Your testimony gets the same treatment. You can testify honestly and convincingly about fatigue, pain, or anxiety, and an administrative law judge can still discount what you said because other parts of the record look inconsistent with it.

A recent Ninth Circuit case, Yandrich v. Bisignano, No. 25-4027 (9th Cir. Aug. 11, 2026), shows both problems in one decision. It is unpublished and nonprecedential, so it does not bind Social Security judges outside the 9th Circuit (Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Orgeon and Washington). I am writing about it anyway, because in my opinion the rules it applies are national rules that reach every claim in every state.  Thanks to my colleague Adriana de la Torre who wrote about the Yandrich case on her excellent LinkedIn feed.

A strong opinion can be undermined by routine treatment notes

Mr. Yandrich’s attorney submitted favorable opinions from three treating providers – Dr. Jamito, Dr. Wingate, and PA Bolden. The ALJ found all three unpersuasive: they were inconsistent with the “longitudinal record,” including those same providers’ own “unremarkable treatment notes.” The ALJ then credited the opinions of three other sources, Drs. Sacks, Ahn, and Melamed, as better supported. The Ninth Circuit affirmed.

That sequence is the shape most of these cases take. The claimant’s own treating sources lost out to agency sources who never actually treated him, and what beat them was their own charts.

That should worry anyone with a pending claim. An opinion can look airtight in isolation. A doctor writes that you cannot maintain attendance, cannot stay focused, cannot get along with coworkers, cannot finish a normal workday. This seems compelling.  But you can still lose if the ALJ looks at the treatment notes and asks whether anything in them supports those conclusions.

Deference to Treating Sources Ended on March 27, 2017

For claims filed on or after March 27, 2017, Social Security no longer gives special weight to an opinion just because it came from a treating doctor. In cases decided before March 27, 2017, the opinions of long time treating sources were given “controlling weight.”  SSA changed this rule in response to the Erin Conn fraud case and now gives no special consideration to treating sources.

In my opinion eliminating the treating source rule makes little sense and can lead to very unfair results.  But these are the rules we have to live with.

Two factors now carry most of the load under 20 C.F.R. § 404.1520c:

• Supportability asks whether the source backed the opinion up with examination findings, testing, observations, and explanation.
• Consistency asks whether the opinion fits the rest of the evidence, medical and nonmedical.

Those regulations apply everywhere. Courts in different circuits describe their review in different terms, but the underlying vulnerability is identical in every state: an opinion that contradicts the provider’s own chart is an opinion in trouble.

Why your records may look better than you feel

Remember that your medical appointments are scheduled to treat you, not to document a disability claim. It is likely that neither you nor your doctor is thinking about how the note will read to an ALJ three years later.

So the treatment note says you were alert, oriented, cooperative, in no acute distress. The physical exam shows normal strength, normal gait, full range of motion. The mental status exam records normal memory, judgment, speech, eye contact, and affect.

None of that proves you can work eight hours a day, five days a week. But when your chart fills up with normal findings and says almost nothing about your functional problems, an ALJ who wants to deny your case can do so by calling the record inconsistent with a later opinion describing disabling limitations.

The gap is worst with conditions like:

• Chronic fatigue
• Migraine headaches
• Fibromyalgia
• Depression and anxiety
  Post-traumatic stress disorder
• Chronic pain
• Long COVID
• Any condition that flares unpredictably
• Medication side effects

A fifteen-minute doctor’s office visit measures almost nothing about attendance, sustained productivity, tolerance for workplace stress, or reliability across a full week.

Think about how this may play out. Someone with severe social anxiety can be perfectly pleasant during a short visit with a doctor he has seen for years. Someone with chronic fatigue has normal strength sitting on the exam table and cannot sustain activity for eight hours. A migraine patient examined between attacks has a completely normal neurological exam. That is what you would expect. But if the provider never writes down why the normal exam is beside the point, the ALJ will use the normal exam against the provider’s own opinion.

What You Can Do to Help Your Medical Record Reflect Those Crucial Work Activity Limitations

First you should never exaggerate, and never ask a provider to write down something that is not true. What you can do is make sure your provider actually knows how your condition affects your day in the context of how your capacity for work would be impacted.

Doctors cannot document problems they have not heard about. A short appointment goes to lab results, medication refills, and whatever hurts most that morning. If you do not raise your functional limitations, the note will not mention them.

Here is what I tell clients to do.

1. Talk about function, not just symptoms

Do not stop at pain, fatigue, anxiety, or headaches. Say what those symptoms stop you from doing.

• “I can stand about 10 minutes before I have to sit down.”
• “After a shower I have to rest for 20 or 30 minutes.”
• “I lose focus after 15 minutes and have to read the same page again.”
• “Three or four days a month I cannot get out of my bedroom.”
• “When I go to the grocery store, my daughter comes and carries the bags.”
• “My medication makes me sleepy for several hours.”
• “If I go to a family event, I spend most of the next day recovering.”

Those sentences do work in a file. “I hurt all the time” and “I can’t work” do not.

2. Send a short message through the patient portal

If you cannot get it all out during a visit, write it down and send it. Keep it short and keep it clinical, covering things like:

• Your worst symptoms
• How often episodes happen and how long they last
• What sets them off or makes them worse
• How long you can sit, stand, walk, or concentrate
• Whether you have to lie down during the day
• How often you need another person’s help
• Medication side effects
• Anything that has changed recently

Ask the provider to review it and, if appropriate, add it to your history. Do not assume a portal message lands in the formal record automatically. It is worth asking the office how they handle patient correspondence.

Something like this works:

“Since my last appointment I have had severe fatigue four or five days a week. On those days I usually have to lie down two or three times for about 30 minutes. Grocery shopping or going to an appointment leaves me worn out for the rest of the day. I am also very sleepy during the day after I take my medication. I wanted you to know about these problems.”

Describe your experience and stop there. No legal conclusions, and no asking the doctor to declare you disabled.

3. Keep a symptom and activity diary

A diary documents patterns you will never reconstruct from memory in an exam room. Depending on your condition, record:

• Date and time of each episode
• What the symptoms were and how bad
• How long they lasted
• What may have triggered them
• Medications taken and side effects
• What you could not finish
• Extra rest or time lying down
• Help you needed from someone else
• Appointments or activities you missed
• How long recovery took

A migraine diary should show how many attacks per month, how long each one ran, whether there was nausea or visual disturbance, what you took, and whether you ended up in a dark room. A fatigue diary should show how much activity you managed before the fatigue hit, how much rest it took, and whether you got going again later.

Be realistic. A diary where every single day is a 10 out of 10 is a diary nobody believes, especially when the rest of the record shows variation. Write down the good days too.

Bring it to appointments, or send a summary. A one-page summary is more useful to a busy doctor than 40 handwritten pages.  Use AI tools to turn your notes into a bar chart, a pie chart or an easy to read summary.

4. Explain how often the bad days come

Most of these conditions fluctuate, and your office visit may well occur on a good day.

Tell your provider how many good and bad days you get in a typical month, how long a flare lasts, what brings one on, what you can and cannot do during one, whether you can see it coming, and how long it takes to get back to baseline.

Frequency and duration are what matter. “I get migraines” tells an ALJ nothing. “I get migraines three times a week, they last four to six hours, and I have to lie down in a dark room” tells an ALJ about attendance.

