Appealing a Social Security Disability Claim decision

In response to the post before this one (Social Security Disability Notice of Award Question), another comment was left and another issue raised. Here are the comments and the response that follows immediately after. (Note: for more information on appeals can be found at Social Security Disability appeals).

"I recently appealed my disability onset date after being approved at initial application (and review at the DQB); there is a six month time difference. I appealed because they did not request all of my medical records in making the initial determination (I supplied as many as I could, but it became very expensive!). On reconsideration, my onset date was changed at the local office but denied at the DQB and I'm now trying to decide if I should pursue it to the ALJ level as my disability case itself has now withstood what amounts to 4 reviews (initial approval, DQB, recon, DQB) and I'd just like them to look at the onset date. The other thing is that the letter I received after the most recent DQB review fails to recognize a key set of medical records that I'm not sure they considered. It is a difficult decision but affects medical insurance and is a significant amount of money."

When I first read your question, I almost had to wonder if the question was being posed by a disability attorney or a disability claimant. Simply because Social Security Disability examiners and claims representatives are not really allowed to inform disability claimants of any decisions sent to disability quality review and disability claimants do not receive this kind of information in their decisional notices.

However, in response to your question, the choice to pursue an onset appeal is always in the hands of disability claimants and/or their disability representatives. It is impossible for me to advise you to pursue your onset appeal or to refrain from doing so. I can only say that every time an individual appeals an onset date they take the chance of having their disability claim decision reopened to a denial.

With regard to "key evidence", I would suggest that often disability claimants consider certain pieces of medical evidence as important indicators of their disability, when in actuality disability examiners and for that matter administrative law judges do not.

You did not state in your question if you actually provided Social Security with your key set of medical records. If you did, then disability quality review examiners most likely considered them in their determination. If you did not provide those records, I am not sure why you acquired other medical records and not those that you deem key to your disability onset.

Of course, a change of onset does make a difference in monetary benefit back pay and the date of Medicare entitlement. And as you stated in your question your disability claim has stood four other reviews.

The decision to pursue this to an administrative law judge has to be your decision, however you should consider this: your disability claim has never been reviewed by an administrative law judge. Even though you only wish them to consider the time frame between your alleged date of disability onset and their established date of onset, they are going to examine the entire disability claim when they make their disability decision.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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