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SOCIAL SECURITY DISABILITY PROGRAMS: 

IMPROVING THE QUALITY OF BENEFIT 

AWARD DECISIONS 

HEARING 

BEFORE THE

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COMMITTEE ON 

HOMELAND SECURITY AND 

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(II) 

COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

JOSEPH I. LIEBERMAN, Connecticut, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

CLAIRE MCCASKILL, Missouri 

JON TESTER, Montana 

MARK BEGICH, Alaska 

SUSAN M. COLLINS, Maine 

TOM COBURN, Oklahoma 

SCOTT P. BROWN, Massachusetts 

JOHN MCCAIN, Arizona 

RON JOHNSON, Wisconsin 

ROB PORTMAN, Ohio 

RAND PAUL, Kentucky 

JERRY MORAN, Kansas 

MICHAEL L. ALEXANDER, Staff Director 

NICHOLAS A. ROSSI, Minority Staff Director 

TRINA DRIESSNACK TYRER, Chief Clerk 

PATRICIA R. HOGAN, Publications Clerk 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

CARL LEVIN, Michigan, Chairman 

THOMAS R. CARPER, Delaware 

MARY L. LANDRIEU, Louisiana 

CLAIRE MCCASKILL, Missouri 

JON TESTER, Montana 

MARK BEGICH, Alaska 

TOM COBURN, Oklahoma 

SUSAN M. COLLINS, Maine 

SCOTT P. BROWN, Massachusetts 

JOHN MCCAIN, Arizona 

RAND PAUL, Kentucky 

ELISE J. BEAN, Staff Director and Chief Counsel 

DANIEL J. GOSHORN, Counsel 

CHRISTOPHER J. BARKLEY, Staff Director to the Minority 

ANDREW C. DOCKHAM, Counsel to the Minority 

KATHRYN EDELMAN, GAO Detailee 

MARY D. ROBERTSON, Chief Clerk 
(III) 

C O N T E N T S 

Opening statements: Page 

Senator Levin .................................................................................................... 1 

Senator Coburn ................................................................................................. 3 

Senator Collins ................................................................................................. 21 

Prepared statements: 

Senator Levin .................................................................................................... 53 

WITNESSES 

THURSDAY, SEPTEMBER 13, 2012 

Judge Patricia A. Jonas, Executive Director, Office of Appellate Operations, 

Deputy Chair, Appeals Council, Office of Disability Adjudication and Review, Social Security Administration, Falls Church, Virginia ......................... 10 

Judge Debra Bice, Chief Administrative Law Judge, Office of Disability Adjudication and Review, Social Security Administration, Falls Church, Virginia ....................................................................................................................... 12

Judge Douglas S. Stults, Hearing Office Chief Administrative Law Judge, 

Office of Disability Adjudication and Review, Social Security Administration, Oklahoma City, Oklahoma ......................................................................... 32 

Judge Thomas W. Erwin, Hearing Office Chief Administrative Law Judge, 

Office of Disability Adjudication and Review, Social Security Administration, Roanoke, Virginia ........................................................................................ 34 

Judge Ollie L. Garmon III, Regional Chief Administration Law Judge, Atlanta 

Region, Office of Disability Adjudication and Review, Social Security Administration, Atlanta, Georgia ............................................................................ 36 

ALPHABETICAL LIST OF WITNESSES

Bice, Judge Debra: 

Testimony .......................................................................................................... 12 

Prepared statement .......................................................................................... 65 

Erwin, Judge Thomas W.: 

Testimony .......................................................................................................... 34 

Prepared statement .......................................................................................... 80 

Garmon III, Judge Ollie L.: 

Testimony .......................................................................................................... 36 

Prepared statement .......................................................................................... 83 

Jonas, Judge Patricia A.: 

Testimony .......................................................................................................... 10 

Prepared statement .......................................................................................... 55 

Stults, Judge Douglas S.: 

Testimony .......................................................................................................... 32 

Prepared statement .......................................................................................... 77 

APPENDIX 

Report of the Permanent Subcommittee on Investigations’ Minority Staff entitled Social Security Disability Programs: Improving the Quality of Benefit 

Award Decisions, September 13, 2012 ............................................................... 86 

EXHIBIT LIST 

1. Documents relating to Alabama Case No. 64: 

a. December 11, 2006 Report of Contact ....................................................... 252 

b. January 10, 2007 Consultative Exam ....................................................... 253 
Page

IV 

c. Explanation of Benefits ............................................................................... 257 

d. March 6, 2007 Medical Exam Record ........................................................ 258 

e. August 13, 2007 Medical Exam Record ..................................................... 259 

f. December 5, 2007 Medical Exam Record ................................................... 260 

g. January 30, 2008 Medical Exam Record ................................................... 261 

h. May 7, 2008 Medical Exam Record ........................................................... 262 

i. May 28, 2008 Hearing Transcript .............................................................. 263 

j. June 17, 2008 Notice of Decision-Fully Favorable .................................... 269 

2. Document relating to Alabama Case No. 65: 

a. October 15, 2009 Notice of Decision-Fully Favorable .............................. 280 

b. December 8, 2008 Physical Summary Form ............................................. 286 

c. Explanation of Determination .................................................................... 287 

d. October 29, 2008 Pharmacy Statement ..................................................... 288 

e. December 9, 2008 Psychiatric Review Technique Form .......................... 292 

3. Document relating to Alabama Case No. 67: 

a. April 23, 2010 Notice of Decision-Fully Favorable ................................... 306 

b. February 6, 2007 Medical Exam Record ................................................... 311 

c. January 28, 2007 Medical Exam Record ................................................... 312 

d. July 22, 2009 Medical Exam Record ......................................................... 313 

e. January 19, 2007 Medical Exam Record ................................................... 314 

f. March 6, 2009 Medical Exam Record ......................................................... 315 

g. August 19, 2008 Medical Exam Record ..................................................... 316 

h. October 8, 2007 Medical Exam Record ...................................................... 319 

i. October 22, 2008 Medical Exam Record ..................................................... 320 

j. December 23, 2008 Medical Exam Record ................................................. 321 

k. January 26, 2009 Medical Exam Record ................................................... 322 

l. January 13, 2009 Vocational Rationale Form ........................................... 323 

m. April 6 and 7, 2010 Medical Exam Records ............................................. 326 

n. April 9, 2010 Hearing Transcript .............................................................. 333 

4. Document relating to Alabama Case No. 69: 

a. September 2, 2008 Notice of Disapproved Claim ..................................... 347 

b. September 26, 2008 Notice of Disapproved Claim ................................... 352 

c. Physical Residual Functional Capacity Form ........................................... 358 

d. February 1, 2007 Excuse from Work ......................................................... 366 

e. July 18, 2008 Medical Exam Record .......................................................... 367 

f. September 10, 2008 Medical Exam Record ................................................ 369 

g. October 10, 2008 Appointment of Representative and Fee Agreement .. 375 

h. October 10, 2008 Request for Hearing by Administrative Law Judge ... 377 

i. January 6, 2010 Clinical Assessment of Pain ........................................... 379 

j. January 7, 2010 Hearing Transcript .......................................................... 380 

k. January 25, 2010 Notice of Decision-Fully Favorable ............................. 385 

5. Document relating to Oklahoma Case No. 102: 

a. Mental Residual Functional Capacity Assessment .................................. 389 

b. Psychiatric Review Technique Form ......................................................... 393 

c. Medical Exam Record .................................................................................. 407 

d. Explanation of Determination .................................................................... 409 

e. May 13, 2008 Hearing Transcript .............................................................. 410 

f. Notice Decision-Fully Favorable ................................................................. 413 

6. Document relating to Oklahoma Case No. 109: 

a. April 25, 2008 Notice of Decision-Fully Favorable ................................... 420 

b. October 24, 2007 Medical Exam Record .................................................... 430 

7. Document relating to Oklahoma Case No. 111: 

a. September 22, 2005 Medical Exam Record ............................................... 439 

b. October 6 and 14, 2005 Medical Exam Records ....................................... 442 

c. January 24, 2008 Medical Exam Record ................................................... 446 

d. February 28, 2006 Medical Exam Record ................................................. 448 

e. March 6 and 27, 2006 Medical Exam Records .......................................... 450 

f. May 22, 2006 Medical Exam Record .......................................................... 452 

g. February 21, 2007 Medical Exam Record ................................................. 453 

h. March 22, 2007 Request for Reconsideration ........................................... 457 

i. May 16, 2007 Function Report .................................................................... 459 

j. November 9, 2007 Letter ............................................................................. 467 

k. December 26, 2007 Notice of Decision-Fully Favorable ........................... 468 

8. Document relating to Oklahoma Case No. 114: 

a. January 4, 2008 Medical Exam Record ..................................................... 480 

b. July 30, 2008 Medical Exam Record ......................................................... 483 

c. July 31, 2008 Medical Exam Record .......................................................... 485 
Page

V 

d. August 5, 2008 Notice of Denial (Initial Application) .............................. 487 

e. November 18, 2008 Medical Exam Record ................................................ 491 

f. December 23, 2008 Notice of Denial (Reconsideration) ............................ 492 

g. April 21, 2009 Letter from Attorney .......................................................... 495 

h. May 21, 2009 Notice of Attorney Advisor Decision-Fully Favorable ...... 497 

i. March 12, 2009 Physical Capacities Evaluation ....................................... 508 

j. November 26, 2008 Medical Exam Record ................................................. 511 

k. January 22, 2009 Letter ............................................................................. 512 

l. July 24, 2008 Medical Exam Record .......................................................... 513 

m. September 4, 2008 Medical Exam Record ................................................ 515 

n. October 14, 2008 Medical Exam Record .................................................... 516 

9. Document relating to Oklahoma Case No. 134: 

a. October 22, 2010 Notice of Decision-Fully Favorable .............................. 517 

b. December 15, 2004 Medical Exam Record ................................................ 531 

c. January 5, 2005 Medical Exam Record ..................................................... 534 

d. February 9, 2005 Medical Exam Record ................................................... 536 

e. April 14, 2005 Medical Exam Record ........................................................ 538 

f. April 21, 2005 Medical Exam Record ......................................................... 539 

g. May 5, 2005 Medical Exam Record ........................................................... 540 

h. May 12, 2005 Medical Exam Record ......................................................... 542 

i. May 19, 2005 Medical Exam Record .......................................................... 544 

j. June 9, 2005 Medical Exam Record ........................................................... 545 

k. June 16, 2005 Medical Exam Record ........................................................ 546 

l. June 23, 2005 Medical Exam Record ......................................................... 547 

m. July 19, 2005 Medical Exam Record ........................................................ 548 

n. August 11, 2005 Medical Exam Record ..................................................... 549 

o. August 29, 2005 Medical Exam Record ..................................................... 551 

p. September 2, 2005 Medical Exam Record ................................................. 553 

q. January 5, 2006 Medical Exam Record ..................................................... 555 

r. July 13, 2006 Medical Exam Record .......................................................... 556 

s. September 21, 2006 Medical Exam Record ............................................... 557 

t. October 16, 2006 Application for Disability Insurance Benefits .............. 559 

u. December 12, 2006 Medical Exam Record ................................................ 562 

v. Explanation of determination .................................................................... 565 

10 Document relating to Oklahoma Case No. 151: 

a. October 22, 2010 Notice of Decision-Fully Favorable .............................. 566 

b. December 15, 2004 Medical Exam Record ................................................ 569 

c. January 5, 2005 Medical Exam Record ..................................................... 594 

d. February 9, 2005 Medical Exam Record ................................................... 595 

e. April 14, 2005 Medical Exam Record ........................................................ 610 

f. April 21, 2005 Medical Exam Record ......................................................... 611 

g. May 5, 2005 Medical Exam Record ........................................................... 612 

11. Document relating to Oklahoma Case No. 103: October 28, 2009 Notice 

of Decision-Fully Favorable ............................................................................. 617 

12. Document relating to Oklahoma Case No. 118: October 10, 2008 Notice 

of Decision-Fully Favorable ............................................................................. 640 

13. Document relating to Oklahoma Case No. 123: April 26, 2010 ALJ Bench 

Decision Checklist, Decision, and Hearing Transcript .................................. 664 

14. Document relating to Oklahoma Case No. 132: April 17, 2008 Notice 

of Decision-Fully Favorable ............................................................................. 707 

15. Document relating to Oklahoma Case No. 166: December 4, 2007 Notice 

of Decision-Fully Favorable ............................................................................. 724 

16. Documents relating to Virginia Case No. 249: 

a. October 28, 2009 Medical Exam Record .................................................... 760 

b. October 31, 2008 Notice of Disapproved Claim ........................................ 765 

c. September 27, 2010 Medical Exam Record ............................................... 768 

d. September 25, 2009 Medical Exam Record ............................................... 777 

e. November 10, 2008 Medical Exam Record ................................................ 778 

f. Disability Report Form 3368 ....................................................................... 780 

g. January 28, 2011 Notice of Decision-Fully Favorable .............................. 782 

h. June 16, 2010 Hearing Transcript ............................................................ 786 

17. Documents relating to Virginia Case No. 257: 

a. Disability Report Form 3368 ...................................................................... 791 

b. April 15, 2009 Notice of Reconsideration .................................................. 797 

c. April 9, 2009 Physical Residual Functional Capacity Form .................... 800 

d. May 1, 2009 Request for Hearing by Administrative Law Judge ........... 807 

e. January 7, 2010 Medical Exam Record ..................................................... 809 
Page

VI 

f. May 19, 2010 Hearing Transcript .............................................................. 811 

g. May 28, 2010 Notice of Decision-Fully Favorable .................................... 814 

18. Documents relating to Virginia Case No. 278: 

a. August 29, 2006 Notice of Disapproved Claim ......................................... 819 

b. April 4, 2007 Notice of Reconsideration .................................................... 822 

c. September 26, 2006 Medical Exam Record ............................................... 825 

d. February 7, 2007 Medical Exam Record ................................................... 831 

e. April 4, 2007 Psychiatric Review Technique Form .................................. 832 

f. April2, 2007 Request for Medical Advice and Physical Residual Functional Capacity Assessment ........................................................................ 846 

g. April 24, 2008 Notice of Decision-Fully Favorable ................................... 855 

h. January 25, 2008 Hearing Transcript ....................................................... 859 

19. September 14, 2011 Social Security Directive from Douglas S. Stults, 

Hearing Office Chief Administrative Law Judge to W. Howard O’Bryan, 

Jr., Administrative Law Judge, Oklahoma City, OK .................................... 877 

20 Office of Appellate Operations, Executive Director’s Broadcast, August 19, 

2011 ..................................................................................................................... 880 

21. Office of Appellate Operations, Executive Director’s Broadcast, January 

13, 2012, highlights top reasons ALJ opinions have errors .......................... 883 

22. Social Security Administration Powerpoint, Fiscal Year 2011, Final Actions Report, Division of Quality, February 8, 2012 ...................................... 889 

23. Responses provided by the Social Security Administration to questions 

raised at the September 13, 2012 hearing ...................................................... 900 

24. Social Security Administration’s response to Recommendations included 

in the Permanent Subcommittee on Investigations’ Minority Staff Report, 

Social Security Disability Programs: Improving the Quality of Benefit 

Award Decisions ................................................................................................ 1123 

25 Responses to supplemental questions for the record from the Social Security Administration. [As of August 2013 when this hearing record went 

to press, responses to the Supplemental Questions to the Record submitted to the Social Security Administration were still pending. Responses 

will be made a part of the Subcommittee hearing exhibit files when 

they are received and will available for review at the Subcommittee offices.] ................................................................................................................... 1128
(1) 

SOCIAL SECURITY DISABILITY PROGRAMS: 

IMPROVING THE QUALITY OF BENEFIT 

AWARD DECISIONS 

THURSDAY, SEPTEMBER 13, 2012 

U.S. SENATE,

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS,

OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 9:33 a.m., in room 

SD–342, Dirksen Senate Office Building, Hon. Carl Levin, Chairman of the Subcommittee, presiding. 

Present: Senators Levin, Coburn, and Collins. 

Staff Present: Elise J. Bean, Staff Director and Chief Counsel; 

Mary D. Robertson, Chief Clerk; Daniel J. Goshorn, Counsel; Brian 

Egger, Detailee (GAO); Christopher Barkley, Staff Director to the 

Minority; Andrew Dockham, Counsel to the Minority; Kathryn 

Edelman, Detailee (GAO); and Priscilla Hanley (Senator Collins). 

OPENING STATEMENT OF SENATOR LEVIN 

Senator LEVIN. Good morning, everybody. The Subcommittee 

meets this morning to look at our Social Security Disability Insurance (SSDI) program. This program provides financial support to 

Americans who, due to a disability, are incapable of working at a 

full-time job. The number of individuals applying for disability insurance aid has been increasing in recent years, made worse by the 

2008 financial crisis when millions of workers lost their jobs and 

their employer-sponsored health insurance. Without health insurance, many of those individuals could not afford to pay for health 

care. Without health care, chronic conditions held in check by medicine and treatment worsened and sometimes became disabling. 

Those workers then turned to Federal disability insurance. 

More individuals receiving disability insurance payments has, in 

turn, increased the stress on the Social Security Disability Trust 

Fund. Recent estimates predict that the trust fund may be unable 

to pay full benefits by 2016, a problem that this country has a 

moral obligation to address. 

Another problem is how long the disability application process 

takes. Applicants can wait 2 years to get a hearing and even longer 

for their case to be decided. During that years-long wait, claimants 

often have less access to medical care or medicines. Although the 

Social Security Administration (SSA) has recently reduced the 
2 

backlog, large numbers of our most vulnerable citizens are still 

waiting in long lines. 

While there are many concerns about Social Security disability 

programs, including exhaustion of the trust fund and the backlog, 

today’s hearing focuses on another set of concerns: what happens 

when an individual finally gets to the front of the line and gets 

their case heard. At the request of Dr. Coburn, the Ranking Republican on our Subcommittee, we launched a bipartisan investigation 

into how decisions are made to award disability benefits. After receiving actual case files from three counties in three different 

States, with all personal information removed, the files were reviewed to see how they were being decided, at both the initial and 

appellate levels. The review examined only cases in which benefits 

were awarded and not any cases in which benefits were denied. 

A number of troubling problems appeared. One judge who 

churned out over 1,500 cases per year took inappropriate shortcuts 

in his opinions, cutting and pasting medical evidence from the case 

file into his opinions without explaining or analyzing what it 

meant, and writing the phrase ‘‘etc, etc, etc’’ rather than describing 

the relevant evidence. His chief judge confronted him in person and 

by letter, but for years he turned out the same poor-quality work. 

In other cases that were reviewed, judges held perfunctory hearings that lasted less than 5 minutes, failed to elicit any testimony 

from the person applying for benefits, or failed to examine medical 

evidence raising questions about whether that person was entitled 

to disability benefits. In still other cases, poorly written opinions 

awarding benefits failed to identify medical evidence showing how 

the requirements for establishing a disability were met, did not acknowledge or address evidence that impairments were not disabling or evidence that the claimant had been working, and at 

times even misreported medical findings or hearing testimony. 

The report’s findings of a large number of poor-quality decisions 

in the 300 case files reviewed are consistent with the Social Security Administration’s own internal research. A Social Security Administration quality review process found that, in 2011, 22 percent 

or over 1 in 5 disability cases decided by administrative law judges 

contained errors or were inadequately justified. Those errors went 

in both directions, awarding and denying benefits. Those errors and 

inadequacies did not mean that the 1 in 5 disability decisions were 

all wrongly decided. What they meant was that the opinions being 

produced in those cases did not contain the type of analysis needed 

to be confident that the cases were correctly decided and that disability benefits go only to the truly disabled. 

Senator Coburn is releasing a report that describes the results 

of the investigation into the disability decisionmaking process. That 

report, in a unique way, provides detailed, relevant information 

about a process that is closed to the public, and necessarily so, 

since disability hearings discuss an individual’s personal medical 

records. The report not only confirms the Social Security Administration’s own findings; it demonstrates what is at stake. It identifies important issues illustrating how the quality of disability benefit award decisions must be improved, and it also shows why oversight by the Social Security Administration and by Congress is so 

critically important. 
3 

The report also contains many recommendations with which I 

agree, including expanding the Social Security Administration’s 

quality review process; closing the evidentiary record at a reasonable time before a hearing to ensure adequate time to review materials; updating the decades-old job list; and increasing training for 

the judges. 

I do have a significant concern about a key recommendation to 

mandate a government representative at all disability hearings because I fear that it would lead to an adversarial process. The Supreme Court has said that the Social Security Act calls for the 

agency to operate ‘‘as an adjudicator, and not as an advocate or adversary.’’ That is a central principle of the disability system, and 

if the proposed government representative is not to advocate for a 

particular position before the administrative law judge, it would 

then seem to be an expensive and a time-consuming duplication or 

a confusion of roles. 

The men and women who administer the Social Security disability programs do not have it easy. The plight of the disabled demands that they do their jobs quickly, given the backlog. The law 

requires them to navigate complex rules and to make difficult judgments. The threat to the program’s solvency hovers over everything. I hope that the work of the Subcommittee will contribute to 

the ongoing efforts to improve the disability award process, and I 

look forward to the testimony of our witnesses today. 

I now turn to my friend, the Ranking Republican Senator 

Coburn, Dr. Coburn, for his opening statement, and I want to 

thank him for the extensive work that he and his hard-working 

staff put into this important effort. Dr. Coburn. 

OPENING STATEMENT OF SENATOR COBURN 

Senator COBURN. Thank you, Mr. Chairman, and I thank those 

that are going to testify before us today. I want to thank you for 

holding the hearing and especially your staff. In a Congress that 

is often divided on partisan issues, this is a unique Committee. The 

staffs work in parallel. We actually compromise. We work to find 

common ground to solve real problem. Without Chairman Levin’s 

support, we would not have been able to undertake this investigation. 

We are here to discuss this report which really looks at how Social Security approves claims for both the SSDI and SSI systems. 

Both of those are critical promises to people in our country that 

have, not through their own means, acquired disabilities that requires that they can no longer achieve what they would like to 

achieve on their own through their own means. 

The Congressional Budget Office has been clear that the disability programs are teetering on bankruptcy. If you actually look 

at their recommendations over the last 5 years, you see we are 

coming closer and closer and closer. We are losing a year almost 

every year in terms of the time of insolvency. 

The Social Security Trustees have concluded that the disability 

insurance program may go bankrupt in 2015, and that is because 

the rolls have grown faster than anticipated. That is completely understandable given our financial experience over the past 4 years 

in this country and the fact that people who were truly disabled 
4 

were still working because they had the benefits and the wherewithal to continue to do that. Losing health insurance through layoffs is one of the reasons that people who were disabled but were 

still working have increased in the number of applications. 

Since January 2009, the Social Security Administration has 

added 5.9 million Americans to the disability rolls. That is about 

78,000 per month. That is 14,000 more added to the disability rolls 

than we actually created in terms of jobs. 

With the trust funds approaching insolvency and the law saying 

that the funds to provide SSDI come from the revenues that come 

into SSDI, Congress is handicapped in terms of supplementing 

that, which means that anyone who is collecting disability that 

should not be collecting disability will ultimately be taking funds 

from those people who actually deserve disability once the trust 

fund reaches its insolvent point. 

Millions of our neighbors depend on these programs to replace a 

portion of the income they earned before they became disabled. For 

many of them, this is a lifeline without which they would be absolutely overwhelmed. 

For the past 18 months, this Subcommittee has conducted a bipartisan investigation into how well the Social Security Administration is running these programs. Our hope is that where we find 

problems, we might also offer solutions. 

We decided to take a look at a random selection of 300 case files, 

all of which came from three counties and represented a broad mix 

of disability applicants. 

We carefully chose three areas of the country that had different 

concentrations of people receiving disability benefits—from a very 

high to a very low to a mid range. We worked closely with the Social Security Administration to develop a methodology that would 

give meaningful results. 

One of the places we looked at was Oklahoma City in my own 

home State. It was and is my firm belief that if Congress is going 

to get serious about reforming our government, oversight must 

start at home. Unfortunately, some of the worst problems we saw 

were in my home State. 

The good news is that Oklahoma is also home to a disability success story. The Oklahoma Department of Rehabilitation Services is 

helping set individuals on disability back into the work force to become productive, self-sufficient Americans. One individual there, 

Jason Price, developed a system of giving monetary incentives to 

vocational rehabilitation counselors who found work for disability 

recipients through the Ticket to Work program. Thousands of people who were disabled are now working in Oklahoma, and nearly 

1,100 of those no longer are on SSDI. 

In 2010 alone, Price’s initiatives resulted in 135 individuals who 

were severely disabled going back to work, ending their dependence 

on disability payments. The State recouped over $2.3 million. I am 

proud of his work, and I hope his example will be shown to other 

States to see how to get even the very severely disabled back into 

the workforce. 

Let me tell you why that is important. When somebody is 

deemed disabled and we help them through the Social Security disability system, we are actually accomplishing one of the intents 
5 

that we intend to. Our compassion becomes real. When somebody 

collects disability that is not truly disabled, we actually harm 

them. We limit their potential. We limit their ability to go through 

a program like Jason Price has developed to actually give them 

real meaning and to perceive their real worth in our society. 

To understand the problems we uncovered, it is important to explain how someone gets disability benefits. The first step is that a 

person applies at his or her Social Security office. They are eligible 

for benefits starting the day their disability began, not simply on 

the date that they made application. To support their claim, they 

can submit medical records if they have them. If they do not have 

medical record, the agency, the Social Security Administration, will 

pay for them to get a consultative exam. This forms SSA’s basis of 

evaluating someone’s initial claim. 

The local office does not make the initial decisions. Rather, this 

is done at the State-level Disability Determination Service, or DDS. 

There is one DDS office in every State, and that is where nearly 

2.5 million applications are first dealt with each year, and 33 to 35 

percent of those applications are approved. 

If it is denied at the DDS level, a person can ask for a different— 

have a second set of doctors take a second look, called a ‘‘reconsideration.’’ If it is denied again, the person can appeal once more to 

request a hearing before an administrative law judge. Then that is 

the point that Senator Levin made. That is where our big backup 

is, at the administrative law judge level. 

At this level, a claimant’s case is supposed to get a fresh review 

by an impartial judge who has independence to decide cases on 

their merits and the record. They are not bound by any prior DDS 

decisions. Social Security has over 1,300 administrative law judges 

who handle the 700,000 appeals they get each year. I am thankful 

to the Social Security Administration for the chart they sent us last 

night listing receipts of applications, receipts for reconsideration 

hearings and appeals, as well as Federal court. And what it shows 

is the tremendous increase that we have seen and the burden 

placed on those people working at Social Security through the financial consequences of the recession that we have been in and a 

significant increase in the workload for the employees that work at 

the Social Security Administration. 

The question that I really have which concern me the most is 

that the initial approval rate is between 33 and 37 percent at the 

initial determination rate. That percentage on reconsideration, 

about a 14-percent approval rate, which figures out to be about a 

3-percent approval rating based on the total number that were denied. So before you ever get to an administrative law judge, we 

have essentially approved about 36 to 40 percent of those people 

who apply for disability. And these are professionals who do this, 

who work for the Social Security Administration. They understand. 

This is not a simple system. It is a complex system. In my mind, 

they do a very good job. 

However, each year approximately 600,000 to 700,000 claimants 

file for a hearing in front of an administrative law judge, and on 

average, of those that are heard, about 61 percent are approved. So 

the real question that I have is: Here are the professionals in the 

Social Security Administration who are taking the record, taking 
6 

the facts, and making a determination. And 61 percent of the time, 

the administrative law judge disagrees with the professionals at 

the Social Security Administration. 

So one of two things is happening: either we are not getting it 

right at the Social Security Administration by the people who work 

these records, know these records the most; or we are not getting 

it right at the administrative law judge level. And the other question that the Committee has not looked at yet is: Who are the number of people who have been denied that should have gotten Social 

Security disability payments? 

So I hope that as we go through our hearing today, we can gain 

some better understanding for why the professionals at Social Security are so often countered by the administrative law judge. One 

of the two is not working well to increase that level, and that is 

a question that has to be determined by this hearing. We need to 

know the answer to that. 

Let me continue on my survey. If an administrative law judge denies a case, a claimant can appeal to the Social Security Appeals 

Council, and anything unresolved after that, they can go to Federal 

court. 

There is another problem. We have different standards on appeal 

by each appellate division. So a Federal judge or magistrate in 

Oklahoma City looks at his district precedents, which are different 

than maybe the Second Circuit precedents. So we actually at the 

Federal court level have a different set of standards based on 

precedents for who becomes qualified and who does not. And I 

think that—Mr. Chairman, we have not had a chance to discuss 

that—is something that should be uniform throughout the country. 

It needs to be the same everywhere, not different in any of the different ten circuits. 

The results of our inquiry, to me, were deeply troubling, and I 

think Social Security is right on top of this. They essentially found 

the same thing we did. What we found was poor-quality decisions 

being made about cases at every level of review. Over and over 

again, this investigation found the Social Security Administration 

failed to follow its own program rules and procedures. The importance of Social Security getting decisions right cannot be overstated. 

Moreover, the agency rarely checks to see if a person’s condition 

improves. While it is supposed to perform continuing disability reviews, what in actuality happens is, what the agency does in terms 

of continuing disability review, it sends out a card and asks the 

question: ‘‘Are you still disabled?’’ That is not a review. And I understand the budget constraints and the difficulties with those continuing disability reviews. 

Overall, the Subcommittee in its investigation found serious 

flaws in more than a quarter of the 300 cases that we reviewed. 

That is not to say that they were in error in terms of their ultimate 

decision or that they were right in terms of their ultimate decision. 

What we found is that they were not following the rules, they were 

not looking at the evidence. And if I may, I would like to put up 

this one—the top ALJ errors that we discovered: inadequate physical examinations, inadequate mental evaluations, claimant credibility issues, drug and alcohol abuse that was unexplained, and in-
7 

complete and inaccurate records, which I would note for the bottom 

is probably the most important aspect. It ought to be complete, and 

it ought to be accurate if it is coming from an administrative law 

judge. It ought to be complete and it ought to be accurate. 

The most concerning findings involved decisions made by a few 

of the agency’s administrative law judges. This was consistent with 

a review that you all have done. In 2011, the Social Security Administration’s Appeals Council found a 22-percent error rate in 

cases it reviewed that were made by ALJs. In the Dallas Region, 

which Oklahoma City is part of, the ALJ error rate was over 26 

percent. 

The kinds of problems we found with ALJ cases were both numerous and troubling. There was conflicting data, missing and insufficient evidence to make a determination according to their own 

guidelines and their own rules. 

Oftentimes, medical evidence was ignored, not looked at at all, 

not considered at all. 

Second, many judges held perfunctory hearings at which claimants did not even say a word. Despite involving some of the most 

complicated cases, some hearings lasted only 3 minutes—leaving 

barely enough time to gavel in and gavel out. 

A third problem involved judges using late-arriving evidence, 

which the agency discourages. Some ALJs raised red flags about 

what they called ‘‘dead man’s reports’’ and ‘‘store bought opinions.’’ 

Fourth, some ALJs would ask vocational experts leading questions that could only give one answer. That is not on the basis of 

fairness and getting to the truth. That is to try to get a result. 

While the Social Security Administration officials that were 

interviewed by the Subcommittee acknowledged that all of these 

were significant problems, they said there was little they could do 

about it because, by law, administrative law judges are given a lot 

of independence to make their decisions. 

The result is a tension between the agency’s ability to control the 

quantity and the quality of a judge’s work. Many people we interviewed said this tension was evident in how the Social Security Administration tried to reduce its enormous disability case backlog. 

Nearly everyone we talked to said there was enormous pressure 

on judges to push through as many cases as possible. In May 2007, 

Commissioner Michael Astrue told Congress that he would end the 

growing wait time for an administrative law judge hearing. To reduce this wait time, the agency encouraged judges, where appropriate, to consider skipping hearings and write decisions on the 

record. 

One judge we encountered in our investigation played a big role 

in this effort. Between 2000 and 2009, an administrative law judge 

from the Oklahoma City office singly handled 5,401 cases—almost 

all of them on the record and without a hearing. His decision rate 

was four times faster than the average judge’s. 

At first I was astounded that somebody could decide 1,800 cases 

a year—especially since on average they are 500 pages long. I am 

a speed reader. I am a fast reader. There is no way I could have 

done that, ingested that information and made a decision on it. I 

still have questions on how that was possible. On average, he decided five cases a day, 365 days per year, for 3 years. 
8 

I soon learned that he could move through them so quickly because the quality of his work left so much to be desired. Unlike the 

other ALJs, he simply cut-and-pasted electronic images of medical 

evidence into his decisions. To speed up the process even more, instead of specifically listing and discussing all of a claimant’s medical impairments, he would just write ‘‘etc, etc, etc.’’ 

Worse still, the images that were pasted into the opinions would 

sometimes have nothing to do with a person’s claim for disability. 

In several cases, the records he pasted said the opposite of his findings. For example, in one case he found somebody could no longer 

work, but pasted in a medical record that concluded, ‘‘Claimant can 

adapt to a work situation.’’ The basis for his decision was exactly 

opposite of the decision that he granted. 

He was eventually asked by the agency to improve his decision 

writing. But instead of reducing his caseload to a manageable level, 

the agency began shipping him cases from around the Nation. He 

told us that at one point he was asked to do 500 cases just from 

Little Rock—an average judge’s caseload for an entire year. When 

he finished those, he was sent cases from Atlanta, Houston, Greenville, Des Moines, and Yakima. 

Why the Social Security Administration did that is a question I 

would love to have answered today. I know the pressure was to decrease backlog. The question is, With what quality and with what 

outcome? Who was denied that should have gotten disability? Who 

got disability that should not? 

The problems we found, however, were not limited to administrative law judges. The Subcommittee also identified a number of 

issues with the cases the State Disability Determination Services 

were making at both the initial and reconsideration levels as well. 

One of the biggest problems was in how the agency used its Medical-Vocational Rules. This complex set of rules—known as ‘‘the 

grids’’—are for people who do not qualify under the more difficult 

‘‘medical listings,’’ but might still be disabled. 

The grids contain a variety of factors—such as a person’s age, 

education, and work experience—laid out in a large set of charts. 

Depending on whether a claimant can perform sedentary, light, 

medium, or heavy work, agency decision makers can use the charts 

to find out whether someone is disabled or not disabled. Finding 

someone disabled this way is referred to in the agency as 

‘‘gridding.’’ 

While most disability awards were at one time made to people 

who met the medical listings, today it is the opposite. The ratio is 

now 4:1 gridding versus a medical determination. A recent analysis 

by the agency found that ALJs awarded benefits through the vocational grids four times more often than through medical diagnoses. 

Another problem is that the grids are easily skirted. Frequently, 

the Subcommittee found that even if the grid found someone not 

disabled, ALJs would overrule it and award disability benefits, 

anyway. 

The most frequently seen problems involved the use of a claimant’s age. The grids relax the rules for claimants once they turn 50 

and then again at 55, appropriately so, making it progressively 

easier for applicants to be accepted when they hit these ages. And 

we all understand that. That is understandable and logical. 
9 

In a lot of cases, the grids found someone was too young when 

their ailment started, and so they were not disabled. The ALJs 

then would just change the disability onset date to the claimant’s 

50th or 55th birthday. By doing so, the claimant now qualified 

under the grids. Nothing indicated that the person was more disabled on their 50th birthday than they were the day before. 

The conclusion is the purpose of this program is to make sure 

that all of our citizens who are truly disabled we help and that the 

safety net be secure. It should be remembered, though, that by the 

law, by the statute, being disabled means ‘‘being unable to work 

any job in the national economy.’’ This is a high bar to meet. The 

agency must make sure it is awarding benefits to people who are 

entitled to them. If something does not change and the programs 

continue to operate the way they are today, there will not be a 

safety net left. The trust fund will be out of money. And those that 

are truly disabled will see a reduction in the payments of their benefits. 

So if, in fact, we are accurate to this point, it means Congress 

has to do something to increase the funding for these programs, either through increasing the tax rates that apply to them or changing the definitions. 

We can start by putting—and I know my Chairman disagrees 

with this, but we can start by putting somebody representing the 

taxpayer in one of these hearings, and just having them there will 

change ALJ behavior, somebody else who knows all the record. And 

my real worry, Mr. Chairman, as we looked at this, is that the 

record was not thoroughly reviewed oftentimes in many of the 300 

cases that we looked at. And having somebody in the room that 

will force the ALJs to truly look at the whole record will make a 

big difference in the quality of the decisions and also the rules by 

which they make those decisions. 

I also would note that this is supported by the ALJs themselves 

and their union. It has been a long-time-standing recommendation 

of the Social Security Advisory Board, the bipartisan board created 

to advise both the President and Congress of the changes needed 

to the agency’s programs. 

Other simple changes would also go a long way as well: 

The evidentiary record should close at least 1 week before the 

ALJ hearing to give the ALJ the opportunity to judge that information in light of the whole record. Late evidence would simply mean 

rescheduling. It would not mean the evidence would not be considered. 

The vocational grids must be eliminated or reformed so that 

someone who is 50 years old is no longer ‘‘approaching advanced 

age in the United States.’’ 

These and other reforms outlined in today’s report I believe are, 

at a minimum, what should be considered by Congress if we are 

to, in fact, continue what our ultimate goal is: to truly help those 

people who have become disabled with their life skills and their income as they mature. 

Mr. Chairman, again, I thank you for this hearing, and I look 

forward to the testimony of our witnesses. 

Senator LEVIN. Well, again, thank you, Dr. Coburn, for this thorough report of the report. 
10 

1The prepared statement of Judge Jonas appears in the Appendix on page 55. 

We will now call our first panel of witnesses for this morning’s 

hearing: Judge Patricia Jonas, the Appellate Operations Executive 

Director and Deputy Chair of the Appeals Council at the Office of 

Disability Adjudication and Review of the Social Security Administration; and Judge Debra Bice, Chief Administrative Law Judge at 

the Office of Disability Adjudication and Review of the Social Security Administration. We appreciate both of you being with us this 

morning. We look forward to your testimony. 

Pursuant to our rules, all witnesses who testify before the Subcommittee are required to be sworn, and at this time I would ask 

you both to please stand and raise your right hand. 

Do you swear that the testimony that you will give before us 

today will be the truth, the whole truth, and nothing but the truth, 

so help you God? 

Judge JONAS. I do. 

Judge BICE. I do. 

Senator LEVIN. We will be using a timing system today. One 

minute before a red light comes on, you will see the lights change 

from green to yellow. That will give you an opportunity to conclude 

your remarks. Your written testimony will be printed in the record 

in its entirety. Please limit your oral testimony to no more than 7 

minutes. 

Judge Jonas, we are going to have you go first, followed by Judge 

Bice, and then after we have heard your testimony, we will turn 

to questions. So please proceed, Judge Jonas. 

TESTIMONY OF JUDGE PATRICIA A. JONAS,1 EXECUTIVE DIRECTOR, OFFICE OF APPELLATE OPERATIONS, DEPUTY 

CHAIR, APPEALS COUNCIL, OFFICE OF DISABILITY ADJUDICATION AND REVIEW, SOCIAL SECURITY ADMINISTRATION, FALLS CHURCH, VIRGINIA 

Judge JONAS. Chairman Levin, Ranking Member Coburn, and 

Members of the Subcommittee, thank you for the opportunity to appear before you today. My name is Judge Patricia Jonas. I am the 

Executive Director of the Office of Appellate Operations and the 

Deputy Chair of the Appeals Council for the Office of Disability Adjudication and Review (ODAR). Since 1940, the Appeals Council 

(AC) has helped oversee the hearings process by reviewing hearing 

procedures and decisions. I oversee approximately 75 administrative appeals judges who review a portion of our administrative law 

judges’ (ADJs) allowances and denials. 

Prior to Commissioner Astrue’s arrival, we had performed very 

little quality review at ODAR. This was due to several years of litigation and congressional reaction to the Bellmon Review in the 

1980s and budget shortfalls. As a result of that litigation and congressional reaction, our policy guidance and feedback to our ALJs 

was very limited. In fact, for many years, a remand order was the 

primary feedback from the Appeals Council to ALJs. While this 

method of feedback and guidance to ALJs is still an appropriate 

mechanism to address individual cases, it has limitations. For example, the number of remands to any ALJ is relatively small, and 

it was generally limited to unfavorable decisions. Today, however, 
11 

we are better leveraging the Appeals Council’s unique position, our 

General Counsel’s Office, and the Federal courts to provide better 

feedback. The key, as Commissioner Astrue advocated, was to institute a more balanced quality review into the hearings process. 

First, we developed serious data collection and management information for ODAR, and we also developed an electronic policy 

compliance system for the Appeals Council. These new tools permitted the Council to capture a significant amount of structured 

data about the application of agency policy in hearing decisions. 

In 2010, our Office of Quality Performance instituted an independent national review of hearings decisions to ensure a consistent and comparative review for all three adjudicative levels of 

our disability process. In 2009, Commissioner Astrue reestablished 

the quality review function in the Appeals Council, known as the 

Division of Quality, that reintroduced a sample review of favorable 

hearing decisions. It took nearly a year to fully implement this office because we had to hire, train, and obtain office space for about 

50 staff to review hearing decisions to identify quality issues. 

In September 2010, the Division of Quality began reviewing favorable decisions. These new quality initiatives have improved our 

feedback and policy guidance. The data we have collected identify 

the most error-prone provisions of the law and regulations and help 

us better train our ALJs, which include annual judicial training 

and mandatory quarterly training for all ALJs. We also recently 

implemented a new process that expands the opportunity for ALJs 

to provide feedback to the Appeals Council on its remands. Improved communication increases consistency. 

We also provide feedback on decisional quality, giving adjudicators real-time access to their remand data. We provide specific 

training that focuses on the most error-prone issues. In addition, 

we provide individualized training as needed. In 2011, the Graduate School USA recognized our government-leading training 

model with the prestigious W. Edwards Deming Training Award. 

These efforts are testing some longstanding traditions within 

ODAR. We are moving from training based primarily on anecdotal 

information to using data to identify issues. We develop training to 

refresh ALJs on policy and offer skill-based training to improve the 

adjudicators’ efficiency and accuracy. 

At the same time, we share this information so that the ALJs 

can more readily use it. Increased feedback and communication is 

improving our hearings process. Of course, opportunities for continued improvement remain. 

I understand the Subcommittee is releasing the report on 300 

disability cases. We recognize that the sample of cases selected for 

the report will limit the ability to generalize conclusions from the 

study, but that said, we believe that the report highlights the same 

concerns we have already identified, and we hope to work with you 

on further improvements to this vitally important program. 

While my office has not yet reviewed the 300 disability cases provided the Subcommittee, the agency’s Office of Medical and Vocational Expertise did a basic review. I understand that they found 

a number of policy issues that are consistent with what we saw 

when the Division of Quality conducted a national random sample 

review of favorable hearing decisions in FY 2011. Two areas of con-
12 

1The prepared statement of Judge Bice appears in the Appendix on page 65. 

cern were the evaluation of medical opinions and the assessment 

of residual functional capacity. Based on data from this review, we 

provided mandatory training to all ALJs on RFC and evaluation of 

medical source opinions. 

Just as with the cases we see at the Appeals Council, the majority of the ALJs in the cases that the Subcommittee requested appear to have complied with our policies. However, there are examples in which ALJs were not policy compliant in evaluating the appropriate weight given to a medical source’s opinion and in assessing the claimant’s residual functional capacity. There were also 

several case examples from one ALJ in which the written decision 

appeared inaccurate and contained boilerplate information that 

was not relevant to the individual claimant. The Division of Quality had identified the same issue in the random sample review, and 

as a result, the Chief ALJ instructed the ALJ to discontinue this 

practice. This example shows that our improvements are producing 

positive results, and we are committed to continuing our progress 

in this area. 

Finally, to guide our ongoing quality improvement efforts, we 

have partnered with the Administrative Conference of the United 

States (ACUS). Later this year, ACUS will issue recommendations 

on several areas of our hearings process, including the scope and 

manner of Appeals Council review, the duty of candor and the submission of all evidence, and the effect of the treating physician rule 

on the role of the courts in reviewing our disability decisions. We 

look forward to ACUS’ findings to help us further improve the 

quality of our hearings and appeals process. 

Thank you, and I am happy to answer any questions you may 

have. 

Senator LEVIN. Thank you so much, Judge Jonas. Judge Bice. 

TESTIMONY OF JUDGE DEBRA BICE,1 CHIEF ADMINISTRATIVE 

LAW JUDGE, OFFICE OF DISABILITY ADJUDICATION AND 

REVIEW, SOCIAL SECURITY ADMINISTRATION, FALLS 

CHURCH, VIRGINIA 

Judge BICE. Chairman Levin, Ranking Member Coburn, and 

Members of the Subcommittee, thank you for the opportunity to appear before you today. My name is Judge Debra Bice, and I serve 

as the Chief Administrative Law Judge in the Office of Disability 

Adjudication and Review. I am responsible for overseeing approximately 1,500 administrative law judges. We strive to make the correct decision as early in the disability process as possible so that 

a person who is eligible for disability benefits receives them in a 

timely manner. 

Our administrative review process generally consists of four levels: initial determination, reconsideration determination, hearing, 

and appeal. 

The provisions in the Social Security Act and regulations have 

been incorporated into a standardized five-step process for making 

disability decisions called the ‘‘Sequential Evaluation Process.’’ A 

disability adjudicator must use this process to arrive at fair, legally 

sufficient, and legally defensible decisions. 
13 

1See Exhibit 22, which appears in the Appendix on page 889. 

Since the Social Security Board established the hearings and appeals process in 1940, we have sought to balance the need for accuracy and fairness to the claimant with the need to handle a large 

volume of claims in an expeditious manner. 

ALJs decide cases de novo, meaning that they must review cases 

with fresh eyes and are not bound by the determinations made at 

the prior levels of the disability process. This is an important principle because a case at the hearings level is often very different 

from what it was at the initial or reconsideration levels. There may 

be new evidence for the judge to consider as well as the testimony 

of the claimant, medical and vocational experts, and other witnesses at the hearing. 

In addition, any change in the claimant’s vocational profile, such 

as age, education, or work experience, must be considered. Thus, 

an ALJ’s decision to allow a claim on appeal does not necessarily 

mean that the earlier determination was incorrect. 

At one time there was a common belief within the agency that 

an ALJ’s qualified decisional independence meant that ALJs were 

independent and not accountable for their conduct and their work. 

Under Commissioner Astrue’s leadership, we have held ALJs accountable where the law permits. Fortunately, most ALJs welcome 

feedback and want to follow policy. The vast majority of issues are 

resolved informally by hearing office management. When they are 

not, management has the authority to order an ALJ to take a certain action or explain his or her actions. ALJs rarely fail to comply 

with these orders. In those rare cases where the ALJ does not comply, we may order counseling or issue a reprimand. However, the 

law forbids us from taking stronger measures, such as removal or 

suspension, unless the Merit Systems Protection Board finds that 

good cause exists. 

In egregious cases, we have been able to remove ALJs, but only 

after completing the lengthy MSPB disciplinary process, which can 

take several years and can consume over $1 million of taxpayer resources. Unlike other civil servants, the ALJs we seek to remove 

receive their full salary and benefits until the full MSPB sustains 

the removal. ALJs do not repay that money even if the MSPB ultimately sustains the disciplinary action. During this period, we 

place ALJs on administrative leave to protect the public, and they 

do not hear or decide cases. 

Thank you, and I will do my best to answer any questions you 

may have. 

Senator LEVIN. Thank you very much, Judge Bice. 

Let us have a 10-minute first round, and we can go back and 

forth. 

You have exhibits there in front of you, I believe. If you would 

look at Exhibit 22,1 this is a 2001 report from the Division of Quality, and last year the Social Security Administration set up a new 

quality review process to examine actions taken by the ALJs in disability cases. If you look at page 2 of that report, it indicates—I 

misspoke. Exhibit 22 is a 2011 report from the Division of Quality. 

Page 2 indicates that the quality review looked at 3,692 cases that 
14 

were effectuated, 2,880 remanded, 665—I am sorry. Let me repeat 

this. 

It looked at 3,692 cases; 2,880 were effectuated, 665 remanded, 

decisions issued on 147. First, Judge Jonas, can you tell us what 

each of these categories are and what these actions mean? 

Judge JONAS. Thank you, Senator, for the question. I am going 

to begin with own motion review for a moment because I think it 

can be confusing. It is a technical term from the Social Security 

regulations, 404.969. And as you mentioned at the beginning, a 

percentage of own motion is not necessarily an indication of error 

in the outcome of the decision. I think that it can be misconstrued 

at times. It is more a measure of whether the ALJ followed the 

agency policy in arriving at the decision. So perhaps it is simpler 

to think of it as saying that the decision may be premature, that 

there was some further policy that the ALJ needed to comply with. 

The regulation 404.969 requires a random sample selection of 

cases. The number of cases, the 3,692, were the number of cases 

that were selected from that random sample that the Division of 

Quality considered during the fiscal year. Effectuation means that 

in the consideration of that case they believed that the ALJ had 

complied with the policy. They did not take review of the case and 

let it go forward for payment. So out of that, 78 percent of those 

were felt that they could go forward with payment. 

For the remands, the 665 means the cases in which they took 

own-motion review and decided that the case needed to be returned 

for a hearing or for some further action. In some cases, the Division 

of Quality issued a decision on their own, and that decision category, 147, reflects that. That might be a situation in which the decision itself was correct, but the onset date was in error. And so 

the Division of Quality has the authority to issue a decision. 

For those cases in which an attorney-advisor issued a decision, 

where the case needed a hearing, it had to be remanded. So 22 percent reflects the combination of those cases that were remanded 

and those cases in which the Appeals Council Division of Quality 

issued their own decision. 

Senator LEVIN. Could that decision be to affirm, or was that a 

decision which would reverse? 

Judge JONAS. If they had the information in the record where 

they could have affirmed, they did. Some of the decisions were denial decisions, some were later onsets, some were to correct the decision itself. If a decision had something inaccurate that would 

have prevented a continuing disability review at a later time, the 

Division of Quality issued a corrective decision. 

Senator LEVIN. So is it fair to say that about 20 to 22 percent 

of the reviewed files contained errors or an inadequate basis for the 

decision? 

Judge JONAS. That is correct. 

Senator LEVIN. Were you surprised by that figure, 22 percent? 

Judge JONAS. Senator Levin, this last year we reviewed over 

150,000 denial decisions. The main workload of the Appeals Council before this Division of Quality was instituted was the review of 

denial decisions, and we had seen—I am not going to describe it 

again as an ‘‘error rate’’—sort of the equivalent in a denial. It is 

a decision to grant review of a case when the claimant is denied 
15 

and requests review by the Appeals Council, and that runs at 

about 20 percent this last year. So it is equivalent. 

Senator LEVIN. Were you surprised by the large number, or does 

that not strike you as a large number? A large percent? 

Judge JONAS. A large percentage, it is very concerning. 

Senator LEVIN. On the gridding matter, you have talked about 

gridding and Dr. Coburn talked about gridding. These are grids developed by the SSA for different levels of work, with columns for 

certain characteristics of the person seeking benefits, such as age, 

education, work experience. Are these grids guidance for the decision makers? Or are they directions? Are they binding? 

Judge JONAS. The application of the medical-vocational guidelines depends on what the claimants’ impairments are. If they have 

exertional limitations only, then those medical-vocational guidelines will direct a result. If there is a combination of impairments, 

both exertional and non-exertional, then those medical-vocational 

guidelines are, in fact, that. They are a guideline, not a direction. 

Senator LEVIN. Do you think the ALJs know that? 

Judge JONAS. Yes. 

Senator LEVIN. They know which are binding and which are 

guidelines that are not binding? 

Judge JONAS. Yes, sir. 

Senator LEVIN. You think that has been clear with the ALJs. OK. 

I notice that there is a reduction in the allowances in each of the 

four levels from 2010 and its previous years and 2011. If you look, 

for instance, at the initial allowance rate, in the 5 years that this 

chart provides or looks at, it went up from 35-percent allowances 

at the lowest level to 37 percent in 2009 and then down to 33 percent in 2011, which was the lowest percent allowed of the 5 years. 

On reconsideration, the allowance rate was 13 percent, then 14 

percent, then 13 percent. And then in 2001, it went down to 12 percent, which may not seem like a lot, but 1 percent when you are 

talking about 12 or 13 percent is a significant change. 

On hearings, the hearing allowance rate went from 61 percent, 

which was steady—this is the ALJ level—for the 4 years before 

2011, and then in fiscal year 2011 dropped to 56 percent. 

The allowance rate at the Appeals Council was steady at 2 percent, but even at the Federal court level, it went from 5 percent 

to 4 percent to 3 percent. So it would look as though there are 

fewer disability findings for the applicant in 2011 as a percentage 

than it was in the previous 4 years. Is that significant? And if so, 

why? 

Judge JONAS. Senator, I think that there are a variety of factors 

that go into the outcomes into these percentages. I am certainly not 

an expert on the case workload at the initial or the reconsideration 

levels to give you a clearer understanding of why there has been 

a reduction. I think there are some issues with regard to the demographics, the type of claims coming forward. 

In looking at the significant reduction in terms of the ALJ level, 

I think that, again, we are seeing cases that have different demographics, perhaps younger individuals. Judge Bice, maybe you—— 

Senator LEVIN. I mean, does it show, for instance, that there is 

greater care being taken? Is that a reflection, or is it premature to 
16 

say that? Judge Bice, just perhaps we would get your comment, 

and then I will call on Dr. Coburn. 

Judge BICE. And, again, I am not an expert on that, but I think 

what Judge Jonas was mentioning is the change in demographics, 

and I know when I was hearing cases, I was seeing a lot more 

younger people applying, or maybe people who had been working 

and had lost jobs and were also applying. But I also think and I 

am very hopeful that it is a result of some of the increased efforts 

we have made on training our judges on our correct policy. As 

Judge Jonas mentioned, we have started a quarterly training for 

all of our adjudicators, and we have been hitting some of these 

most error-prone areas that were identified in her reviews. 

Senator LEVIN. Thank you. 

Judge JONAS. Senator Levin, I might supplement this as well. 

We have had a significant turnover in staff that support the administrative law judges over the last 5 years, and we have had the 

opportunity to have significant amounts of training for support 

staff as well as for the administrative law judges. I am cautious 

about saying that the reduction is the result just of increased quality. But I agree with Judge Bice; I think it is a significant part of 

this decision. 

Senator LEVIN. Thank you. Dr. Coburn. 

Senator COBURN. Thank you. Judge Bice, I just want your opinion on this. Are the rules for determining disability clear enough 

so that two trained, knowledgeable professionals could look at the 

same case and come up with the same decision? In other words, 

how subjective is this? If I went before and had a disability that 

was borderline and you had two ALJs looking at it, they all looked 

at exactly the same information, are they going to come to the 

same result? 

Judge BICE. No, and one of the factors is the qualified decisional 

independence of the judges. We do not tell the judge how to decide 

a specific case or put agency pressure on that. But we all follow the 

same law, regs, and agency policy. And we have invested a lot of 

time and effort into training our judges so that they all have that 

same understanding of the law. And I believe in most cases the 

vast majority of our judges do reach the right conclusion. They are 

very dedicated public servants. They want to apply the law correctly. They follow agency policy. At the hearing level, you can 

have a lot of conflicting medical evidence, and there really is substantial evidence to support different conflicting results. 

And so that is the job of the judge. I always tell our judges, ‘‘Do 

not abdicate your role as a judge. Really develop it. Ask those difficult questions, make those difficult decisions.’’ But they need to 

assess the credibility of the claimant. This is the first time that 

anyone is seeing the claimant and talking to the claimant about 

the claimant’s testimony about their subjective symptoms, about 

their activities of daily living. Sometimes we get new information. 

So that can make a difference. 

Senator COBURN. So tell me why—what was the reasoning that 

the Social Security Administration has discontinued the Minnesota 

Multiphasic Personality Test for use by the ALJs since it is—as a 

trained medical professional, I know how to use that test, and so 

do ALJs. Why have they been excluded from using that test? 
17 

1See Exhibit No. 23 which appears in the Appendix on page 900. 

Judge BICE. Senator Coburn, I would like to get back to you on 

the record for that. That is really an area for disability policy people. As judges, we administer the policy that is created, and, while 

you are a doctor, I am not. 

Senator COBURN. Well, does it make sense to limit the ability of 

ALJs? Given that part of their problem is independence or part of 

their advantage is truly independence, why would we limit their 

ability to use a very well proven, half-century-old psychological 

technique to look at—why would we take that tool away from 

ALJs? Can you give me any explanation of why you would think 

that should not be in the armamentarium of an ALJ in assessing 

a case? 

Judge BICE. I am going to defer to our disability policy people 

and ask to get back to you on the record for that.1

Senator COBURN. All right. Would you make sure that comes to 

me? 

Judge BICE. I will make sure it does. 

Senator COBURN. Thank you. 

Judge BICE. Thank you. 

Senator COBURN. We have concluded pretty much what the Social Security Administration has in terms of cases that do not meet 

the requirements for quality. What are the three biggest problems, 

Judge Bice, that you see that account for that lack of almost a 

quarter of the cases do not fit to the parameters of quality in the 

decisions? 

Judge BICE. Thank you for the question. I think it is important 

to recognize your cases came from 2006 to 2009. We have really invested a lot in training since then. I think the first one is the quality review that Judge Jonas spoke about. 

Senator COBURN. We did have cases in 2010. 

Judge BICE. Oh, OK. I am sorry, so 2010. But as Judge Jonas 

said, it was in 2010 that we were really starting that quality review. I know as a judge I received very little feedback initially. I 

could get remands that would tell me if I did something wrong, but 

that was usually on a denial. I was not receiving ongoing feedback 

on the favorables. Now, with the Division of Quality, we are providing that information to our judges, and we are actually providing it to them now in real time. We created an electronic tool 

where they can go in daily and see what the Appeals Council has 

seen on their cases. And we are also providing information. We are 

working on developing a training tool for them so that when they 

see that they have made an error, according to the Appeals Council—either a remand or a decision by the Appeals Council—they 

can click on a link and get a summary of what the policy is and 

examples of how they should apply that policy in real life. 

So these are the things we are trying to give back to the judges— 

that feedback on an ongoing basis. And we really believe most of 

our judges will self-correct if they get that information. 

Senator COBURN. Do you all know by judge error rate in terms 

of compliance with the rules? 

Judge BICE. I am going to defer to Judge Jonas. 
18 

Judge JONAS. Senator, as I mentioned earlier, in our denial reviews—over 100,000 each year—we have information about the 

mistakes or the errors or the concerns—the policy issues—and certainly we make that available. And the point I think Judge Bice 

was making about individual accountability is sort of a national approach that we have been using for training that I summarized in 

my testimony about using data that it is not anecdotal anymore. 

So an ALJ knows that these are the issues that they are having. 

So we have a national approach to provide the information so 

that it is consistent to the ALJs and to the senior attorneys so that 

they are informed. And at the local level, they have got the tool 

that Judge Bice was discussing. 

But these are complicated—I think you addressed this during 

your opening, that these are complicated rules. People work very 

hard. We think that most people who come to work want to do a 

good job, whether you are at the DDS or at the ALJ level. So we 

have a lot of information. They have a record to review. We want 

to give them tools that they can use to assist them and do this, not 

just to make them more effective but also efficient in doing what 

they are doing. 

So one of the tools that we have been developing—I discussed it 

in my testimony—at the Appeals Council level, developing a policycompliant tool for analyzing cases. We are developing a policy-compliant tool for the judges to use at the hearings level. 

Judge BICE. In fact, it is an electronic bench book, and actually 

we have been training on it in this last month, and this is going 

to be a policy-compliant electronic tool to help the judge in the adjudication of their claim. For instance, one example would be when 

the judge gets to the step on the listing. In this electronic tool, it 

will actually bring up the most current section of that listing and 

the specific areas that must be met in the record, and then we go 

through that, and it helps the judge make sure that they are making a correct decision at that level. 

Senator COBURN. You discussed the difficulty and the time constraints and the Merit Review Board of taking and terminating a 

judge who is noncompliant. I think your figure was $1 million, was 

what the cost was. Three cases wrongly decided is $1 million, on 

average. And when you have an ALJ that is an outlier—and let me 

State, the vast majority are wonderful public servants. There is no 

complaint there. But the fact is what we have discovered, like in 

Oklahoma City, one judge had a significant problem with quality. 

And no wonder. He was doing 1,500 cases a year. 

So I go back to this. Is somebody in the Social Security Administration tracking judge by judge based on quality so you know who 

is the problem and who is not? Where is the management to say 

here is a judge that has a 40-percent error rate in terms of the 

quality, not whether they decided the case right or wrong, but in 

terms of meeting the standards that you expect an ALJ to do, 

where is the management system to hold them accountable? That 

is what I am asking. 

Judge BICE. In a broad area, we take the results of the reviews 

done at the Division of Quality. And I believe they are valid at the 

regional level, correct? They do not go down to the judge level. So 

we do not have any valid data at that judge level, but just like in 
19 

your report, we found what those common errors are, and we are 

addressing those with all of our judges, because if those are common errors, we are going to hit all of our judges and make sure 

that they are trained on that and that they are given the tools. 

This quarterly training we do is a cooperative effort. It is from the 

Appeals Council. 

Senator COBURN. I understand that, and I am not trying to be 

confrontive. But my point is, let us say you do all that, and in our 

region out of Dallas, we still have five judges that do not comply 

with your quality standards, do not follow the training. Who is 

watching that? And where is the control for that on a per judge 

basis? 

Judge BICE. Let me give you the example of what we do when 

we find judges that are not compliant with policy, and it might 

come various ways. 

Senator COBURN. And this is a rarity. 

Judge BICE. I know. 

Senator COBURN. I am not trying to generalize that this is across 

the board. 

Judge BICE. But we share your concern, and so we start with 

training. That is our building block. We go to the judge. We make 

sure that that judge has been trained on the policy. If they need 

remedial training, we will give them that. And this, again, is the 

broad approach that we take to this. And then we will monitor to 

make sure that that judge is now complying with the policy that 

we have trained them on. 

If we find that that judge continues to be noncompliant, we can 

issue a directive to the judge saying, ‘‘You have been trained on the 

policy. The expectation is that you will follow that, and if you do 

not, we can take disciplinary action.’’ Most of the judges going 

down this path, correct. But if they would not, after we had issued 

a directive to follow the policy, then we could start down a disciplinary track. 

Senator COBURN. So you are keeping track. 

Judge BICE. As we become aware of it. I am not keeping track 

individually because I do not have valid data. But if I from other 

sources become aware of problems—— 

Senator COBURN. I guess then that is my question. Why would 

that not be part of the management system of the ALJs and the 

Social Security Administration to not track the four or five or ten 

outliers out of 1,500 to know when you have a problem and correct 

it rather than to anecdotally discover it. 

Judge BICE. And, again, I think because we do not have valid 

data at the judge level, so—— 

Senator COBURN. OK, but what I am asking is why haven’t you 

developed valid data at the judge level? 

Judge JONAS. Senator, certainly you have talked about that 

phrase ‘‘outliers.’’ So an outlier could be in terms of the outcome 

of the decision is one issue. 

Senator COBURN. Well, I was very specific. I am saying they do 

not meet the quality parameters under which you all say are the 

guidelines for which they should make a decision. I am not talking 

about the results of the decisions. I am talking about the quality 

of the work product as inside your guidelines. 
20 

Judge JONAS. I am going to refer back to the testimony that I 

gave at the beginning just as a predicate for my answer, and it is 

the notion about litigation and concerns about the Bellmon Review. 

I mentioned that our review at the Division of Quality is a random 

sample. That regulation and the comments that came to it from 

1998 reflect part of that history of litigation with regard to what 

was then described as targeting ALJs about outcomes. 

The random sample does give us some indications where there 

is an issue. As an example, in our Division of Quality, if we are 

seeing cases even just coming in on the random sample repeated 

from a judge who is not following that policy—say four out of the 

four cases they reviewed they took own motion—then it allows us 

to go back and do a focused review as to what might be happening. 

We do not want to draw assumptions just on the basis of a handful 

of cases. We want to know a little bit more. What Judge Bice was 

alluding to earlier is we want to make sure that there is not something about the circumstance that the judge is working in that 

might be directing something, and it might be the type of cases he 

received or something in the hearing office that might be impacting 

that. So it requires us to look a little bit more deeply. 

Senator COBURN. So I understand this, because I am going to be 

on this for the next 4 years, you are saying, given previous case 

law and the Bellmon Review, that you are prohibited from actively 

managing quality parameters of ALJs. Is that what your testimony 

is? 

Judge JONAS. My testimony is that in our understanding of and 

your concern about respecting the administrative law judge qualified decisional independence, we are cautious about how we use information and how we follow those regulations. I do not think it 

precludes us from looking at individual ALJs. The Commissioner 

has a responsibility for oversight of the program and can look at 

any decision at any time. But we want to be cautious about that 

and careful. We want to be sure that we are doing this in a way 

that will facilitate improvement of the program. So when we look 

at an individual, if there is something about that case or something 

about the way a case has been adjudicated, we will look more carefully before we draw a conclusion. I think that requires us to manage very carefully at the administrative law judge level. 

Senator COBURN. But your testimony still is you do not have the 

capability to find the outliers through your management system. 

For example, in Oklahoma City, one of the administrative law 

judges that we interviewed and that we looked at their cases, the 

one that did over 5,100 cases in 3 years, you do not have a management system to say that is going on, nor a flag that says somebody 

is handling four times as many cases as everybody else is handling, 

and we have no management system with which to deal with that. 

Judge BICE. I think we have a system. We get information from 

the reviews that are done, because if the Appeals Council does see 

something in the review, they are letting me know, and then we 

are taking further looks at that. We also get it from maybe bias 

complaints and all that. But it would take a lot more resources 

than we have right now to review. We have several hundred cases 

for every ALJ to get a valid sample. So I do not have the resources, 

and I do not think Judge Jonas has the resources, but we are look-
21 

ing—we are very concerned. I am very concerned about judges that 

pay a high number of cases, judges that pay a low number of cases, 

judges that produce a whole lot of decisions, judges that produce 

very little decisions. And we are looking at a number of factors, 

other factors in addition to just those, to try and identify judges or 

offices where we need to take a closer look. And when we have that 

data that says we should take a closer look, then we can perhaps 

do a focused review. 

Senator COBURN. Well, I am way over my time, and I want to 

defer to my Ranking Member. I would just ask that you all submit 

to this Committee what your management system is to capture, not 

after the fact but to anticipate outliers in the future, because the 

importance of that is creating the expectation on the ALJs that 

they will operate within the bounds that they are asked to operate 

within. And if there is no expectation, then there will not be any 

change in performance. And so all I am asking is what is the system and send it to me so we can look at it and analyze the management system for that. 

I understand the independence issue, but it does not change the 

fact that if the expectation is I am free to do whatever I want in 

the poorest quality that I want, like we saw on these 5,100 cases, 

I would love to see somebody review those 5,100 cases just to see 

what was the quality, because the samples that we got show a tremendous high number of problems—not in terms of outcomes necessarily but in terms of following your own guidelines on how those 

cases are to be decided. 

Thank you. 

Senator LEVIN. Thank you, Senator Coburn. 

Our Ranking Member, Senator Collins. 

OPENING STATEMENT OF SENATOR COLLINS 

Senator COLLINS. Thank you, Mr. Chairman. 

First, let me commend you and Senator Coburn for undertaking 

this investigation. I believe that there are very serious fairness and 

fiscal issues that are at stake. The fairness issues are obviously 

that we want to make sure that individuals who are unable to 

work and meet the high standard of being unable to perform any 

substantial gainful activity in the economy receive their benefits 

and do so promptly. At the same time, we want to make sure that 

those who do not qualify are not receiving benefits, and this is particularly important because of the fiscal issue. 

As Dr. Coburn has reminded us, the trustees of the Social Security system project that the disability insurance component of the 

trust fund will be exhausted in the year 2016. That is truly alarming and calls upon us to make sure that those who do not meet the 

standards are not receiving benefits as well as making sure that 

those who do meet the standards receive their benefits. 

Mr. Chairman, I suspect that you remember back in 1983 and 

1984 that Senator Cohen and you did an in-depth investigation on 

the Social Security Disability Program. I was a staffer on that investigation, and ironically, what we were looking at back then was 

the fact that people who clearly lacked the ability to work were 

being denied benefits unfairly. So it happens on both sides, and 

that is why we have to be careful as we proceed here not only to 
22 

preserve the independence of ALJs but to recognize that they are 

an important check on a system that back in 1983 and 1984 produced outcomes that were just inexplicable. I remember one infamous case was an individual who literally was in an iron lung and 

was found to have work capacity. And so it does go both ways. 

But that brings me to follow up on Dr. Coburn’s question on 

outliers. Now, if the Wall Street Journal in its article last year was 

able to identify this ALJ in West Virginia who approved 100 percent of some 729 cases and then also indicated that there were 27 

judges that awarded benefits 95 percent of the time, it seems to me 

that, if the paper can come up with a system, Social Security ought 

to be able to come up with a system that identifies outliers. And, 

again, I want to emphasize there can be outliers on both sides. 

There can be an ALJ who, for reasons that do not follow the standards, is turning down everybody as well as someone who is approving everyone. 

But my question is very similar to Dr. Coburn’s. Doesn’t Social 

Security have a system to identify outliers and then take a look at 

their cases and see if more training is needed, if there is a disregard for standards, if there perhaps is an alcohol or drug abuse 

problem? There could be numerous reasons for it. Is there no system now in place that automatically flags the true outliers? Judge 

Jonas or Judge Bice, I am not sure which of you I should be directing this to. 

Judge BICE. I will start, and then I will defer to Judge Jonas. We 

do have a system where we can track the judges that are paying 

a lot of cases or denying a lot of cases, producing a lot or producing 

very little. We have good statistical data on that. 

