Some of the most common conditions which cause back pain include arthritis and DDD (degenerative disc disease). If you suffer from chronic debilitating back pain then it is likely there are resulting physical limitations from your condition. Although this point seems obvious, the SSA will be looking at the medical record first and foremost for "objective" findings (X-Rays, MRIs). Next, do the progress notes document in some way that there are physical limitations (inability to stand/sit for certain period of time, inability to crouch, bend, stoop, kneel and frequently lift/carry 10lbs or more). Consistent progress notes from a treating physician over a period of time lend credibility and would likely include patient comments/reports of pain (perhaps in addition to numbness/radiating pain from pinched nerves); prescriptions of strong painkillers (norco, oxycontin, etc) are yet another factor lending credibility to the overall picture and especially if more than one physician and/or specialists have consistent reports. Finally, is the claimant's appearance consistent with the medical record - if there are inconsistencies with the medical record and anything that the Judge sees in person then that may influence the question of credibility.
Claimant has lost at the ALJ hearing. Filing an appeal of the ALJ decision is an option if an error of law or fact was made by the Judge. See a discussion of top 10 issues for appealing an ALJ decision here. Perhaps most common is that the ALJ did not give the treating physician the sufficient weight that his/her opinion should have been given. If the Appeals Council agrees with the reasons your lawyer set forth on appeal, the remedy is much likelier to be that the case is remanded (sent back) to the very same Judge who denied the case which statistically usually results in the same result, however we have seen exceptions. Subsequent filing (post-ALJ decision) of a new claim is another option provided that there is no DLI (date of last insured) problem and that the subsequent filing sets forth either a new condition(s) or "new and material" evidence not previously considered.
The "AOD" (alleged onset date) is the date from which the claimant represents that he/she became unable to continue working because of disabling conditions. This becomes an important point in time from which to establish the point from which benefits begin (+5 months if SSDI). At the ALJ hearing, the issue may arise from which point the medical records support that the claimant's limitations were well established or implied - and if later than the AOD then the Judge may raise the question of whether there is agreement to "amend onset date" to the date from which the records support the existence of the limitations. Although this raises the issue that less amount of past due benefits would exist, it may be favorable towards a finding of disabled (e.g. a favorable grid rule applicability upon claimant having reached a certain age which is later than the original AOD). Again, the attorney and claimant must discuss implications of this if onset date is to be amended.
"The Vocational Expert is out to get me!" (anonymous claimant)...Although the VE (Vocational Expert) may present some hurdles for a claimant seeking benefits, he/she is not "out to get" claimants. The role of the VE is to identify jobs from the "DOT" that a claimant could potentially still do given his/her limitations and transferrable skills (considering claimant's age, past relevant work and education). If the ALJ (Judge) and lawyer both present a series of hypothetical questions that include ALL the claimant's limitations (physical and mental), then the number of potentially available hypothetical jobs should begin to drastically diminish or result in a conclusion by the VE that there would be NO jobs for someone with all the limitations described in the hypothetical questions. Thus, the real objective becomes more about convincing the ALJ that the limitations included in the hypothetical questions are indeed ones the claimant has.
Sometimes, after all the wait..the claimant arrives late or even misses the hearing..outta luck? If the attorney representative is hired, and a 1696 is filed, it's not the end of the day. The attorney can offer evidence, provide argument, cross examine the experts (medical expert ((ME)) and vocational expert ((VE))..yet, the Judge will require the claimant to show cause why he/she was not there. It may be the case (as happened to us recently) where the client had moved, changed phone numbers, and believed that his hearing was to be held on a different day. As long as the claimant provides a valid reason why he/she was not present and provides testimony for Judge's questions, then all is not lost.
"RFC" stands for residual functional capacity. It is an important term to understand that the SSA uses in the analysis towards whether or not a person is disabled under their definition. Essentially, they are trying to define what the limitations are and resulting type of work they can perform (e.g. sedentary, light, etc). It is not absolutely scientific but an attempt to be specific about limitations (either mental or physical). Examples of physical limitations may relate to how long a person can stand/sit continuously, how much they can lift and how frequently, etc. Click on this link for an RFC form to help document a claimant's physical limitations.
The time that elapses from the point of requesting a hearing to the actual hearing is approximately 16 months. Is there any relief from this agonizing wait? 1) Not objecting to a VTC "video teleconferencing" hearing typically reduces the wait time before compared to a face to face hearing. Claimants can balance that factor against not having the face to face element factor in their hearing. 2) OTR - "on the record" decisions requests are another strategy to obtain a favorable decision without having a hearing. In cases where the medical record is overwhelmingly compelling, this should be an avenue for the attorney to consider. 3) Compassionate Allowance (CAL) - if a claimant's condition has progressed considerably to the point where it meets one of the compassionate allowances conditions, this might provide a fast track towards a favorable ruling.
The questions the judge will ask a claimant at the hearing are predictable. "..Are you able to drive? Why did you stop working on that particular date? Tell me about your typical day." The claimant must show his/her disabling condition prevents him/her from being able to work. The judge looks for a complete picture of how the disabling condition affects the person - why they can't do their past work and daily living limitations. Credibility is key - the judge scrutinizes the claimant very closely during these routine questions. Lawyers can go through these questions to prepare their clients before the hearing; the importance of detailed answers can help make the picture more real.
If one is applying for SSDI (Social Security Disability Insurance), then the term "DLI" (date last insured) is important because it is the date by which one must demonstrate that the disabling condition(s) prevented the person from work. Usually, if one is under 50 and has not worked 5 of the last 10 years at the time of applying for disability benefits, the DLI date may become a critical point of inquiry.
Example: Joe is 39 years old and has a DLI of 2/22/2012. He stopped work in 2/2/2010 (severe back pain) but didn't consistently start seeing his doctor util late 2011 regarding his condition. Demonstrating to SSA that his disabling condition prevented him from work before the DLI may be an issue.