5. Give the whole picture on daily activities

If you tell a provider you cook, clean, drive, shop, or take care of a family member, say how you do it. How long it takes. How often. Whether someone helps. Whether you take breaks. Whether you use a cane or a walker. Whether you leave it half done. Whether it costs you the rest of the day.

Making a sandwich is not cooking dinner for four every night. Driving five minutes to the pharmacy is not driving for hours. Left without context, a chart note reading “patient cooks and shops” can do real damage to your case.

6. Report side effects and how well treatment actually worked

Tell your provider if a medication causes:

• Sleepiness
• Dizziness
• Confusion
• Trouble concentrating
• Nausea
• Frequent bathroom trips
• Balance problems

Also say whether the treatment fixed the problem, helped some, helped for a while, or did nothing.

“Improved with medication” reads to an ALJ as a condition under control. If the medication took your pain from a nine to a seven and you still cannot stand for more than 10 minutes, your provider needs to understand that partial improvement is not restored function, and the note needs to say so.

Do not stop a medication or ignore medical advice to make your claim look better. If you cannot follow a treatment recommendation because of side effects, cost, transportation, fear, or your mental health, tell the provider that. An unexplained gap in treatment is one of the first things an ALJ will find.

7. Bring someone who watches you every day

When it makes sense, bring your spouse, an adult child, or a caregiver. They remember what you forget, and they see things you do not notice about yourself: how often you repeat the same question, how often you walk away from a task, how much help you need after twenty minutes of yard work.

The provider runs the appointment. But a second set of observations often produces a fuller history.

One warning here, and it comes straight out of  the Yandrich case. A witness statement that just repeats what you have already said is worth almost nothing. Yandrich’s lay witness testified, the ALJ discounted her testimony because it “largely repeated” Mr. Yandrich’s own claims, and the Ninth Circuit held that the same reasons for rejecting his testimony were good enough to reject hers. When your testimony goes down, an echo of your testimony goes down with it.

So what your witness brings has to be her own. Not what you told her about your pain, but what she has watched: the loads of laundry she finished after you started them, the nights you were up walking the hallway, the family dinners you left after twenty minutes. First-hand observation survives on its own. A restatement of your complaints does not.

8. Ask about function instead of asking about disability

Skip “do you think I’m disabled?” Ask questions your doctor can actually answer:

• “Is my need to switch between sitting and standing consistent with my condition?”
• “Could my medication be causing this much daytime sleepiness?”
• “Would you expect these migraines to interfere with regular attendance?”
• “Are my concentration problems consistent with my diagnosis or my medication?”
• “Should I be restricting lifting, standing, walking, or repetitive hand use?”
• “Can you explain why my exam looks normal between episodes?”

Most doctors are far more comfortable answering medical and functional questions than issuing a verdict on a legal standard they have never read.

9. Read your records and correct real errors

Get copies of the important treatment notes and go through them. Watch for:

• A note saying you denied symptoms you actually reported
• A wrong description of your daily activities
• A note saying medication resolved something when it only helped a little
• A wrong work status
• A wrong frequency for your symptoms
• Copied text from an old visit that is no longer true (I see this a lot)

Under HIPAA you can ask a provider to amend a record you believe is inaccurate or incomplete. The provider can refuse, and in that case you generally have the right to file a statement of disagreement that goes into the record with the note. HHS explains the process for reviewing and correcting medical records.

Keep the request specific and factual. Correcting an objectively wrong statement is one thing. Arguing with your doctor’s medical judgment is something else, and it will not go anywhere.

10. Keep your story straight across the whole file

Social Security compares what you told your treating doctors against what you told the consultative examiner, the physical therapist, the mental health counselor, the ER staff, your private disability insurer, the workers’ compensation carrier, the SSA field office, and the judge. Then it compares all of that against your function reports, your application, your testimony, and your reported daily activities.

That does not mean repeating the same sentence at every visit. Symptoms get better and worse. If your abilities change, say when they changed and why. What you are aiming for is a record that makes sense read start to finish.

A check-box form may not be enough

An functional capacity form (sometimes called an “RFC form”) helps most when the provider explains the reasoning behind each limitation that matters.

Checking a box for “would miss four or more days of work per month” is not enough on its own. The provider should say what symptoms cause the absences, how often those symptoms occur, how long an episode lasts, what findings or treatment history support that frequency, whether the symptoms have persisted despite treatment, whether the medications cause fatigue or confusion, and why the normal office findings do not tell you anything about sustaining a 40-hour week.

When I send a treating doctor a functional capacity form, I am not asking the doctor to stretch the truth. I am asking for the connection between diagnosis, symptoms, treatment history, clinical findings, and specific work-related limits to be written down. Without that connection, the ALJ gets to say the opinion contradicts the provider’s own records.

Your testimony has to fit the record too

The second half of the Yandrich opinion was about the claimant’s own testimony.

Yandrich testified that fatigue and social anxiety kept him from working. The ALJ discounted that after pointing to normal clinical findings and reported activities that looked inconsistent with the limitations he described. The Ninth Circuit held the ALJ had tied the finding to specific evidence, which was enough.

The standard of review for symptom testimony varies by circuit. Social Security’s own policy about how judges must evaluate your symptoms does not: it is described in Social Security Ruling SSR 16-3p, which applies in every state.  A Social Security ruling consists of guidelines set out by SSA instructing decision makers how to evaluate evidence in disability claims.

Under Ruling SSR 16-3p, SSA weighs all the evidence in assessing the intensity, persistence, and limiting effects of your symptoms: objective medical evidence, treatment history, medications and side effects, your efforts to get relief, statements you made to medical providers, what you put on SSA forms, your daily activities, statements from family and friends, and whether your own statements have held up over time.

SSA cannot reject what you say just because the objective evidence does not fully prove how bad your symptoms are. It can rely on genuine inconsistencies between your statements and the rest of the evidence. The difference between those two things is where a lot of cases are won and lost.

Your medical record has to tell one coherent story

Both the medical opinions and the testimony in the Yandrich case failed for the same reason. The opinions went out because they conflicted with the longitudinal treatment record. The testimony went out because it conflicted with clinical findings and reported activities.

A normal exam or a load of laundry does not prove you can work. What it does, when nobody has bothered to explain it, is hand the ALJ a reason to set aside evidence that should have helped you.

A well-built record answers four questions:

1. What symptoms do you have?
2. How do they limit specific work-related functions?
3. What findings and treatment history support those limits?
4. How do you square the apparently normal findings and the daily activities with an inability to sustain full-time work?

Answer those while the claim is being developed. Answering them for the first time in a request for review, after an unfavorable decision, is a much harder fight.

What You Can Learn from Cases Like the Yandrich Case

• A strongly worded medical opinion will not automatically outweigh three years of unremarkable office notes, and an ALJ is not required to accept your testimony just because your diagnosis could plausibly produce the symptoms you describe.
• Do not assume your doctors already know how bad it is. Explain what you cannot do, with specifics. Keep a diary if your condition fluctuates.
• Bring up side effects, bad days, the help you need from other people, and what an ordinary errand costs you the next day.
• Read your records and get the factual errors fixed.

Social Security looks at the whole file. Your diagnoses, your treatment notes, the medical opinions, your function reports, your daily activities, and your testimony all need to add up to the same account of why you cannot hold a full-time job. Yandrich came out of the Ninth Circuit, but the lesson applies in every disability case: favorable evidence persuades when it is supported, explained, and consistent with everything else in the record.

