Erie Family Health Center May 1, 2013

1. Advocating for Your Patients in Social Security Disability Cases Jessica Sanchez & Rachelle Sico Erie Family Health Center May 1, 2013 1 1

2. Severe impairment lasting more than 12 months? Severe impairment lasting more than 12 months? Severe impairment lasting more than 12 months? Income above $1040 a month? Meets or equals Social Security listing? Can patient do past work? Can patient perform any work in the national economy? Five Step Evaluation 2

3. Lupe suffers from Dupuytren’s Contractures and Diabetes Mellitus. The secondary effects that result from his diabetes include fatigue, neuropathy and diarrhea. At the hearing, Lupe was granted SSDI based in large part on his provider’s opinions that were well-supported in the chart. Health Justice Project provided representation during his SSDI hearing in front of an Administrative Law Judge, Medical Expert and Vocational Expert. “Lupe’s” Story Lupe was referred to the Health Justice Project for legal assistance because he was not able to obtain SSDI benefits after stopping consistent work in 2010. 3

4. Social Security Administration Medical Consult • Each applicant is examined by an SSA Medical Consult. • Typically exams are brief and conclusory. • The Judge frequently take their opinion into consideration. • For people who do not have other medical evidence, the SSA Medical Consult opinion typically is given deference. 4

5. Why are Medical Providers so Important to Social Security Disability Cases? 5

6. Why are Medical Providers so Important to Social Security Cases? “When a treating source has offered a medical opinion that is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence, it must be given controlling weight, i.e., it must be adopted.”– SSA 6

7. Who is a Treating Source? • Acceptable medical sources include: • Licensed physicians (medical or osteopathic) • Licensed or certified psychologists • Provides medical treatment/evaluation and has an ongoing relationship with a patient. 7

8. The Importance of Medical Evidence Medical evidence includes statements from a treating source that detail the nature and severity of the patient’s impairments including: • The patient’s symptoms, • The patient’s diagnosis and prognosis, • What the patient can still do despite impairment(s), and • The patient’s physical or mental restrictions. 8

9. Medical Record Notes:Examples of Medical Evidence vs. Strong Evidence Weak Evidence • Pt has uncontrolled diarrhea and must now use adult diapers. • Pt has the following medical conditions: polio, diabetes, Dupuytren’s Contractures. • I examined Pt and noticed he had a very difficult time lifting his left leg to get up on my exam table. • Pt’s prognosis is poor and I don’t foresee improvements in the near future. • Because of his medical conditions Pt cannot work. • Pt came in for disability paperwork today. • Pt thinks he has diabetes. • Pt is disabled. 9

10. Refer for Legal Services Refer to Health Justice Project by: • Using the Internal Referral System via EMR, or • Contact Us: (Toll Free) 1-800-424-4839 (Local) 312-915-6470 (Fax) 312-915-6588 E-mail: healthjustice@luc.edu *If there are any legal issues which we identify, but do not cover within the clinic, we will provide the patient with other appropriate legal referrals. 10