain injury. SSA is also receptive to comments offered by those who work for Social Security and Disability Determination Services, as well as from medical and scientific experts. SSA also looks for diseases and conditions that are most likely to meet their definition of disability.

One of the main methods used to identify diseases and conditions that qualify for CAL is through research. The National Institute of Health has been the leader in this research and has identified many of the conditions on the list as a result. Earlier this year, eight research projects were approved through the Disability Determination Process Small Grant Program. This will involve graduate students who will utilize innovative research methods with focuses on topics such as CAL, the Wounded Warriors initiative, disability enrollment issues and more. Managed by Policy Research, Inc., the program is taking applications from grad students who are interested in this type of research. Applications can be found here:  http://www.policyresearchinc.org/projects/ddp_grant.shtml.

Below is the list of the newly-added CAL diseases and conditions. For the complete list, please visit: http://www.ssa.gov/compassionateallowances/conditions.htm

Aicardi-Goutieres Syndrome

Alobar Holoprosencephaly

Alpers Disease

Alpha Mannosidosis

Carcinoma of Unknown Primary Site

Cerebrotendinous Xanthomatosis

Child Neuroblastoma

Child Non-Hodgkin Lymphoma

Chondrosarcoma with multimodal therapy

Cornelia de Lange Syndrome-Classic Form

Ewings Sarcoma

Follicular Dendritic Cell Sarcoma with metastases

Fucosidosis - Type 1

Galactosialidosis - Early Infantile Type

Glioma Grade III and IV

Hallervorden-Spatz Disease

Hepatoblastoma

Histiocytosis

Hutchinson-Gilford Progeria Syndrome

Hydranencephaly

Hypocomplementemic Urticarial Vasculitis

Hypophosphatasia Perinatal lethal Form

I Cell disease

Infantile Free Sialic Acid Storage Disease

Juvenile Onset Huntington Disease

Kufs Disease Type A and B

Lissencephaly

Lymphomatoid Granulomatosis Grade III

Malignant Brain Stem Gliomas - Childhood

Malignant Melanoma with metastases

Mastocytosis Type IV

Medulloblastoma with metastasis

Merkel Cell Carcinoma with metastases

Myocolonic Epilepsy and Ragged Red Fibers Syndrome

Written by Anna Westfall & Attorney Andrew November

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Lay Witnesses and Your Disability Claim

While a disabled person has the best understanding of how they feel, a spouse, relative or close friend may also be witness to the day-to-day challenges of the disabled person. Since this person can provide additional insight, he or she can be a very valuable lay witness when it comes to a hearing in front of an ALJ.

Often in the past, ALJs have not given the testimony of lay witnesses very much weight. However, because of cases such as Caldwell vs. Astrue (http://tinyurl.com/cch8jwm), the testimony of a lay witness must be taken into account.  Social Security recognized the importance of lay witness testimony when it promulgated the guidelines in Social Security Ruling 06-3p.

Unfortunately, many ALJs believe spouses, relatives and close friends provide testimony that is biased due to the fact that they are close to and care for the claimant. This is a problem because these are the people who tend to observe a claimant’s disabilities and day-to-day struggles more than any other person.

Depending on the particular case, it may be more effective to find a lay witness that is outside the claimant’s close circle, such as a former coworker who can testify in regards to how the claimant performed at a past job while struggling with a disability, or a neighbor who has seen the claimant attempt to cut the lawn but fail to do so due to pain. ALJs tend to characterize these types of people as being more objective than spouses, relatives and close friends.

Regarding the testimony itself, the more objective a lay witness can be, the better it is for the ALJ to make an informed decision. By emphasizing observations over conclusions, this allows the ALJ to come to his own conclusions because he can then consider the testimony along with all the other objective evidence in the file. The lay witness is neither a doctor nor a psychic, therefore, it is best if testimony is left at what the lay witness has seen or heard, rather than give an opinion on why the claimant is disabled or how. Similarly, statements such as “totally disabled” or “permanently disabled” made by a lay witness could cause the ALJ to give little weight to his or her testimony, particularly if the medical evidence does not reflect “total” or “permanent” disability.

“Before and After” testimony is quite helpful from lay witnesses, especially if the lay witness is a spouse, relative or close friend. These types of lay witness often know a claimant intimately before and after they became disabled and can testify as to what sorts of activities they used to engage in that they can no longer do, especially working. They can also describe how some activities have changed, such as needing assistance putting on socks or bathing.