The post How “Unremarkable” Treatment Notes can Sink Your Social Security disability case appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

Every year, SSA produces what is known as a “waterfall chart.”  Not sure what waterfalls have to do with this but this chart shows the approval rates for each stage of the disability adjudication process.  It is interesting to look at the waterfall charts over the past 1o to 15 years where you can see how approval rates have fluctuated.  Generally speaking approvals at initial have remained fairly constant – around 35% of initial applications are approved.  Reconsideration (the first appeal) fluctuates between 12% and 18%.  At the hearing level, however, we have seen approval rates (nationally) as high as 63% and as low as 45% (in 2023). In 2025, hearing approvals averaged 50% nationally.

There are many theories about why approval rates at hearings go up and down.  My own theory is that Social Security administrators are very focused on the state of the Disability Trust fund.  According to a “think tank” called the Bipartisan Policy Center, the Social Security trust fund will become “insolvent” in 2032. This  means that the funds coming in (via taxes) won’t be sufficient to pay benefits.  In theory (and this is unlikely to happen) this insolvency will trigger an automatic cut in benefits of 22%.

Possible Fixes to Social Security Insolvency

At some point – probably at the very last minute – Congress will act and shore up the trust fund by:

• removing or raising the wage limit for payroll tax contributions to Social Security (in 2026 wage earners pay Social Security tax on the first $184,500 of gross earnings)
• raising the tax rate (in 2026 both employers and employees pay Social Security tax of 6.2% of income)
• move funds from general revenue to Social Security
• raise the retirement age – in 2026 FRA or “full retirement age” is 67
• change the COLA (cost of living adjustment formula) to reduce annuala increases to Social Security recipients
• change the requirements to qualify for Social Security disability – for example in 2025 the Trump Administration floated the idea of modifying or eliminating the Grid Rules (Medical Vocational Guidelines) but tabled that idea after significant negative feedback
• increase funding for more continuing disability reviews to terminate disability benefits for claimants where there has been medical improvement
• tightening the definitions set out in SSA’s Listings of Impairments
• increasing funding for fraud investigations

Depending on your political leanings and/or personal economic situation you may find some of these alternatives attractive and others as being totally unacceptable. Which of these changes are adopted will depend in large part on politics.  We are already starting to see proposals for Congressional commissions to study the problem, but I suspect that the real bargaining won’t begin in earnest until sometime in 2031.

In the meantime, the current Social Security Commissioner, Frank Bisignano, is taking steps to reduce staffing costs at SSA (around 20% of SSA staff has been laid off), to use more automation and to centralize continuing disability reviews.  There have also been efforts to reduce the independence of Social Security Administrative law judges so that SSA can put downward pressure on approval rates.

Social Security Changes Driven by Political Forces

I think it is important to look at the 2025 and future waterfall charts in the context of the political and financial realities that  Congress is facing when looking at Social Security.

One final point – Social Security has long been considered the “third rail” of American politics meaning that members of Congress have been reluctant to take any action that might reduce Social Security benefits.  I think this “third rail” argument applies mainly to Social Security retirement.  Organizations like the AARP are hyperfocused on any threats to Social Security retirement and they will mobilize senior voters (and senior voters are more likely than younger voters to cast ballots) against any politician who even implies support of changes to Social Security retirement.

The AARP is not a disability benefits organization and their core mission is directed mostly to preserve Social Security retirement.  There really is no organization like the AARP to focus on the interests of individuals seeking or trying to preserve disability benefits.  In a political sense, therefore, Social Security disability is a much easier target for Congress although I suspect that the AARP and organizations like it would be concerned about the “slippery slope” whereby changes to Social Security retirement could be tossed into a bill focused primarly on Social Security disability.

So, in the context of Social Security’s political and economic realities here is the most recent (2025) waterfall chart. We will break down the meaning of this chart in a future blog post:

The post Social Security’s Future – Turbulent Times Ahead appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

As you may know, Social Security defines “disability” in terms of how your medical problem prevents you from engaging in “substantial gainful activity” or SGA. SGA can mean any activity roughly equal to a 30+ hour per week minimum wage job. The SGA table published by SSA says that in 2026, SGA is assumed if you are earnings $1,690 per month gross (this is equal to just over $20,000 per year).

So if you have the capacity to reliably perform a simple, entry level job like packing ink pens in a box or monitoring a conveyor belt, you could perform SGA and are not disabled. It does not matter to SSA what you did before – if you were a neurosurgeon or nuclear physicist earning $1 million per year, you are not disabled if you could pack ink pens in a box.

If you are under the age of 50, you have to prove to SSA that you do not have the capacity to perform any job that exists in the United States. Not impossible, but very difficult.

However…

When you turn age 50 and even more so at age 55 the rules change dramatically in your favor.

Age 50+ – A Huge Advantage

At age 55, SSA assumes that many entry level jobs would not be available to you because of your age and your chronic health issues.

Workers over age 50 can use the “Grid Rules” to argue to SSA that you are disabled even if you have the capacity to work. I have published an entire website about the Grid Rules called Gridrules.net where you can see how you fit into these regulations.

• At age 50, a worker with marketable skills can be found disabled even if he/she has the capacity to stand and walk for 2 hours a day and lift 10 lbs. occasionally.
• At age 55, a worker with marketable skills can be found disabled even if he/she has the capacity to stand and walk for 6 hours a day, and lift 20 lbs. occasionally.

While the Grid Rules were originally designed to help physical laborers like construction workers qualify for disability, I use this argument when representing teachers, nurses, executives and data analysts.

Limits to When the Grid Rules Apply

There are a few strings that apply to a Grid Rule argument. For example you can only use the grid rules if you have physical limitations. They do not apply if your impairments arise from mental health conditions like depression or PTSD.

Secondly, if you have marketable skills, we would have to prove why they have been eroded – usually we can make a good argument that pain or medication side effects make it all but impossible for you to use your skills and education.

But in my practice my clients and I usually win an approval if the client is over age 55 with physical impairments like chronic back pain, neck pain, hand/wrist pain, knee pain, ankle pain, etc.

The Grid Rules are such a powerful tool that benefits disability claimants that some in Congress want to eliminate this provision in the law.  A proposal to do away with the Grid Rules was floated in 2025 but after public backlash, SSA backed down.  I would not be surprised to see a proposal to tighten or eliminate the Grid Rules to come back in 2026 or 2027. This is why I strongly suggest you take action today.

So if you are struggling with a physical injury that limits your capacity to stand/walk, lift or both, you owe it to yourself to look at the Grid Rules as the basis for a possible disability claim. If you’d like to know how the Grids rules apply in your case feel free to reach out to me asap – click here to contact me.

The post Over 55 with back, neck or knee problems? You are Likely to Win Your Disability Case. Here’s Why appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

Many people assume the Appeals Council is simply a next step in the process—a second chance to tell their story and hope for a different result.

That is understandable, but it is not quite right.

The Appeals Council does not act like a second ALJ. It does not rehear the case, and it does not decide disability from scratch. Its job is much narrower and more technical. In most cases, it is not looking for a better answer. It is looking for a legal mistake.

Understanding that difference can mean the difference between a strong appeal and one that is almost certain to fail.

What the ALJ Does

To understand the Appeals Council, it helps to first understand the role of the Administrative Law Judge.

