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 treating professional is asked to consider the capabilities of the claimant as they relate to performance in a competitive work environment. Thus, the medical professional will be asked to predict, in consideration of a patient’s disabling condition(s), the number of hours a claimant can sit, stand, and walk in the course of an 8-hour work day; how much can be lifted or carried in the course of that day; how often the claimant may require breaks or rest periods or position or postural change in the course of an 8-hour work day; and how many days the claimant would likely be absent from work per month as a consequence of the disabling condition. The mental health professional is asked to consider the applicant’s capacity to concentrate, persist, memorize, and attend. Thus, the helping professional should consider the claimant’s work experience, age, education, and level of disability when composing the narrative report as well as completing impairment questionnaires frequently requested by Social Security as a means of measuring residual functional capacity of claimants. Next, the Social Security Administration wants to know whether the claimant is capable of performing past relevant work. For example, a 45-year-old teacher may have sustained an injury that has left her confined to a wheelchair. However, she retains her cognitive abilities and can continue to fulfill all the duties and responsibilities of teaching. Therefore, she is not disabled and is capable of engaging in her past relevant work. If an individual is incapable of his or her past relevant work, the question arises as to whether age, education, and experience lends itself to other work in the national economy. For example, a 40-yearold plumber at a medium exertional level, with a high school diploma, has sustained a back injury that precludes him from bending, crouching, lying on his back, reaching, carrying heavy tools, etc. However, he is capable of applying other skills that may have been a part of his work regimen such as using a computer, record-keeping, estimating, calculating, sales, etc., which would qualify him for work at a light or sedentary level. Therefore, he is not considered disabled. On the other hand, if that plumber is 60 years old, he is considered to be approaching retirement age. Job retraining at his educational and experiential level would be difficult and could create hardships, and, therefore, he would be considered disabled. Thus, it is imperative for the practitioner to understand the nature of the claimant’s past relevant work and to what extent his ability to perform that work has been compromised by a medical or mental condition. Unfortunately, it is clear that many medical practitioners have no interest in performing disability evaluations, or they complete the forms in a haphazard fashion in an attempt to clear off their desk. Claimants do not benefit from assessments that are inflated, exaggerated, or that do not reflect the objective evidence based on medically accepted diagnostic testing (x-rays, MRIs, CT Scans, EMGs, etc.) or progress notes recording patient complaints, symptoms, and clinical findings. This is especially true in the case of evaluating the subjective complaint of pain, in the absence of quantifiable medical tests. One test that may interject a level of objectivity—because it may meet the Daubert criteria for admissibility as evidence in Federal Court (medical testimony based on published articles in the peer-reviewed medical literature)—is the Pain Validity Test, recently described in this journal. Some health care professionals attach fees to their compliance for requests for records and documentary support for their patients. Sometimes these fees are excessive and unrealistic. These fees, which may be legal, may also be skirting the ethical duty of the caring professions. Some licensing boards or state regulations may limit the amount that may be charged for copying records. The patients who are often most in need of medical and psychological support are also likely to be among the most impoverished segment of society, and charging them for cooperation and support creates a significant hardship on people who are already experiencing serious medical and psychological complications. The imposition of fees may impede the ability of the claimant to provide the medical evidence necessary to prove a case for disability benefits, thus denying them the opportunity for relief. If a claimant cannot afford the fee for records, the Administrative Law Judge has the authority to subpoena these records. While medical professionals may balk at providing patient records at no fee to patients or their advocates in a disability claim, most regularly provide copies of records free of charge to medical specialists to whom their patients are referred or to other practices if the patient relocates or changes insurance programs. Furthermore, in some states, providing medical records at no charge to patients or in support of their applications to public programs, including disability programs, is mandatory. In California, for example, the California Health and Safety Code section states: (d) (1) Notwithstanding any provision of this section, and except as provided in Sections 123115 and 123120, any patient or former patient or the patient’s representative shall be entitled to a copy, at no charge, of the relevant portion of the patient’s records, upon presenting to the provider a written request, and proof that the records are needed to support an appeal regarding eligibility for a public benefit program. These programs shall be the Medi-Cal program, Social Security Disability insurance benefits, and Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits. For purposes of this subdivision, “relevant portion of the patient’s records” means those records regarding services rendered to the patient during the time period beginning with the date of the patient’s initial application for public benefits up to and including the date that a final determination is made by the public benefits program with which the patient’s application is pending. (Legislative Counsel of California, 2008) It further states that medical providers may not refuse requests for provision of medical records because of outstanding charges and that failure to provide medical records is considered unprofessional conduct, can result in a fine of no more than $100, and can be considered as grounds for disciplinary action by the provider’s licensing agency, board, or commission. Ethically, a physician should feel obliged to provide these records without cost. It is a sad commentary that very often they have to be compelled to do so. In some instances, fees for documentation are contingent on the patient’s retention of legal advocacy in the effort to obtain benefits under Social Security.
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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