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Post by prescient on Oct 20, 2014 23:09:45 GMT -5
What percentage of cases are remanded because the ALJ did not understand the medical evidence? I have never seen or heard of one. Congress could have required doctors instead of lawyers on appeal from the initial denial, but has chosen to go with lawyers all these decades, opting for an understanding of the intricacies of due process over the medical aspects of the case. The folks at the AC and all the Art. III judges who hear appeals from ALJ decisions are lawyers, not doctors. The COSS is neither. The vast majority of the cases involve the same common ailments: DDD, HTN, DM, CAD, obesity, arthritis, COPD, CTS, MDD, ADHD. Very few cases are any kind of complicated medical mystery. I have had a couple of those, where, despite concerted efforts, the doctors were at a loss to understand and/or treat some obscure illness, a very few cases among thousands. Those cases were actually easier because the quality of the medical record was unusually excellent. All the ALJs I know are very adept at understanding the medicals. I'm not talking about knowing what the impairments are. As I clearly stated before, what people who don't have extensive experience in either treating or evaluating medical records lack, is what the effect these impairments have on a claimant's residual functional capacity. Failure to formulate a proper RFC is one of if not the #1 cause of all remands. Please explain what is the basis for your finding that a person with impairments X, Y, Z, can do sed/light/medium etc work? Even in SSA hearings, we don't let VE's testify unless they've been certified as an expert in vocational information. And if they attempt to testify to matters that differ from the DOT, reps and/or judges rightly question them to provide the basis for their opinion, no? I know if I were a claimant, it would be infuriating to learn that the person denying my claim has absolutely no medical background. And to compare an ALJ to an article III judge is pretty laughable. At least in the real courts, you have extensive briefs from both sides clearly articulating their position on the issues. In SSA land, you have the claimant's testimony and his rep's argument. In an SSA hearing, there is no "opposing" attorney who has briefed the issues for you. It's all on you (with some assistance from the writer) to defend your decision.
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Post by gary on Oct 20, 2014 23:18:31 GMT -5
To think that Article III courts always have "extensive briefs from both sides clearly articulating their position on the issues" is a bit idealized. Sometimes they do; sometimes not so much.
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Post by ALJD on Oct 21, 2014 0:10:56 GMT -5
Civilized discourse please. Address the issue and stay away from outright personal attacks. First and last warning in this thread. Next violation gets permanently moderated by yours truly. Thanks.
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Post by Deleted on Oct 21, 2014 0:30:22 GMT -5
Good point, but it sure would be nice if the judges they picked were always attorneys who have a gift for working with legal-medical analysis. It's not fun to see a decision from a judge who flat out does not understand the medical evidence. Couldn't there be testing on this? I have a feeling that would eliminate a good portion of the applicants. Personally I would be happy if they gave extra weight to those who applied with a medical background. I am a former medic, and have an extensive medical background. A lawyer with medical training ( nurse, medic, or former SSA attorney) is a big plus. I'm a former Army Combat Medic too (no combat, that's just what the Army called it in 1981) and having a medical background does help, but an ALJ's job really is looking at the REAL Doctors' opinion (not my previous training) and drafting an RFC from all of the evidence and having some medical background might help, but until you get into the actual CFRs, medical records and the job, you will see that the legal background is the most important.
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Post by Deleted on Oct 21, 2014 1:37:10 GMT -5
At least, in most states, they are physicians. Although Mr. Pierce articulated his point rather crudely, the fact remains -- does it make sense to continue to hire SSA ALJs who do not have extensive medical knowledge? The translation of a claimant's medical/education records into an RFC is the single most important job an ALJ has. 4 weeks in Falls Church is not nearly enough medical training to permit an ALJ, who has never read medical records as part of their career, to be able to do this job duty with any type of expertise. Why can't OPM create 2 registers? One for SSA which makes medical experience a required element, and a separate register for everyone else? I take serious issue with the idea that anyone must have "extensive medical knowledge" to evaluate a case. The ALJ is not being asked to render a diagnosis, provide treatment, or otherwise render care. The ALJ is being asked to determine whether a claimant's diagnosis, medical history, and other evidence meets a legal definition. I have reviewed thousands of medical records and I certainly do a better job of it today than I did when I started but that isn't because I went to medical school. This isn't a medical question it is a legal question. We don't make judges who hear med mal or workers comp cases go to medical school why would we ask ALJs to do so. It is a legal question not a medical question if the ALJ is unsure of the accuracy of the diagnosis or the records are poor there are options to try to cure the problem but you aren't going to do H&P in the hearing room. Thank you!!