At the hearing level, the ALJ is the main decision-maker. The ALJ represents the Commissioner of the Social Security Adminstration and serves as both the representative of SSA and the finder of facts in your case.  This is where the case is developed, reviewed, and decided. The ALJ listens to testimony, reviews medical records, weighs medical opinions, and decides what the claimant can still do despite their impairments.

In practical terms, the ALJ is responsible for:

• Deciding which medical opinions are persuasive
• Evaluating the claimant’s testimony about pain and limitations
• Interpreting tests like MRIs and X-rays
• Resolving conflicts in the medical evidence
• Determining the claimant’s residual functional capacity, or RFC

That last step is especially important. The RFC is the ALJ’s conclusion about a person’s functional ability, and it often drives the outcome of the case.

What many people do not realize is how much discretion the ALJ has. Two judges can review the same record and still reach different conclusions. In fact, if you look at the approval rates for judges in the same hearing office, you may find one who approves 75% of cases, while the judge down the hall approves only 25%.  This disparity in outcomes is a topic for a different blog post but it is the reality of the current Social Security disability decision making process.  The ALJ is allowed to interpret the evidence, draw conclusions, and resolve inconsistencies.

That is where the Appeals Council comes in—but not in the way most claimants expect.

What the Appeals Council Needs to See

Once a case reaches the Appeals Council, the question is no longer, “Is this person disabled?”

The real question becomes: “Did the ALJ make a reversible error?”

That is a very different issue.

The Appeals Council does not reweigh the evidence. It does not decide whether it agrees with the ALJ. And it does not take a fresh look at credibility. Its role is limited to deciding whether the ALJ’s decision is legally sound.

In general, the Appeals Council is looking at three things:

1. Did the ALJ apply the correct legal standard?
2. Is the decision supported by substantial evidence?
3. Does the decision contain internal inconsistencies or procedural errors?

If the answer to those questions is yes, the Appeals Council will usually affirm the ALJ’s denial, even if the case was close, and even if another judge might have decided it differently.

When More Than One Answer Is Reasonable

This is where many claimants run into frustration. A case can look strong from the claimant’s perspective and still lose if the ALJ’s conclusion was reasonable.

For example, a claimant may have an MRI showing a herniated disc. He may testify that he has severe back pain that radiates into his legs. He may say that standing, walking, and lifting are difficult.

That may sound convincing. But the record may also include:

• Treatment notes showing a normal gait
• Conservative treatment like epidurals or pain meds instead of surgery
• Medical comments suggesting only moderate limitations

An ALJ might review that evidence and conclude that the claimant can still do light work, such as standing or walking for six hours in a workday and lifting up to 20 pounds occasionally.

Another judge might have reached a different conclusion. But that does not matter at the Appeals Council level. If the ALJ’s interpretation is reasonable, the Appeals Council usually will not overturn it.

That is one of the hardest parts of the process to accept: showing that the ALJ was wrong is not enough. You have to show that the ALJ made an actual error.

Where the Appeals Council May Intervene

Although the Appeals Council gives deference to ALJ decisions, it is not powerless. When there is a clear error, especially one that affects the outcome, it can remand the case.

Some of the most common problems include the following.

Internal contradictions

One of the strongest grounds for remand is when the ALJ’s own findings do not match up.

For example, imagine the ALJ says a claimant is limited to occasional handling and fingering. But then, in the hypothetical posed to the vocational expert, the ALJ includes frequent handling and fingering instead.

That kind of inconsistency matters. The vocational expert’s testimony is only reliable if it matches the RFC. If it does not, the step-five finding becomes shaky. In that situation, the Appeals Council may send the case back for a new hearing with instructions to the juge.

These types of internal contradictions and somewhat obvious mistakes may arise because the judge is not the only person involved in writing the hearing denial.  SSA uses a staff of decision writers, usually located in a different state, to actually write the hearing decisions.  I recently had a former Social Security staff attorney on my Wednesday evening livestream and she explained that SSA gives decision writers very strict time deadlines to draft decisions.  Because decision writers were not actually at your hearing, they are working under time pressure, they have to plow through hundreds of pages of evidence, and they have to use some of the time allowed to listen to an audio of the hearing, mistakes arise.

Judges are also very busy and they sometimes release hearing decisions with obvious mistkaes.

Failure to follow SSA policy and procedure

ALJs must follow specific rules when deciding disability cases. If those rules are ignored or applied incorrectly, the Appeals Council may step in.

This can include:

• Using the wrong standard for medical opinions
• Failing to consider all of the claimant’s impairments
• Skipping or misapplying steps in the sequential evaluation process
• Incorrectly applying the Grid Rules

These are not just disagreements over evidence. They are problems with how the decision was made.

Ignoring important evidence

There is a difference between weighing evidence differently and failing to address it at all.

The Appeals Council will not usually interfere just because the ALJ gave more weight to one piece of evidence than another. But problems arise when the ALJ:

• Fails to even  mention significant and relevant evidence
• Misstates what the records actually say
• Picks out only the evidence that supports denial

When that happens, the issue is not judgment. It is whether the decision is based on a fair and accurate reading of the record.

Vocational Errors

The final step of the disability process often depends on vocational expert testimony, which makes it a common place for mistakes.

Examples include:

• A hypothetical question that does not match the RFC that the  judge found as part of his/her analysis
• Jobs identified by the vocational expert that conflict with the claimant’s limitations
• Reliance on obsolete jobs
• Reliance on jobs that exist in such small numbers that they are not relevant

When those problems occur, they can undermine the denial and justify remand.

New Evidence

Another area that causes confusion is new evidence.

Yes, the Appeals Council can look at new evidence, but only under limited circumstances. The evidence must be new, material, and related to the time period before the ALJ’s decision. Even then, it must create a reasonable probability of a different outcome.

That is a high bar. Simply adding more medical records is usually not enough. The new evidence has to matter in a meaningful way and directly affect the basis for the ALJ’s decision.

How to Win at the Appeals Council

Because the Appeals Council has such a limited role, the strategy on appeal has to change as well.

At the hearing level, the goal is to present the claimant’s story and build the strongest possible case for disability.

At the Appeals Council level, the focus shifts to a more precise question: where did the ALJ go wrong?

Strong Appeals Council arguments usually:

• Point to specific inconsistencies in the decision
• Identify legal standards the ALJ failed to follow
• Show how the error affected the outcome

What usually does not work as well is simply re-arguing the medical evidence or saying the claimant should have won.

The difference between the ALJ and the Appeals Council is not just technical. It shapes the entire appeal process.

The ALJ is the one who decides the case. That is where testimony is weighed, credibility is assessed, and the final disability finding is made.

The Appeals Council has a different job. It serves as a safeguard to make sure decisions are legally correct and procedurally fair.

That is why:

• Strong cases can still be denied on appeal
• Weak cases can sometimes be remanded because of technical errors
• Success at the Appeals Council level depends more on spotting mistakes than rearguing the facts

What Should You Do If You Received an Hearing Denial from Your ALJ?

Your first step should be to discuss the possibility of appeal with your lawyer.  Some lawyers do not handle post-ALJ hearing work at all and may need to refer you to an Appeals Council/Federal Court specialist.  In my practice I usually associate an Appeals Council/Federal Court attorney to work with me in spotting issues for appeal.

You may find that you have to speak with several appellate attorneys to find one who agrees that there are strong grounds for appeal.  Unfortunatley if there are no clear errors of analysis, you may find it difficult to find a lawyer to help with your post ALJ hearing appeal.  You do  have the right to file an appeal with the Appeals Council on your own, but everything else being equal you are much better off if an appellate lawyer will accept your case.