Whether lay witnesses are allowed to testify in person is up to the ALJ’s discretion. In cases where a live lay witness is not permitted, the ALJ may consider written testimony instead. This can be in the form of a questionnaire, letter, or an affidavit signed by the lay witness and notarized. Often this is the preferred form of lay witness testimony, as the witness can collect his thoughts and put them on paper well before a hearing takes place. This also allows a claimant’s representative to review the statement ahead of time to determine whether or not it is helpful to the claim. 

Overall, it is not always necessary to have a lay witness testify on a claimant’s behalf, but it is empowering for a claimant to know that he or she has this right in case it is needed.

Written by Anna Westfall & Attorney Andrew November

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SSA's Hearing Backlog is Top Priority

In February, President Obama’s budget plan for fiscal year 2013 was introduced. Only a slight increase from the 2012 budget amount is proposed for SSA. SSA’s budget amount for 2012 was already $400 million less than the 2010 appropriation. With all of the goals set forth in SSA’s latest strategic plan, how will they be accomplished?

SSA Commissioner Michael Astrue, in response to the budget proposal, stated: “I committed, by the end of FY 2013, to eliminate the hearings backlog and reduce the time it takes for a hearing decision to 270 days. Mustering help from across the agency, we remain determined to achieve this goal despite the significant increase in hearing requests.” (NOSSCR Forum, February 2012, page 4)

This means SSA has to make some tough choices. Other parts of the agency will see fewer resources. SSA will lose almost 5,000 employees within the next two years. On the other hand, over 1,500 ALJs and support staff will be hired to accommodate the hearing backlog. Therefore, claims pending at the initial and reconsideration levels will increase, as well as the wait time for a decision at these levels of adjudication, while the wait time at the hearing level will continue to be reduced to Astrue’s goal of 270 days.

In an earlier report, TRAC discovered that SSA was in line with achieving this goal until 2010, when the amount of disability cases rose so significantly that even the increased amount of SSA staff could not handle the burden. “While considerable progress has been made, the agency’s goal of reducing average processing days to 326 days next year and 270 days in 2013 will not occur unless these recent trends can be reversed.” (TRAC SSA http://trac.syr.edu/tracreports/ssa/266/)

Interestingly, SSA’s previous fiscal strategy for years 2008 through 2013 also included plans for reducing the hearing back log. According to a study done by the Transactional Records Access Clearinghouse (TRAC) through Syracuse University in 2011, the backlog of disability cases awaiting a hearing actually continued to rise during the quarter of 2011 in which the measurement was taken, from July until September.

TRAC reported a 9.3% rise in such cases from last year (click here to view TRAC’s data).This was the 5^th straight quarter in which the hearing backlog actually increased rather than decreased, creating a 11.1% increase overall.

Will Commissioner Astrue be able to achieve his goal before his term is complete? This challenge is a daunting one for SSA that must be handled with great attention and care. Disabled Americans are entitled to a timely decision, which is why this has become Astrue’s top priority. Fiscal year 2013-2016 will be the true measurement of the success of this goal.

Written by Anna Westfall & Attorney Andrew November

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SSA makes Electronic Filing a Requirement for Representatives

In January of this year, SSA announced that starting March 16th, 2012, representatives requesting direct payment of fees will be required to file appeals online. This is now part of the "affirmative duties" representatives are required to follow as outlined in the Rules of Conduct and Standards of Responsibility for Representatives.

This is in line with SSA’s goal of increased use of online services, as we saw in the plan for fiscal year 2013-2016. The rule applies to filing Requests for Reconsideration and Requests for Hearing only. Appeals to the Appeals Council cannot be filed online and must be either faxed, mailed or delivered to SSA.

Claimants without representation are not required to follow this rule, but they are still encouraged to use the iAppeal system whenever possible. While the appeal process can sometimes be confusing, the iAppeal system can easily be used by anyone because it guides the claimant through a series of prompts in which information is entered. A claimant can check his or her work before submitting same to SSA.

Once the information is submitted, it is received almost instantly by the local field office through which the claimant applied. A paper SSA-827 (authorization to disclose information to SSA) still must be submitted by either fax, mail or in-person delivery, but SSA hopes to eventually make that part on the online appeal process, as well.