Senator COLLINS. But that is the number of cases. 

Judge BICE. Right. 

Senator COLLINS. That is a different issue. 

Judge BICE. The quality is much more difficult to track, and I 

will defer to Judge Jonas on that. But I want to mention one thing 

in terms of expectations for our judges. This year I issued a memo 

to our judges. We are not silent on what we expect our judges to 

be doing in terms of quality. I issued a memo to all of our adjudicators, administrative law judges and senior attorneys, as to what 

they need to be doing, and it is many of the things that you found 

in your report. We talked about that their decisions have to have 

a very specific residual functional capacity, that they have to evaluate all medical source statements, that they have to apply the law 

and policy correctly. So we have gone through that, and we are 

very, very clear in our message to our judges that we do expect 

them to follow the policy, and we are giving them that information 

when they are not. 

But I will defer to Judge Jonas on the difficulties of tracking 

quality. 

Judge JONAS. I will comment briefly before we go to the quality. 

You noted that newspapers and others are able to look at data. So 

the agency has been very transparent with the administrative law 

judge data for a number of years, both in terms of the number of 

cases issued and the outcomes. And I think that is an important 

factor about making sure that the agency is transparent in what 

it does. 
23 

It is harder to evaluate whether the outcome was correct or not, 

and that is where we do not have statistically valid data at the 

local office level. In FY 2011, we did about 3,600 reviews under the 

random sample selection criteria that is described in the regulation. This year, we are doing close to 7,000 of those. But it still 

gives us data that is only statistically valid at the regional level 

and at the national level. But when we do those reviews, it raises 

issues about individuals, so that does give us a chance to look more 

deeply and, again, probe more deeply as to what might be happening. In fact—— 

Senator COLLINS. But then what happens? Say that an individual ALJ as a result of that review appears not to be following 

the law and regulations. 

Judge JONAS. This gives us an opportunity to do a focused quality review, but it is a post-effectuation review. It is not in line. I 

did not make clear earlier the difference between the types of reviews. Our Division of Quality is doing this random sample review 

in a pre-effectuation level. So the own-motion review means that if 

we take review, it is precluding effectuation of the benefits until we 

decide whether that case either has to go back or can be effectuated. 

But in a post-effectuation review, our of Office of Quality Performance as well as the Division of Quality can do a post-effectuation focused review, a probe to see what might be happening. 

Senator COLLINS. But do they? 

Judge JONAS. And we do that. And when we get the results of 

one of those reviews, the Division of Quality reports that to Judge 

Bice, to me, and to the executives in ODAR for whatever educational or other sort of executive decisions we need to make about 

that data. 

Senator COLLINS. Well, let me give you an example of a system 

that I think offers a model for you. In Maine, several years ago 

there was a program that identified outliers among physicians who 

were performing too many caesarean sections, and what happened—— 

Senator COBURN. You are getting real personal here. 

Senator COLLINS. Sorry about that. [Laughter.] 

And it was an extremely effective program because statistical 

analysis was used to identify the outliers, and then that physician 

was counseled by other physicians who did ob/gyn work. And it was 

astonishing to see within the next 2 years the physician who was 

the outlier’s numbers dropped dramatically. 

Similarly, I am told that Medicare has an extensive integrity program to review the decisions of providers. It just seems to me you 

could do more without compromising the professionalism, the independence, the integrity of your program if you looked at models 

that Medicare is using and that the medical profession is using. 

And, again, I want to emphasize I think this goes both ways. We 

do not want people who are just automatically turning down everyone or doing only cursory reviews, as well as those who are automatically approving everyone. 

But what troubles me is your system, as you have described it, 

does not seem rigorous enough to me to identify outliers, which I 

think you could do easily statistically, and then have some sort of 
24 

panel of ALJs review the cases. Because who knows? Maybe there 

were a batch of cases where every single one of them did deserve 

to be approved or every single one did deserve—so, but have someone take a look at the quality of the cases and whether the law, 

the regulations, the best practices are being implemented. That is 

what I think you need. 

Judge JONAS. Senator, let me add something to what I said before as well. In my testimony, I talked about a vigorous data collection tool at the Appeals Council when we review cases, and it does 

collect about 170 different types of errors. So we do have quite a 

bit of data about this. 

In my testimony I also discussed that we have been working with 

the Administrative Conference of the United States, asking them 

for recommendations in some areas, and this is actually one of 

those areas in which we have asked them for some recommendations in terms of how we might better use the focused reviews for 

identifying outliers and how that information would be appropriately used. We expect those recommendations by the end of the 

year. 

Senator COLLINS. Well, I am now over my time, but I just hope 

you will make this a priority. There just seems to be a vagueness 

in the system right now, and I think it could be tightened up using 

the medical model I have described without in any way undermining the decisional independence of the ALJs. 

Thank you, Mr. Chairman. 

Senator LEVIN. I have a few more questions, and then we will 

call on other Senators to see if they have additional questions. 

My understanding of the Bellmon Review was that the court said 

you could not look at outcomes and act against judges based on an 

outcome survey. What you are telling us today is that you do a random survey not of outcomes but of errors, in effect, error rates, and 

where that random survey shows that there is a particular judge 

that has a significant—or judges that have significant numbers of 

errors, that then you do a focused review of those judges. Do I have 

that right? 

Judge JONAS. Senator, the random selection is selecting cases as 

they come in. It is not identifying a particular ALJ. 

Senator LEVIN. OK. But, however it selects them, if that turns 

out that there is an indication that particular ALJs have a large 

number of errors that you then can do a focused review of that 

ALJ. Is that true? 

Judge JONAS. The regulation that I was referring to is the preeffectuation random selection review. Post-effectuation, our focused 

reviews are not just about ALJs. They can be about other participants in the hearing process. It might be about something we see 

either through the random sampling reviews or through our denial 

reviews, or it might be about a particular type of medical report we 

see that is coming in. We have done focused reviews on those 

issues. 

Senator LEVIN. I think what Dr. Coburn was getting at—and I 

am not sure I understand your answers—is that we see error rates, 

that is what we are focused on, not outcomes but error rates, since 

you have a way of determining errors, you have standards, and if 

they are not met, there are errors. How do you get to judges that 
25 

have large error rates? Put aside outcomes. It does not mean they 

are wrong. Just error rates. How do you get to those judges that 

have large numbers of errors? 

Judge BICE. Do you mean how do we find them? 

Senator LEVIN. Yes. He used the word ‘‘anecdotal.’’ So far that 

is about what I see as anecdotal. I do not see that there is any kind 

of a management process, which is what I think he was getting at, 

to try to find those ALJs to take initiative or to affirmatively look 

for ALJs that have large numbers of error rates. 

Judge JONAS. So, Senator, let me address it this way. Until we 

reinstituted the quality review of favorable decisions in 2011, our 

focus would have been principally on reviewing those denial decisions. That is when we would have seen a decision for review as 

to whether or not there was a mistake or an error in terms of 

whether they were following the policy. So in my testimony, I mentioned the feedback from that. So if we identified in those reviews 

that there was some sort of policy problem with them, the feedback 

to the ALJ was typically a remand to that individual. 

When the Commissioner authorized us to reinstitute the Division 

of Quality to look at favorables, that is what gave us the opportunity to start looking at the favorables in a systematic way into 

this random sample that you then identify where are those significant problems. And that is at a national level that we are having 

that conversation. 

I think Judge Bice could certainly comment at a local level. 

There has always been a discussion about the quality of decisions. 

Judge BICE. Right, and I think what—— 

Senator LEVIN. It is only one at a time. I may be wrong. 

Judge BICE. OK. Yes, and I think it is important that through 

the requests for review, the reviews of denials and remands, we are 

able to identify some ALJs or other adjudicators with issues and 

that we might then look at that in more depth. 

Senator LEVIN. Let me interrupt because I think maybe I am not 

really understanding what you are saying. I think the question is— 

to me it sounds anecdotal. Is there a way—and I do not want to 

misstate Dr. Coburn’s question because he states them better than 

I can. But the way I understand it, there is no management tool 

that is in place to affirmatively take the initiative to identify ALJs 

with large error rates. Is that accurate? And if so, can that be put 

in place? You cannot, obviously, go through millions of cases or 

hundreds of thousands of cases and look at every single case to determine whether or not there is an error rate, whatever your hundreds of thousands number, you cannot do that. I do not think. But 

is there not some way that you can identify ALJs, taking an affirmative action, taking the initiative to identify the ALJs that have a 

large number of error rates? He asked you, I think, to do that for 

the record. I will put that question that way. It does not exist now, 

obviously, or else you would have said it exists. 

Judge JONAS. Let me summarize this, and perhaps it links back 

to my testimony. The fundamental way in which we improve quality and address these issues is to capture data, and so we capture 

structured data with these tools that we developed that were available to the Appeals Council beginning in 2008 and 2009. That is 

our foundation for quality, for identifying quality problems. So we 
26 

1See Exhibit No. 23 which appears in the Appendix on page 900. 

build on that structured data. We capture that, analyze that data 

to decide and to look at the various offices, various ALJs. 

We then can do the focused review to probe more deeply on a 

particular issue, particular area, particular type of disability, and 

that is what allows us then to go back and address that by building 

these policy-compliant tools like the electronic bench book that 

would then facilitate the appropriate action by the ALJ. 

Senator LEVIN. I understand. That does not get to what I am 

asking about, and if there is a way of doing that, I think we would 

like to know, and if not, tell us why not. 

Two other quick questions. One, there seemed to be very significant differences in the regions. Region VIII has a 15-percent error 

rate, according to this chart. Region VI has a 26-percent error rate. 

One in four cases were problematic—in other words, not wrong or 

right but problematic. Can you tell us why there is such a big difference between Region VIII and Region VI? 

Judge BICE. I noticed the same thing. We have gotten this data. 

It is something I would like to explore, but I have not gone there 

yet, and I do not know if Judge Jonas has done anything at the 

Appeals Council. 

Senator LEVIN. Would you let us know the answer after you look 

that up. 

Judge JONAS. We will provide that.1

Senator LEVIN. Let us know what you find. 

Finally, on the government representative issue, I believe that, 

Judge Bice, you were a government representative, if I understand 

what I heard. 

Judge BICE. Yes. 

Senator LEVIN. And this was some years ago. Can you give us 

your experience. There was some kind of a pilot project, was there, 

back in—was it as early as the 1980s? 

Judge BICE. Yes, it was. We briefed the Senate Finance Committee on much of this information. But during the 1980s—I believe it began in 1982—the agency tried a pilot where there was 

a government representative at the hearing at selected hearing offices. I participated in the pilot from 1984 to 1987. 

During the course of the pilot, there was a U.S. district court 

case, Sallings, that enjoined the project, and subsequently the 

agency discontinued the project because of the interruption caused 

by the court case and because of fiscal constraints. 

Congress originally supported the project, but as it was developing and proceeding, there was a lot of congressional opposition 

to that, and, in fact—— 

Senator LEVIN. What is your personal experience? 

Judge BICE. My personal experience? I can tell you a little bit 

about what I did. 

Senator LEVIN. No. Just what did you find? Did you find it useful? Not useful? 

Judge BICE. We were present in the hearing, questioned the witnesses. We reviewed the cases ahead of time. We could request evidence. Overall, I did not see a significant difference in the case outcomes or in the timeliness of the decisions. Again, these are com-
27 

plicated cases with substantial evidence on either side. There were 

a handful of cases where I know I made a difference, but by and 

large, I did not see a significant change in the outcome of the hearings. 

Senator LEVIN. OK. Dr. Coburn. 

Senator COBURN. I just want to go back to one of the things 

that—we are concerned about high denials as well as high approvals. But the one thing this study found is the judge that did the 

most cases had the highest approval rate. The one doing 5,100 

cases over 3 years approved almost all of them. And what we are 

hearing today is you have no system to capture that or to manage 

that. And so I look forward to your commitment to return to us 

what your management system is for that. 

One of the things in discussing with the ALJs was the pressure 

to decide cases. One of the factors we heard in talking with them 

is there is pressure to get it decided and to get it decided quickly. 

Do you think ALJs can sometimes feel pressured to move faster 

than they would like? In other words, the pressure is so great that 

the attention to the case becomes sacrificed because of the pressure 

to move the case? One, where is the pressure coming from? From 

the agency or somewhere else? Each judge is expected, I think, to 

decide somewhere between 500 and 700 cases a year. That would 

imply to me, given the depth of the complexity as well as the mass 

of the paper, that they are going to have to move quickly to be able 

to do that. Is 500 to 700 cases a reasonable demand? And are there 

not pressures—are there not results from the pressure to move 

cases quickly, just taking in human nature, that might increase the 

error rate? 

Judge BICE. Thank you. In 2007, Judge Cristaudo, who was the 

Chief Administrative Law Judge at the time, asked judges to do 

500 to 700 decisions a year, but it was very important that he 

asked 500 to 700 legally sufficient decisions a year. That has not 

increased. We have not increased that expectation. It still to this 

day is 500 to 700 cases. 

We have invested a lot in the training of our judges. We provide 

them with lots of tools. They are not working in isolation. The case 

is developed before it comes to them. It might have been reviewed 

by a senior attorney. They have senior attorneys available to them 

to assist with that. 

My personal experience is I have been able to do over 500 cases 

in a year in a legally sufficient manner. And I can say that in 2007 

there were 46 percent of our judges that were within that range. 

There are now 77 percent as of the end of FY 2011. And that was 

without an uptick in the allowance rate. So I do think it is fair and 

reasonable. I think the judges have to work hard at it, but I am 

giving them those tools. And I am very, very careful in my messaging that I always want judges to do legally sufficient decisions. 

When I talk to judges about moving a case, I always tell them, ‘‘If 

it is ready to be decided, you need to decide it.’’ And I want them 

to decide it and move it along quickly at that point. But if judges 

need the case developed, they should develop the case, again, in an 

efficient manner. They should get the evidence that they need. If 

they need additional medical evidence or a consultative examina-
28 

tion, they should do that. They should do a really good hearing 

and—— 

Senator COBURN. But you all have limited judges on getting the 

evidence they need because you have told them they cannot use the 

Minnesota Multiphasic Personal Test. 

Judge BICE. That is one exam, but they do have the right to request the medical evidence if the claimant does not submit it or a 

consultative exam. 

Senator COBURN. I know you are not a doctor. 

Judge BICE. Right. 

Senator COBURN. But you are much better. You are a judge—the 

point being that is key medical evidence that is recognized worldwide as a standard with which physicians make judgments all the 

time. And when we limit—you say you take the time to develop the 

case, to mature the case, and then you limit what—the other thing 

is you have limited—they cannot use any social media. So if somebody is out riding a horse, roping a calf, but they are making a 

claim for totally disabled and they have got Facebook showing 

them do that, you are telling the judge, ‘‘You cannot look at that.’’ 

I mean, that is part of the rules of Social Security today. 

Is there a limitation on the number of cases that the judge can 

see a year? 

Judge BICE. Yes. Twelve hundred. 

Senator COBURN. So how did our judge in Oklahoma City do 

1,500 and 1,600 a year? 

Judge BICE. Because Commissioner Astrue for the first time limited the number of cases that a judge can be assigned last summer, 

and he limited it to 1,200 because of the concern of judges doing 

a high number of cases. And so we have implemented that. We will 

not assign more than 100 cases to a judge in any 1 month so that 

they can work on an even basis. And we do look at the judges that 

have high numbers. We have looked at their allowance rates. Not 

everyone that produced high numbers had a high allowance rate, 

and some had, in fact, a very low allowance rate. 

So we are looking at those dynamics, but we capped them at 

1,200, and we continue to monitor that monthly. 

Senator COBURN. OK. My other in regards to that is if a judge 

is doing 1,200 cases a year, that is three cases a day—actually, 

that is more than three cases a day. That is three cases a day, 365 

days a year, three-plus cases. Average background is 500 pages. 

How in the world can they possibly do that? 

Judge BICE. I am not going to speak for those individual judges. 

Again, this was a cap. My expectation is 500 to 700 cases, and I 

have always told the judges, ‘‘I do not want you doing more if you 

cannot do them in a legally sufficient manner.’’ But I know many 

of our judges have developed very efficient means of reviewing the 

record. We have a lot of electronic tools. The case comes to them 

exhibited. The medical records are marked with whom they came 

from, the dates they came from. There is case data that is available 

electronically, a cover sheet that the legal assistants prepare for 

them outlining a lot of the information. They have senior attorneys 

available to help them. 

Senator COBURN. Yet our study shows 25 percent of those cases 

did not look at the complete record. 
29 

1See Exhibit No. 23 which appears in the Appendix on page 900. 

Judge BICE. And we are encouraging our judges to do that. That 

is our expectation. We are training them on how to do that. 

Senator COBURN. All right. I want to cover one more topic, and 

you may have to defer on that, and that is fine. The outdated job 

list, cases filed show that the DDS examiners and the ALJs relied 

on the Dictionary of Occupational Titles. When was that last revised? It occurred in 1977? That was before Facebook, iPads, computers generally throughout every bit of our commerce. And so Social Security has a plan that is going to cost $108 million to create 

a new OIS system that will not be ready until 2016. 

Are you familiar with the Department of Labor’s O’NET system? 

Judge BICE. Yes, I have been on it. 

Senator COBURN. And so why is that, first of all, not sufficient, 

one? And in what way specifically is it not sufficient? And, number 

two, why should we take $108 million to create a new system out 

here for Social Security when we could use O’NET and put that 

$108 million into speeding up the processing and the availability 

for people’s adjudication of claims? 

Judge BICE. And you are correct, that is outside my area of expertise, so I would like to defer and get back to you on the record 

with that answer. 

Senator COBURN. Judge Jonas, do you have any comments on 

that? 

Judge JONAS. Senator Coburn, I think we all agree it is an outdated resource. I am aware that we have recently signed an agreement with the Department of Labor to build on something they already have. I am not aware of the details about this, but we will 

provide that for the record.1

Senator COBURN. OK. I just want everybody in the hearing room 

to understand. We have a system. It is outdated. The Department 

of Labor has a system. Maybe it is going to be modified. In the era 

of trillion-dollar deficits that both Republicans and Democrats can 

claim responsibility for, $108 million to create a list of jobs in our 

economy, does anybody think that might be a little high besides 

me, $108 million for a list of jobs when we have got a database at 

the Department of Labor that lists all the jobs? Does anybody have 

any comment on that? 

Judge JONAS. I think we would prefer to get back to you on the 

record. 

Senator COBURN. OK. Do you think it is quite remarkable that 

our list of jobs that we are using now at the Social Security system 

has no computer-related jobs in it for comparison, since the definition of ‘‘disability’’ is there is no job in the economy that you can 

perform? 

Judge BICE. One of the things that we do at the hearing level 

is we do have a vocational expert there, and we can rely on their 

testimony and their expertise. 

Senator COBURN. So the assumption is they would be additive to 

the old system that we have today. 

Judge BICE. Right, and they might explain why it is in conflict 

with—— 
30 

Senator COBURN. And do you see that—I would ask Judge Jonas 

this. In your review of both approved and denied claims, do you see 

the utilization of that effectively representing the jobs in the economy today? 

Judge BICE. I do not think I have that detailed information of 

what we have seen. 

Senator COBURN. OK. All right. Well, that is fair. That is fair. 

One last question. Since 1980, the number of claimants that are 

represented by attorneys has doubled in terms of the actual number of cases. Why is that? 

Judge BICE. I do not have an explanation for that. 

Senator COBURN. You do not dispute the number, though? 

Judge BICE. I do not have that data, so I cannot agree or disagree with it. We could get that for you or look at that. I can tell 

you as a judge, we do advise unrepresented claimants of their right 

to representation, but we are neutral. We neither recommend nor 

discourage. We just tell them of the right. 

Senator COBURN. All right. Thank you, Mr. Chairman. 

Senator LEVIN. Thank you very much, Dr. Coburn. Our two witnesses, thank you both for—oh, I am sorry. I did not see you come 

back. 

Senator COLLINS. That is OK. 

Senator LEVIN. I saw you leave, but I did not see you come back. 

I apologize. Senator Collins. 

Senator COLLINS. I am stealth-like. [Laughter.] 

I will just ask one question, and it is a philosophical question. 

The Supreme Court has described the Social Security Administration’s administrative process as ‘‘unusually protective of the claimant.’’ 

First of all, do you agree that the disability determination and 

appeals process as it currently stands is structured in a way that 

tends to favor the claimant? And a related question: If you do 

agree, is that the way that it should be? Judge Jonas, we will start 

with you. 

Judge JONAS. Thank you, Senator. I agree that our policies are 

structured in a way—and I think Judge Bice just mentioned the 

notion about making sure that the claimant is aware of their rights 

so that they are protected. We look at that in terms of reviewing 

cases at the appellate level to ensure that the claimant’s due process rights are protected. 

It is certainly a culture in which we recognize that individuals 

can come without needing someone else with them and that we will 

look at them. It is protective, I would agree. 

Senator COLLINS. And my second question is: Should it be? The 

reason I ask that is I believe one of the recommendations that has 

been made in this report is to have a government representative 

at the ALJ hearing. And I am trying to decide whether that is a 

good idea or not, whether that would change it into more of an adversarial proceeding, which I do not think really is the goal of the 

process, or whether that government representative is needed to 

bring more balance into the process and to ensure that the taxpayers’ interest is represented. So, again, I have not reached a conclusion on that, but when I look at what the Supreme Court said 
31 

and your response, Judge Jonas, I am trying to evaluate that recommendation in the report. 

Judge BICE. I will just give you a little background. I do not 

know if you heard it before, but during the 1980s there was a pilot 

of the government representative project. So we have had some experience with that. There was a district court case that enjoined 

the process, and we discontinued it. We have not pursued it. Congress was in support of it originally. During the pilot, there was 

congressional opposition. 

We are always looking to improve our processes and our hearings, but we want them to be fair, accurate, and efficient. We are 

not sure whether a government representative approach can be 

crafted that would meet those principles. 

Senator COLLINS. So what would your concerns be? How would 

it undermine fairness, for example? 

Judge BICE. I do not have any official position on that. I am just 

saying that is kind of what our broad views are given the experience in the 1980s. 

Senator COLLINS. Well, let me just end my questions by saying 

that it would be helpful to me if you take a close look at the recommendations that were included in this report and provide us 

with your official reaction to the recommendations as we all seek 

to achieve the goal of a system that is financially responsible, fair 

and equitable, and that provides benefits to those who meet the requirements in the law, but does not provide benefits to those who 

do not. We need to make sure we are fulfilling both goals. 

Thank you, Mr. Chairman. 

Senator LEVIN. I wonder if it would be agreeable to you, Senator, 

and also to Dr. Coburn, if we ask actually the Social Security Administration for their reaction officially to the recommendations in 

the report rather than to ask these witnesses. 

Senator COBURN. I am fine with that. 

Senator COLLINS. That is probably a better approach, but if our 

witnesses have any insights that they would like to share with us 

as they think more deeply about that, I would welcome that also 

since they are on the front lines. 

Senator LEVIN. All right. 

Senator COLLINS. Thank you. 

Senator LEVIN. We would then add that, welcoming your insights 

on that question or any other question that we have asked, and 

there will be questions for the records, and we will send along to 

the Social Security Administration a request that they give us 

their—— 

Senator COBURN. I would just add, a timely response is important to me. Oftentimes what happens in Committee hearings is we 

get an answer back 6 months later. I would consider that untimely. 

I just would let you know that. 

Senator LEVIN. To put a finer point on that, we would appreciate 

your response in 30 days to that question, and we will ask the Social Security Administration to give us their official response relative to the recommendations or any other comments they may 

have within 30 days as well. We thank you both, and we go to our 

next panel. 
32 

1The prepared statement of Judge Stults appears in the Appendix on page 77. 

We now will call our second panel of witnesses for this morning’s 

hearing: Judge Douglas Stults, the Hearing Office Chief Administrative Law Judge at the Office of Disability Adjudication and Review of the Social Security Administration in Oklahoma City; 

Judge Thomas W. Erwin, the Hearing Office Chief Administrative 

Law Judge at the Office of Disability Adjudication and Review in 

Roanoke, Virginia; and, finally Judge Ollie L. Garmon, III, the Regional Chief Administrative Law Judge (Region IV) at the Office of 

Disability Adjudication and Review of the SSA in Atlanta, Georgia. 

We appreciate all of you being with us this morning, and, again, 

we look forward to your testimony. Pursuant to Rule VI, which I 

believe you hear because I think you all were in the room, all of 

our witnesses who testify before this Subcommittee are required to 

be sworn, so we would ask you to please stand, raise your right 

hand. 

Do you swear that the testimony that you will give before this 

Subcommittee will be the truth, the whole truth, and nothing but 

the truth, so help you God? 

Judge STULTS. I do. 

Judge ERWIN. I do. 

Judge GARMON. I do. 

Senator LEVIN. Thank you. The same timing system will be in effect. You will see a yellow light come on one minute before the red 

lights comes on, and we would ask that you limit your oral testimony to no more than 7 minutes, and your written testimony will 

be made part of the record. 

I think, Judge Stults, we have you going first, followed by Judge 

Erwin and then Judge Garmon. Judge Stults. 

TESTIMONY OF JUDGE DOUGLAS S. STULTS,1 HEARING OFFICE CHIEF ADMINISTRATIVE LAW JUDGE, OFFICE OF DISABILITY ADJUDICATION AND REVIEW, SOCIAL SECURITY 

ADMINISTRATION, OKLAHOMA CITY, OKLAHOMA 

Judge STULTS. Well, thank you, Mr. Chairman, Ranking Member 

Coburn, and Members of the Subcommittee. My name is Doug 

Stults, and I am the Hearing Office Chief Administrative Law 

Judge (HOCALJ) for the Oklahoma City, Oklahoma, Hearing Office. I have 4 years and 5 months of experience as an administrative law judge, and I have served 3 years and 9 months as chief 

judge of the Oklahoma City Hearing Office. 

Prior to becoming an administrative law judge, I worked at the 

Oklahoma City Hearing Office for 12 years, 3 years as the hearing 

office director, 5 years as a group supervisor, and 4 years as an attorney-advisor. Prior to working for ODAR, I was a staff attorney 

for the UAW Legal Services in Oklahoma City for about 71⁄2 years, 

and prior to that I practiced law in central Oklahoma for about 81⁄2

years. 

The Oklahoma City Hearing Office primarily serves central and 

western Oklahoma, specifically Oklahoma City, Lawton, Ardmore, 

and Clinton, Oklahoma, as well as Wichita Falls, Texas, and Santa 

Fe, New Mexico. Thus, the claimants served by the Oklahoma City 
33 

Hearing Office live in urban, suburban, and rural areas and are of 

diverse cultural and economic backgrounds. 

The Oklahoma City Hearing Office is presently staffed with 13 

administrative law judges, supported by 59 staff, specifically one 

hearing office director, four group supervisors, one administrative 

assistant, two hearing office systems administrators, 12 senior attorneys; three attorney-advisors, six paralegal-analysts, three lead 

case technicians, 13 senior case technicians; six case technicians; 

four case intake analysis; and two contact representatives. Fiftyseven percent of our employees in Oklahoma City have 6 or more 

years of ODAR experience and 39 percent have 16 or more years 

of ODAR experience, myself included. 

In fiscal year 2011, the Oklahoma City Hearing Office achieved 

our regionally set dispositional goal, with 7,216 claimants served. 

We also completed all of our aged cases, which were defined as 750 

days old. Thus far in fiscal year 2012, we have served 6,317 claimants. Through the end of July of 2012, Oklahoma City administrative law judges’ dispositions have averaged 37.8 percent fully favorable, 3.2 percent partially favorable, 41.7 percent unfavorable, and 

17.2 percent dismissals. Further, through the end of August of 

2012, the Oklahoma City Hearing Office has had an average processing time of cases of 381 days. Our average cases pending per 

ALJ in the office is 591 days. The average age of pending cases 

overall is 258 days. Cases under 365 days old are 76 percent. Our 

receipts per day per ALJ are 2.31; hearing scheduled per day per 

ALJ is 2.39; and then hearings actually held per ALJ is 1.79, making a heard-to-scheduled ratio of 75 percent. Our dispositions per 

day per ALJ thus far in fiscal year 2012 is 2.15, and our dispositions-to receipt ratio is 103 percent. 

As the Hearing Office Chief Judge, I strive to ensure that my 

hearing office handles hearing requests in an orderly manner. I 

discuss ALJ workload and case assignment regularly with our 

hearing office director, who oversees the direction of our staff involved in preparing cases for hearing. Generally, cases are worked 

up for hearing in hearing request order date, with the oldest cases 

prepared first. Our hearing office director then randomly assigns a 

minimum number of cases to each of our Oklahoma City ALJs, at 

least 40 cases per month so far this fiscal year. I personally use 

our agency’s technology to manage performance, quality, and productivity of our ALJs, mainly with the help of our Case Processing 

Management System and Disability Adjudication Reporting Tools 

(DART), including the ‘‘How MI Doing’’ and the ODAR Management Information Dashboard. My top priorities include the handling of our oldest cases, the number of hearings scheduled and 

held by each ALJ, the pending of each ALJ, and our monthly 

dispositional totals. I pass on general information concerning each 

of these categories to all of our ALJs and then pass on specific information to individual ALJs as necessary. 

I endeavor to work closely with our Oklahoma City ALJs. I have 

an unconditional open-door policy. I speak with all of our ALJs, 

both formally and informally, concerning questions, problems, or 

suggestions that they may have regarding individual cases as well 

as office policies and procedures. I regularly send emails to clarify 
34 

1The prepared statement of Judge Erwin appears in the Appendix on page 80. 

issues and procedures for our ALJs and also to share general information. 

Now, while ALJs have qualified decisional independence under 

the Administrative Procedure Act, they must decide cases based 

upon the facts in each case and in accordance with agency policy. 

If I see a performance or quality issue with an ALJ in my office 

that I need to address, I will discuss that issue with the judge as 

soon as possible to ensure that the ALJ’s actions are consistent 

with agency policy, and that the ALJ is performing at an acceptable level of productivity. While I exercise appropriate management 

oversight of the ALJs in my office and can take a number of actions 

to help ALJs improve their performance, I cannot and I do not 

interfere with or influence the ultimate decision in any case. In addition to my managerial duties, I hold hearings for disability cases 

regularly. 

I thank you for the opportunity to be here today, and I will be 

happy to answer any questions that you may have of me. 

Senator LEVIN. Thank you very much, Judge Stults. Judge 

Erwin. 

TESTIMONY OF JUDGE THOMAS ERWIN,1 HEARING OFFICE 

CHIEF ADMINISTRATIVE LAW JUDGE, OFFICE OF DISABILITY ADJUDICATION AND REVIEW, SOCIAL SECURITY 

ADMINISTRATION, ROANOKE, VIRGINIA 

Judge ERWIN. Thank you, Mr. Chairman, Ranking Member 

Coburn, and Members of the Subcommittee. My name is Thomas 

Erwin, and I serve as the Chief Administrative Law Judge for the 

Roanoke, Virginia, Hearing Office. I have a little more than 3 years 

of experience as an ALJ and 1–1/2 years as a Hearing Office Chief 

ALJ. 

Prior to becoming an ALJ, I was an attorney-advisor in the Roanoke, Virginia, Office of Disability Adjudication and Review for 3 

years. Before joining the Social Security Administration, I served 

as a U.S. Navy JAG attorney on active duty for 5 years in San 

Diego and Port Hueneme, California, and was appointed as the Officer in Charge of the Naval Legal Service Office Branch Office in 

Port Hueneme. One of my duties in the Navy was to serve as criminal defense counsel in courts-martial cases; so yes, Tom Cruise did 

play me in the movie ‘‘A Few Good Men.’’ [Laughter.] 

I then worked in private practice in Southern California as a certified specialist in family law prior to joining the Social Security 

Administration in 2006. 

The Roanoke, Virginia, Hearing Office serves a broad area of 

southwest Virginia and southeast West Virginia. This service area 

is a part of a cultural region commonly known as Appalachia. The 

region’s economy, once highly dependent on mining, forestry, agriculture, chemical industries, and heavy industry, has become more 

diversified in recent times. 

The Roanoke Hearing Office has eight ALJs, three of whom have 

fewer than 2 years of experience on the job. The newest judge has 

been with the office only since June of this year. 
35 

The office has had significant ALJ turnover over the past several 

years and has lost eight judges to transfer or retirement. Social Security has assigned eight new judges in the same period; seven of 

these judges were new to the position or had less than 1 year of 

experience as an ALJ when they reported. The office has 48 employees. 

For fiscal year 2012, through August, the Roanoke Hearing Office has received 3,690 hearing requests, an average of 335 cases 

per month. We have issued 3,643 decisions, so we have processed 

close to 99 percent of our total receipts. We have just under 4,700 

cases pending in our office, an average of over 580 cases pending 

per judge. Our average processing time is 432 days from the request for hearing to decision. 

The Roanoke hearing office has an allowance rate of 57 percent 

for fiscal year 2012. The judges have an allowance rate of 55 percent, with most of the judges having an allowance rate between 45 

and 57 percent. The difference in allowance percentages between 

the overall office rate and the judges represents favorable decisions 

processed by our senior attorneys. 

As a chief judge, it is my job to make sure that the office functions smoothly and that we process cases fairly and efficiently. I 

strive to ensure that my hearing office handles hearing requests in 

an orderly manner. I work with three other office managers to 

make sure cases are worked up and ready for a hearing, that they 

are assigned to judges to allow them to hold hearings, and that 

writers draft legally sufficient decisions. I monitor the workloads of 

the judges to make sure they have sufficient cases at various 

stages of the process to allow them to review cases before scheduling, hold hearings, and issue decisions. 

A hearing office has many working parts, all of which need to operate smoothly to maintain both quality and productivity. The senior case technicians prepare the files and get them ready for hearing; the judges hold the hearings; and then the writers must draft, 

based on the directions they receive from the judges, legally sufficient and defensible decisions. As chief judge, I work with my fellow supervisors to manage performance, quality, and productivity 

at each phase of a case’s development and resolution. 

I work with the ALJs in the office to make sure they are aware 

of monthly and yearly goals, that they move cases through each 

stage of the process in a timely manner, and that they issue quality 

decisions as quickly as possible. If the judges are having a problem, 

I help them resolve the issue so that they can continue doing their 

job. I try to lead by example. 

While ALJs have qualified decisional independence under the 

Administrative Procedure Act, they must decide cases based on the 

facts in each case and in accordance with the agency’s policy. If I 

see a performance or quality issue with an ALJ that I need to address, I will discuss the issue with the judge as soon as possible 

to ensure that the ALJ’s actions are consistent with the agency’s 

policy and that the ALJ is performing at an acceptable level of productivity. While I exercise appropriate management oversight over 

the ALJs in my office and can take a number of actions to help 

ALJs improve their performance, I cannot and do not interfere with 

or influence the ultimate decision in any case. 
36 

1The prepared statement of Judge Garmon appears in the Appendix on page 83. 

Thank you for the opportunity to be here today. I would be happy 

to answer any questions that you have. 

Senator LEVIN. Thank you very much, Judge. Judge Garmon. 

TESTIMONY OF JUDGE OLLIE L. GARMON III,1 REGIONAL 

CHIEF ADMINISTRATIVE LAW JUDGE, ATLANTA REGION, OFFICE OF DISABILITY ADJUDICATION AND REVIEW, SOCIAL 

SECURITY ADMINISTRATION, ATLANTA, GEORGIA 

Judge GARMON. Thank you, Mr. Chairman, Ranking Member 

Coburn, and Members of the Subcommittee, my name is Ollie L. 

Garmon III, and I serve as the Regional Chief Administrative Law 

Judge in Region IV, which is commonly known as the Atlanta Region. The Montgomery, Alabama, Hearing Office is one of the offices in the Atlanta Region. I have 21 years’ experience as an ALJ, 

3 years as a hearing office chief, 4 years as an assistant to the regional chief, and 9 years as the regional chief judge. 

As the regional chief judge, I provide general oversight for all 

program and administrative matters concerning our hearings process in the Atlanta Region. The Atlanta Region is composed of 37 

hearing offices, nearly 400 administrative law judges, and a total 

staff of nearly 2,300 people in the following eight States: Alabama, 

Florida, Georgia, Kentucky, Mississippi, North Carolina, South 

Carolina, and Tennessee. This region serves a population of about 

60 million citizens. We have approximately 25 percent of the agency’s hearings caseload, which results in more than 200,000 decisions per year. 

I began my legal career in the private sector as an associate for 

a law firm; I then became a sole practitioner, after which I organized and was a partner in a law firm. During this same time, I 

served in the public sector as a city attorney and was elected county prosecuting attorney for a 4-year term. In 1979, I was elected 

to a 4-year term to a full-time judicial position of county court 

judge where I also served as a juvenile court judge. Afterwards, I 

was appointed by the Governor of the State of Mississippi to the 

position of Commissioner of the Mississippi Workers’ Compensation 

Commission for a 6-year term. 

One of the hearing offices in Region IV is located in Montgomery, 

Alabama. The Montgomery Office’s service area includes Alexander 

City, Anniston, Auburn, Demopolis, Montgomery, Opelika, Selma, 

and Tuskegee. The Montgomery Office currently has ten judges. 

We expect two new judges to report for duty on September the 24th 

of this year. The support staff for the ALJs includes a mix of attorney-advisors, paralegal specialists, and legal assistants. We have 

hired at least half of this office’s staff within the past 3 years. The 

office has a high transfer rate for ALJs, who frequently request reassignment to other offices. 

In fiscal year 2011, the Montgomery Office received 8,357 cases 

for adjudication and issued 7,252 dispositions. In fiscal year 2012 

to date, the office has received 6,540 cases for adjudication and 

issued 6,246 decisions. The Montgomery Office currently has 8,323 

cases pending, and the current average processing time is 430 

days. The rate of average dispositions per ALJ per day is 2.37. 
37 

1See Exhibit 22, which appears in the Appendix on page 889. 

Let me emphasize that while I can take actions to ensure that 

ALJs move their caseloads and apply the law and our policies correctly, the Administrative Procedure Act grants all ALJs qualified 

decisional independence. Qualified decisional independence means 

that ALJs must be impartial in conducting hearings. They must decide cases based on the facts in each case and in accordance with 

the agency’s policy, as set out in the regulations, rulings, and other 

policy statements. It means, however, that ALJs make their decisions free from agency pressure or pressure by a party to decide a 

particular case, or a particular percentage of cases, in a particular 

way. If we see a performance or quality issue with an ALJ that we 

need to address, we will discuss the issue with the judge as soon 

as possible to ensure that the ALJ’s actions are consistent with the 

agency’s policy and that the ALJ is performing at an acceptable 

level of productivity. While we exercise appropriate management 

oversight over the ALJs in our offices and can take a number of 

actions to help the ALJs improve their performance, we cannot and 

do not interfere with or influence the ultimate decision in the case. 

Thank you for the opportunity to be here today, and I would be 

happy to answer any questions that you may have. 

Senator LEVIN. Thank you so much, Judge Garmon. 

Let me start by asking the same question that I asked of our earlier panel. If you take a look at Exhibit 22,1 which is the 2011 report issued by the Social Security Administration’s Quality Division—are we short a book up there? 

This is the Final Actions Report, the Division of Quality, and it 

shows that in your regions the error rate, I guess—we will simplify 

it—was 24 percent in Region III, 23 percent in Region IV, and 26 

percent in Region VI. The national average is 22 percent. 

Were you aware of this report prior to the hearing? Was this 

made available to you before we let you know that we wanted you 

to testify? And were you familiar with it before that time? Judge 

Stults. 

Judge STULTS. Yes, I was aware of it. I had seen it. 

Senator LEVIN. Good. Judge Erwin. 

Judge ERWIN. Yes, sir. 

Senator LEVIN. Judge Garmon. 

Judge GARMON. Yes, sir. 

Senator LEVIN. And what was your reaction to it, Judge Stults? 

Judge STULTS. Well, I would begin by saying this is just one of 

many tools that is at the disposal of a hearing office chief judge to 

determine quality. This is important. There are policy issues that 

are not well covered in decisions, certainly as well as they should 

be. Another such tool is something I mentioned in my opening remarks. Recently the agency has given us access to look at our AC 

affirmation rates, the How MI Doing. I have used that as a tool because it now is looking more at unfavorable cases, but generally I 

have found that if a judge is doing quality unfavorables, they are 

probably doing quality favorables as well. But, quite frankly, perhaps the best gauge of quality within a hearing office is the staff 

itself, decision writers in particular. They are going to come to 

management in general, and they will come to me in particular and 
38 

tell me what problems any particular ALJ may have both in their 

conduct of a hearing and/or in their decisional instructions. 

Senator LEVIN. Judge Erwin, what was your reaction to the report? 

Judge ERWIN. Well, I think I was a little fortunate in that the 

Roanoke Office had closer to a 10-percent error rate, so I was glad 

to see that coming out of my office. I also think that we have all 

talked about—— 

Senator LEVIN. Your office was much lower than the other offices 

in the region? Is that what you were—— 

Judge ERWIN. That is what my understanding was, yes, when I 

saw the report. 

Senator LEVIN. OK. 

Judge ERWIN. So I just happened to be fortunate there. 

Senator LEVIN. So your reaction was relief? [Laughter.] 

Judge ERWIN. I lost my train of thought for a minute. This is one 

tool that we have. I think we have all discussed and acknowledged 

that this does not talk about whether the decision was correct, but 

whether there was an error in the policy. A lot of times what we 

have to talk about when we are at the front lines and writing cases 

is about a balance, trying to do quantity and trying to do quality. 

In the past, as a decision writer, I can say that I was writing decisions between 2006 and 2009, which is when a lot of the cases 

you reviewed were happening. A lot of times we were told a fully 

favorable decision is where you save time. So I would not be surprised if you looked at some of my old decisions and I did not 

evaluate every opinion that was in the record and cite every conflicting evidence because we were giving greater emphasis—and we 

still have the writers give greater emphasis—to the unfavorable decisions. 

So, again, it goes down to quantity versus quality. Again, I would 

say I was a little surprised to see that the number was that high, 

but, again, we would need to get into the nature of the decision to 

see whether the decision itself was correct. And it seems like what 

we have got is more a problem of documentation and making sure 

the decision instructions and the decisions themselves comply with 

the policies as opposed to worrying about the results here, again, 

making sure that the decisions themselves are better written. And 

I can say that Judge Bice, our Chief Judge, has recently this year, 

through trainings and directives, stressed that. And I have had 

meetings with my judges and my decision writers to stress that a 

favorable decision needs to have a fully articulated residual functional capacity, and it needs to be supported with documentation. 

Senator LEVIN. Judge Garmon. 

Judge GARMON. Well, I guess humorously I would say that I was 

happy I was not on top of the list, but also sad at the same time 

that we were not lower than we were as far as personal feelings 

went. 

But, of course, again, it brings forth the admonition that we have 

got to be more careful, and we agree with you with regard to the 

quality of the decisions that are going out the door and the possible 

problems. And with the number of offices that we have in our region, of course, we had some that were higher, some that were 
39 

lower, a mix, as you might imagine. So, yes, we are aware of this, 

certainly working on this. 

Senator LEVIN. If you were given the so-called error rate ALJ by 

ALJ rather than office by office, would that help you in terms of 

your counseling with the ALJs? If you knew that there was an ALJ 

that had insufficient findings in 40 percent of the cases and you 

had another ALJ that was insufficient in 5 percent of the cases, 

would that not give you some guidance as to which of your ALJs 

needed some additional counseling and training? Would it be helpful to know those judge by judge? Judge Stults. 

Judge STULTS. Yes, and, in fact, we have that. Again, as I said 

a second ago, under our DART report, the ‘‘How MI Doing,’’ it 

breaks down for the HOCALJ the AC affirmation rate for every 

judge in my office, and that started this summer. I have used that 

for three different judges—two informal discussions, one formal discussion. And at least I believe it was effective in bringing to the 

attention of two of those judges that they were making mistakes 

they were not aware of. So I was very pleased when this became 

available to us, and I use it regularly. 

Senator LEVIN. That is the AC—— 

Judge STULTS. And, again, that is for unfavorables, but, again, 

as I said a second ago, if a judge is deciding an unfavorable case 

well, providing sufficient rationale and then—of course, there is 

also a decision-writing aspect in here. But if they are doing 

unfavorables well, generally they are doing favorables well. 

Senator LEVIN. Well, but my question is a little different. If the 

breakdown for the entire office is useful, would not a breakdown 

of this particular rate be useful judge by judge? 

Judge STULTS. Certainly. It would be more information. But 

there is a lot of information already available to a hearing office 

chief judge. 

Senator LEVIN. All right. But if this were doable, practically, if 

we could get these numbers judge by judge, if they were available 

to the chief judges, that would add some additional information for 

you? 

Judge STULTS. I believe it may help affirm a trend that would 

already be known to exist. 

Senator LEVIN. Hopefully? 

Judge STULTS. Probably. 

Senator LEVIN. Probably, OK. Judge Erwin, would that be useful 

to you? 

Judge ERWIN. Well, I would again agree that, as chief judge, I 

already review all of the remands that come in, whether they are 

the own-motion ones where they are looking for policy problems or 

whether they are the remands where a case is being remanded for 

further action, either by the Appeals Council or the district court. 

I do pick up on trends. I recently had training with both the judges 

and the writers because there was a problem with the criteria analysis under the psychiatric review technique that sometimes the 

judges were not having a proper residual functional capacity evaluation with the criteria as stated earlier in the decision. And what 

I did was I addressed that with the judges and the writers to say 

if the judge makes it a problem, to go ahead and let me know, and 

we will make sure the decision goes out in a correct way. 
40 

To answer your question, I think any more information along 

those same lines would be helpful. 

Senator LEVIN. I am going to wait until Dr. Coburn asks the 

question about workload because I have got to tell you, I agree 

with him. Just how does a judge do three or four or five cases a 

day, not just looking at the material I guess in a file, but also having read presumably hundreds of pages before that? So I am not 

going to ask that question, but if for some reason Dr. Coburn does 

not ask that question in his round, I will be asking it. It is stunning to me. I know he is a fast reader, and he is amazing, how 

much information he soaks up. But when he says he could not do 

it, I got to tell you, I am a little bit slower than he is, but I could 

not come close to doing it. And I would like to know, after listening 

to your answer to him, I am sure, I am curious as to that same 

question. How can you do a quality job with that kind of a responsibility to read that many pages? 

Dr. Coburn. 

Senator COBURN. Do you want me to ask that question first? 

[Laughter.] 

Senator LEVIN. Well, if you do not ask, I will ask it on my second 

round. I did not want to take your time asking it. 

Senator COBURN. Well, first of all, let me welcome all of you. 

Thanks for being here and thanks for what you do. This is hard 

work to make good decisions on this stuff. It is not easy. 

Judge Erwin, you said you knew for your office what your rating 

was, and it was 10 percent. 

Judge ERWIN. Correct. 

Senator COBURN. Do each of you all know for your office what 

it was? 

Judge GARMON. Yes. 

Senator COBURN. And what was it? 

Judge GARMON. Well, I have a number of offices. 

Senator COBURN. Well, for your area, what were you rated? 

Judge GARMON. What was I what? 

Senator COBURN. Rated. In other words, Region VI I think is 

Oklahoma City. 

Judge GARMON. Yes. 

Senator COBURN. It was 26 percent. 

Judge GARMON. Yes. We were 24 percent. 

Senator COBURN. What about your office? 

Judge GARMON. As I said, they varied. 

Senator COBURN. What was the range? 

Judge GARMON. Off the top of my head, I do not remember, sir, 

but I can get you that information. 

Senator COBURN. You were 24, though, in your area. 

Judge GARMON. Yes, sir. Average, yes. 

Senator COBURN. And how about you, Judge Stults? 

Judge STULTS. As I recollect, we were a bit above regional average. I know it was in the 20s. Again, I do not remember that off 

the top of my head. 

Senator COBURN. OK. Fair enough. Some of the ALJs we have 

talked to during our investigation stated that the agency puts a lot 

of pressure on them to get the cases through. Do you think there 
41 

is an inordinate amount of pressure put on ALJs to move the 

cases? Anybody can answer. 

Judge ERWIN. I will take this. I do not think there is an inordinate amount of pressure. I think there is pressure in any job. When 

I was in the Navy, there was pressure. When I was in private practice, there was pressure. The staff in our office has pressure to get 

the job done. So everybody in any job has pressure to get the job 

done. 

As a public servant, I am aware that we still have a backlog of 

800,000 people, claimants, awaiting a hearing on their claim even 

though we are holding more hearings than we ever have and making more decisions. For a number of factors relating to the economy 

and the baby boomers aging, we are getting a record number of receipts as well. 

I do personally believe that the goal of 500 to 700 is attainable, 

mainly because I am doing it. I review cases before they get scheduled. Sometimes they can be approved without having a hearing. 

I then review the case again before a hearing, and I then issue decision-writing instructions and get the cases out. I am going to be 

between 500 and 600 this year, as I have been for I guess all 3 

years I have been an ALJ. 

So is there pressure to get decisions out? Of course. Is it inordinate pressure? I do not believe so. 

Senator COBURN. So how can somebody effectively do 1,500 cases 

a year? 

Judge ERWIN. I do not want to speak for that person, but I do 

not think I would be able to get 1,500 cases out in a year the 

way—— 

Senator COBURN. Do you know anybody that could get 1,500 

cases out in a year? The number one guy in your law school, could 

he have gotten 1,500 cases out in a year, or gal in your law school? 

Because most of the time they are gals now, and they are smarter 

than we are and tougher than we are. That is coming from an obstetrician’s viewpoint. [Laughter.] 

Senator LEVIN. Is that physiologically or is that—— 

Senator COBURN. It is called two X chromosomes. We are missing 

one little arm on one chromosome. 

Judge ERWIN. I think the number one guy from my law school 

probably would spend too much time making sure the citations are 

correct. [Laughter.] 

He might be overly perfect. 

Senator COBURN. So the guy in the middle of your class. 

Here is the point. I will go back to what Senator—in Judge 

Stults’ office, we had a guy do 5,100 in 3 years. He is also the same 

guy Judge Stults has written reviews on four times in 3 years. 

Would it not make sense to you that somebody that is deciding that 

number of cases would have bigger quality problems, one? And if 

you have bigger quality problems, the potential for an error in the 

ultimate decision, whether denial or acceptance, would seem to me 

by logic to go up. Would you agree with that or disagree with that? 

Judge ERWIN. I would probably agree that when you have judges 

that issue an inordinate number of cases, whether they approve an 

inordinate amount or disapprove an inordinate amount, it makes 

our impartiality look suspect when these judges are so far from the 
42 

norm. And if the goal is between 500 and 700 cases and someone 

is doing 1,500 cases, I do think it could create an appearance that 

they are not giving the case the full attention that it needs to get. 

Senator COBURN. Let me ask just theoretically all three of you, 

if you have somebody that is at a performance level based on number of cases done that is far above everybody else in your office 

under your authority, what do you do? I mean, what is your management approach to that? Do you say, ‘‘Gosh, these are good 

cases,’’ or ‘‘Thanks for the job’’? Or does it raise a question in your 

mind of comparison? There are stellar individuals, I understand, 

that can accomplish more than others. You know, they do not sleep. 

They do not have a social life. All they do is work. I understand 

that. But what is your thought process on this? 

Judge GARMON. I will speak for the regional office and let these 

two judges speak for what goes on at the hearing level. When we 

review our data and we see large numbers, then certainly it raises 

a flag, and you sit there and you look at it and you think, ‘‘Why 

is this person getting this much out?’’ The opposite side of the fence 

is you see somebody producing hardly anything, and you ask the 

same questions. 

We then follow up at the regional level. We have field liaison officers who are in contact almost every day with our field office management, our hearing office management. And we start working 

with the hearing office chief to determine what is going on here, 

and we begin to review decisions or we ask questions. Is there 

something inordinate about the cases that they are getting? In 

some areas you may have a large number of dismissals, for instance. 

So there are a lot of factors that have to be looked into, but, yes, 

it raises questions, and we do begin to work with the hearing office 

management to determine what is going on in that particular hearing office with that particular judge. And we do that without necessarily having the hard data with regard to quality. We can already go in and begin to review their decisions that they just made 

to determine whether or not something is going on. It is not a perfect process, and it takes hours to go through some of these decisions. We listen to sometimes also the hearings, and we have realized, of course, that in some cases these judges were missing in 

areas where there were quality questions. 

Senator COBURN. Does anybody else want to comment on that? 

Judge STULTS. I can tell you exactly what I did when I was appointed chief judge. Yes, you have many different statistical reports 

that can give you all sorts of information from how many dispositions per month to average processing time to number of hearings 

heard and scheduled. 

In my case, when I became chief judge, you do look at the fringe, 

both too many and too few, and I counseled several judges. This 

judge that we are talking about in particular, he was not holding 

enough hearings, so we started getting him hearings, which, of 

course, cuts into the time available to look for On the Record 

(OTRs) cases. That first fiscal year his number of OTR cases 

dropped dramatically, and it has taken 3 years, but this judge that 

we are talking about, this year as we speak, he has 519 total dispositions for the year. His pay rate is about 54 percent. He is back 
43 

into the middle. And this was a concerted, planned, organized effort, both formally and informally, to move him there. And when 

I was appointed chief judge, I had several judges that needed some 

advice and guidance to increase their number of hearings, to do 

work more timely. This judge we are talking about is just one of 

several. 

Senator COBURN. Would it be helpful or do you see a correlation 

between large numbers of cases that are handled and the quality 

parameters—not deciding it right or wrong, but the quality parameters, in other words, meeting the guidelines under which you are 

to work. Is there a correlation, in other words, as the number of 

cases go up, do the quality parameter problems increase in your observation? I am not asking you for science or stats or anything else. 

What is your feeling about that? 

Judge STULTS. Well, in my observation, most judges are good 

judges, but they are very poor decision writers. That was not their 

function. And, again, in the case of the judge we are talking about, 

he took upon himself for some very unique reasons to write these 

himself. In retrospect, that was probably not the best decision. 

So if a judge devotes their full time and attention to reviewing 

case files, working with the staff to prepare for hearing, goes in, 

holds a fair and complete hearing, and then makes a timely instructional document to a decision writer, who then is trained and 

has more time to really delve into the issues and to make sure a 

legally sufficient decision is written, then, yes, I think judges can 

be very efficient and very productive, well above the 500- to 700- 

case range. 

Senator COBURN. You mentioned the words ‘‘unique reasons.’’ 

Judge STULTS. Very unique reasons. 

Senator COBURN. What do you mean by that? 

Judge STULTS. Well, it is kind of like the movie ‘‘The Perfect 

Storm.’’ During these 3 years we were talking about for this particular judge, he was chief judge. Hence, he could assign cases to 

himself. He could assign as many cases as he wanted to himself. 

That cannot happen anymore. This will never happen again. We 

are limited to 1,200 cases a year; and, number two, a judge cannot 

assign himself a case. I cannot even assign myself a case. I have 

to have a member of management assign me a case. 

So that is what happened. He was in charge. For a number of 

reasons—and I do not want to take too much time here. 

Senator COBURN. No, I do not want you to go into the details. 

Judge STULTS. But I have explained it to Mr. Dockham, and it 

will not, it cannot happen again. 

Senator COBURN. I am over. I will go back to—— 

Senator LEVIN. You can keep going if you want. 

Senator COBURN. No. Go ahead. 

Senator LEVIN. Going back to this document that we have here, 

Exhibit 22, and this Final Action Report. Region VIII here has a 

very low rate. Now, again, we are not looking at erroneous decisions. That is not the judgment. The question is judgments—are 

they problematic. These are decisions that have some errors, that 

policy was not followed. That does not mean that, again, they 

reached the wrong decision. I want to emphasize that. We do not 
44 

know whether they did or not. But these are cases which have 

problems in them in terms of following the rules and the process. 

Have any of you talked to the chief judge in Region VIII and try 

to ask him, ‘‘How come your rate is so much lower than our rate?’’ 

Do you know who that is, by the way? Do you guys get together 

every year, the chief judges? 

Judge GARMON. Yes, sir, we get together. In fact, more often that 

that, and we are often on the phone talking to each other. The 

judge in that region is recently stepping down. Her name is Marsha Stroup, and Judge Stroup is a very fine judge. 

This particular region has been a region that has performed well 

over the years historically within ODAR. It is not a large region 

insofar as the number of offices and judges and so forth. And she 

has managed that region very well, and so did her predecessor. 

Senator LEVIN. Could their caseload be lower? Could that be a 

reason, do you know? 

Judge GARMON. Caseload being lower? I would have to look at 

some statistics, but there is a possibility, but I really do not know, 

Mr. Chairman. I would not know how to answer that question. 

Senator LEVIN. Do you have any other comments about talking 

to the chief judge in Region VIII to figure out why they are so 

much lower than the national average? Have either of the other 

two of you done that? 

Judge STULTS. No. 

Senator LEVIN. OK. Judge Erwin. 

Judge ERWIN. I have not spoken to them. 

Senator LEVIN. All right. On page 9 of the report, there is a 

three-page list identifying in a more detailed way the nature of the 

problems that have been found in these cases. On page 10, in the 

middle, the listing indicates 46 percent of the problems involved, 

or about half, are inadequacies relating to identifying and evaluating the evidence. Consultative examiner, the opinion was rejected 

without adequate articulation. A non-examining source, the opinion 

did not identify or discuss that source. Residual functional capacity, 

the effects of a combination of impairments inadequately evaluated. 

Have you looked at those specific identified problems that are 

common to see if those problems are common in your offices? Do 

you take this report and put it to that kind of use? Judge Stults. 

Judge STULTS. Well, again, I have been with this agency 16 

years, and I think everyone would agree the top ten reasons for remand have not changed much at all over the last 16 years. This 

information is available and is being shared. Again, I go back to 

the website, the ‘‘How MI Doing’’ that every judge has at their fingertips. And Judge Jonas and Judge Bice talked about the ability. 

You can drill down, see your remands and see the reasons, and 

now they are adding a feature that will help explain the policy that 

should have been followed. 

So this is a recent development, but it is one of many recent 

training initiatives that this agency has undertaken. So, yes, we 

have talked about reasons for remands at judges’ meetings, and I 

think probably that is true for all three of us. 

Senator LEVIN. Now, I asked the first panel this question about 

the grids as to whether or not the guidance as to how those grids 
45 

are to be used is clear, and their answer was, yes, sometimes it is 

guidance, sometimes it is direction, it is mandates. 

Is it clear to your judges how these grids are to be used, or is 

there any uncertainty or confusion? Because apparently our staff 

found that there was some uncertainty among ALJs as to whether 

these were binding or whether these were goals? 

Judge ERWIN. I think it is pretty clear to the judges. 

Senator LEVIN. You think it is? 

Judge ERWIN. Yes. 

Senator LEVIN. Judge Stults. 

Judge STULTS. Oh, yes, very clear. 

Senator LEVIN. OK. 

Senator COBURN. Is it clear that they are binding, or is it clear 

that they are guidance? 

Judge STULTS. Well, both. That is the function of the grid—if 

there are only exertional functional limitations, then the grid directs an outcome. But if there are non-exertional functional limitations, then the grid is a framework for either a favorable or unfavorable outcome. 

Senator COBURN. So why have we seen the shift from 1:4 to 4:1 

from medical reasons for disability to grid-related disability over 

the last 5 years in this country? 

Judge STULTS. Age of the claimant. The grid really does not kick 

in until 50. As people get older—and we are seeing a lot or at least 

I am seeing a lot of older claimants—the grid kicks in at 50 and 

55 when you are—— 

Senator COBURN. So what you are saying, it is demographic. 

Judge STULTS. Yes, that is my personal experience. 

Senator COBURN. Any other comments? 

[No response.] 

Senator COBURN. Thank you. 

Senator LEVIN. No, that is fine. There is a demographic shift, I 

know, but not quite to that extent. I do not think it is 1:4/4:1. Are 

there any other reasons that you can think of besides demographics 

as to why there has been that shift? 

Senator COBURN. We heard earlier from both our chief appellate 

judge and chief judge that the one of the requirements that they 

wanted to firm up on was residual functional capacity and medical 

criteria. If, in fact, that is the case, if the medical criteria is actually looked at more firmly, you would—I would tend to think we 

would shift given—forget age for a minute. Those under 50, we 

would see more back towards medical criteria as a basis for disability than functional residual capacity. Would you disagree with 

that statement? 

Judge ERWIN. Do you mean a finding under Step 3 of the sequential evaluation process? 

Senator COBURN. Yes. 

Judge ERWIN. Is that what you are talking about? 

Senator COBURN. Yes. 

Judge ERWIN. I guess in my experience, generally the DDS is 

going to find a lot of the Step 3 cases and pay those. And so the 

ones we get are the ones where the medical evidence was not so 

clear as to, again, have a presumptive disability by meeting a list-
46 

ing where you have to do a more thorough analysis under Steps 4 

and 5. I do not know if that answers your question or not. 

Senator COBURN. I think to go back, Mr. Chairman, one of the 

things that has happened is we have seen a large percentage of 

people, given the severe dip in the economy, that were at that age 

group that were operating with significant disabilities now shift off 

of employment, probably not by choice, and go this direction. So I 

think that can—the demographic shift probably can explain for it, 

but it should not explain for it in the future if the economy comes 

back up. So it is one of the things we are going to be tracking over 

the next couple of years, what is utilized. 

You all were all present 

Senator LEVIN. Just to interrupt you, and I am done with my 

questions, I am not sure it can explain that great a shift, though, 

demographically, can it? 

Senator COBURN. I think it can. If you have auto workers, we hit 

this economy, and they are 50 years of age, and they have been 

working with arthritis in their knees and back and hands and elbows, and all of a sudden they are laid off, you are going to see 

a disproportionate number of those—— 

Senator LEVIN. I agree. 

Senator COBURN. —who qualify under the disability guidelines 

go and get that; whereas, if they still had that job, they probably 

would not. 

Senator LEVIN. I think that is true. 

Senator COBURN. And so functional residual capacity at that age, 

they can go to the grid, be gridded, and done. 

Senator LEVIN. But is the demographic shift in terms of the age 

of the applicants that dramatic that it explains the 1:4 versus 4:1 

ratio in terms of the use of the grid? It is hard to imagine it, but 

it could be. And if it is, so be it. 

Senator COBURN. Well, the other question that would go to that 

is: Can gridding be done at the DDS level? And the answer is yes. 

So why would that not be taken out before it gets to you? 

Judge GARMON. Senator Coburn, it depends on the information 

that the DDS has in front of it at the time. Remember, the DDS 

is at the very front end of the process. By the time the case gets 

to an administrative law judge, a lot of other medical evidence may 

have gotten into the file at that particular point in time. I can give 

you a personal example. 

A friend of mine, Tommy Warren, who was Director of the DDS 

in Alabama—and I was the Hearing Office Chief in Birmingham at 

that time—we were both puzzled at some times why they denied 

a case at the DDS level and we would get it and sometimes pay 

it on the record at the hearing office level. So we got together, we 

got his doctors, we asked him to give us a sample of the cases that 

he was interested in, and so we got the doctors to come over and 

look at those cases, considering the case and what we had in the 

case at that particular time. 

When they came over after looking at the cases, they really did 

not disagree with these files that we had paid on the record because there was additional medical evidence in the file or the 12- 

month period had gone by at that particular point in time. The 
47 

1See Exhibit 4 which appears in the Appendix on page 347. 

2See Exhibit 4b which appears in the Appendix on page 352. 

claimant was still disabled, or at least there were medical records 

in the file that tended to indicate that. 

So, yes, they do apply, but they apply it with what they have at 

that point in time. 

Senator COBURN. I referenced in my opening statement kind of 

some midnight advisories and cheaply bought information that 

ends up showing up late in the process. And as a physician who 

has testified before an administrative law judge before, it is true 

that the medical record continues to mature during these cases. 

But it is also true that sometimes we are selecting the medical information we want presented in the case. And so tell me how you 

all decide a balance between here is what Tom Coburn, a primary 

care physician, has said about this patient’s ability to work under 

the guidelines of disability that we use in terms of range of motion, 

etc, lifting capabilities, and observation, versus somebody who saw 

this patient for 10 minutes and has written another one that says 

they are totally disabled, and you have got conflicting information. 

Here is somebody who has taken care of somebody for 15 years and 

says they are not disabled. Here is somebody that saw them for 10 

minutes and says they are. How do you balance that information? 

Judge GARMON. Well, first of all, we have a ruling that says that 

a treating physician’s information is to be given more credibility 

under our guidelines, and so we weigh that evidence more than we 

would somebody coming in at the last moment with a 10-minute 

examination or however you described it. So the judge in his mind 

is actually looking at all of that. We certainly are under a duty to 

try to get as much of the claimant’s treating information as we possibly can that is there. 

Now, I will tell you also that, when I was hearing cases in one 

State—a lot of times claimants just did not get any medical information, often because the fact that there was abject poverty and 

sometimes I would have a claimant walk in that I could just tell 

had some serious problems here and I am not a doctor, but I could 

tell. And I would send that person out to have a consultative examination, because if I had gone ahead at that particular point in 

time, I probably would not have found them disabled. 

So a judge is using his common sense. He is looking at the demeanor of the claimant. He is looking at everything that is going 

on in that hearing at that particular point in time and trying to 

make the best decision he can with the authority that he has got 

and with the instructions that he has got on how he is to decide 

those cases. 

Senator COBURN. Let us go to Exhibit 4,1 Alabama Case 69. The 

role of attorneys was something that a lot of the ALJs raised as 

sometimes a problem. In this case, this judge relied primarily on 

a three-question form filled out by the claimant’s doctor the day before the hearing. That form was requested and sent to SSA by that 

claimant’s attorney. 

Exhibit 4b 2 is a standard Notice of Disapproved Claim from SSA 

when a case is denied. It shows the case was denied on September 

26, 2008. 
48 

1See Exhibit 4g which appears in the Appendix on page 375. 

Then if you look at Exhibit 4g,1 you will see a form submitted 

when a claimant hires a representative, this one dated October 10, 

2008, 2 weeks after being denied. 

The questions I have for—and all of you are free to comment on 

this. How common is it for someone to get an attorney if they are 

denied the first time? Fairly common. 

Judge ERWIN. Yes, sir. 

Senator COBURN. All right. Do people who hire attorneys usually 

do so at the beginning of the process or the middle of the process? 

Judge STULTS. Middle. 

Judge GARMON. Middle, I would say. 

Senator COBURN. OK. What does it say about our program that 

people need to have an attorney to process through this system? 

Any comments? 

Judge STULTS. I would just say that our local bars are much 

more aggressive in locating claimants perhaps today than they 

were 10, 15, 20 years ago. I was a private practitioner 30 years ago 

in central Oklahoma, and you did not see ads, you did not see TV 

or radio commercials that some of our representatives are now 

playing pretty regularly. And I think this goes back to the grid 

question. I think some of our representatives focus in on older folks 

seeking to see if they might want to become claimants. 

So I think it is the sophistication of the bar in reaching out to 

claimants to become a part of the process. 

Senator COBURN. Yes. 

Judge ERWIN. I do not think a claimant needs to have a representative. To me, one of the best roles a representative does is 

get me the medical evidence in a timely manner and get the claimant to the hearing. If the claimant is going to come to the hearing, 

and if they filled out the forms in advance, we can request their 

medical records, and then I can ask questions of the claimant. If 

we do not have the medical records, I will have to ask the claimant 

at the hearing: ‘‘Do we have everything? Is there any doctor that 

you have seen so I can get the objective findings?’’ And then maybe 

I have to have a supplemental hearing, or I have to look at the 

records that I get. 

But there was a question earlier. Are we too claimant friendly? 

I do not think we are too claimant friendly, but we are very claimant friendly. And in the instance of a claimant without a representative, one of the hats we have to wear is to help them develop the 

record. And if I have a claimant that is going to appear and is 

going to cooperate and help me develop the record, I do not believe 

that person needs a representative. 

Senator COBURN. OK. 

Judge GARMON. By the same token—and I do not necessarily disagree with what my fellow judges said, but also at the same time— 

you sometimes have people who come in and their educational level 

is such that they really do not understand the process. A lot of 

times their memory, past medical treatment, and things of that nature are very limited and where I have found that the representative is especially helpful is in that and also in gathering things 

other than medical evidence. Sometimes there can be employment 
49 

1See Exhibit 4i which appears in the Appendix on page 379. 

records that are missing from the file or other things like that, or 

the lack thereof. 

So there can be a very valid role for having a representative in 

a case, and I think sometimes they are very well served by having 

a representative. 

Senator COBURN. OK. Well, let us continue on with this one case 

because I want to kind of use it. Go to Exhibit 4i,1 if you will. In 

this case, a medical expert was asked to testify about the clinical 

assessment of pain. Do medical experts usually get evidence in advance of the hearing? 

Judge STULTS. Yes. 

Judge GARMON. Yes. 

Senator COBURN. OK. How long do they usually have to look it 

over? 

Judge STULTS. In our office, I would say they get at least 20 days 

prior to hearing. 

Senator COBURN. OK. Is it generally a good practice for medical 

experts to see the evidence for the first time at a hearing? 

Judge STULTS. No. 

Senator COBURN. All right. So on page 3 of the hearing transcript, page 4j, the judge asks the doctor what he thinks, the doctor 

read the document into the record and said, ‘‘So that would preclude an employment.’’ So here is a case where a doctor had never 

seen the information, read the statement, and a decision is made. 

Is this really expert testimony when all we are doing is reading the 

statement by an expert and answering one question? 

And how does that fit into the quality parameters that you all 

are supposed to work under? 

Judge GARMON. Of course, this is where I am trying to put myself in the mind of the judge and the doctor and everybody else in 

there. I cannot really do that. But, I have seen doctors that I respect be able to give decisions, and valid decisions, who I have seen 

give decisions both ways—I mean, not just one way or the other 

way, but who have in cases read reports. Sometimes we get reports 

at the last moment. And so I have also—if the doctor felt that he 

needed more time—asked for more time to review the record. So in 

this particular case, I cannot say. I was not there. I do not know. 