Finally, keep in mind that you have only 65 days (60 day deadline + 5 days assumed for mailing) from the date on the ALJ denial notice to file an appeal.  So you have to move quickly when a hearing denial is received.

The post Denied at Hearing? Why You Shouldn’t Give Up! appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

The rules don’t explicitly say that older workers deserve a different standard. They don’t even acknowledge that aging itself should matter. Yet something fundamental shifts in the disability process the moment a claimant crosses that milestone birthday—a shift from asking what’s possible to asking what’s likely.

This is what I call the “Age 55 Paradox,” and understanding it is essential to navigating the entire disability evaluation process.

Age Alone Changes Nothing in Terms of How SSA Defines “Disability”

Let’s be clear from the start: turning 55 is never, by itself, a reason for approval. The Social Security disability standard remains grounded in medical severity, just as it always has been. This isn’t like Social Security retirement, where you automatically qualify upon reaching a certain age.

To win a disability case at any age, you must still:

• Demonstrate you cannot return to your past work
• Show medically determinable impairments
• Prove functional limitations

Your birth date doesn’t change these requirements. Whether you’re 35 or 65, you must prove that you have limitations in your capacity to reliably perform work.

But here’s where things get interesting: once your age category changes, Social Security’s vocational analysis shifts in a way that rarely gets explained to the public.

What Really Happens at 55: The Vocational Lens Turns Toward Reality

At age 55, Social Security formally classifies you as being of “advanced age.” That label isn’t just cosmetic—it reflects a built-in assumption baked into the system:

Older workers face far greater challenges adjusting to new work.

Once that assumption enters the analysis, several vocational rules move sharply in the claimant’s favor.

The “Grid Rules” suddenly work for you. At light and sedentary exertional limits, a claimant who cannot return to their past work may suddenly fall under a “disabled” grid rule—where a 49-year-old or 54-year-old with the exact same medical limitations would not.
Transferable skills become harder to prove. At advanced age, skills must transfer with almost no vocational adjustment. Even small differences in workplace tools, processes, or environments can defeat transferability.

Non-exertional limitations carry more weight. Pain, fatigue, medication side effects, postural restrictions, manipulative limits, stamina issues, or mental health symptoms shrink the available job base more meaningfully for older workers.

In other words: age doesn’t change the impairment; instead age changes what that impairment realistically means in the labor market.

The Contradictions Hidden in Plain Sight

For all the clarity these age-based rules bring, they also expose deep inconsistencies in how disability cases are decided.

Birthdays create artificial cliffs. The system relies strictly on chronological age. Someone who is 54 years and 10 months may be vocationally identical to someone who is 55 years and 1 day but the rules treat them very differently.

SSA helps older claimants but won’t say so. The grid rules plainly benefit older workers. Yet Social Security rarely frames it this way. Age is publicly described as a neutral “vocational factor,” not a benefit driver even though age changes outcomes more dramatically than many functional findings do.

The rules reflect an outdated economy. The grid rules were designed when the labor market was far more physical and less flexible. Some policy experts argue they’re no longer relevant in today’s economy and influential intellectuals at several Washington, D.C. think tanks are pushing the Trump Administration to remove age as a consideration. Those of us representing real claimants in real life counter that older workers still face the same challenges—or greater ones—when trying to retrain or transition to new fields.

Small details trigger huge outcomes. A one-level shift from light to medium residual functional capacity (RFC), or a minor finding on skill transfer, can completely reverse a case outcome—even when two claimants have nearly identical real-world job prospects.

These contradictions explain why the system feels both predictable and arbitrary, depending on where you happen to fall.

Examples of How Age Impacts Disability Adjudication

A few concrete examples make the paradox unmistakable.

Example 1: Light RFC + Unskilled Work History

Age 54: Denied at step five—vocational witnesses testify that jobs exist
Age 55: Approved under Grid Rule 202.06 or 202.04 with identical limitations

Example 2: Sedentary RFC + Limited Education

For many older claimants, this combination triggers a grid rule leading directly to “Disabled.”

Example 3: Borderline Age Cases

A claimant a few months shy of 55 may still qualify under the higher age category if other factors support it.  Here is a link to the borderline age regulation.

Same medical facts. Same functional limits. Different vocational interpretation—because age shifts how “realistic” job adjustment is presumed to be.

What This Means If You’re Approaching 55

The age rules don’t replace medical findings—they amplify them. This means several strategic elements become critically important for advanced-age claimants:

• RFC documentation must be precise. Small variations in exertional classification have outsized consequences once age 55 enters the picture.
• Work history forms must be accurate and detailed. Skill level, duties performed, tools used—these details often determine whether transferable skills exist.
• Borderline age arguments can’t be overlooked. They can change outcomes in a narrow set of cases, but only when properly raised and supported.

The Truth the System Won’t Say Out Loud

Social Security is designed to make age appear as though it plays only a minor supporting role. But in practice, age 55 is the moment the analysis fundamentally shifts. It stops asking whether an older claimant could theoretically do something new and starts asking whether it’s credible to expect them to succeed in a new field.

That’s the Age 55 Paradox: the rules quietly recognize something that public-facing guidance avoids saying outright: older workers don’t transition the way younger workers do.

And the disability framework finally reflects that reality but only after the medical case is already made.

The post The Age 55 Paradox: How Social Security Quietly Shifts Disability Outcomes appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

I’ll exactly how the borderline age policy works in Social Security disability cases, why it matters, and how strategic use of this rule can significantly increase a claimant’s past due benefits. I have used the borderline age policy in several recent cases without any push back from judges and the net result meant thousands of dollars added to lump sum payments for my clients.

WATCH A SHORT VIDEO ON THE BORDERLINE AGE RULE

What Is the Borderline Age Rule?

The Borderline Age Rule comes into play when a claimant is close to aging into the next higher age category defined by the Social Security Administration (SSA). These categories are:

• Younger individual: 18–49
• Closely approaching advanced age: 50–54
• Advanced age: 55–59
• Closely approaching retirement age 60+

SSA uses these categories to determine how easily a claimant can adapt to other work, which is a critical factor in disability decisions under the Grid Rules (also known as the “Medical-Vocational Guidelines).” I publish a website explaining how the grid rules work – you can find it at https://gridrules.net.

Basically the grid rules change the definition of disability. If you are a younger (under age 50) claimant, in order to win disability benefits you have to prove that you are not capable of reliably performing any job that exists in the United States economy.

After age 50, and even more so after age 55 and especially after age 60, you don’t have to prove as much to win. At age 50 you can win even if you have the capacity to perform sit down (“sedentary”) work. At age 55 you can be found disabled even if you can perform light work.

Light work is defined by SSA as having the capacity to stand and walk for six hours or more per day and to lift 20 lbs. about 1/3 of the day. Lifting 20 lbs. for 2 hours per day is not easy – but under the Grid Rules you can still be legally “disabled” even if you have this capacity.

The grid rules are a great argument for anyone over 50 but especially those over age 55.

Not surprisingly there is a catch to using the grid rules. First you must have a physical impairment – you cannot use the grid rules for mental health issues or non-physical impairments.

Second, and this is critical – you must not have any skills that transfer to a lighter job.