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Post by 71stretch on Oct 21, 2014 3:51:58 GMT -5
Does anyone besides me see a problem with these judges discussing cases involving specific claimants with the media? What about the next claimant who comes before these judges, and who has read this article? Wouldn't they have a reasonable argument that under the circumstances, they do not think that these judges can give them a fair hearing? I am, frankly, stunned that the judge would discuss with the media his reactions to the testimony he just heard. It is one thing for the reporter to sit in on the hearing with the claimant's permission. It is quite another to discuss the matter with the reporter afterwards. As a state ALJ, it would never occur to me to do such a thing. On another issue, does some familiarity with medical terminology and experience digesting medical reports help? Surely. Should it be a requirement? No, I don't think so.
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Post by workdrone on Oct 21, 2014 7:24:42 GMT -5
I am, frankly, stunned that the judge would discuss with the media his reactions to the testimony he just heard. It is one thing for the reporter to sit in on the hearing with the claimant's permission. It is quite another to discuss the matter with the reporter afterwards. As a state ALJ, it would never occur to me to do such a thing. Indeed. I was quite stunned as well. Shockingly, from what I have heard, it appears the three Miami ALJs coordinated with the WP reporter and interacted with him over a several week period on this article. Not sure what these judges were hoping to gain from it, but it certainly goes against everything I have been taught about how to deal with the media.
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Post by ssalawman on Oct 21, 2014 8:45:59 GMT -5
I liked the comparison between the well trained lower level decisionmakers, and the ALJ, who is merely a lawyer. At least, in most states, they are physicians. Although Mr. Pierce articulated his point rather crudely, the fact remains -- does it make sense to continue to hire SSA ALJs who do not have extensive medical knowledge? The translation of a claimant's medical/education records into an RFC is the single most important job an ALJ has. 4 weeks in Falls Church is not nearly enough medical training to permit an ALJ, who has never read medical records as part of their career, to be able to do this job duty with any type of expertise. Why can't OPM create 2 registers? One for SSA which makes medical experience a required element, and a separate register for everyone else? Because if ALJs had medical experience they wouldn't follow the Commissioner's edicts to deny more cases. They would actually render decisions based on the evidence.
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Post by Deleted on Oct 21, 2014 8:56:29 GMT -5
Robg, you noted, "If a claimant is indigent, and terminally ill, a decision from ODAR is not going to help any time soon." Actually, Medicaid benefits kick in as soon as the Title XVI benefits are awarded. Medicare benefits are approximately 2 years after the EOD of the Title II. This appears to award the indigent, but punish the Title II beneficiaries, who have contributed to the trust fund... This is not the only part of the Act that seems unfair to Title II recipients. You bet, that's true. I was thinking about the time between application and decision. If an indigent person is in a medical/financial emergency, the amount of time between application and decision (a year?) basically means that the claimant is going to have to find another way to eat and get reasonable and necessary medical treatment until the decision comes down. So, ODAR not so good at dealing with emergencies. To bring it back around to the article, when people in our country undergo a medical and financial meltdown, there should be a network of safety nets to prevent a descent into abject poverty, homelessness, and loss of access to medical care. Unemployment, food stamps, housing assistance, disability insurance, workers compensation, social security disability, Medicare and Medicaid. Even if we're just half as lazy and incompetent as some say we are, ALJ's are just part of a complex equation. And, to make matters more complicated, a significant percentage of the population doesn't even want that safety net to exist. In that kind of atmosphere, blaming a mid-level governmental officer, ALJ's, for the backlog seems very much like an inability to see the forest for the trees.
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Post by funkyodar on Oct 21, 2014 8:57:59 GMT -5
Funny. Guess I missed the edict to deny more cases and/or ignore the evidence. Would have thought that would have been a point brought up in the three weeks of new office orientation, the four weeks of training or the phase three acclimation. Not even a vod on it. Commissioner must need some help getting her edicts out...
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Post by Deleted on Oct 21, 2014 9:05:43 GMT -5
I chose my words carefully, robg. I agree with you. People are dying before getting a decision, not because they are not getting a prompt decision. The benefit is just part of the equation. It is not a problem that is exclusively ODAR's responsibility and it is not solely within ODAR's ability to resolve. But it is a process that has an indefensible problem, and a solution must be provided. You are correct. You did choose your words carefully. I did not mean to direct that statement at you personally, but more generally, and in response to the article. I have been thinking that a real fix to the question of an uninsured indigent with an emergent need is a constitutionally protected right to reasonable health care. I could probably be hung in my neighborhood as a communist for suggesting such a thing as universal health care. But, imagine the impact on the disability system if access to Medicaid and Medicare were not the issue? A quick search found this site. I'm going to read it in more detail later, but it is interesting, even if you don't buy it all hook, line, and sinker... healthcare.procon.org/#Background
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Post by Gaidin on Oct 21, 2014 9:15:51 GMT -5
I wonder what sort of medical background you think they should be looking for? An attorney who has done lots of medical related law? One who was a CNA at a nursing home? An LPN? A physical therapist? A 2 year RN? A 4 year RN? A NP or PA? An MD who has never been licensed? An MD whose license is retired? An MD who isn't board certified? Are some Board certifications better than others?? What about other kinds of practitioners (i.e. psychologists, dentists, podiatrist, etc...).