Senator COBURN. Well, if you go and look at the record, you can 

see what was turned in, and right there, and it is a subjective assessment. It is not an objective assessment. 

Let me ask a couple questions, because I know we want to close 

out this hearing. Do you all agree that you should not get lastminute evidence before a hearing? In other words, there ought to 

be a time frame that you get to look at it, instead of it being given 

to you the day before or the day of the hearing? Do you agree, if 

you have information that is coming in that is new, that has to be 

looked at in light of the whole record, that to spring that on you 

the morning of the hearing is inappropriate and that we ought to 

have some guidelines for a cutoff date for the admission of information, and if new information comes, that we ought to delay the 

hearing rather than continue the hearing with new information 

that had not been seen in light of the rest of the record? 
50 

Judge ERWIN. I will certainly agree that it makes it difficult 

when you get sprung a large amount of evidence the night before 

or the day of the hearing. 

Senator COBURN. Any disagreement with that? 

Judge GARMON. No, sir. I mean, that is certainly reasonable. I 

would say also it depends on the evidence. If it is just a little bit, 

it does not make much difference. But if they come in with a stack 

of papers that high, yes, that is a whole lot of—— 

Senator COBURN. Or if it is a major—or maybe it is one piece of 

evidence, but it contradicts everything else in the record. 

Judge GARMON. Well, then, that is a different question. 

Senator COBURN. That is right. 

Judge GARMON. Yes. 

Senator COBURN. So the point is late evidence ought to be considered in a thoughtful, intelligent way and not because it is just immediate to the hearing, and there is nothing wrong, if you are 

going to submit late evidence, fine, let us just delay the hearing to 

give the ALJ the time to consider that in light of the whole record. 

Judge GARMON. Yes, sir. I have actually continued cases where 

I have had too much at one point. 

Senator COBURN. All right. One other thing that I would like to 

ask you, because several ALJs have told me that they rely often 

on the Minnesota Multiphasic Personality Inventory (MMPI), or 

did until they were told they could not use it anymore as an assessment capability of the individual. And I can testify as a practicing 

physician up until January of this year that that is a valuable tool 

used throughout the medical community to assess large, difficult 

areas in terms of both personalities but also objectivity in terms of 

the statements of the patient as well as their overall condition. 

Do any of you have an opinion about whether or not you ought 

to be able to use tools that are out there that will actually help you 

decide the case better and whether or not the Social Security Administration ought to restrict your ability to use those tools since 

you are the decider of fact? 

Judge GARMON. Well, since medicine is a higher art than being 

a judge—— [Laughter.] 

Senator COBURN. I do not know that it is. You know, we say 60 

percent art, 40 percent science. My lawyer friends tell me that 

being a judge is 60 percent the law and 40 percent interpretation 

of the law. So I think they are a little bit reversed. 

Judge GARMON. All right. The point, though, is that I think along 

this line it would have to be deferred to our policy people. We did 

not make that decision. 

Senator COBURN. No, no. I am asking you about your opinion of 

the decision. You have an independence. I mean, we have heard 

from your bosses today that said they cannot get involved in interfering with your decisions, but yet they do because they have restricted your access to a tool that many of the ALJs in this country 

have used very effectively in deciding cases in the past. And so 

what, in fact, they are doing by limiting the MMPI is saying they 

are going to decide what you can look at and what you cannot. 

Judge STULTS. Well, I would have to agree with Judge Garmon. 

It is a policy determined by the agency. We, in our qualified 
51 

decisional independence, are limited to do what the Commissioner 

says. 

Now, I will tell you this right now: We are still getting consultative exams with the MMPI in it, and that will continue for a period of time. So at least for me personally, it is a little premature 

because I have not had the opportunity to have cases come before 

me where I do not have that as a tool. 

Senator COBURN. Well, but the point is you do not have the ability now under the rules to request an MMPI on a case. 

Judge STULTS. That is true. 

Senator COBURN. Our judges could not answer it, but why would 

we limit your ability to utilize information that would help you 

make a better decision in a case? 

In other words, somebody needs to explain to this Subcommittee 

why in the world we would take something that has been used for 

years, that is recognized scientifically to be very valid and a very 

good tool for large areas in health care and also judgment and say 

all of a sudden you cannot use it? 

Judge GARMON. Yes, sir, and as I understood the answer of the 

prior panel, that information is coming to you, and you will get the 

reasoning behind it. 

Senator COBURN. Were any of you shocked that you could not use 

that anymore? Did it cross your mind that, ‘‘Here is a tool that may 

help me decide a case accurately that I no longer am going to be 

able to utilize’’? 

Judge GARMON. Well, sir, I am not a doctor, so I—again, you are 

asking me to step into your role—— 

Judge ERWIN. Without speaking to policy, without speaking for 

the agency, I did use the information, and a number of judges have 

wished they could still get it. 

Senator COBURN. OK. 

Judge ERWIN. That is my personal opinion. I do not speak for the 

agency. 

Senator COBURN. I understand, and I know that is not policy. I 

am just saying, anybody that has used it and seen it has seen the 

value of it. Why do we take a valuable tool and restrict its use 

given that we are—you have significant freedom to make policy decisions about an individual case as long as you are doing it within 

the parameters of guidelines that the Social Security Administration sets up. Why would we restrict your ability to utilize information to help you make that case? 

All right. I will have some additional questions for the record, 

Mr. Chairman. I again thank you, and I thank all of you. Thank 

you for your service, one. You have got a tough job. Tough. Good 

luck. 

Judge GARMON. Thank you. 

Judge STULTS. Thank you. 

Senator LEVIN. Dr. Coburn, I think we probably should then official ask the Social Security Administration to answer that question 

since this panel is not able to answer it. I think it is your suggestion—and I totally agree with it—that we find out. I do not know 

what an MMPI is, frankly, but I know that Dr. Coburn does, and 

we should know why information which has been traditionally relevant in a case is no longer apparently requestable. 
52 

1See Exhibit No. 23 which appears in the Appendix on page 900. 

Senator COBURN. Yes. 

Senator LEVIN. So if that is all right with you we will official ask 

the Social Security Administration to give us the answer within 30 

days as to why it is that they have taken that step.1

I want to thank Dr. Coburn, and I want to thank his staff and 

my staff for the work that they have done on this. It is a significant 

problem which has been addressed here. From my offices back in 

Michigan, this is not the number one problem by any means that 

we have with Social Security disability. The number one problem 

we hear about is the long wait, and that is something which I 

think has now been somewhat shortened, actually, but nonetheless 

represents a huge problem for us. 

I think the second problem we hear the most about is the fear 

that the Social Security disability program may run out of funding—will run out of funding at the current rate in a couple of 

years, and what are we going to do about that? But this problem 

that has been identified and gone into and investigated by this 

Subcommittee now relates to that second question. It probably relates to the first question, for that matter. 

So I want to thank Dr. Coburn for his leadership in looking at 

the problem. We just simply should not have 20 or 25 percent of 

the cases that have, according to the Social Security Administration, errors or inadequacies in them. The Social Security Administration has begun to tackle the problem. We both gave them credit 

for doing so. We hope our report helps that effort, and I know that 

is clearly the intention of the report. 

With that, I will thank again Dr. Coburn, and our staffs, and 

thank our panel, and we will stand adjourned. 

[Whereupon, at 12:45 p.m., the Subcommittee was adjourned.] 
(53) 

A P P E N D I X 

Opening Statement of Senator Carl Levin 

Chairman, Permanent Subcommittee on Investigations 

hearing on 

Social Security Disability Programs: 

Improving the Quality of Benefit Award Decisions 

The Social Security Disability Insurance program provides financial support to 

Americans who, due to a disability, are incapable of working at a full-time job. The number of 

individuals applying for disability insurance aid has been increasing in recent years, made worse 

by the 2008 financial crisis when millions of workers lost their jobs and their employersponsored health insurance. Without health insurance, many of those individuals couldn't afford 

to pay for health care. Without health care, chronic conditions held in check by medicine and 

treatment worsened and sometimes became disabling. Those workers then turned to federal 

disability insurance. 

More individuals receiving disability insurance payments has, in turn, increased the stress 

on th(( Social Security Disability Trust Fund. Recent estimates predict that trust fund may be 

unable to pay full benefits by 2016, a problem this country has a moral obligation to address. 

Another problem is how long the disability application process takes. Applicants can 

wait two years to get a hearing and even longer for their case to be decided. During that yearslong wait, claimants often have less access to medical care or medicines. Although the Social 

Security Administration has recently reduced the backlog, large numbers of our most vulnerable 

citizens are still waiting in long lines. 

While there are many concerns about Social Security disability programs, including 

exhaustion of the trust fund and the backlog, today's hearing focuses on another set of concerns: 

what happens when an individual finally gets to the front of the line and gets their case heard. At 

the request of Dr. Coburn, the Ranking Republican on our Subcommittee, we launched a 

bipartisan investigation into how decisions are made to award disability benefits. After receiving 

actual case files from three counties in three different states, with all personal information 

removed, the files were reviewed to see how they were being decided, at both the initial and 

appellate levels. The review examined only cases in which benefits were awarded, and not any 

cases in which benefits were denied. 

A number of troubling problems appeared. One judge who churned out over 1,500 cases 

per year took inappropriate shortcuts in his opinions, cutting and pasting medical evidence from 

the case file into his opinions without explaining or analyzing what it meant, and writing the 

phrase "etc., etc., etc." rather than describing the relevant evidence. His chief judge confronted 

him in person and by letter, but for years he turned out the same poor quality work. 

In other cases that were reviewed, judges held perfunctory hearings that lasted less than 

five minutes, failed to elicit any testimony from the person applying for benefits, and failed to 
54 

examine medical evidence raising questions about whether that person was entitled to disability 

benefits. In still other cases, poorly written opinions awarding benefits failed to identifY medical 

evidence showing how the requirements for establishing a disability were met, did not 

acknowledge or address evidence that impairments were not disabling or evidence that the 

claimant had been working, and at times even misreported medical findings or hearing 

testimony. 

The report's findings of a large number of poor quality decisions in the 300 case files 

reviewed are consistent with the Social Security Administration's own internal research. An 

SSA quality review process found that, in 2011, 22% or over I in 5 disability cases decided by 

an Administrative Law Judge had contained errors or were inadequately justified. Those errors 

went in both directions, awarding and denying benefits. Those errors and inadequacies did not 

mean that the I in 5 disability decisions were all wrongly decided; what they meant was that the 

opinions being produced in those cases did not contain the type of analysis needed to be 

confident that the cases were correctly decided and disability benefits go only to the truly 

disabled. 

Senator Coburn is releasing a report that describes the results of the investigation into the 

disability decision making process. That report,in a unique way, provides detailed, relevant 

information about a process that is necessarily closed to the public, since disability hearings 

discuss an individual's personal medical records. The report not only confirms the Social 

Security Administration's own findings, it demonstrates what is at stake, identifies important 

issues illustrating how the quality of disability benefit award decisions needs to be improved, and 

why oversight by the SSA and Congress is so important. 

The report also contains many recommendations with which I agree, including expanding 

the Social Security Administration's quality review process; closing the evidentiary record at a 

reasonable time before a hearing to ensure adequate time to review materials; updating the 

decades-old job list; and increasing training for the judges. 

I do have a significant concern about a key recommendation to mandate a government 

representative at all disability hearings, because of the likelihood that it would lead to an 

adversarial process. The Supreme Court has said that the Social Security Act calls for the 

agency to operate "as an adjudicator, and not as an advocate or adversary." That is a central 

principle of the disability system, and if the proposed government representative is not to 

advocate for a particular position before the Administrative Law Judge, it would seem to be an 

expensive and time consuming duplication or confusion of roles. 

The men and women who administer the Social Security disability programs don't have it 

easy. The plight of the disabled demands that they do their jobs quickly, given the backlog. The 

law requires them to navigate complex rules and make difficult judgments. The threat to the 

program's solvency hovers over everything. I hope that the Subcommittee's work will 

contribute to the ongoing efforts to improve the disability award process, and I look forward to 

the testimony of our witnesses today. First, I turn to my friend, the Ranking Republican Senator 

Coburn, for his opening statement, and thank him for the extensive work he and his hardworking 

staff put into this important effort. 
55 

HEARING BEFORE 

THE COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

UNITED STATES SENATE 

SEPTEMBER13,2012 

STATEMENT 

OF 

JUDGE PATRICIA JONAS 

EXECUTIVE DIRECTOR 

OFFICE OF ApPELLATE OPERATIONS 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

SOCIAL SECURITY ADMINISTRATION 
56 

Chairman Levin, Ranking Member Coburn, and Members of the Subcommittee: 

Thank you for the opportunity to appear before you today. My name is Judge Patricia 

Jonas. I am the Executive Director of the Office of Appellate Operations and the Deputy 

Chair of the Appeals Council (AC) at the Social Security Administration Office of 

Disability Adjudication and Review (ODAR). Since 1940, the AC has operated under a 

direct delegation of authority from the Commissioner of Social Security to help oversee 

the hearings process. The AC conducts reviews of practices and decisions based on 

this authority. I oversee approximately 75 administrative appeals judges of the AC who 

review both the allowances and denials made by our administrative law judges (ALJ). 

I understand the Subcommittee is preparing to release a report concerning 300 

disability cases-100 each from Buchanan County, VA, Dallas County, AL, and 

Oklahoma County, OK. We have not yet seen that report, but we look forward to 

reviewing it and working with the Subcommittee to collect meaningful data about areas 

of mutual concern. We recognize that the conclusions of this study will be severely 

limited by the statistically non-representative sample of cases that was studied. That 

said, we are hopeful that the report will identify data that merit further research. We are 

also pleased to share with you the agency's preliminary findings from its separate 

review of the 300 cases. 

In addition to addressing the findings from your report, I want to take this opportunity to 

update you on the improvements we have made to the hearings and appeals process. 

The Supreme Court has recognized that we are "probably the largest adjudicative 

agency in the western world," and we take very seriously our responsibility to issue 

timely and accurate decisions.1 

When Commissioner Astrue arrived five years ago, there was widespread discontent 

with backlogs and delays in the disability system. There was also significant concern 

about the quality of our decision-making. The majority of a prior agency plan to fix those 

problems-Disability Service Improvement (DSI)-was halted so that resources could 

be redirected to backlog reduction. The numbers tell the story. At the time, over 63,000 

people waited over 1,000 days for a hearing, and some people waited as long as 1,400 

days. We were failing the public. 

Right from the beginning, Commissioner Astrue's refrain was that we could not take the 

easy road of short-term fixes on backlogs that would aggravate our quality issues. With 

that principle in mind, Commissioner Astrue developed an operational plan that focused 

on the gritty work of truly managing the unprecedented hearings workload. We made 

dozens of incremental changes, including using video more widely, improving 

information technology, simplifying regulations, standardizing business processes, and 

1 Heckler v. Campbell, 461 U.S. 458, 461 n.2 (1983). 

1 
57 

establishing AU productivity expectations, to name just a few. Additional resources 

provided by Congress in the Recovery Act were critical to supporting these initiatives. 

Today, the result is clear-the plan has worked. Average processing time, which stood 

at 532 days in August 2008, steadily declined for more than three years, and currently 

stands at 359 days. 

This improvement in our ability to hold hearings and issue timely decisions is even more 

impressive when you consider that we have given priority to the oldest cases, which are 

generally the most complex and time-consuming. Since 2007, we have decided over 

600,000 of the oldest cases. Each year, we lower the threshold for aged cases to 

ensure that we continue to eliminate the oldest cases first. We ended fiscal year (FY) 

2011 with virtually no cases over 775 days old. Through the steady efforts of our 

employees, we now define an aged case as one that is 725 days or older, and we have 

already completed over 90 percent of them. Next year, our management goal is to raise 

the bar on ourselves again by focusing on completing all cases over 675 days old. 

As we have worked to provide your constituents with quicker decisions, we have not 

forgotten our duty to ensure that every decision is fair and meets the requirements of 

the law. In short, we strive to make sure that our decisions are of the highest quality. 

Prior to Commissioner Astrue's arrival, due to several years of budget shortfalls, the 

agency had performed very little quality review at ODAR, in large part due to litigation 

and congressional reaction to the "Bellmon Review" in the 1980s. And perhaps equally 

important, as a result of that litigation and congressional reaction, our policy guidance 

and feedback to our AUs was limited. For many years, a remand order was the 

primary method of providing written feedback from the AC to AUs. While this method 

of providing feedback and guidance to AUs is still an appropriate mechanism when 

addressing individual cases, there are limitations. For example, the number of remands 

to any AU is relatively small, and, until the reintroduction of a favorable review effort at 

the AC, the feedback was generally limited to cases in which the AU made an 

unfavorable decision. 

However, under Commissioner Astrue's leadership, we took aggressive steps to 

institute a more balanced quality review into the hearings process. The first step was to 

develop serious data collection and management information for ODAR, and the next 

step was to revive development of an electronic policy-compliant system for the AC, 

which had been terminated by the DSI initiative. These new tools permitted the AC to 

capture a significant amount of structured data concerning the application of agency 

policy in hearing decisions. In December 2008, Commissioner Astrue provided 

resources to our Office of Quality Performance to institute an independent national-level 

review of hearings level decisions to ensure a consistent and comparative review for all 

three adjudicative levels of the agency's disability process. Also, in 2009, 

Commissioner Astrue reestablished the quality review function in the AC, known as the 

Division of Quality (DQ), that reintroduced review of a sampling of favorable hearing 

decisions. This office took about a year to implement fully since we had to hire, train, 

2 
58 

and lease office space for about 50 staff whose function is to identify quality issues in 

the processing of disability cases at the hearings level. Beginning in September 2010, 

the DQ began to conduct the reviews of favorable hearings level decisions. 

These new quality initiatives have given us a new opportunity to improve our feedback 

and policy guidance. The data collected from these quality initiatives identify the most 

error-prone provisions of law and regulation and this information is used to design and 

implement our AU training efforts, including the annual judicial training and mandatory 

quarterly training for all AUs. We have also recently implemented a new process that 

expands the opportunity for AUs to provide feedback to the AC when a remand is 

issued. 

We also provide feedback on decisional quality, giving adjudicators real-time access to 

their remand data. We develop and deliver specific training that focuses on the most 

error-prone issues that our judges must address in their decisions. In addition, we 

make available specific training to address individualized training needs. 

These efforts are testing some longstanding traditions within ODAR. We are moving 

from training based primarily on anecdotal information as to our most significant 

problems to a data-based identification of issues. Training materials are developed so 

that they are not only a policy reminder, but a skill-based training designed to improve 

both the adjudicator's efficiency and accuracy in case adjudication. We are transparent 

with the information that we are collecting so that the AUs can more readily make use 

of the information. Providing a mechanism for the AUs to question the AC about a 

remand is also a new innovation. We believe that our hearings process is improving 

because of this increased feedback and communication. 

As you are aware, there is a public dialogue about our AUs and our hearing process. 

Certainly, the fact that better AU data are readily available is a factor. Allegations both 

of "paying down the backlog" and fraud in the disability system have appeared in the 

media from time to time. These allegations are based mostly on anecdote and 

innuendo, and unfairly diminish our accomplishments over the past five years. 

Moreover, these reports often ignore the reality that we are making quicker, higher 

quality disability decisions. Over the past five years, the allowance and denial rates 

have become more consistent throughout the AU corps. Since FY 2007, there has 

been more than a two-thirds reduction in the number of judges who allow more than 85 

percent of their cases. 2 

Of course, opportunities for continued improvement remain. Due to challenges 

maintaining our staffing levels and difficulty keeping up with demand, we have begun to 

lose ground with respect to our average processing time these last two years. At this 

point, it appears all but certain that we will not meet our average processing time goal of 

270 days in FY 2013; however, full funding of the President's budget would allow us to 

make progress. 

2 See Appendix A. 

3 
59 

300 Case Study Preliminary Findings 

While my office has not yet reviewed the 300 disability cases provided the 

Subcommittee, which consisted of a mixture of decisions from all levels of our 

adjudication process and were weighted toward allowances, the agency's Office of 

Medical and Vocational Evaluation did a basic review of them. I understand that they 

found a limited number of policy issues that are consistent with what we saw when the 

DO in the AC conducted a national random sample review of favorable hearings level 

decisions in FY 2011. 

Two areas that concerned us in our AC sample results were the evaluation of medical 

opinion and the assessment of residual functional capacity (RFC). Using the data we 

collected at the AC, we provided mandatory training to all ALJs on RFC and evaluation 

of medical source opinion earlier this year. Just as with the cases we see at the AC, the 

majority of the ALJs in the cases that the Subcommittee requested appear to have 

complied with our policies. However, there also are examples in which ALJs were not 

policy compliant in evaluating the appropriate weight given to a medical source's 

opinion and in assessing the claimant's RFC. There were also several case examples 

from one ALJ in which the written decision appeared inaccurate and contained 

boilerplate information that was not relevant to the individual claimant. That same issue 

had been seen by the DO in the random sample review and, as a result, the Chief ALJ 

had instructed the ALJ to discontinue this practice. This example shows that our 

improvements are producing positive results. 

Building Speed and Quality into the Hearings and Appeals Process 

When the agency established the hearings process in 1940, it designed the process to 

handle a substantial number of cases-that is, a larger number than was handled in 

other hearing processes. 3 However, over the years, that number has grown. In FY 

2007, we received nearly 580,000 hearing requests; last fiscal year, we received over 

859,000 hearing requests, which was a record number. The main reason behind this 

workload growth in recent years has been the flood of new appeals caused by the aging 

of the baby boomers and the economic downturn. Rapid expansion of large firms 

representing claimants may also be a factor in the higher rate of appeal. 

To address these growing workloads, we decided to return to the gritty work of truly 

managing our hearings and appeals workloads. 

We hired additional ALJs for the offices with the heaviest workloads and informed our 

entire corps of our expectation that they should issue between 500 and 700 legally 

sound decisions annually.4 When we established that productivity expectation in late 

3 Basic Provisions Adopted by the Social Security Board for the Hearing and Review of Old-Age and Survivors 

Insurance Claims, at 4 (January 1940). 

'In addition, we limit the limit the number of cases assigned per year to an AU. 

4 
60 

2007, only 47 percent of the ALJs were achieving it. In FY 2011, 77 percent met the 

expectation, and we expect that percentage to rise this fiscal year. 

We opened five National Hearing Centers (NHC) to further reduce hearings backlogs by 

increasing adjudicatory capacity and efficiency with a focus on a streamlined electronic 

business process. Transfer of workload from heavily backlogged hearing offices is 

possible with electronic files, thus allowing the NHC to easily provide assistance to 

these areas of the country. 

In 2010 and 2011, we opened 24 new hearing offices and satellite offices. While a lack 

of funding forced us to cancel plans for additional offices, those we did open are making 

a substantial difference in communities that were experiencing the longest waits for 

hearings. 

We increased usage of the Findings Integrated Templates that improve the legal 

sufficiency of hearing decisions, conserve resources, and reduce average processing 

time. We introduced a standard Electronic Hearing Office Process, also known as the 

Electronic Business Process, to promote consistency in case processing across all 

hearing offices. We also built the "How MI Doing" tool that gives adjudicators extensive 

information about the reasons their cases were subsequently remanded and allows 

them to view their performance in relation to the average of other ALJs in the office, 

region, and Nation. Currently, we are developing training modules for each of the 170 

bases for remands that eventually will be linked to this tool so that ALJs can obtain 

training on targeted issues. 

We expanded automation tools to improve speed, efficiency, quality, and accountability. 

We initiated the Electronic Records Express project, which provides electronic options 

for submitting health and school records related to disability claims. This initiative saves 

critical administrative resources because our employees burn fewer CDs freeing them 

to do other work. In addition, appointed representatives with e-Folder access have selfservice access to hearing scheduling information and the current Case Processing and 

Management System (CPMS) claim status for their clients, reducing the need for them 

to contact our offices. We have registered over 9,000 representatives for direct access 

to the electronic folder. We also implemented Automated Noticing that allows CPMS to 

automatically produce appropriate notices based on stored data. We implemented 

centralized printing and mailing that provides high-speed, high-volume printing for all 

hearings and appeals offices. We implemented Electronic Signature that allows ALJs 

and Attorney Adjudicators to sign decisions electronically. 

Additionally, we are developing another automated tool, the electronic bench book 

(eBB), which we believe will help ALJs review, decide, and provide instructions for 

decision writers in a fully electronic environment. Last month, we initiated a pilot of the 

eBB in three hearing offices. The eBB is a web-based tool that aids in documenting, 

analyzing, and adjudicating a disability case according to our regulations. Wherever 

possible, we reuse data to limit the need to re-enter information. eBB is designed to pull 

in and display information entered from various sources. eBB should make review of 

5 
61 

the electronic file and instructions to decision writers more complete and efficient, which 

would reduce the number of cases remanded because of incomplete documentation. 

We have Federal disability units that provide extra processing capacity throughout the 

country. In recent years, these units have been assisting stressed State disability 

determination agencies. After evaluating our limited resources, our success in holding 

down the initial disability claims pending level, and a further spike in hearings requests, 

we redirected these units in February 2012 to assist in screening hearings requests. 

Our Federal disability units can make fully favorable allowances, if appropriate, without 

the need for a hearing before an AU. 

We also listened to criticism from Congress and others. We have tried to make the right 

decision upfront as quickly as possible. For instance, we are successfully using our 

Compassionate Allowances (CAL) and Quick Disability Determination initiatives to fasttrack disability determinations at the initial claims level for over 150,000 disability 

claimants each year, while maintaining a very high accuracy rate. Currently, about 6 

percent of initial disability claims qualify for our fast-track processes, and we expect to 

increase that number as we add new conditions to our CAL program. This helps keep 

these cases out of our appeals process altogether. 

At the AC, we also made improvements that helped us to handle the influx of cases 

from the hearing offices and improve the quality of decisions throughout our entire 

hearings and appeals process. For example, we developed and are now using the 

Appeals Review Processing System (ARPS), an Intranet case processing system that 

helps staff identify errors, prepare recommendations for review, identify trends, and 

provide feedback to adjudicators and staff. 

Over the last few years, the AC has developed an interactive training model that 

received the prestigious W. Edwards Deming Training Award from the Graduate School 

USA in 2011. 

In the future, we plan to implement a new case assignment model for the AC that will 

group cases with similar issues and assign those cases concurrently. This change will 

improve consistency and help identify areas for future training, while also decreasing 

processing times for all claimants. 

However, of all the important improvements we have made or plan to make at the AC, 

none is more important than the recent creation of the DQ. In 2008, we presented 

Commissioner Astrue with a plan that would allow us to gather comprehensive data on 

the quality of our hearing decisions. Recognizing an obvious need, Commissioner 

Astrue established a workgroup in 2009, which led to the establishment of DQ in 

September 2010. 

Even in the beginning, when the data were just trickling in, we began to identify 

decision-making issues that we knew needed to be addressed through rulemaking or 

sub-regulatory action. 

6 
62 

Currently, DQ reviews a statistically valid sample of un-appealed favorable ALJ hearing 

decisions before those decisions are effectuated (i.e., finalized), as authorized by 20 

CFR 404.969 and 416.1469. In FY 2011, DQ reviewed 3,692 partially and fully 

favorable decisions issued by ALJs and attorney adjudicators, and took action on about 

22 percent, or 812, of those cases. 5 

While longstanding regulations do not permit our DQ to do pre-effectuation reviews that 

are based on a specific ALJ or hearing office, the DQ is able to conduct posteffectuation focused reviews on specific hearing offices, ALJs, representatives, doctors, 

and disability program issues, etc.6 These reviews allow us to better understand how 

our complex disability pOlicies are being implemented by various parties throughout the 

hearings level. We identify potential subjects for focused reviews from a variety of 

sources, including data collected through our systems, findings from pre-effectuation 

reviews, and internal and external referrals received from various sources regarding 

potential non-compliance with our regulations and policies. One way we use these 

reviews is to identify common errors in ALJ decisions. The results of these reviews 

show common errors to be failure to adequately develop the record, lack of supporting 

rationale, and improper evaluation of opinion evidence. We have used this information 

to develop and implement mandatory training for our ALJs. Furthermore, we use the 

comprehensive data and analysis provided by DQ to provide feedback to other 

components on policy guidance and litigation issues. 

Moreover, since we are handling more cases in both our hearing offices and at the AC, 

the number of new Federal court cases filed challenging our final decisions has gone 

up. In FY 2007, dissatisfied claimants filed 11,920 new cases. That number rose to 

15,644 in FY 2011, and we project that there will be about 19,100 new cases filed in FY 

2013. Our success in the courts has also improved. In FY 2011, courts affirmed our 

decisions in 51 percent of the cases decided, up from 49 percent in FY 2007, and court 

reversals have decreased from 5 percent to fewer than 3 percent of cases over this 

time. 

Finally, notwithstanding our impressive work to-date, we have sought outside advice 

from the Administrative Conference of the United States (ACUS) to 9uide our future 

quality improvement efforts in our hearing offices and at the AC. Currently, ACUS is 

studying: 

• The effect of the treating physician rule on the role of the courts in reviewing 

our disability decisions and the measures that we could take to reduce the 

number of remanded cases; 

5 In those instances, the AC either remanded the case to the hearing office for further development or issued a 

decision that modified the hearing decision. 

'Since these focused reviews are post-effectuation reviews, they do not change case outcomes. 

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63 

• The AC's role in reviewing cases to reduce any observed variances and the 

efficacy of expanding the AC's existing authority to conduct more focused 

reviews of judge decisions; and 

• How the AC can select cases for review-as well as when the AC should 

select cases for review (i.e" pre- or post-effectuation)-and what should be 

the scope and manner of review, 

We expect ACUS to deliver its preliminary findings by the end of this calendar year and 

a draft final report with recommendations early next year, 

Additionally, we have also asked ACUS to review and analyze the Social Security Act 

and our regulations regarding the duty of candor and the submission of all evidence in 

disability claims, ACUS will also survey the requirements of other administrative 

tribunals, as well as the Federal Rules of Evidence, Federal Rules of Civil Procedure, 

and other applicable authority, regarding the duty of candor and submission of all 

evidence and then make recommendations for improvements in the Social Security 

adjudication process, 

Conclusion 

Contrary to popular anecdote and innuendo, we have made extraordinary gains 

improving the speed and quality of our hearings and appeals process over the past five 

years, We have done so against extraordinary obstacles, including demographic 

challenges, the economic downturn, and fiscal belt tightening, Resources permitting, 

we believe that we can continue to improve by building upon our productivity gains and 

the body of quality review data that we have accumulated, 

Finally, I look forward to reviewing the Subcommittee's report concerning 300 disability 

cases, Without having seen the report, I will do my best to answer any questions you 

may have today, Although the report will be severely limited by the statistically nonrepresentative sample of cases that was studied, we are nonetheless hopeful that the 

report will identify possible trends that merit further research, 

8 
Appendix A 

Number and Percentage of ALJs with 100+ Dispositions in Allowance Rate Groups 

Source: CPMS MI_ DART T_ (DmJ 

by ODAR 0ESSIIDMlA. Sep1embef 4, 2012 
65 

HEARING BEFORE 

THE COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

UNITED STATES SENATE 

SEPTEMBER 13, 2012 

STATEMENT 

OF 

JUDGE DEBRA BICE 

CHIEF ADMINISTRATIVE LAW JUDGE 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

SOCIAL SECURITY ADMINISTRATION 
66 

Chairman Levin, Ranking Member Coburn, and Members of the Subcommittee: 

Thank you for the opportunity to appear before you today. My name is Judge Debra 

Bice, and I am the Chief Administrative Law Judge at the Social Security Administration. 

I am responsible for overseeing approximately 1,500 administrative law judges (AU) in 

the Office of Disability Adjudication and Review (ODAR). My testimony will focus on the 

process through which we determine disability at all adjudicative levels across the 

agency. My testimony will also address the challenges we face hiring, managing, and 

disciplining our judge corps. 

How We Determine Disability-The Sequential Evaluation Process 

Our general process for determining disability is admittedly complicated, but it is 

necessarily complex to meet the requirements of the law as designed by Congress. 1 

We evaluate adult claimants for disability under a standardized five-step evaluation 

process (sequential evaluation), which we formally incorporated into our regulations in 

1978. At step one, we determine whether the claimant is engaging in sUbstantial gainful 

activity (SGA). SGA is significant work normally done for payor profit. The Social 

Security Act (Act) establishes the SGA earnings level for blind persons and requires us 

to establish the SGA level for other disabled persons.2 If the claimant is engaging in 

SGA, we deny the claim without considering medical factors. 

1 Section 223(d) of the Act defines "disability" as "the 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 

which has lasted or can be expected to last for a continuous period of not less than 12 months; or in the case of an 

individual who has attained the age of 55 and is blind (within the meaning of 'blindness' as defined in section 

216(i)(1)), inability by reason of such blindness to engage in substantial gainful activity requiring skills or abilities 

comparable to those of any gainful activity in which he has previously engaged with some regularity and over a 

substantial period of time. An individual shall be determined to be under a disability only if his physical or mental 

impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, 

considering his age, education, and work experience, engage in any other kind of substantial gainful work which 

exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or 

whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. For purposes of 

the preceding sentence (with respect to any individual), 'work which exists in the national economy' means work 

which exists in significant numbers either in the region where such individual lives or in several regions of the 

country. In determining whether an individual's physical or mental impairment or impairments are of a sufficient 

medical severity that such impairment or impairments could be the basis of eligibility under this section, the 

Commissioner of Social Security shall consider the combined effect of all of the individual's impairments without 

regard to whether any such impairment, if considered separately, would be of such severity. If the Commissioner 

of Social Security does find a medically severe combination of impairments, the combined impact of the 

impairments shall be considered throughout the disability determination process. An individual shall not be 

considered to be disabled for purposes of this title if alcoholism or drug addiction would (but for this 

subparagraph) be a contributing factor material to the Commissioner's determination that the individual is 

disabled. For purposes of this subsection, a 'physical or mental impairment' is an impairment that results from 

anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical 

and laboratory diagnostic techniques." 

2 For blind persons, the SGA earnings limit is currently $1,690 a month. Currently, other disabled persons are 

engaging in SGA if they earn more than $1,010 a month. Both SGA amounts are indexed annually to average wage 

1 
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If a claimant is not engaging in SGA, at step two, we assess the existence, severity, and 

duration of the claimant's impairment (or combination of impairments). The Act requires 

us to consider the combined effect of all of a person's impairments, regardless of 

whether anyone impairment is severe. Throughout the sequential evaluation, we 

consider all of the claimant's physical and mental impairments singly and in 

combination. 

If we determine that the claimant does not have a medically determinable impairment, 

or that the impairment or combined impairments are "not severe" because they do not 

significantly limit the claimant's ability to perform basic work activities, we deny the claim 

at the second step. If the impairment is "severe," we proceed to the third step. 

Listing of Impairments 

At the third step, we determine whether the impairment "meets" or "equals" the criteria 

of one of the Listing of Impairments (Listings) in our regulations. 

The Listings describe for each major body system the impairments considered so 

severe that we can presume that they would prevent an adult from working. The Act 

does not require the Listings, but we have been using them in one form or another since 

1955. The listed impairments are permanent, expected to result in death, or last for a 

specific period greater than 12 months. 

Using the rulemaking process, we revise the Listings' criteria on an ongoing basis. The 

Listings are a critical factor in our disability determination process, and we are 

committed to updating each listing at least every five years. In the last five years, we 

have revised five of 14 body systems in the Listings, and in FY 2013 we plan to revise 

two more body systems and obtain public comments on the remaining seven body 

systems. Vllhen updating a listing, we consider current medical literature, information 

from medical experts, disability adjudicator feedback, and research by organizations 

such as the Institute of Medicine. As we update entire body systems, we also make 

targeted changes to specific rules as necessary. 

If the claimant has an impairment that meets or equals the criteria in the Listings, we 

allow the disability claim without considering the claimant's age, education, or past work 

experience. 

As part of our process at step three, we developed an important initiative-our 

Compassionate Allowances (CAL) initiative-that allows us to identify claimants who 

are clearly disabled because the nature of their disease or condition clearly meets the 

statutory standard for disability. With the help of sophisticated new information 

growth, using the National Average Wage Index. However, the Act specifies that we cannot necessarily count all 

the person's earnings. For example, we deduct impairment-related work expenses when we consider whether a 

person is engaging in SGA. 

2 
68 

technology, we can quickly identify potential Compassionate Allowances and then 

swiftly make decisions. We currently recognize 165 CAL conditions, and we expect to 

expand the list later this year. We continue to review our CAL policy to ensure we base 

it on the most up-to-date medical science. 

Residual Functional Capacity 

A claimant who does not meet or equal a listing may still be disabled. The Act requires 

us to consider how a claimant's condition affects his or her ability to perform past 

relevant work or, considering his or her age, education, and work experience, other 

work that exists in the national economy. Consequently, we assess what the claimant 

can still do despite physical and mental impairments-Le., we assess his or her residual 

functional capacity (RFC). We use that RFC assessment in the last two steps of the 

sequential evaluation. 

We developed a regulatory framework to assess RFC. An RFC assessment must 

reflect a claimant's ability to perform work activity on a regular and continuing basis (Le., 

eight hours a day for five days a week, or an equivalent work schedule). We assess the 

claimant's RFC based on all of the evidence in the record, such as treatment history, 

objective medical evidence, and activities of daily living. 

We must also consider the credibility of a claimant's subjective complaints, such as 

pain. Such complaints are inherently difficult to assess. Under our regulations, 

disability adjudicators use a two-step process to evaluate credibility. First, the 

adjudicator must determine whether medical signs and laboratory findings show that the 

claimant has a medically determinable impairment that could reasonably be expected to 

produce the pain or other symptoms alleged. If the claimant has such an impairment, 

the adjudicator must then consider all of the medical and non-medical evidence to 

determine the credibility of the claimant's statements about the intensity, persistence, 

and limiting effects of symptoms. The adjudicator cannot disregard the claimant's 

statements about his or her symptoms simply because the objective medical evidence 

alone does not fully support them. 

The courts have influenced our rules about assessing a claimant's disability. For 

example, when we assess the severity of a claimant's medical condition, we historically 

have given greater weight to the opinion of the physician or psychologist who treated 

that claimant. While the courts generally agreed that adjudicators should give special 

weight to treating source opinions, the courts formulated different rules about how 

adjudicators should evaluate treating source opinions. In 1991, we issued regulations 

that explain how we evaluate treating source opinions. 3 However, the courts have 

continued to interpret opinions from treating physicians in conflicting ways. 

, Under those regulations, we will give controlling weight to a treating physician's opinion if it is well-supported by 

medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other 

substantial evidence in the record. In that case, a disability adjudicator must adopt a treating source's medical 

opinion regardless of any finding he or she would have made in the absence of the medical opinion. 

3 
69 

Once we assess the claimant's RFC, we move to the fourth step of the sequential 

evaluation. 

Medical-Vocational Decisions (Steps Four and Five) 

At step four, we consider whether the claimant's RFC prevents the claimant from 

performing any past relevant work. If the claimant can perform his or her past relevant 

work, we deny the disability claim. 

If the claimant cannot perform past relevant work (or if the claimant did not have any 

past relevant work), we move to the fifth step of the sequential evaluation. At step five, 

we determine whether the claimant, given his or her RFC, age, education, and work 

experience, can do other work that exists in the national economy. If a claimant cannot 

perform other work, we will find that the claimant is disabled. 

We use detailed vocational rules to minimize subjectivity and promote national 

consistency in determining whether a claimant can perform other work that exists in the 

national economy. When we issued these rules in 1978, we noted that the Committee 

on Ways and Means, in its report accompanying the Social Security Amendments of 

1967, said that: 

It is, and has been, the intent of the statute to provide a definition of disability 

which can be applied with uniformity and consistency throughout the nation, 

without regard to where a particular individual may reside, to local hiring 

practices or employer preferences, or to the state of the local or national 

economy.4 

The medical-vocational rules, set out in a series of "grids," relate age, education, and 

past work experience to the claimant's RFC to perform work-related physical activities. 

Depending on those factors, the grid may direct us to allow or deny a disability claim. 

For cases that do not fall squarely within a vocational rule, we use the rules as a 

framework for decision-making. In addition, an adjudicator may rely on a vocational 

expert to identify other work that a claimant could perform. 

How We Determine Disability-The Administrative Process 

The Supreme Court has accurately described our administrative process as "unusually 

protective" of the claimant. 5 Indeed, we strive to ensure that we make the correct 

decision as early in the process as possible, so that a person who truly needs disability 

benefits receives them in a timely manner. In most cases, we decide claims for benefits 

using an administrative review process that consists of four levels: (1) initial 

4 43 Fed. Reg. 55349, 55350 (1978) (quoting H.R. Rep. No. 544, 90th Congress, 1st 5ess., at 30 (1967)). 

5 Heckler v. Day, 467 U.S. 104 (1984). 

4 
70 

determination; (2) reconsideration determination; (3) hearing; and (4) appeals. 6 At each 

level, the decision-maker bases his or her decisions on provisions in the Social Security 

Act (Act) and regulations, as outlined above. 

Initial and Reconsideration Determinations 

In most States, a team consisting of a State disability examiner and a State agency 

medical or psychological consultant makes an initial determination at the first level. The 

Act requires this initial determination.7 A claimant who is dissatisfied with the initial 

determination may request reconsideration, which is performed by another State 

agency team. In turn, a claimant who is dissatisfied with the reconsidered determination 

may request a hearing8 

Hearing Level 

We have over 70 years of experience in administering the hearings and appeals 

process. Since the passage of the Social Security Amendments of 1939, the Act has 

required us to hold hearings to determine the rights of individuals to old-age and 

survivors' insurance benefits. 

Over the years, the numbers of ALJs and hearing offices rapidly grew as the Social 

Security program grew. Recently, we added staff to help us meet growing demand and 

allow us to focus our resources on those parts of the country with the greatest need for 

hearings. In addition, we have expanded the use of video hearings, opened five 

National Hearing Centers to deal only with backlogged cases by video, and realigned 

the service areas of some of our offices. However, the attributes of the hearings and 

appeals process have remained essentially the same since 1940. When it established 

the hearings and appeals process in 1940, the Social Security Board sought to balance 

the need for accuracy and fairness to the claimant with the need to handle a large 

volume of claims in an expeditious manner.9 Those twin goals still motivate us. As the 

6 20 C.F.R. §§ 404.900, 416.1400. My testimony focuses on disability determinations, but the review process 

generally applies to any appealable issue under the Social Security programs. 

7 Sections 205(b) and 1631(c)(1)(A) of the Act, 42 U.S.C. §§ 405(b), 1383(c)(1)(A). 

B For disability claims, 10 States participate in a "prototype" test under 20 C.F.R. §§ 404.906, 416.1406. In these 

States, we eliminated the reconsideration step of the administrative review process. Claimants who are dissatisfied 

with the initial determinations on their disability cases may request a hearing before an AU. The 10 States 

participating in the prototype test are Alabama, Alaska, California (Los Angeles North and West Branches), 

Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania. 

, Basic Provisions Adopted by the Social Security Board for the Hearing and Review of Old-Age and Survivors 

Insurance Claims, at 4-5 (January 1940). 

5 
71 

Supreme Court has observed, the Social Security hearings system "must be fair-and it 

must work."1o 

When a hearing office receives a request for hearing from a claimant, the case file is 

prepared by hearing office staff prior to the case being assigned to a judge and 

scheduled for hearing. The AU decides the case de novo, meaning that he or she is 

not bound by the determinations made at prior levels of the disability process. The AU 

reviews any new medical or other evidence that was not available to prior adjudicators. 

The AU will also consider a claimant's testimony and the testimony of medical and 

vocational experts called for the hearing. Since the AU considers additional evidence 

and testimony, his or her decision to allow an appeal does not necessarily mean that 

the earlier decision was incorrect based on the evidence available at the time. If a 

review of all of the evidence supports a decision fully favorable to the claimant without 

holding a hearing, the AU or attorney adjudicator may issue an on-the-record fully 

favorable decision. 11 

In contrast to Federal court proceedings, our AU hearings are non-adversarial. Formal 

rules of evidence do not apply, and the agency is not represented except by the AU, 

who has dual responsibilities. 12 At the hearing, the AU takes testimony under oath or 

affirmation. The claimant may elect to appear in-person at the hearing or consent to 

appear via video. The claimant may appoint a representative (either an attorney or nonattorney) who may submit evidence and arguments on the claimant's behalf, make 

statements about facts and law, and call witnesses to testify. The AU may call 

vocational and medical experts to offer opinion evidence, and the claimant or the 

claimant's representative may question these witnesses. 

If, following the hearing, the AU believes that additional evidence is necessary, the AU 

may leave the record open and conduct additional post-hearing development; for 

example, the AU may order a consultative exam. Once the record is complete, the AU 

considers all of the evidence in the record and makes a decision. The AU decides the 

case based on a preponderance of the evidence in the administrative record. A 

10 Richardson v. Perales, 402 U.S. 389, 399 (1971). 

11 Under the Attorney Adjudicator program, our most experienced attorneys spend a portion of their time making 

on-the-record, disability decisions in cases where enough evidence exists to issue a fully favorable decision without 

waiting for a hearing. 20 C.F.R. §§ 404.942, 416.1442. 

12 Starting in the 1970s under Commissioner Ross, we tried to pilot an agency representative position at select 

hearing offices. However, a United States District Court held that the pilot violated the Act, intruded on AU 

independence, was contrary to congressional intent that the process be "fundamentally fair," and failed the 

constitutional requirements of due process. Salling v. Bowen, 641 F. Supp. 1046 (W.D. Va. 1986). We subsequently 

discontinued the pilot due to the testing interruptions caused by the Salling injunction, general fiscal constraints, 

and intense congressional opposition. Congress originally supported the project; however, we experienced 

significant congressional opposition once the pilot began. For example, Members of Congress introduced 

legislation to prohibit the adversarial involvement of any government representative in Social Security hearings, 

and 12 Members of Congress joined an amicus brief in the Salling case opposing the project. 

6 
72 

claimant who is dissatisfied with the ALJ's decision generally has 60 days after he or 

she receives the decision to ask the Appeals Council (AC) to review the decision.13 

Appeals Council 

Upon receiving a request for review, the AC evaluates the ALJ's decision, all of the 

evidence of record, including any new and material evidence that relates to the period 

on or before the date of the ALJ's decision, and any arguments the claimant or his or 

her representative submits. The AC may grant review of the ALJ's decision, or it may 

deny or dismiss a claimant's request for review. The AC will grant review in a case if 

there appears to be an abuse of discretion by the ALJ; there is an error of law; the 

actions, findings, or conclusions of the ALJ are not supported by sUbstantial evidence; 

or if there is a broad policy or procedural issue that may affect the general public 

interest. 

If the AC grants a request for review, it may uphold part of the ALJ's decision, reverse 

all or part of the ALJ's decision, issue its own decision, remand the case to an ALJ, or 

dismiss the original hearing request. When it reviews a case, the AC considers all the 

evidence in the ALJ hearing record (as well as any. new and material evidence), and 

when it issues its own decision, it bases the decision on a preponderance of the 

evidence. 

If the claimant completes our administrative review process and is dissatisfied with our 

final decision, he or she may seek review of that final decision by filing a complaint in 

Federal District Court. However, if the AC dismisses a claimant's request for review, he 

13 The Appeals Council is headquartered in Falls Church, Virginia. It is our last administrative decisional level. 

Created on March 1, 1940 as a three-member body, the Appeals Council was established to oversee the hearings 

and appeals process, promote national consistency in hearing decisions made by referees (now AUs) and ensure 

that the Social Security Board's (now the Commissioner's) records were adequate for judicial review. The Appeals 

Council has grown over time due to the growth in the increasingly complex programs it reviews and the increased 

number of requests for review that it receives. Currently, the Appeals Council is made up of approximately 75 

Administrative Appeals Judges, S6 Appeals Officers, and several hundred support personnel. The Appeals Council is 

physically located in Falls Church, Virginia with additional offices in Crystal City, Virginia, and in Baltimore, 

Maryland. Cases originate in hearing offices throughout the country. The Appeals Council looks at each case in 

which a request for review is filed (over 173,000 in FY 2011). The Appeals Council may grant, deny, or dismiss a 

request for review. If the Appeals Council grants the request for review, it will either decide the case or return 

("remand") it to an AU for a new decision. The Council also performs quality review, policy interpretations, and 

court-related functions. The Appeals Council is the core component of the Office of Appellate Operations, one of 

the parts of Our Office of Disability Adjudication and Review. The Office of Appellate Operations provides 

professional and clerical support for the Appeals Council, and also maintains and controls files in cases decided 

adversely to claimants by AUs and the Appeals Council, in case a further administrative or court appeal is filed. 

When a claimant brings a civil action against the Commissioner seeking judicial review of the agency's final 

decision, staff in the Office of Appellate Operations prepare the record of the claim for filing with the Court. This 

includes all the documents and evidence the agency relied upon in making the decision or determination. 

7 
73 

or she cannot appeal that dismissal; instead, the ALJ's decision becomes the final 

decision. 

Federal Level 

If the AC makes a decision, it is our final decision. If the AC denies the claimant's 

request for review of the ALJ's decision, the ALJ's decision becomes our final decision. 

A claimant who wishes to appeal our final decision has 60 days after receipt of notice of 

the AC's action to file a complaint in Federal District Court. 

In contrast to the ALJ hearing, Federal courts employ an adversarial process. In District 

Court, an attorney usually represents the claimant and attorneys from the United States 

Attorney's office or our Office of the General Counsel represent the Government. 

When we file our answer to that complaint, we also file with the court a certified copy of 

the administrative record developed during our adjudication of the claim for benefits. 

The Federal District Court considers two broad inquiries when reviewing one of our 

decisions: whether we correctly followed the Act and our regulations, and whether our 

decision is supported by substantial evidence of record. On the first inquiry-whether 

we have applied the law correctly-the court typically will consider issues such as 

whether the ALJ correctly evaluated the claimant's testimony or the treating physician's 

opinion, and whether the ALJ followed the correct procedures. 

On the second inquiry, the court will consider whether the factual evidence developed 

during the administrative proceedings supports our decision. The court does not review 

our findings of fact de novo, but rather, considers whether those findings are supported 

by substantial evidence. The Act prescribes the "substantial evidence" standard, which 

provides that, on judicial review of our decisions, our findings "as to any fact, if 

supported by substantial evidence, shall be conclusive." The Supreme Court has 

defined substantial evidence as "such relevant evidence as a reasonable mind might 

accept as adequate to support a conclusion:14 The reviewing court will consider 

evidence that supports the ALJ's findings as well as evidence that detracts from the 

ALJ's decision. However, if the court finds there is conflicting evidence that could allow 

reasonable minds to differ as to the claimant's disability, and the ALJ's findings are 

reasonable interpretations of the evidence, the court must affirm the ALJ's findings of 

fact. In practice, courts in many parts of the country do not apply the substantial 

evidence standard as Congress intended, which results in many inappropriate remands. 

If, after reviewing the record as a whole, the court concludes that substantial evidence 

supports the ALJ's findings of fact and the ALJ applied the correct legal standards, the 

court will affirm our final decision. If the court finds either that we failed to follow the 

correct legal standards or that our findings of fact are not supported by SUbstantial 

evidence, the court typically remands the case to us for further administrative 

14 Consolidated Edison Co. of New York v. N.L.R.B., 305 U.S. 197 (1938). 

8 
74 

proceedings, or in rare instances, reverses our final decision and finds the claimant 

eligible for benefits. 

ALJ Hiring. Management Oversight. and Disciplinary Processes 

In order to issue timely, fair, and quality decisions in our hearings and appeals process, 

we must have the appropriate tools to hire, manage, and discipline our judge corps 

without infringing on their qualified decisional independence. 

Hiring Process 

On Commissioner Astrue's watch, we have raised the standards for ALJ selection, 

hiring people who we believe will take seriously their responsibility to the American 

public. We have hired 794 judges since 2007. Insistence on the highest possible 

standards in judicial conduct is a prudent investment for taxpayers, especially since 

ALJs may be removed only for good cause established and determined by the Merit 

Systems Protection Board. 

We originally planned to hire 125 ALJs in September of FY 2012; however, we 

ultimately decided to hire 46 judges who will report on September 23,2012. 

We depend on OPM to provide us with a register of qualified ALJ candidates. During 

the Azdelliitigation, which began in the late 1990s, use of the register was temporarily 

frozen due to an MSPB decision that was subsequently overturned by the United States 

Court of Appeals in 2003 (at which time OPM was able to reopen the then-existing 

register to agency requests for certificates). Since 2003, however, OPM not only reopened the then-existing register, but also established a new examination, administered 

it three times, generally, beginning in 2007, and established (and subsequently 

supplemented) a new register. For our hearing process to operate efficiently, we need 

ALJs who can treat people with dignity and respect, be proficient at working 

electronically, handle a high-volume workload without sacrificing quality, and make swift 

and sound decisions in a non-adversarial adjudication setting. 

OPM should continue to engage the agencies who hire ALJS and some authoritative 

outside groups, such as the Administrative Conference of the United States and the 

American Bar Association, to incorporate their expertise in the ALJ examination 

process. I would like to pOint out that the total number of Federal ALJs is 1,726 as of 

March 2012, and our corps represents about 86 percent of the Federal ALJ corps-we 

have the greatest stake in ensuring that the criteria and hiring process meet our needs, 

but recognize that OPM is required to produce an examination that meets the needs of 

the Government - and the public it serves - as a whole, pursuant to congressional 

directives. 

Management Oversight and Disciplinary Processes 

9 
75 

Under Commissioner Astrue's leadership, we have not hesitated to hold ALJs 

accountable where the law permits. Although the Administrative Procedure Act (APA) 

does not expressly state that ALJs must comply with the statute, regulations, or subregulatory policies and interpretations of law and policy articulated by their employin~ 

agencies, both the courts 15 and the Department of Justice's Office of Legal Counsel 6 

have opined that ALJs are subject to the agency on matters of law and policy. 

One of Congress' goals in passing the APA was to protect the due process rights of the 

public by ensuring that impartial adjudicators conduct agency hearings. Employing 

agencies are limited in their authority over ALJs, and Federal law precludes 

management from using many of the basic tools applicable to the vast majority of 

Federal employees. Specifically, OPM sets ALJs' salaries independent of agency 

recommendations or ratings. ALJs are exempt from performance appraisals, and they 

cannot receive monetary awards or periodic step increases based on performance. In 

addition, our authority to discipline ALJs is restricted by statute. We may take certain 

measures, such as counseling or issuing a reprimand, to address ALJ 

underperformance or misconduct. However, we cannot take stronger measures against 

an ALJ, such as removal or suspension, reduction in grade or pay, or furlough for 30 

days or less, unless the Merit Systems Protection Board (MSPB) finds that good cause 

exists.17 

We have taken affirmative steps to address egregiously underperforming ALJs. With 

the promulgation of our "time and place" regulation, we have eliminated arguable 

ambiguities regarding our authority to manage scheduling, and we have taken steps to 

ensure that judges are deciding neither too few nor too many cases. By management 

instruction, we have limited assignment of new cases to no more than 1,200 cases 

annually. 

Our Hearing Office Chief Administrative Law Judges (HOCALJ) and Hearing Office 

Directors work together to identify workflow issues. If they identify an issue with respect 

to an ALJ, the HOCALJ discusses that issue with the judge to determine whether there 

are any impediments to moving the cases along in a timely fashion and advise the judge 

15 "An AU is a creature of statute and, as such, is subordinate to the Secretary in matters of policy and 

interpretation of law." Nash v. Bowen, 869 F.2d 67S, 680 (2d Cir.) (citing Mullen, 800 F.2d at S40-41 n. Sand 

Association of Administrative Law Judges v. Heckler, 594 F. Supp. 1132, 1141 (0.0.c. 1984)), cert. denied, 493 U.S. 

812 (1989). 

16 "Administrative law judges have no constitutionally based judicial power .... As such, AUs are bound by all 

policy directives and rules promulgated by their agency, including the agency's interpretations of those policies 

and rules .... AUs thus do not exercise the broadly independent authority of an Article 111 judge, but rather 

operate as subordinate executive branch officials who perform quasi-judicial functions within their agencies. In 

that capacity, they owe the same allegiance to the Secretary's policies and regulations as any other Oepartment 

employee." Authority of Education Oepartment Administrative Law Judges in Conducting Hearings, 14 Op. Off. 

Legal Counsell, 2 (1990). 

17 The MSPB makes this finding based on a record established after the AU has an opportunity for a hearing. 

10 
76 

of steps needed to address the issue. If necessary, the Regional Chief ALJ and the 

Office of the Chief ALJ provide support and guidance. 18 

Generally, this process works. The vast majority of issues are resolved informally by 

hearing office management. When they are not, management has the authority to order 

an ALJ to take a certain action or explain his or her actions. ALJs rarely fail to comply 

with these orders. In those rare cases where the ALJ does not comply, we pursue 

disciplinary action. Our overarching goal is to provide quality service to those in need 

and instill that goal in all of our employees, including ALJs. 

The current system limits how we address the tiny fraction of ALJs who hear only a 

handful of cases or engage in misconduct. A few years ago, we had an ALJ in Georgia 

who failed to inform us, as required, that he was also working full-time for the 

Department of Defense. Another ALJ was arrested for committing a serious domestic 

assault. We were able to remove these ALJs, but only after completing the lengthy 

MSPB disciplinary process that lasts several years and can consume over a million 

dollars of taxpayer resources. 19 In each of these cases, unlike disciplinary action 

against all other civil servants, the ALJs received their full salary and benefits until the 

case was finally decided by the full MSPB-even though they were not deciding cases. 

We are open to exploring options to address these issues, while ensuring the qualified 

decisional independence of these judges. 

Conclusion 

Our highly-trained disability adjudicators follow a complex process for determining 

disability according to the requirements of the law as designed by Congress. I look 

forward to reviewing the Subcommittee's report concerning 300 disability cases. 

Without having seen the report, I will do my best to answer any questions you may have 

today. Although the report will be severely limited by the statistically non-representative 

sample of cases that was studied, I am nonetheless hopeful that the report will identify 

data that merit further research. 

18 Our managerial AUs playa key role in AU performance. They provide guidance, counseling, and encouragement 

to our line AUs. However, the current pay structure does not properly compensate them. For example, due to pay 

compression, a line AU in a Pennsylvania hearing office can earn as much as our Chief Administrative Law Judge. 

Furthermore, our leave rules limit the amount of annual leave an AU can carry over from one year to the next. 

These compensation rules discourage otherwise qualified AUs from pursuing management positions, and the APA 

prevents us from changing those rules. 

19 Since 2007, we have filed removal charges with the MSPB against nine AUs. The MSPB upheld our removal 

charges against five AUs; three AUs left the agency or retired in lieu of removal. One removal action is currently 

awaiting a decision from the MSPB. Additionally, from 2007 to present, we either sought to file or filed charges 

seeking suspension against 29 AUs. Of these AUs, 22 were suspended, six either retired or separated from the 

agency; and one case is currently before the MSPB. 

11 
77 

HEARING BEFORE 

THE COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

UNITED STATES SENATE 

SEPTEMBER 13, 2012 

STATEMENT 

OF 

JUDGE DOUGLAS STULTS 

HEARING OFFICE CHIEF ADMINISTRATIVE LAW JUDGE 

OKLAHOMA CITY, OKLAHOMA HEARING OFFICE 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

SOCIAL SECURITY ADMINISTRATION 
78 

Mr. Chairman, Ranking Member Coburn, Members of the Subcommittee: 

My name is Douglas Stults, and I serve as the Hearing Office Chief Administrative Law Judge 

(HOCALl) for the ODAR Oklahoma City, Oklahoma Hearing Office (HO). I have four years 

and five months of experience as an ALl and three years and nine months experience as a 

HOCALl. Prior to becoming an administrative law judge (ALl), I worked for ODAR in the 

Oklahoma City HO for 12 years, 3 years as the Hearing Office Director (HOD), 5 years as a 

Group Supervisor, and 4 years as an Attorney-Advisor. Prior to working for ODAR, I was a 

staff attorney for the UA W Legal Services Plan in Oklahoma City for 71f, years and had 

practiced law in central Oklahoma for 8Y, years before that. 

The Oklahoma City HO primarily serves central and western Oklahoma, specifically Oklahoma 

City, Lawton, Ardmore, and Clinton, Oklahoma, as well as Wichita Falls, Texas and Santa Fe, 

New Mexico. Thus, the claimants served by the Oklahoma City HO live in urban, suburban, and 

rural areas and are of diverse cultural and economic backgrounds. 

The Oklahoma City HO is presently staffed with 13 ALls, supported by 59 staff, specifically: I 

Hearing Office Director; 4 Group Supervisors; I Administrative Assistant; 2 Hearing Office 

Systems Administrators; 12 Senior Attorneys; 3 Attorney-Advisors; 6 Paralegal-Analysts; 3 

Lead Case Technicians; 13 Senior Case Technicians; 6 Case Technicians; 4 Case Intake 

Assistants; and 2 Contact Representatives. Fifty-seven percent of our employees (41 of 72) have 

6 or more years of ODAR experience and 39% (28 of 72) have 16 or more years, myself 

included. 

In fiscal year (FY) 2011, the Oklahoma City HO attained our regionally-set dispositional goal, 

with 7,216 claimants served. We also completed all of our aged cases (750 days old). Thus far 

in FY 2012, we have served 6,317 claimants. Through the end of July 2012, Oklahoma City 

ALls' dispositions have averaged: 37.8 percent fully favorable; 3.2 percent partially favorable; 

41.7 percent unfavorable; and 17.2 percent dismissals. Further, through the end of August 2012, 

the Oklahoma City HO has: 

Average Processing Time of 381 days; 

Average Cases Pending per ALJ of 59 1; 

Average Age of Pending Cases of258 days; 

Cases under 365 days old of 76%; 

Receipts per day per ALl of2.31; 

Hearing Scheduled per day per ALl of2.39; 

Hearings Held per ALl per day of 1.79; 

Held to Scheduled Ratio of75%; 
79 

Dispositions per day per ALl of2.15; and 

Dispositions to Receipt Ratio of 103%. 

As the HOCALl, I strive to ensure that my hearing office handles hearing requests in an orderly 

manner. I discuss ALl workload and case assignment regularly with our HOD, who oversees the 

direction of our staff involved in preparing cases for hearing. Generally, cases are "worked-up" 

for hearing in hearing request date order, with the oldest cases prepared first. Our HOD 

randomly assigns a minimum number of cases to each Oklahoma City ALl; 40 cases per month 

so far in FY 2012. 

I use our agency's technology to manage performance, quality, and productivity, mainly with the 

help of the Case Processing Management System (CPMS) and Disability Adjudication Reporting 

Tools (DART), including the "How MI Doing" and ODAR Management Information Dashboard 

(ODAR MIND). Top priorities include the handling of our oldest cases, the number of hearings 

scheduled and held per ALl, the pending per ALl, and the monthly dispositional totals. I pass 

general information concerning these categories onto all ALls, and pass specific information on 

to individual ALl s as necessary. 

I endeavor to work closely with our Oklahoma City ALls. I have an unconditional "open door" 

policy. I speak with all of our ALls, both formally and informally, concerning questions, 

problems, or suggestions that they might have, regarding individual cases as well as office 

policies and procedures. I regularly send e-mails to clarifY issues and procedures for our ALls 

and share general information. 

Let me emphasize that while I can take actions to ensure that ALls move their caseloads and 

apply the law and our policies correctly, the Administrative Procedure Act grants all ALls 

"qualified decisional independence." "Qualified decisional independence" means that ALls 

must be impartial in conducting hearings. They must decide cases based on the facts in each 

case and in accordance with the agency's policy, as set out in the regulations, rulings, and other 

policy statements. It also means, however, that ALls make their decisions free from agency 

pressure or pressure by a party to decide a particular case, or a particular percentage of cases, in a 

particular way. If I see a performance or quality issue with an ALJ that I need to address, I will 

discuss the issue with the judge as soon as possible to ensure that the ALl's actions are 

consistent with the agency's policy, and that the ALl is performing at an acceptable level of 

productivity. While I exercise appropriate management oversight over the ALls in my office 

and can take a number of actions to help ALls improve their performance, I cannot and do not 

interfere with or influence the ultimate decision in any case. 

In addition to my managerial duties, I hold hearings for disability cases. 

Thank you for the opportunity to be here today. I would be happy to answer any questions that 

you may have. 

2 
80 

HEARING BEFORE 

THE COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

UNITED STATES SENATE 

SEPTEMBER 13, 2012 

STATEMENT 

OF 

JUDGE THOMAS ERWIN 

HEARING OFFICE CHIEF ADMINISTRATIVE LAW JUDGE 

ROANOKE, VIRGINIA HEARING OFFICE 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

SOCIAL SECURITY ADMINISTRATION 
81 

Mr. Chairman, Ranking Member Coburn, Members ofthe Subcommittee: 

My name is Thomas Erwin, and I serve as the Chief Administrative Law Judge (AU) for the 

Roanoke, Virginia hearing office (HO). I have a little more than 3 years of experience as an AU 

and I liz years as a hearing office chief AU (HOCAU). Prior to becoming an AU, I was an 

attorney advisor in the Roanoke, Virginia Office of Disability Adjudication and Review (ODAR) 

office for three years. Before joining the Social Security Administration, I served as aU. S. 

Navy JAG attorney on active duty for five years in San Diego and Port Hueneme, California, and 

was appointed as the Officer in Charge ofthe Naval Legal Service Office Branch Office in Port 

Hueneme. One of my duties in the Navy was to serve as criminal defense counsel in courtsmartial cases; so yes, Tom Cruise did play me in the movie A Few Good Men. I then worked in 

private practice in Southern California as a certified specialist in family law prior to joining the 

Social Security Administration in 2006. 

The Roanoke, Virginia HO serves a broad area of Southwest Virginia and Southeast West 

Virginia. This service area is a part of a cultural region commonly known as Appalachia. The 

region's economy, once highly dependent on mining, forestry, agriculture, chemical industries, 

and heavy industry, has become more diversified in recent times. 

The Roanoke Hearing Office has eight AUs, three of whom have fewer than two years of 

experience on the job. The newest judge has been with the office only since June of this year. 

The office has had significant AU turnover over the past several years, and has lost eight judges 

to retirement or transfer. SSA has assigned eight new judges in the same period; seven ofthese 

judges were new to the position or had less than one year of experience as an AU when they 

reported. The office has 48 employees. 

For fiscal year 2012, through August, the Roanoke hearing office has received 3,690 hearing 

requests, an average of 335 cases per month. We have issued 3,643 decisions, so we have 

processed close to 99% of total receipts. We have just under 4,700 cases pending in our office, 

an average of over 580 cases pending per judge. Our average processing time is 432 days from 

the request for hearing to decision. 

The Roanoke hearing office has an allowance rate of57% for fiscal year 2012. The judges have 

an allowance rate of 55%, with most judges having an allowance rate between 45 and 57%. The 

difference in allowance percentage between the overall office rate and the judges represents 

favorable decisions processed by our senior attorneys. 

As a HOCAU, it is my job to make sure that the office functions smoothly, and that we process 

cases fairly and efficiently. I strive to ensure that my hearing office handles hearing requests in 

an orderly manner. I work with three other office managers to make sure cases are worked up 

and ready for a hearing, that they are assigned to judges to allow them to hold hearings, and that 

writers draft legally sufficient decisions. I monitor the workloads of the judges to make sure 

they have sufficient cases at various stages ofthe process to allow them to review cases before 

scheduling, hold hearings, and issue decisions. 
82 

A hearing office has many working parts, all of which need to operate smoothly to maintain both 

quality and productivity. The senior case technicians prepare the files and get them ready for 

hearing; the judges hold the hearings; and then the writers must draft, based on directions they 

receive from the judges, legally sufficient and defensible decisions. As HOCALl, I work with 

my fellow supervisors to manage performance, quality, and productivity at each phase of a case's 

development and resolution. 

I work with the ALls in the office to make sure they are aware of monthly and yearly goals, that 

they move cases through each stage of the process in a timely manner, and that they issue quality 

decisions as quickly as possible. If the judges are having a problem, I help them resolve the 

issue so that they can continue doing their job. I try to lead by example. 

Let me emphasize that while I can take actions to ensure that ALls move their caseloads and 

apply the law and our policies correctly, the Administrative Procedure Act grants all ALls 

"qualified decisional independence." "Qualified decisional independence" means that ALls 

must be impartial in conducting hearings. They must decide cases based on the facts in each 

case and in accordance with the agency's policy, as set out in the regulations, rulings, and other 

policy statements. It also means, however, that ALls make their decisions free from agency 

pressure or pressure by a party to decide a particular case, or a particular percentage of cases, in a 

particular way. If! see a performance or quality issue with an All that I need to address, I will 

discuss the issue with the judge as soon as possible to ensure that the ALl's actions are 

consistent with the agency's policy, and that the All is performing at an acceptable level of 

productivity. While I exercise appropriate management oversight over the ALls in my office 

and can take a number of actions to help ALJs improve their performance, I cannot and do not 

interfere with or influence the ultimate decision in any case. 

Thank you for the opportunity to be here today. I would be happy to answer any questions that 

you may have. 

2 
83 

HEARING BEFORE 

THE COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

UNITED STATES SENATE 

SEPTEMBER 13, 2012 

STATEMENT 

OF 

JUDGE OLLIE L. GARMON, III 

REGIONAL CHIEF ADMINISTRATIVE LAW JUDGE 

ATLANTA REGION 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

SOCIAL SECURITY ADMINISTRATION 
84 

Mr. Chairman, Ranking Member Coburn, Members of the Subcommittee: 

My name is Ollie L. Garmon, Ill, and I serve as the Regional Chief Administrative Law Judge 

(RCALJ) for Region IV (Atlanta). The Montgomery, Alabama hearing office (HO) is one of the 

offices in the Atlanta region. I have 2 I years' experience as an ALJ, 3 years as a Hearing Office 

Chief ALJ (HOCALJ), 4 years as the Assistant to the RCALJ, and 9 years as the RCALJ. 