The borderline age rule allows Social Security adjudicators and judges to apply the grid rules even if you have not yet celebrated a birthday that will put you into the next age category. If a person is “within a few days to a few months” of the next category, SSA does not apply the age limits strictly.

Example: How Borderline Age Can Unlock Thousands in Back Pay

Let’s say you are:

• 54 years and 7 months old at the time of onset
• Unable to perform your past relevant work
• Limited to a light residual functional capacity status due to one or more medical impairments
• Unable to use any skills you may have acquired because of distractions due to severe pain (i.e., no transferable skills)

Under a strict reading of the grid rules, you would fall within the “closely approaching advanced age” category at onset. A judge might find you disabled as of your 55th birthday but you would lose out on 5 months of past due benefits.

But if the judge applies borderline age rule and treats you as if you were age 55 then you would meet the grid rule and qualify for that extra 5 months of benefits. If your monthly payment is $2,000 per month, those extra 5 months would put another $10,000 in your pocket.

Further, the borderline age rule can keep you qualified for SSDI if your date last insured has run out. Continuing with our example from above, if your date last insured was 2 or 3 months prior to your 55th birthday, you would not meet the grids at light but applying the grids non-mechanically would mean that you could fit into the grids as of your date last insured, even before actually turning age 55.

In my experience disability adjudicators rarely invoke the borderline age rule independently. Judges sometimes do, but more often than not you have to ask. So if you are just under one of these important age categories, do not forget to argue that the borderline age rule should apply to your claim.

The post Unlock Thousands in Social Security Disability Back-Pay with the Borderline Age Rule appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

Benefits to Current Claimants

Clients already receiving Social Security, SSI, or SSDI benefits will continue receiving payments without interruption. This has been true in all 20 previous shutdowns since 1976, and disability benefits remain funded as “mandatory spending” outside of congressional appropriations.

Pending Claims and Applications

Hearings: The Social Security Administration (SSA) will hold already scheduled disability hearings.

Initial Applications: State Disability Determination Services will continue processing initial claims, but processing speed may vary because each state controls its own staffing and funding during a lapse. Each state must independently determine whether it can maintain operations (pay its employees) during a federal funding lapse. This could lead to some states processing claims more or less as usual, but others, more affected by the funding lapse, may be processing claims more slowly.

Appeals/Reconsiderations: These will continue but probably with reduced support staff, resulting in extended processing times.

Anticipated Service Disruptions

SSA has furloughed about 6,200 employees out of roughly 51,800. However, about 88% of staff remain working on essential functions. This is higher than in prior shutdowns, which should limit disruption compared to 2013.

What we Expect:

Customer Service: Phone wait times will rise; many calls may go unanswered.

• Field Offices: Field offices will continue taking benefit applications and processing post-entitlement actions that impact payments, but with reduced staffing creating longer waits and limited walk-in availability.
• We are already having problems with field office personnel wrongly refusing to speak to us. NOSSCR (an advocacy group of which I am a member) has communicated this concern to SSA and I expect that this particular issue will be resolved within the next week or two.

Documentation Services: Benefit verification letters, replacement cards (except original and replacement Social Security cards, which will continue), and non-claims-related earnings record corrections will not be processed during the shutdown

Medicare Cards: Replacement Medicare cards will not be issued during the shutdown

Online Services: SSA’s online portal will remain operational, but technical support will be unavailable

Overpayment Processing: Suspended for the duration of the shutdown.

Here is a link to SSA’s contingency plan for the shutdown.

Thanks to my friend and colleague Karl Osterhout and to NOSSCR.org for providing up to date information about the impact of the shutdown on SSA operations.

The post What Does October 2025 Government Shutdown Mean for Social Security? appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

In this blog post I will discuss winning strategies that I have used over the past few years to develop a compelling case for benefits based on Lyme disease.

Lyme Disease – the Basics

Lyme disease is caused by a bacteria called Borrelia burgdorferi, transmitted by ticks. While early-stage Lyme disease is well understood, PTLDS is still gaining wider medical acceptance. A recent Johns Hopkins study found that 14% of early-diagnosed patients developed prolonged symptoms such as fatigue, musculoskeletal pain, and neurocognitive impairment. More recently the Wall Street Journal published an article entitled “Chronic Lyme Disease Acceptance Grows Among Doctors After Years of Debate.”

Interestingly, the aftermath of COVID-19 has offered the public and medical professionals a clearer picture of how infectious diseases can lead to persistent, debilitating post-viral syndromes. I believe that this context helps Social Security judges understand chronic Lyme within the broader framework of post-infectious disability syndromes.

Can You Use SSA’s Blue Book of Listings to Win Your Lyme Disease Case?

Unfortunately, Lyme disease is not listed in SSA’s Blue Book of Listed Impairments. However, you can argue that your impairments equal a listed impairment. The listings I most frequently look to include:

• Listing 14.02 (Systemic Lupus Erythematosus)
• Listing 14.09 (Inflammatory Arthritis)
• Listing 11.17 (Neurodegenerative Disorders) –  if neurological involvement is well documented

In order to show that a Lyme case equals one of these listings, you would have to provide well-supported medical opinions which clearly explain how the combination of your symptoms is functionally equivalent in severity to the criteria of a listed impairment.

In my experience State Agency adjudicators are usually not very receptive to the argument that Lyme Disease equals one of these listings. While I have had some success making this argument to an Administrative Law Judge at a hearing most judges will decide Lyme cases under a functional capacity analysis.

How Do You Win a Disability Case When There are No Objective Tests to Assess the Severity of your Lyme Symptoms?

Lyme Disease cases pose a challenge because there are no objective tests like MRIs or CT scans to assess the severity of your symptoms. While there are tests to confirm that you have Lyme, these tests do not offer your doctors any insight as to the symptoms you might be experiencing.

By contrast, in a back pain case, an MRI showing a herniated disc with spinal cord compression can be associated with symptoms of back pain and radiating pain and numbness into the legs. There is no such test to assess Lyme symptoms.

Currently doctors identify symptoms based on what you report – in other words the evidence of your functional impairment is subjective, not objective. Social Security disability decision makers are much more comfortable approving cases where there is clear objective evidence of functional impairment.

SSA evaluates disability based not on your diagnosis, but on how symptoms impair your functional capacity. This is the essence of the residual functional capacity (RFC) determination under SSR 96-8p, which requires a function-by-function analysis of what the you can still do, despite your limitations.

For PTLDS, common limitations often include:

• Inability to sustain attention for extended periods
• Severe fatigue leading to frequent unscheduled breaks
• Sensory issues, like light or sound sensitivity
• Chronic pain interfering with manual dexterity or mobility

Under SSA law, disability judges are required to consider how symptoms of “invisible illnesses” like Lyme Disease wax and wane over time by reviewing the entire medical record. Further, Social Security Ruling 16-3p requires adjudicators and judges to assess the “intensity, persistence, and limiting effects” of symptoms based on the full record.”

This is why it is so important for you to visit your doctor regularly, seek treatment with a specialist, and follow all recommended treatment. While it may seem futile to continue to visit your doctor when there are no effective treatments for your Lyme symptoms, SSA expects to see a “paper trail” of treatment records if you hope to win.

What Can You Do About SSA Consultative Examinations that Cast Doubt on Your Credibility?

SSA often orders consultative exams (CEs), which may last only 15–30 minutes and lack access to long time treatment records. In years past, SSA was required to give more weight to the opinion of a treating physician over that of a CE doctor who saw you for less than an hour. However, SSA eliminated the “treating source” rule and now adjudicators and judges can deny a claim based on the report of a CE physician or even a non-examining medical consultant over the opinion of a doctor who has treated you for 15 years.