Because filing online appeals is now an “affirmative duty,” failure to do so may lead to an investigation by the Office of General Counsel to find out why a representative is failing to follow the rule. However, there are exceptions:

1.     Some types of appeals cannot be filed online. As already stated above, this does not apply to the Appeals Council. This rule also does not apply to appeals of onset dates, non-disability appeals, paper claims, or technical denials.

2.     If the online system is down, or an error occurs that prevents the representative from filing the appeal, the paper appeal will still be accepted. SSA realizes that a system limitation is not the fault of the representative who was attempting to comply with the rule. 

With this new rule, SSA can continue to move forward with their goals of reducing their carbon footprint, increasing use of online services, and delivering quality disability services to the public. Less paper is wasted, disability claims move faster, and everyone is kept on the same page – even if it is an electronic one!

Written by Anna Westfall & Attorney Andrew November

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Social Security Administration’s Strategic Plan for 2013-2016 – Part 4

In the last part of our four-part series, we will explore SSA’s fourth goal, Strengthen our Work Force and Infrastructure. SSA must incorporate technology with man power in order to adequately face the daunting logistical and technical challenge of delivering services to the public. With veteran SSA staff now retiring, and technology and the buildings that house that technology now aging, SSA must carefully plan how to move forward amidst these changes.

STRATEGIC GOAL #4:  Strengthen our Work Force and Infrastructure

Because a generation of SSA employees is now in the process of retiring, SSA is charged with the important task of obtaining replacement employees that can operate just as efficiently and effectively. In order to achieve this, SSA plans to refresh their training and tech support procedures for new employees, as well as offer high-value learning and leadership development opportunities in hopes that those employees will stay with SSA for the long-term. The public that utilizes services through SSA is changing, as well. With so many different services offered, SSA sees people of many different ages and cultural backgrounds. In order to stay current with the diverse public, SSA employees must also be diverse. SSA hopes to recruit and retain individuals from different backgrounds, including veterans and people with disabilities, in order to better serve this diverse public.

SSA’s information technology system, which consists of national databases, software applications, large back-end computer platforms, which support thousands of networked computers, printers, fax machines and phone systems, is housed in two different buildings. One of these buildings house SSA’s National Computer Center. Even though the technology itself is newer, the building itself was built in 1979. Fortunately, Congress has already approved the building of a new structure, which will reduce the threat of the computer system being damaged by leaks caused by aging plumbing, or fires that may be a result of aging electrical wiring. With so much private and sensitive information stored on their databases, security of that information that is communicated through SSA’s IT system is crucial. SSA plans to continue to improve upon their cyber security protections, including increased monitoring. Technology is essential to everything SSA does, so this is a particularly important part of the strategic plan for fiscal year 2013-2016.

Those of us in the Cleveland area may remember that several SSA field offices either closed or consolidated with other offices within the last couple years. This is keeping in line with SSA’s goal of reducing their “carbon footprint.” SSA saved over $15 million last year by cancelling leases held by field offices. Along these same lines, SSA wants to explore the possibilities of Telework to increase productivity and further reduce not only their carbon footprint, but those of their employees (please visit http://www.telework.gov/ for more information on Telework). The field offices that continue to exist will benefit from greater security for employees and the public alike, in the light of heightened threats and violence towards government agencies. The field offices will also become “greener” by December 2012 by reducing energy and water usage. This will complete SSA’s Environmental Management System Plan, which is also in accordance with Executive Orders 13423 and 13514.

SUMMARY

With changes such as the advancement of online services and new disability development tools, these goals are exciting for SSA employees and the public alike. By the end of 2016, the public can expect:

-          High-quality disability services and timely decisions

-          Superior customer service and increased access to services

-          Increased accuracy and efficiency of records and payments

-          Well-educated employees, state-of-the-art technology and updated infrastructures

In order for SSA to measure its success, they will turn to quarterly internal progress reviews. These will allow SSA to make adjustments if and when necessary. The Commissioner and other executives will receive a monthly Tracking Report to assess whether or not SSA is reaching its goals in a timely fashion. If all goes according to plan, SSA hopes to have all of its strategic goals accomplished within the next two years.

Written by Anna Westfall & Attorney Andrew November

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