As an RCALJ, I provide general oversight for all program and administrative matters concerning 

our hearings process in the Atlanta region. The Atlanta region is composed of 37 hearing 

offices, nearly 400 administrative law judges, and a total staff of nearly 2,300 people in 

following eight states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South 

Carolina, and Tennessee. This region serves a population of about 60 million citizens. We have 

approximately 25 percent of the agency's hearings caseload, which results in more than 200,000 

decisions per year. 

I began my legal career in the private sector as an associate for a law firm; I then became a sole 

practitioner, after which I organized and was a partner in a law firm. During this same time, I 

served in the public sector as a city attorney and was elected county prosecuting attorney for a 4-

year term. In 1979, I was elected for a 4-year term to a full time judicial position of county court 

judge where I also served as a juvenile court judge. Afterwards, I was appointed by the 

Governor of the State of Mississippi to the position of Commissioner of the Mississippi 

Workers' Compensation Commission for a 6-year term. 

One of the Hearing Offices in Region IV is located in Montgomery, Alabama. The Montgomery 

Office's service area includes Alexander City, Anniston, Auburn, Demopolis, Montgomery, 

Opelika, Selma, and Tuskegee. 

The Montgomery Office currently has 10 judges. We expect two new judges to report for duty 

on September 24, 2012. The support staff for the ALJs includes a mix of attorney advisors, 

paralegal specialists, and legal assistants. The office has a high transfer rate for ALJs, who 

frequently request reassignment to other offices. 

In fiscal year (FY) 2011, the Montgomery Office received 8,357 cases for adjudication and 

issued 7,252 dispositions. In FY 2012 to date, the office has received 6,540 cases for 

adjudication and issued 6,246 decisions. The Montgomery Office currently has 8,323 cases 

pending and the current average processing time is 430 days. The rate of average dispositions 

per ALJ per day is 2.37 .. 

Let me emphasize that while I can take actions to ensure that ALJs move their caseloads and 

apply the law and our policies correctly, the Administrative Procedure Act grants all ALJs 

"qualified decisional independence." "Qualified decisional independence" means that ALJs 

must be impartial in conducting hearings. They must decide cases based on the facts in each 

case and in accordance with the agency's policy, as set out in the regulations, rulings, and other 

policy statements. It also means, however, that ALJs make their decisions free from agency 

pressure or pressure by a party to decide a particular case, or a particular percentage of cases, in a 

particular way. If! see a performance or quality issue with an ALJ that I need to address, I will 
85 

discuss the issue with the judge as soon as possible to ensure that the ALl's actions are 

consistent with the agency's policy, and that the ALl is performing at an acceptable level of 

productivity. While I exercise appropriate management oversight over the ALls in my offices 

and can take a number of actions to help ALls improve their performance, I cannot and do not 

interfere with or influence the ultimate decision in any case. 

Thank you for the opportunity to be here today. I would be happy to answer any questions that 

you may have. 

2 
86 

United States Senate 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

Committee on Homeland Security and Governmental Affairs 

SOCIAL SECURITY DISABILITY PROGRAMS: 

IMPROVING THE QUALITY OF BENEFIT AWARD 

DECISIONS 

MINORITY STAFF REPORT 

PERMANENT SUBCOMMITTEE 

ON INVESTIGATIONS 

UNITED STATES SENATE 

RELEASED IN CONJUNCTION WITH THE 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

SEPTEMBER 13, 2012 HEARING 
87 

SENATOR CARL LEVIN 

Chairman 

SENATOR TOM COBURN, M.D. 

Ranking Minority Member 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

9/27/(2 

ELISE .T. BEAN 

Staff Director and Chief Counsel 

DANIEL J. GOSHORN 

Counsel 

BRIAN EGGER 

Detailee 

CHRISTOPHER J. BARKLEY 

Staff Director to the Minority 

ANDREW C. DOCKHAM 

Counsel to the Minority 

DANIEL P. LIPS 

Policy Advisor & Investigator to the Minority 

KATHRYN EDELMAN 

Detailee 

DEBBIE SHAW 

Detailee 

MARY McKOY 

Detailee 

MARY D. ROBERTSON 

Chief Clerk 

Permanent Subcommittee on Investigations 

199 Russell Senate Office Building - Washington, D.C. 20510 

Majority: 202/224-9505 - Minority: 202/224-3721 

Web Address: htto:llwww,hsgac.senate.gov/subcommittees/investigations 
88 

SOCIAL SECURITY DISABILITY PROGRAMS: 

IMPROVING THE QUALITY OF BENEFIT A WARD 

DECISIONS 

Table of Contents 

I. EXECUTIVE SUMMARY ............................... 4 

A. Investigation Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 

B. Findings of Fact. . .. ................................. 5 

(1) Low Quality Decisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 

(2) Insufficient and Contradictory Medical Evidence. . . .. .. 5 

(3) Poor Hearing Practices. . . .. ....................... 5 

(4) Late Evidence.. . .. .............................. 5 

(5) Inconsistent Use of Consultative Examinations by ALJs. 6 

(6) Misuse of Medical Listings. . . .. .. . . . . . . . . . . . . . . . . . . 6 

(7) Reliance on Medical-Vocational Guidelines.... . ....... 6 

(8) Outdated Job List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 

C. Recommendations.... ............................... 7 

(1) Require Government Representative at ALJ Hearings ... 7 

(2) Strengthen Quality Review Process.. . .. . . . . . . . . . . . . . . 7 

(3) Close the Evidentiary Record.. . . . . . . . . . . . . . . . . . . . . . . 7 

(4) Strengthen Use of Medical Listings.. . . . . . . . . . . . . . . . . . 7 

(5) Expedite Updated Job List.. . .. ..................... 8 

(6) Focused Training for ALJs.. . . . . . . . . . . . . . . . . . . . . . . . . 8 

(7) Strengthen Consultative Examinations.. . .. ........... 8 

(8) Reform the Medical-Vocational Guidelines. ........... 8 

II. BACKGROUND INFORMATION ON SOCIAL SECURITY 

DISABILITY INSURANCE AND SUPPLEMENTAL 

SECURITY INCOME ................................... 9 

III. BACKGROUND ON SELECTION OF 300 DISABILITY 

CASE FILES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 20 

IV. PROBLEMS WITH DECISIONS MADE BY 

ADMINISTRATIVE LAW JUDGES. . . . . . . . . . . . . . . . . . . . . .. 23 

A. Misuse of Vocational Experts ........................... 26 

B. Questionable Hearing Conduct and Use of Hearing Evidence.. 43 

C. Improper Application of Medical Listings ................. 60 

D. Failure by ALJ to Conduct a Proper Credibility Analysis ..... 77 

E. Poorly Drafted On-The-Record Decisions by Senior 

Attorney Adjudicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 81 

F. Poor Quality Opinions from ALJ Howard O'Bryan .. '" . . ... 86 
89 

V. PROBLEMS WITH MEDICAL-VOCATIONAL RULES 

THAT ALLOW FOR "GRIDDING" .................... 106 

VI. CASES AWARDED WITH INSUFFICIENT, LATE AND 

CONTRADICTORY EVIDENCE...................... 126 

A. Use of Late-Breaking Evidence. . . . . . . . . . . . . . . . . . . . . . . 126 

B. Insufficient Evidence Cited to Support Case ............ 136 

C. Benefits Awarded in Cases With Contradictory Evidence. . 143 

VII. PRO PERL Y DECIDED CASES SHOW CONTRAST 

WITH QUESTIONABLE CASES...................... 155 

# # # 

II 
90 

SOCIAL SECURITY DISABILITY PROGRAMS: 

IMPROVING THE QUALITY OF BENEFIT AWARD 

DECISIONS 

In April 2012, the Social Security Trustees estimated the Social Security 

Disability Trust Fund, which supports the Social Security Disability 

Insurance (SSDJ) program, could be exhausted by 2016. 1 Under a 

"high-cost" scenario, a less-likely but still realistic possibility, the 

Trustees estimated the Disability Trust Fund could be exhausted as early 

as 2015. To stave this off, the Trustees suggested that "legislative action 

is needed as soon as possible." 

Significant stress on the trust fund is due in part to the fact that the 

number of individuals receiving disability benefits continues to rise at an 

unprecedented rate. Understanding this phenomenon is a complicated 

analysis. Researchers at the Center for American Progress assert the 

"program provides strong incentives to applicants and beneficiaries to 

remain permanently out of the labor force, and it provides no incentive 

to employers to implement cost-effective accommodations that enable 

employees with work limitations to remain on thejob.,,2 These 

researchers determined that "too many work-capable individuals 

involuntarily exit the labor force and apply for and often receive," Social 

Security Disability Insurance. 3 Such a conclusion raises questions as to 

whether benefits are going to those Congress intended when it created 

the disability programs. 

The stress to the disability system was likely exacerbated when the 

financial crisis hit in 2008, resulting in a number of individuals losing 

jobs and, in tum, employer sponsored health insurance benefits. Census 

data indicated that between October 2008 and June 2010, job losses 

among workers with disabilities far exceeded those of workers without 

disabilities.4 Without health insurance, it is possible that chronic 

conditions held in check by medicine and treatment worsened and 

became more difficult to manage or even became disabling. Those 

workers potentially turned to Federal disability insurance. In other 

cases, workers with disabling conditions who had refrained from 

applying for disability insurance because they were able to manage their 

I The 2012 Annual RepOlt of the Board of Trustees of the Federal Old-Age and Survivors 

Insurance and Federal Disability Insurance Trust Funds, 

http://www ,ssa.gov 1 oact/tr/20 12/(r20 12.pdf. 

2 Center for American Progress, Autor and Duggan, Supporting Work: A Proposal for 

Modernizing the US Disability Insurance System, January 2010, 

http://www .americanpro gress.o rg/wp-content/uploads/issues/20 I 01 12/pdfl autordugganpaper .pdf. 

3 [d. 

4 H, Stephen Kaye, Ph.D., The impact of the 2007-09 Recession on Workers with Disabilities, 

Vol. 133, No. 10, October 2010, http://www.bls.gov/opub/mlr/2010/IO/art2exc.htm. 
91 

2 

impairments and sustain work, lost those paychecks, and then applied 

for disability insurance payments. 

Whatever the reason, the result is that 5.9 million Americans have been 

awarded ssm benefits since January 2009.5 Economists estimate that 

Americans added to the disability rolls could account for as much as a 

quarter of the two percent drop in the labor force participation rate since 

2007.6 Reports also show that the country's population between the 

ages of25 and 64 receiving ssm benefits rose to a record-high of 5.3 

percent in March 2012, compared to 4.5 percent in 2007. Applications 

for disability benefits filed by this age group rose to 18 per 1,000 last 

year, up from 8 per 1,000 in 1990.7 Amid all the statistics, one thing is 

clear: more Americans than ever are turning to the disability programs 

to make ends meet and more work is needed to ensure scarce benefits go 

only to the disabled. 

The flood of Social Security disability applications over the past few 

years has tested the agency's resources and personnel. As a result, 

disabled Americans are waiting longer and longer before receiving the 

benefits they deserve. Many now wait as long as two years before 

having their application finalized. 

Oversight of these programs by Congress, however, is critical to the 

long-term vitality of this important safety net. Congress and Social 

Security Administration (SSA) need to ensure that benefits are protected 

for those who would choose to work, but cannot do so because oftheir 

disability. Every person who is wrongfully added to the disability rolls 

by the agency takes money out of the pockets of the disabled. 

If Congress fails to ensure the financial sustainability of our nation's 

disability programs, everyone loses. Taxpayers will bear heavier costs; 

the Social Security Administration will have to do more with less; and 

most worrisome, there will be nothing left to give to those who need it 

most. 

Over the past two years, the U.S. Senate Permanent Subcommittee on 

Investigations has conducted several bipartisan inquiries into aspects of 

the Social Security Administration's disability programs, including how 

j Award statistics collected from Social Security Administration, Office of the Chief Actuary, 

Beneficiary Data, Benefits Awarded by Type of Beneficiary, 

http://www.ssa.gov/OACT/ProgDa(a/awards.html. Information does not account for 

beneficiaries leaving the ssm rolls. 

6 Daniel Hartley, Federal Reserve Bank of Cleveland, The Labor Force: To Work or Not to 

Work (Fall 201 I), http://www.clevelandfed.org/Forefront/2011/falllff 2011 fall 06.cfm. 

7 Alex Kowalksi, Disabled Americans Shrink Size of U.S. Labor Force, Bloomberg, May 3, 

2012, htlp:IIv.'Ww.bloomberg.com/news/2012-05-03/disabled-americans-shrink-size-of-u-slabor-force.htm!. 
92 

3 

it processes applications. To increase its understanding, the 

Subcommittee undertook a review of the quality of disability claims 

approved by the agency at the initial application stage and each level of 

appeal. This Report describes the investigation's review, findings, and 

recommendations. 
93 

4 

I. EXECUTIVE SUMMARY 

A. Investigation Overview 

On March 1,2011, the Subcommittee requested that SSA provide case 

files, with personal information removed, for SSA beneficiaries accepted 

into the ssm or Supplemental Security Income (SSI) program from 

three specific counties in Virginia, Alabama, and, Oklahoma, reflecting 

different levels of per capita enrollment in the SSDI and SSI programs. 

After the Subcommittee provided selection criteria, SSA randomly 

selected 300 electronic case files, 100 from each specified county that 

met the criteria.8 The cases provided a cross-section of applicants who 

were awarded disability benefits at different stages of review within 

SSA: initial application, reconsideration, appeal before an 

administrative law judge (ALl), or appeal before the Social Security 

Appeals Council. 

The Subcommittee requested only cases in which disability benefits 

were awarded, and not any cases in which benefits were denied, in order 

to focus on the process and analysis performed by the agency (at each 

level of review and appeal) in determining when a claimant met the 

program's definition of disability. The Subcommittee was interested, in 

particular, in how the agency handled a claimant's available medical 

evidence and the evidence needed to support an award of benefits under 

existing program rules. The investigation examined the decisions 

reached, rationale used, subjective claimant testimony, objective medical 

evidence, any expert or physician opinions rendered, and other relevant 

evidence contained in the case files provided by SSA. 

In conducting its investigation, the Subcommittee consulted with SSA 

disability experts, SSA Administrative Law Judges, and others. It 

reviewed not only the 300 case files, but also SSA policies, procedures, 

guidelines, regulations, administrative decisions, and court cases. 

By limiting its review to 300 case files from three counties, the 

Subcommittee was able to drill down into the specifics of each case. 

The resulting findings are representative of each county and provide a 

detailed case study of how disability approval decisions are made, their 

weaknesses, and how they can be improved. While the resulting 

findings cannot be statistically extrapolated into a nationwide analysis of 

SSA disability cases, the same types of issues affected decisions across 

all three counties, suggesting they may be a factor elsewhere in the 

nation. 

8 The SSA Office ofthe Inspector General reviewed SSA's proposed sampling methodology and 

stated to Subcommittee staff they had "no comment" with regard to the methodology. 
94 

5 

B. Findings of Fact 

Based upon its review of the 300 disability case files, the Report 

makes the following findings off act. 

(1) Low Quality Decisions. The investigation's review of300 

disability case files found that more than a quarter of agency 

decisions failed to properly address insufficient, contradictory, 

or incomplete evidence. The report's findings corroborate a 

2011 internal quality review conducted by SSA itself, which 

found that on average nationwide, disability decisions made at 

the ALl level had errors or were insufficient 22 percent of the 

time. The three counties examined by the Subcommittee are in 

regions with even higher individual error rates, according to 

SSA, of between 23-26 percent. It is likely that the three 

counties had error rates in excess of their regional averages, 

raising serious questions about the quality oftheir decisions. 

ALls also failed in some cases to adequately analyze the effect 

of factors such as obesity and drug and alcohol abuse on a 

claimant's impairment.9 

(2) Insufficient and Contradictory Medical Evidence. In many 

cases, at both the initial and appellate levels of review, the 

state-based Disability Determination Services (DDS) 

examiners and SSA Administrative Law Judges (ALls) issued 

decisions approving disability benefits without citing adequate, 

objective medical evidence to support the finding; without 

explaining the medical basis for the decision; without showing 

how the claimant met basic listing elements; or at times 

without taking into account or explaining contradictory 

evidence. 

(3) Poor Hearing Practices. Some SSA ALls held perfunctory 

hearings lasting less than 10 minutes, misused testimony 

provided by vocational or medical experts, and failed to elicit 

hearing testimony needed to resolve conflicting information in 

a claimant's case file. 

(4) Late Evidence. Some case files showed that disability 

applicants, usually through their representatives, submitted 

medical evidence immediately before or on the day of an ALl 

hearing or after the hearing's conclusion, a practice leading to 

9 Given the high number of questionable decisions, a similar review of claimants the agency 

denies is needed to ensure that benefits are not being denied to individuals that are disabled. 
95 

6 

confusion about the supporting evidence and inefficiencies in 

case analysis. 

(5) Inconsistent Use of Consultative Examinations by ALJs. In 

many cases before ALIs, Consultative Examinations (CEs) 

submitted on behalf of either SSA or a claimant were either 

summarily dismissed or heavily relied upon, with little to no 

explanation. In addition, the CEs themselves often consisted 

of lit tIe more than conclusory statements with insufficient 

reference to objective medical evidence or how the CE's 

findings related to other evidence in the case file. 

(6) Misuse of Medical Listings. In many case files, ALI 

opinions failed to demonstrate how a claimant met each of the 

required criteria in the SSA's Medical Listing ofImpairments 

to qualify under "Step Three" in the application process. 

A wards at Step Three are reserved for those who have medical 

conditions SSA has determined to be severe enough to qualify 

an applicant for benefits. 

(7) Reliance on Medical-Vocational Guidelines. The majority 

of disability awards reviewed by the Subcommittee at the ALI 

level utilized SSA medical-vocational grid rules. A recent 

SSA analysis found that benefit awards were made under these 

grid rules at a rate of 4 to 1, compared to awards made due to a 

claimant's meeting a medical listing. At times, these decisions 

were the result of a claimant's representative and the ALI 

negotiating an award of benefits by changing the disability 

onset date to the claimant's 50th or 55th birthday. 

(8) Outdated Job List. Some case files showed DDS examiners 

and ALIs relied on the Department of Labor's outdated 

Dictionary of Occupational Titles (DOT), which SSA is in the 

process of replacing with a new Occupational Information 

System, to identify jobs open to claimants with limited 

disabilities. The last major revision to the DOT occurred in 

1977, yet the new database is not expected to be ready until 

2016. In the meantime, SSA disability decision-makers will 

continue to rely on the DOT which does not reflect current 

labor market trends or jobs available in the national economy. 
96 

7 

C. Recommendations 

The Report makes the following recommendations: 

(1) Require Government Representative at ALJ Hearings. To 

ensure key evidence and issues are properly presented, reduce 

instances in which SSA ALls overlook evidence indicating a 

claimant is not disabled, and increase consistency and 

accountability in ALl decision-making, a representative of the 

agency should participate in all ALl disability hearings and 

decisions. Including a government representative at the ALl 

Level has long been a recommendation of both the Association 

of Administrative Law Judges and the Social Security 

Advisory Board. lo Congress should specifically designate 

funds for such a program. 

(2) Strengthen Quality Review Process. The new ALl review 

process initiated by the Quality Division of the Office of 

Appellate Operations should be expanded and strengthened by 

conducting more reviews during the year and developing 

metrics to measure the quality of disability decisions. Such 

information should be made available to Congress. 

(3) Close the Evidentiary Record. To eliminate the confusion, 

inefficiencies, and abuses associated with the current practice 

of allowing medical evidence to be submitted at any point in a 

disability case, the evidentiary record should close one week 

prior to an ALl hearing, with exceptions allowed only for 

significant new evidence for which exclusion would be 

contrary to the public interest. 

(4) Strengthen Use of Medical Listings. SAA should provide 

additional training to ALl s on the use of SSA Medical 

Listings, and direct ALl decisions to identifY how a claimant 

meets each required element of a listing, citing objective 

medical evidence and not just conclusory statements by an 

expert. 

10 See Social Security Advisory Board, Charting the Future of Social Security's Disability 

Programs: The Need for Fundamental Change, January 2001, 

http://www.ssab.gov/publications/disability/disabilitywhitepap.pdf; Testimony of Association of 

Administrative Law Judges, Committee on Ways and Means, Subcommittee on Social Security 

and The House Committee on the Judiciary, Subcommittee on Courts, Commercial and 

Administrative Law, July 22, 2011. 
97 

8 

(5) Expedite Updated Job List. SSA should move more quickly 

to ensure the Occupational Information System can serve as a 

usable replacement for the Dictionary of Occupational Titles 

to identify jobs that claimants with limited disabilities can 

perform in the national economy. 

(6) Focused Training for ALJs. The Office of Appellate 

Operations, Quality Division, should provide training to all 

ALJs regarding adequate articulation in opinions of 

determinations that involve both obesity and drug and alcohol 

abuse. This training should emphasize the proper way to 

analyze and address these issues as required by law, 

regulation, and agency guidance. 

(7) Strengthen Consultative Examinations. Because many 

disability claimants do not have sufficient funds to obtain 

detailed medical evidence of their conditions, SSA should 

determine, with input from ALJs, how to improve the 

usefulness of agency-funded Consultative Examinations 

(CEs), including by requiring an explanation of any significant 

disparity between the CE's analysis and other evidence in the 

case file. 

(8) Reform the Medical-Vocational Guidelines. The medicalvocational guidelines should be reviewed to determine if 

reforms are needed. Additional study should be conducted to 

evaluate whether the current guidelines utilize the proper 

factors and if they appropriately reflect a person's ability to 

work. 
98 

9 

II. BACKGROUND INFORMATION ON SOCIAL 

SECURITY DISABILITY INSURANCE AND 

SUPPLEMENTAL SECURITY INCOME 

Social Security Disability Insurance (SSDI). Congress enacted the 

ssm program in 1956 to provide a safety net for individuals who, after 

working for a time, become disabled and no longer able to provide for 

themselves. These individuals are awarded disability benefits when 

certain program qualifications are met, but are too young to qualify for 

retirement benefits. ssm provides monthly cash payments to 

beneficiaries from the ssm Trust Fund (financed through payroll taxes) 

based on a beneficiary's past wages. These payments are indexed to 

reflect changes in national wage levels. To take advantage ofthe 

program, a worker must have worked a minimum amount of time to be 

covered or "insured" by the program. 

By the end of December 2010,10.2 million people were receiving ssm 

payments.] 1 In total in FY201 0, the ssm Trust Fund paid $124.2 

billion in benefits. In FY2011, payments grew to almost $129 billion 

and for FY2012, SSA estimates that it will pay $134 billion. 12 In sharp 

contrast, in FY20 11, the ssm Trust Fund will only take in $114 

billion. lJ In August 2012, the agency reported 10.8 million individuals 

were receiving SSDI benefits. 14 

A nnua IN urn b ero fSSDI B ene fi' IClanes ·c In urrent p ayment S tatus 

Year Total Number of Beneficiaries Total Benefits Paid 

2006 8.615 million $ 92.384 billion .. - _. 

2007 8.918 million $ 99.086 billion 

2008 9.274 million $ 106.301 billion 

2009 9.696 million $ 118.329 billion 

2010 10.185 million $ 124.191 billion 

2011 10.614 million $ 128.900 billion 

Source: Information prOVIded by CongressIOnal Research Services 

Note: Numbers include all workers, spouses, and children receiving SSDI payments. 

Once an individual's application for ssm is approved, there is a fivemonth waiting period before he or she begins to receive benefits. ssm 

beneficiaries also qualify for Medicare coverage 24 months after ssm 

eligibility begins. Benefit payments continue as long as the beneficiary 

11 Information provided by Congressional Research Service. 

12 Social Security Administration. Office of the Budget, FY20I2 President's Budget., Budget 

Overview, February 2012, http://www.ssa.gov/budget/20 12BudgetOverview,pdf. 

13 Social Security Administration, Office of the Chief Actuary, The 20 J 1 OASDI Trustee's 

Report, http://v.,ww.ssa.gov/oactlTRSUM/index.html. 

14 Social Security Administration. Benefits Paid by Type of Beneficiary, 

http://www.ssa.gov/OACT/ProgDataJicp.html. 
99 

10 

remains disabled, or until the beneficiary reaches the full retirement age. 

Very few individuals leave the disability rolls by returning to work or 

medical improvement; most simply convert automatically to retirement 

benefits at the Federal retirement age (FRA). 

Reasons for SSDI Worker Benefit Terminations , 2011 

Reason for Termination Number of Percentage of 

Beneficiaries Terminations 

Reached Full Retirement Age 338,222 51.73% 

Death 235,734 36.05% 

Return to Work 39,813 6.09% 

Medical Improvement 23,271 3.56% 

Other 14,759 2.26% 

Elect Retirement Benefit 2,078 0.31% 

Total Terminations/Suspensions 653,877 100.0% 

Source: SOCIal Secunty AdrmmstratlOn, Benefits Termmated/or All DIsabled BeneficiarIes, 

Table 50, Number, by reason for termination 2011, htlp:llwww.ssa.gov/policy/docsl 

statcomps/di asr/201Ilsect03f.html#table50. 

Supplemental Security Income (SSI). Unlike ssm, SSI (established 

in 1972) is a means-tested benefit paid to the disabled poor, elderly, and 

blind who have limited income and resources. To qualifY for the SSI 

program, an individual must meet the same definition of "disability" as 

under the ssm program, but also only have a maximum of$2,000 of 

countable resources ($3,000 for a married couple). An individual may 

qualifY for both SSI and ssm. 

Under program regulations, a number of items are excluded from what is 

considered an individual's resources, including: a house and the land it 

is on; a vehicle, regardless of value; household goods and personal 

effects; and cash accounts with certain designations. 15 An individual 

does not need to meet the same work history requirements as the SSDI 

program to receive benefits, only maintain countable resources below 

the $2,000 limit. SSI payments change with a beneficiary's monthly 

earnings, resources, and living conditions. Individual financial 

circumstances often change, requiring SSA to frequently reassess 

recipients' eligibility for benefits. 

The SSI program is funded through the Federal Government's General 

Fund, which is financed by tax payments from the American public. In 

most States, SSI recipients also receive Medicaid and food assistance. 

In FY2012, SSA expects to payout almost $51 billion in Federal and 

State Supplementation benefits to about 8.3 million SSI recipients. 16 

15 All examples provided by SSA. For a comprehensive list of excludable resources, see 

http://www.ssa.gov/ssi/text-resources-ussi.htm. 

16 Information provided by Social Security Administration. 
100 

11 

SSI benefits and administrative expenses are considered mandatory 

spending. According to SSA, the actual amount dispersed in FY2011 

was $52.4 billion in Federal benefits and $3.8 billion spent in 

beneficiary services. I? In FY2012, the program is estimated to spend 

$48.1 billion in benefits and cost $3.7 billion in beneficiary services, 

administration, and research. 

A nnua IN urn b ero fSSIB fi' . C ene IClanes lD urrent p ayrnent S 

Year Number of Recipients Total Benefits Paid 

2006 5,829,765 $ 30.783 billion 

2007 5,959,794 $ 32.771 billion 

2008 6,118,824 $ 34.475 billion 

2009 6,322,253 $ 38.130 billion 

2010 6,556,915 $ 40.076 billion 

2011 6,930,667 $ 41.464 billion 

Source: InformatiOn prepared by CongressiOnal Research Service 

Note: Numbers include all blind and disabled receiving SSI payments. 

tatus 

Due to complex program rules and inadequate program administration, 

SSA made $4 billion in overpayments to SSI recipients in 2009, who did 

not properly report assets. I8 

Definition of 

"Disability." To qualifY 

for ssm or SSI a 

claimant must meet 

SSA's definition of 

disability, which is 

defined as the inability to 

engage in substantial 

gainful activity (SGA) 

due to a medically 

determinable physical or 

mental impairment 

expected to result in death 

or last at least 12 months. 

SGA is essentially 

Chart 841 $SA's FlVe..step Sequential Evaluation 

for Determmlng Disability for Adults 

17 Social Security Administration FY2013 Presidents Budget, Key Tables, Table 6, 

http://www.ssa.gov/budget/2013KeyTables.pdf 

IS SSA Inspector General O'Carroll also reported that SSA made $800 million in underpayments 

to SSI recipients, putting the program as a whole at a 10 percent improper payment rate. This is 

based on the fact that in 2009, SSA paid $48.3 billion to SSI beneficiaries. See Testimony of 

SSA Inspector General Patrick O'Carroll before the United States House of Representatives, 

Subcommittee on Social Security, Committee on Ways and Means (June 14,2011), 

http://waysandmeans.house.gov/UploadedFiles/ocarroI222.pdf. 
101 

12 

detennined by the amount of money a claimant makes per month. If a 

claimant is earning over $1,000 a month, they are generally deemed to 

be performing SGA. 

In order for the agency to award benefits, SSA must find the claimant 

unable to perfonn any kind of work that exists "in the national 

economy," taking into account age, education, and work experience. 

For many years, SSA has used a guidebook called the Dictionary of 

Occupational Titles (DOT), previously maintained by the Department of 

Labor, in detennining the types of jobs that exist for individuals alleging 

disability.19 The last major revision to the DOT by the Department of 

Labor was in 1977. In 2008, SSA detennined to replace the DOT with a 

new database called the Occupational Information System (OIS). In 

July 2011, SSA determined that it could replace the DOT with the new 

OIS by 2016, but at a cost of $1 08 million. A 2012 Government 

Accountability Office (GAO) report stated that, by February 2012, SSA 

had made progress on this effort, but it was too early to tell if the 2016 

deadline would be met. 20 

The Application and Appellate Process. Once a claimant files an 

application for disability benefits with SSA, it is forwarded to a central 

office in the person's home state, called the state disability determination 

service (DDS). There is one DDS office in each state, which provides 

an initial determination based on the medical evidence in the claimant's 

file. Due to an historical anomaly, DDS employees are employees ofthe 

various state governments, though they are paid by funds from SSA. 

Each state's DDS contracts with SSA to adjudicate medical eligibility 

for disability benefits under ssm and SSI rules and regulations. 

If the claimant does not provide all of his or her own medical evidence, 

DDS will contact the claimant's doctor(s) to request the medical 

evidence on behalf of the claimant. The DDS then conducts a five-step 

sequential evaluation (outlined in the graphic above) to determine if an 

applicant is disabled. An applicant can be denied at any step, even if 

they meet a later criterion. 

FunctionalNocational Grids (Step 5 Analysis). While a claimant's 

medical condition may be severe enough to qualifY for benefits at step 

three, under SSA's current rules most claimants qualifY for benefits at 

step five under an analysis oftheir residual functional capacity (RFC). 

An RFC measures what an individual can still do despite their functional 

limitations caused by alleged medically determinable mental or physical 

19 Information provided by the Social Security Administration. 

20 Government Accountability Office, Modernizing SSA Disability Programs, Program Made, 

but Key Efforts Warrant More Management Focus, GAO-12-420, 

http://gao.gov/assets/600/591701.pdf. 
102 

13 

impairments. The RFC is determined by the adjudicator at each level of 

decision. The RFC is an individual's maximum remaining ability to 

perform sustained work on a regular and continuing basis for eight hours 

a day, five days a week, or an equivalent work schedule. 21 The agency 

then determines if the claimant can do any other work that exists, 

considering the individual's RFC, age, education, and work experience. 

In 1979, SSA issued regulations aimed at standardizing decision-making 

at step five where the agency considers whether the claimant can 

perform any job that exists in the national economy. To implement 

those regulations, SSA also developed Medical-Vocational Guidelines 

for DDS examiners and ALJs to use when analyzing a particular case. 

The Medical-Vocational Guidelines include three charts or "grids." 

Each grid corresponds to a claimant's ability to perform certain types of 

work determined by the decision-maker: sedentary; light; or medium. 

Columns related to a claimant's age, education, and work history are 

also factored into these grids. 22 Once the DDS or ALJ adjudicator 

determines the level of work a claimant is capable of performing and 

assigns the person to the sedentary, light, or medium grid, the 

adjudicator can then use the additional factors in the grid involving age, 

education, and work experience, to determine whether SSA policy 

indicates that the examiner or ALJ should find the individual to be 

disabled. The vocational grids direct a finding of disabled or not 

disabled only when all ofthe criteria of a specific rule are met. The 

analysis can be complicated. The Social Security Advisory Board has 

explained: 

The medical-vocational guidelines, which are based solely on 

the capacity for physical exertion, function as reference 

points, or guiding principles, for cases involving severe nonexertional impairments. Ifa claimant's impairment is nonexertional (e.g., postural, manipulative, or environmental 

restrictions; mental impairment) or if the claimant has a 

combinational of exertional and non-exertionallimitations, 

the vocational rules will not direct the conclusion of the 

claim. Instead the adjudicator will use the guiding principles 

to evaluate the case. This is often a difficult area for 

adjudicators and results in more subject decision making.23 

21 SSR 96-9R: Policy Interpretation Ruling, Titles II and XVI: Determining Capability to do 

Other Work - Implications of a Residual Functional Capacity for less than a full range of 

sedentary work, effective/publication date: 07/02/96. 

22 See 20 C.F .R. Appendix I to Subpart P or Part 404 Listing ofImpairments. 

23 Social Security Advisory Board, Aspects of Disability Decision Making: Data and Materials, 

February 2012, 

http://www.ssab.gov/Publications/DisabilitylGPO Chartbook FINAL 06122012.pdf. 
103 

14 

These guidelines provide standardized guidance intended to eliminate 

the time, costs, and inconsistencies associated with SSA decisionmakers analyzing specific claimant circumstances. With regard to age, 

under the grids, once an individual reaches 50 years old (categorized as 

"closely approaching advanced age"), the vocational guidelines make it 

easier for those persons to meet the disability standard. The rules 

provide even more favorable outcomes for persons 55 years old or older 

(categorized as "advanced age"). SSA has determined that at those ages, 

it is less likely an individual will be able to learn a new skill to perform 

new types of jobs. 

The portion of the grid governing disability determinations for 

individuals that are 55 and older (or advanced age) that are limited to 

sedentary work is excerpted below: 

Table No. I-Residual Functional Capacity: Maximum Sustained Work 

Capability Limited to Sedentary Work as a Result of Severe Medically 

Determinable Impairment(s) 

Rule Age Education Previous work Decision experience 

201.01 Advanced Limited or less than high Unskilled or none Disabled 

age school 

Advanced Limited or less than high Skilled or 

201.02 semiskilled-skills Disabled 

age school not transferable 

Advanced Limited or less than high Skilled or Not 201.03 semiskilled-skills 

age school transferable disabled 

Advanced High school graduate or 

201.04 more-does not provide for Unskilled or none Disabled 

age direct entry into skilled work 

Advanced High school graduate or Not 201.05 more-provides for direct Unskilled or none age entryil1to skilled work disabled 

Advanced High school graduate or Skilled or 

201.06 more-does not provide for semiskilled-skills Disabled 

age direct entry into skilled work not transferable 

Advanced High school graduate or Skilled or Not 201.07 more-does not provide for semiskilled-skills 

age disabled direct entry into skilled work transferable 

Advanced High school graduate or Skilled or Not 201.08 more-provides for direct semiskilled-skills 

age disabled entry into skilled work not transferable 

"Less than Sedentary" RFC. The agency has ruled that to be 

categorized as able to perform sedentary work, an individual must be 

able to sustain sitting six hours of an eight hour work day and be able to 
104 

15 

occasionally lift ten pounds. If the adjudicator determines the claimant 

cannot perform those functions, or their equivalent, the adjudicator can 

find the individual has a "less than sedentary" residual functional 

capacity (RFC). The agency, in Social Security Ruling 96-9p, explained 

that "an RFC for less than a full range of sedentary work reflects very 

serious limitations resulting from an individual's medical impairment(s) 

and is expected to be relatively rare." The same ruling made clear that 

the ability to perform less than sedentary work "does not necessarily 

equate with a decision of 'disabled.'" 

Social Security Ruling 96-8p. DDS examiners and ALIs may also rely 

on Social Security Ruling 96-8p in approving claims related to an 

individual's ability to engage in an eight hour work day. 24 This ruling 

provides that an individual must be able to sustain work-related physical 

and mental activities in a work setting on a regular and continuing basis. 

A "regular and continuing basis" is defined eight hours a day, for five 

days a week, or an equivalent work schedule. If the individual's alleged 

impairments prevent participation in a full workday, the agency may 

award disability benefits. 

The guidelines regarding how to treat claimants who are 50 or 55 years 

of age or older in the three Medical-Vocational Guideline grids have not 

been revised in more than 25 years. Several years ago, SSA considered 

raising the ages to reflect "adjudicative experience, advances in medical 

treatment and healthcare, changes in the workforce since [SSA] 

originally published [the] rules for considering age in 1978, and current 

and future increases in the full retirement age under Social Security 

law," but no action was actually taken.25 

A Denial Can Be Appealed. If an individual is denied benefits at the 

DDS evaluation or "Initial Application," in most states, a claimant has 

four opportunities to appeal the denial: (I) reconsideration, a de novo 

re-evaluation by another DDS examiner; (2) a de novo hearing by an 

Administrative Law Judge (ALI) in SSA's Office of Disability 

Adjudication and Review (ODAR); (3) a request for review by the 

24 See SSR 96-8p: Policy Interpretation Ruling. Titles II and XVI: Assessing Residual 

Functional Capacity in Initial Claims, Effective/Publication Date July 2, 1996, 

http://www.ssa.gov/OPHome/rulings/di/01/SSR96-08-di-01.htm!. 

25 In 2005, under Commissioner Jo Anne Barnhart, SSA attempted to raise the ages in the 

vocational grids on that basis. See Age as a Factor in Evaluating Disability, 70 Fed. Reg. 67101 

(Nov. 4, 2005). Almost four years later, under Commissioner Michael J. Astrue, without 

explanation, the proposed increase in ages was withdrawn. See Age as a Factor in Evaluating 

Disability, 74 Fed. Reg. 21563 (May 8, 2009). 
105 

16 

Social Security Appeals Council (SSAC); and (4) an appeal to Federal 

district court. 26 

Continuing Disability Reviews (CDRs). After an individual is 

determined to be disabled, SSA is required to conduct periodic medical 

and work reviews to ensure that beneficiaries continue to qualify for the 

program.27 By regulation, these reviews are set for between six months 

and seven years based on the beneficiary's likelihood of medical 

improvement.28 Due to growing numbers of beneficiaries, budget 

constraints, and the agency's choice to focus resources on the 

application backlog, however, the agency has not performed all ofthe 

required reviews on a timely basis, resulting in a 1.5 million CDR 

backlog. If the agency were to perform these reviews in accordance 

with current law, it would result in $15.8 billion in lifetime Federal 

benefits savings, according to the SSA inspector general. 29 

SSA Quality Reviews. The decisions made by SSA's DDS examiners 

and ALls are subject to SSA's Office of Quality Review (OQR).JO 

SSA's OQR is charged with assessing the integrity and quality ofthe 

administration of SSA programs in headquarters and in the field. Its 

responsibilities include conducting broad-based studies ofSSA's ssm 

and SSI programs. OQR shares information about recurring errors, 

common deficiencies, and policy inconsistencies through its reports. 

OQR's key functions include providing support and guidance to 

program and integrity field staff, ensuring proper case documentation, 

and delivering quality review feedback to operating components. In 

addition, OQR's Division of Disability Initial develops disability policy 

and procedures for conducting quality reviews. Those key functions 

include analyzing data to identify significant errors, targeting areas 

needing study to determine corrective action, and issuing prepayment 

and quality review reports. OQR's Division of Appeals has overall 

responsibility for the development, coordination, analysis, and reporting 

of quality review and feedback data at the DDS examiner level and can 

address similar issues at the ALl or Disability Determination Board 

levels. 

26 In ten states. the first level of appeal, reconsideration by another DDS examiner, is 

unavailable. See POMS DI 12015.100, Disability Redesign Prototype Model, listing the states in 

which Reconsideration currently does not exist. 

27 20 C.F.R. §§ 404.1589 and 416.989. 

28 20 C.F.R. §§404.1590 and 416.990. 

29 Social Security Administration, Office of Inspector General, "Full Medical Continuing 

Disability Reviews," Report A-07-09-29147 (March 2010). 

30 SSA Organizational Manual, Subchapter TK, Office of Quality Performance, 

http://www.socialsecurity.gov/org/orgdcgp.htm#ogr. 
106 

17 

OQR also works with the Office of Appellate Operations (OAO) to 

develop a statistically significant sample, most recently of about 3,500 

cases, to conduct annual prepayment reviews ofSSDI and SSI 

payments. If the review finds a problem with a particular payment, SSA 

will withhold payment until adequate information has been provided. 

In addition, in 2011, OAO established a Division of Quality (DQ) and 

instructed DQ staff to begin conducting post-payment "focused quality 

reviews" (FQRs) to identifY recurrent decisional issues in disability 

cases, problematic patterns in the adjudication of disability cases, and 

where policy or procedural changes may be needed. 3

] As of January 

2012, DQ had completed about 16 such reviews for specific ALJs and 

about three for entire hearing offices. A team ofDQ staffers conducts 

the FQR, which takes about four to five days to complete. Once a team 

selects a FQR subject, it screens a sample of 60 to 80 cases for a random 

period against several criteria. Criteria may include: (1) how many 

decisions were on the record, (2) how many were bench decisions, (3) 

how long a hearing lasted, (4) whether claimants submitted additional 

evidence after a DDS examiner decision, (5) whether a case file included 

opinion evidence after the DDS determination, or (6) whether case files 

included opinion evidence from treating, examining, or non-examining 

sources. DQ staff then conducts a more in-depth review of about 25 

percent of the screened cases and issues a report on its findings. The 

report and its findings are discussed with the ALJs that were the subjects 

ofthe review and could be used by SSA when taking formal disciplinary 

action against an ALJ for consistently issuing disability decisions that 

are legally insufficient. 

A 2011 report summarizing the DQ reviews reported that DQ staff 

found, after reviewing disability decisions across the country, that 22 

percent contained errors, meaning the DQ reviews identified a quality 

problem in more than one out of five disability cases.32 At the same 

time, it is important to note that DQ reviews may identifY a quality error 

in a decision without also finding that the decision on whether to award 

31 When DQ finds, based on its sampling of pre-payment cases, that there is a much higher-thanaverage rate of review for an ALl or hearing office, then it may conduct an FQR to evaluate 

what may be a problematic pattern in the adjudication of disability cases. The Office of 

Appellate Operations also selects subjects for FQRs based on various analyses. The Office of 

Appellate Operations also works with the ODAR Division of Management Information and 

Analysis, as well as the SSA Office of Quality Perfornlance, to develop algorithms to improve 

the selection process for additional FQRs. Office of Appellate Operations, Executivc Director's 

broadcast, 1113/12. 

32 See Fiscal Year 2011, Final Actions Report, Division of Quality, February 8, 2012, provided to 

the Subcommittee by the Social Security Administration. The Appeals Council took own motion 

review on 22 percent of the 3,692 decisions reviewed. Six hundred sixty-five of those cases 

were remanded to hearing offices for further development because the record was not sufficient 

to render a decision. 
107 

18 

disability benefits was incorrect. 33 Of the cases identified by DQ as 

containing an error, the Office of Appellate Operations, on its own 

motion, remanded 82 percent to the originating hearing office for further 

development because the record was not sufficient to render a decision.34 

The cases selected for review were selected using a random selection 

sampling process. 

The 20 II DQ report not only reported a national error rate of 22 percent 

for SSA decisions as a whole, it also provided a chart identifying the 

extent of problematic cases found in each SSA regional office. When 

broken down by region, the rate ranged from a low of 15.5 percent 

(Region 8) to a high of26.2 percent (Region 6).35 

OvVI1 Motion Rate by Region 

As stilted i.lbove~ the Counrd took own moti(m on 22% of the 3692 decis.ions; f1jvit'wed. The 

regional own motion r.'l:lf? ranged from 15.5% (ReB/on 8) to 26,2% {Rt'gian 6}, witt'! <In averaCe 

r<lte 'Of 22% ami an 'Overall rate of 22%. 

Own Motioo 

~FF ~£M DEC OMbte Total Cases 

1&0 34 3 20.8% 202 

259 IS 10 24.7% 3·1~ 

779 72 15 23.8% 366 

U8 12 12 23.2% 362 

305 ,1 11 18.2% 373 

156 77 lL 26.2% 347 

159 61 17 2U% 337 

273 39 11 15.5% 323 

277 60 20 22.7% 352 

10 269 53 !l 19.2% 333 

NHC 270 

Total 2SIlO 

The three ODAR hearing offices examined in this Report are 

encompassed within the chart's statistics. The ODAR hearing office in 

Oklahoma City, Oklahoma is part of Region 6, which had the highest 

error rate of26.2 percent. The ODAR hearing office in Montgomery, 

Alabama is part of Region 4, which had a 23.2 percent error rate. 

Finally, the ODAR hearing office in Roanoke, Virginia is located in 

Region 3, which had a 23.8 percent error rate. 

The Office of Appellate Operations DQ staff reports its data and 

findings (but no recommendations) to the Office ofthe Chief 

Administrative Law Judge and ODAR executives for whatever 

educational or other action they deem appropriate. 

]] Id. at 2. 

]4 Id. 

]SId. at 6. 
108 

19 

After receiving the DQ data collected in 2011, ODAR responded by 

developing and implementing mandatory continuing education training 

for ALJs beginning in January 2012. The first three training topics 

address the following issues in detail: 

• Assessing Credibility; 

• Phrasing the Residual Functional Capacity; and 

• Evaluating Medical Source Statements. 

These issues were also identified by the Subcommittee investigation as 

problems, as further discussed with regard to specific case files below. 
109 

20 

III. BACKGROUND ON SELECTION OF 300 

DISABILITY CASE FILES 

To examine the process used by SSA to award benefits to individuals in 

both the SSDI and SSI programs, the Subcommittee developed a case 

study based upon detailed analysis of 300 specific case files. The case 

files were selected to reflect certain common diagnoses asserted by 

disability applicants, as well as decisions made at the initial application 

and each subsequent level of appeal. 

Selection of Counties. To ensure that the 300 case files reflected 

different types of counties, the investigation examined data to determine 

whether disability benefits were concentrated in certain parts of the 

United States. To determine the percentage of individuals receiving 

disability benefits, the Subcommittee compared U.S. Census Bureau 

data on the population size of each county in the United States to the 

data maintained by SSA on the number of ssm and SSI recipients in 

each county in the United States.36 This comparison provided the 

percentage ofthe population in each county receiving SSDI or SSI 

benefits in 2009. 

Based on this data, three counties were selected to represent three 

different levels of population density with regard to individuals enrolled 

in the ssm and SSI programs (high, low, and mid-range): 

• Low-Density Disability Population: Oklahoma (3.20 percent 

on ssm; 2.31 percent on SSI); 

• Mid-Range Density Disability Population: Alabama (8.54 

percent on ssm; 12.14 percent on ssm, SSI, or both); and 

• Highest Density Disability Population: Virginia (19.27 

percent on ssm; 20.7 percent on ssm, SSI, or both). 

The county in Virginia had the highest percentage of individuals 

receiving disability benefits in the country in 2009. 

Disability Case Files Requested. In cooperation with the investigation, 

SSA agreed to obtain 100 case files from each of the specified counties 

in response to selection criteria specified by the Subcommittee. The first 

selection criterion was designed to reflect how disability benefits were 

36 Social Security Administration, Annual Statistical Report on the Social Security Disability 

Insurance Program, 2009; http://www.ssa.gov/policyldocs/statcomps/oasdi sc/index.html 

compared fa U.S. Census Bureau; State and County QuickFacts; 

http://guickfacts.census.gov/gfdlindex.html. 
110 

21 

awarded at the initial application stage and at each subsequent stage in 

the appellate process in each of the three counties. To ensure a crosssection of the decision-making process, the Subcommittee requested the 

selection of approximately 20 cases approved to receive disability 

benefits at the initial application process and then at each of the four 

subsequent levels of appeal: reconsideration; ALJ hearing; Social 

Security Appeals Council; and Federal district court. The selection 

criteria excluded review of any case file in which benefits were denied. 

Secondly, to ensure the case files reflected typical disability applicants, 

the Subcommittee requested that the bulk of the case files be divided 

among the three most common specific diagnoses, using national 

percentages for diagnoses of individuals on the disability rolls. The 

three most common 2009 diagnoses were: musculoskeletal system and 

connective tissue problems (24.9 percent); mental disorders (27.5 

percent); and mental retardation or developmental disabilities (8.9 

percent).37 To ensure consideration of all potential diagnosis groups, the 

Subcommittee also requested that at least some of the case files reflect 

all ofthe remaining diagnosis categories. 

Using these selection criteria, SSA developed criteria to randomly select 

100 case files from each of the three counties for Subcommittee review. 

Redaction of Personally Identifiable Information. Prior to the 

disability case files being provided to the Subcommittee, SSA removed 

all personally identifiable information from each case file. The 

redactions included removing all claimant names, addresses, telephone 

numbers, dates of birth, tax information, and any other information that 

could be used to specifically identify a particular claimant. SSA then 

assigned an identifying number to each case file, such as Oklahoma 

Case 101. 

Contents of the Case Files. The contents of each disability case file 

were generally uniform. The file generally included a SSA disability 

application form and associated subjective questionnaire documents 

completed by the applicant (i.e., questionnaires about a claimant's pain 

or activities the claimant performed on a daily basis), agency-generated 

documents relating to case process or appeals, correspondence between 

the agency and the claimant (or the claimant's representative), and any 

medical evidence or consultative exams related to the applicant. The 

quantity and type of medical evidence submitted with each case file 

varied greatly. Duplicative pieces of medical evidence were frequently 

37 Social Security Administration, Annual Statistical Report on the Social Security Disability 

Insurance Program, 2009, Table 6, Distribution by sex and diagnostic group, December 2009, 

http://www .ssa.gov /policy/ docs/statcomps/ di asr/2009/index.html. 
111 

22 

provided in applications where the claimant was represented by an 

attorney or claim representative. The size of each case file varied 

greatly, ranging from just over 100 pages of documents to over 1,500 

pages. 

Review of Agency Process to Award Disability Benefits. In reviewing 

the 300 disability case files, the Subcommittee investigation focused on 

the process utilized by the agency, at all levels, to determine the award 

of disability benefits. The Subcommittee's review examined the 

agency's evaluation of evidence, both medical and other, available to 

support a claim of disability. The amount of medical evidence in each 

case file varied widely, but when available, generally included medical 

testing results, physician or therapy progress notes and reports, and 

general hospital and physician records. The case file also included 

SSA's evaluation of reports issued by consultative examiners and 

claimants' subjective allegations made on SSA application forms 

supplementing disability applications (e.g., reports by claimants of pain, 

third-party reports of claimant activity, reports on a claimant's ability to 

perform activities of daily living, and work history). 

By reviewing these 300 case files in detail, patterns emerged suggesting 

areas of weakness and ways in which SSA could improve its awards of 

disability benefits. 
112 

23 

IV. PROBLEMS WITH DECISIONS MADE BY 

ADMINISTRATIVE LAW JUDGES 

Administrative Law Judges (ALJs) playa significant role in the 

adjudication of disability claims filed with the Social Security 

Administration (SSA). As a group, ALJs decide approximately 700,000 

cases every year, and each ALJ is expected to process at least 500 cases 

per year.38 This volume of cases represents nearly a quarter of all of the 

disability claims filed with SSA in a typical year, all of which must be 

examined by less than two percent ofSSA's workforce. 39 Importantly, 

in most cases, ALJs effectively provide the final opportunity for 

claimants who have been denied to make their case for disability 

benefits. 

In the three counties examined by the investigation, benefit award 

decisions at the ALJ level were fraught with significant problems. 

These problems ranged from basing decisions on evidence of 

questionable value, to citing insufficient evidence to support the decision 

made, misusing expert testimony, and holding perfunctory hearings. 

The result was a large number of poor quality decisions, raising 

questions about whether they were decided correctly. 

A number of ALJs who spoke with the Subcommittee suggested that at 

least part ofthe problem lay in the heavy workload that comes with the 

job. In recent years, as a concerted effort was made to reduce the 

growing backlog of undecided disability applications, ALJs were 

encouraged to decide no fewer than 500 cases per year. Since most 

cases contain several hundred pages of documents - many over 1,000 

pages, including complex medical documents making a proper 

decision and producing a high quality written description ofthat 

decision on more than one case per day is difficult. 

Others pointed out how quality can suffer in some offices because the 

program's rules have become so complex that applying them correctly is 

also difficult. There are more than a dozen categories of "medical 

listings" for which disabled Americans can qualifY, each containing 

subcategories of ailments, which themselves also have subcategories. 

For claimants that do not have a disability that fits into a medical listing, 

they can also qualifY under the "Medical-Vocational" guidelines. Using 

lengthy and complex "grids," ALJs must determine if a person's medical 

condition is severe enough to qualifY for benefits based upon age, 

38 Statement of Michael J. Astrue, Commissioner, Social Security Administration before the 

Committee on Ways and Means Subcommittee on Social Security, June 27, 2012, 

http://www.ssa.gov/legislation/testimony_062712.html 

39 Social Security Administration, Hearings and Appeals, Information about Social Security's 

Office of Disability Adjudication and Review, http://www.ssa.gov/appeals/about_odar.html 
113 

24 

education, and past work history. Keeping all ofthese rules, options, 

and guidelines straight, and applying them correctly, is a challenge for 

even the most conscientious and experienced judges. 

In addition, even when large numbers of poor quality decisions are 

identified, senior SSA officials explained that there is little the agency 

can do to correct the underlying problems, because ofthe Administrative 

Procedures Act (APA). The APA, which applies more broadly than to 

disability programs and the SSA, establishes the principle of "qualified 

judicial independence" for the work of administrative law judges.40 This 

law ensures that, while ALJs remain employees of the Executive 

Branch, and therefore work for SSA, they retain significant freedom in 

how they conduct their work. 

For claimants, this independence is intended to assure them of a fair and 

impartial hearing if their initial applications are denied by agency 

personnel. According to agency officials, however, it can also create an 

accountability problem in which the agency has little recourse if it 

disagrees with the manner in which ajudge conducts business or makes 

decisions. 41 

In an interview, the SSA Chief Administrative Law Judge Debra Bice 

acknowledged the tension between independence and accountability for 

ALJS. 42 Judge Bice, who has nearly 30 years' experience with Social 

Security disability programs, much of the time at the agency and some 

as a claimant representative, is responsible for overseeing over 1,400 

ALJs. Having become an ALJ in 2008, Ms. Bice rose to the position of 

Chief Judge in January 2011. 

She told the Subcommittee that one particular concern that has surfaced 

during her tenure is so-called "high producers" - ALJ s that decide a 

40 See 75 Fed. Reg. §§39154, 39156, Final Rules Setting the Time and Placc for Hearing Before 

an Administrative Law Judge (discussing qualified judicial independence). 

41 A March 2012 report of the SSA Inspector General explained: "While the APA and the Act 

permit SSA to review ALl decisions, the Agency cannot review ALJ decisions in any manner it 

chooses. For instance, in October 1981, SSA instituted the Bellmon Review Program where the 

Appeals Council reviewed pre-effectuation decisions of ALls with high allowance rates. Under 

the program, the AC reviewed these ALls' decisions to determine whether the decisions were 

correct, and, if they were not, the AC issued final decisions or returned cases to ALJs with 

instructions for additional actions. The Association of Administrative Law Judges filed suit 

against SSA and alleged that the Bellmon Review Program violated ALls' decisional 

independence. When the district court issued its decision in 1984, it used the Bellmon Review 

Program. The court did not find that the Bellmon Review Program violated the law, but it did 

find that focusing review on ALls with high allowance rates created an 'atmosphere of tension 

and unfairness which violated the spirit of the APA, ifno specific provision thereof.'" SSA 

Office ofInspector General, "The Social Security Administration's Review of Administrative 

Law Judge's Decisions," A-07-12-21234, March 2012, h!tp:lloig.ssa.gov/sites/defaultlfilesl 

audit/full/pdfl A-07 -12-21234.pdf. 

42 Subcommittee interview of Debra Bice (8/3/2012). 
114 

25 

disproportionately large number of cases each year. When asked 

whether she was concerned about the poor quality of work being done 

by some ofthe high-producing ALJs, she said she was. She added, 

however, that she was not sure what the agency could do about it 

because of the independence ALJs are afforded. In 2011, the 

Commissioner unofficially capped the number of cases each ALJ can 

decide at 1,200, which he did by limiting their assignments to no more 

than 100 per month.43 

Absent a change in law or program rules, however, Judge Bice told the 

Subcommittee that she is limited to emphasizing the role of training to 

better prepare new judges and refresh senior ones. Noting that some 

judges "hadn't been trained in years," she explained that she now holds 

quarterly discussions with small groups of judges to talk about their 

work. Her top advice for judges, she said, is to "never abdicate the role 

of judge." She explained that the job of a judge is not "just taking a case 

and paying it," but striving to "make sure they are impartial," and decide 

each case on its merits. 

The Subcommittee also interviewed Judge Patricia Jonas, Executive 

Director of the Office of Appellate Operations (OAO).44 Judge Jonas 

discussed the Division of Quality (DQ) recently established by the OAO. 

She explained that the DQ is responsible for reviewing unappealed 

decisions by ALJs and hearing office senior attorney adjudicators. She 

disclosed that in its first full fiscal year of operation, FY20 11, the 

division found errors in 22 percent of the cases it reviewed, which 

resulted in OAO's issuing, on its own motion, remand orders or 

corrective decisions in numerous cases that had not been appealed.45 In 

an agency newsletter, the OAO noted the following "top 10 reasons for 

remand of the unappealed hearing decisions: 

• RFC exertional limitations inadequately evaluated; 

• RFC - mental limitations inadequately evaluated; 

• Claimant credibility failed to discuss appropriate credibility 

factors; 

• Drug or Alcohol Abuse insufficient articulation of [drug and 

alcohol abuse] rationale; 

• RFC - non-mental non-exertionallimitations inadequately 

evaluated; 

• Incomplete/inadequate record record inadequately developed; 

• Onset date/closed period/[continuing disability review]; 

43 ld. 

44 Subcommittee interview of Patricia Jonas (7/30/2012 and 819/20 I 2). 

45 Office of Appellate Operations, Executive Director's Broadcast, VoL 3, Special Edition -

Quality Review, January 13,2012. 
115 

26 

• RFC effect of combination or impairments inadequately 

evaluated; 

• Treating source - recontact necessary.,,46 

A number of the issues identified by OAO as top concerns mirror the 

concerns identified by the Subcommittee investigation in this case study. 

The following cases illustrate a number ofthe problems identified by the 

Subcommittee investigation in its review ofthe 300 case files. 

A. Misuse of Vocational Experts 

ALJs rely on vocational experts (VEs) to provide independent thirdparty analysis during hearings on the capacity of claimants to perform 

work. In fact, ~proximately 76 percent of all SSA hearings in FY2010 

involved VEs.4 In the cases reviewed in the investigation, ALJs often 

cited the testimony of these experts to award disability benefits. 

However, instead of simply relying on the independent judgments ofthe 

VE present at the hearing, a few ALJs at times appeared to ask leading 

questions and even manipulate the process in a manner that resulted in a 

finding of disability. 

SSA guidance for the use of vocational experts is provided for ALJs in a 

detailed manual called the "Hearings, Appeals and Litigation Law 

Manual," or HALLEX. All ALIs are supposed to follow HALLEX 

guidelines, which were drafted by the SSA Deputy Commissioner for 

Disability Adjudication and Review for that purpose.

4S 

Vocational experts (VEs) are not employees ofSSA, but are private 

contractors paid by the agency for each hearing they attend. Frequently, 

they work in the field of vocational rehabilitation, developing expertise 

in helping individuals find work or retraining people looking to get back 

into the workforce. Most of the ALI hearings reviewed by the 

Subcommittee had a Vocational Expert present to testify regarding 

whether there were jobs the claimant could potentially perform that exist 

in the national economy. The VE's role is to provide an opinion about 

whether a claimant's limitations are severe enough to limit their ability 

to work. 

46 1d. 

47 Office of the Inspector General, Social Security Administration, Availability and Use of 

Vocational Experts, May 2012, http://oig.ssa.gov/sites/defaultifiles/audit/full/pdfi'A-12-11-

11124.pdf. 

48 See Social Security Administration, HALLEX 1-1-0-1, Purpose. 

http://www.ssa.gov/OPHome/hallexll-Ol/I-I-0-I.html. 
116 

27 

HALLEX provides basic procedures for the use ofVEs, but notes: "The 

ALJ should take care to elicit useful and objective testimony from the 

VE.,,49 ALJs elicit this testimony by asking the VE questions about the 

claimant, or instead, "The ALJ may use hypothetical questions to elicit 

the VE's opinion about the availability of jobs that an individual could 

perform given certain factual situations."so The second option allows an 

AU to craft various scenarios to which a VE is required to respond. A 

vocational expert is not supposed to independently review any 

claimant's medical records to ensure that the hypothetical they are given 

match the claimant in the hearing room. 

In the cases reviewed in the investigation, VE testimony was usually 

provided in response to the ALJ posing "hypothetical" questions about 

claimants with the same disabling conditions as the actual claimant, 

rather than asking directly about claimant. Under HALLEX guidelines, 

these hypothetical disabling conditions are supposed to be garnered from 

the medical evidence of record, going no further.s1 Considering only the 

hypothetical conditions set by the judge, the VE then opines on whether 

jobs exist that the claimant could perform. The VE can also testify 

regarding the number of those jobs that exist in the nation, and 

sometimes the region. 

In some instances, the investigation found ALJs using YEs in 

inappropriate ways or in ways that failed to yield useful results. In a few 

cases, the ALJ construed a hypothetical situation so narrowly that it 

elicited testimony from a VE that no jobs were available. In a number of 

cases, the hypothetical situations were not supported by the medical 

evidence of record for the relevant claimant, or were contradicted by the 

available evidence. At other times, a VE was asked only a single 

question, seemingly to obtain a pre-determined result. In one instance, 

when a judge received testimony that jobs were available for the 

claimant, the ALJ kept asking questions - adding hypothetical 

limitations each time until the VE said that no jobs could be found. 

Using the testimony provided in response to the final question asked, the 

judge ruled fully favorable for a claimant's disability application. In still 

another instance, an ALJ misreported the testimony provided by a 

vocational expert, claiming it supported a decision to award benefits 

when it did not. Sometimes, testimony from medical experts present at 

the hearing received similar treatment. 

49 Social Security Administration. HALLEX 1-2-5-55. The Vocational Expert's Testimony. 

http://www.ssa.gov/OP Home/hallex/I-02/1-2-5-55.html. 

50 Social Security Administration, HALLEX 1-2-6-74. Testimony of a Vocational Expert. 

http://www.ssa.gov/OP Home/hallex/I-02/1-2-6-74.html. 

51 Established case law is clear that a hypothetical must match the claimant's medical record. It is 

not intended to examine a variety of scenarios that are unrelated to a claimant. 

http://caselaw.findlaw.com/us-9th-circuitl1608455.html. 
117 

28 

These actions gave the appearance that the ALJs at times were 

manipulating the use of expert witnesses to obtain a pre-determined 

answer. To the extent this happened, expert witnesses were used to give 

the appearance of independent third-party corroboration of 

determinations that may not otherwise have been supported by evidence 

in the case file. Examples of cases raising these issues follow. 

Virginia Case 278. AU Richard Swartz awarded disability benefits to a 

claimant for "disorders of back," though two prior DDS examiners had 

found the claimant was able to work. A functional assessment study 

conducted by the claimant's physical therapist even suggested the 

claimant may have exaggerated his pain to restrict his work. Whether or 

not the claimant was credible, however, this case highlights how the 

testimony of a vocational expert was used to find a claimant disabled, 

despite a VE testifYing several times during a hearing that jobs were 

available that the claimant could perform, and never appeared to 

conclude there was no work for the claimant. 

Having applied for disability alleging chronic back pain, the claimant 

was denied by DDS at both the initial application stage and upon 

reconsideration. He then appealed to have his case heard by an ALl 

His case file contained conflicting medical evidence about whether his 

condition was serious enough to keep him from working. One physical 

therapist who conducted an exam, for example, stated that based solely 

on how the claimant presented at the exam, he could do only sedentary 

work and could not immediately return to his former job. This same 

therapist, however, found evidence that his claimed symptoms did not 

properly match his claimed illness. She reported the claimant could not 

sit during the exam for more than IS minutes, but wrote, "It should be 

noted that he drove approximately 1 [.5] hours to the clinic this morning 

.... " In another place, the physical therapist wrote: "Utilizing 

Waddell's Non-organic physical signs oflow back pain, the patient 

tested positive in I of 5 categories." Waddell's tests are performed 

sometimes to determine if a patient is exaggerating, though they can also 

simply indicate non-physical reasons for pain. Testing positive in any 

one ofthe five areas, as the claimant did, is an indication that some of 

the pain was not physical and that his claims may not be credible. 

The physical therapist concluded this exam by finding some evidence of 

"inappropriate illness behavior," because of inconsistencies between the 

physical exam and the claimant's answers to a questionnaire. She also 

wrote: "The patient's activities qualifY him for a sedentary physical 

demand level of work." After making that determination, however, she 

also wrote: "Based on the objective findings of the Functional Capacity 
118 

29 

Evaluation it would appear that the patient could not return to work at 

this time. With observed demonstration of the inability to sit greater 

than 15 minutes or stand greater than 15 minutes, the patient would be 

ineffective in an office situation. However, this decision as always is left 

to the discretion and judgment ofthe referring physician .... " 

Several months later, medical records related to a worker's 

compensation claim, dated February 7, 2007, found the claimant 

continued to allege pain, prompting discussion ofa surgical remedy, but 

also that the claimant "can return to work tomorrow." His doctor wrote: 

"[Another doctor] had contemplated a fusion and I concur that this was a 

reasonable option. The patient declined surgery and continues to decline 

surgery as ofthis day's date .... He can return to work tomorrow with 

restrictions.... I do not see any reason what so ever to escalate or 

increase his narcotic requirement and do believe that he should be 

referred to a pain management group so they can wean him from Lortab 

to anti-inflammatories over-the-counter alone." 

On April 2, 2007, both a psychologist and a physician at the DDS level 

reviewed the claimant's records, each separately noting possible 

problems related to the claimant's credibility: "Based on the evidence of 

record, the claimant's statements are found to be partially credible." 

At the ALl hearing, the following exchange between ALl Richard 

Swartz and a vocational expert (VE) present at the hearing transpired: 

ALl: Would you give us your assessment of his past 

relevant work experience? 

VE: Yes, sir. The work he did as a welder/fabricator is 

SVP: 5, which is skilled, and it's classified as heavy 

exertional level. 

ALl: That basically covers it all? 

VE: Yes, it does. He's just a, he's a skilled welder. 

ALl: Okay. Are there any welding jobs at a sedentary, 

light level so he could transfer these skills to such a 

thing? 

VE: No, most of the welding jobs are between medium 

and heavy. 

Claimant's Attorney: You can stand up long as you need to. 
119 

30 

AU: Ifthe claimant is about 36 or 37 years old, in that 

neighborhood. If, with his education level and this 

past work experience, ifhe were limited to do the 

sedentary or light work where he would need some 

sort of an occupation where he could change 

positions throughout the workday, more than, more 

than most standard breaks and lunch, in order to 

relieve discomfort, can you suggest any jobs at either 

one of those exertionallevels? 

VE: As long as he's able to sit, and stand and walk six 

hours in an eight-hour day, and be productive, 

there's some unskilled, light exertionallevel jobs. 

We have, there's a, a storage rental clerks, storage 

facility rental clerk. Do you need a DOT numbers 

on these? 

AU: No. 

VE: On the DOT number, you don't need 80,500 

nationally; 6,400 in the Mid-Atlantic. We have 

unskilled sales clerk, which is at the light level. 

There's 164,600 nationally; there's 5,800 in the MidAtlantic. We have assembler small parts, there's aand that's under skilled, light. There's 30,500 

nationally, and 4,700 in the Mid-Atlantic region. Do 

you need more than that, Your Honor? 

AU: No. How about at the sedentary level? Are there any 

there for you where you would have the opportunity 

to change positions occasionally if you wanted to? 

VE: Yes. 

ALI: Other than the regular breaks, and so forth. 

VE: Yes, your Honor. Again you'd have to be able to sit 

six hours out of an eight-hour day and be productive. 

There's a charge account clerk. There's 380,000 

nationally, and there's 34,000 in the Mid-Atlantic 

region. There's an order clerk, 587,000 nationally; 

27,400 in the Mid-Atlantic. There's an office clerk 

with addresser, there's 343,000 nationally, and 

17,500 in the Mid-Atlantic. Would you need more 

than that, sir? 
120 

31 

ALJ: No, I guess that would do. Are there any hazards 

involved in these jobs so if a person had some sort of 

problem they were required to avoid hazardous 

situations. Would that be a difficulty in any of 

these? 

VE: No, Your Honor. 

ALJ: How about if they were limited to only occasional 

stooping and crouching? Could they do that, with all 

of these, with these jobs, would that, would that be a 

problem? 

VE: No, Your Honor. 

ALJ: If your discomfort limited you to, to the extent that 

you were required to change positions from sitting to 

standing, or standing to sitting, at least briefly in 

order to relieve discomfort for about every 15 

minutes, could you still perform any of these jobs? 

VE: It would be, I mean, you, you've got to be productive 

in an eight-hour work day. I guess it goes with the, 

the frequency and duration. Ifhe's able to sit and 

stand every 15 minutes and still be productive, then 

that would work but if, ifhe basically having 

problems staying on task then that would take those 

jobs away. 

