Will an Administrative Law Judge understand my rare medical condition?
I represent claimants with a wide variety of physical and mental conditions. I regularly talk to claimants with a rare or unique diagnosis that are concerned that their diagnosis will not be properly understood by the Social Security Administration (SSA). These individuals want to make sure that they have a legal team that will advocate for them to the SSA regarding their unique struggles. My law office understands that the disability appeal process can be complicated on its own, and even more so if you don’t feel that anyone understands what your medical conditions put you through. I try to make sure my clients know that I have a plan for each claim, no matter how common or rare their medical conditions may be.
If you look at SSA’s website for information regarding medical conditions, you may come across their Listing of Impairments. SSA has special rules regarding how a person with some common medical conditions should be evaluated for disability. If a person with a medical condition discussed in the corresponding Listing meets the criteria established, SSA should find that person is disabled. If you have a rare medical condition, you may not find that the SSA has a Listing for your condition. This does not mean that you can’t be found disabled, but that the SSA must determine your Residual Functional Capacity (RFC). SSA will look at how your conditions and symptoms affect your ability to do work-like tasks and then determine if you can do any jobs with the limitations that you have.
So how do you prove your limitations? The first place the SSA will evaluate will be your medical records. Therefore, it is important for you to follow up with your doctors as often as necessary for your conditions. SSA requires that you have what they call a “medically determinable impairment” that can be shown by medically acceptable clinical and laboratory diagnostic techniques. They cannot rely on your symptoms alone, so if there is any specific objective testing that is needed to confirm your diagnosis or monitor your progress, it would be a good idea to make sure that it is included in your medical file. In evaluating your symptoms, the SSA will look to see if your limitations are consistent with your medical record. When you see your doctors, make sure to be honest and forthright with them regarding your level of functioning and symptoms. I’ve seen examples of medical files where patients tell their doctors that they are doing well with their symptoms at doctor visits, and report to my office severe limitations that they go through on a daily basis. When we go before an administrative law judge (ALJ) at a disability hearing, this creates a conflict in the record that the ALJ is required to address. In order to avoid these problems, you want to be open with your doctors about how your conditions are affecting your daily life. You may want to ask your doctor to write a statement of their medical opinion regarding your symptoms and functional limitations.
After your hearing, sometimes an ALJ will determine that they need more information from a qualified medical source. In those instances, they can do two things. One option the ALJ can take is to request interrogatories from a medical doctor. In this process, the ALJ will provide your medical file to a qualified, objective medical doctor (this means that the doctor will not be someone who has any relationship to you) for review. After the review, the ALJ will submit written questions to the doctor asking them what effects your medical conditions will have on your ability to work. The other option that an ALJ can take to get more information is to request a supplemental hearing for a medical doctor to testify as a qualified medical expert. At the hearing, the ALJ will ask the doctor’s opinion about how your medical conditions would limit you in a work environment. Your attorney will have an opportunity to ask additional questions, so you may want to have an attorney with experience cross-examining medical experts in disability hearings.
Just because your medical condition is rare, it does not mean that the SSA will not be able to find you disabled. However, you need to make sure your case is built properly so that the ALJ and SSA can efficiently and correctly evaluate your claim. Having an experienced disability attorney can help you through the disability appeal process.
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Author: Scott Lewis