In my experience State Agency adjudicators will rarely approve an “invisible illness” case if there is a CE report that minimizes your symptoms. However disability judges usually recognize that a long time treating physician – and especially the opinion of a specialist – almost certainly has more value than the observations of a storefront industrial clinic doctor who saw you for a CE. Most judges also recognize the limitations associated with a 30 minute CE appointment.

In cases where I have to rebut the conclusions of a CE doctor I focus on

• CE’s failure to consider claimant’s full history
• Inadequate testing (e.g., no neurocognitive screening)
• Lack of familiarity with Lyme/PTLDS-specific functional effects

Arguing for Approval Under a Functional Capacity Theory of Disability

If you are under the age of 50, in order to win you have to prove that your “residual functional capacity” has been so eroded that even simple, unskilled entry-level sedentary work would not be possible because:

• You would be off-task more than 15% of the work day
• You would miss more than one to two work days per month
• The combined effect of your symptoms and medication side effects would not allow you to physically or cognitively perform the duties of a simple job.

At hearings, disability judges bring in vocational witnesses to answer hypothetical questions about your capacity to reliably perform a simple, entry-level, sit down job.

Since judges know what factors will prompt a vocational expert to identify jobs that exist for any set of factors included in a hypothetical question, it is easy for a judge who wants to deny your claim to create a hypothetical question that supports a denial.

In my experience it has been increasingly difficult for anyone under age 50 to win disability benefits and this is especially the case for those pursuing benefits based on subjective reporting of symptoms, which is the case in Lyme Disease. Therefore if you are under the age of 50 there needs to be extensive treatment records documenting truly severe symptoms. Further judges will expect to see evidence of visits with specialists and unsuccessful trials of various treatments.

If you are over the age of 50, and even more so if you are over the age of 55, the odds begin to shift in your favor.

Because Lyme Disease can and often does produce symptoms that limit you physically, you can argue for disability under the Grid Rules as well as a functional capacity argument.

In several recent Lyme cases I have successfully argued that Grid Rule 202.06 applies because Lyme, especially cases where treatment was delayed, can cause both physical and cognitive limitations and negate any transferable skills.

While it is always helpful to have treatment records from specialists in the file of a 50+ claimant, there is an unspoken bias in the SSD system in favor of older claimants. Although the grid rules only apply to cases where there are physical (exertional) impairments, your over 50 status will help you even if your primary Lyme impairments are cognitive or fatigue based. SSA recognizes that claimants over the age of 50 with a significant medical issue will have a very difficult time finding a new job.

Use Non-Medical Evidence to Strengthen Your Case

Lay evidence from family, friends, or (especially) former coworkers—submitted via the SSA-3380 form or narrative statements using form SSA-795 can strengthen your case.

These third-party statements are particularly effective in documenting:

• Daily fatigue and need for rest
• Difficulty with memory, attention, or completing tasks
• Mood changes or social withdrawal
• Changes in personal hygiene, routine, or mobility

Without question, SSA makes it difficult to win disability benefits because of symptoms associated with Lyme Disease. However, it has also been my experience disability judges uniformly recognize that Lyme Disease is a real and legitimate ailment so the challenge is to prove that your symptoms create a work preclusive level of impairment.

So if you are struggling with symptoms associated with chronic Lyme Disease and do not have the stamina or mental capacity to hold a job, the disability option may be a viable path forward.

The post Winning Social Security Disability Claims for Lyme Disease: What Works for Me appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

In this post, I will explain what a CDR is, how the process works, the strategic decisions you must make if you receive a notice of intent to terminate benefits, and how ongoing medical treatment is your strongest line of defense.

What Is a Continuing Disability Review (CDR)?

• The passage of a designated review period (SSA puts a code on every claim classifying it as one where medical improvement is likely, possible, or not likely at all. If your claim is coded as “medical improvement is likely’ you will be reviewed often.
• Your age – in my experience claimants over age 50 generally face fewer reviews than those under 50
• A tip or report suggesting medical improvement.
• Your return to work (remember that the IRS shares earnings record information with SSA).

SSA uses two types of reviews:

1. Long Form Review: This involves collecting and evaluating updated medical records. SSA may send you forms like the SSA-454 (Continuing Disability Review Report) and SSA-827 (Authorization to Release Medical Information)*.

2. Short Form Review: A less intensive review using the SSA-455 (Disability Update Report). Based on your responses, SSA may decide to continue benefits without a full review.

What Happens If SSA Moves to Terminate Your Benefits?

If SSA determines that you are no longer disabled, they will issue a Notice of Cessation, which is letter explaining the termination of your benefits. From the date of the notice, you have:

• 60 days to appeal** by filing a Request for Reconsideration of the cessation.
• If you file your appeal within 10 days, you can elect to have your benefits continue during the appeal process by completing form SSA 792.

This decision – whether to continue benefits during appeal or not –  is perhaps the most crucial choice you’ll face in the CDR process.

Should You Elect to Continue Benefits During Your Appeal?

Pros of Continuing Benefits:

Ongoing income: Disability benefits often cover essential living expenses like rent, food, and medical care. Electing to continue benefits can provide a financial lifeline while your appeal is pending.

Cons of Continuing Benefits:

No past-due benefits: If you win your appeal after electing continued benefits, there will be no “past due” lump sum for an attorney to receive as a fee. This creates a significant barrier to hiring a lawyer under a traditional 25% contingency fee. More specifically you would have to pay a lawyer several thousand dollars up front to represent you in an overpayment case

Risk of overpayment: If you lose your appeal, you will be responsible for repaying all benefits paid during the appeal period which can add up to tens of thousands of dollars over one to two years. Currently this type of overpayment is dischargeable in bankruptcy but that is not an ideal solution for many people.

Medical Treatment: Your Best Defense Against a CDR Termination

The most effective defense against losing benefits during a CDR is consistent, documented medical treatment. SSA’s decision to continue or terminate benefits is based on whether your condition has medically improved and they need medical records to evaluate that question.

Here’s Why Ongoing Medical Care Is So Important:

1. Creates a Strong Paper Trail: Regular treatment generates continuous, dated records.

SSA uses the term “longitudinal treatment record” when it refers to on-going assessments and treatments of chronic and worsening symptoms, treatment resistance, or permanent limitations.

2. Supports Functional Limitations:

Doctors’ notes, physical therapy evaluations, pain management reports, and mental health notes can all document how your impairments limit your daily functioning.

3. Demonstrates Credibility:

In my experience, SSA is more likely to believe a claimant who actively seeks care than one who goes months or years without treatment. My experience has been that Social Security equates no treatment with no problems. SSA does not care that you can’t afford treatment or that there is nothing that a doctor can do for you – if you do not go to the doctor, SSA will assume that you are not going because your medical problems have resolved.

4. Refutes “Medical Improvement”:

To terminate benefits, SSA must find that there has been medical improvement related to your ability to work.  A detailed and thorough medical record showing ongoing or worsening impairments undercuts this conclusion.

