SSA medical issue

[southerner]

chris said:

The "grids"?

The Grids refer to a portion of the regs which reflect various characteristics (age, education, PRW (past relevant work) experience, and RFC (residual functional capacity)).

Basically, they are broken down into various factors. Age goes from younger individual (YI), closely approaching advanced age (CAAA), advanced age (AA), and close to retirement age. Education is marginal (up to 6th grade), limited (7th-11th), and high school (12th or GED), or greater. PRW can be unskilled, semi-skilled, or skilled. An additional consideration is transferability of skills. RFC can be sedentary, light, medium, heavy, or very heavy, as well as any range inbetween.

By fitting an individual into a specific grid or rule, a finding of disabled or not disabled is warranted. For the most part, this includes an RFC for sedentary, light, and medium which relates to Tables 1, 2, and 3, respectively. When significant non-exertional restrictions/limitations are involved, or when an RFC may fall inbetween and different results would occur, or the issue of transferability of skills is at issue, a VE could be particularly useful.

As noted by a previous poster, it is not always possible to fall into specific rule criteria, so it is more the exception to apply a rule than not.

It is more involved than this, but this is a simplistic explanation.

[hooligan]

The GRIDS are also referred to as the medical-vocational guidelines. They are generalizations that are intended to bring a degree of standardization to the decision making process. There are two that tend to be the most critical.

If a person is limited to sedentary work and unable to return to a previous occupation or one where learned skills would transfer, there are presumed to be jobs until the person reaches age 50. GRID 201.14 directs a finding of disabled for an individual age 50 with a high school education, limited to sedentary work and unable to transfer skills to sedentary occupations.

The same mechanism applies to GRID 202.06 if the individual is age 55 and limited to light work with no transferability.

Most of the other GRID rules suggest that the individual would be not disabled unless there are additional non-exertional factors. Typical factors that would preclude work include the inability to sustain an 8 hr day on a regular basis; an excessive number of unscheduled breaks during the day; less than occasional use of both upper extremities; marked limitation in the ability to maintain concentration, persistence or pace.

[johnthornton]

If you are outside the system, I know all of this looks like Gobbledygook. Rest assured that the instructors at the ALJ training course are very good and you should have a good understanding of the Grids by the time you report to work in your Hearing Office.

[ruonthelist]

John T makes a good point. Those of you who do not work in the field now will probably get very little out of the discussion of grids, VEs, and SSRs. I know I wouldn't have when I was in the interview stage. However, after you have had the training course you may find it useful to come back and re-read these threads.
Good luck in the New Year as you get ready for your interviews.

[chris]

While I don't understand eveything that has been discussed, it has been a very interesting discussion and my thanks to all.

[yogibear]

Let's take it back a step. I just would like to clarify. Y'all have good insights, and experience is different than black letter regulations, but I need to point out that VEs are way down on the sequential evaluation.

First, you need a complaint. No complaint, no consequent limitations can be found, even if there is a diagnosis.

Now, say complaint is generalized pain. Vague. Now you need a diagnosis by a medically acceptable source...meaning mainly MD, Ph.D. If Nurse practitioner diagnoses fibromyalgia...doesn't fly according to black letter law. You have various avenues to deal with this problem and get an acceptable medical opinion for diagnosis, if you believe claimant is credible (interrogatories to treating MD, CE, etc). In reality, this problem rarely arises, but I've seen it. However, the ALJ can be and should be guided on their analysis and findings on the claimant's "crediblity."

After you have a DX, then you can look to all medical sources non-medical sources to determine what you believe is the nature and severity of the claimant MDIs, with different weights attached to the sources and depending on multiple factors.

Another Example: Usually, the MDI issue arises because a claimant who has multiple impairments heard something or concluded something on their own, say that they were hypoglycemic, then they next question this or tell another doctor that they have a history of blood sugar problems...diabetes is recorded. THe claimant then repeats a diagnosis of diabetes, but they do not have diabetes, never get treated for diabetes and it's only a notation on the ambulance run sheets, er reports and noted in medical history. I've seen it with asthma and allegeries. You need to weed out and clarify the allegations, the MDIs and the nature and severity of the consequent limitations.

Supposed claimant reports generalized pain and there is an MRI of degenerative disc disease, but he/she talks about right foot pain and thigh pain mostly...subjective complaints and objective tests to support pain complaints. There is not much else in the record, so the ALJ considers the nexus between the allegations and MDI (medically determinable impairments), and makes a "judgment." Most ALJs would accept this nexus and continue on through the sequential evaluation.

Then you go on to consider severity, listing levels and then medical vocational factors (VEs come in here). Pain and VEs are talking apples and oranges. VEs receive a hypothetical from the ALJ identifying what they can and cannot do physically and mentally with age, education and work experience in the mix....any information about diagnoses is extraneous.

That's it in a nutshell, but it's never that simple. However, many allegations can be dealt with at the MDI and severity step. You'll all get training on this.

Hope this helps.

[southerner]

I agree with yogi as to MDI substantiation when there are vague or undocumented allegations.

As to ultimate disposition, however, the Fifth Circuit has been more concerned as to a severe impairment (2nd step of sequential). If there were even some substantiation or non-medical corroboration and it might (not does) impact ability to to perform SGA, we have learned that a non-severe denial likely will not fly. This circuit does not favor non-severe denials. As such, from a practical basis, those types of denials are few and far between. As a matter of course, most ALJ's proceed to the next step in my office.

