Get informed, and keep up to date.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
The Social Security Administration has the right, which it often exercises, to have claimants examined by a Consulting Examiner (CE). This medical professional is contracted by the Social Security Administration to review the claimant’s treatment records, examine the claimant, and provide an extensive report. The CE does not have the benefit of a long-term relationship with the patient. As any helping professional can attest, patients are not always open and forthcoming on initial meetings. They are often shy, anxious, and even ashamed of their medical or mental condition. Some claimants may not fully understand the CE’s role and may not have the degree of trust and rapport needed to candidly describe their personal circumstances. This may result in a CE report that minimizes the claimant’s complaints and a determination that the claimant’s condition does not rise to the standard of disability as defined by SSA. The treating provider often has a more thorough knowledge of the claimant and a more comprehensive understanding of his or her circumstances. The claimant’s health needs typically represent only a portion of the constellation of issues regularly addressed by the primary health care giver. Patients are more likely to reveal their anxieties, fears, concerns, and hopes to their physicians and therapists. Many medical professionals have a lengthy relationship with their patients, providing them with the opportunity for longitudinal observation of their patient’s lifestyle, personality functioning, interpersonal relationships, health issues, pain tolerance, stress response, work life, and financial status. Therefore, Social Security rules provide that the treating professional’s opinion is given greater weight than the opinion of the consulting examiner. Why would medical personnel be uncooperative with the process of assisting their patients’ in applying for disability benefits? Medical professionals are sometimes unfamiliar with the Social Security Administration’s regulations and criteria, and thus the importance of providing documentation, including records, reports, and other related materials, may not be apparent to them. Medical professionals are not required to appear at hearings, testify, or otherwise engage in the disability determination process. Their participation is limited to providing treatment records and possibly compiling a narration supported by the claimant’s medical record that is consistent with the language of Social Security Disability and that addresses that agency’s core concerns. At the Appeals level, the only participants in the hearing are the Administrative Law Judge, his or her clerk, the claimant, the claimant’s advocate, and either a Medical Examiner (ME) or a Vocational Examiner (VE), although occasionally both an ME and VE are present. The ME may be asked to offer a professional opinion on the claimant’s condition based on the available medical evidence, while the VE may be requested to provide an opinion as to whether the claimant can either resume past relevant work or is appropriate for other jobs in the national economy. Adequately responding to claimants’ requests for narrative reports requires a tacit understanding of Social Security Administrative rules and definitions. Under the Social Security Act, disability means “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months” (SSA, 2007a). Thus, it is not only a matter of identifying a diagnosis, past treatment, or course of a disease process that is acceptable as evidence of the above. Rather, it is also a description of the symptoms, effects of medicines, and state of mind and body that affects the individual’s capacity to engage in substantial gainful activity that is essential to disability determination. The Social Security Administration has established a set of Medical Listings to various classes of disabling conditions and requires that in order to be found disabled, an individual’s condition must meet or equal at least one of those listings. An individual who may not meet a specific listing may still be found disabled as the result of the cumulative effects of multiple impairments, the experience of severe pain on exertion, and/ or the effects of the medications necessary to treat the condition(s). It is therefore the responsibility of the practitioner to become acquainted with the process and terminology in order to appropriately respond to the claimant’s needs. These listings and full explanations are available online through the Social Security Administration Web site at www.ssa.gov. The applicant must meet another test of disability: that of residual functional capacity (RFC). Work is divided into categories of heavy, medium, light, and sedentary. A manual laborer would likely be categorized as heavy, a firefighter or police officer as medium, a bus driver as light, and a secretary as sedentary. Of course, different jobs require different levels of exertion at different times. However, the Dictionary of Occupational Titles is referenced by the Social Security Administration as the arbiter of work definitions. Each work level corresponds to the amount of exertional and non-exertional effort required of the worker.
The American College of Forensic Examiners International began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more, please visit www.acfei.com.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Let me share with you just a few of the numerous reasons so you can better decide for yourself, as thousands wisely did before you:
Accreditation. The American College of Forensic Examiners Institute is an approved provider of continuing education by the following:
Continuing education alignments. In addition to the several accreditations above, we are also proud to inform you that:
To learn more, visit www.acfei.com
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and patients to provide the support and advocacy consistent with professional ethics.
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
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