ALJ: Okay. He's described to us frequently why he has to 

just, has to sleep during the day. Could he do that on 

any of these jobs? 

VE: No, Your Honor. The -- you get a 15 minute break in 

the morning, a lunch break, and 15 minute break in 

the afternoon, and ifhe's having to take more than 

that, then it would probably result in being 

discharged. 

ALJ: He's also testified so some ongoing depression or 

anxiety that has developed since the time of his 

accident. If this affects his ability to perform all of 

the different parts of employment or at least ... , 

would it compromise any of these jobs? 
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32 

VE: Not these jobs, your Honor. These are unskilled 

jobs, but probably unskilled jobs or jobs ... 30 days ... 

AU: Would he have to be able to work eight hours a day 

in order to do these jobs, with at least some position 

or other. 

VE: He would have to work eight hours a day. 

AU: That's all the questions I have. Counsel, do you 

have any? 

Claimant's Attorney: I don't think so, Judge. 

During the hearing, AU Swartz posed and then continued to limit the 

hypothetical, which is supposed to mirror the claimant's condition, until 

the VE testified there were no jobs the claimant could perform. Further, 

all hypotheticals presented to VEs that the AU eventually relies on to 

award benefits are supposed to be supported by the claimant's medical 

records, but no medical record supported the ALI's hypothetical that the 

claimant needed to nap during the day. During the hearing, the AU 

asked the claimant whether he took naps during the day. The claimant 

responded: 

Oh, yeah. Yeah, I, some days, you know, I might take a nap 

for a hour or something, you know, it, you know, I do that if, 

like if! don't sleep good at the night or something, it hits me 

during the day. If! can get comfortable, I'll take a nap, you 

know? 

This testimony does not indicate that the claimant needed regular or 

lengthy naps during the workday. Nonetheless, the ALJ used this 

testimony, with no supporting medical records or evidence, to narrow 

the hypothetical posed to the VE in such a way that the VE testified that 

no jobs existed the claimant could perform. 

ALJ Swartz ruled fully favorable for ssm in a decision dated April 24, 

2008, which was written by a staff attorney. In the decision, Judge 

Swartz selectively cited the testimony of the VE: "The vocational expert 

testified that claimant's past relevant work as a Dob title withheld], a 

skilled job performed at the heavy level of exertion, provides no skills 

that are transferable to sedentary work." He also wrote: "Limitations 

imposed by back disorder preclude performance of even sedentary work 

on a regular and continuing basis .... Considering the claimant's 

limitations, he cannot make an adjustment to any work that exists in 

significant numbers in the national economy .... The claimant's 
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33 

description of his limitations is consistent with the medical evidence of 

record, and his testimony is credible." 

ALabama Case 69. In this case, AU Vincent Intoccia approved ssm 

and SSI benefits for a woman based on "arthritis; obesity; hypertension; 

GERD [acid reflux]; asthma; degenerative disc disease L4-L5; spinal 

stenosis; and glaucoma." Her initial claims for benefits had been denied, 

because DDS determined she lacked sufficient medical evidence and had 

too many resources to qualifY for SSI. She was ultimately awarded 

benefits under both the SSI and ssm programs, however, based in part 

upon a pain assessment from her doctor that arrived hours prior to the 

start of her AU hearing. At the hearing, Judge Intoccia presented the 

pain form to the medical expert (ME) and vocational expert (VE) present 

at the hearing, neither of whom had a prior opportunity to review it, and 

then announced a fully favorable decision from the bench. 

In August 2008, the 59 year-old claimant filed for ssm benefits, 

claiming a disability that began on August 15,2007. In its Notice of 

Disapproved Claim on September 26, 2008, the DDS examiner wrote: 

We have determined that your condition is not severe enough 

to keep you from working. We considered the medical and 

other information, your age, education, training, and work 

experience in determining how your condition affects your 

ability to work. 

You state that you are disabled because of high blood 

pressure, a bad back, arthritis in your knees and hand, acid 

reflux, eye problems, and chest pain. The evidence shows 

that you have some restrictions. Your restrictions prevent you 

from performing your past work as a [JOB TITLE 

WITHHELD] as you describe this work. However, your 

restrictions do not preclude you from performing that type of 

work as it is normally performed in the national economy. 

In reviewing the available medical records, the examiner noted how the 

claimant's own description of her "activities of daily living" revealed 

"mod[erate] limitations due to pain and requires some assistance; 

however, [signs or symptoms] appears to be partially consistent wi 

findings" that the claim should be denied. 

The claimant's file contained conflicting evidence regarding the severity 

of her medical conditions. Among the various records SSA reviewed 

before denying the case at the DDS level were at least 10 notes from her 

doctor stating the claimant would be absent from work for medical 

reasons on certain days between 2005 and 2007. In each case she was 
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34 

cleared to return to work. According to one note from her doctor, she 

sustained, "multiple injuries connected with job fall on 12-21-06," but 

was allowed to return to work on February 12,2007. 

On July 18,2007, the claimant experienced chest and body pain, and 

was admitted to the hospital for two days, forcing her to miss work. 

Doctors ruled out a heart attack and discharged her, but diagnosed her 

with, "Uncontrolled hypertension" and "Arthritis," while also noting her 

condition had "improved." In August 2008, the month she filed for 

disability, medical records show the claimant complained of hand pain, 

but her other medical conditions appear to have improved, with medical 

records indicating her lumbar spine had returned to normal, she had only 

mild stenosis (a narrowing of blood vessels), and an ankle injury had 

healed. 

In September 2008, the claimant was examined at a family medical 

center regarding her application for disability benefits. The report 

concluded: "She can perform all activities without assistance. She 

needs to have some physiotherapy for lower back problems as well as 

wrist and knee problems." There was no mention of complications from 

glaucoma or problems with her sight. 

Following SSA's initial denial of both claims, the woman hired an 

attorney on October 10, 2008, and appealed the same day requesting a 

hearing before an administrative law judge, noting that she would submit 

additional evidence into the record. The key piece of new evidence was 

submitted on January 6, 2010, the day before her hearing with Judge 

Intoccia. It was a one-page form titled "Clinical Assessment of Pain," 

filled out by her doctor at the request of the attorney. 

The form contained four questions, each listing options for the doctor to 

circle. The first three listed four possible options, labeled A through D, 

with A indicating pain that was insignificant and D indicating pain that 

was severe. For the first two questions, the doctor placed a mark 

between the C and D options, indicating that the claimant's level of pain 

was between "distracting" and "virtually incapacitating." In the third 

question, about whether any medications would produce side effects 

limiting work, the doctor circled C, indicating the patient could 

experience limitations due to "distraction, inattention, drowsiness, etc." 

The form provided no other information about the source of the pain. 52 

52 In the Subcommittee's interview with Roanoke, Virginia Hearing Office Chief Administrative 

Law Judge Thomas Erwin, he indicated this form was originally created by one of the disability 

attorneys that frequently appears before ALJs in the office representing claimants. Other 

claimant representatives were now utilizing this form to provide proof of a claimant's pain. 
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35 

After calling the hearing to begin at 8:44 a.m. the following morning, on 

January 7, Judge Intoccia entered the "pain assessment" form from the 

claimant's doctor into the record. After directing questions to the 

claimant, Judge Intoccia asked the vocational expert (VE) a single 

hypothetical that involved the new piece of evidence: 

Let's assume a hypothetical individual, same vocational 

profile as during the period at issue. Let's assume that such 

an individual could perform a full range of sedentary work 

activity and then let's superimpose on top of that the pain 

assessment by Dr. [] otherwise set forth at Exhibit 5F, dated 

116/2010. Ifwe superimpose those non-exertionallimitations 

by the pain on top of the full range of sedentary work 

activity, could someone under those facts and circumstances 

go back to any of those three jobs or any other jobs? 

The VE replied, "No, sir, neither." 

The judge then turned to the medical expert present for an evaluation of 

the doctor's "pain assessment." The medical expert explained that the 

pain assessment from the day before showed the claimant, who was 

present for the hearing, had pain that was "intractable and virtually 

incapacitating." The medical expert interpreted the assessment as 

yielding a more severe diagnosis even than the claimant's doctor that 

indicated: 

Well, on [claimant doctor's] pain assessment he, on the first 

and second factor he gave a, a C and aD. D says pain is 

present and found to be intractable and virtually 

inc[ap]acitating to the individual. On the, the second factor 

he also listed a C and aD. D says the increase of pain to 

such an extent that bed rest and/or a medication is necessary 

upon physical activity. And then the third factor, he 

indicated a, a C evaluation. To what extent will side effects 

impact upon the ability? The drug side effects can be 

expected to be severe and to limit effectiveness due to 

distraction, inattention, and drowsiness, etcetera. So that 

would preclude employment. 

It appears the medical expert mischaracterized what the document said. 

While he noted that the doctor circled both the C and D options on the 

form for the first two questions, he only explained the more extreme 

pain description found in D. In reality, the doctor had clearly placed a 

mark between the two options, seemingly in an attempt to split the 

difference, although he did not provide any written explanation of what 

he meant. The meaning of the document was also ambiguous because it 
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36 

was little more than a basic questionnaire containing no original analysis 

from the treating physician. Had the evidence not been created, 

submitted, and analyzed in less than 24 hours, it might have allowed 

more opportunity for the medical and vocational experts to review it and 

contact the doctor for an explanation, leading to a more informed, and 

perhaps different conclusion. 

At the hearing, however, after receiving the medical and vocational 

expert testimony, ALJ Intoccia immediately concluded the proceedings 

by announcing, "after review of the available evidence of record it 

appears that a wholly favorable Bench Decision can be issued in this 

particular claim." In a bench decision the judge announces his decision 

at the hearing in the presence of the claimant, which is followed 

typically by a brief written statement sent in the maiL His bench 

decision concluded the claimant met vocational listing 201.06, which he 

"based on VE testimony." Listing 201.06 finds someone is disabled if 

they are "limited to sedentary work" for a severe impairment, but also 

are past the age of 55 and do not have "transferable" skills. 

Oklahoma Case 105. Judge Wayne Falkenstein awarded ssm and SSI 

benefits to a man alleging chronic knee pain based on knee surgery that 

occurred in 1984, shoulder pain, coronary artery disease, and obesity. 

During a brief ALJ hearing, the claimant was not asked a single medical 

question about his ailments, and the attorney told the judge several times 

that he was unsure the medical evidence was sufficient to qualify for 

disability. Yet, using a hypothetical scenario discussed with the medical 

expert and a vocational expert, the judge found the claimant disabled 

under the agency's Medical-Vocational Rules. 

Medical Evidence of Record. The claimant's sparse medical records 

consisted only of notes from a hospital visit on August 5, 2006, and a 

2007 consultative examination performed at the request of DDS 

following his application. 

Notes from the 2006 hospital visit described the claimant as "a 49 [year] 

old who complains of chronic left knee [following] surgery in 1984 and 

right shoulder pain, no [history] of injury." The claimant stated that he 

used no over-the-counter medications for his pain, but was prescribed 

Naproxen, if needed, for pain relief. The physician noted that the 

claimant's "left knee without inflammation or deformity, no effusion + 

good ligament stability, scar consistent with [history]. Right shoulder 

+TTP, no deformity noted. Decrease [range of motion]." 

The physician's findings in the consultative exam performed in March 

2007, with regard to the claimant's allegations of knee and shoulder 

pain, noted: 
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37 

The patient is able to walk without an artificial device. The 

patient's gait is normal, safe, and stable. The patient can do 

heel walking normally. Toe walking is weak. Straight-leg 

raise test is negative on both sides.... Motor strength is 5/5 

in the quadriceps and hamstrings. Dorsiflexion and plantar 

flexion of the feet are in the normal range. Cervical spine 

with flexion, extension, lateral flexion and rotation is within 

normal limits. Dorsolumbar flexion, extension and lateral 

flexion is decreased associated with pain and stiffness. Hip 

joints with internal rotation, external rotation, abduction, 

adduction, forward flexion and backward flexion are within 

normal limits associated with some stiffuess without any 

significant pain. Knee joints with flexion and extension are 

within normal limits bilaterally. 

There is pain and stiffuess on the left side, only stiffuess on 

the right side.... Shoulder joints with forward elevation, 

abduction, adduction, external rotation and internal rotations 

are within normal limits bilaterally.. .. By palpation, none of 

the joints are tender. There is no swelling or erythema noted 

in any of the joints. 

Initial Application. The claimant submitted his initial application for 

benefits on July 9, 2007. DDS reviewed the claimant's application for 

both ssm and SSI based on diagnoses of "os teo arthrosis and allied 

disorders" and "disorders of back discogenic and degenerative." 

DDS denied the claim at initial application on September 10,2007, and 

explained: 

The claimant is a 50 year old male with a 12th grade 

education. He alleges knee and back pain. The claimant's 

impairments have been determined to be non-severe in 

nature. His consultative examination revealed that he has full 

range of motion in both upper and lower extremities. He is 

[status post] arthroscopic surgery from 1984, with no 

inflammation or effusion. Right shoulder had TTP, 

decreased [range of motion] with abduction. [Activities of 

daily living] are not limited to pain. 

The claim was again denied on November, 13,2007 after 

reconsideration, which explained its decision by noting: "He has 

no recent [testing]. He is on no med[ication]s, according to his 

3373. He has no recent [doctor] visits .... He drives, shops in 
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38 

stores, cooks 3 meals per day. After review ofthe medical 

evidence, this case appears non-severe." 

ALJ Hearing. On February 11,2009, nearly two years after the date of 

his last known medical appointment, the claimant appeared for a hearing 

before Judge Falkenstein. In the interim period, no new medical 

evidence ofthe claimant's condition was provided. 

At the start of the 12-minute hearing, Judge Falkenstein asked the 

claimant's attorney, "what's your theory on how you're going to win." 

The claimant's attorney responded: 

[W]ell, that's a good question, Your Honor. I don't, I don't 

know if, ifthe, you know, if you feel that an orthopedic 

evaluation would, would help. Or I know that's not, you 

know, necessarily, you know, your duty of that but I know we 

are really lacking in the medical [emphasis added]. 

The Judge immediately turned to the medical expert present at the 

hearing, who opined: "[T]here's nothing here that I can marshal that 

would meet or equal a listed impairment." The ALJ then questioned the 

vocational expert regarding available jobs for the claimant. The VE 

found, under the limitations expressed by the judge, the claimant had no 

skills that were transferrable to the type of work the claimant could 

perform. With regard to the type of work the claimant previously 

performed, the VE found that "jobs utilizing transferable skills would 

not be appropriate." The VE went on to say "in looking at unskilled 

work [the hypothetical person based on the claimant's alleged 

limitations] suggests a full range of sedentary work and a reduced range 

oflight, unskilled work." The VE went on to agree with the AU that 

"there are no skills transferrable to sedentary" work. 

The judge then asked the claimant's attorney "how do you think you 

stand?" The attorney replied 

ATTY: [W]ell, your honor, I know the medical, you know, 

evidence is, is weak, you know. It's, may not even 

support a medically determinable, determinable 

problem. I know that - well, it's, you know, it's old, 

what, I think, oh, a couple of years since he's been 

there and had any treatment and 

AU: Record closed. 

The transcript shows that the AU interrupted the attorney, closed the 

record, and awarded benefits. 
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39 

In his decision, issued on March 4,2009, the ALJ wrote: "[T]he 

claimant has the following severe impairment(s): degenerative joint 

disease, status post left knee surgery, coronary artery disease, and 

obesity." No medical evidence in the record mentioned degenerative 

joint disease and the only reference to coronary artery disease called it 

"mild coronary artery disease without significant symptoms" rather than 

"severe." 

To support his decision, the Judge cited the testimony of the medical 

expert to determine the claimant could only perform sedentary work and 

wrote that "the vocational expert at the hearing stated [the claimant's] 

capabilities essentially limited the claimant to sedentary work. [emphasis 

added]." The judge concluded: "[C]onsidering the claimant's age, 

education and work experience, a finding of 'disabled' is directed by 

Medical-Vocational Rule 201.14," or the vocational grid. Essentially, in 

this case, the judge cited the medical and vocational expert testimony to 

justify a decision that had virtually no medical support in the case file. 

Oklahoma Case 104. In this case, Judge Lance Hiltbrand awarded SSI 

benefits to a claimant based on "deafness in both ears, degenerative joint 

disease of the right hip, degenerative disc disease ofthe cervice and 

lumbar spine, bilateral carpal tunnel and hypertension." In his opinion 

explaining the decision, he put significant weight on the testimony of a 

vocational expert at his hearing. The hearing transcript discloses, 

however, that the judge asked the VE only one question, based upon a 

hypothetical situation that was not supported by the medical evidence. 

The VE, who is not trained or expected to ensure that a hypothetical 

matches the circumstances of the actual claimant, opined under the 

hypothetical scenario given that the person would be unable to perform 

work. 

On April 4, 2008, the claimant filed for ssm and SSI benefits, alleging 

that her disability began at various times between 1999 and 2003. At the 

ALJ hearing, she asked that her onset date be amended to the date of her 

application - April 4, 2008 - due to a lack of medical evidence prior to 

2008. Because she was not insured for SSDI benefits through that new 

date, however, she was, technically, not eligible for ssm benefits. 

Prior to reaching the ALJ level, however, both the SSDI and SSI claims 

were denied by DDS on August 1, 2008, due to insufficient medical 

evidence. In the SSI denial, the agency explained, "We have determined 

that your condition is not severe enough to keep you from working." 

While the claimant suffered a degree of deafness, it began when she was 

a child and had not prevented her from working. The ssm denial 

concluded, "your condition was not disabling." In its Explanation of 
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40 

Determination, DDS wrote that the claimant, "has a RFC for a wide 

range oflight work with limited hearing.... She can communicate with 

coworkers and supervisors.... Vocational Rule 202.11 directs a 

decision of not disabled." 

On September 17, 2008, the claim was again denied, this time under 

reconsideration, which DDS explained in the following way: 

We have determined that your condition was not disabling on 

any date through 3/3112008, when you were last insured for 

disability benefits .... Your arthritis causes you some pain 

and discomfort; however, you can still move well enough to 

do some types of work. With hearing aids you can hear well 

enough to work injobs that do not require perfect hearing. 

Medical evidence does not show any impairments which 

keep you from working. 

The claimant, a 54 year-old woman, testified she had moved from 

California to Oklahoma so her sister could care for her. She explained 

that her disability required her sister to take complete care of her, and 

her sister did all the cooking, cleaning, yard work, laundry, driving, 

shopping, and caring for their dogs. However, in medical records from 

August 26, 2008, she told her doctor she: "Moved to Oklahoma 8 

m[onths] ago to take care of her mother who had a stroke." Her SSA 

Form 3368, dated April 4, 2008, filled out by disability claimants, also 

explained that, "I stopped working because I came to OKC. And the 

pain." 

The claimant also alleged disabling hearing loss. However, in doctor 

notes from May 20, 2008, the physician noted that the claimant had 

some hearing ability: "The patient states that she was born deaf but 

states that she reads lips very well; however, throughout the examination 

I noticed on multiple occasions that she seems to hear me without 

looking at my face, but when we are further away from each other she 

does have a significant amount of difficulty hearing me and I have to 

repeat myself on several occasions." 

DDS sent her for a hearing test and the resulting consultative exam 

record from July 17,2008, stated she had worn hearing aids since the 

age of21 due to hearing loss beginning at age five. The consultative 

examiner found her "hearing aid on the right is non functional" and "her 

present hearing aid on the left is approximately eight or nine years old" 

and "was not functioning real well." He used a stock hearing aid from 

the office and put it into her right ear, observing, "You will notice that 

she got much better function from her stock aid on the right than with 
130 

41 

her own hearing on the left." The examiner concluded, "She basically 

needs new binaural hearing aids." 

Judge Hiltbrand held a hearing for the claimant on August 18,2009, at 

which the claimant asked that her disability onset date be amended to 

April 4, 2008, the date of her application. Her attorney explained to the 

judge, "As you can see from the record, we don't have any medical 

going back." Judge Hiltbrand responded, "Okay. So, we're looking at 

basically from May the 21 st 2008 to the present .... " 

During the hearing, the woman explained that when she was working in 

2005, she stopped working because she, "stepped offthe back of a 

ladder and whatever I did, I really didn't hurt myself, but I guess I did 

because after my hip really started hurting a lot and my back. And so 

and I really I wanted to leave California and come back to Oklahoma 

and live with my family. So, I quit [the job] and moved back to 

Oklahoma." The judge asked if she received workers compensation for 

the fall, but she responded, "I never even went to the hospital, the 

doctor." 

She continued to explain to the judge that she was currently living with 

her sister, who "just recently got on" Social Security Disability as well. 

Her sister, she said, took care of her to such an extent that she even had 

to help her dress in the morning, including pulling up her pants. When 

the judge questioned how the sister could do this with her disability, the 

woman responded, "You know she's dealing with hers quite well." She 

added that her sister did her laundry and was the "worker in the house." 

In his September 9, 2009, fully favorable decision, ALI Hiltbrand 

disagreed with the DDS determination regarding Vocational Rule 

202.l1, which should find the claimant "not disabled." He based his 

disagreement on the testimony of the vocational expert at the hearing. 

The testimony ofthe vocational expert, however, was based on a 

hypothetical created by the judge that was not based on evidence in the 

medical record. fn the hypothetical, the judge described the claimant's 

various conditions, but added the assumption the claimant would 

experience "a mild to severe level of fatigue and discomfort affecting 

her ability to work in a competitive environment." This fatigue 

symptom was not mentioned or supported in the available medical 

evidence in the case file. 

Moreover, in the same July 2008 document generated by a DDS doctor 

used by the judge to identifY and support restrictions on the claimant's 

ability to lift, sit and stand, a separate section called "Postural 

Limitations," contained no limitations on the ability of the claimant to 

engage in a variety of physical activities. This section provided options 
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42 

for a DDS physician to identifY any limitations with respect to climbing, 

balancing, stooping, kneeling, crouching, or crawling. When presented 

with the option for each activity to select whether the limitations were a 

factor "frequently," "occasionally" or "never" - the examiner chose 

"None established." The document did not refer to any issues involving 

fatigue or discomfort. 

During the hearing, Judge Hiltbrand offered the following hypothetical 

to the vocational expert to analyze: 

ALl: Assume a hypothetical the same education and work 

experience as that ofthe claimant has the following 

exertional and nonexertionallimitations, which I will 

give you at this time. This hypothetical individual 

can occasionally lift and carry objects no more than 

20 pounds, frequently lift or carry objects up to 10 

pounds, stand and/or walk at normal pace, six hours 

in an eight-hour workday and sit with no breaks for a 

total of six hours in an eight-hour workday. As to all 

postural limitations as to climbing, balancing, 

kneeling, crouching and crawling, all those are 

going to occasional. She is going to have limited 

hearing. She should avoid loud background noises. 

She may have difficulty hearing, dealing with the 

general public, or working on the telephone or 

dealing with people on the telephone. As to 

environmental limitations as to any loud noises, 

avoid concentrate exposure and experiences a mild 

to severe level of fatigue and discomfort affecting 

her ability to work in a competitive environment. 

Based on-these exertional, non-exertionallimitations 

can this hypothetical individual perform any of her 

past relevant work as she previously performed it or 

how it shall be performed in the national and 

national economy, please? [emphasis added] 

VE: No, Your Honor. 

ALl: Okay. Any other work? 

VE: No, Your Honor. 

The judge based his decision to award benefits in large part on the VE's 

testimony. His opinion did not address the contradictory medical 

evidence in the record or perform a credibility analysis of the claimant's 

testimony. 
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43 

Moreover, the judge did not address the credibility of her testimony that 

her disabled sister was capable of meeting all of the claimant's physical 

needs, including dressing and feeding her. Finally, he found her 

disabled beginning in April 2008, despite the fact that he mentioned 

during the hearing that the relevant medical records were dated from 

May 2008, the following month. 

B. Questionable Hearing Conduct and 

Use of Hearing Evidence 

Administrative Law Judges determine some of the most challenging 

disability cases that come before the Social Security Administration. By 

the time a case reaches an ALJ, claimants have already been denied 

benefits, in most states twice. Hearings provide an opportunity for 

claimants to make their case personally before an impartial judge. They 

also allow the judge to get answers to questions about potentially lacking 

or conflicting evidence, whether a claimant is credible, or whether a 

condition has worsened. 

Similar to other judicial venues, the ALJ hearing is not simply an 

informal meeting between the agency and a claimant. Rather, hearings 

are intended to be run as judicial proceedings that allow claimants the 

opportunity for due process and for the judge to obtain all relevant facts. 

SSA guidelines are clear: "The ALJ must inquire fully into all matters at 

issue and conduct the administrative hearing in a fair and impartial 

manner.,,53 

During an interview, SSA's Chief ALJ, Debra Bice, was adamant about 

the high standards applicable to the conduct of disability hearings. 54 

When asked about how to conduct a good hearing, she reiterated what 

she described as her constant message to ALJs: "Don't abdicate your 

role as judge." She said that disability ALJs were responsible to "know 

the law" and "know your case" well enough to "provide a full and fair 

hearing." She added that she instructed the judges: "Don't just look at 

the physician's records and pay a case." 

The role of the judge at the hearing, she went on, is to ask questions that 

present the issues in the case: "Claimants should get a chance to tell 

53 SSA identifies the elements of a hearing as an introduction; an opening statement; oaths or 

affirmations; adducing the evidence; receipt of oral testimony; presentation of written or oral 

argument; and a closing argument. Each of these elements of the hearing is accompanied by 

detailed procedures. Social Security Administration. HALLEX 1-2-6-1. Hearings - General. 

http://www.ssa.gov/OPHome/hallex/I-02/1-2-6-I.htm!. 

54 Subcommittee interview ofSSA Chief Administrative Law Judge Debra Bice (8/312012). 
133 

44 

their story." With few exceptions, a good hearing takes 45 to 60 minutes 

to conduct, sometimes longer, according to Judge Bice. 

Asked about extremely short hearings, Judge Bice responded that there 

are "serious problems with a three minute hearing." She indicated that 

short hearings can erase the appearance, if not the reality, of a process 

that is independent and impartial, making them look instead like 

stagecraft. Moreover, she added, "If a claimant doesn't speak, that's not 

a hearing." 

The chief judge spoke even more strongly about the problem of judges 

having off-the-record conversations with claimant representatives, 

calling it a matter of ethics. While making provision for the way judges 

and representatives can develop friendly relationships after years of 

seeing each other on a regular basis, she stressed the importance of 

maintaining professionalism. "My policy is you don't want to talk to a 

representative anywhere outside of a hearing room. ALJs should not go 

offthe record," explained Judge Bice. In Federal courts, such off-therecord conversations are considered ex parte meaning a conversation 

between ajudge and only one of the parties involved - and a violation of 

the code of conduct for United States Judges.55 Despite SSA hearings 

being set up as "non-adversarial" proceedings involving only a single 

party, off-the record conversations threaten the impartiality of the ALl 

hearing and render the hearing record incomplete. 

Chief Judge Bice told the Subcommittee that, at all times, ALls need to 

"make sure they are impartial" in fact, while also "presenting 

impartiality." In particular, she warned that judges and claimant 

representatives should not meet prior to hearings to talk about cases, a 

practice she called, "very dangerous." "Very rarely should judges call 

representatives to talk on the phone" about cases, she explained, 

insisting that it only take place when there is no other option. Citing an 

example of something even more off-limits, Judge Bice said judges 

"shouldn't be having lunch with representatives." 

The Subcommittee investigation found that in a significant number of 

the 300 cases it reviewed, ALls held hearings that failed to meet the 

standards laid out for them by agency rules and Chief Judge Bice. 

Problems included perfunctory hearings that were less than 15 minutes 

long, including some that lasted only three minutes. In some hearings, 

the transcript showed that the ALl did not ask the claimant a single 

medical question. In others, the ALl turned over all questioning to the 

55 See United States Courts, Rules and Policies, Codes of Conduct for United States Judges, 

Canon 3: A Judge Should Perfonn the Duties of the Office Fairly, Impartially, and Diligently, 

ht1p:llwww.uscourts.govlRulesAndPolicies/CodesOfConductlCodeConductUnitedStatesJudges.a 

spx. 
134 

45 

claimant's representative. In those cases, the judge rarely crossexamined the claimant or asked follow-up questions to clarifY the 

answers. In many cases, the judge did not address or resolve issues 

involving conflicting evidence in the case file. In some cases, the judge 

issued a decision citing evidence that was either not in the case file or 

was directly contrary to the records or hearing testimony that did exist. 

In one instance, a judge appeared to coach a claimant about how to get 

higher benefits by making his financial condition look worse than it was. 

Still other hearing transcripts mentioned off-the-record conversations 

between judges and attorneys that were never explained on the record. 

The following cases illustrate some ofthe troubling practices identified 

during the investigation. 

The problem encountered most frequently by the Subcommittee was that 

of short hearings in which the ALl failed to properly address the 

relevant issues. In Oklahoma Case 148, for example, the claimant 

alleged a disability related to depression and anxiety. On March 21, 

2007, she was sent for a mental evaluation to determine whether she met 

the criteria for medical listing 12.04, related to "affective mood 

disorders." While the examining doctor found she did have some 

moderate mental impairments, the claimant's condition was determined 

to be non-severe and not to have met the listing criteria. After a fiveminute hearing on June 16,2008, however, ALl Wayne Falkenstein 

awarded benefits to the woman. The judge opened the hearing by asking 

the claimant only three questions, each to obtain administrative details 

about her birthdate, home address, and level of high school education. 

He then turned to a medical expert, who had not personally examined 

the claimant, asking for a review of the medical file. The medical expert 

said the claimant met the medical listing for 12.04, and without further 

questions the judge closed the hearing. 

Oklahoma Case 153 is a case involving a woman who alleged crippling 

hand pain from carpel tunnel syndrome, yet also worked as a bartender. 

One doctor found she had "adequate dexterity" with her hands and 

fingers; another described her as disabled. ALl Wayne Falkenstein held 

a 17-minute hearing which failed to address the conflicting medical 

evidence. Moreover, most ofthe time in the hearing was spent trying to 

call a medical expert whom the judge had asked to testifY by telephone. 

After several wrong number attempts, he sent his assistant to find the 

number. When the correct number was eventually found, the judge 

spoke briefly with the expert and closed the hearing. 

Virginia Case 267, decided by ALl David B. Daugherty, involved a 

hearing that lasted only three minutes, from 9:18 a.m. to 9:21 a.m. The 

claimant alleged back pathology, shoulder arthritis, left knee arthritis, 
135 

46 

depression, and anxiety, and was examined on October 21, 2007. A 

consultant's report from the examination states: 

The number of hours the claimant could be expected to sit, 

stand and walk will be 4 to 5 hours in an 8-hour workday 

with normal breaks. The claimant does not require any 

assistive devices for ambulation. The amount of weight the 

claimant could lift and carry is 15 to 20 pounds frequently. 

Slight limitation in bending, stooping, crouching and 

crawling. No limitations in reaching, handling, fingering or 

grasping. No other relevant visual, communicative, 

workplace or environmental limitations. 

This and other medical evidence weighing against the claimant was 

dismissed by ALI Daugherty. Instead he based his favorable decision 

on a checklist form filled out by a doctor (Doctor One), apparently at the 

request of the claimant's attorney. On July 22, 2008, at his three-minute 

hearing, Judge Daugherty elicited evidence to support Doctor One's 

characterization of the claimant's limitations and at one point had to 

remind the claimant that he had seen Doctor One. The following is the 

hearing testimony in its entirety. 

ALJ: Mr.--

CLMT: Yeah. 

ALI: -- my name is David Daugherty and I'll be judge for the 

hearing. All right, Bill do you have any objections to me 

admitting the exhibits. 

REP: No, Your Honor. 

ALI: Okay, so you would admit all of the exhibits. 

ALI: Now, Mr. [NAME REDACTED], raise your right hand 

and I'll swear you in. You, too, [VOCATIONAL 

EXPERT] 

ALI: Mr. [NAME REDACTED], what are your primary health 

problems; what keeps you from working? 

CLMT: I was born with scoliosis; I have pain, anxiety, and 

depression. 

ALI: High blood pressure? 
136 

47 

CLMT: Yes. 

ALJ: You have pain every day? 

CLMT: Yes. 

ALJ: Pain right this minute? 

CLMT: Yes. 

ALJ: Who's your doctor? 

CLMT: [DOCTOR Two] and [Doctor Three]. 

ALJ: You seeing Doctor One? 

CLMT: Yes. 

ALJ: Okay, let the record show that I'm trying to find some 

information (INAUDIBLE). 

[VOCATIONAL EXPERT SWORN IN] 

ALJ: MR. [NAME REDACTED], as a result of this claimant's 

impairments (INAUDIBLE) is limited to lifting 10 pounds 

occasionally, less than 10 pounds frequently; he can stand 

and/or walk less than three hours a workday; sit less than 

three hours in a workday; never climb, crouch, crawl or 

kneel. How does the combination of those limitations 

affect his ability to work and hold down a full-time job? 

VB: (INAUDIBLE). 

ALJ: I agree with that. I'm going to write a favorable decision 

(INAUDIBLE). You may be excused. 

ATTY: Thank you, Your Honor. 

The differences between the medical evidence in the file and hearing 

testimony as presented by the judge are difficult to reconcile. The 

consultant's examination report in the case file states the claimant could 

lift "15 to 20 pounds frequently," but at the hearing the judge said the 

claimant could lift "10 pounds occasionally, less than 10 pounds 

frequently." The consultant's examination report states the claimant 

could "stand and walk ... 4 to 5 hours in an 8-hour workday with normal 

breaks"; the judge said the claimant could "sit less than three hours in a 
137 

48 

workday." The consultant's examination describes a "[s]light limitation 

in bending, stooping, crouching and crawling," but the judge said the 

claimant could "never climb, crouch, crawl or kneel." The hearing 

record and subsequent written opinion contain no explanation for the 

judge's recitation of facts that contradict the contents of the case file. 

Oklahoma Case 151. During another hearing, ALJ Peter Keltch 

appeared to coach a claimant about how he might increase the amount of 

his benefit check by saying that he was renting a room from his partner, 

rather than living there for free. The judge gave this advice before he 

knew the claimant's living arrangements, raising questions about his 

impartiality and adherence to program rules in this instance. 

In addition, this case raises concerns about how the judge justified 

awarding ssm benefits to a claimant who could not establish the onset 

of his disability during a period in which he was insured. The primary 

issue needing resolution at the hearing involved whether the claimant's 

disability onset date occurred prior to the claimant's "date last insured," 

or DLI. Anyone found to have become disabled after his or her DLI 

does not qualifY for ssm benefits. 56 

The claimant applied for disability benefits based on symptomatic 

human immunodeficiency virus (HIV) infection. 57 He alleged a 

disability onset date of April IS, 2003, nearly two years before his DLI 

of March 31, 2005. The claimant provided, however, medical records 

supporting his claim of disability dated no earlier than 2007, two years 

after his DLI. 

DDS Review a/Claim. DDS determined that the claimant had failed to 

prove he was disabled before his DLI. Upon reconsideration of the 

initial application, DDS sustained the denial and sent the claimant a 

letter explaining: 

We have determined that your condition was not disabling on 

any date through 03/31/05, when you were last insured for 

disability benefits.... [Y]ou said that you were unable to 

work because of acquired immune deficiency syndrome, joint 

pain with neuropathy, asthma, allergies, and anxiety. The 

medical evidence shows the following: Although you 

56 Someone that does not qualify for ssm, for example due to a DLI problem, could still qualify 

for SSI, assuming they meet the resource and disability requirements. 

5) While many individuals with HlV infection have a condition that prevents them from being 

able to work, an HIV diagnosis alone does not guarantee an award of benefits. As with other 

impairments, the allegations must meet program requirements. Therefore, individuals with HIV 

infection who are asymptomatic or who have less severe HIV manifestations, may not meet 

program requirements to be awarded benefits. 
138 

49 

sometimes had problems with asthma and allergies, you were 

able to breathe adequately most of the time. While your joint 

pain and neuropathy caused discomfort, you could still move 

around and walk well enough to do some types of work. 

Your anxiety kept you from doing stressful and complex 

work, but you could do simple, routine work. Although you 

tested positive for HI V, the medical evidence does not show 

any other impairments which kept you from working on or 

before the date you were last insured for disability benefits. 

ALJ Review of Insured Status. The hearing transcript shows that ALJ 

Keltch was well aware of the disability onset issue. In fact, the judge 

stated: 

I'm showing here the date last insured of March 31, 2005. 

So, you're not currently insured from Disability. So, you 

apparently stopped paying in the first quarter in 2000. I don't 

have any record of any payments in and then that means that 

your insurance expired March 31st of2005, which is fine if 

you are disabled as ofthe date you said, which was April 15, 

2003. So, if you're actually disabled in '03, then you still 

had coverage. However, if I find that you were not disabled 

until 2006, '07, '08, '09, sometime later, then you wouldn't 

have any insurance coverage. 

Judge Keltch made clear that he needed to find the claimant disabled 

prior to March 31,2005, the claimant's DLI. No medical evidence in 

the file, however, supported such a finding. Medical evidence from a 

treating physician stated that the claimant had been "his patient since 

2004," but made no mention of disabling health issues dating that far 

back. The statement by the physician only confirmed the claimant was a 

patient; it made no mention of a disabling condition. Medical evidence 

from another doctor stated the doctor saw the claimant five times in six 

months between October 2008 and February 2009, but those dates were 

long after the DLI expiration date. While both doctors stated the patient 

was currently disabled, neither doctor provided evidence of disability to 

support the alleged onset date of2003. 

A medical treatment note dated August 16,2007, noted that the 

claimant, a hairdresser, complained he was in such pain that "he cannot 

even finish one person's haircut." This note was again, after the DLI. It 

also indicated the claimant was working until at least 2007, which the 

judge did not ask about during the hearing. Another treatment note 

dated January 19,2009, a date that is, again, years past the DLI, reported 

"his symptoms are improving." One of his doctor's noted, "chronic pain 

syndrome is nearly controlled at this point." 
139 

50 

Despite the lack of medical evidence establishing the disability onset 

date, Judge Keltch found the claimant disabled beginning April 2003, 

the claimant's alleged onset date, and well before his DLI, making him 

eligible for disability benefits. His opinion did not explain the basis for 

that onset date. 

ALl Coaching a/Claimant. A second set of issues involves the judge's 

conduct during the hearing, when Judge Keltch appeared to coach the 

claimant on how to secure a higher monthly disability check than he 

may have been entitled to. The hearing transcript shows how Judge 

Keltch advised the claimant, who had no income and lived rent-free with 

his partner, in the following way to receive full benefit checks each 

month. 

Judge Keltch: Do you have income from any source? 

Claimant: No. 

Judge Keltch: How are you living? 

Claimant: [My roommate] supports me. He buys my 

medications. 

Judge Keltch: If you get your benefits do you and [your 

roommate] have an agreement that you're 

going to pay [your roommate] back some 

money? 

Claimant: Yes, sir. 

Judge Keltch: I'll tell you and a little secret about that. If 

you go in, if you're approved and they say 

now where've you been living and if you say 

I've been having a free apartment, they say oh 

well we'll deduct a third off of your benefits 

because you didn't have any rent to pay. But 

if you go in and say I've been living with a 

friend and I'm going to pay him back, then 

they give you the full check. I mean it's 

between you and him to pay him back ifhe's 

been paying the rent and bills. 

Claimant: Yes, sir. 

Judge Keltch: If you go in there and say well I've just been 

provided a place to stay and they say oh well 

for Supplemental Security Benefits then you 

don't get it, or the check. 

Claimant: Yes, sir. 
140 

51 

Judge Keltch: You knew that didn't you (to claimant's 

attorney)? 

Attorney: Yes, sir. 

While the claimant and attorney responded affirmatively when Judge 

Keltch asked if the claimant had an agreement to pay a portion ofthe 

rent to his roommate, even the suggestion ofthe judge to advise the 

claimant on how to maximize his monthly benefit payments potentially 

violated the ALJ's obligation to remain impartial. 

Oklahoma Case 102. ALJ Ralph L. Wampler awarded ssm and SSI 

benefits to a 26 year-old woman who alleged that she was disabled 

because she had poor reading and spelling skills as well as a learning 

disorder. The claimant supported her allegations with statements on her 

application documents, but the case file contained no objective medical 

evidence to support her claim. Judge Wampler held a three-minute 

hearing during which he questioned the medical expert regarding 

whether the claimant met a medical listing 12.05 for mental retardation. 

In response, the medical expert indicated that the claimant did not meet 

all ofthe listing criteria in l2.05(D). Despite this testimony, Judge 

Wampler ended the hearing, awarded benefits under listing 12.05(C), 

and wrote that the award was supported by the expert's hearing 

testimony, even though the expert had not discussed 12.05(C). 

Initial Application and Reconsideration. When the claimant first 

applied for benefits, DDS requested a consultative exam be performed. 

The evaluator that performed the Mental Residual Functional Capacity 

examination found the claimant was "markedly limited" in her ability to 

understand and remember detailed instructions, as well as in her ability 

to carry out detailed instructions. The evaluator found the claimant "can 

perform only simple tasks with routine supervision [and] can relate on a 

superficial work basis." 

DDS also had a psychiatric review technique performed. The evaluator 

found: 

26 years old alleges poor reading, spelling, developmental 

delay and learning disorder. No known mental health 

treatment past or current. CE exam shows verbal scores of 

66, performance of 78 and full scale of69. Claimant 

retain[ s] ability do simple work. 

The evaluator noted the claimant had a "12th grade education attended 

special education throughout school year, alleges poor spelling skills, 

poor reading, developmental delay and learning disability. No medical 

sources provided by claimant." 
141 

52 

The psychological evaluator met with the claimant and determined: 

Affect and behavior were observed to be fairly talkative, 

fidgety and serious. She was cooperative with the examiner. 

Attention was focused. Effort and motivation were good. 

Results are interpreted as being valid. Observations of 

adaptive behavior and interpersonal style suggest a level of 

functioning that is consistent with the obtained IQ score. 

The examiner's primary diagnosis was that the claimant had a learning 

disorder; there were no other diagnoses of note. The examiner noted the 

claimant had four children and was pregnant with her fifth. He noted the 

claimant's "medical problems include hypertension .... She is supposed 

to take medication for hypertension but she doesn't." 

The examiner provided no other details as to the claimant's activities of 

daily living or her social interactions. The examiner noted the claimant 

"last worked at a call center for less than one week. The job ended 

because was told she wasn't fit for job." The claimant stated on her 

disability application forms that she primarily stays home and cares for 

her four children with the help of her boyfriend. 

DDS denied the initial application and request for reconsideration. In 

the explanation of determination DDS found: 

26 years old alleges poor reading and spelling skills, 

developmental and learning disorder. Claimant received a 

mental [psychiatric review technique form] and a [medical 

residual functional capacity] assessment for simple work. 

The claimant appealed. 

ALl Hearing. At the hearing stage, Judge Wampler held a hearing 

lasting three minutes. At the hearing, a medical expert testified she had 

reviewed the medical documents in the file. No medical records were 

included in this file, however, except the briefCE report and IQ test 

results of66, 69, and 78. 

The medical expert opined the claimant generally met the criteria of 

Listing 12.05, the listing for mental retardation. A claimant meets the 

criteria of this listing if they meet anyone offour tests, labeled A 

through D. Under 12.05(D), a claimant meets the requirements if a 

single test shows they have an IQ between 60 and 70 resulting in at least 

two of the following: (1) marked restriction of activities of daily living; 

(2) marked difficulties in maintaining social functioning; (3) marked 
142 

53 

difficulties in maintaining concentration, persistence, or pace; or (4) 

repeated episodes of decompensation, each of extended duration.58 

The medical expert testified that the claimant generally met the 12.05 

listing, but under questioning from the judge was able to identify a 

"marked" limitation in only one instead of the listed areas. 

Judge: 

ME: 

Judge: 

ME: 

Judge: 

ME: 

Judge: 

ME: 

Judge: 

ME: 

Judge: 

ME: 

What do[es the medical record] show the claimant 

suffers from? 

This individual has a diagnosis of mild mental 

retardation and a diagnosis of a learning disorder. 

It's my opinion that she meets 12.05. 

12.05. Okay. Now, can you address the B 

criteria? 

Yes, your honor. In restrictions of daily, daily 

living activities, I believe there's a mild 

restriction. 

Uh-huh. 

In maintaining social function, I believe there is a 

moderate limitation. 

Uh-huh. 

In maintaining concentration, persistence, or pace, 

there's a marked to extreme restriction. 

Okay. And then episodes of deterioration? 

I don't have - Your Honor, she's living in a pretty 

restricted environment -

Uh-huh. 

- and, not doing things that are, are causing these 

to occur and don't have any I have very limited 

documentation, actually, but I don't have 

documentation. 

58 Social Security Administration, Medical Listing 12.05(D), 

http://www.ssa.gov/disability/professionalslbluebookl12.00·MentalDisorders·Adult.htm# 12 05. 
143 

54 

Judge: Okay. 

ME: So, I'd just say I don't have enough information. 

The medical expert's testimony established a marked limitation in only 

one area, maintaining concentration, persistence, or pace. After a 

question regarding the duration of the claimant's alleged impairment, 

Judge Wampler stated that he didn't "see a need to of going any 

further," and ended the hearing. 

In his written opinion, Judge Wampler stated that he was awarding 

benefits to the claimant based on listing l2.05(C), which has different 

criteria and was not even referenced during the three-minute hearing. 

His opinion cited the medical expert as having testified that the claimant 

met the requirements of"12.05(C)," even though she had testified about 

12.05(D) and did not find that the claimant met the criteria in that listing. 

While the claimant may well have met the requirements of the 12.05(C) 

listing and should have received benefits, the judge incorrectly cited the 

hearing testimony as support for his finding. 

Alabama Case 73. In 2010, AU Frederick McGrath awarded ssm 

benefits to a 49 year-old veteran for "disorders of the back and chronic 

headaches." Judge McGrath's decision finding the claimant disabled 

relied in part on a perfunctory eight-minute hearing that took place by 

video instead of in person and in which the judge spoke only to the 

attorney, without eliciting testimony from the claimant. The claimant's 

case file contained a number of conflicting medical records, some 

showing a possible disability and others showing he could work. During 

the hearing, Judge McGrath did not discuss any of the conflicting 

evidence regarding his disability, asking only for an opening statement 

from his attorney. 

A review of the records shows the claimant had a history of painful 

headaches, though the same records also show he worked despite them 

for several decades. Complicating the case, his long-term use of 

prescription drugs for the headaches led doctors to raise concerns that he 

overused certain medicines - which one said worsened his condition -

and that he may have been "drug seeking." And while he claimed that 

low back pain kept him from working, a consultative exam more than a 

year after his alleged onset date determined he could do "light work." 

His claim for ssm was denied on October 15,2009, because DDS 

found his medical records showed he was still capable of work: 

You state you are disabled because of degenerative disc 

disease and chronic headaches. The evidence shows you 
144 

55 

have some restrictions and are not able to perform work that 

you have done in the past. However, based on your age, 

education and past work experience, you are still able to 

perform certain types of work. 

On December 14,2009, the claimant appealed the denial and requested a 

hearing with an ALl. 

Medical and Work History. The claimant's medical records showed that 

he had struggled with depression since 1982 and with headaches "since 

he was 15," but also worked for more than three decades with these 

same conditions. A review of the records he supplied to SSA show that 

he complained also of back pain, but that he was never kept from 

working for extended periods oftime. 

Records covering the period 2007 to 2009 indicate that the claimant 

worked off and on at various jobs, despite severe headaches. On August 

17,2007, the claimant underwent a neurological exam for his headaches, 

at which the doctor wrote: "[O]ver the years he has self medicated with 

over the counter remedies including Goody Powders, etc. He reports 

that for the past 15 years he estimates he has taken Goody Powders on a 

daily basis - he can take up to 6 to 18 per day." Regarding the frequent 

headaches, he wrote: "Certainly, medication overuse has been a 

contributing factor." 

During a clinic visit the following week, again for headaches, the 

claimant became agitated when he did not receive the prescription he 

wanted, which the doctor attributed to him being "drug seeking": 

"He was recommended to taper off BC aspirin powders. 

[Another doctor] recommended using Lortab for his 

headache and handed him a prescription of Top am ax. Patient 

states that Topamax prescription has not been beneficial and 

that in fact has caused him numbness to right lower 

extremity. Patient grabbed prescription bottle and threw it 

across the room into the trash can. Patient missed trash can 

and then got up and threw it again in the trash can .... 

I personally feel that this patient is drug seeking and I did not 

feel comfortable with this patient in the room throwing his 

prescription across the room and into trash can. Patient left 

office visit extremely frustrated .... " 

Notes from October 12,2007, showed the claimant continuing to work, 

which he explained was possible because of a Valium prescription. His 

doctor recommended lowering the dose, but noted how the claimant 
145 

56 

resisted: "[H]e is now working in Jacksonville Florida. He is trying to 

find jobs here and there, but he always comes back home to Selma .... 

He reports that as long as he takes [his] medications, his pain is 

relatively well controlled .... We were discussing last time maybe the 

possibility of decreasing the Valium to one a day, but he reports that 

since he has to be traveling so much to work, he feels that the Valium 

will need to be kept at the same dosage." 

A medical progress note from May 8,2008, reported the patient 

complained of back pain, but that, "He was laid off his job so he is 

basically not lifting or carrying anything heavy." Another medical note 

over a year later, from October 12,2009, stated: "Currently he is in so 

much pain that he cannot do a good job at keeping up with his work so 

he quit his job last year and is pursuing on disability benefits." 

Numerous records from the Veterans Administration noted the claimant 

also struggled with cocaine addiction. One from November 21, 2008, 

recorded how, "[Patient] denies cocaine use, but is on VA papers." On 

February 6, March 24, May 19,24 and September 28, 2009, medical 

progress notes state that an "active problem" was "cocaine 

depend[ence]." 

On May 22,2009, the patient visited the VA for an evaluation of his 

"ambulatory status," which would later be a central piece of evidence 

discussed in the short hearing. While the evaluation was described by 

the claimant's attorney during the hearing as containing a "prescription" 

for a walker, the notes show it was the claimant who requested it: 

"Patient arrived clinic ambulatory without assistive device .... 

Prosthetics service issued the claimant a dolomite Four Wheel Rollator, 

as requested." 

Following his application for disability, the claimant underwent a 

consultative exam at the request of DDS on October 12,2009. The 

examining doctor found he "walks [with] obvious pain, limps both ways 

but tolerates it well." The doctor also noted the claimant "would 

definitely benefit using a walker to help [with] balance as well as ease 

[with] walking." 

On October 15,2009, another DDS consultative examiner reviewed the 

claimant's records and called the findings into question, saying his 

"statements about his allegations are partially credible." This examiner 

found that the claimant could perform in the "light work range," or 

several degrees of difficulty more than the "less than sedentary" range of 

work. Also according to this examiner, the applicable vocational rule in 

this case was 202.21, which provided a determination of "not disabled." 
146 

57 

Perfunctory Video Hearing. On August 13,2010, ALl Frederick 

McGrath held an eight-minute video hearing in which he indicated to the 

claimant he would rule favorably. During the brief hearing, the judge 

did not ask a single question ofthe claimant, and only asked the attorney 

for an opening statement. The hearing left a number of issues 

unresolved, including: (1) how to handle records giving conflicting 

accounts of cocaine and barbiturate abuse; (2) whether the claimant was 

fired from his job or quit because of his disability; and (3) how to handle 

the October 2009 consultative exam which found him fit for light work 

and not disabled. 

ALl McGrath opened the hearing by saying, "I note you're going to be 

using a walker today and I note that for the record. I'm going to speak 

to your attorney for a few minutes." He then turned to the claimant's 

attorney for an opening statement. The attorney responded: "Thank 

you, Your Honor. We submit that this gentleman is unable to work on a 

competitive basis due to the pain in his low back, some in his neck and 

of course his chronic headaches. The walker that you mentioned was 

prescribed by the VA on May 22 of '09 .... " He added the claimant "just 

contacted us a couple of weeks ago, and so we haven't had time to 

further develop the case, but ifneed be I'll certainly obtain those 

records." 

Judge McGrath responded; "[I]fhe can't meet the full range of sedentary 

work I'm going to find him disabled. You'll get a decision. Any 

additional records you have available you need to barcode in just so that 

he has a complete record. That concludes the hearing." 

On September 14, 2010, ALl McGrath issued a fully favorable decision, 

finding the claimant disabled for "disorders ofthe back and chronic 

headaches." As in the hearing, the decision did not discuss any ofthe 

unresolved issues or conflicting evidence, as required by program rules. 

Among his findings of fact was that the claimant "has the residual 

functional capacity to perform a limited range of sedentary unskilled 

work," based in part on the use of a walker and because he "is 

illiterate." 

Judge McGrath's finding of illiteracy was not, however, supported by 

the evidence, and even contradicted what little evidence on this issue 

was in the file. The only reference to the claimant's literacy was in a 

consultative exam on August 4,2009, in which the examiner found he 

had no difficulty with reading. 

Alabama Case 72. In 2010, ALl David Horton awarded SSI child 

benefits to a teenage girl a month before her 18th birthday, concluding 
147 

58 

she had several "severe impairments," including "morbid obesity; severe 

degenerative disc disease; diabetes mellitus; and chronic anemia." 

At a 17-minute hearing, Judge Horton explained that he would hold a 

shorter hearing than usual because he wanted to get a decision out 

quickly. He noted that if the decision were issued after her 18th birthday, 

the claimant would also be required to undergo evaluation as an adult. 

Under SSA program rules, this evaluation would require the agency to 

consider whether as an adult she was able to work. Children, in contrast, 

are not required to be evaluated on their ability to work, but only on 

whether they have "marked" limitations in two of six "domains of 

functioning. " 

In this case, the doctors and examiners who evaluated the claimant did 

not find marked limitations in two domains. ALJ Horton determined, 

however, that she had marked limitations in: (I) moving about and 

manipulating objects, and (2) health and physical well-being, and 

awarded her SSI benefits. In his fully favorable decision, Judge Horton 

relied on the claimant's brief hearing testimony to make these findings. 

His opinion did not address conflicting information in the case file; in 

particular, two key pieces of evidence that specifically addressed the 

child's abilities in each of the six domains offunctioning and concluded 

she had mild limitations, but was not disabled. 

One of these records came from her teacher. A March 5, 2009 

assessment from the claimant's lith grade English teacher found the 

child not only had few limitations, but was succeeding in school. The 

teacher, who taught the claimant 1.5 hours each day, completed a 

detailed questionnaire at the request ofthe agency, describing the child's 

capacity in all six "domains." In the two areas found by Judge Horton to 

have "marked" limitations - "Moving about and manipulating objects" 

as well as "Health and physical well-being" - the teacher reported for 

the first "no problems observed in this domain; functioning appears ageappropriate" and for the second, "[n]one of which I am aware." The 

teacher even went on to write: 

Prior to this survey, I had no indication that there was any 

problem with this student. Compared with the "general" 

population of our school, this child's behavior is far preferred 

to that of most students her age. 

The ALJ opinion does not address this evidence. 

The second key record is a consultative examination performed at the 

request of the agency. On March 17,2009, the consultative examiner 

for the agency found marked limitations for the claimant in only one 
148 

59 

domain offunctioning, "Moving about and manipulating objects." In 

the domain of "Health and physical well being," the CE determined the 

child's limitations to be "Less than marked." The ALl dismissed the 

CE's opinion, however, writing later in his decision: 

The State agency medical consultant's assessment regarding 

health and well being is given little weight because evidence 

received at the hearing level shows that the claimant is more 

limited in this domain that than determined by the State 

agency consultant. Furthermore, the State agency consultant 

did not adequately consider the combined effect of the 

claimant's impairments. 

During the hearing, though, ALl Horton asked the claimant only to 

confirm facts already in the medical record, drawing out no new 

information. He began the hearing announcing that he had read the 

materials in the record so that there was little need for a normal-length 

hearing: 

Okay. I'm going to try to keep the testimony fairly short this 

morning because I reviewed the medical evidence pretty 

thoroughly in here. I'm just going to kind of ask you some 

questions about your treatment. I normally like to get 

testimony from just one person at a time, but in this particular 

case, since again I think the medical evidence kind of speaks 

most of what's here, if at some time you need to chime in, 

[Claimant] it's okay, but normally I don't allow that, but in 

this particular case, again, just because I think the medical 

evidence is what it is, I just want to verifY some things in 

here in the quickest way we can get it in there. 

His remarks contain no indication that the file contained conflicting 

information regarding her disability, nor does the judge examine that 

issue during the hearing. 

The ALl hearing concluded after 17 minutes, and the judge issued a 

decision two days later unusually fast compared with other agency 

decision times. Before adjourning, he explained why he was issuing the 

decision so quickly: 

Okay. Both what I'm going to do in a case like this because 

again I pretty well reviewed the medical record is I'm going 

to review it one more time, issue a decision in this case. 

We're going to try to get that decision out fairly quickly since 

your daughter is going to tum 18 here next month. But it 

sometimes takes a little while to get out in the mail and get to 
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60 

you and so forth, but you will get a decision in the next few 

months based on everything that I see in the record. 

And if you should be awarded benefits, one of the things you 

may want to make sure is to take care of any medical needs 

as quickly as possible because should she be awarded 

benefits there'll be an age 18 redetermination coming up very 

quickly. So just keep that in the back of your mind about 

medical treatment and so forth. But anyway, I appreciate you 

all coming out today and giving me your testimony. I hope 

you get doing better because you're awfully young to have 

such severe problems, so again I hope things get going better 

for you, but appreciate it. 

By moving so quickly and disregarding the conflicting evidence in the 

case file, the judge enabled the claimant to obtain SSI benefits under 

criteria designed for children and avoid having to be evaluated under 

adult criteria, as required for all claimants 18 years of age and older. 

C. Improper Application of Medical Listings 

As noted above, in many cases, SSA issues disability benefits based 

upon finding a "medical allowance" at step three of the five-step 

disability analysis. Making an award of disability benefits at step three 

of the sequential process and finding the claimant meets a medical 

listing requires an exact and object level of proof. This is the only step 

in the process where benefits can be awarded solely on the basis of 

medical factors. If an individual is not working and provides proof of 

one of the listed impairments, or an impairment of equal severity, the 

agency will award disability benefits without considering vocational 

factors (i.e., the claimant's age, education, or previous work history).59 

To be found disabled at step three, a claimant must meet the criteria for 

at least one illness on a "Listing ofImpairments," developed by SSA. 

The Listing ofImpairments is broken down into 14 body systems. For 

each "listing," SSA specifies very specific medical criteria that must be 

met before a claimant is deemed to "meet a listing" and qualifY for 

disability benefits. SSA developed these medical listings and more 

importantly, their required elements, to insure disability payments are 

only made for particular conditions under particular circumstances. The 

Listings are also intended to promote national uniformity and 

consistency at all adjudicative levels. 60 

59 Social Security Advisory Board, Aspects of Disability Decision Making: Data and Materials, 

February 2012, 

http://www.ssab.govlPublications/Disability/GPO Chartbook FINAL 06122012.pdf. 60 Id. 
150 

61 

Since the 1990s, the Government Accountability Office (GAO), the SSA 

Office of Inspector General, and Social Security Advisory Board "have 

expressed concerns that the medical listings being used [by SSA] no 

longer provide current and relevant criteria to evaluate disability 

applicants' inability to work.,,61 In fact, in 2003, GAO placed SSA's 

disability programs on the high-risk list "in part because their programs 

continue to emphasize medical conditions in assessing work capacity, 

without adequate consideration of work opportunities afforded by 

advances in medicine, technology, and changes in the labor market.,,62 

In July 2012, GAO noted that SSA has made some progress in updating 

the medical listings for eight ofthe 14 body system medical listings. 

The agency continues to experience delays, however, with the remaining 

six body systems. GAO also noted that two of the six remaining body 

system listings to be updated were mental and neurological disorders, 

which were among the most frequently used in the eligibility 

determination process. GAO also determined that SSA would likely 

miss its targeted time frames for four of these six body systems. 

Therefore, GAO recommended that SSA explicitly identifY the resources 

needed to fund the work needed to complete these updates.63 

Some of the ALl decisions reviewed by the Subcommittee relied upon a 

medical listing to award disability benefits. In a number of those cases, 

the ALl merely provided the listing number and stated that the claimant 

"met the listing" at Step 3 of the sequential decision process, because the 

claimant alleged a particular diagnosis. At times, the ALls failed to 

explain how the objective medical evidence in the case file demonstrated 

that the elements of the particular listing were met. 

A second set of issues involved medical listing 12.05, which identifies 

the medical criteria for "mental retardation." To meet this listing as an 

adult, a person must not only provide evidence such as low scores during 

IQ testing, but must also demonstrate that the condition existed prior to 

the age of22 years old, and that the claimant also had certain other 

limitations restricting the ability to work.64 Frequently, ALJs relied 

heavily on IQ testing results, but failed to demonstrate how a person met 

the age-related requirement or other required limitations. The 

Subcommittee investigation also detected a strange pattern in some cases 

6J Government Accountability Office. Modernizing SSA Disability Programs, Program Made, 

but Key Efforts Warrant More Management Focus, GAO-12-420, July 2012, 

http://gao.gov/assets/600/591701.pdf. 

62 Government Accountability Office, Modernizing SSA Disability Programs, Program Made, 

but Key Efforts Warrant More Management Focus, GAO-12-420, July 2012, 

http://gao.gov/assets/600/591701.pdf. 

63 Id. 

64 Social Security Administration, Medical Listings, 12.00: Mental Disorders, 

http://www.ssa.gov/disability/professionalslbluebooklI2.00-MentalDisorders-Adult.htm# 12_05. 
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62 

in which the claimant applied for disability benefits related to 

musculoskeletal or other physical ailments, but after getting denied and 

obtaining an attorney, applied for and were found to have met the 

medical listing for mental retardation.65 

In an interview with ALl Thomas Erwin, the Hearing Office Chief 

Administrative Law Judge from Roanoke, Virginia, he noted that cases 

like this are difficult. He explained that he sometimes has to take 

additional steps to make sure he has all the information he needs when a 

claimant changes allegation in the middle of the application process. "If 

a claimant says back pain, but suddenly there is a record for depression 

and anxiety from a psychologist, I may send the person for an 

independent exam.,,66 

SSA guidelines allow for an ALl to request an additional consultative 

exam, which will be arranged through the State DDS office.67 By going 

through the DDS office, this reduces the chances any interested parties 

might sway the results for or against the claimant. Judge Erwin noted 

that some attorneys will try to provide a "store bought opinion," which 

he said were more frequent for mental exams than for physical exams. 

"If it's clear the attorney just sent the person out, my Spidey sense goes 

off a little," he added. 

Oklahoma City ALl Dell Gordon sounded a similar note, explaining that 

mental impairments were the most difficult to deal with, requiring more 

of his time and attention. The difficulty, he said, was in sorting through 

good evidence and "evidence that doesn't seem genuine." The problem 

is that "canny attorneys can buy an extremely favorable description that 

finds someone extremely disabled," even if they do not have a long-term 

relationship with the claimant. 68 

Virginia Case 249. In 2010, ALl William Russell awarded ssm 

benefits to a 55 year-old woman finding she met the criteria of Listing 

12.05(C) for mental retardation. To meet this listing, a person is 

required to show the condition began before the age of22; to 

demonstrate an IQ between 60 and 70; and to demonstrate a "significant 

work-related limitation." 

65 Indeed, Roanoke, Virginia Hearing Office Chief Administrative Law Judge Thomas Erwin 

noted this was a frequent occurrence with regard to claimants that appeared before ALIs in his 

office. 

66 Subcommittee Interview of Judge Thomas Erwin (9/7/12) 

67 HALLEX 1-2-5-20. Consultative Examinations and Tests. 

http://www.ssa.gov/OP Home/hallexlI-02/1-2-5-20.html 

68 Subcommittee Interview of Judge Dell Gordon (9/7/12) 
152 

63 

This case highlights the difficulty for ALls as they weight all relevant 

evidence. While the case file contains sufficient records to support the 

l2.05(C) listing, it also fit a pattern that several judges raised as suspect. 

In the claimant's original application for benefits, the only work-related 

limitation she alleged was COPD, a severe breathing condition. The 

ALJ awarded benefits, however, finding the claimant met the listing for 

"mental retardation" with a second "significant work-related limitation" 

of anxiety. 

Moreover, during the ALl hearing, the judge noted that she needed more 

evidence, and so requested an additional consultative exam. Only, the 

exam was arranged by the claimant's attorney, rather than by the judge. 

When asked about the doctor to whom the client was sent, Judge Erwin 

noted that he was familiar with the person. He explained how this 

particular doctor "only does those for attorneys," referencing 

consultative examinations for disability claims. 

In his opinion, the Judge pointed to no specific medical evidence 

supporting his finding, and simply restated the medical listing: 

The claimant's impairments meet listing 12.05(C). The 

"paragraph C" criteria of this listing are met because the 

claimant has mental retardation initially manifested before 

age 22 with a valid verbal, performance, or full scale IQ of 

60 through 70 and a physical or other mental impairment 

imposing an additional and significant work-related 

limitation of function. 

Medical Evidence of Record. Progress notes in the claimant's file were 

from her treating physician and dated between 2007 and November 

2009. The claimant was treated for seasonal allergies, high cholesterol, 

headaches, and hypertension, all of which were controlled with 

medication. After she applied for disability benefits, she complained of 

sleep apnea, which was successfully treated with a Continuous Positive 

Airway Pressure (CPAP) machine. 

DDS sent the claimant for a consultative examination on October 29, 

2008. The physician found: 

The claimant's appearance, behavior and speech were 

normal. Thought process and content were normal. 

Concentration and attention were normal. Judgment and 

insight were normal. Attitude and degree of cooperation was 

normal. Fund of information seems adequate. 

DDS denied the claim and reasoned: 
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64 

The evidence shows that you have pain in your back, but you 

are still able to sit, stand, walk, and move about within an 

adequate range without assistance. You have breathing 

problems, but a recent breathing study has shown that you 

return a sufficient ability to breathe. There are many jobs in 

the economy that do not require much education. Migraines 

are very bothersome, but generally respond well to treatment 

and medication. There is no evidence that you have 

significant difficulty with vision. Your hypertension has not 

caused you any severe complications. 

Attorney Procured Mental Opinion Inconsistent with Medical Records. 

Following SSA's denial of the claimant's initial application, her attorney 

sent the claimant for a mental evaluation on September 27, 20 I O. 

Having only a 7th grade education, the doctor found the claimant 

"produces IQ scores ofVCI 66, PRI 60, WMI 71, PSI 68, and FSIQ 60." 

Despite her low IQ, the claimant had never before complained ofa 

mental impairment. In the report from that doctor, it was noted that the 

claimant's "Standardized test scores (Lorge-Thorndike) from fourth 

grade report Total IQ 53, but the referenced standardized test results 

were not present in the claimant's file. The same physician also 

diagnosed her with generalized anxiety disorder and mild mental 

retardation. 

No evidence indicated the claimant ever complained of a mental 

condition prior to the 20 I 0 medical evaluation arranged by her attorney. 

There are no references in the progress notes that she suffered from 

mental retardation or a low IQ. She arrived to all appointments alone, 

"wanted to know her lab results" and asked questions directly of the 

doctor, and "verbalized understanding [of] all instructions and agree[d] 

with treatment plan[s]." Her 2008 consultative examination found her 

thought process, concentration, and judgment to be "normal." 

She applied for disability in 2009, and progress notes indicated she 

suggested to her physician that she might qualifY for benefits based on 

chronic obstructive pulmonary disease (COPD). Nowhere in the 

physicians notes is such a condition discussed prior to the claimant's 

suggestion. The physician indicated he would obtain the records SSA 

procured during the claimant's CE, if any existed, regarding a COPD 

evaluation. The ALl opinion does not reference this condition. 

Despite conflicting medical evidence of record, the ALJ apparently 

relied solely on the mental evaluation procured by the claimant's 

attorney and found the claimant qualified for benefits based on Listing 

12.05(C). 
154 

65 

Alabama Case 57. In 2010, ALJ Vincent Intoccia awarded ssm and 

SSI benefits in a bench decision during a four-minute hearing to a 35 

year-old man complaining of "mental problems and seizures." The 

Judge determined the claimant met the criteria of listing 12.05(C). 

While the case file contained records indicating that the claimant had a 

low IQ, it did not demonstrate an "onset of the impairment before age 

22" or existence of a second, significant work-related limitation that 

took effect prior to the expiration ofthe individual's disability insurance. 

DDS denied the claim on May 30, 2008, explaining: 

We have determined your condition was not disabling on any 

date through 7112/06, when you were last insured for 

disability benefits. In deciding this, we considered the 

medical records, your statements, and how your condition 

affected your ability to work. 

When applying for disability benefits, you must meet certain 

eligibility requirements. The information in your file shows 

that you last met the insured status requirements for 

consideration of disability was 6/30/07. 

Two months later on July 23, 2008, the claimant obtained representation 

and appealed the denial. 

The majority ofthe medical records in his case file pertain to treatment 

related to a November 2007 accident when the claimant was hit by a 

car. The claimant sustained a broken tibia and clavicle and a cerebral 

hemorrhage. The accident occurred five months after the claimant's 

DLl and therefore, could not be used to award benefits to the claimant. 

In addition, medical evidence indicated the claimant's limitations as a 

result ofthe accident would not create work-related limitations that 

would persist beyond a year, as required to meet the criteria of Listing 

12.05(C). Medical records dated February 4,2008 show that following 

surgery, the claimant had no clavicle pain and was healing. His 

physician cleared him to bear weight on his injured leg as much as he 

could tolerate, and x-rays showed "excellent alignment of his fracture." 