5. What You Must Do:

• Don’t skip appointments: Missing care, even for understandable reasons like lack of transportation or money, weakens your case.
• See specialists: The more qualified the provider, the more weight SSA gives their opinions.
• Keep a treatment journal: Note your symptoms, how your conditions affect your activities, and any medication side effects. This information can be shared with your providers and SSA.
• Ask your doctors to complete functional capacity forms. These forms identify specific activity limitations associated with your medical condition and can be very persuasive to SSA. Here are two sources of free FCE forms you can use:
  • Mike Murburg’s FCE forms
  • HowToGetOn FCE forms

Practical Tips for Dealing with a Notice of a Continuing Review

1. Respond Promptly: Whether you receive a mail-in form or full CDR paperwork, respond quickly and accurately. Failure to respond can result in an automatic cessation.

2. Organize Your Records: Keep copies of all medical visits, test results, prescriptions, and therapy sessions. Being proactive helps your attorney (if you have one) prepare a strong defense.

3. Be Honest: Exaggerating your symptoms can backfire. SSA reviews your activities and may use surveillance or social media to challenge your statements.

4. Understand the Timeline: Reconsideration decisions can take 6 to 12 months. If denied, the appeal proceeds to a hearing before an administrative law judge, which can take another 12 to 18 months. Be prepared for a long process.

How Can an Attorney Help You Avoid CDR Problems?

If you have been approved for disability benefits and SSA has not contacted you about a possible CDR, there is really no need hire a lawyer. As noted above your best course of action would be to continue going to the doctor, keeping a symptom/pain journal and keeping copies of your medical records.

If you are thinking about trying to return to work full time or part time, your attorney can be a good resource for understanding SSA’s trial work period and substantial gainful activity income limits.

I am happy to answer questions from my past clients about post-approval work activity at no charge. This is part of my on-going responsibility to my client base.

I also sometimes hear from disability claimants who I did not previously represent who have questions about CDRs. I try to answer questions from non-clients in blog posts or on my weekly livestream, and I am available for consultations for a nominal fee.

Final Thoughts: Plan Ahead and Stay Vigilant

A Continuing Disability Review is not something to take lightly. SSA may only review your case every few years, but when they do, the consequences of not being prepared can be severe. Choosing whether to continue benefits during appeal and ensuring ongoing medical care are two pivotal factors that can determine the outcome of your case.

If you are receiving disability benefits, the best time to prepare for a CDR is now. Stay engaged with your medical treatment, document your limitations, and keep your contact information current with SSA. If you do receive a CDR notice, act quickly and contact your lawyer for help navigating this complex process.

The post Continuing Disability Reviews – What You Need to Know appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

Most of the LTD policies I see are company provided. These company sponsored policies are sometimes called “ERISA policies” because the rules that govern how they are administered are set out in a federal law called the Employee Retirement Income Security Act of 1974 (ERISA).

If you worked for a company that gave you the option of purchasing short term and long term insurance as a payroll deduction, you almost certainly have an ERISA policy.

Under the terms of your ERISA policy you are required to apply for Social Security disability if your LTD claim is approved. Why? Because the insurance company has the right to offset what it pays you by what you receive from Social Security.

Here is an example – let’s say that your LTD policy pays you $2,500 per month if you meet the insurance company’s definition of disability. If your Social Security disability benefit is $2,000 per month, then the insurance company will reduce what it pays you to $500 per month since SSA is paying $2,000.

Your monthly payment remains at $2,500 per month but it will come from two sources instead of one.

You Do Not Get to Keep Your Social Security Disability Lump Sum Payment

Unfortunately this offset also applies to the lump sum payment that SSA will send you for past due benefits. Assuming that the onset date for Social Security disability was after the start date of your LTD payments, the insurance company will require you to turn over your lump sum payment when you receive it.

Needless to say, it is very upsetting to receive a check in the mail from SSA in the amount of $30,000 for past due benefits, only to have the LTD carrier demand that you turn that payment over to them.

Their argument, by the way, is that your monthly premiums were kept low by the expectation that your Social Security disability payment would reduce the insurance company’s obligations.

The Insurance Company Will Pay Your Legal Costs in Your Social Security Disability Case

The only positive element to this arrangement is that the LTD carrier will not require you to repay the portion of your lump sum that was used to pay your Social Security attorney. You will not have to pay back money you never received.

So if your total past due payment was $24,000, and SSA paid your attorney 25% ($6,000), the insurance company will ask you to pay them back $18,000, since that is all that you actually received.

In essence, therefore, the LTD carrier ends up paying your legal fees to win your Social Security disability claim.

Why Bother Filing for Social Security Disability at All?

Why, you may ask, should you even bother filing for Social Security disability if winning will not change what you receive each month?

There are two answers to this question.

First, you don’t really have a choice – the LTD insurance company will require you to file for Social Security disability. If you refuse they can cut you off completely.

Second, winning Social Security disability does give you a margin of safety. LTD companies can be aggressive when it comes to finding a reason to cut you off. They may claim medical improvement. They may base a termination on an absence of medical treatment. Further, many LTD policies change how they define “disability” after one or two years.

I have seen policies that define disability in terms of your inability to perform the duties of your own occupation for the first two years, then it changes to “any occupation” thereafter. I have also seen policies that limit payment to one year or two years if the underlying medical issue is mental health.

If you have Social Security disability in the “background” you are protected from arbitrary decisions by the LTD carrier.

Further, your Social Security disability payment will include cost of living increases and you will become eligible for Medicare.

So, while the advantage to you in winning Social Security disability may not seem important now, it actually can a vital safety net be down the road.

Should You Let the Insurance Company Choose Your Social Security Representative?

Finally, what should you do if the insurance company offers to provide you with a representative to assist with your Social Security disability claim? Should you agree to use their representative or choose your own?

In my experience, the companies that LTD carriers make available to LTD claimants are non-attorney representative companies who employ case managers to process your claim along with hundreds of others. The biggest complaint I hear about these non-attorney rep firms has to do with communication – you will typically have to go through a voice mail tree to reach a live person.

Further, to my knowledge, none of these non-attorney rep firms actually try cases. They hire contract lawyers to appear at hearings – I know this because in the past I did contract hearing work for several of these companies. At that time, the non-attorney rep firm would pay around $450 to $500 for a hearing. Typically I would get a file two or three weeks prior to the hearing and I would review the file and appear at the hearing.

I think that the bigger concern is one of confidentiality. Remember that the LTD company will be looking for a way to cut you off. By hiring one of their agents (remember these are non-attorneys who are not subject to rules about client confidentiality) you are making available to the insurance company all of your medical records. Further, any communication you make to the non-attorney rep firm becomes part of your file and can be used against you.

The good news is that every LTD insurance company I have dealt with has no objection if you choose your own attorney. Further, if you sign up with a non-attorney rep firm but later choose your own attorney the non-attorney rep firm will withdraw.

In my opinion any representative working on your disability case should be focused on one thing – helping you, and not serving the interest of an insurance company. This is my opinion – others may disagree.

Takeaways…

• So, what you can takeaway from this post is as follows:
  most long term disability policies require to you file for Social Security disability
• if you win your Social Security disability case you will almost certainly have to repay any lump sum you receive back to the insurance company
• the long term disability company will not make you repay the portion of your lump sum used to pay your Social Security disability attorney, so, in essence, they will be paying your legal fees
• you are not bound to use the non-attorney rep firm that your LTD carrier may offer you

The post Why Your Long Term Disability Insurance Company Can Demand That You Turn Over Your Social Security Disability Lump Sum Payment appeared first on Social Security Disability | Expert Help | Free Case Evaluation.