I agree that the ability to review a chart before you get the job has to be helpful but the issues are questions of law. Not writing a legally sufficient decision that links evidence to determination is a failure in analysis and I don't see how medical school can fix it.
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Post by bartleby on Oct 21, 2014 9:26:17 GMT -5
Robg, you are so correct. We had hoped the ACA would take care of that, but it didn't. I would think that it would be a great idea to award temporary Medicaid benefits to the indigent when they apply to help them, but also to help us document the case for later hearing. I have only had three (3) claimant's that were on ACA this year and everyone of them were working part-time. In Georgia, if you are broke, you can't afford ACA. I feel Obama messed up on that as he could have extended Medicare for the uninsured, something he had control over. The idea of extending Medicaid by the Government subsidizing it was all political, because each year the Fed. Government would be withdrawing more and more support, leaving more and more expense on the State. By extending Medicare the State would have had no say on it. Also, many Judges I know would like to be able to award Medicare or Medicaid without monetary benefits sometimes and to award benefits for a specific amount of tiem, ie, a year, and then have the claimant come back in front of the same Judge to see how they are doing. The recommended medical reviews we do make are useless and never followed by the effectuating unit..
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Post by bartleby on Oct 21, 2014 9:33:10 GMT -5
Gaidin, maybe be an Army medic with specialization in Eye, ear, nose and throat training, be an EMT, be a physician's assistant with an ophthalmologist, be a master optician, have completed nursing school, without taking the boards, be a Doctor of Chiropractic, and have attended medical school for a short period in the Dominican Republic doing surgery and delivering babies? Oh, it might be good for them to have a JD and a Master's in Litigation? And throw in a Fellow with the American Board of Disability Analysts? Sounds good to me..
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Post by JudgeRatty on Oct 21, 2014 9:43:57 GMT -5
Funny. Guess I missed the edict to deny more cases and/or ignore the evidence. Would have thought that would have been a point brought up in the three weeks of new office orientation, the four weeks of training or the phase three acclimation. Not even a vod on it. Commissioner must need some help getting her edicts out... I was going to make a comment about that post....but you beat me to it.
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Post by hopingforalj on Oct 21, 2014 14:05:46 GMT -5
In my home state there is no access to medical treatment except free county healthcare depts. which only offer basic PCP treatment at best, the only way on Medicaid for most of my clients is through the Social Security disability system.
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Post by ssalawman on Oct 21, 2014 14:07:22 GMT -5
Funny. Guess I missed the edict to deny more cases and/or ignore the evidence. Would have thought that would have been a point brought up in the three weeks of new office orientation, the four weeks of training or the phase three acclimation. Not even a vod on it. Commissioner must need some help getting her edicts out... I was going to make a comment about that post....but you beat me to it. Please explain the "How Am I Doing?" desktop tool as anything other than a means to bring down the pay rate.
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Post by funkyodar on Oct 21, 2014 14:18:13 GMT -5
Really? I'm lost in your "logic." I look at the "How Am I doing?" tool as constant reminders to get cases moving and to get the dipsositions/scheduled hearings numbers up. It seems to me to only be concerned with making sure the numbers are met (with the possible exception of the AC feedback tab). And everyone knows it is easier to make the numbers by paying cases.
So, care to explain how one could possible make the leap that such a tool encourages the denial of cases? Especially such as to support your initial position that the Commissioner wants cases denied despite the evidence?
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Post by JudgeRatty on Oct 21, 2014 14:18:18 GMT -5
I was going to make a comment about that post....but you beat me to it. Please explain the "How Am I Doing?" desktop tool as anything other than a means to bring down the pay rate. Really? I saw it as a tool to show the AC agreement rate on cases that were appealed and a tool to improve the quality of decisions. Silly me. At no time have I ever heard of anyone encouraging any ALJ to pay or not to pay a claim. EVER. Now, if you are having that pressure, it sounds like you should get on the phone to "say something" about it.
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Post by ssalawman on Oct 21, 2014 15:23:21 GMT -5
Really? I'm lost in your "logic." I look at the "How Am I doing?" tool as constant reminders to get cases moving and to get the dipsositions/scheduled hearings numbers up. It seems to me to only be concerned with making sure the numbers are met (with the possible exception of the AC feedback tab). And everyone knows it is easier to make the numbers by paying cases. So, care to explain how one could possible make the leap that such a tool encourages the denial of cases? Especially such as to support your initial position that the Commissioner wants cases denied despite the evidence? Are you saying the evidence doesn't support ALJ's denying more claims? 2011 ALJs allowed 58%, 2012 ALJs allowed 52%, 2013 ALJs allowed 48%.
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