At the February 3, 2010, four-minute hearing, Judge Intoccia did not ask 

the claimant any questions, and the claimant did not speak. Only the 

judge, the claimant's attorney, and a vocational expert provided 

testimony for the record. The key exchange discussing the claimant's 

medical listing was as follows: 
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66 

ALl: And it's my understanding, [claimant's attorney], 

essentially your position is that [claimant] meets 

12.05C? 

ATTY: Yes, sir. 

ALl: Okay. I would, I really have to agree with you on 

that position. I really have no questions for him 

unless you do. 

Judge Intoccia immediately issued a bench decision and provided only 

the following explanation: 

To summarize briefly, I found you disabled as of July 1,2006 

because of mild mental retardation, Fetal Alcohol Spectrum 

Disorder (FASD) and 22all Deletion Syndrome so severe 

that your impairment(s) meet the requirements of (C) listed in 

the Listing ofImpairments. 

Here, the claimant's verbal, performance and full-scale IQ scores were 

rated as 69, 68 and 73. The medical record, however, contained little 

concrete evidence of a second severe impairment prior to the claimant's 

DLI of June 2007. The only evidence in the claimant's file that 

mentioned the secondary impairments listed above only speculated they 

were issues for the claimant. A medical record from a mobile clinic on 

August 19, 2009 stated: 

[Claimant] with a long history ofneurodevelopmental 

abnormalities as well as a behavioral associated with material 

drinking. His manifestations are likely to be due to prenatal 

exposure to alcohol, but additional medical work up is 

needed and in this context chromosome analysis as well as 

DNA analysis for Fragile X syndrome and a CGH array will 

be requested today. [Claimant's] father was encouraged to 

continue with current interventions and therapies ... 

Chromosome analysis was reported as normal (46XY) and a 

DNA study for Fragile X was negative. However, a CGH 

array revealed a 22q II deletion of2.4Mb typical of the 

DiGeorge Syndrome deletion. This finding was discussed 

with [claimant's] father by phone. 22qll deletion is among 

the most common chromosomal abnormality in humans and 

it is associated with neurodevelopmental disabilities 

including cognitive deficiencies associated medical problems 

and mental illness later in life. In this context, the family was 

encouraged to follow up in our clinic for further discussions 
156 

67 

and additional recommendation. This laboratory result 

suggests a dual diagnosis Fetal Alcohol Spectrum Disorder 

(F ASD) and 22q 11 deletion syndrome. 

The examining physician only speculates as the claimant's potential 

diagnoses. No other medical record in the file indicated the claimant 

returned to confirm the potential diagnoses, or for the suggested 

treatment. 

The Judge also failed to address the claimant's extensive history of 

alcohol abuse. A consultative exam stated the claimant "began drinking 

alcohol around the age of eighteen. At one time, he drank an estimated 

'one or two' cases of alcohol [per] week." It also noted he "has gotten 

into a car to drive in front of police while drinking. He bought paper to 

roll marijuana cigarettes in front ofa policeman and was subsequently 

charged with possession." The physician noted the claimant "has been 

arrested twice for DUI and once for possession of marijuana." 

Virginia Case 287. In 2009, All Geraldine Page made a fully favorable 

award of SSI and ssm benefits effective August 31, 2005, under listing 

l2.05(C) due to obesity, migraine headaches, chronic fatigue syndrome, 

anxiety, and mild mental retardation. The All determined the claimant 

met the criteria of medical listing l2.05(C) - cited above - due to an IQ 

between 60 and 70 and the other listed ailments, which the judge 

determined to be so severe as to limit her ability to work. Objective 

medical records, however, inconsistently referred to those other 

impairments and failed to support a finding that they were severe enough 

to cause work-related limitations. The claimant worked as a custodian 

part-time and on an as needed basis. 

Medical Listing Requirements. Judge Page cited a report that found "the 

claimant obtained a verbal IQ score of70, a performance IQ score of65, 

and a full scale IQ score of65" to satisfy the first criterion of l2.05(C). 

Under the listing, the Judge must also find "a physical or other mental 

impairment imposing an additional and significant work-related 

limitation of function." To satisfy that part ofthe listing, the judge 

provided only the following conclusory statement: 

Thus, the claimant's obesity, migraine headaches, chronic 

fatigue syndrome, and anxiety impose additional and 

significant work-related limitation on her ability to function 

mentally and physically. Consequently, the Administrative 

Law Judge finds that, taking into consideration the additional 

mental and physical impairments the claimant possess, both 

of the criteria in Section l2.05(C) are satisfied. 
157 

68 

The ALJ did not explain how the additional impairments limited the 

claimant's ability to work, especially in light the claimant's continuing 

to work even after alleging a disability. 

Claimant's Work Record. Evidence in the claimant's file indicated she 

was able to work for more than seven years despite her disability, 

although her wages did not rise to the level of SGA, according to agency 

documents. A vocational rehabilitation report noted that the claimant is 

"on the substitute list for the [] County Public School as a custodian and 

cook" and "hoped she could get a permanent job with the school 

system." On her application, the claimant reported she worked for the 

school from 2000-2007, one day a week for six hours a day as both a 

substitute custodian and kitchen worker. 

Psychological Evaluations. In a consultative exam dated May 27, 2008, 

the examiner found the following: 

The results of this psychological evaluation revealed a 

woman who has had a work history that extended for five or 

six years. Apparently, she must have been functioning 

reasonably well to have sustained employment for that long. 

She does a wide variety oftasks around the house and 

socializes with various people. She has a wide variety of 

avocations that she enjoys thoroughly. Her communication 

skills are good. She showed no real problems with either 

memory deficits or concentration [but] is somewhat anxious 

and is overreactive to stressors. It is perplexing that the 

claimant has never really sought any extensive psychotherapy 

to assist her in dealing with her periodic anxiety and periodic 

episodes oftransient depression. Neither of these appears to 

be incapacitating. 

From a psychological point of view, it is the examiner's 

opinion that [the claimant] is capable of functioning in a 40-

hour per week job, depending upon the circumstances. It is 

felt that she could be an effective worker, sustain her 

employment, get along reasonably well with fellow 

employees, supervisors, and even the general public. It is 

likely that she would need to work around somebody who 

watches over her to some extent but this does not have to be 

extensive after she learned the ropes and demands ofthe 

employment. 

The examiner also noted the claimant had a Global Assessment of 

Functioning, or GAF, of between 65 and 70. The GAF is a tool used by 
158 

69 

mental health professionals to determine a person's capacity for social or 

professional engagement. It runs from 0-100, and a score between 60 

and 70 is given to those with mild limitations. A prior exam in 

September 2007 found the claimant with a GAF of 57. 

In yet another psychological evaluation, dated May 10,2007, the 

examiner noted that, despite a 2006 GAF score of 54, he rated her with a 

GAF of70. He went on to explain how the claimant had attended 

community college classes for several years, and: 

denies that she has been depressed and states that her mood is 

usually"good." She states that she sleeps well and energy is 

adequate; appetite is good; she is irritable at times. She 

enjoys socializ[ing] and is not withdrawn or agoraphobic. 

She reports no acute anxiety or panic attaches but states that 

she is afraid to drive herselfto work and has never driven 

alone. She is able to drive when accompanied by her mother. 

The examiner determined that he did "not believe that any 

pharmacological treatment or medications are indicated at this time" and 

recommended that the claimant begin counseling to "work towards 

becoming more independent." 

In a psychological evaluation on October 20, 2006, the claimant noted 

"she is currently working for [employer]" and "she has worked in the 

past with JPTA and WIA. She is uncertain of any employment 

problems." The claimant also noted "her income helps with the 

household income, and this is mainly her step-father's income." The 

claimant reported "she spends her time working." 

ALJ Hearing. At the ALJ hearing in April 2009, the claimant testified 

she was seeking treatment for her anxiety and saw a therapist for the first 

time earlier that week. Because she had so recently begun treatment, no 

treatment records existed documenting the extent to which the claimant 

suffered from anxiety and none were included in her case file. In 

addition, no documentation supported the conclusion that the claimant's 

obesity, migraine headaches, or fatigue prevented her from working, in 

light of her actual work record. 

In the fully favorable decision explaining her reasons for finding the 

claimant met listing 12.05(C), Judge Page referred to one of the records 

discussing the claimant's GAF score. The judge cited only the oldest 

GAF score of 54, even though later scores for the claimant ranged from 

57 to 70, and even the doctor who assigned the score of 54 had 

concluded the "prognosis for placement in an employment position 

comparable to her skill level would appear to have a fair prognosis." 
159 

70 

While the judge's decision to award benefits may have been the correct 

one, her opinion failed to provide a reasonable explanation of how the 

claimant's other ailments significantly limited her ability to work, given 

the claimant's work history. 

Virginia Case 282. In this case, ALJ Karen Peters awarded benefits to a 

claimant under the affective disorder listing 12.04 for bipolar disorder, 

stating that the requirements ofthe listing were met, though her decision 

did not explain why. Moreover, the file contained evidence from a 

medical exam in which the doctor determined the claimant did not meet 

12.04, and in fact called her impairments "non-severe." 

Under listing 12.04, the SSA regulations layout the requirements 

needed for this impairment. For someone diagnosed with bipolar 

disorder, such a person must also meet the following to be awarded 

benefits (in pertinent part): 

12.04 Affective disorders: Characterized by a disturbance of 

mood, accompanied by a full or partial manic or depressive 

syndrome. Mood refers to a prolonged emotion that colors 

the whole psychic life; it generally involves either depression 

or elation. 

The required level of severity for these disorders is met when 

the requirements in both A and B are satisfied, or when the 

requirements in C are satisfied. 

A. Medically documented persistence, either continuous or 

intermittent, of one of the following: 

3. Bipolar syndrome with a history of episodic periods 

manifested by the full symptomatic picture of both manic 

and depressive syndromes (and currently characterized 

by either or both syndromes); 

AND 

B. Resulting in at least two of the following: 

1. Marked restriction of activities of daily living; or 

2. Marked difficulties in maintaining social functioning; or 

3. Marked difficulties in maintaining concentration, 

persistence, or pace; or 

4. Repeated episodes of decompensation, each of extended 

duration; 
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71 

Prior to the claim being denied by SSA, a consultative examiner 

reviewed her records on August 12, 2008, and found that they showed 

her to have a non-severe mental impairment and even questioned 

whether her claims were fully credible: 

In assessing the credibility of the claimant's statements 

regarding symptoms and their effects on function, her 

medical history, her activities of daily living and the type of 

treatment she received were considered. Based on the 

evidence of record, the claimant's statements are found to be 

partially credible. 

Another doctor looked over the material two days later and concurred: 

Consequently, while the MER indicates the likelihood of 

diagnoses of Depressive Disorder NOS and Anxiety Disorder 

NOS, the associated symptoms would not appear to be severe 

enough to prevent the performance of all levels of work. 

Therefore, the claimant's disability allegations cannot be 

viewed as fully credible. 

The claimant was then seen in a consultative examination on January 5, 

2009, to evaluate whether she met the criteria of either listing 12.04 or 

12.05. The physician determined she did not and indicated that her 

impairments were "not severe." 

On June 3, 2010, Judge Peters conducted a hearing by video at which the 

claimant appeared with her attorney. During the hearing it was 

discussed that the claimant had previously received SSI benefits, but was 

dropped from the program when she got married because she no longer 

met the resource test. During this discussion, however, the woman 

became unable to speak or answer questions, only able to nod. Judge 

Peters cut the hearing short after 14 minutes, deciding that she would 

have to send the claimant for a second consultative exam. 

In July 2010, the claimant's attorney arranged for her to see a 

psychologist, but this exam was also cut short because of a similar 

incident. The psychologist wrote: 

Upon trying to administer her the third subtest to the W AISIV [the claimant] fell into a total silence and seemed unable 

to speak or move. The examiner made several efforts to 

draw her out of this "spell" but was rather unsuccessful. 

Then help was sought from her son in the waiting room. He 

immediately came and recognized this pattern and began to 
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72 

comfort her and talk with her. We got her something to 

drink, which she did through a straw. He reports that this 

Conversion Disorder pattern has been worsening of late, and 

she is having it almost every three days at this point in time. 

He also noted that they almost always try to have someone 

around her all of the time ifnot most ofthe time. 

Eventually, while her son monitored her, the examiner went 

and talked with the facility guard who is also the head of the 

facility. We inquired with the son about calling 9-1-1, but he 

insisted that that would really not do any good. It was then 

offered to him that we would help him get her to the car, and 

he believed that was a good idea, which we did. Her son as 

well as the guard and facility head helped her to the car with 

the use of a rolling chair. She was successfully loaded in the 

car and then left. During this episode, she spoke only single 

words such as "help and "drink." Her son seemed very 

familiar with this pattern and was very comforting toward her 

during the time that it occurred. Therefore, obviously, the 

testing was truncated. 

Judge Peters' fully favorable decision referenced the July consultative 

exam and stated that claimant met the 12.04 listing. Instead of 

explaining how any ofthe evidence in the file supported this decision, 

however, the judge wrote: 

The claimant's impairments meet the criteria of section 

12.04. The paragraph A criteria are satisfied because the 

claimant has bipolar disorder. The paragraph B criteria are 

satisfied because the claimant's impairments cause marked 

difficulties in maintaining social functioning, and marked 

difficulties in maintaining concentration, persistence, or pace. 

ALJ Peter's failed to explain how the marked difficulties the claimant 

experienced any marked difficulties with regard to social function. In 

fact, the claimant told the physician at her consultative exam that "she 

goes to the grocery store with someone," "she does attend church," and 

she "socializes with family members." 

Virginia Case 291. ALJ Gordon Malick awarded disability benefits to a 

claimant under a listing for Crohn's Disease, but lacked the necessary 

medical evidence to support the award.69 

The listing states, in pertinent part: 

69 The judge awarded the decision under listing "5.07(B)," but since there is no such listing, he 

likely meant to refer to "5.06(B)." 
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73 

5.06 Inflammatory bowel disease (IBD) documented by 

endoscopy, biopsy, appropriate medically acceptable 

imaging, or operative findings with: 

A. Obstruction of stenotic areas (not adhesions) in the small 

intestine or colon with proximal dilatation ... requiring 

hospitalization for intestinal decompression or for 

surgery, and occurring on at least two occasions at least 

60 days apart within a consecutive 6-month period; or 

B. Two ofthe [following specific medical conditions] 

despite continuing treatment as prescribed and occurring 

within the same consecutive 6-month period[,f° 

It is important to note that in meeting the requirements of listing 

5.06(B), a claimant must be found to have met two ofthe listed criteria. 

Further, each of the criterion is based on objective medical testing, 

containing little if any room for subjective judgment from an ALI The 

claimant appears to lack the secondary medical criteria necessary for 

disability benefits. 

Medical Evidence of Record. The claimant complained of several days 

offatigue following injections she took six times per year to treat her 

Crohn's disease. These injections appear to have successfully controlled 

the claimant's condition. A physician's note dated October 12, 2006 

read: "[S]he has had no hospitalizations or flares during the last year. 

She is currently in maintenance with Remicade 7.5 mg every 8 weeks 

without any complications." On that same date, the physician 

determined the claimant's Crohn's disease was "currently in remission." 

Attorney Procured Examining Physician Opinion. The claimant's 

attorney sent her to a physician, who provided an opinion on the 

claimant's ability to work. He concluded she would have difficulty 

holding down a job, but identified only one reason - fatigue. 

70 A claimant must prove two of the following: (I) Anemia with hemoglobin ofless than 

10.0 g/dL, present on at least two evaluations at least 60 days apart; (2) Serum albumin of 

3.0 g/dL or less, present on at least two evaluations at least 60 days apart; (3) Clinically 

documented tender abdominal mass palpable on physical examination with abdominal 

pain or cramping that is not completely controlled by prescribed narcotic medication, 

present on at least two evaluations at least 60 days apart; (4) Perineal disease with a 

draining abscess or fistula, with pain that is not completely controlled by prescribed 

narcotic medication, present on at least two evaluations at least 60 days apart; (5) 

Involuntary weight loss of at least 10 percent from baseline, as computed in pounds, 

kilograms, or BM!, present on at least two evaluations at least 60 days apart; or (6) Need 

for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nutrition via 

a central venous catheter. 
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With regard to the standard residual functional capacity, I 

think that the fatigue is her only limiter. Her ability to walk 6 

hours in an 8 hour day is probably limited but most of the 

other things would not be a problem. I also don't think this is 

psychological, she said that you [her attorney] had suggested 

she may need to see a therapist but she and I both feel that 

this is probably not necessary .... 

With respect to disability, it sounds as ifher primary problem 

is fatigue. She doesn't have any actual focal deficits that 

would be causing a problem with work, but definitely fatigue 

is a side effect both of Remicade and ofCrohn's disease. 

Fatigue, even if significant, is not, however, one of the criteria for 

Listing 5.06. Indeed, at reconsideration, DDS determined: 

The evidence shows that you are treated for Crohn's disease 

and that you experience joint and muscle pain at times. 

However, you have not become malnourished nor 

underweight from digestive troubles. You remain able to 

stand, walk, and move about adequately without assistance. 

You have good use of your hands and arms. We realize that 

you may continue to experience difficulties, but your 

condition is not so severe as to be considered disabling. 

In his fully favorable decision, Judge Malick awarded benefits based on 

"5.07B," but based his findings primarily on the severity of the 

claimant's fatigue, rather than on her meeting one of the specified 

medical conditions. Citing the exam document noted above as Exhibit 

IF, he wrote: 

Based on the medical evidence and statement from the 

claimant's physician (Exhibits IF, 3F, 6F), the 

Administrative Law Judge finds that the claimant's 

impairments are severe and meet the criteria of section 5.07B 

Also cited were Exhibit 3F, which explained the Crohn's disease to be 

"[c]urrently in remission," and Exhibit 6F, which related to complaints 

of shoulder pain. 

While the claimant may have experienced significant fatigue and 

perhaps could have qualified for disability benefits by meeting the 

required criteria, Judge Malick justified the award by citing the Crohn's 
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Disease medical listing, without explaining how the claimant met any of 

the specific requirements. 

Oklahoma Case 186. In this case ALJ Lance Hiltbrand awarded a 7 

year-old child SSI benefits for an "affective mood disorder" under 

medical listing 112.02, which he determined began on the day the child 

was born. Listing 112.02 does not, however, have any criteria for 

children under the age of one. Medical records were also not provided 

for any time prior to when the child was five years old. 

The child was denied SSI benefits when he was in Kindergarten, but his 

mother reapplied while he was in first grade after a series of suspensions 

from school the year before. The documents in the file contained 

conflicting evidence regarding whether the child met the criteria for 

listing 112.02. 

Since to meet the listings, the criteria require feedback from "parents or 

other individuals who have knowledge of the child," the child's teacher 

filled out a detailed Teacher Questionnaire on September 24,2007, 

shortly after the application was filed. She described the child as having 

few limitations, citing as the most serious problem for the first-grader, 

"organizing own things or school material." 

On November 29,2007, SSA sent the claimant to a consultative 

examiner for allegations of mood disorder, ADHD, "intermittent 

explosive traits," and a learning disorder. The examiner found some of 

the impairments to be severe, but also determined they "[do] not meet, 

medically equal, or functionally equal the listings." The teacher 

evaluation and CE, thus, agreed that while the child had some issues, he 

did not meet the requirements of the affective mood disorder listing. 

On February 27, 2008, a DDS doctor reviewed the claimant's file after a 

request for reconsideration. Out of six major domains of functioning, 

the DDS doctor found the child with three areas in which there were "no 

limitations" and three in which they were "less than marked." As such, 

he concluded the child did not meet the requirements of a listing and the 

claimant was denied benefits. 

Judge Hiltbrand held a hearing on March 24, 2009, at which the child 

appeared along with his mother and her boyfriend. Discussion about the 

child's disruptive classroom behavior consumed much of the time, but 

his mom explained that he was different at home. 

MOM: And [the claimant's teacher] writes comments like 

he's finally calmed down and sat down and started 

working by II :00, which means from the time he got 
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there until 11 :00 he's been bouncing off the wall. 

He's been up walking round the classroom, 

bothering the other children. [His teacher] has 

[stated] again, very disruptive in the morning, calms 

in the afternoon. [Claimant's teacher] has [written] 

disruptive during film. Sent to the hall. And it's not 

really a week goes by he's not sent to the hall or ISR. 

His desk is away from the rest of the children in the 

classroom because he gets up, walks around the 

classroom. He talks out loud. Laughs to himself. 

When he's supposed to be doing work he'll fiddle 

and push the pencil somewhere else. 

ALl: Will that be tolerated at home ifhe did something 

like that at home? 

MOM: No. He's a 

BOYFRIEND: He doesn't do it at home. 

MOM: totally different person at home. 

His mom went on to explain how the child's school principal believed 

the behavior problems were related to immaturity, "the principal at [the 

child's elementary school] said that it's his maturity level. That he has a 

because he's the youngest second grader at the school because he 

turned seven in August." 

In addition to being the second youngest child in his grade, the mom 

also explained he had a disruptive daily schedule. She woke her four 

children up every morning at 4 a.m. because, having only one car, her 

boyfriend drove her and the children to her work at 4:45 a.m. While the 

children would come home and try to get some additional sleep, they 

were taken most mornings to before-school care and stayed for afterschool care. 

Near the end ofthe half-hour hearing, the judge noted how, "it seems 

like he's extremely well behaved here." ALl Hiltbrand then ordered an 

additional consultative exam before making his decision. This 

consultative exam took place several months later on June 24, 2009, at 

which the doctor found the child met listing 112.02, finding severe 

impairments in almost every possible category. 

Judge Hiltbrand issued a fully favorable decision relying heavily on the 

June exam. While the CE noted the child met the medical listing, it also 

stated the claimant 
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did not demonstrate any hyperactive or impulsive behavior 

during the evaluation. He looked around the room more as 

the evaluation proceeded but never got out of his seat. He 

followed instructions without having them having to be 

repeated and worked carefully. He smiled frequently and 

appropriately and only sometimes frowned when he was 

trying to figure out an answer. He put forth good effort and 

his test results are thought to be a valid assessment of his 

current functioning. 

The judge also determined that the child's mood disorder began the day 

he was born in 2001, citing his "premature birth and low birth weight." 

The opinion did not reference any medical records prior to 2006, when 

the child was five years old, in reaching that determination. Therefore, 

the ALJ determined the claimant was disabled five years prior to the 

availability of supporting medical evidence. 

D. Failure by ALJ to Conduct a Proper Credibility 

Analysis 

One ofthe main reason identified by the DQ for remand was the failure 

of the ALJ to perform a proper credibility analysis ofthe claimant. In at 

least two cases, the investigation discovered evidence ofthe ALJ failing 

to conduct such an analysis. In both cases, claimants were awarded 

disability benefits, but the evidence questioning credibility was not 

mentioned or discussed by the ALJs in their decisions. 

Oklahoma Case 109. In this case, Judge Lance Hiltbrand awarded ssm 

benefits to a woman who claimed she was unable to work due to an 

injury to her right shoulder. The injury was so severe, she claimed that 

she could not use her right arm. Though a doctor observed her using the 

same arm without any problem, the ALJ awarded full disability benefits 

based on her ailment. 

The ALJ noted the claimant said her disability began when she "was 

injured on the job while working as a cake decorator" in late 2003. In 

July 2004, the claimant underwent surgery for a tear to her rotator cuff 

in her right shoulder. 

She applied for disability benefits in November 2005, but was denied by 

DDS following her initial application and after reconsideration. She 

filed a request for an ALJ hearing on January 12,2007. 

On October 24, 2007 the claimant's attorney sent her for a consultative 

exam for an evaluation "of injuries which [the claimant] stated occurred 
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... while working." The claimant told the examining doctor that she was 

stacking boxes and "she felt a 'pulling sensation' in her right arm and 

shoulder." She explained how she never reported the injury, but instead 

continued to work. In May 2004, the claimant "took a leave of absence 

so she could find out what was wrong with her right shoulder." After 

both surgery and physical therapy, the claimant stated "she has no relief 

of the pain in the fingers of her right hand or her right forearm." 

Further, the claimant stated: 

She has pain in the right shoulder with raising her arm above 

her head. She states she has pain in the right shoulder with 

lifting a can of vegetables. She states she has pain in the 

right shoulder with turning or twisting at the elbow. She 

states she has pain in the right shoulder with pushing and 

pulling. She states she has numbness and tingling in the right 

shoulder. She states she has popping, clicking, and locking 

ofthe right shoulder. She denies other complaints to the 

right shoulder. 

Once the claimant was out ofthe doctor's office, however, things 

changed. The doctor noted the claimant: 

was observed leaving the office today unlocking her truck 

door and opening it with her right arm. She was also 

observed extending her right arm to place a bag in to the right 

front passenger seat. She was observed utilizing both of her 

arms to steer the wheel of her vehicle. 

The doctor concluded the claimant "has sustained no permanent partial 

impairment to the right arm or the right hand as a result of the above 

stated accident." The doctor also opined the claimant's "period of 

temporary total disability has long since ended and she may return to 

employment. She is in no further need of medical care or continuing 

medical maintenance." As such, the doctor stated "based on age, 

education, training, and work experience [the claimant] is not 

permanently and totally disabled or in need of vocational rehabilitation." 

Despite the CE doctor stating the woman used both hands to drive the 

car, at the hearing, the claimant testified,"I drive one-handed, unless it's 

real windy and then I keep that one down there." She also testified that 

she goes to casinos with family members. 

Despite this evidence from the claimant's own attorney showing the 

claimant had full use of her right shoulder and arm just five months 

before her hearing, Judge Hiltbrand awarded the 44 year- old claimant 
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benefits without addressing any ofthe issues raised by these 

inconsistencies. 

Oklahoma Case 145. This next case involved a veteran who sought 

disability benefits for post-traumatic stress disorder (PTSD), which he 

said arose from his military service. Throughout his medical files, 

however, his doctors noted not only how he was prone to exaggeration, 

but at times even directly accused the claimant of malingering. 

He applied for disability in August 2005 for back pain and anxiety, but 

in January 2006 was denied at the initial level by DDS. Among the 

medical evidence DDS considered in making its determination was a 

consultative exam to assess the claimant's physical condition, which was 

done on October 18, 2005. The doctor conducting the exam was a 

primary care physician not a psychologist, but nonetheless noted the 

claimant "has a history of social anxiety." Another medical record 

reviewed by DDS was a "mental status exam" held on November 7, 

2005. The psychologist, who was not a treating physician, diagnosed 

the claimant with "schizophrenia" and "paranoid type Posttraumatic 

Stress Disorder." He added: "Prognosis is judged to be fair. There is a 

moderate probability that treatment will result in substantial 

improvement over the next twelve months." 

Then in December 2005, a second consultative examiner reviewed all of 

the claimant's medical records, making particular mention of the 

diagnosis of "schizophrenia" at the November mental status exam. She 

wrote: "This [diagnosis] of Schizophrenia is not consistent with any of 

the [medical evidence of record], current or distant." 

The initial claim was denied in January 2006, and again upon 

reconsideration in August 2006, but ALl Peter M. Keltch approved the 

case in June 2008, relying heavily on the same two exams from October 

and November 2005. Judge Keltch determined the claimant suffered 

from "Schizophrenia, post traumatic stress syndrome, and a history of 

polysubstance abuse." Judge Keltch concluded the claimant met the 

criteria for medical listings 12.03(A), (B) and (C) related to 

"Schizophrenic, paranoid and other psychotic disorders." 

A more thorough review of the file, however, might have raised 

questions about whether benefits should have been awarded. In 1997, 

eight years prior to his disability application, the claimant applied for 

veterans benefits related to PTSD. On September 30, 1997, a 

psychiatrist conducted an examination, but failed to make a final 

diagnosis because of the claimant's "malingering." 
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The differential diagnosis is so broad because I find the 

veteran to not be a very credible historian. He generally 

endorsed the presence of almost all symptoms asked of him. 

Reference should also be made to the admission and 

discharge notes regarding his 1997 psychiatric hospitalization 

which also raises issues of credibility. If the veteran's history 

was accurate, it would be my opinion that he does have a 

post-traumatic stress disorder related to his [military] 

experiences. However, I do not believe that his history is 

accurate based on his clinical presentation. 

Then in October 2006, nearly a year after the consultative examinations, 

the claimant again underwent a mental evaluation. During the exam, the 

man discussed his military service and how he had recently lost his 

cousin, who "was his closest friend." In the conclusion of the 

evaluation, the examiner determined: "[The] results were not valid. His 

profile was similar to the profiles of others who try to present 

themselves with more serious pathology than they have. Over reporting 

psychopathology is common for negative and defiant personality types 

His medical records mentioned, as well, that he applied for serviceconnected disability benefits from the Department of Veterans Affairs 

on multiple occasions, but was turned down each time. 

On June 9, 2008, Judge Keltch held a hearing to consider the case, but 

the claimant did not appear to testify. Judge Keltch explained he had a 

prior conversation with the man's attorney and concluded it would be 

dangerous to have him in the hearing room: "The reason he is not in the 

hearing room is that the gentleman has a severe mental problem, and it is 

thought to be safer, number one, for him not to be in the hearing room 

" 

At the hearing, which lasted approximately 10 minutes, the judge asked 

the medical expert present to consider the mental evaluation from 

November 2006, which resulted in a diagnosis of schizophrenia. The 

medical expert present, who had not met or examined the claimant, said 

she concurred and that he met medical listing 12.03, at which point the 

hearing was closed. 

In his fully favorable decision, ALJ Keltch relied heavily on the 

November 2006 mental status exam (MSE), as well as the medical 

expert at the hearing. He failed, however, to mention how the December 

2006 exam said the MSE was inconsistent with the rest of the medical 

record. Moreover, his decision made no mention of the multiple 
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references to malingering, and that other doctors had called the 

claimant's truthfulness into question. 

E. Poorly Drafted On-The-Record Decisions by Senior 

Attorney Adjudicators 

Administrative Law Judges are supported by staffers to help organize 

case files, write decisions and deal with claimants. Among them are 

attorneys - called "senior attorney adjudicators" - who help draft their 

decisions once an ALJ has determined a case. In recent years, however, 

senior attorneys have also been allowed to write favorable, on-the-record 

decisions that do not need the approval of an ALI. By allowing senior 

attorneys to screen cases to write favorable decisions the senior attorney 

determines meet program requirements, the agency has intended to 

move "payable" cases through the system more quickly, leaving the 

more difficult decisions for the judges. 71 

In the cases reviewed by the Subcommittee, however, some of the 

opinions written and approved only by senior attorneys contained a 

number of problems. 

Oklahoma Case 149. In this case, the claimant applied for back pain, 

but was awarded benefits under medical listing 12.05(C) for mental 

retardation. The 2008 written opinion by an SSA senior attorney 

included only the information favorable to the claimant, while failing to 

explain or acknowledge conflicting evidence in the file. 

To qualifY for this medical listing, a claimant must report an IQ of 

between 60 and 70, show that the impairment has been present since at 

least age 22, and have an additional impairment severe enough to restrict 

work. In this case, the claimant was determined to have an IQ score of 

70, but two doctors remained unconvinced that the listing criteria were 

met. 

On October 11,2006, a DDS doctor reviewed the claimant's file to 

determine if she met medical listing 12.05, and found she did not. His 

determination apparently stemmed in part from the fact that the woman 

did not claim to have any mental impairments. 

47 yr. old female does not allege mental. She has not had 

psychiatric treatment. She has pain due to physical problems 

and there is associated depression. She was in Special Ed 

from the 6the grade on. She lives with her two sons. She was 

71 See Amendment to the Attorney Advisor Program, 72 Fed. Reg. 44763 (August 9, 2007); 

Extension of Sunset Date for Attorney Advisor Program, 76 Fed. Reg. 18383 (Apri14, 2011). 
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cooperative at the psych CEo [IQ] scores V 72 P 73 and FS 

70. ADL's She is able to do the cleaning, cooking and 

laundry. She is able to drive and shop for groceries. She goes 

to church. Some restrictions are present due to pain. 

One of the considerations the agency must make is whether a claimant 

can manage their own funds, if awarded benefits. Patients found to meet 

medical listing 12.05 nearly always are found incapable of doing this, 

resulting from their mental condition. Here as well, the record contained 

conflicting information. On August 31, 2006, a State consultative doctor 

said the woman could not manage her funds. One month earlier, on July 

8, 2006, however, a psychiatrist evaluated her in his office and 

concluded that she did not suffer from mental retardation and could 

manage her own funds. The psychiatrist's determination matched the 

one reached three months later, in October 2006, when the doctor 

described previously found that the claimant did not qualifY under the 

12.05 listing. 

The June 3, 2008, decision written by the senior attorney found that the 

claimant had an IQ score of70, and a secondary condition of back pain 

that significantly limited her ability to work. To establish the second 

condition, the attorney cited a "medical source statement" from the 

claimant's doctor, which was a questionnaire filled out at the request of 

her attorney. The questionnaire said the woman suffered from a 

degenerative lumbar spine, even though another medical record from 

October 27,2006, had found: "No traumatic or degenerative 

abnormality of the lumbar spine is present." 

In the final decision, the SSA senior attorney determined the claimant 

suffered from "mental retardation" and "degenerative disc disease." The 

opinion did not acknowledge or explain the conflicting evidence in the 

case file on both points. 

Oklahoma Case 114. In this case a SSA senior attorney awarded 

benefits to a woman for back pain and obesity, but failed to explain how 

the medical evidence supported the alleged onset date. Moreover, the 

opinion's brief analysis of the objective medical evidence consisted 

primarily of a paragraph cut-and-pasted from a letter written by the 

claimant's attorney. 

The claimant applied for benefits after having back surgery, alleging that 

her disability began on September 5, 2007, "due to Crohn's disease, 

neck and back problems, and arthritis." 

She received payments under a private disability insurance policy, and 

saw a rheumatologist for only the second time on January 4, 2008. The 
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first visit had been prior to her surgery three months earlier. In a record 

in the case file describing the visit, the doctor explained there had been a 

"misunderstanding" and that he had been asked "to write for disability 

without seeing her." He noted that he would need some information 

from her employer, adding: 

I told her that I think she is best served working to maintain her 

activity level. However, she has been off work. I recommend 

physical therapy ... for three weeks. To Whom It May Concern: 

The patient is unable to work until July 4, 2008. At that time, she 

will have no restrictions. 

In early July, the rheumatologist saw her again and extended the 

disability until September, but noted that this was in order to collect 

additional information. 

On July 30, 2008, the claimant visited her regular doctor to help deal 

with her back pain. The notes from her doctor said that one of the 

activities she enjoys is "bicycling." 

She states she has difficulty sitting and standing for more 

than 10 minutes. She has difficulty performing laundry, 

vacuuming, baking, and getting into the lower shelves at the 

grocery store. She enjoys sewing, crocheting, reading, 

bicycling, cooking, and baking. 

It is unclear from the notes whether she was continuing to bicycle or had 

enjoyed it in the past. 

On August 4, 2008, her initial application was denied. She was denied 

again by DDS under reconsideration on December 23, 2008, which 

noted: "You are recovering well from your back operation and should 

be able to return to work within twelve months." 

A note in the file indicated the claimant saw her rheumatologist again on 

November 18, 2008, but got into a dispute with him about failing to 

comply with his prescribed treatment. He concluded the note saying that 

he would no longer see her as a patient: "Will discharge the patient for 

noncompliance." She found a new rheumatologist, but the records show 

she visited her only one time on November 26,2008. That 

rheumatologist found that the claimant was disabled and could not work. 

On April 21, 2009, the claimant's attorney wrote a letter to the 

Oklahoma City Office of Disability Adjudication and Review asking for 

an on-the-record decision. The letter also referenced a form filled out by 

the claimant's new rheumatologist the month before on March 18, and 
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asked that it be given "controlling weight," despite the fact that she had 

only seen the patient one time. The letter from the attorney contained 

the following paragraph: 

[DOCTOR 1] is the claimant's treating rheumatologist. She 

completed the enclosed physical capacities dated March 18, 

2009 indicating the claimant cannot perform the requirements 

of even sedentary work. The claimant needs to alternate her 

sitting and standing at will throughout the day. She cannot 

use her hands adequately for simple grasping, fine 

manipulation, and repetitive motion tasks. The claimant can 

lift!carry occasionally up to 5 pounds but should never 

lift/carry over that amount. [DOCTOR 1] writes the claimant 

is in constant pain and her condition is chronic and incurable. 

The claimant requires daily pain medication and prolonged 

periods of rest due to fatigue and pain. [DOCTOR 1] writes 

the claimant has chronic pain and inflammation in the joints, 

diffuse musculo-skeletal pain which is causing fatigue, 

inability to concentrate and potential absences from ajob due 

to disease exacerbation. The pain, according to [DOCTOR 

1], would be disabling to the extent that it would prevent the 

claimant from working full time at even a sedentary position. 

One month later on May 21, 2009, the SSA senior attorney issued a fully 

favorable on-the-record decision. It concluded that the claimant's 

disability began on September 5,2007, as she alleged, but did not cite 

any evidence prior to October 14,2008 nearly a year after the fact. 

More significantly, the decision contained a brief section analyzing the 

medical records used to conclude the woman was disabled. Not only 

was the March 18,2009, doctor form given controlling weight as 

requested, the SSA senior attorney simply copied and pasted the above 

excerpted paragraph from the letter of the claimant's attorney into the 

official opinion. The opinion also did not acknowledge or explain the 

conflicting evidence in the file indicating the claimant was recovering 

from her back surgery and her initial rheumatologist did not view her as 

having severe or lasting problems. The SSA senior attorney's opinion 

raises questions about whether the medical evidence was properly 

reviewed and analyzed. 

Oklahoma Case 127. In 2010, an SSA senior attorney awarded benefits 

to a man for degenerative disc disease and depression, finding the 

claimant could perform "less than sedentary" work despite a State 

consultant finding he was not disabled and could perform "light" work. 
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In the senior attorney's opinion, he discounted the opinion of doctors 

who performed examinations at the request ofSSA, saying: "The State 

agency medical consultants' physical assessments are given little weight 

because the State agency consultants did not adequately consider the 

claimant's subjective complaints or the combined effect of the 

claimant's impairments." In contrast, the SSA scnior attorney placed 

significant weight on the claimant's subjective complaints, while failing 

to acknowledge that those complaints did not always match the medical 

records. 

One central issue involved the claimant's ability to walk. The claimant 

said that his disability began when he was 48 years old in December 

2006, which is when he stopped working due to back pain which he 

described as so severe that he could barely walk. Over the course of the 

next several years, though, his medical records show that he could walk 

much further than he described. 

During a doctor visit on February 16, 2007, two months after he alleged 

his disability began, his doctor wrote: "The patient, two weeks ago, 

joined the [gym] and has been exercising regularly since that time." On 

May II, 2007, the same doctor wrote: "The patient has been walking 

four times per week." On August 6,2007, his doctor wrote: "The 

patient's been walking I-mile 3 to 4 time per week." He was reported to 

be "walking I mile per day 5-days per week," again by his doctor on 

October 31, 2007. Nine months later, on July 30, 2008, the doctor once 

more noted: "The patient is walking one mile a day at least five times 

per week." 

During a doctor visit in October 2008, he said, "His wife lost her 

insurance so he'll be transitioning to a new insurance company soon." 

The next month, in November 2008, he applied for disability insurance. 

In January 2009, he filled out paperwork for SSA writing, "I have 

problems walking, standing, bending, sitting for any length of time." In 

a second form from February 3, 2009, filled out by his wife, she 

answered a question about how far he could walk writing, "end of drive 

way." However, the records that followed said he could still walk and 

work. 

During a consultative exam with the State agency doctor in April 2009, 

the doctor concluded he could do light work, adding, "The claimant 

appears to ambulate in a safe and stable gait at an appropriate sp[eed] 

without the use of assistive devices." 

On July 22, 2009, he visited his own doctor, complaining of back pain, 

but the doctor again noted that he and his wife had been making a 

regular practice of taking walks: "The patient seems to be doing much 
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better on the Cymbalta. We are still dealing with pain issues .... He's 

been walking a mile and a quarter with his wife every day over the past 

2 Y:, months." 

The claimant's initial application was denied by DDS, which explained 

that he was "given a residual functional capacity rating for light work 

with occasional stooping, and a mental status rating for unskilled labor. 

... Using the Medical Vocational Guidelines and Rule #202.14, which 

directs a decision of not disabled, this case is denied at step 5, for other 

work." He was denied again upon reconsideration in November 2009. 

On March 2010, his attorney for the claimant wrote a letter to the SSA 

senior attorney working on the case in the Oklahoma City SSA office. It 

read: "This letter is to advise you that based upon new medical records 

received and income verification, we wish to amend our onset date to 

February 28, 2008." Two weeks earlier, the claimant's attorney had 

faxed five pages of medical records to the office. While the letter said 

that he wanted to change the onset date because of "new evidence," 

some ofthe records were already included in the file. Moreover, only 

one ofthe records was dated after the denial at reconsideration. Two 

were from December 2003 and March 2006 - outside the relevant time 

frame. None of the "new" records or the existing records in the file 

explained why the new onset date should be February 28, 2008, which 

was only a few days before the claimant's 50th birthday. 

On April 2, 2010, eight days after receiving the letter from the 

claimant's attorney, the SSA senior attorney issued a fully favorable 

opinion finding the claimant disabled. The decision failed to 

acknowledge or explain why the determination was inconsistent with the 

records in the file showing the claimant's regular walking routine. 

F. Poor Quality Opinions from ALJ Howard O'Bryan 

The 16 disability opinions reviewed in the investigation from ALl 

Howard O'Bryan, age 87, of Oklahoma City, Oklahoma stand out for 

their numerous problems and require their own analysis. Judge 

O'Bryan's opinions not only lacked sufficient judicial analysis or 

evidentiary support, but were at times incomprehensible. However, as 

one of the agency's highest producing ALls in the nation, the impact of 

his opinions on the disability program has been larger than most. 

Since at least 2006, Judge O'Bryan has issued more than 1,000 decisions 

each year - several years approaching 2,000. The highest three years 

were 2007 to 2009 in which he decided 1,833; 1,846; and 1,722 cases, 

respectively. Many ofthe decisions reviewed in the investigation were 

written during this time period. His rate for approving the award of 
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disability benefits in the cases he reviewed was similarly high, ranging 

each year between 90 and 100 percent. 

While the investigation questions whether all ofthese cases were 

properly awarded, the opinions were most notable for their decidedly 

poor quality. First, his opinions contained substantial amounts of 

agency-approved "boilerplate" language. Most of this language was not 

specific to an individual case, but rather explained how the disability 

programs worked. In sections that appeared to apply to a specific 

claimant, however, the opinions also contained a pervasive use of 

boilerplate. Commonly, Judge O'Bryan used the following sentence 

after several pages of medical images, seemingly to explain why 

disability benefits should be awarded: "Various physicians, treating and 

non-treating, have written that the claimant suffered from various 

medical problems and that the claimant has significant work 

restrictions." 72 

Second, instead of providing an analysis of the information contained in 

an individual case file, Judge O'Bryan typically included partial images 

of medical records from the case file that he electronically copied into 

his opinion without explanation. For example, he routinely copied part 

of a doctor's examination report describing a claimant's medical 

condition and inserted it into his opinion on the case with no attribution 

or explanation. At times, the images he pasted into the record had 

nothing to do with the case, or directly contradicted his award of 

benefits. For example, in Oklahoma Case 135, a woman alleged 

various ailments ranging from hip pain to PTSD and depression. Judge 

O'Bryan awarded her full disability benefits, but also copied into his 

decision another doctor's opinion that her claims were not always 

credible: "[Claimant] was very manipulative and an unreliable 

historian." 

Third, instead of precisely identifying a claimant's disabling condition, 

the judge typically wrote a long list of maladies, followed by "etc., etc., 

etc." He used this technique whether he found a person disabled under 

the Medical-Vocational Rules or the medical listings. In some cases, he 

found claimants met three or more medical listings followed by "etc., 

etc., etc." - something the Subcommittee did not encounter in any other 

ALl opinion. In one extreme case, Oklahoma Case 135, Judge O'Bryan 

made the following "finding offact:" 

The severity ofthe claimant's affective (mood) disorders, 

classed as major depression(2960), anxiety related disorders, 

post traumatic stress disorder (3000), disorders of 

72 See, e.g., Oklahoma Cases 132 and 166. 
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backdiscogenic and degenerative (7240), chronic liver 

disease and cirrhosis, Le., Hepatitis C,(571 0), history of 

broken left femur, broken hip left side, etc., etc., etc., meets 

the criteria of section( s) 12.04, 12.06, etc., 

Agency Directive to Judge 0 'Bryan. The agency was aware of Judge 

O'Bryan's inadequate opinions and reprimanded him several times over 

the past four years. An internal agency document produced to the 

Subcommittee stated that in 2008, Regional Chief Administrative Law 

Judge Joan Parks Sanders verbally counseled Judge O'Bryan regarding 

the content of his opinions. Two years later in 20 I 0, Oklahoma City 

Hearing Office Chief Administrative Law Judge (HOCALJ) Douglas S. 

Stults verbally counseled Judge O'Bryan twice about the content of his 

opinions. 

On September 14,2011, HOCALI Stults went farther and sent Judge 

O'Bryan a formal directive, which explained: 

a review of 168 decisions issued by [Judge O'Bryan] in 

FY2011 shows that, in 153 of those decisions, [Judge 

O'Bryan] included significant amounts of superfluous 

information, including unnecessary and lengthy citations to 

legal and medical authority. In addition, [Judge O'Bryan] 

inserted images of the claimant's medical records in [his] 

findings offact and conclusions oflaw, instead of analyzing 

the information. Furthermore, instead of making specific 

findings, [Judge O'Bryan] simply state[d], "etc. etc. etc," at 

some points of the decision. 

The directive went on to remind Judge O'Bryan of his obligations: 

[As a] Social Security Administration (SSA) Administrative 

Law Judge (ALI), you are responsible for conducting 

hearings and issuing legally sufficient and defensible 

decisions. See HALLEX 1-2-0-5.B. A legally sufficient and 

defensible decision requires that you comply with SSA's 

laws, regulations, rulings, and policies. In order for SSA to 

continue to meet its obligations to the public, it is essential 

that ALIs discharge their duties in a timely manner that 

reflects a high degree of responsibility, professionalism, and 

integrity. You are expected to provide hearings and 

decisions to claimants in a timely and judicious manner. 

SatisfYing these responsibilities requires an ALI to follow 

both the letter and the spirit of the policies he is bound to 

follow. 
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The formal directive stated that while it was not a disciplinary action, 

should Judge O'Bryan continue to fail to follow agency policy, it "may 

lead to disciplinary action." To date, the Subcommittee is aware of no 

disciplinary action taken by the agency against Judge O'Bryan. 

When interviewed regarding the directive to Judge O'Bryan, HOCALJ 

Stults told the Subcommittee that he felt the directive he sent to Judge 

O'Bryan was probably "too harsh" and "discussed more than it needed 

to.,,73 Judge Stults explained that the catalyst for sending the directive 

related to Judge O'Bryan's inserting active links to internal agency 

documents into his decisions, which caused problems when the 

decisions were effectuated. The letter, however, contains no mention of 

a concern regarding pasting these links into a decision. 

With regard to Judge O'Bryan's decision writing, Judge Stults stated 

that Judge O'Bryan had taken it upon himself and volunteered to review 

and write the on-the-record decisions to help process the disability cases 

awaiting action in the Oklahoma City hearing office. Further, Judge 

Stults told the Subcommittee that Judge O'Bryan "was good at it." 

Judge Stults explained that Judge O'Bryan reviewed "raw" cases that 

had not undergone any review or preparation by office staff, which made 

them more difficult to review. He said that allowed the other ALJs in 

the Oklahoma City hearing office to divide up the remaining cases that 

had been prepared by office staff for ALJ review, which enabled those 

judges to act more quickly. Judge Stults explained that the Oklahoma 

City office lacked adequate staffto properly support its ALJs, so Judge 

O'Bryan's actions provided welcome assistance to the other judges. 

Interview of Judge 0 'Bryan. Judge O'Bryan was also interviewed.74 

When asked about his unusual approach to deciding cases, he explained 

that a lot of what was seen by the Subcommittee was the result ofa 

particularly busy period between 2006 and 2009. "I did an awful lot of 

cases in those years," said Judge O'Bryan, referencing the years he often 

decided more than 1,800 cases. 

It was in this time period, he went on, that the agency developed a 

significant backlog, but "did not have adequate resources to do cases." 

To play his part and help, the judge did as much of the work he could to 

free up others. "Rather than utilize personnel, I would review raw cases 

to see what could be allowed on-the-record," he explained. The term 

"raw cases," he said, referred to cases that no one had yet looked at or 

73 Subcommittee interview of Oklahoma City Hearing Office Chief Administrative Law Judge 

Douglas S. Stults (8/31/2012). 

74 Subcommittee interview of Judge Howard O'Bryan, (8/3112012). 
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prepared for a judge. He added, "I was the only one who would agree to 

review raw cases." 

"I was trying to keep up the number of dispositions for the office," 

Judge O'Bryan went on, noting, "I wrote all ofthem myself." He was 

able to dispose of so many cases during this time, he said that SSA 

began shipping him cases from around the nation. He said that, at one 

point, he was sent 500 cases from Little Rock, Arkansas - equivalent to 

a single judge's workload for a whole year. "I was asked to review 

those cases to see if they could be allowed," he said. According to 

Judge O'Bryan, he was able to get through so many cases, that SSA sent 

him huge blocks of cases from such cities as Houston, Texas; Atlanta, 

Georgia; Baton Rouge, Louisiana; Greenville, South Carolina; and 

Yakima, Washington. He said he also received cases from Missouri. 

Asked how he was able to get through so many cases from other states 

in such a short period of time, Judge O'Bryan explained that he only 

handled the cases that he thought should result in the award of disability 

benefits, and sent the rest back to the states they came from for hearings. 

He explained that in a typical case, the possible denial of benefits 

mandated a hearing and written opinion, which took more time than 

writing an opinion granted disability benefits based upon the records 

already in the case file. 

According to Judge O'Bryan, he saw plenty of cases that did not require 

much time to decide. "You could take one look at them and see the 

person was dying," he said. Judge O'Bryan explained as well that he did 

not "always need an ME [medical expert], because you can read the 

medicals as well as a medical advisor." 

When asked about the problems with his opinions, he defended his 

approach as acceptable practice. He stated that SSA encouraged the way 

he wrote his decisions, and claimed that he rarely ever had decisions 

reversed by the Social Security Appeals Council. "I'm very, very careful 

about what 1 put into decisions," he said. 

Regarding the frequent use of "etc., etc., etc." when identifYing a 

claimant's conditions, Judge O'Bryan explained it was for times when a 

person has, "a whole bunch of other things wrong with them and 1 didn't 

feel it was necessary to list them. I was just trying to rule on the major 

impairments." 

On the issue of inserting images from medical records in place of 

describing the claimant's medical conditions and analyzing them, he 

said that his technique helped him get the opinions done more quickly. 

"In spite of the numbers," said Judge O'Bryan, "our office was still 
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running low in the region. In order to help get these out, I reviewed for 

OTRs [on-the-record opinions]." And so, he said, "I used a little 

different technique. The rules don't say how you have to set up a case." 

Judge O'Bryan rejected the notion that he failed to include case-specific 

analysis in his opinions, saying, "I thought I put analysis in. I really did 

... I would cut and paste images followed by rationale." 

Judge Stults supported Judge O'Bryan's statements and noted that Judge 

O'Bryan's opinions "passed muster with the Appeals Counsel," meaning 

they were never remanded for legal insufficiency. Judge Stults asserted 

that pasting images into ALl opinions was a widely-used technique by 

many ALls, including himself, after SSA switched to electronic medical 

files in 2006. 

Judge O'Bryan also pushed back at first when asked about why he used 

boilerplate language in his opinions, explaining: "It wasn't boilerplate at 

all. ... I may have used similar language." He later conceded, however, 

"I may have taken a few shortcuts. I maybe should have written them 

better." But with the time constraints on ALJs, he said, "You do 

whatever you can do to make them go. You try to get through them the 

best you can." Later in the interview, he said: "In the past we all used 

boilerplate. At one time, the agency encouraged boilerplate. We could 

cut and paste and had a ball doing it, because it saved so much time." 

When asked about how much time he spent deliberating on each case, 

Judge O'Bryan said it varied. Some cases, he said, he "can review in a 

matter of a few minutes. You can take one look and know they meet a 

medical listing." For others, he said, "I've spent an hour or two, some 

took days," while others took as little as 30 minutes. Asked about a 

typical case, he said he typically took one or two hours to review it and 

reach a decision. The reason he could proceed so quickly for the cases 

decided between 2006 and 2009, he said, was because he chose cases 

that were "clear cut, no questions about them." 

"In the end," Judge O'Bryan concluded, "I feel I have made the right 

decisions." Judge Stults told the Subcommittee that he was sure "Judge 

O'Bryan looked at every page of every file." 

Judge O'Bryan told the Subcommittee that he no longer produces 

decisions at the rate he did during the time frame, 2006 to 2009. One 

reason may be that SSA now limits disability ALJs to deciding no more 

than 1,200 cases per year. Judge O'Bryan indicated that in 2010 and 

2011, he decided 1,343 and 1,164 cases per year, respectively. He also 

noted that in 2012, to date, he had decided 502 cases. In addition, Judge 

Stults told the Subcommittee that Judge O'Bryan no longer writes his 

own decisions, reviews raw cases, or decides cases sent from other 
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states; instead Oklahoma City SSA staff writers prepare the decisions for 

Judge O'Bryan to approve and sign. It is unclear whether this 

arrangement was established in response to the September 2011 letter 

criticizing the poor quality of the judge's opinions. 

Another relatively recent change is that, according to Judge O'Bryan, he 

now approves the award of disability benefits in only about 54 percent 

of the cases he reviews, which is close to the SSA average for disability 

ALJs. Judge O'Bryan continues to decide disability cases, and continues 

to be one of the most active judges in the Oklahoma City hearing office. 

During the course of the investigation, under the random case selection 

process used by SSA, the Subcommittee reviewed 16 opinions issued by 

Judge O'Bryan, all of which raised concerns about the poor quality of 

the case description and analysis. Several examples follow. 

Oklahoma Case 111. In 2007, Judge O'Bryan awarded disability 

benefits to a truck driver who alleged a back-related work injury from 

September 22, 2005. The claimant's case file contained records from 

several doctors indicating the man could return to work, one of whom 

wrote that he could return to work with "no restrictions," but Judge 

O'Bryan found him disabled. In his opinion, the judge wrote that the 

claimant could do only work that was "less than sedentary" and utilized 

the formulation of "etc., etc., etc.," for which he claimed support from 

"various doctors." 

On September 22, 2005, the claimant sustained a work injury after 

falling from the top of a railroad car ladder. Records from five hours 

after the incident state: "Patient states: 'Slipped coming down hand rail 

injuring right shoulder, right knee and neck.'" The claimant also told 

the doctor he had previously injured his shoulder and knee, and had: 

"Two surgeries [on his] right shoulder and arthroscopy [on his] right 

knee." 

Medical notes from October 6 and 14, 2005, several weeks after the 

injury, show the patient had returned to work with light duty 

restrictions. According to the records, "Patient has been working within 

the duty restrictions. He states that his right knee is fine, but his right 

shoulder is still hurting." 

He had neck surgery in December 2005 and shoulder surgery in March 

2006, followed by rehabilitation until June. Throughout the first half of 

2006, the claimant's medical records show steady progress toward 

recovery, ending with his clearance to return to work with no 

restrictions. 
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These records, starting from January 24, 2006, following his neck 

surgery but prior to his shoulder surgery, showed him "temporarily 

totally disabled," but that, "His neck and right-arm radicular pain have 

abated ... [the patient] is very pleased with the results of surgery." 

Records from February 28, 2006, completed by same treating physician, 

show "the patient has had excellent results from his surgery, and, at 

present, has no symptoms of an active radiculopathy or myelopathy." 

The surgeon also fully cleared him to return to work at this point, 

stating, "the patient can return to gainful employment at any time. He 

will be on a 25-pound permanent weight [restriction] in lifting, bending, 

pulling, tugging, etc. The patient tells me that he has decided not to 

return to work as a truck driver in the future." His doctor instructed him 

to "continue his home exercise program and is to stay active." 

In early March, prior to shoulder surgery, the claimant indicated he was 

eager to proceed, explaining to his doctor, "He is left hand dominant. He 

thinks he can protect the right shoulder and continue to be fairly 

functional." On March 21, 2006, the claimant underwent the shoulder 

surgery. Six days after the surgery, he told his orthopedist, "I feel 

great." The orthopedist wrote in response, "I can tell a big difference. 

He has no pain or popping reported. His wounds are benign. He is only 

six days following the surgery. Physical therapy for a couple of weeks 

recommended. " 

A follow up appointment with an orthopedist on May 22, 2006, reported: 

"Range of motion [in his shoulder] is steadily improved. He is doing 

very well. ... He is reporting no pain .... The patient has reached 

maximum medical improvement. He is released today without 

restrictions in regards to his shoulder. He will take over the counter antiinflammatories on an as needed basis." Regarding his "Work Status" 

the doctor wrote, "No restrictions." No medical records exist in the file 

after this date. 

Seven months later, the claimant filed for ssm benefits. His initial 

application was denied at the DDS level on February 21, 2007, which 

the agency explained was because of conclusions made by two separate 

doctors at evaluations from February 6, 2007. The agency explained: 

We have determined your condition is not severe enough to 

keep you from working.... Although you have pain and 

discomfort in your neck and shoulder, you can move them 

well enough to do some types of work .... We realize that 

your condition keeps you from doing any of your past work, 

but it does not keep you from doing other work which is less 

demanding. 
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He requested reconsideration on March 12,2007, explaining, "I am 

unable to work." In May, he filled out a form for the agency explaining 

his limitations, adding at the end: "I can not go back to work, I'm on 

pain meds, I've got restrictions for life and I've not had any income 

since 9/22/05 - because of that I'm not real happy about you all keeping 

me from receiving SSA disability." DDS again denied benefits under 

reconsideration, and he appealed to have his case heard before an ALl 

The claimant's attorney followed up by writing directly to an SSA senior 

attorney working with the ALJs in the ODAR office in Oklahoma City 

on November 9,2007, saying: "[D]ue to [the claimant's] age and his 

medical condition, I would request that you as a Senior Attorney please 

review the file for the possibility of an on the record favorable decision." 

AU Review. On December 26, 2007, Judge O'Bryan issued a sparsely 

worded "on-the-record" fully favorable decision for the claimant, 

awarding him SSDI benefits. Despite having been medically approved 

to return to work with no work-related residual impairment by his 

treating physician, Judge O'Bryan found the claimant disabled because 

of: "Other and unspecified arthropathies (7160), etc., etc." and 

"Disorders of back discogenic and degenerative (7240), etc., etc., etc." 

He found that the claimant: "is functional below the sedentary level for 

any sustained, continual or regular activity." In the section explaining 

his findings, he cut and pasted various portions of medical evidence 

from the case file into his decision, one of which was a consultative 

examination used to deny the initial claim. He then wrote: "Various 

physicians, treating and non-treating, have written that the claimant 

suffered from various medical problems and that the claimant has 

significant work restrictions." 

Judge O'Bryan concluded: "Considering the claimant's age, education, 

work experience, and residual functional capacity, there are no jobs that 

exist in significant numbers in the national economy that the claimant 

can perform." 

Oklahoma Case 134. Here, a 52 year-old man applied for ssm and SSI 

benefits alleging osteoarthritis in his knee, legs, and back, as well as 

depression. The claimant asserted that he was becoming "more and 

more house-bound," "had no interest in anything," "could barely 

function," and could not drive. In October 2007, Judge O'Bryan made a 

fully favorable award of benefits after an on the record review and 

determined no hearing was needed. He awarded benefits beginning in 

November 2004, finding the claimant's condition met the criteria for the 

following grid listings: 12.04 (affective disorder); l.04A (spine 
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disorder); and 12.06 (anxiety disorder), "etc." The opinion failed to 

acknowledge or discuss evidence in the case file of possible 

malingering and a higher activity level by the claimant than he admitted. 

In addition, his decision failed to discuss any ofthe specific elements 

required to meet each listing or to identify the evidence of record that 

proved the listings were met. 

Evidence of Physical and Mental Health. Despite the claimant's 

subjective assertions that he could barely function and was house-bound, 

the evidence of record contained hundreds of pages of medical records 

from the Veterans Affairs (VA) clinic chronicling treatment between 

August 2004 and October 2006. The medical records documented the 

claimant was physically active in a number of ways. Further, in a 

December 2006 evaluation, the physician examining the claimant 

reported actions by the claimant which countered his claims of chronic 

pain. 

The majority of the claimant's records related to his weekly therapeutic 

Hepatitis C support group notes. These records documented the 

claimant engaged in a wide variety of physical activities, as well as 

tracking his mental health. 

In December 2004, a psychologist noted the claimant "retold his story of 

losing his job about 5 weeks ago and how much struggle he has been 

having over this." The physician notes indicated "he is extremely 

anxious over this because of its cyclic nature and for what he was 

terminated over." The claimant reported that he was "drawing 

unemployment and he has enough money saved to get by on." The 

psychologist noted the claimant's responses were not, in fact, reflective 

of someone "extremely anxious," but were, "suggestive of an individual 

in a very relaxed state and low [an]xiety." As the session concluded, the 

psychologist "asked [the claimant] how he felt and he said 'great.'" 

In January 2005, the claimant reported that he had "started going to the 

[health club] and swimming laps twice a week now." The claimant 

stated: "I feel good but it wears me out quite easily." At the same 

session, the claimant discussed going back to work, but "stated that he 

frequently will procrastinate when it comes to looking for ajob which he 

has also done in the past." The next month, February 2005, the claimant 

stated that "his mornings are quite full every day and he is slowly trying 

to expand into the afternoons." He also discussed that he was 

"concerned that ifhe goes on ajob interview in the afternoon that he 

will not be up to his full potential and not make a favorable first 

impression." Therefore, the therapist "discussed the possibilities of 

moving the interviews to the morning or reducing his morning activities 
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for the day ofthe interview to preserve more energy for later on in the 

day." 

At a meeting on April 14,2005, the claimant "was very supportive of 

other group members facing crises" and "shared that he has found 

exercising in the VA's health wing very beneficial." He also "reports 

that he continues to exercise and to spend time volunteering." The next 

week, on April 21, the claimant reported "he continues to look for 

employment and participate in [the] upward bound program," which 

provides support for individuals preparing to attend college.75 

On May 5, 2005, the claimant expressed that "he experienced two 

occasions where he felt somewhat depressed," but "he was able to 

challenge his negative thoughts and reframe his situation, thus elevating 

his mood and continuing to move forward." He also "reported that he 

continues to stay very active and revealed that he has applied for 

employment at the VA." The therapist reported the claimant's condition 

had improved. On May 12,2005, the claimant reported "that he 

continues to volunteer at the VA, participate in the Upward Bound 

Program, and to challenge his negative thoughts." By May 19,2005, the 

claimant stated "he has gotten much of his strength and energy back 

following [his Hepatitis] treatment" and "continues to volunteer at the 

VA." 

On June 9, 2005, the claimant "reports that he has been feeling good and 

has made progress on his home projects" and gave a good deal of advice 

during today' s group." The next week, on June 16, the claimant had a 

"bright affect with upbeat mood" and "reports that he continues to 

volunteer 25 hours per week, but he is too tired to look for ajob." On 

June 23, the claimant "pointed out that his schedule is quite busy." The 

next month, on July 19,2005, the claimant was seen for a rash on his 

arms "likely starting after exposure to outdoor plants." He reported that 

"he is doing well and discussed his physical activity as well as active 

participation in V A programs such as volunteering and Upward Bound 

program" on August 11,2005. At the same time, blood tests confirmed 

prescribed treatment was successful, and no sign of Hepatitis C was 

detected in his RNA, even six months after treatment. 

On August 29,2005, the claimant reported to his counselor that his 

current leisure interests were "working with Upward Bound, exercise, 

work on the house, movies, reading computers, volunteering, and water 

aerobics." In September 2005, the claimant "denies any significant neck 

or low back pain but says that he is involved with therapeutic recreation 

75 United States Department of Education, Upward Bound Program, 

http://www2.ed.gov/programs/trioupboundlindex.html. 
186 

97 

5 times a week [at the VA] doing comprehensive abdominal [exercises], 

stretches as well as he [is] personally doing swimming [exercises] at the 

local [gym] 5xJweek." The progress notes repeatedly stated the claimant 

had "a bright affect with upbeat mood." 

Records throughout 2006 continued to document the claimant's active 

lifestyle, which included pottery, drumming, a walking-stick making 

group, and yoga classes, as well as a college-level course. In January 

2006, the therapist noted the claimant "is positive and encouraging of 

others and appears to benefit from the social interaction" of his group." 

In the spring of 2006, he stopped attending his Hepatitis support group, 

but instead participated in a weight management support group. In July 

2006, the claimant developed a "rash [on his] lower legs after he went 

out on his farm." 

In late summer 2006, the claimant stopped exercising and complained to 

his physician of fatigue and liver pain. On September 21, 2006, the 

claimant's physician confirmed the claimant's pain was "NOT liver 

related." The physician noted "we cured his virus" and "[claimant] is 

clearly poorly conditioned cardiovascular wise and needs to start 

exercising to reverse his fatigue rather than obsess about 18 months ago. 

He need not return to liver clinic." 

In the same month, October 2006, the claimant applied for disability. 

Potential Evidence of Malingering. In December 2006, a physician 

reviewed the claimant, whose chief complaint was "chronic bilateral 

knee pain, left ankle pain, neck pain, and low back pain." The physician 

noted the claimant "ambulates with crutches" and "has chronic pain 

behaviors." He stated the claimant "exhibits chronic pain with attempts 

to manipulate the shoulders." The physician noted, however, the 

claimant acted much differently when he got to the parking lot. The 

doctor stated he: 

observed the patient in the parking lot. He drives a small 

traditional Volkswagen. He was able to get into the 

Volkswagen without difficulty. This required flexing his 

knees to at least 90 degrees. He fastened his seat belt and 

turned his head 90 degrees to the right to look over his right 

shoulder to back out. He had no trouble using his left 

shoulder to slam the car door. 

DDS Review. The DDS determined the claimant failed to meet program 

qualifications and wrote in its explanation of determination: 
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52 year old male [complains of] knee problems, hepatitis C 

and mental problems. He has the residual functional capacity 

to lift/carry 20 Ibs occasionally, 10 Ibs frequently and to 

stand/sit/walk 6 hours in an 8 hour workday. One of his past 

relevant jobs was as a retail sales worker where he lifted 

50lbs occasionally. He cannot do the job as he describes it. 

In the DOR the job is Sales Attendant, 299.577-010, which 

carries a light strength rating. He has the residual functional 

capacity to do this job as it exists in the national economy. 

DDS affirmed the denial on reconsideration. The claimant retained an 

attorney and requested a hearing before an administrative law judge. 

Judge 0 'Bryan's Decision. ALJ O'Bryan made a fully favorable 

decision for the claimant on the record without holding a hearing a 

practice reserved for cases that are obvious and do not require hearings. 

Judge O'Bryan cited no specific evidence and performed no analysis, 

but found: 

The severity ofthe claimants affective (mood) disorders 

(2960), anxiety related disorders (3000), hepatitis C, 

disorders ofthe back discogenic and degenerative (7240), 

knee and leg problems, obesity and hyperalimentation 

(2780), etc., etc., etc., meets the criteria ofsection(s) 12.04, 

1.04A, 12.06, Social Security Ruling 02-0Ip, etc., etc., etc., 

of20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 

404.1 52(d)). 

Judge O'Bryan awarded benefits based on the claimant's meeting the 

grid listings for anxiety and affective disorders, as well as a spinal 

condition, but identified no medical evidence from the record that 

supported his decision. Instead, he just stated "etc.," specifYing only 

that "various physicians, treating and non-treating, have written that the 

claimant suffered from various medical problems and that the claimant 

has significant work restrictions." 

Judge O'Bryan also dismissed the doctors at the DDS-level who denied 

the claim, stating: 

The State agency medical opinions are given little weight 

because other medical opinions are more consistent with the 

regard as a whole and evidence received at the hearing level 

shows that the claimant is more limited than determined by 

the state agency consultants. ... The Administrative Law 

Judge affords greater weight to the opinion ofthe examining 

(nontreating) source. The opinion is well supported by 
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medically acceptable clinical and laboratory findings and is 

consistent with the record when viewed in its entirety .... 

The State agency did not adequately consider the entire 

record, including the subjective complaints and other 

allegations of the claimant. 

The ALJ did not identify what new medical evidence proved this 

statement, or the opinion ofthe examining physician he relied on to 

award benefits. 

Oklahoma Case 144. In 2009, ALJ O'Bryan awarded disabled widow's 

benefits and SSI to a claimant for affective mood disorders and anxiety 

disorders. While an award of benefits may have been warranted, in 

drafting his fully favorable decision, Judge O'Bryan included many of 

the problematic features described earlier. The opinion also failed 

adequately to address significant evidence of drug and alcohol abuse, as 

well as the significance of claimant's past work record. Finally, the case 

file contained few, if any, medical records to support the claimant's 

allegation of disabling anxiety. 

In her application, the claimant wrote she became disabled in August 

2003, but also that she worked until 2004. According to her paperwork, 

she quit her job, "because I have been taking care of my husband who 

recently passed away." After her husband, who was also on disability, 

died in 2008, she decided to apply for disability benefits even though she 

had been denied three times in the past. On the application she wrote: 

"So when he passed in August 12, 2008, I'm left in an awful place, so I 

thought - now its time - its proper, its my right to apply for disability -

which I am doing again and again." 

One key issue was that the claimant did not have many medical records 

available to support her claim. A case manager from a mental health 

clinic noted on May 10, 2009, that the claimant: "is in a difficult spot 

without having ample records to back her claim of being disabled due to 

mental illness. [The claimant] has been denied three times and from the 

way she puts it, her attorney is reluctant to take her case at this point." 