[yogibear]

Thanks Southerner for adding your experience and knowledge about your Region/Circuit. Just an FYI to others out there; Southerner brings up a good point. There are definitely some Circuit Court decisions that have an impact on the analysis under the sequential evaluation. I'm from the East Coast, but we've had transfer ALJs from the West Coast/California where there are some Circuit Court differences in the analysis. But you will definitely be informed about those variations. And you will learn or be told what has been found "to fly" in your Region or Circuit on appeal.

[privateatty]

I think I know what Deltajudge is saying, but not in the same context. I've dealt with many many scores of "VE(s)" outside of SSA cases as I know nothing about SSA. Crossed them and shamelessly lead them--when I could get away with it (some really need to be lead).

Vocational rehabilitation counselors go to school for the most part to help injured workers go back to work. Instead, most of them become evaluators, and are chagrined to find that they often have to "play to get paid"...now don't misunderstand me, most are very honest and respectable people, but they gotta know what side of their bread is buttered. And yes, there is alot of subjective testimony an expert can offer. Often, they can be more subjective than a psychologist. How do you measure effort--by a functional capacity evaluation? Many know nothing about manual work and pretend that they do. Sciatica? An Italian opera.

3OW is right too, more expert testimony (presuming that they have the resume to back that up) would help the record and relying upon one shores it up immeasurably from my perspective. If I am so lucky to become an ALJ, I would look the VE in the eye and ask a few questions--because its just not the credibility of the Claimant I'm interested in.

[morgullord]

To get a better understanding of what vocational experts should be providing to you at a hearing, read Social Security Ruling 00-04p. You can find this Ruling on the SSA website: www.ssa.gov.

[oldtimer]

Instead, most of them become evaluators, and are chagrined to find that they often have to "play to get paid"

Although some judges may try to "game" the system in order to obtain a particular result, if you follow the rules, there's no "pay to play" aspect; the VEs (and MEs) are maintained by each office on a roster and assigned in rotation as needed. In other words, you don't say (knowing that she ALWAYS finds jobs), "I want VE Jane Doe for this hearing," but, instead, "I want a VE," and your scheduler arranges for whomever is up next and available on that date.

This is something you should be aware of in advance and, more importantly, accept in advance: don't decide before the hearing whether or not a claim is going to be paid and schedule accordingly, e.g., you want to deny a claimant with psychiatric impairments who also is a drug addict, so (contrary to the rulings and SSA policy) you don't schedule a VE (who might opine that a claimant with these limitations cannot perform past work or other work), or you attempt to schedule a VE whom you know will certainly identify jobs for the claimant. Just play by the rules and do your job properly (or, more bluntly, on occasion, "just hold your nose," no matter how "odious" the claimant might be.

[deltajudge]

Oldtimer, you know that the slate of VEs selected by whatever ODAR are periodically evaluated by the ALJs at the request of the office management. For this reason, it doesn't take long for a savvy VE to evaluate the individual ALJs in the office, i.e., hipay or lopay, hence they tailor their testimony accordingly so as not to be dropped from the slate at the next round of evaluations. That's why I had little faith in VEs.

[yogibear]

VEs have input into a very limited issue and their opinions are qualified by the Grid which further accounts for age, education and work experience. The ALJ determines whether their responses are consistent with the DOT (SSR 00-4p). Furthermore, the ALJ knows/.should know what types of limitations will result in a finding of no significant jobs in the national economy from his/her growing experience with VEs, and the ALJ determines what a significant number of jobs is with some guidance in the Courts.

The ALJ can use multiple rulings (i.e., 85-15, 96-8p and 96-9p for starters) to make a finding of disability without VE input. But VEs are scheduled, because sometimes it's hard to predict the most accurate RFC without the actual hearing or you may need the VE to clarify PRW.

I don't think it's accurate to use the term "pay or play" in reference to VEs. When used properly VE testimony ties a case (favorable or unfavorable ) up nicely for a legally defensible decision. But the ALJ determines too many issues for the VE to get away with any "pay or play" approaches to their job.

[oldtimer]

Oldtimer, you know that the slate of VEs selected by whatever ODAR are periodically evaluated by the ALJs at the request of the office management. For this reason, it doesn't take long for a savvy VE to evaluate the individual ALJs in the office, i.e., hipay or lopay, hence they tailor their testimony accordingly so as not to be dropped from the slate at the next round of evaluations. That's why I had little faith in VEs.

I'm still not following. Yes, we are requested annually to evaluate the VEs, so management knows whether or not to renew their contracts. But how does it then follow that a VE would learn whether or not an ALJ is "hipay" or "lopay"? For that matter, how would a VE know whether a particular ALJ had "voted for him/her" (as opposed to, at best, simply knowing that a majority of judges had voted to renew his/her contract)?

Unless an ALJ either "cross-examines" a VE and clearly indicates disbelief with his/her responses, or simply tells the VE off-the-record that he/she is "wrong," I just don't understand how a VE knows this information. For example, I ask at least 2 hypotheticals, ranging from the DDS RFC to assuming that, in effect, all the claimant's testimony was credible; as a result, no one, not the claimant, attorney, nor VE, upon leaving the hearing room, knows which hypothetical I'm planning on adopting and hence what my decision is.

Failing to use a VE when required, especially when the decision is unfavorable, not only makes the decision difficult to write, but also makes the decision indefensible.