Her application was denied at the first two levels of review, and she 

appealed the case to appear before an administrative law judge. 

Claimant's Work History. On her Request for Reconsideration - a form 

filled out by those denied benefits at the DDS level- the claimant said 

she worked briefly in February 2009 as a waitress, six months after 

filing her original disability application. The job did not last more than a 

few weeks, but raised questions about her ability to work. Asked on the 

form to explain why she requested reconsideration, she wrote: 
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I got turned down I am broke - I attempted to work. Worked 9 

days 1/30-2/16. Couldn't cope small diner - I could only handle 

about 2 tables - they weren't happy with me and I couldn't 

handle it. 

On another form, she was asked ifthere was any change in her disability 

since she applied in August 2008, to which she replied "yes." She 

elaborated: "When you denied my disability - I had no money - I 

attempted to work, started 1130109 - quit 2/16/09. Diner waitress - too 

nervous couldn't cope .... Small diner, they all said I'm too stressed -

need to improve - need to get faster, I couldn't concentrate. Getting 2 

tables overwhelmed me." 

A medical evaluation undertaken at SSA's request just a few months 

earlier, in December 2008, noted that the claimant had indicated she had 

"worked for many years despite ... anxiety and polysubstance abuse." 

The opinion awarding benefits contains no analysis ofthe claimant's 

work history to determine whether, in the past, she was able to work 

despite experiencing anxiety and what, if anything, had changed. 

Evidence ofD&A Abuse. In addition, the claimant's file contained 

significant evidence that the claimant had a serious drug and alcohol 

addiction. The presence of drug or alcohol abuse requires the decision 

maker to determine whether the claimant's drug addiction or alcoholism 

is a contributing factor material to the determination of disability. The 

decision maker must determine the claimant would be disabled 

independent oftheir drug or alcohol addiction.76 The records reflect that 

various doctors struggled to determine whether the addiction was related 

to her depression and anxiety, and whether she would suffer those 

mental impairments if she discontinued her drug and alcohol 

dependence, as the following demonstrates. Judge O'Bryan's opinion, 

however, simply concluded this information was "not material," failing 

to offer any explanation as to why. 

The claimant was referred by the state DDS office for a psychological 

exam in October 2008, at which the doctor reported that she had been 

drinking heavily and taking her deceased husband's anxiety medication, 

Xanax. 

[The claimant] stated that she drinks beer, "more these past 

two years," estimating that on average she drinks, "eight 

76 See 20 CFR §416.935, "How we will detennine whether your drug addiction or alcoholism is 

a contributing factor material to the detennination of disability," 

http://www.ssa.gov/OPHome/cfr20/416/416-0935.htm. 
190 

101 

beers a night, up to three cases a week." She considers 

herself to have been a problem drinker, "from 2004 until the 

present time." 

During the same evaluation she "reported that she has been taking 

Xanax all of her life," adding "I take my husband's, .5 mg. every day." 

One of the agency doctors, writing a "case analysis" on December 12, 

2008, asked another doctor, "Do you agree DAA [drug and alcohol 

abuse] material?" She added this case was "[a] bit complicated. Get 3rd 

party [assessment] from the neighbor who sees her often. Then we'll 

deal with the [alcohol] use. Right now I can't say DAA because I don't 

know if sober she would do better." 

A subsequent evaluation by a DDS consultant on December 31, 2008, 

raised similar questions, saying the claimant: "has suffered anxiety with 

panic attacks for many years but has not sought [mental health] 

treatment in about 5 years and no [medical records] since 2005 exists. 

[The claimant] worked for many years despite the anxiety and 

polysubstance abuse. [The claimant] has long [history] of[alcohol] 

dependence and drug addiction, she continues to drink to excess daily." 

The report noted that drugs and alcohol could be contributing to her 

condition: "Many of the limitations noted by the Clmt and 3rd party 

could be related to the [alcohol] effects andlor some depression." 

Whether drugs and alcohol was a primary cause of the woman's 

disability remained a pertinent, but unsettled, question: "[T]he claimant 

admits to daily heavy [alcohol] use but we do not have evidence to 

support establishing DAA as material.. .. There is no evidence to 

indicate she functions well or better sober." 

On February 2, 2009, mental health clinic records state that the claimant 

had "been on Xanex for 2 years. She reports being prescribed to take it 

3 per day in 2000 to 2003, and was taking her husband's prescription 

recently before his death in 8/09. She ran out of medication about 2 

weeks ago, and has resorted to alcohol to curtail her anxiety." The 

doctor also noted: "She has some awareness that her Xanex use is 

abusive," and "She is dependent on her Xanex." The clinic records also 

indicate alcohol was a problem: "She was arrested in the 80s for a DUI. 

In 2004 she moved out of her husband's house and got a DUI." 

In the course of the 2009 evaluation, according to the psychologist, the 

claimant said: "I have and have had anxiety for I 0 years. I was taking 

my husband's Xanex, but he died and now I don't have any. I need to 

get out of the house and go to work." The psychologist concluded that 

her behavior may be manipulative and drug-seeking: "[S]he is 
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dependent, and will use others to get her needs met, she is addicted to 

Xanex." 

Judge o 'Bryan Opinion. DDS denied the claimant's initial application 

and request for reconsideration. On appeal, Judge O'Bryan found the 

claimant's disability began on August 12,2008, the day her husband 

died. He later amended the disability onset date to February 12,2008, 

six months prior, though the change was not explained. 

His fully favorable decision, rendered "on-the-record" and without a 

hearing, failed to adequately acknowledge the evidence of past work and 

drug and alcohol abuse. With respect to the latter issue, the decision 

simply said, without further explanation: "The claimant's substance use 

disorder(s) is not a contributing factor material to the determination of 

disability." 

Judge O'Bryan found the claimant disabled under medical listing 12.04 

for affective disorders. Later in his opinion, he explained the listing was 

met because, "The paragraph A criteria are satisfied because the 

claimant has 12.04, 12.06, 12.09, etc." This explanation is difficult to 

understand, but may amount to a circular argument in which "12.04 was 

met because the claimant has 12.04." The 12.04 listing requires an 

individual to have several specific symptoms, such as an inability to 

sleep, appetite disturbance characterized by weight loss, feelings of guilt 

or worthlessness, or hallucinations, with resulting factors that limit the 

claimant's abilities. Within his opinion, Judge O'Bryan not only did not 

discuss whether the claimant had any ofthe required symptoms, he 

inserted images from a consultative exam on December 31, 2008 that 

found the claimant did not meet the requirements of listing 12.04. 

The remainder ofthe opinion failed to identify any symptoms 

experienced by the claimant or to discuss the medical evidence. Rather, 

it consisted only of reproductions of portions of the claimant's 

application, which appear to have been copied and pasted into the 

document, primarily a several-page October 2008 consultative exam 

record (referenced above). This record, however, had also been 

submitted to the DDS examiner who referenced it specifically and 

rejected it as unreliable evidence, concluding: "Medical evidence does 

not show any other impairments which keep you from working." The 

DDS examiner then denied the request for benefits. The O'Bryan 

opinion simply does not explain why he reached the opposite 

conclusion. 

Oklahoma Case 146. In 2010, Judge O'Bryan awarded a 43 year-old 

woman ssm and SSI benefits effective June 1,2007, based on 

depression and diabetes. The evidence of record, however, documented 
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103 

consistent noncompliance with her prescribed medical treatment, which 

can disqualify someone from receiving benefits, as well as evidence that 

the claimant had worked after her alleged disability onset date. 

The claimant applied for benefits on February 26, 2009, disclosing in her 

application that she was experiencing financial and marital difficulties: 

"My husband and I are talking about possibly reconciling. I may be 

moving in with my mother because I can't afford to keep my 

apartment." In addition to alleging depression and diabetes, she claimed 

to suffer from Bell's palsy and repeated MRSA infections. 

Her application was denied by DDS on June 3, 2009, and again under 

reconsideration on October 20,2009. DDS explained in its denial that 

since she was still working and earning more than was allowed, her 

medical condition did not qualify her for disability. The agency 

provided the following explanation for denying her reconsideration 

request: 

The medical evidence shows the following: While you are 

treated for Bell's palsy, medical records indicate this is not a 

disabling condition. Your MRSA has responded to treatment 

and will not keep you from doing all types of work. While 

your depression and anxiety keep you from doing stressful 

and complex types of work, you can do simple, routine work. 

Although you are experiencing pain in your back, shoulders, 

knees, and your legs from neuropathy, you are able to sit, 

stand, bend and walk well enough to work. Your diabetes 

could be controlled by medicine and diet if you would follow 

prescribed treatment. Medical evidence does not show any 

other impairments which keep you from working. On further 

review of the evidence and your description of the job you 

did as a clerical worker for some time, evaluation reveals that 

you are able to return to this job. 

On March 10,2010, ALl O'Bryan reversed the previous denials, ruling 

fully favorably for the claimant. His opinion failed to take into account 

the woman's long history of noncompliance with her prescribed 

treatments for diabetes as well as evidence the claimant worked a fulltime job for a three-month period following her application for benefits. 

Like many of his other decisions, this one contained little original 

analysis. Rather, in its place he cut and pasted unexplained computer 

screen shots into the decision from the claimant's records. 

Noncompliance with Prescribed Treatment. Over a period of several 

years, a number of doctors prescribed various treatments for the 
193 

104 

claimant's conditions, but she often failed to comply with them. SSA 

rules require a person to follow their doctor's prescribed treatments, 

stating: "If you do not follow the prescribed treatment without a good 

reason, we will not find you disabled or, if you are already receiving 

benefits, we will stop paying you benefits."n Her medical records 

showed not only that the claimant was non-compliant, but possibly 

willfully so. 

On November 25, 2006, a physician made the following stark 

assessment of her condition: 

Diabetes mellitus type 2, uncontrolled, due to patient 

noncompliance. She refuses a diabetic diet. Cover with 

Humalog and start metformin but I seriously doubt this will 

be of benefit to her. She constantly drinks Coke whenever 

she can. She has no insight to her disease process or is not 

willing to have insight to it .... She is uncontrolled today and 

is unwilling to assess her needs for insulin control or 

management. 

Three months later, on March 11,2007, the same physician stated in 

medical notes that the claimant's Type II diabetes remained 

uncontrolled: 

Patient very noncompliant with treatment. When told I had a 

magic wonder drug that would help her, she said I don't want 

drugs, I want food. She is not willing to comply with diet nor 

to assist with her therapy. I will add Jenova but I doubt this 

is going to have a significant effect if she doesn't comply 

with diet. ... She has no retinopathy, nephropathy. She is 

grossly obese. 

A medical note dated August 14,2008 stated: "[Claimant] admits to 

dietary noncompliance." On September 15,2008, the claimant's 

treating physician recorded her weight at 284 pounds and diagnosed her 

with "uncontrolled and noncompliant with diabetes and hypertension," 

adding she "admits to noncompliance with sweets, Cokes, and foods." 

He further explained: 

We discussed the importance of compliance with micro and 

macrovascular complications. Recommended a healthy diet, 

which she is very resistant to and actually leaves tearful 

today because ofthat. .. She needs to monitor her sugars. 

77 20 C.F.R. §404.1530. Need (0 follow prescribed treatment, 

http://www.ssa.gov/OPHome/cfr20/404/404-1530.htm. 
194 

105 

The same pattern continued. A year later, on August 11, 2009 the 

claimant's physician's noted the claimant was "quite noncompliant with 

diet-she does take [medications] as directed. Poor control ofDM 2 

[Type 2 Diabetes]. Discussed need to make good food choices or 

[number]s will not improve." 

Despite this extensive evidence in the claimant's file, Judge O'Bryan 

failed in his opinion to acknowledge or address the claimant's 

noncompliance with dietary restrictions, failure to control her blood 

sugar, and failure to take her medication after 2007. 

Evidence of Work. A second set of issues involved evidence that the 

claimant was working at the time she requested the ALJ hearing, 

contrary to her claim that she was disabled. 

On May 26,2009, a doctor performing a consultative examination 

wrote: "She reported that she is currently working a full-time job, so she 

goes to work, and when she is home she cleans or runs errands." On 

July 23, 2009, she disclosed to the SSA: "I did work for 3 months as a 

Cashier at [a] store since filing for disability. It was very difficult to be 

on my feet for 7-8 hours a day and to perform the multitude of tasks 

expected of me. I didn't get along well with management because they 

cared more about profits and percentages than about people. They did 

not care about my health." 

Such work and activities are inconsistent with the claimant's allegations 

of disability and should have been addressed by the ALJ through 

questioning at a hearing, but Judge O'Bryan instead decided the case by 

examining her case file and without holding a hearing. 

In his opinion, Judge O'Bryan found the claimant to be disabled because 

of: "Primary: AFFECTIVE MOOD DISORDERS (2960), etc., etc., etc., 

Secondary: DIABETES MELLITUS (2500), etc., etc., etc." To support 

his decision, he included several screenshots of medical records, one of 

which said: "Claimant can adapt to a work situation." Then he wrote: 

~Various physicians, treating and non-treating, have written that the 

claimant suffered from various medical problems and that the claimant 

has significant work restrictions." This portion ofthe decision never 

named the physicians, the medical problems, or the work restrictions. 
195 

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V. PROBLEMS WITH MEDICAL-VOCATIONAL 

RULES THAT ALLOW FOR "GRIDDING" 

When claimants apply for Social Security disability benefits, they can 

receive an award in one oftwo ways. The first, which has already been 

discussed, is to meet the criteria for a "medical listing. " If a claimant 

meets the medical listing criteria, the disability application process ends 

at Step Three with an award of benefits. The second way for claimants 

to receive an award of benefits occurs at Step Five of the process if they 

meet the requirements ofthe "Medical-Vocational Rules." 

The Medical-Vocational Rules apply to claimants who do not meet the 

criteria for a medical listing, but still have a severe enough impairment 

that they may not be able to work. To help DDS examiners and 

appellate personnel determine in these circumstances when someone is 

disabled, promote consistent decision making across the agency and the 

country, conserve resources, and increase efficiency, SSA has developed 

a grid incorporating a number of variables providing guidance on how to 

handle disability claims that reach Step Five. 78 When a person is 

analyzed under the Medical-Vocational Rules to determine whether they 

are disabled, it is commonly referred to as "gridding." 

More than 80 grid options apply to claimants, with variables that include 

a person's age, level of education, past work history, ability to speak 

English, and his or her "residual functional capacity" known as an 

RFC. An RFC reflects an individual's capacity for engaging in 

"substantial gainful activity," or SGA. Persons who engage in SGA 

cannot be considered disabled. RFCs can range from a person being 

able to engage in "heavy" work on the high end to "sedentary" and "less 

than sedentary" work on the low end. 

In the cases examined in the investigation, a large number of claimants 

were awarded disability benefits via "gridding." While some ofthese 

cases appear to have correctly applied the gridding rules, others raised 

questions about whether they were used as intended. This finding was 

confirmed by the Office of Appellate Operations (OAO), which found 

78 From the introduction to the Medical-Vocation Rules: "The following rules reflect the major 

functional and vocational patterns which are encountered in cases which cannot be evaluated on 

medical considerations alone, where an individual with a severe medically determinable physical 

or mental impairment(s) is not engaging in substantial gainful activity and the individual's 

impairment(s) prevents the performance of his or her vocationally relevant past work. They also 

reflect the analysis of the various vocational factors (i.e., age, education, and work experience) in 

combination with the individual's residual functional capacity (used to determine his or her 

maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work) in 

evaluating the individual's ability to engage in substantial gainful activity in other than his or her 

vocationally relevant past work." http://www.ssa.gov/OPHome/cfr20/404/404-app-p02.htm 
196 

107 

that hearing offices decided cases at Step Five versus Step Three at 

about a 4 to 1 ratio. 79 

One key issue involves how the grid rules treat older workers. Under 

the grid rules, SSA assumes a person becomes significantly less able to 

work once they reach the age of 50, and even less capable once they 

reach 55 or 60. As persons reach those specified ages, the grid rules are 

progressively less likely to find them able to work and more likely to be 

disabled. For example, under the grids, a 49 year-old that can perform 

sedentary work, has less than a high school education, and whose past 

work is considered unskilled is found "not disabled." See 201.18. In 

contrast, a 50 year-old that can perform sedentary work with the same 

education and past work experience is "disabled." See 201.09. Because 

of the way the rules are designed, it is possible to find someone "not 

disabled" on the day before their 50th birthday, but "disabled" on the 

next day with nothing changed but their age. 

In a large number of cases reviewed by the Subcommittee, claimants 

alleged their disabilities began before the ages of 50, 55, or 60, but had 

RFCs suggesting they could work. In some cases, ALJs adjusted the 

onset date oftheir disabilities to the date on which they turned one of the 

ages specified under the grid rules and found them to be disabled. This 

practice is known as "amending the onset date." In fact, this practice is 

encouraged by the agency in its rules and regulations. In a section 

entitled, "Your age as a vocational factor," the agency says: 

We will not apply the age categories mechanically in a 

borderline situation. If you are within a few days to a few 

months of reaching an older age category, and using the older 

age category would result in a determination or decision that 

you are disabled, we will consider whether to use the older 

age category after evaluating the overall impact of all the 

factors of your case.so 

The intent of these rules is to give claimants the benefit of the doubt in 

"borderline" situations. 

Oklahoma Case 170. DDS awarded ssm benefits to a 60 year-old 

woman alleging arthritis in her hip, PTSD, and incontinence. While her 

medical records reveal some evidence of mental or physical 

impairments, she received treatment for both and was physically active. 

She was nevertheless approved for benefits under the "gridding" rules 

79 Office of Appellate Operations, Executive Director's Broadcast, Vol. 3, Special EditionQuality Review, January 13,2012. 

80 20 C.F.R. §404.l563. Your age as a vocational factor, 

http://www.ssa.gov/OPHome/cfr20/404/404-1563.htm 
197 

108 

based upon her age and work experience. The claimant was 59 years old 

when she applied, and her application was denied. Within days of her 

denial she turned 60 years old and was then approved for benefits 

several months later under program rules. The decision to award her 

benefits did not address the contradictory medical evidence in the case 

file. 

Application Denied at DDS and Approved upon Reconsideration. The 

claimant applied for benefits on September 3, 2008, alleging a disability 

beginning on October 20, 2006. For several years after her alleged onset 

date, however, the claimant's records showed her to be physically active 

and even working thrce days a week at a health club as a receptionist. 

On September 30, 2008, DDS denied this claim, making the following 

determination: 

We have determined that your condition is not severe enough 

to keep you from working .... The medical evidence shows 

the following: While you have been treated for arthritis and 

incontinence, this condition has not seriously affected your 

ability to work. Although you are experiencing pain in your 

right hip, you are able to sit, stand, bend, and walk well 

enough to work. Although you sometimes experience PTSD, 

there are no sign of a severe mental illness which keeps you 

from working. Most of the time you can think clearly and 

carry out normal activities. Medical evidence does not show 

any other impairments which keep you from working. Based 

on your description of the work you performed as a cashier 

for several months, evidence indicates you are capable of 

doing this type of work as it is generally performed. 

When the claimant applicd for reconsideration on November 7, 2008, 

she had just recently turned 60 years old. DDS revicwcd the case file 

once more then reversed itself on February 18, 2009, finding her 

disabled as of October 20, 2006. The explanation accompanying the 

reversal said the claimant now met the rules for disability based on 

vocational factors, specifically Grid Rule 202.06. This rule states an 

individual is disabled if they have a residual functional capacity for no 

more than light work, are of advanced age (60 years or older), and are a 

high school graduate with no skilled work or transferable skills. DDS 

found, "The claimant can not return to [prior work]. The claimant's age 

and mental limitations limit the claimant's ability to transfer skills. The 

claimant's vocational profile matches vocational rule 202.06 which 

directs a decision of disabled." 

Evidence o/Increasing Health and Work Activity The DDS award of 

benefits did not take into account the records in her case file 
198 

109 

demonstrating the claimant's physical activity, lack of incontinence, and 

mental health. Over a period of several years, the claimant had 

complained of chronic hip pain as well as depression, but received 

treatment for both. On August I, 2006, the claimant was seen by a 

physician at a Department of Veterans Affairs (VA) medical center as a 

new patient. Physician progress notes from that date state: "Here for 

first time visit. Interested in getting care and help with medications." 

The claimant's past medical history noted problems with hypertension, 

high cholesterol, and an acne-like rash on her face. The medical notes 

from this visit also stated that she "feels depressed, tired, stressed, lack 

motivation, does not want to be around people." There is no mention of 

PTSD. Reports from all other body systems were determined to be 

normal. The gynecology section noted the date of her last mammogram 

and pelvic examinations and noted she had never received a bone 

density scan, but did not mention any complaints of incontinence. Her 

social history noted that she was retired. 

Her doctor recommended a treatment plan that consisted of four items: 

(1) a change in her blood pressure medication; (2) a referral to a 

dermatology clinic for her rash; (3) a referral to the gynecology clinic 

for a bone density test and mammogram; and (4) a discussion of her 

depression complaints. The notes also state that while they discussed 

treatment options for depression, including medication and counseling, 

the claimant indicated that she wanted "to think about it." 

Two weeks later on August 15,2006, the claimant went to her initial 

gynecology appointment. Progress notes from that appointment state 

she "presents today as a referral because she 'just got into the VA 

system.' [Patient] has no [complaints] today." The notes further stated 

that "[s]he has no [gynecological] complaints." 

In November 2006, nearly a month after her alleged disability onset 

date, the claimant told her doctor "that she has been taking Naproxen for 

right hip pain. States it helps but she does not want to continue taking 

it." The following month in December 2006, she began an exercise 

regimen. Progress notes state: "[V]eteran began initial program of 

aerobic exercise including walking on the treadmill and light weight 

resistance exercises. Veteran will also begin ABlback groups on 

12/27/06 to work on strengthening core muscles." She would continue 

this exercise regimen for the next several years. 

In April 2007, the claimant began attending psycho-educational group 

sessions in which she was able to discuss events in her life. Progress 

notes indicate in 2007 she was actively dating, took multiple out-of-town 

trips, and went out with friends. 
199 

110 

Around the middle of 2007, the claimant complained again of chronic 

hip pain, which she described as "excruciating." But on June 21, 2007, 

her progress note stated: "[V]eteran is currently using the bicycle, arc 

trainer, ab machine, treadmill, and an assortment of free weights and 

machine weights. She is doing an excellent job of maintaining loss of 

inches while building overall strength and fitness." In July 2007, she 

returned from travelling and "reports she had a great time on her 

vacation to the Grand Canyon." 

On October 1,2007, a progress note with her physician contained a 

section asking: "Does the patient display any of the following: 

immobility; incontinence; poor nutritional status?" to which the doctor 

wrote: "No." 

A medical progress note from February 12,2008, found the claimant 

was continuing her gym routine, "4 dayslwk (treadmill, bike and arc 

slider), abs class 3xwk, walks her dog 15-20 min most days; had been 

doing weights," but her trainer "told her to quit" because "adding muscle 

would make her gain weight." In addition, she was eating out on a 

regular basis and had "gone to Vegas twice lately." 

By April 24, 2008, her psychiatric progress notes found, "[Patient] doing 

well. Plans on a train trip to LA with fr[ien]d in July. May have to sell 

dog, [name withheld], blc she is gone too much. Is exercising at VA 

gym and attends MAPS. Has found some [] friends through the MAPS 

group." The notes made no reference to issues involving PTSD. On 

June 2008, medical records stated the claimant was "doing very well 

physically." 

By August 2008, group therapy notes even stated the claimant "was 

cheerful and had good energy." While the claimant believed she was "in 

a personal relationship that was not serving her needs," physically she 

appeared to be fit and healthy. 

Despite evidence of increasing emotional and physical health, on 

September 3, 2008, the claimant applied for disability benefits. In her 

disability application forms, the claimant alleged an inability to bend and 

stoop due to pain and difficulty walking and standing for long periods of 

time. 

On September 8, 2008, the claimant visited her doctor at the Veterans 

clinic who advised her, "to continue general aerobic exercises at least 

twice a week." Several days later on September 16, her doctor said she 

was physically well enough to "return to a regular exercise program ... 

this will include both aerobic and strengthening to help her attain her 
200 

III 

goals. Arc Trainer, bicycle and cross trainer for aerobics and moderate 

weight lifting for toning." 

Her application for benefits was denied on September 30, 2008, and she 

applied for reconsideration on November 7, 2008. On November 17, 

2008, her doctor advised her to get more exercise, writing: "Advised to 

gradually increase until walks briskly (15-20 minute mile) for 1 hour at 

least 3-4 times weekly. Other forms of exercise may be utilized if 

desired or needed by the patient." 

According to a psychological evaluation on January 21, 2009, the 

woman explained that at least one of her recent job losses was unrelated 

to any disability: "She reports being fired from last work at [name 

withheld] for being disrespectful to customers and from [name withheld] 

after three weeks due to she stayed in the bathroom too long." 

During a psychological exam on February 10,2009, she told her doctor, 

"she is applying for Social Security Disability benefits, 'for my hip, it's 

been hurting four or five years, I can walk and it goes out, and the pain 

goes into my back and in the other hip I have numbness down my right 

leg.'" When asked to describe her typical day, she noted she, "had been 

going to the gym, but the doctor took me off until he finds out about my 

hip .... " 

She explained again that she was not working, in part, because of factors 

unrelated to disability: "last worked as a part-time crew member at 

[name withheld] in December, 2008, ajob from which she was 

terminated after only ten days of employment because, 'he said I was 

being disrespectful to customers.' Prior to that, she had worked as a 

crew member at [name withheld] part time for three weeks until being 

terminated because, 'they said I stayed in the restroom too much,' and 

prior to that, she had been a receptionist part time at the [name withheld] 

for five months until quitting because, 'J felt unsafe there.'" 

The DDS decision to grant the claimant benefits upon reconsideration 

under the grid rules failed to acknowledge any of the evidence in the file 

about the claimant's physical activity, lack of incontinence and PTSD 

complaints, and ability to work. 

Oklahoma Case 177. The Social Security Appeals Council (SSAC) 

overturned ALJ Thomas Bennett's denial of benefits for a claimant who 

alleged disability due to arthritis, anxiety, and depression. The SSAC 

did not disagree with his review of the medical records, which found her 

not to be disabled, but rather that he incorrectly stated her age. In so 

doing, SSAC found the woman qualified for disability benefits by 

meeting the grid rules. 
201 

112 

The majority of records in evidence involved prison medical records 

from 2005-07, which documented only routine check-ups. Notes from 

her last prison health checkup dated February 2007, stated the claimant 

told the physician she had a history of Hepatitis C, but reported no other 

issues. The physician prescribed ibuprofen, but failed to document why. 

An earlier progress note dated April 2005, stated the claimant had 

arthritis in her back, but no x-rays or other tests corroborated this 

finding. The state DDS sent the claimant to both physical and 

psychological consultative examinations. 

Physical CEo On September 17,2007, a doctor performed a 

"comprehensive internal medicine examination" on the claimant. Her 

chief compliant was "chronic low back pain and pain in neck shoulders, 

hand, knees, and feet," however, the claimant "does not take 

medication." The physician wrote: 

The patient has normal speech and hearing. She has normal 

cognitive function. She has good dexterity of her hands and 

fingers and good grip strength. She has some mild limited 

rotation of her neck and some mild limited flexion of her 

back. She ambulates in the hallway at a normal gait and pace 

and without a limp. She has no chronic pain behaviors or 

malingering behaviors. She has flat affect and appears to be 

depressed. 

The doctor also noted that the claimant "has adequate muscle strength 

and tone in the upper and lower extremities" and "can heel, toe and 

tandem walk without difficulty." The notes contained no reference to 

the presence of arthritis. 

Psychological CEo On October 11,2007, the claimant was assessed by a 

licensed psychologist. Based on his assessment, the psychologist 

determined the claimant "reported the onset of severe anxiety symptoms 

in the eighth grade." He also pointed out "she has a history of substance 

abuse, most notably prescription medications." The psychologist 

determined the claimant had "generalized anxiety disorder" and 

"avoidant personality disorder." The claimant had, however, never 

taken medications for either ofthese conditions, making it difficult to 

determine how long they had really existed and whether they had 

responded or would respond to treatment. The analysis did not contain 

any information or documentation establishing that the claimant suffered 

from the disorders prior to 12/3112006, the latest date on which she was 

insured. 
202 

113 

The psychologist also found: 

Cognitively, her memory and concentration were within 

normal limits. Her vocabulary is average, as is her ability to 

perform simple math operations. She is able to reason 

abstractly, and she has a below average fund of General 

Information. It is estimated that her intelligence lies within 

the low average range. 

The CE made no recommendations regarding particular work 

limitations, but stated the claimant had a history of substance abuse and 

could manage her own money. 

DDS Explanation of Determination. The DDS denied the claim and 

explained that the claimant did not have enough evidence to make any 

finding of a disability. 

Insufficient [medical evidence of record] at [date last 

insured], 12/31/06. Currently, with CE in file, claimant 

shows no manifestations of osteoarthritis or rheumatoid 

arthritis in hand or fingers. Joints have normal [range of 

motion], back has slight decrease in [range of motion], SLRnegative, heel/toe waling normal, normal gait. Physical is 

nonsevere. 

The initial denial was affirmed at reconsideration for the same reason 

and stated "insufficient evidence to find the claimant disabled prior to 

12/31/2006, the date she was last insured to receive benefits." 

ALJ Determination. The claimant appealed the decision and requested a 

hearing before an ALl. On February 2, 2009, however, the claimant 

wrote to the Oklahoma City ODAR and explained that she "will not be 

able to attend the hearing scheduled ... due to [her] health problems, in 

particular [her anxiety] of being around people." Therefore, she 

requested "the Judge to make a decision on [her] case based on the 

records without [her] live testimony." 

ALJ Thomas Bennett denied the claim. Based on the medical evidence, 

Judge Bennett determined "the claimant does not have an impairment or 

combination of impairments that meets or medically equals" a listed 

impairment. The Judge's opinion explained: 

In activities of daily living, the claimant has mild restrictions. 

In social functioning, the claimant has moderate difficulties. 

With regard to concentration, persistence or pace, the 

claimant has mild difficulties. As for episodes of 
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decompensation, the claimant has experienced no episodes of 

decompensation, which have been of extended duration. 

This is identical to the assessment of the State agency. 

With regard to her residual functional capacity, Judge Bennett found that 

the claimant could perform sedentary work. The judge also found: 

The claimant's medically determinable impairments could 

reasonably be expected to cause the alleged symptoms; 

however the claimant's statements concerning the intensity, 

persistence and limiting effects of these symptoms are not 

credible to the extent they are inconsistent with the above 

residual function capacity assessment. 

Therefore, "considering the claimant's age" - which the ALJ believed to 

be 44 years old - "education, work experience, and residual functional 

capacity," Judge Bennett explained that "there are jobs that exist in 

significant numbers in the national economy that the claimant can 

perform." 

On April 28, 2010, the Social Security Appeals Council (SSAC) notified 

the claimant that the ALJ had incorrectly considered the claimant to be 

44 years old. She was actually 49. The SSAC concluded that, due to 

her age, the claimant would qualify for disability benefits under a grid 

rule when she turned 50. On June 16,2010, the SSAC overturned Judge 

Bennett's decision and found the claimant disabled by moving her 

disability onset date to her 50th birthday. The SSAC, however, 

acknowledged "the claimant's subjective complaints are not fully 

credible for the reasons contained in the body of the hearing decision." 

This case demonstrates how a person who appears to be healthy enough 

to work, based exclusively on the available medical records, was found 

to be disabled simply because of her age. While the judge mistakenly 

believed her to be five years younger than she was, this age difference 

did not change that the fact that her case file lacked the required 

evidence for a medically supported finding of disability. 

Alabama Case 87. In this case, a 49 year-old man was in a car accident 

in 2008, and sustained lower leg and collarbone fractures. The 

individual underwent corrective surgery and while DDS determined his 

injuries would not last more than 12 months, Judge Samuel Childs 

decided otherwise and awarded SSDI and SSI benefits based on the grid 

rules. In this case, the judge applied the rules to the man "nonmechanically" as ifhe were 50, during a period in which he was actually 

49 years old. 
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Medical Evidence of Record. The claimant underwent corrective 

surgery shortly after the accident and his post-surgery notes from 

February 8, 2008 stated: "[O]verall he is doing very well ... excellent 

alignment of the fracture with good callus formation." A year later, on 

March 9, 2009, an SSA consultative examination found the claimant had 

light work restrictions, but the examiner also noted: "[The claimant's] 

allegations are considered partially credible based on the objective 

information in file." As of September 2009, the claimant reported "no 

neck pain now" and stated he "wishes to return to the gym doing 

activities and wants to go to therapy." His physician gave "him a 

prescription for physical therapy." 

In January 2010, the claimant complained of some residual rib pain and 

breathing difficulty and underwent a rib fixation procedure. Medical 

records documenting the procedure reported: "[H]e tolerated the 

procedure well with some improvement in his pain and resolution of his 

difficulty breathing .... [The claimant] was allowed to ambulate as 

tolerated." Further, "all lab work and radiological exams were within 

acceptable limits." A post-surgical exam on February 2, 2010 resulted 

in the doctor reporting: "everything looks good .... However, he remains 

frustrated that he was not immediately cured by this operation. If the xray shows the plates to be in good position, and I suspect they are, we 

will give him a period of about ten weeks to heal and then I will follow 

him up in 2 liz months .... " That assessment was echoed in a follow-up 

appointment two-and-a-half months later on April, 20, 2010, where the 

doctor reported "the rib fixation appears to be in good position." The 

doctor reported the claimant "still has a little bit of popping when he 

does certain activities, but his pain has almost completely resolved." 

The doctor "reviewed his chest x-ray and the plates appear to be in good 

position." 

While he was healing from surgery, on April 29, 2010, the claimant saw 

a doctor because he "stuck a piece of2x4 in his right palm about four or 

five days ago" and he complained that "it still hurts." The medical 

report did not address the reason the claimant was working with a 2x4 

piece of wood, and no inquiry was made to determine whether the 

claimant may have been engaged in paid work. 

DDS Review. The claimant filed his claim on October 9,2008. He 

stated he "became disabled on 10/4/08 because of acute multisystem 

trauma secondary to [a] motor vehicle accident, hypertension, 

dysthymia, sleep apnea, C6-7 fracture, left clavicle fracture." In 

response, DDS determined: "the evidence indicates [the claimant's] 

condition is severe and keeps [the claimant] from working at the present 

time." DDS denied the claim, however, finding the claimant's injuries 

were "not expected to remain severe enough for 12 months in a row to 
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keep [the claimant] from working." DDS explained that "in order to be 

eligible for disability benefits, a condition must keep [an individual] 

from doing any work for twelve (12) months from the onset of your 

condition." Therefore, DDS determined "since you should be able to 

return to some types of work within twelve (12) months, [the claimant 

did] not meet the requirements for disability benefits." 

AU Review. On appeal, despite the fact that the claimant was only 49 

when his accident occurred, Judge Childs decided to "non-mechanically 

apply the grids in this case," and treat him as ifhe were 50 when the 

accident took place. The judge reasoned that since the accident was only 

two weeks prior to his 50th birthday, the claimant should be considered 

under the grid rules. Judge Childs then found the claimant met grid rule 

201.14 on the basis of his age and inability to perform even sedentary 

work, even though his limitation was expected to last less than twelve 

months and no medical evidence indicated he was unable to work. 

Interestingly, the judge also added the following to his decision, which 

suggests that even if a claimant were found able to work, they could still 

be considered disabled under the grid rules. 

Even if the claimant had the residual functional capacity for 

the full range of sedentary work, considering the claimant's 

age, education, and work experience, a finding of disabled 

would be directed by Medical-Vocational Rule 201.14. 

The ALl made a fully favorable award of disability benefits. His 

opinion did not discuss the lack of medical evidence establishing the 

claimant's inability to work, or the March 2009 note in which the 

claimant sought medical attention for a hand injury he sustained while 

carrying a 2x4 piece oflumber. 

Alabama Case 64. In some cases, ALls found claimants to be disabled 

even when medical consultants rendered opinions finding they were not. 

The claimant applied for SS1 on November 30, 2006, and alleged her 

disabling back and leg pain began a week earlier on November 22, 2006 

less than the 12 months required to establish a disability. Despite 

medical records suggesting that she did not have a disability, Judge 

Intoccia found her disabled under the grid rules based upon her age and 

limited work history. 

Medical Evidence a/Record. The DDS examiner noted the claimant had 

"not seen a doctor in over 5-6 years," and sent her to a physician for a 

DDS consultative exam on January 10,2007. The claimant reported to 

the physician that she "last worked in 1996 doing maintenance work in a 

dance studio. She worked there for five years." The claimant told the 

doctor: "I was told there was no more work for me there to do, and they 
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let me go. I didn't look for any work after that. I could've worked but I 

didn't." 

With regard to the claimant's physical health, the doctor noted the 

claimant "stood up from sitting with ease and moved about with 

reasonable agility." While the claimant carried a cane, the doctor 

"determined [the cane] not to be required indoors and probably not 

outside, either." He also found: 

The strength of her major muscle groups including those of 

her shoulders and pelvic girdles, those of the proximal and 

distal portions of her upper and lower limbs, her hand grip 

strength and finger dexterity were all rated 5 out of 5. She 

could make a fist with each hand; she could oppose the 

thumb to the fingers of each hand. She could button and 

unbutton clothes, tie shoelaces, pick up small objects, hold a 

glass, tum a doorknob, etc. 

The doctor also noted: "She sat comfortably in the chair, virtually in the 

same position, for about one and a half hours; she did not appear to be in 

any distress." He then described the claimant as having a tendency "to 

be very evasive, contradictory, and to exaggerate. She did not appear to 

be a credible historian." He concluded: 

Based on the medical findings for this examination, I would 

conclude that she could perform work-related activities such 

as sitting, standing, walking, lifting, carrying, and handling 

objects with some minor limitations. There is no problem 

with hearing or speaking, and she could travel a reasonable 

distance. 

The 2007 consultative exam thus concluded that the claimant could 

perform a variety of work-related activities with only "some minor 

limitations." 

DDS Review. The DDS denied the claim and found the "medical 

evidence in [the] file [was] insufficient to establish a diagnosis." The 

only evidence considered by the DDS was the consultative exam. DDS 

explained its denial: 

You state that you are disabled because of having pain in 

your back and left leg. It has been determined that your 

medical condition does not significantly affect your ability to 

carry out most routine activities. Since your ability to work 

is not significantly affected, you do not meet the 

requirements for disability benefits. 
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The claimant appealed the decision. 

Additional Medical Evidence. After the January 2007 consultative 

exam, the clamant began to see a physician. Her physician noted on 

March 6, 2007, that the claimant complained of a "[history] of headache, 

last worked in 5 years. Having some low back pain." He also noted that 

the claimant was "awaiting disability." When she saw her physician in 

August 2007, he noted the claimant had "missed blood pressure 

med[ication]s past 2 days." In December, the physician noted her 

"hypertension [was] uncontrolled." On January 30, 2008, the doctor 

reported the claimant was "doing well, no chest pain." Later that year, 

on May 7, 2008, the doctor noted that the claimant was "doing better." 

No medical evidence indicated the claimant's condition had worsened 

since her consultative exam. 

ALJ Hearing. On May 28, 2008, in a 12-minute hearing, Judge Intoccia 

announced he was making a fully favorable bench decision and awarded 

disability benefits "as of November 22, 2006, because of gouty arthritis, 

hypertension, urinary tract infections, and osteoarthritis so severe that 

you are unable to perform any work existing in significant numbers in 

the national economy." Arthritis was not mentioned in any of the 

medical evidence in the case file; her hypertension was being treated 

with medication. 

During the hearing, the claimant did not speak, and the judge did not ask 

her a single question. He did, however, add the following: 

And based upon review of the available evidence of record it 

appears that a wholly favorable Bench Decision can be issued 

in this particular pursuant claim pursuant [to] Grid Rule 

201.01. There are no other jobs that exist in the national 

and/or regional economy in significant numbers based upon 

her Residual Functional Capacity of a full range of sedentary, 

as coupled with her vocational profile during the period at 

issue. 

Because the claimant had reached age 62, had "limited education," and 

the Judge determined the claimant had the residual functional capacity 

"to perform less than the full range of sedentary work," he found her 

disabled. 

The judge's opinion did not discuss the consultative exam which found 

that the claimant could perform a number of work-related activities with 

only "some minor limitations." Instead, despite the absence of medical 
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evidence supporting a finding of a reduced residual functional capacity, 

Judge 1ntoccia used the grid rules to award benefits to the claimant. 

Virginia Case 244. ALJ William Russell ruled favorably for a claimant 

in an on-the-record decision, without holding a hearing, and awarded her 

ssm benefits. The claimant alleged disability beginning November 15, 

2006 due to osteoarthritis, anxiety, and depression. The claimant's 

attorney requested the case be processed by a Kentucky Social Security 

office, despite the claimant's residing in Virginia. The claimant 

originally alleged her disability began when she was 53 years old, but 

AU Russell amended the claimant's onset date (at the request of the 

claimant) to the date of her 55th birthday and awarded disability benefits 

under Grid Rule 202.02. 

Medical Evidence a/Record. While the claimant's medical records 

showed her seeking medical care for a variety of ailments, the claimant 

received successful treatment for each of her complaints. When she 

twisted her ankle in October 2007, she was told "just to take ibuprofen." 

The following month, x-rays of her ankle and cervical spine were 

normal. The claimant also had high blood pressure, high cholesterol, 

anxiety and acid reflux, all of which were treated with medication. 

Physician progress notes indicated that, with respect to her depression 

and anxiety, she sought treatment and received counseling and 

medication in 2006. Physician notes dated December 2007, indicated 

she was "smiling, alert, and oriented and stated 'I am doing much 

better. '" 

A consultative examination in October 2008 was even more positive. It 

described the claimant as an "alert and cooperative, physically healthyappearing, 55 year-old female who was fully ambulatory, and free of any 

acute distress and who was not using an assistive device." The 

physician noted the claimant "was free of any workplace or any 

environmental limitations" and "would have minimal manipulative and 

minimal postural limitations." With regard to the claimant's residual 

functional capacity, the physician determined: 

This lady, in her present state of health, could occasionally 

pick up and carry 20 pounds of weight up to one-third of an 

8-hour workday with frequent breaks. She could frequently 

pick up and carry 10 pounds of weight up to one-half to twothirds of an 8-hour workday. Sitting, standing, and walking 

were unaffected. 

According to SSA regulations, these restrictions allowed the claimant to 

perform "light" work. 
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DDS Review. In October 2008, DDS denied the claim and found, 

according to the grid rules, the 53 year-old claimant was not disabled. 

DDS determined that the claimant, given her education and past work 

experience, "retains the capacity to perform such jobs as: ticket-taker 

(amusement and rec.); folder (laund.); marker (rettr.)." DDS also noted 

the claimant's "allegations are not fully credible and [claimant had a] 

non severe impairment." 

The claimant requested the agency reconsider her denial, which was 

affirmed upon reconsideration because there were "no new allegations or 

worsening." As mentioned earlier, "on 10114/08 [the claimant] was seen 

for a physical CE and she was alert, cooperative, and healthy-appearing, 

NAD [nothing abnormal detected]. She was very well oriented, related 

well to others and gross mental status was intact. She had normal affect 

[and] memory." On July 16,2009, the claimant changed attorneys, 

requesting new representation. 

ALJ On-the-Record Decision. While DDS denied the claimant, who 

initially alleged that her disability began when she was 53 years old, she 

was approved by Judge Russell in August 2009, after moving her onset 

date to her 55th birthday. Under the grid rules for "advanced age," 55 

and older, the Judge used the DDS finding to award benefits under the 

grid rules for claimants able to perform light work. His decision shows 

how the grid rules allow claimants to be categorized as disabled and 

receive disability payments, despite being found able to perform light 

work. 

Suspect Use of Gridding Rules. The 300 cases reviewed in the 

investigation provided evidence of some troubling results under the 

gridding rules. In some cases, ALJs found a claimant disabled and 

awarded benefits even when medical evidence indicated that the 

claimant was able to work. In other cases, some ALJs found claimants 

to be able to perform work at a "less than sedentary" level, even if other 

agency officials or doctors found them able to work at a higher level. In 

still other cases, "less than sedentary" seemed to function as a catch-all 

to find a person disabled if they did not match either the medical listings 

or the grid rules. Judges would simply total up a claimant's various 

medical ailments and explain that even though a plain reading of the 

Medical-Vocational Rules would find "not disabled," additional 

evidence obtained by the judge found the person to be limited to less 

than sedentary work, and so a finding of disability was most appropriate. 

Several examples illustrate these concerns. 

In Virgillia Case 257, Judge Peters awarded ssm and SSI benefits to a 

claimant. The claimant's attorney and Judge Peters agreed, in an off-
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the-record conversation prior to the hearing, to amend the claimant's 

onset date to take advantage of the grid rules. 

When the claimant applied, she alleged her disability began on 

November 6, 2007. The 48 year-old female asserted she suffered from 

"diabetes, heart, hypertension, cholesterol, depression, degenerative disc 

disease, left elbow pain, limited use of left hand, headaches, dizziness, 

numbness in feet, fatigue, shortness of breath, blurred vision." DDS 

denied the claim on April 15,2009, and reasoned: 

Records reveal no significant damage to vital organs due to 

hypertension, diabetes mellitus, or cholesterol levels. There 

is no significant abnormality related to headaches, dizziness, 

numbness fatigue, shortness of breath, and blurred visions. 

She has adequate range of motion and muscle strength 

throughout. 

In assessing the claimant's credibility, the DDS doctor who reviewed the 

claimant's file determined: 

Of greatest significance in determining credibility of the 

claimant's statements regarding symptoms and their effects 

on her functioning was her medical history. The description 

ofthe symptoms and limitations provided by the claimant 

throughout the record has been inconsistent and is not 

persuasive. Based on the evidence of record, the claimant's 

statements are found to be partially credible. 

On May I, 2009, the claimant appealed her denial and requested a 

hearing before an ALJ. 

In the meantime, in January 20 I 0, the claimant was referred to a doctor 

to be evaluated for gastric bypass surgery. The examining doctor noted 

the claimant had worked at her job "until she was laid off." The 

evaluating physician determined, after the claimant completed a basic 

personality inventory, that she "presents as an acceptable candidate for 

gastric bypass surgery." He also noted that "she displays a willingness 

to follow medical directions and complicated medication routines." 

ALJ Hearing. On May 19,2010, Judge Peters held a hearing and went 

on the record at 11 :24 a.m. The hearing transcript is excerpted below: 

ALJ: Well, good morning. Judge Peters, I'm the 

Administrative Law Judge. Counselor, do I need to 

go over the definition of disability in any preliminary 

matter? 
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Atty: You don't, your honor. I waive reading of those. 

ALI: All right. Now, according to my notes, this lady 

applied July lIth of2008. Her date last insured is 

12/31/08; so she's well within her insurance status 

.... Any objection admitting the record, sir? 

Atty: I do not, your honor. 

ALI: Let me state for the record that just before we went 

on the record, we had a brief discussion - or I had a 

brief discussion with about the possibility of 

amending the onset in this case to this lady's 49-anda-half birthday which is how far we can take a grid 

backwards. You would be 50 as ofthis year? 

Clmt: Yes. 

ALI: So you['re] just 49. Okay, so if you move that six 

months, September, October, November, December, 

January - so we're talking about March 19th ofthis 

year, that isn't going to give her much of a lump 

sum. 

Atty: Right. 

ALI: But, at least that get us lined up with where the 

medical record is, I think. And the reason I'm trying 

to reach an agreement on this ma'am, is that we have 

a physical assessment [] by a physician. A physician 

actually reviewed you[r] record April 9th of201O. 

He put you at a light exertional level. It seems to me 

that over time you've actually been getting worse so 

that you wouldn't disagree with that. And so it 

seems to be that some point in time, you along the 

way, probably have actually reached the sedentary 

exertionallevel. And the, the furtherest back I can 

stretch it and meet the grid rules would be age 49-

and-a-half, and that simplifies things for us and 

allows me to reach a decision more quickly and 

conclusively using that grid rule. But you are giving 

up a little bit of - not a little bit - you're giving up 

your onset date of July '08 excuse me, you onset 

date of November '07 and moving it forward to 
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March of '09. Are you satisfied with that result? Do 

you understand why we're trying to -

Cmt: Yes. 

ALJ: - to settle it that way? 

Clmt: Yes. 

ALJ: Okay. If you're satisfied with that ma'am, then I 

will find in your favor that you are at a sedentary 

exertionallevel, and that you could not return to 

your past work at a sedentary exertionallevel with 

some other limitations that you might have, and that 

therefore you would fit that grid rule. Okay? 

Anything else sir? 

Atty: I think that's everything, your honor. 

ALI: All right. Thank you all so much, we appreciate 

your coming and we'll get a decision out to you as 

quickly as we can ma'am. 

Clmt: Thank you. 

ALI: All right, thank you. 

Judge Peters closed the hearing at 11 :28 a.m., four minutes later, and 

awarded the claimant benefits under Medical-Vocation Grid Rule 

201.14, finding she could perform sedentary work. The decision noted 

"at the hearing, the claimant and her representative amended the alleged 

onset date of disability from November 6, 2007 to March 19, 2010, 

which is within 6 months of the claimant's 50th birthday." While this 

decision may have reduced the amount of back-pay by two years by 

moving the disability onset date from 2007 to 2009, the judge also 

essentially ignored the evidence questioning whether the claimant was, 

in fact, disabled. 

Oklahoma Case 129. In this case, an SSA senior attorney awarded 

disability benefits for a rotator cuff injury and "continued chronic pain 

and limited mobility of the left shoulder." The claimant, who was "right 

hand dominant," was cleared to return to work with some restrictions, 

but was ultimately found by SSA unable to do any job in the national 

economy because of the grid rules. After alleging a disability that began 

in 2006, the claimant's disability onset date was moved to after her 50th 

birthday, at which point she was found disabled. 
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The claimant injured her rotator cuff on the job in 2006, and later 

received corrective surgery. Following surgery and physical therapy, 

her physician cleared her to return to work in 2007, with only an overhead lifting restriction and a 39-pound weight lifting restriction. Her 

physician indicated she could do work with her hands, but should work a 

shortened day during her recovery period. Evidence suggests the 

claimant returned to work for a short period of time, but stopped because 

her former job required her to lift 60-75 pounds. 

The claimant filed for ssm and SSI benefits on March 13, 2009, 

alleging a disability that began on November 26, 2006 when lifting a 

heavy object at work. On May 5, 2009, the claimant amended the 

application to move the date of disability back to May 26, 2006, six 

months earlier. 

Her claim was denied by DDS. The claimant obtained an attorney, and 

on November 4,2009, requested an ALl hearing, explaining, "Based on 

my age, education and ability I do not believe that I can perform any 

substantial gainful work activity." 

A review of her medical records, however, showed the claimant could 

still work, even if not at her prior position. She had shoulder surgery on 

May 22, 2007, and on September 28,2007, her treating physician 

commented, "I think she is doing very well, but I don't think she is 

going to be able to go back to all of this overhead work that she has been 

doing .... I am going to get a functional capacity exam on her to see what 

she can do." 

The physician's notes later reported: "The functional capacity exam felt 

that she could perform medium level work for an 8 hour day. At her 

regular job she has to lift [objects] that weigh 60 pounds. During 

testing, she could only lift 39 pounds safely. She could only push 48 

pounds safely. They felt that she could lift the lightest [objects], which 

fell within the safety requirement, and I agree with this." 

Notes from her rehabilitation clinic found on October 23, 2007, five 

months after her disability onset date: "[W]e recommend a work 

reintegration program in which she would begin working a shortened 

day and only lift the lightest [objects]. She can then be advanced as 

tolerated." 

By March 2009, she continued to complain of shoulder pain, but a 

physical examination documented "she has good passive [range of 

motion]." The examiner even questioned whether the claimant was 

providing a credible description of her abilities. He wrote: "I am not 
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sure whether she is fighting me or not on the exam. Her exam is too 

random to make any objective findings." While also stating that she was 

under a "reasonable" permanent restriction for light duty, continuously 

lifting 25 pounds and occasionally 50 pounds, he also called them 

"somewhat generous." He said she could return to work on March 9, 

2009. 

Shortly after, on May 4, 2009, the claimant's application for benefits 

was denied by DDS, which explained: "Your condition is not severe 

enough to keep you from working .... Based on your description of the 

work you performed as a Dob title] for several months, evidence 

indicates you are capable of doing this type of work." The claimant 

appealed this decision. 

On October 14,2009, DDS denied the claim again under 

reconsideration, explaining: "Although you cannot move your left 

shoulder as well as you used to, you can still perform some types of 

work. Medical evidence does not show any other impairments which 

keep you from working. Your condition prevents you from doing your 

past work, but it does not prevent you from doing other work which is 

less demanding." 

While the claimant appealed to have her case heard before an 

administrative law judge, her attorney wrote a letter to an SSA staff 

attorney of the Oklahoma City office on January 14,2010. The letter 

said he was, "asking you to consider an amended onset date of May 22, 

2007, in this matter. It is my understanding that the amendment ofthe 

claimant's onset date to May 22, 2007, will allow for the issuance ofa 

fully favorable decision in this case." 

A little more than a week later, his request was granted. On January 25, 

2010, an SSA senior attorney awarded benefits by deciding the case in 

the manner requested by the attorney. The senior attorney adjusted the 

disability onset date and also found the claimant capable of only 

sedentary work. Such a finding is counter to SSA regulations, which 

state the ability to lift 39 pounds is "light work," a level higher than 

"sedentary." The senior attorney amended the claimant's onset date 

from 2006 (the date of her original injury) to May 22, 2007, the date of 

her surgery. By doing so, the claimant's onset date was then after the 

claimant's 50th birthday, at which point the SSA Medical-Vocational 

Rules offer a grid, which makes it easier to find the claimant is disabled. 
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VI. CASES A WARDED WITH INSUFFICIENT, LATE 

AND CONTRADICTORY EVIDENCE 

An award of disability benefits must be supported by medical records 

establishing how the claimant is disabled. The 300 cases reviewed in the 

investigation, however, found case files that contained no medical 

evidence at all as well as case files where the medical evidence 

contradicted or disputed a claim of disability, but was not addressed by 

the agency. Other cases contained medical evidence indicating the 

claimant was suffering only a non-severe condition or one that would 

not last more than one year, as statutorily required. In still other cases, 

the medical evidence consisted of only the claimant's subjective 

complaints, with no objective tests such as x-rays, doctor notes, or 

laboratory findings, to support the claim. In addition, in some case files, 

the medical evidence was submitted at the last minute, giving medical 

experts insufficient time to evaluate the new evidence or to weigh it 

against other information in the file. 

A. Use of Late-Breaking Evidence 

On the Social Security Administration website, the agency encourages 

claimants requesting a hearing with an administrative law judge to 

submit any new evidence as soon as possible.8l While the rules in most 

SSA regions allow new evidence to be introduced at or even after the 

hearing, doing so is discouraged because it gives too little time for 

proper review. In a document titled, "Best Practices for Claimant's 

Representative," the agency strongly suggests getting all evidence 

submitted "more than 10 working days before" a hearing. 

Early submission (more than 10 working days before 

hearing) allows hearing office personnel to exhibit the 

evidence and ensures that the claimant's copy of the file 

includes a copy of all the evidence that has been received. It 

also gives the ALI time to review all the evidence, and helps 

to ensure that all relevant evidence is timely provided to 

experts scheduled to appear at [the] hearing.82 

In Region One, which includes six Northeastern states, it is not merely a 

suggestion, but a requirement that all evidence be submitted "no later 

than 5 business days before the scheduled [ALI] hearing. Failure to 

&1 Social Security Administration, Hearings and Appeals, Best Practices for Claimants' 

Representatives, http://v.'WW.ssa.gov/appeals/best practices.html 

82 Social Security Administration, Office of Disability Adjudication and Review, Office of the 

Chief Administrative Law Judge, "Best Practices for Claimant's Representatives," January 2011, 

hltp:llwww.ssa.gov/appeals/documentslBestPractices 508.pdf. 
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127 

comply with this request may result in the ALl declining to consider the 

evidence.,,83 

While a mandatory deadline is in place only in this one region, the 

agency's Chief ALl, Debra Bice, told the Subcommittee that she 

strongly discourages late evidence in all regions, because it leaves too 

little time for proper review. 84 When asked how ALls should handle 

late-arriving evidence, she said: "My policy is if evidence comes in at 

the last minute, you can do a hearing, but you may need a supplemental 

hearing" to allow sufficient time for review. 

In several cases reviewed in the investigation, late evidence was 

introduced into the hearing record and given controlling weight, leading 

to a claimant being found disabled. In some of these cases, the evidence 

arrived only hours before the hearing began, while in others the evidence 

came in the final days or weeks before the hearing even though that 

hearing took place one or two years after the DDS denial of benefits. In 

several of those cases, the claimant's attorney submitted the new 

evidence, often in the form of a questionnaire from the claimant's 

treating physician showing a total disability. Judge Howard O'Bryan 

called such reports "dead man's reports," and told the Subcommittee 

they were often disregarded.85 

For example, in Alabama Case 69, mentioned in a prior section, a 

hearing held on the morning of January 7, 2010 featured evidence 

created and submitted the day before, on January 6,2012. Not only was 

the evidence late-breaking, it consisted of a one-page questionnaire in 

the form of a "pain assessment" created by the claimant's attorney. The 

options it provided and asked the doctor to circle were vague and 

difficult to understand and assess with specificity. The ALl nevertheless 

afforded it controlling weight and used it to determine the claimant was 

disabled. Several other examples follow. 

Alabama Case 67. Administrative Law Judge Tracy Guice awarded 

disability benefits in a bench decision to a 39 year-old female "as of 

January 23,2007 because of partial complex seizure disorder; sleep 

apnea disorder; lumbar disc disease; bursitis; right shoulder; headaches; 

depression; asthma; and morbid obesity so severe that you cannot 

perform your past relevant work or other work existing in significant 

numbers in the national economy." The evidence in the claimant's case 

83 The five-day submission requirement applies to claims filed in: Maine, New Hampshire, 

Vermont, Massachusetts, Rhode Island, and Connecticut. Website of the Social Security 

Administration, "Request for Hearing by Administrative Law Judge - Form HA-501," 

http://www.ssa.gov/onlinelha-501.html, accessed August 30, 2012. 

S4 Subcommittee interview of Chief AU Debra Bice (8/3/2012). 

85 Subcommittee interview of AU Howard O'Bryan (8/3112012). 
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file did not sufficiently support a finding of disability, but evidence 

submitted less than 24 hours prior to the hearing was used by the judge 

to issue a bench decision - typically reserved only for those cases with 

the most obvious disabilities. 

Medical Evidence of Record. Most records in the claimant's file 

pertained to the claimant's hernia repair in 2006-2007. Following a 

2006 hernia surgery, she experienced an infection that required a second 

surgery in January 2007. When discharged on January 28, 2007, her 

physician noted "she had significant improvement in her preoperative 

pain status." 

She underwent outpatient surgery later that year to remove a benign 

uterine fibroid. Neither the hernia, nor the fibroid surgery was expected 

to cause disabling loss in function lasting over 12 months. The 

remaining evidence in the record consisted of brief progress notes from 

her treating physician that documented routine visits for complaints 

including a urinary tract infection, headaches, indigestion, anemia, 

hypertension, and insomnia, all of which were treated by her physician. 

None of the treating physician's notes mention the issue of disability 

until July 2009, when the claimant told her physician "she is going to 

apply for disability." 

Evidence of Work. The case file also contained evidence suggesting that 

the claimant may have been working during the time frame the claimant 

asserted she was unemployed and disabled. A medical note dated 

February 6, 2007, after the claimant's alleged disability onset date, 

stated that the claimant was "having some lower abdominal pain;" and 

her physician noted the claimant "[ d]oes a lot of lifting at work." The 

physician found the claimant's "abdomen benign," but noted "the patient 

[was] post-excision of infected hernia mesh." 

Morbid Obesity. A number of notes in the claimant's file also described 

the claimant as a "morbidly obese female," which resulted in related 

health issues. For example, her physician prescribed the use of a 

continuous positive airway (CPAP) machine to address the claimant's 

sleep apnea. She was also routinely advised to lose weight. However, 

her weight increased rapidly from 215 pounds in January 2007 to 288 

pounds in 2009, though only five feet tall. A doctor's note from August 

2008 said the claimant "was 140 Ibs. in high school" and that her weight 

had doubled since then. 

Her physician noted on October 8, 2007, that he was "concerned about 

[the claimant's] weight gain [and] encourage[d] exercises." Just over a 

year later, on October 22,2008, the claimant's physician again noted she 

was a "morbidly obese female." At the same time, her doctor stated she 
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was in "no acute distress." Her doctor also noted her "vital signs [were] 

stable," "lungs are clear," "cardiovascular system [was] normal," and 

"extremities [were] stable." In January 2009, the claimant stated "she 

desire[d] obesity surgery." But her doctor noted, "she has not lost any 

weight since starting" and noted his "referral to obesity clinic." 

DDS Review. Alabama DDS reviewed the claim and determined the 

claimant was not disabled. The DDS examiner determined the claimant 

could perform other jobs that existed in the national economy, based on 

a review of the Dictionary of Occupational Titles, and cited specific 

examples: (1) hander; (2) lens inserter; or (3) cufffolder. 

New Evidence Prior to ALJ Hearing. On April 8, 2010, at 2 p.m. the 

day before the claimant's ALJ hearing, the claimant's attorney sent 

documents from the claimant's treating physician dated April 6, 2010 

and April 7, 2010. Included in the documents was a one-page letter 

from the doctor to SSA stating, "Unfortunately, this pleasant young lady 

is 100 [percent] disabled" with a short explanation of her medical 

history. The ALI heavily relied on this letter to award benefits, despite 

contradictory medical evidence and evidence suggesting the claimant 

was able to work. 

During the I5-minute ALJ hearing, Judge Guice asked the medical 

expert present ifthe claimant could perform work that "involved 

complex instructions." He responded: "There is not information in here 

that indicates that she would not be able to perform complex tasks." 

When pressed by the ALI, however, the doctor testified it "would 

probably be difficult, yes." The basis for his view, however, was not 

requested and is unclear from the evidence in the file. Judge Guice then 

asked the vocational expert whether the claimant could perform past 

work or any other work, to which he responded: "No to both questions." 

The judge then announced that based on the record and the "testimony 

of the experts, I'm going to issue a fully favorable bench decision." 

Virginia Case 240. ALI David Daugherty of the Huntington, West 

Virginia ODAR office ruled favorably in an on-the-record decision, 

finding a 28 year-old claimant disabled due to sciatica, traumatic 

arthritis, and chronic pain. 

Medical Evidence of Record. The claimant alleged his disability began 

on March 30, 2009, the same day he was laid off from his job as a truck 

driver. On May 27, 2009, the claimant was evaluated for depression at a 

care center. Physician notes documented the claimant worked at the 

same job for eight years; the physician noted the "[p ]atient report[ ed] he 

lost his job on March 30." The physician noted the claimant's 'job was 

his life," and that he complained "now he has too much time on his 
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hands." The physician stated the claimant "has been trying to find ajob, 

but with the economy it's very hard." The physician also reported the 

claimant experienced "financial problems, kid's birthday coming up 

[that created] a lot of stress on him trying to provide for his family." 

The record mentioned the claimant "has back pain" and his "medications 

include methadone." The claimant was prescribed Celexa for his 

depression. 

The latest medical record in the file dated September 1,2009, regarding 

the patient's depression, noted the claimant's "interest ok," "sleep ok," 

but that he "report[ed] feeling bored/restless being out of work." He 

reported "being worried about finding ajob." 

DDS Review. Based on the evidence, the DDS denied the claim and 

explained after reconsideration: 

The evidence shows that you are suffering from pain in your 

back and left leg. Despite this pain, you are still able to sit, 

stand, walk and move about within an adequate range 

without assistance. Blood levels of cholesterol do not affect 

a person's ability to perform work. Sleeping problems can be 

controlled with medication. Your feelings of fatigue may be 

bothersome, but it does not prevent you from work. You 

have had problems with depression, anxiety, and substance 

abuse in the past, but you still retain the capacity to interact 

appropriately with others as well as to understand and follow 

work related instructions with normal supervision. 

As such, the DDS found that "based on the description of the job you 

performed as a heavy equipment operator in the past for 10 years, we 

have concluded that you have the ability to do this job." 

Attorney-Procured Medical Assessment. In the decision awarding 

benefits, Judge Daugherty relied solely on the attorney-procured medical 

opinion that arrived two-and-a-halfweeks before the decision was 

issued. The physician evaluated the claimant on February 11,2010. On 

March 1, 2010, Judge Daugherty found "[h laving considered all the 

evidence, [he] was satisfied that the information provided by [the doctor] 

most accurately reflects the claimant's impairments and limitations." 

The physician's opinion, labeled "Social Security Disability Medical 

Assessment," opined the claimant had been "injured in a very serious 

accident" and "had extensive degenerative arthritis, high blood pressure, 

high cholesterol, and previous fractures involving his collarbone." No 

other medical records in the file supported or even mentioned these 

findings. The physician also referred to an MRI performed at a local 
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hospital that was "positive." The medical file, however, contained no 

MRI. 

Judge Daugherty's opinion acknowledged that the evidence would 

suggest a finding of "not disabled," but that he was ruling in favor ofthe 

claimant anyway. 

If the claimant had the residual functional capacity to 

perform the full range of sedentary work, considering the 

claimant's age, education, and work experience, a finding of 

"not disabled" would be directed by Medical-Vocational 

Rule 201.27. However, the additional limitations so narrow 

the range of work the claimant might otherwise perform that 

a finding of disabled is appropriate under the framework of 

this rule. 

Judge Daugherty's approved the claim based on the attorney-procured 

medical opinion, despite the fact the opinion was inconsistent with the 

other medical records in the case file. 

Alabama Case 54. ALJ Vincent lntoccia ruled fully favorable for a 

claimant who was not only working after his alleged disability, but 

reported earnings significantly higher than "substantial gainful activity" 

or SGA. Under SSA rules, even if a person alleges a serious injury or 

illness, earning above SGA means that person is considered "not 

disabled." In this case, the judge used late-arriving evidence to make a 

questionable determination that the claimant was working in a "sheltered 

workshop." By doing so, he ruled that none of the claimant's earnings 

would count against him, and found him disabled. 

A "sheltered workshop" under SSA rules is an organization that 

provides a non-competitive work environment for people with 

impairments. These organizations train individuals in how to return to 

the workforce free from work pressures, and are often funded with 

government money. 

A sheltered workshop is a private non-profit, state, or local 

government institution that provides employment 

opportunities for individuals who are developmentally, 

physically, or mentally impaired, to prepare for gainful work 

in the general economy. These services may include physical 

rehabilitation, training in basic work and life skills (e.g., how 

to apply for a job, attendance, personal grooming, and 
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handling money), training on specific job skills, and 

providing work experience in the workshop.86 

In contrast to that description, the claimant's employer was a for-profit 

manufacturing company. 

The claimant alleged problems with his right leg and knee, chronic 

obstructive pulmonary disease, colon issues, and diabetes, which he said 

made him unable to work beginning on January 1,2009. 

After this date, however, the claimant reported income above the 

program's allowable amounts in both 2009 and 2010. Yet, when asked 

in paperwork for SSA, "[ d]id you work at any time after the date your 

illness, injuries, or conditions first interfered with your ability to work?" 

he answered "No" and that he stopped working on December 31, 2008. 

The reason for the contradictory information was explained during the 

ALl hearing in which the claimant explained that his employer let him 

keep working with a reduced workload after he could no longer do his 

old job. 

On December 10,2010, the employer wrote a short, two-paragraph letter 

to the claimant's attorney "at the request of[the claimant]." It said the 

claimant had become "physically unable to perform his duties" and 

"should be considered a candidate for disability." The letter ended with 

the employer's human resources specialist saying she would "be more 

than happy" to do what was needed to help with his disability claim. 

At the hearing on February 1,2011, which lasted 15 minutes, the judge 

confirmed with the claimant that he had "continued to work at the same 

place" he had prior to his alleged disability. The judge also asked the 

claimant, "are you still working a 40-hour week?" to which he answered, 

"Yes." During the remainder of the hearing, ALJ Intoccia queried the 

claimant about the employer's accommodations, such as allowing for an 

increase in breaks and a higher than usual number of days off per month. 

He asked the claimant whether it, "would be fair to say that part of the 

reason that they are letting you get away with all of this, missing days at 

work is because of the past relationship that you've had with this 

employment," and the claimant said, "Yes." 

The claimant informed the ALJ, however, that only a week-and-a-half 

prior to the hearing, on January 20,2011, his employer issued him a 

second letter from the same human resources specialist, this time 

threatening potential disciplinary action ifhe did not correct his 

86 RS 02101.270 Services for Sheltered Workshops, https:llsecure.ssa.gov/poms.NSFI 

Inx/0302101270. 
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"attendance problem." The letter said: "[W]e are having to inform you 

that we would take the necessary step to correct that problem ... if you 

are having any personal problems that are contributing to the absences 

on your record, we urge you to utilize the [Employee] Assistance 

Program." He said he forgot to bring the letter from home, but the judge 

told his attorney, "It might not hurt to fax it in to the e-file after the 

hearing." 

In addition to the letter arriving late into the case file, it contradicted the 

claimant's explanation that he had received special accommodations 

from the employer. Ifthe employer had approved and arranged for a 

special work schedule, it was not clear why the claimant was being 

threatened with disciplinary action for doing what had been approved. 

Second, it appeared that the letter was created to assist his disability 

claim by showing that the work arrangement might soon come to an end. 

The prevalence of issues related to the claimant's apparent ongoing 

work overshadowed questions related to his medical impainnents. At 

the hearing, his attorney offered to explain his client's medical records, 

but the judge declined, saying he was only concerned about "the issue of 

the employment" and to get the letter sent in as soon as possible. 

ATTY: Your Honor, I did not go into the medical evidence 

when, when I still was examining my client. I 

thought you wanted me to just go onto the issue of 

the employment. 

ALl: That's all that I'm concerned about. Oh, unlessATTY: I had gotten all those hospital records in. I, I was 

prepared -

ALl: Right. 

A TTY: - to go over them with you. 

ALJ: Uh-huh. 

ATTY: But that's fine. 

ALl: Yeah, they're in here. Then we'll go ahead and 

close the hearing, and, and get a decision out as 

soon as possible, and do you think in the next five, 

six days you could fax that letter into the e-file? 

ATTY: Yes 
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In his fully favorable decision, Judge Intoccia found the claimant 

disabled from January 1,2009, based primarily on the late evidence 

regarding the claimant's work conditions. The judge found that "the 

claimant has not engaged in substantial gainful activity since January 1, 

2009." In 2009, agency rules determined "substantial gainful activity" 

was $11,760 and in 2010 it was $12,000. During that same period, 

however, the claimant's records show he earned $22,671.19 in 2009 and 

$43,219 in 2010 - several times the amount allowed. The judge 

explained his ruling by saying: 

according to the credible testimony ofthe claimant these 

earnings were because the claimant was provided special 

accommodations beginning January 1,2009 by his long time 

employer of 18 years so [he] could keep his health insurance. 

These special accommodations included, but were not limited 

to, performing only 50% of his assigned duties and allowing 

him to take a 30-minute break every hour in an eight hour 

work day, which in essence constitutes a less than sedentary 

type of accommodated/sheltered environment. In addition, 

he is permitted to be absent for five workdays per month, 

although the policy only allows for no more than two 

absences. Despite the claimant performing his work at a 

level substantially less than what is permitted in a 

competitive work environment versus what other employees 

are allow[ ed] to do he was still paid by his employer. 

The judge went on to explain that SSA regulations allow certain types of 

income that exceed SGA not to be counted against a claimant, including 

income from sheltered workshops, which as explained above, are 

rehabilitation centers dedicated to putting individuals back in the 

workforce. SSA guidance does not allow for a person's place of 

employment to be considered a sheltered workshop simply because an 

employer allows a person to remain working for insurance purposes. 

Moreover, the explained purpose of the arrangement was not to get him 

into the workforce, but to await a time when he would leave the 

workforce. Seemingly in recognition of these limitations, the judge 

concluded the claimant worked in a "sheltered workshop type of 

environment." 

Oklahoma Case 200. Judge Ralph Wampler awarded benefits to a 

woman for diabetic neuropathy, a condition causing stomach pain. 

Benefits were awarded even though the claimant explained that she 

could perform the type of activities ordinarily performed by people who 

can do "light" work. The judge determined instead she could only 

perform work that was "less than sedentary," relying heavily in his 
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opinion on a letter provided by the claimant's attorney that arrived six 

days after her hearing. 

On July 9, 2008, the woman underwent a physical exam to determine 

her "residual functional capacity." The doctor concluded she was not 

disabled, but rather able to do many things. 

Claimant lives with her family. She is able to take care of her 

personal needs with no problems. She does prepare meals 

multiple times a week. Some of the chores she does around 

the house include: light cleaning, laundry, most weeding and 

watering and sometimes she does the mowing. She is able to 

drive. She does the grocery shopping. She enjoys reading, 

watching television, knitting, photography and gardening. 

She attends Church, bible study groups, she goes for walks 

with friends, and she visits family. 

She continued, however, to complain of stomach pain and underwent 

exploratory surgery. The doctors concluded that there was no 

identifiable source of her pain, and she suffered from diabetic 

neuropathy. 

At the claimant's hearing on September 9,2009, the judge said he was 

unfamiliar with diabetic neuropathy and would need more information 

from the attorney before making a decision. 

ALJ: I think I have a good idea about this case. 

ATTY: All right, Judge. 

ALJ: But I'll tell you what I need from you. I'm not that 

familiar with this abdominal neuropathy. I need a 

one-page brief from you within ten days. That give 

you enough time? 

ATTY: Yes, Judge. 

ALJ: Okay. At this time, I'll take the matter under 

advisement. 

Six days after the hearing, on September 15,2009, the claimant's 

representative sent a one-page letter to the judge that contained a single 

paragraph about diabetic neuropathy, copied word-for-word from an 
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136 

online journal article, though the source was not attributed.87 The letter 

also referenced a "Physical Capacity Evaluation" dated January 2009 

and filled out by the claimant's doctor, which the attorney asked to be 

given "controlling weight" in the final opinion. It was a two-page 

questionnaire in which the doctor checked a box that said the claimant 

had: "No ability to work. Severe limitation of functional capacity, 

incapable of minimal activity." 

In his November 4,2009, fully favorable decision, Judge Wampler 

relied heavily on the September 15, 2009 letter from the attorney. He 

concluded the claimant qualified under the grid rules, because she could 

not perform "even a limited range of sedentary work." This description 

stood in contrast, however, to the claimant's own explanation of her 

daily activities, which were inconsistent with a "less than sedentary" 

RFC. As controlling evidence, he referenced the January 2009 "Physical 

Pain Evaluation" and concluded "the claimant's chronic abdominal pain 

has persisted and appears to result from diabetic neuropathy." 

B. Insufficient Evidence Cited to Support Case 

When an individual applies for disability benefits, but does not have 

sufficient medical records for the agency to make a decision, SSA has a 

number of options. For applicants whose medical records are available, 

but were simply not submitted, the agency can go to each of the 

claimant's medical providers and ask for all of the records, for which the 

agency bears the expense. For claimants that do not have medical 

records, the agency can send the claimant to a physician for an 

evaluation paid for by SSA, which is called a consultative exam (CE). 

According to agency regulations, these consultative exams should be 

done by a doctor from the medical field in which the claimant is alleging 

a disability.88 

If after these attempts are made, and a person is found to be disabled, he 

or she will be awarded benefits. If the available records show the person 

not disabled, they will be denied. In a number of cases examined in the 

investigation, however, claimants who did not have sufficient medical 

evidence to support the claim were approved anyway. 

In these cases, the kinds of problems found by the investigation included 

cases that lacked any records mentioning the disabling condition at all or 

87 Bernstein, Gerald, M.D., "The Diabetic Stomach: Management Strategies for Clinicians and 

Patients," Diabetes Spectrum, Volume 13, Number 2000, 

http://journal.diabetes.org/diabetesspectrumlOOvI3nl/pg II.htm. 

88 See 20 C.F.R. §404.1519g, "Who we will select to perform a consultative examination" 

(explaining that a "qualified" medical source must "have the training and experience to perform 

the type of examination or test [the agency 1 will request"). 
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137 

mentioned other non-disabling conditions. In others, doctors from the 

wrong medical field provided the key diagnosis. Some cases did not 

contain any evidence of objective medical tests, but only the claimant's 

subjective complaints. A last set of cases referenced the alleged 

disability, but said that it was "non-severe," "well-controlled," or "in 

remission." 

Alabama Case 95. In this case, the claimant applied for disability 

benefits alleging disabling pain, high blood pressure, and diabetes. The 

DDS examiner awarded benefits, relying on a medical opinion provided 

by an obstetrician-gynecologist to diagnose medical conditions outside 

of his area of expertise involving degenerative disc disease and 

hypertension, diagnoses which conflicted with medical records obtained 

from the claimant's doctors in the correct field. 

The available medical records in the case file noted that the claimant's 

diabetes and blood pressure were controlled through medication. 

Related to her back pain, the results of magnetic resonance imaging 

(MRI) on every section of her spine showed only mild findings. Nerve 

conduction studies were normal with only mild inflammation in the 

lumbar spine and the T -6. 

On August 7, 2009, DDS sent a letter asking if the claimant's treating 

physician would perform an examination of the claimant for purposes of 

her disability claim, but he replied "No." DDS then requested that 

another physician review her medical records and render a medical 

opinion on the claimant's condition, which he did on October 24, 2009. 

The consultative examiner hired by the agency was not an orthopedic 

specialist, who would be familiar with the claimant's alleged health 

problems, but an obstetrician-gynecologist (Ob-Gyn). It appears from 

the case file the DDS examiner requested the Ob-Gyn specialist to 

analyze these issues involving back pain, hypertension, and diabetes. 

The Ob-Gyn reviewed the MRIs already in the case file and inaccurately 

concluded they demonstrated the claimant had a ruptured disc even 

though she did not. The claimant's own physician, who had ordered the 

MRls and reviewed them, noted in September 2008, that the "alignment 

[of her spine] is anatomic. Vertebral body height and marrow signal are 

normal. The discs demonstrate normal morphology." The same report 

went on to state each specific level of the claimant's spine was 

"normal." There was no evidence whatsoever of a ruptured disc. The 

MRI reports noted mild degeneration, but specifically noted "no nerve 

herniation." Despite these findings, the Ob-Gyn specialist diagnosed the 

claimant with "degenerative disk [sic] disease ofthe cervical spine" and 

for the "lumbar spine." 
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138 

The Ob-Gyn specialist also diagnosed the claimant with "hypertension," 

though the claimant had only two medical records mentioning it, one 

from 2006 and one from 2008. In the 2006 record, the doctor noted test 

results that did not lead to a diagnosis of hypertension, but only what 

"could be a possible cause of potential hypertension." The 2008 record 

was from a pain clinic, and made a passing reference to the claimant 

having a history of hypertension. 

DDS found the claimant capable only of "sedentary" work, which in 

combination with the claimant's vocational factors, allowed her to be 

found disabled under the "gridding" rules under Vocational Rule 201.06. 

DDS based its analysis primarily on an analysis by a specialist from an 

unrelated field of medicine. 

Oklahoma Case 156. DDS approved benefits for a 42 year-old man 

alleging depression, anxiety, "nerves," lower back problems, and 

asthma. His case file contained virtually no medical evidence prior to 

2008, when SSA paid for several examinations, yet he was awarded 

benefits under medical listing 12.05(C) for mental retardation and 

depression. This listing requires establishing the mental impairment 

before the age of 22, which in this case was more than twenty years 

prior. 

The claimant applied for both ssm and SSI benefits shortly after being 

fired from his work as a mason. SSA awarded benefits by finding the 

claimant met medical listing l2.05(C) for mental retardation, which 

requires the claimant to demonstrate a valid IQ score between 60 

through 70 along with a physical or other mental impairment imposing 

an additional and significant work-related limitation of function. A 

claimant under this listing must also show the mental impairment to 

have begun prior to age 22. 

While the medical evidence documented the claimant's IQ scores met 

the requirements of12.05(C) (VIQ of6l; PIQ of68; FSIQ of61), no 

other objective medical evidence in the file established "an additional 

and significant work-related limitation offunction." The only available 

evidence submitted with the application consisted of the claimant's 

subjective allegations of pain in his application for benefits. In response, 

the agency paid for the claimant to receive both a psychological and 

physical consultative exam to assess his allegations. 

The "Work History" filled out by the claimant for SSA indicated that he 

worked from 2000 until November 2007, as a mason. He alleged, 

however, that his disability began more than a year before he stopped 

working, in July 2006. 
228 

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In January 2008, the claimant attended the consultative examination to 

evaluate his physical condition. The examining physician found: 

The patient has normal speech and hearing. He has normal 

cognitive function. He has good dexterity of his hands and 

fingers and good grip strength. His hands are callused. He 

has some mild limited rotation of his neck and some mild 

limited flexion of his back. He ambulates in the hallway at a 

normal gait and pace without a limp. He has no chronic pain 

behaviors or malingering behaviors. 

While the claimant "state[d to the physician] he has had chronic back 

pain for years," the physician documented the claimant "has not had an 

MRI scan," "has never had back surgery," and "has no chronic pain 

behaviors." The case file, thus, not only lacked objective evidence of 

the claimant's physical limitation, but also a physician's opinion that he 

observed no limitations during the exam. 

A month later, in February 2008, DDS sent the claimant to a 

psychologist for a consultative exam for an evaluation of his mental 

state. In that exam, the physician noted the above cited IQ scores and 

"the presence of depression was also noted." The examining physician 

reported the claimant told her "he had experienced depression 'for 

years '" and "reported a suicide attempt occurred in the 1980s." As a 

result, the physician determined the claimant was depressed. No 

objective evidence supported the claimant's claim of depression "for 

years," nor did the evidence support the fact the depression constituted a 

"significant work-related limitation offunction" since it did not prevent 

the claimant from working from 2000 to 2006. 

The claimant also told the examiner that he had attended special 

education classes in school, but that he dropped out in fifth grade 

because of a drugs and alcohol problem. No evidentiary proof, however, 

was provided that the claimant attended special education or any other 

document that supported the onset of a mental impairment prior to the 

age of22. Nor did it provide evidence of an additional significant workrelated limitation, especially in light of the claimant's long work history. 

The claimant also reported to the psychological examiner that he had 

hepatitis Band C, but never sought treatment. 

The claimant previously received SSDI from 1991 through 1997; his 

payments were then suspended due to an incarceration for almost five 

years. The claimant reapplied for ssm in 2001, but was denied 

benefits. Based on his most recent application, DDS found the claimant 

met the medical listing for disability for both a developmental disorder 
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140 

(based on recent testing results) and affective mood disorder and 

awarded benefits beginning in 2006. The case file simply did not 

contain sufficient medical evidence supporting an award dating back to 

2006. 

Virginia Case 229. This 59 year-old claimant sustained a crush injury to 

his foot at work in January 2006, underwent a partial foot amputation, 

and received a prosthesis that should enable him to walk. The medical 

record documented that his wounds were healing well when the agency 

awarded benefits at the reconsideration level. By law, disability benefits 

may only be awarded to individuals with an impairment "which has 

lasted or can be expected to last for a continuous period of at least 12 

months." In this case, an award was made on October 26, 2006 - only 

ten months after the injury. Nothing in the record suggested that the 

claimant would suffer from permanent restrictions. 

On January 19,2006, the claimant was admitted to a hospital due to 

"trauma, right foot and right lower leg, with pain." The medical records 

indicated a truck bed fell on the claimant's right foot. 

On January 23, 2006, the claimant underwent a "mid foot amputation 

from the right foot," after which "there were no immediate post 

procedure complications." When the claimant saw his physician on 

February 27, 2006, the reported "his pain [was] significantly better." On 

March 10, 2006, the claimant returned for the physician to check his 

foot. The physician noted "his wound continues to granulate well" and 

the claimant "reports no problems." 

He applied for disability benefits but was denied by DDS on May 23, 

2006 because, "We have determined that your condition is not expected 

to remain severe enough for 12 months in a row to keep you from 

working." 

Medical evidence indicated that by August 8, 2006, he was making 

progress in his healing. 

All of [the claimant's] incisions are well healed. He has 

excellent motion to his knee with full extension and flexion 

to 130 degrees, which is painless. He has significant quad 

atrophy and does have some pain with patellofemoral 

loading. His extensor mechanism is intact. The soft tissue 

injury around the midfoot appears to be healing well. ... xrays taken today show excellent alignment to his tibia 

fracture. He appears to have completely healed both portions 

of his segmental fracture. 
230 

141 

With regard to the claimant's use of his prosthesis, the doctor noted: 

"Once the knee pain has improved and he is able to tolerate full 

weightbearing on the right lower extremity, we can modify the 

prosthesis as needed." The physician also stated that "on physical 

exam, his wound is healed except for that small punctuate area that is 

over the distal tip. There is an eschar over it. This is not debrided." 

Since the claimant was unable to bear weight due to continued pain 

around his knee, his physician stated: 

[I have] given a slip for physical therapy for quad 

strengthening and range of motion as I think at least some 

portion of his pain is patellofemoral in nature secondary to 

his quad atrophy. I will see him back in six weeks time. We 

will repeat x-rays to the right tibia then. 

Review by DDS. On his application forms, "the claimant [] described 

[daily] activities that are significantly limited." When DDS reviewed 

the claimant's initial application, it found that "based on the evidence of 

record, the claimant's statements are found to be partially credible." 

When DDS reconsidered the claimant's application, a different DDS 

examiner found the same statements "to be fully credible" and the 

"assessment supports a fully favorable allowance determination." The 

DDS award of benefits was in October 2006, just ten months after his 

injury, when medical evidence indicated the claimant was healing well. 

No evidence in the record supported a finding that the claimant's 

condition would prevent him from working for a full year or that the 

claimant would be unable to walk using his prosthesis. Further, the 

claimant's physician clearly stated that the knee pain was likely due to 

muscle atrophy from lack of use. Insufficient medical evidence existed 

to award this claimant benefits. Further, no evidence indicated the 

claimant's listed resources decreased below allowable amounts at 

reconsideration. 

Alabama Case 65. In this case, ALI Charles Thigpen awarded benefits 

to a 35 year-old woman based on cervical spondylosis, tension 

headaches, migraines, a history of anxiety and depression, and 

fibromyalgia. The ALI ignored evidence the claimant failed to comply 

with prescribed medications, which was in part the reason the claim was 

denied by the DDS examiner. 

DDS Review o/Claim. Specifically, DDS noted that while the 

claimant's physician prescribed various medications to prevent migraine 

headaches, the medical evidence documented the claimant had not filled 

any prescriptions. On December 8, 2008, an examining doctor wrote: 
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"35 [year old] woman alleges intractable migraine ... there is no 

indication in the pharmacy print out of [the claimant] ever obtaining the 

Keppra. These drugs are intended as preventative therapy and body of 

evidence in [the medical records] indicates very poor compliance in 

treatment." In fact, the claimant filled only narcotic pain medications, 

sleeping medications, abortive pain medications, and anxiety pills. The 

agency's denial also noted that the claimant's alleged impairments did 

not prevent her from working. 

You state that you are disabled because of migraines and 

depression. It has been determined that your medical 

condition does not significantly affect your ability to carry 

out most routine activities. Since your ability to work is not 

significantly affected, you do not meet the requirements for 

disability benefits. 

The ALI failed to address the issue that the claimant was able to work 

despite her mental impairments and was failing to take medication 

intended to alleviate her symptoms. The judge rendered an on-therecord decision. 

The ALI also failed to address the lack of sufficient medical evidence in 

this case to substantiate the claimant's allegations of anxiety and 

depression. In fact, on December 9, 2008, a psychiatric consultative 

examiner determined the woman's depression and anxiety symptoms 

were "not severe." The examiner also noted that despite receiving 

Xanax, an anxiety medication, from her treating physician, there was 

"no professional [mental health history]." The examiner went on to say 

the "complaints are overwhelmingly of a physical nature; therefore, 

there is no need for further [mental health] development. Her mental 

health [history] doesn't appear to affect her current functioning." While 

the file shows the claimant took medication for anxiety as needed, no 

treatment records or other evidence existed that documented her mental 

condition had any impact on her ability to function. 

Oklahoma Case 178. DDS awarded ssm and SSI benefits under 

reconsideration for a man who met Medical Listing 12.05(B) for mental 

retardation. Under this listing, a claimant qualifies for benefits ifthey 

have "a valid verbal, performance, or full scale IQ of 59 or less" and 

provide proof ofthe impairment prior to the age of22. While the 

claimant stated he attended special education classes in school, no proof 

was provided the claimant's mental impairment began before age 22. 

The claimant, who was married and had seven children from his current 

and prior marriages, initially applied for benefits alleging diabetes and 

blurred vision, making no mention of any mental impairment. In fact, 
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the records show the opposite. On November 2, 2005, the claimant 

visited the hospital, but denied, "any nervousness, tension, mood 

changes, depression, changes in memory, suicidal ideation or homicidal 

ideation." The application was denied for lack of evidence, with DDS 

making the following finding: 

31 y/o male alleges diabetes and blurred vision. The medical 

evidence in file is insufficient to show an impairment. 

Additional evidence was not available. In addition, the 

claimant failed to return Work History and Function Report 

forms that were sent to him on 11/08/06, 12/19106, and 

OS/29/07. The case is denied due to insufficient evidence. 

In October 2007, the claimant obtained an attorney and filed for 

reconsideration by the DDS in Oklahoma City. DDS sent the claimant 

for a consultative evaluation. The DDS examiner diagnosed the 

claimant with mild mental retardation and impulse control disorder after 

an IQ exam found scores of 56, 58, and 62. The examiner also noted: 

"He has a lih grade education, but was in special education throughout 

school." Rather than require the claimant's attorney to obtain objective 

records to substantiate his education history, however, the examiner 

wrote: "He alleged problems with reading and writing at Initial level." 

An eye exam, also done at the request of DDS on September 27, 2007, 

resulted in the doctor reporting that tests "failed to reveal any diabetic 

retinopathy or hypertensive retinophathy." Moreover: 

[b ]ased on the examination findings, the patient should not be 

limited in work-related activities such as sitting, standing, 

walking lifting, carrying, handling objects, hearing, speaking, 

traveling, and/or mental activities such as understanding and 

memory, sustained concentration and persistence, social 

interaction and adaptation. 

Despite this medical evidence and the lack of any other evidence of a 

significant work-related limitation, the DDS office awarded disability 

benefits to this individual based upon the findings of mental retardation 

and affective mood disorders. 

C. Benefits Awarded in Cases With Contradictory 

Evidence 

Cases containing contradictory evidence present a particular problem for 

agency officials, especially if the differing opinions come from two 

sources of seemingly equal weight. In these borderline cases, it is not 

unusual for the agency to choose the outcome most favorable to the 
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claimant. In addition, in a number of cases examined in the 

investigation, when the contradictory evidence came from two 

seemingly unequal sources, DDS and ALJ decision-makers still tended 

to cite the most favorable evidence to find claimants disabled. 

Contradictory evidence came in a number of forms. In some cases, it 

involved conflicting medical records between two doctors. In such 

cases, the disability decision maker is required to explain why it chooses 

to give more weight to one than another, though often that did not 

happen. In other cases, evidence of a person working after their alleged 

disability onset date provides contradictory evidence regarding the 

claimant's ability to work. 

As part ofthe disability application, a claimant is required to state the 

date on which they believe their disability began. This date is known as 

the "disability onset date." When benefits are awarded, the evidence 

must support a finding that the alleged disability began on the specified 

disability onset date. Evidence of work after the disability onset date 

raises questions about an award of benefits, even if the work results in 

earnings below the SGA rate which is currently about $12,000 per year, 

since the claimant must be found unable to perform any job in the 

national economy. 

When evidence of work activity existed, ALJs generally assumed it 

provided earnings below the SGA rate or relied on statements by the 

claimant that they were incapable of working at SGA, without any 

further questioning. ALJs rarely addressed a claimant's current work 

activity other than eliciting perfunctory statements that the claimant was 

not earning SGA. There were many instances when medical records 

suggested that a claimant was or might be working, at which point an 

ALJ should have asked whether the claimant was, in fact, employed. 

Additional appropriate questions might be whether the claimant was 

intentionally working under SGA in order to qualifY for disability 

benefits, receiving unreported wages, or was capable of working longer 

hours equal to SGA. Some claimants also admitted engaging in such 

activities as cooking, cleaning, driving, and sitting for extended periods 

oftime that belied the functional limitations described to them in an 

application form or related document. This contradictory information 

should also be acknowledged and examined, but rarely was. 

Oklahoma Case 181. In this case, ALJ Lance Hiltbrand awarded SSI 

benefits to a child without properly addressing conflicting medical 

evidence about his impairment. Three doctors determined that the child 

did not have marked limitations in any of six "domains of functioning" 

required to qualifY for benefits, though program rules required two 

marked limitations. Despite this medical evidence, Judge Hiltebrand 
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concluded the child had marked limitations in three domains, and 

awarded benefits, without fully explaining why he differed from the 

doctors. 

The child was in the custody of his grandparents, who applied for 

disability benefits on August 7, 2007, while the child was still in 

preschool. They alleged attention deficit and hyperactivity disorder 

(ADHD) and oppositional/defiant disorder. 

The initial application for benefits was denied by DDS on January 3, 

2008, and again under reconsideration on March 25, 2008. The 

reconsideration denial explained: "The medical evidence shows the 

Attention Deficit Hyperactivity Disorder and behavior problems appear 

to respond to treatment. There is no evidence of a disabling condition 

due to a learning disability." 

Medical evidence dated 2007 through 2009 demonstrated the child's 

symptoms were well-controlled by treatment and medication. In fact, 

one of his kindergarten teachers remarked on an October 22,2007, 

evaluation "his amazing progress in my classroom gave us both the 

awareness he is exceptional - and shy - just trying to cover it up .... Of 

all my students, I am most thrilled with [the child]. A student like [name 

withheld] is the reason I am a teacher." 

His kindergarten teacher made several written comments on a November 

2007 evaluation including: 

This is [claimant's] second year in kindergarten. He is 

currently on medication for ADD & ADHD. I have seen 

remarkable improvement in [claimant] this year as compared 

to last year. [Claimant] is currently working on grade level 

in all areas. [Claimant] is currently taking Adderal for ADD 

& ADHD .... Last year, [claimant] had problems in all areas. 

I am seeing considerable improvement in behavior and 

academics this year. ... Since [claimant] has started taking 

medication, I have no problem wi [claimant's] behavior. ... 

Since [claimant] started medication for ADD & ADHD, I 

have seen positive things. He can sit and complete his work. 

He cooperates with others. He participates in circle activities 

and centers. He is a completely different child than he was 

last year. 

Despite the treatment leading to improvements, some behavioral 

challenges remained, causing stress on the grandfather. The child's 

physician commented on November 21, 2007, at a pediatric visit, 
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"Grandfather reports things are better but then launches into a litany of 

problem behaviors, many of which sound like normal kid behavior." 

On January 3, 2008, a DDS consultative examiner found the child with a 

"less than marked" limitation in acquiring and using information as well 

as for health and well being. All other domains were found to have "No 

limitation." 

Several days later on January 8, 2008, the grandfather took both the 

claimant and his older sister for a consultation at a child study center, 

but the physician noted the grandfather, "has a very negative attitude and 

very unrealistic expectations of his 7 & 6 y.o. grandchildren .... By 

teacher report does not quite make criteria for ADD but by report of 

[grand] father teacher is the one who recommended evaluation for 

ADD." 

The child was seen by a different consultative examining doctor on 

March 24, 2008, to evaluate his "domain limitations," and found the 

child's limitations were "less than marked" for acquiring and using 

information, but he had "no limitation" for the five other domains. A 

pediatric evaluation in April 2008 when the child was six years old 

noted, "He has problems with noncompliant behavior, but does not 

appear to have oppositional defiant disorder at this time." 

In February 2009, his first grade teacher wrote, "[Claimant] is a strong 

student with great potential. He is currently on medication to help him 

focus. His grandparents, guardians are very good about seeing that he 

takes his medication before he comes to school." The teacher described 

a number of behavior problems, which she attributed to abuse by his 

father who had recently been released from prison. She described how 

his behavior improved significantly when the grandparents regularly 

gave him his prescribed medications. 

On May 26, 2009, notes from a pediatric visit showed that the father's 

recent return from prison had negatively impacted the boy's behavior 

and he, "had real problems, sounds like aggression as well as not staying 

in seat & not getting work done. About to be suspended for rest of year 

... [but] Grandfather started giving [medication], behavior at school 

much better." The notes contained an assessment of the ADHD, saying 

it was, "improved with meds though some residual [symptoms]. Hard to 

sep[arate] from other behaviors." 

On June 2, 2009, a counselor providing services to the child wrote that 

he, "is being seen for issues related to depression, anger, self-esteem, 

and social relationships. In the past, [ claimant] has had difficulties 

paying attention in class, following directions, and getting along with his 
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peers. His teacher has reported classroom behaviors including 

difficulties with school work, paying attention, fighting, stealing, and 

lying. These behaviors have resulted in [claimant's] diagnosis of 

Depressive Disorder 311, and ADHD 314.09. Continuation of 

counseling services with [claimant] is anticipated with expected 

prognosis fair-good." 

On August 13,2009, the day prior to the ALJ hearing, the child's 

grandfather submitted two signed statements explaining his financial 

difficulties, and how additional funds would help with the care for both 

the child and his sister, though almost none of the expenses were 

medical: 

As I stated when this claim was started 2 years ago, there is a 

loan for my grandson's hous[e]hold expenses. I have spent a 

fortune on him and it has been very difficult financially for 

me and my wife. We have a balance of over $14500 in credit 

cards for things we had to buy or repair because of him. 

Because he was crank baby he has violent outbursts and 

damages the home. I have also had to spend so much money 

on clothes, furniture, counseling, medications, toys and 

school supplies, etc. The household expenses average $477 a 

month. This amount multiplied by 25 months is $11,925.00. 

This is the amount I need reimbursed. 

I hereby certify that we are in a difficult financial situation. 

We could really use the 08/2009 check to help with back to 

school expenses. I also would like to request an advance of 

the backpayment for the loan. This would be to help payoff 

the credit card that has expenses incurred for [the child's] 

care. Not having this credit card debt would ease our 

monthly expenditures so we can better care for [the child] 

and [his sister J. 

At the June 30, 2009, hearing, the judge obtained the opinion of a 

medical expert by telephone, and explained to the claimant's attorney, 

"I've used him - well, I've had him testify a lot," but that he was very 

"competent." During the hearing, the medical expert testified that the 

child had "less than marked" limitations in all six domains of 

functioning. Moreover, "with the introduction of Adderall and 

particularly adding a second dose in the afternoon, his problems 

disappeared for [a certain] period with medical improvement both in 

school and somewhat at home." The doctor concluded that the child did 

not have either oppositional defiant disorder or post-traumatic stress 

disorder, but was possibly at risk for these in coming years. 
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Before closing out the hearing, Judge Hiltbrand suggested to the 

grandfather that he might be more lenient than usual in this case: "[W]e 

don't want to penalize a good parent ... and a good family environment. 

You've done a wonderful job. You did all the right things. I know it's 

hard when you have to sometimes tum against a loved one, your son and 

others, but I think you had - you saved an individual. So you should be 

very proud." 

Judge Hiltbrand overturned the DDS determination in a fully favorable 

ALl decision from August 14, 2009, awarding SSI benefits. Despite 

none of the doctors finding a marked limitation in more than one 

domain, the judge found the child had marked limitations in three 

domains including: acquiring and using information; attending and 

completing tasks; and interacting and relating to others. He determined 

the child was disabled since August 7, 2007, the day his grandparents 

filed an application for benefits and while the child was still in preschool. 

In his opinion, he wrote: "Although [the medical expert] indicated the 

claimant's limitations were less than marked in the six areas, the 

Administrative Law gave some weight to the testimony ofthe 

grandfather at the hearing and the opinion of [a counselor], and finds the 

claimant is more limited than determined." Judge Hiltbrand added that 

the "State agency medical opinions are given little weight." He 

reasoned the child would "likely need to remain on medication," but 

failed to acknowledge the substantial improvement made since he had 

started medication, as noted by both his teacher and doctor. 

Alabama Case 62. In 2009, ALl Charles Thigpen awarded SSI and 

ssm benefits to a claimant disabled for major depressive disorder, panic 

disorder, and hypertension as of October 2006, but whose records 

document nearly uninterrupted work activity through May 2009. In 

addition to containing conflicting information about the claimant's 

ability to work, the case file also contained conflicting information about 

the claimant's wages. Judge Thigpen calculated his wages to be nearly 

one-third less than the records showed was the case. 

Following initial application, the claimant was sent at the request of 

DDS for two consultative examinations, one mental and the other 

physical. The first, a mental evaluation on February 23, 2007, led the 

doctor to conclude: "Attention and concentration adequate for two-hour 

periods across an eight-hour day ... No significant limitations." On 

March 8, 2007, she underwent a physical exam, at which the doctor 

found: "Based on the information in the file the severity of her 

impairments is not consistent with the severity ofthe medical in the file. 

Claimant symptoms are partially credible." 
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On March 9, 2007, the day after her physical exam, DDS denied the 

application, giving the following reasons: 

You state you are disabled because of cholesterol, high blood 

pressure and nervous problems. Considering the restrictions 

of your conditions, individually and combined, you cannot do 

the jobs you have done in the past. However, the evidence 

shows you are able to carry out most activities. Therefore, 

based on your age, education and past work experience, you 

are capable of performing certain types of work and do not 

meet the requirements for disability benefits. 

Five days later, the claimant hired an attorney and requested a hearing at 

the ALJ level, citing as the reason for appealing the DDS decision: "I 

am disabled because of cholesterol, high blood pressure and nerve 

problems." When asked on Form SSA-3441, filled out by claimants 

wishing to appeal to an ALJ, whether her condition had worsened since 

she first applied, she answered, "no." 

Throughout the application process, the claimant continued working, 

providing significant evidence that she might not have met the statutory 

definition of disability. According to May 2007 treatment notes from 

her mental health clinic, the claimant said she had a long history of work 

prior to applying for disability: "Worked from 1967-2006 first in 

factories then in home health. Due to multiple medical problems 

including hypertension, high cholesterol, and what appears to be 

congestive heart failure she was unable to work and has now filed for 

disability." 

During the early part of 2007, the claimant was put on bed rest 

stemming from a stressful divorce, but she returned to work on May 29, 

2007. A treatment note from her mental health clinic showed she was, 

"working 14 hours per week on a PRN [as-needed] type basis." Notes 

from the same clinic on the next day states the claimant "report[ s] 

situational stresses daily and her largest concern is financial. Not being 

able to pay her bills." 

On June 27, 2007, her therapist noted, "she is doing much better with the 

increase in Xanax and starting the Lexapro meds. Sleep has improved, 

eating less has lost a few pounds, not as irritable or anxious. Also feel[s] 

better about herself since working a few hours a week and is maintaining 

her home." Two months later in August, her therapist wrote: "Client 

need[s] to be financially stable to help minimize her stresses." Notes 

from August, though, also show she was still employed, "working about 

17 hours a week ... doing light duty." 
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On October 29,2007, the therapist commented that the claimant, 

"report[ed] changes in mood d[ue] to lack of financial support," and 

urged her, "to contact lawyer concerning disability claim." A January 

2008 note from the mental health clinic said the claimant, "Works 17 

hours a week, part time, light duty spread over five days.... Has not 

heard from social security yet." By September 25, 2008, notes from the 

same clinic show the claimant had significantly increased her workload, 

and "went back to working 35 hours a week and said she is doing 

okay." Records from her employer show that she continued at her job 

through May 2009. 

ALJ Decision. In his February 2009 decision, ALl Thigpen ruled 

favorably for the claimant, determining her disability began on the day 

she filed her application, October 16,2006. His ruling failed to address 

why evidence of the claimant's current and past work history was not 

relevant to her disability claim. He even appeared to have made a basic 

factual error in determining the claimant's earnings - finding them too 

low - and increasing her odds of acceptance into the program. He 

wrote: "At the hearing, the claimant testified that she is working parttime as a horne health aide for the elderly. She stated she works about 

thirty-five hours per week and earns $300 every two weeks," averaging 

$4.29 per hour or less than minimum wage. As such, the judge found 

"these earnings are too low to be considered substantial gainful 

activity." 

The error appears to have stemmed from the ALl misinterpreting the 

claimant's hearing testimony in January 2009. At the hearing, the 

claimant told the judge, "I'm just working part time," but that "it's just 

minimum wage, you know. I bring horne less than probably about threesomething every two weeks." 

Two pay stubs in the file, one from September 2008 and another from 

December 2008, show the claimant earned $6.55 an hour, the minimum 

wage at that time. Yet they also show that the claimant earned $412.65 

and $458.50 respectively in each of the two-week pay periods, or more 

than fifty percent higher than the amount of$300 per week determined 

by the ALl. The judge erroneously reported her total income as the 

amount she kept after taxes, rather than reporting her actual income as 

reported on the pay stubs in the file. Additionally, a record of monthly 

earnings from her employer showed that in July 2008, she earned 

$1,158.85, which when divided by her hourly wage amounted to an 

average of39.7 hours worked per week that month. 

Further evidence of the claimant's ability to work was delivered at the 

hearing by the vocational expert present. Under questioning by Judge 
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Thigpen about whether the claimant could, "do her past work or other 

work?" the vocational expert answered, "Yes, sir." The judge then 

asked several more rounds of questions, each time increasing the 

claimant's hypothetical limitations. Each time the vocational expert 

affirmed such a person could work, concluding, "I didn't see anything 

that would preclude work on her testimony." 

Despite the available evidence, Judge Thigpen ruled that the claimant 

was not capable of returning even to her current job, finding: "The 

claimant has the residual functional capacity to perform less than a full 

range of sedentary work .... The claimant is unable to sustain a full eighthour workday or forty-hour workweek at a regular and consistent 

basis." Records from her employer show, however, that despite the 

judge's findings the claimant did, in fact, return to her old job, which she 

retained as of May 2009, the last records available. 

The judge found her reported wages were under SGA, and apparently 

relied on that fact in support of his determination that the claimant was 

incapable of working. In fact, the records show the claimant worked just 

under the limit permissible under SSA regulations to qualify for 

disability benefits, earning around $1,000 per month. In July 2008, she 

earned $1,100, indicating she was capable of working a fu1l40-hour 

workweek. In awarding benefits, however, the ALJ failed to question 

the claimant at the hearing about whether she was capable of working 

more than 35 hours and failed to address in his opinion the conflicting 

evidence regarding her ability to work. 

Alabama Case 66. AU Vincent Intoccia awarded ssm and SSI 

benefits to a claimant in a bench decision for glaucoma, severe bilateral 

spinal stenosis, and a back impairment. The case contained a number of 

pieces of conflicting medical evidence, raising questions about why it 

was approved. In particular, it contained two medical reports within a 

month of each other with vastly different conclusions about the 

claimant's RFC. During the hearing, the judge referenced only the more 

severe RFC, leaving out reference to the one suggesting the claimant 

could work. 

Further, the claimant made clear to his physician that his unemployment 

payments were running out and he hoped to be awarded disability 

benefits. Since unemployment insurance (UI) is reserved for those who 

can work, but cannot find it, receiving UI conflicts with a claim of 

disability. Rather than properly resolving these conflicts with a 

thorough hearing, Judge Intoccia held only a brief session at which the 

claimant did not speak, nor was asked any questions. 
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Medical Evidence a/Record. In February 2007, the claimant saw a 

physician for a glaucoma evaluation. The doctor concluded that the 

claimant's "visual field is consistent with his optic nerve exam showing 

marked constriction of the visual field to probably less than 5 to 10 

degrees in the right eye. The left visual field appeared more normal 

although was slightly depressed superior nasally." The physician 

concluded the claimant "has severe advanced primary open angle 

glaucoma with his right eye worse than the left eye." The physician 

went on to state that "we will have to work together to accomplish 

successful treatment of [the claimant's] glaucoma condition." Later that 

year, on September 11,2007, the claimant's physician stated he did "not 

rec[ommend a] job working [at] night due to depth perception." He did 

not state the claimant could not work. 

Despite his alleged vision problems, the claimant listed that his physical 

activities included "take my daughter to school. No problem driving in 

daytime .... I have to be very careful driving at night. I don't unless I 

have to." While the claimant stated he had "a severe blind spot on [the] 

right side," he had no problem standing, walking, or sitting. The 

claimant also claimed that he was "laid off due to my vision problems" 

from his job as an equipment operator, which he had held for nearly 12 

years, from 1995 to February 2007, presumably because his vision had 

worsened over time. 

Other Income. The claimant reported that he received unemployment 

insurance from March 2008 through May 2009 in monthly amounts 

ranging from $844 to $1,055. The claimant also received a pension 

payment each month under the retirement plan of his former employer of 

$521.50. 

DDS Review. In August 2008, DDS denied the claim based on the 

claimant was a "younger individual" under the age of 49 and had a high 

school education, he could perform "medium work range." This 

included a conclusion that the claimant was under no restrictions for 

lifting, sitting, standing, pushing, or pulling. Even though "the claimant 

has not acquired transferable skills," "the overall vocational profile 

remains favorable for work adjustment to other jobs. Examples of jobs 

this claimant can perform include: (1) scrap sorter; (2) plugger; and (3) 

battery stacker." All of these jobs qualified as work under the "medium 

work range." 

DDS denied the claim for disability benefits and explained: 

We have determined that your condition is not severe enough 

to keep you from working. We considered the medical and 

other information, your age, education, training, and work 
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experience in determining how your condition affects your 

ability to work. 

You state you are disabled because of glaucoma. The 

evidence shows you have some restrictions and are not able 

to perform work that you have done in the past. However, 

based on your age, education and past work experience, you 

are still able to perform certain types of work. 

Post-DDS Medical Evidence. On September 9, 2008 only a month 

after the DDS decision - the claimant retained an attorney. Little more 

than a week later, on September 18, the claimant visited a doctor, but the 

results ofthe exam were far different than the DDS determination in 

August. During this exam, the doctor found the claimant had such a 

severe back impairment he could barely walk, sit, stand, climb, or lift. 

The doctor limited the claimant to lifting no more than 5 pounds along 

with sitting and standing restrictions to no more than 1-3 hours per day. 

The next month, the claimant saw an orthopedist on October 28, 2008 

for an evaluation of his back. The physician noted "it is my 

understanding that he is trying to obtain some unemployment benefits 

for his back problem." At the same time, he told the doctor his 

"unemployment benefits ran out." The examining physician noted that a 

prior doctor "ordered an MRI scan ... which showed significant grade II 

spokdylolisthesis at LS-S 1 level with severe bilateral formaminal 

stenosis." The claimant "complain[ed] of right hip and lower leg pain," 

but the physician noted the claimant "has not had any treatment per se 

for his back problem" even though he claimed "intermittent problems 

forthe last 15 years." 

The physician recommended treatment with medication and a back 

brace. The physician noted the claimant "may eventually need 

evaluation to see ifhe is a surgical candidate for stabilization of his 

lower back which would give him the best chance for him to do any type 

of work in the future." 

ALJ Hearing. Judge Intoccia made a fully favorable decision under the 

grid rules, which he made with a "bench decision" - typically reserved 

for only claimants with obvious disabilities. At the outset ofthe hearing, 

the claimant agreed to amend his onset date to October 10, 2008, just 

before his back exam on October 28, 2008. 

The brief hearing included one question to the vocational expert based 

on the most severe assessment provided on September 18, 2008. Based 

on this, the VE found the claimant could perform no jobs that existed in 

the national economy. The judge did not mention the DDS 
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determination or the October assessment of the claimant's back pain. 

No questions were asked of the claimant. The ALl noted that the 

claimant "has a good work history ... [that] goes to his credibility ... 

generally individuals with work histories such as this don't pretend to be 

disabled unless they really are." His bench decision, by nature, failed to 

explain how various doctors could come to such different conclusions 

within a month of one another. Moreover, his decision did not reconcile 

why the claimant was collecting unemployment insurance, which is 

statutorily limited to individuals that are able and available to work, 

while claiming at the same time to be disabled. 

Judge Intoccia determined the claimant "is entitled to a Step Five finding 

within the framework of Grid Rule 201.28." While Grid Rule 201.28 

mandates a finding of "not disabled," Judge Intoccia determined the 

claimant was further limited due to his "inability to complete a 

scheduled workday, which precludes all competitive employment and, 

as such, there are no other jobs available that [the claimant] could 

perform." Therefore, while the grid rules, which considered the 

claimant's age, education, and previous work experience, directed a 

finding of "not disabled," the ALl further limited the claimant's alleged 

capabilities to find him disabled. 
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VII. PROPERLY DECIDED CASES SHOW CONTRAST 

WITH QUESTIONABLE CASES 

Despite the problems revealed in this report, the investigation found no 

apparent problems with a third of the case files. Those properly decided 

cases were found at all levels of review, from the initial application stage 

to the ALJ level through the Appeals Council. They properly weighed 

the medical evidence and made reasonable conclusions based on the 

entirety of the record. The ALJ decisions were written carefully to show 

that the conclusions were documented by the relevant exhibits and did 

not rely on poor or incomplete arguments. These cases demonstrate not 

only the best practices at the agency, but also help illuminate the 

problems that need to be tackled by providing an informative contrast. 

Alabama Case 50. In 2009, DDS awarded SSI benefits after finding a 

17 year-old boy met Medical Listing 112.05(C) due to a full scale IQ 

score of 59. The case file contained extensive information about the 

claimant's activities and abilities. 

Reports by the Claimant's Parent. When DDS contacted the claimant 

on April 7, 2009, DDS reported the following additional information: 

Heart murmur/hole in heart - no treatment in 3 years. Is 

supposed to get [follow up] every two years but Medicaid ran 

out. His mother said he has no symptoms. [Learning 

disabled] - has been in special [education] all through school 

until this year when he was mainstreamed into regular 

[education] classes. His mom says he gets "easier work." 

She says he is not as mature as other kids his age and has 

problems learning. 

The contact form also reported "no new information identified." When 

questioned regarding the claimant's social activities, the claimant's 

mother responded on agency forms the claimant "does not play sports 

but he is in the band at school." She also stated "sometimes he won't 

ask for help if he needs it" and "only finishes his homework because I 

stay on him to get it done." 

Medical Evidence of Record. On September 22, 2003, the claimant, who 

was in the fifth grade at the time, was re-evaulated to determine if he 

still qualified for special education classes. During that evaluation, the 

examiner noted: 

[The claimant] appears to be small physically for his 

chronological age. He is presently in the 5th grade. [The 

claimant] report[ ed] that he resided in the home with both 
245 

156 

parents. He also stated that he enjoys playing games, 

jumping on the trampoline, bike riding and riding his skate 

board. 

With regard to the examination the psychologist noted: 

[The claimant] appeared to be attentive and cooperative 

during the entire testing session. Rapport was easily 

established and effectively maintained. [The claimant] was 

eager to complete the assignment. He appeared confident 

and comfortable in his interactions with the examiner. 

Overall he appeared to understand instructions given. [The 

claimant] maintained good interest and effort throughout the 

entire testing session. 

Ultimately, in a decision signed by the claimant's parents and his 

teachers, the claimant remained in special education classes. The 

claimant's Individualized Education Plan CIEP) for the 2009-10 school 

year stated: 

[The claimant] is a 16 year old eleventh grader [in high 

school] currently resides with both parents. [The claimant] 

reported having five sisters and two brothers. He enjoys 

basketball and would like to play baseball. [The claimant] is 

part of [the] Middle School marching band and [] drum line. 

He enjoys mathematics and working out. [The claimant] 

reported that one day he would like to be a personal trainer. 

He also stated that he takes medication for occasional 

headaches. 

In May 2009, the claimant received a physical consultative exam, which 

noted the claimant "has seen his cardiologist 1 [year] ago, was told 

everything is fine and to [follow up] in 2 [years]." The examiner noted 

the claimant's general appearance was "normal habitus, well developed, 

and [], well groomed, appears mildly less than state[d] age, no acute 

distress, color good." The physician continued to review the claimant 

and noted no issues. The examiner stated the claimant's ventricular 

septal defect was "stable and without any symptoms." 

The agency referred the claimant to a psychologist for a psychological 

consultative exam on June 19, 2009. The psychologist that conducted 

the report found, in part: 

Today the patient's chief compliant was "nothing." His 

mother who came with him reported that his "mental 

maturity is behind and he has been in special education." 
246 

157 

She also reported that he had a heart murmur. He has had no 

nervous trouble or depression of any significance. He has 

never had a behavior problem. He is being treated by [his 

physician], a pediatrician [], and takes no medication. 

His mental retardation was obvious. He was a pleasant, softspoken young man. His thoughts and conversation were 

logical. Associations were intact. His affect was normal. 

No confusion was noted. He denied anxiety and was not 

restless. His mood was normal and he rarely cries. His sleep 

has been good and his appetite fair. His weight has been 

stable while his energy level is normal. No psychomotor 

retardation or agitation was noted. His was not suicidal or 

homicidal. There was no evidence of any hallucinations, 

delusions or persecutory type fears. No phobias or obsessive 

compulsive traits or any significance were noted. He was 

alert. 

The CE went on to report the claimant "plays drums in the school band 

and practices a good deal at home making his mother miserable." The 

examiner also pointed out the claimant "attends church where his 

behavior is good." Like at church, his behavior was good at school. The 

examiner noted his "teachers have had no complaints about his behavior 

in school and his conduct grades have been good." 

The CE also included intelligence testing. The CE documented the 

claimant received a full scale IQ score of 59 on the Wechsler Adult 

Intelligence Scale IV, which the examiner concluded placed the claimant 

"in the mild range of mental retardation at the time of testing." 

DDS Determination. DDS determined the claimant met medical listing 

1I2.05(C). A claimant meets this listing with "a valid verbal, 

performance, or full scale IQ of 59 or less." As stated, in the most 

recent CE, the child received a full scale 10 score of 59. Therefore, 

DDS relied on proper evidentiary proofto award benefits. 

Oklahoma Case 173. This case file is an example of one in which 

sufficient medical evidence existed and was cited to support a favorable 

decision by DDS. The claimant alleged disability beginning March 

2003, due to a congenital hip defect, hip dysplasia, and degenerative 

disease in her knees. She submitted detailed subjective documentation 

providing thorough descriptions of her daily activities, her pain, her 

treatment, and her medical condition. The claimant also submitted 

evidence regarding how her alleged impairments affected her daily life 

and prevented her from being able to work. Each of the claimant's 
247 

158 

subjective allegations was also substantiated by objective medical 

documentation in the case file. 

The claimant worked as a legal secretary until March 2003, at which 

time she had already undergone several hip surgeries and revisions. 

Specifically, she underwent a left hip arthroplasty in 2000, and several 

revisions (in 2001, 2002, 2003, and 2005) due to frequent hip 

dislocations. She underwent a right hip replacement in 2004, and a left 

hip replacement in 2005. She also fractured her knee in 2005, which 

required her to make temporary use of an electric scooter. In June 2006, 

she had spasticity and internal rotation. Her physician prescribed she 

use a cane and walker prior to her surgeries, as of2006, she was still 

using a cane, walking with a limp, and complaining of hip and knee 

pain. She was taking oxycontin, a powerful pain medication. 

In a letter dated December 31, 2003, her treating physician listed her 

diagnoses, symptoms, treatments, and described in detail her functional 

abilities, activity limitations, and pain. Her physician's treatment notes 

consistently stated the claimant was disabled. Even in 2006, when the 

claimant expressed a desire to return to work, her physician opposed the 

idea and stated: 

[W]e spent quite a bit of time discussing the pros and cons of 

her returning to work. I am not at all sure that she will be 

able to tolerate a fulltime position. I am, in fact, very 

concerned that she is setting herself up for failure .... I 

would like to see her start in a much reduced work load 

fashion. 

DDS properly applied the treating physician's recommendations, and 

came to an appropriate determination that the claimant was disabled 

effective March 2003, the date she stopped working. The case file 

contained sufficient medical evidence, which substantiated each of the 

treating physician's statements regarding her disability and the 

claimant's numerous subjective allegations. 

Virginia Case 264. This case file presents an instance in which the ALl 

properly evaluated the evidence. Here, the ALJ addressed the lack of 

medical evidence in the record to support the claimant's alleged 

disability onset date by amending the onset date as supported by the 

record. The ALl also properly explained the weight given to the treating 

physician's opinion. In addition, the ALl addressed portions ofthe 

treating physician's opinion that were inconsistent with the record and 

provided a sufficient explanation of the weight he was according each 

opinion in the file. The ALl's opinion also addressed the claimant's 

obesity and its effect on her alleged impairments. 
248 

159 

The claimant separately applied for SSI and SSDI in April and May 

2008, respectively, alleging disability beginning in January 2002, due to 

lower back and hip pain. After the claim was denied by DDS, the 

claimant retained an attorney and added an allegation of anxiety. She 

submitted new evidence in the form of treatment notes from a 

psychiatrist who began treating her for anxiety in 2009. 

Amended Onset Date. The records documented that the claimant 

sustained a back injury at work in January 2002; she was diagnosed with 

a bulging disc. Her physician treated the injury with epidural injections 

in May and June 2002. She returned to light duty work in February 

2003, and received a worker's compensation settlement a few months 

later. There are very few medical records in the file after this date until 

2009, following the claimant's SSDI and SSI applications. 

Accordingly, ALJ De Monbreum correctly explained during the hearing 

that the file lacked medical records that supported a claim for disability 

back to 2002, for either an ongoing back injury or a work impairment 

due to anxiety. During the hearing, ALJ De Monbreum explained that 

no medical records substantiated the claimant's allegation of a mental 

condition prior to April 2009, the date her treatment began. He 

suggested that she amend her onset date to April 2009. While the 

progress notes in the claimant's file showed less than disabling levels of 

this mental impairment, the claimant did proffer a medical source 

statement from her psychiatrist that opined that the claimant was 

markedly limited in numerous areas of functioning required to perform 

work activity. 

In his decision, ALJ De Monbreum discussed the claimant's medical 

progress notes, and specifically cited her treating physician's medical 

opinion, which found that the claimant had marked limitations in 

numerous work-related functions. The ALJ discussed the weight he 

accorded the physician's opinion and addressed weaknesses in the 

physician's opinion, which opined the claimant was limited in all areas 

of functioning. The ALJ noted the claimant stayed home and cared for a 

son and handicapped brother. He pointed out that if she was limited as 

the doctor suggested, she would not be capable of caring for her son and 

brother or even attending the ALJ hearing. 

The ALJ noted that no other medical opinions existed in the file, and he 

gave substantial weight to the treating physician after reviewing her 

treatment notes. While another decision maker may have reached a 

different conclusion, ALJ De Monbreum sufficiently addressed all 

relevant factors in this file, and clearly and thoroughly explained his 

rationale for finding the claimant disabled at a later onset date. 
249 

160 

Analysis afClaimant's Obesity. The ALJ also sufficiently explained 

why he believed the claimant could claim an impairment due to obesity, 

although she had not alleged that factor. This diagnosis appeared on 

several medical notes, and the ALJ analyzed this diagnosis as required 

by SSR 02-1p, which requires ALJs to consider obesity in determining 

whether claimants have medically determinable impairments that are 

severe, in determining whether those impairments meet or equal a 

listing, and in determining a claimant's residual functional capacity. In 

this case, the ALJ noted the claimant's BMI of32.0 which rendered her 

obese by National Institute of Health guidelines. The ALJ's thorough 

explanation of how obesity is factored into the residual functional 

capacity indicated that he properly made such a consideration. The 

Subcommittee investigation found such a thorough analysis of the 

obesity guidelines absent in most decisions in which obesity was an 

obvious factor. 

Alabama Case 68. The ALJ properly analyzed whether a claimant met 

one ofSSA's Listing ofImpairments. Here, the claimant was a 26 yearold man diagnosed with sickle cell disease. Claimants with documented 

sickle cell disease meet the criteria of Listing 7.05, ifthey have one of 

the following: (1) documented painful thrombotic crises at least three 

times within the past five months prior to adjudication; (2) required 

extended hospitalization at least three times within the past 12 months 

prior to adjudication; (3) chronic severe anemia with persistent 

hematocrit of less than 26 percent; or (4) the disease has caused an 

impairment to another body system that meets another listed 

impairment. 

In this case, the claimant's treating physician completed a medical 

statement in support of the claimant's disability application. The 

statement indicated the claimant's condition met the criteria of Listing 

7.05 by asserting the claimant had painful thrombotic crises at least three 

times within the past five months, had chronic anemia with hematocrit 

below 26 percent, and required the patient be hospitalized three times 

within the past year. Ifthe ALJ accepted this statement on its face 

without verifYing whether it was consistent with the medical evidence in 

the record, the ALJ might have awarded benefits finding that the 

claimant met the criteria of Listing 7.05. 

ALl David Horton correctly did not apply Listing 7.05, however, 

because the medical evidence in the record was inconsistent with the 

statements made by the treating physician. Despite the treating 

physician's statement, the medical records only showed two 

hospitalizations within a five month period of time - on November 22, 

2008 and December 10, 2008 - not the three required to meet the listing. 
250 

161 

Also, the physician's statement regarding hematocrit levels was 

inconsistent with the medical evidence. 

Judge Horton correctly found the claimant did not meet the criteria of 

the listing and instead analyzed the claim at step five of the sequential 

evaluation process, related to vocational factors. 

Oklahoma Case 150. This case provides an example of an ALI opinion 

which properly explained how the medical evidence in the case file 

supported the ALI's decision that the claimant's impairments met the 

criteria of Listing 2.07 A and B, Disturbance of Labyrinthine-Vestibular 

Function. This listing is met if the claimant has frequent attacks of 

balance disturbance, tinnitus, and progressive loss of hearing with 

documented hearing loss established by audiometry, and disturbed 

function of vestibular labyrinth demonstrated by caloric or other 

vestibular tests. 

In her fully favorable decision, ALJ Kim Parrish explained: 

The medical record describes a several year history of 

progressive hearing loss, episodic dizziness, loss of balance, 

headaches and tinnitus. Audiogram showed bilateral low 

frequency hearing loss. Electronmystagmography and 

bithermal caloric testing showed strong unilateral weakness 

on the left and right benign paroxysmal positional vertigo. 

There is objective medical evidence that the claimant is 

unable to heel, toe or tandem walk due to difficulty with 

balance, and he has to hold on to the wall during ambulation. 

Based on careful evaluation of the evidence of record, the 

Administrative Law Judge finds that there is evidence of a 

history of frequent attacks of balance disturbance, tinnitus, 

and progressive loss of hearing as well as disturbed function 

of vestibular labyrinth demonstrated by caloric or other 

vestibular tests and hearing loss established by audiometry. 

The undersigned concludes that the claimant has impairments 

that meet the criteria of Listing 2.07 A and B. 

Alabama Case 65. This case provides an example of proper analysis of 

claimant noncompliance with prescribed treatment. Failure to comply 

with a physician'S treatment orders was rarely addressed by DDS or 

ALJs in their decision making rationale. Discussed earlier as an 

example of an ALJ ignoring clear evidence of noncompliance, this case 

also serves as an example of how examiners at the DDS level properly 

analyzed a claimant's lack of compliance with prescribed treatment and 

denied benefits. 
251 

162 

In her initial application, the claimant alleged disabling migraine 

headaches. The treating physician's notes referred to numerous 

medications the physician prescribed, which the claimant reported did 

not work. The DDS examiner reviewed the pharmacy print-out showing 

the drugs filled by the claimant for a lO-month period of time. DDS 

determined the claimant had never filled the prescriptions for the drugs 

prescribed to prevent her headaches. DDS concluded the claimant had 

failed to comply with her prescribed medication regimen. 

The DDS examiner also reviewed other medical records and concluded 

the claimant failed to comply with her scheduled follow-up 

appointments. The ALI, however, failed to address this issue, 

overturned the DDS decision, and awarded benefits. 

### 
252 

REPORT OF CONTACT CCOUNT NUMBER AND S'YMBOL 

(Use ink or typewrite" 

NE MAT SE GL 

DDS 0 

o 

WN MAM NAME OF WAGE EAR OR SE PERSON 

TO: o 000 0 0100 

o 0 

o o 

PERSON(S) CO"'" ACTED!WO ADDRESSES 0 WE OR SE PERSON 0 OTHER (Specify) 

CONTACT MADE: 

000 0 BO 0 CS 0 HOME 0 PHONE: 

SUBJECT INITIAL CLlIIMANT CONTACT FORM 

12/5/-6 CALL~D FOR ICC NO ANSWER, SNET LETT~R 

A. Name = Correct, (X ) Yes () No 

B. Address: correct, (X ) Yes () No 

o OTHER 

c. Phone Nu,mber: correct, (X ) Yes, ( ) No, ( ) No Phone 

DATE OF CONTACT 

12/1112006 

D. Third Party name, address, phone number in file: (X) Yes, ( ) NO, 

If not in file, list third party contact here; 

E. Representative Information: 

II. Confirm alleged disabling conditions, symptoms, functional restrictions: 

(X ) covered in file 

( ) Additional Information; low back pain, no surgery 

III. 

BROKE LEFT LEG OVER 20 l'RS AGO I 1'1' HURTS 

Confirm treatment sources, dates, tests/ x-rays, medicationl etc., include 

future treatment and identify any sources not previous ly reported; 

A. (X ) No new information identified 

B. { ) New Information RAVE NOT SEEN A DOCTOR IN OVER 5-6 YRS 

IV: The following information was discussed with the claimant or appl,icant: YES 

{I} The role of the disability specialist; (2) General claim information. such as 

name, address, phone number, contact sources; (3)Illnesses, injuries or conditions 

and functional e££ect(s); (4 ) Treatment sources; (5 )The date work first stopped due 

to alleged illnesses, injuries or conditions and any work since filing; (6) The 

Social Security Administration's definition of disability and general social 

Security program requirements; (7) The possibility of an examination{s) to document 

the case; (8) Appeal rights; (9) cooperation during the disability claim process 

V: Other information provided: YES 

(I) circwnstances the claimant or applicant should call; (2) The telephone number 

and extension; (3) A letter w.ill be sent confirming this phone co.ntact. 

SIGNATURE 

DISTRICT OFRCE (Name, Address & Code) 

Fonn SSA-6002 (8-1981) ef (12-2004) 

OCR OFR OSR 

o OTHER (Spacly) 

Permanent Subcommittee on Investi ations 

EXHIBIT#la 

CLAIMS o CLERICAL 

DATE OF REPORT 

12111/2006 

PAGE 1 OF 1 

269 
253 

DISASILITY DETERMINATION SERVICE 

CLUifL,-- --J. Ii 

RE: 

Date of Appointment: January 10, 2007 'l'DN-. to 7 

.. 

resented for examination on January 10, Z007. . She was as~ed to ascribe her present medical problems and she replied, 

"My low back has been bothering me for about two years. It bothers me about every second or third day." (There was no injury.) "Sometimes! can nardly lift,anything. Sometimes it feels like there's a light burning sensation the.e." (There are no radiculopathies.) 

"When the pain comes on it lasts for about 20 minutes to 30 minute,.. 

I dop't need any kind of medicine." 

"1 broke my left ankle about 20 years ago, when I Slipped and fell 

when I was going into a home to clean it. I had surgery on my left 

ankle. If I do a lot of walking, ~t bothers me then. When I do a "hole ;Lot of walking it may swell." 

Past History: Left an~le surgery. Gravida Ill, para III - children 

aged 40 years, 39 years and 37 years - all normal pregnanciee and 

deliveries. No other surgeries or hospitalizations. 

Allergies: None known. 

Medications: None. 

Family lIisto:ry, Mother died at the age of 57: she was on dialysis 

and had IDDM. She has no knowledge of her father's health status. 

One sister died at the age of 59; she had some type of cancer. 

Functional Enquiry: All other systems were negative. 

Social History: She had been married for 40 years. She lives w~th 

~~~n~USb"d in a trait:~nW~iCh they own. S~~el!~;k:~r!~~r!nf~~9~ive 

)'ears.£2.. wae loik I ere wii no idtJ [Ilk for me there to QO, and 

they let me go. :r didn't look for any work after that. I could·'ve 

worked but I didn't," prior to working at the dance studio she did 

domestic work for seven years. 

Her husband receives a social security disability check of $670 a month. He has HT and DM. She receives food stamps in the amount of 

Permanent Subcommittee on Investigations 

EXHIBIT#lb 

338 
254 RE:-.. Page 2 

$139 a month. 

She went to school to grade 9. She can ~ead and w~ite "a little." 

She smokes two packs of cigarettes a day and drinks about two ounces of gin a day. She claims that she ueed to use marijuana when she was younger but not recently. 

She likes to cook. She loves to go fishing, play dominoes, sew, 

watch TV - especially the soap operas - and wo~k in her vegetable 

and flower gardens. 

On Examination: She stood 62" tall. She weighed 160 pounds. He~ 

blood pressure was 130/80. Visualasseesment usl,ng Snellen chart at 20 feet, without glasses. right eye, 20/50; left eye, 20/40; 

both eyes, 20/25. With glasses. right eye, 20/25; left eye, 20/20; 

both eyes, 20/20. PERLA. Fundi, negative. 

IIIIIIIIIIIIIIIIIIIIF"~Y was examined in the presence of our nurse. 

She presented with a straight cane in her right hand whiCh was determined not to be required indoors and prObably not outside, either. 

She was asked why she used it and she said, "It· s to balance myself." 

She admits that she has never fallen. 

She sat comfortably in the chair, virtually in the Bame position, 

for about one and a half hours; she did not appear to be in any distress. 

She had a tendency to be very evasive, contradictory, and to exaggerate. 

Sne did not appear to be a credible historian. 

She wore a short brown wig with blonde htghlights. She wore a white 

ehort-sleeved ~-8hirt, blue jogging pants, and White tennis shoes. 

She stood up f~om sitting with ease and moved about with reasonable 

agility. She wore bifocal glasses. She had very poor oral hygiene, 

with foul breath. Only three very ca~ious teeth remain, with only a small portion of each of those remaining teeth just at or above 

the gumline. 

Chest. Clear to A and p. ~here we~e no ~a1es and no rhonchi. There was no prolonged expiratory phase. RR, 12 per min. ~here was no pulmonary impairment. . 

CVS. PR, 72 per min RSR. There were no murmurs aUdible. A few 

veins were noted, mostly on the left leg, b.ut none were prominent 

and none were tortuous. There were no stasis changes. All peripheral 

pulses we~e palpated. There was no peripheral edema. ~er feet were warm and Of normal color. The Bkin of her feet appeared healthy. 

339 
255 

RE: Page 3 

GIT: Her abdome~ was soft. There were no abnormal masses palpated. 

There was no tenderne~s to palpation. 

Extremitiesl There waS a full range of motion of her head and neck, 

her Shoulder joints, her elbow joints, her wrist joints, her knee 

joints, and her right ankle joint. Range of motion of-the left ankle 

joint: dorsiflexion, 15 degrees; plantar flexion, 35 degrees; inver~ 

sion, 25 degree~; eversion, 15 degrees. Back flexion. 110 degrees. 

She could touch her toes with her knees straight. Back extension, 

25 degrees. Left hip flexion. 120 degrees: extenSion, 25 degrees. 

She walked with a fairlY briSk, reasonably coordinated gait, without 

her cane. She could walk on her heels and toes and squat fully and 

arise with ease and without any support. 

eNS: She was alert and well orientated as to time, place and person. 

Her recent and remote memory were intact. Cranial nerves II through 

Xli were normal. Sensory exam, normal to all modalities. ~otor 

exam, normal throughout. Cerebellar function, normal. Tone. normal 

and equ~l. Deep tendon reflexes were symmetric and equal. 

The strength of her major ,muscle groups including those of her shoulder 

and pelvic girdles, those of the proximal and distal portions of 

her upper and lower limbs, her hand grip strength and ~inger dexterity, were all rated a~ 5 out of 5. She could make a fist with each hand; 

She could oppose the thumb to the fingers of each hand. She could 

button and unbutton clothes, tie shoelaces, pick up small objects, 

hold a glass, turn a doorknob, etc. 

There was no paraspinous cervical, dorsal or lumbar muscle tenderness or Spasm. 

There were no trigger points palpated across her upper, mid~ or low 

back. 

There was no joint which was red, hot, swollen or tender. 

There was a vertical scar 3," long at the medial aspect of her left 

ankle, and a vertical scar 5~" long at the lateral aspect of her 

left anKle. 

She had dark red chipped nail polish on her fingernailS. 

X-ray of L-S spine, A-P and lat. (P and I): 

The bony structures are intact with no evidence of fracture or degenerative lipping. The intervertebral discs are well 

maintained in height. The hips and sacrOiliac jOints are normal_ 

340 
256 

RE: Page 4 

summary: Normal A:"'P and lateral lumbar spine. 

The medical evidence ot record provided by the DDS was reviewed, 

and those findings were considered in the overall assessment aIIIIIIe Ba~ed on the medical findings of this examina~ 

r-would conclude that she cOUld perform work-related activities such as sitting. standing, walking, lifting. carrying and handling objects, 

with Bome minor limitations. There is nO problem with hearing or speaking, and she could travel a reasonable distance. 

B.SC.PHM-"l, M.D. - , D.A.B.D.C. 

Diplomat~he American Board of Disability consultants 

PNG:ao 

341 
257 

iDcial Security Administration 

EXPLANATION OF DETERMINATION 

The evidence listed was used in evaluatina vou:t' claim. 

In addition to the reports listed .. information that you and others 

provided. about how your condltion(s) affects your' ability to function was 

considered. 

We have determined that your condition is not severe enough to be 

considered. disabling. In decidinq this, we considered. the medical 

records, your statements and how your condition affects your ability to 

'Work. 

You state that you are disabled because of having pain in your back and 

left leg. It has been determined. that your medical condition does not 

significantly affect your &bill ty to carry out most routine activities. 

Since your ability to work is not eignificantly affected. you do not meet 

the requirements for disability benefits. 

If your condition gets worse and keeps you from working, write, call or 

visi t any Social Security office about filing another application. 

In evaluating this claim, we hsve considered and agree with the opinions 

and comments about the condi tion( s) considered for disability benefits 

given by the treating doctor/consulting physician. 

[1 - BJS 

Permanent Subcommittee on Investigations 

EXHIBIT#lc 

242 
258 

PA 

DA TE: 03/06/2007 

SUBJECTIVE: Hx o{headache, last worked in 5 years. Having some low 

back pain. 

OBJECTIVE: Weight 152. BP __ . LllngS' are clear. CV normal. Abdomen 

benign. Extremities normal. Neuro unchanged. 

ASSESSMENT: 

1. Hypertension, grade 4. 

PLAN: Clonidine 0.2 given, BP down to 170/S0; Clonidine 0.2 hs, Benicar 

20/12.5. FlU in 6-S weeks. Encourage compliance, awaiting disability. 

Permanent Subcommittee on Investigations 

EXHffiIT#ld 

314 
259 

-

PJPA~TI~ENN1T~:j& ...... l11"""-----------

DATE: 08/13/2007 

SUBJECTIVE: History of HTN. OA. On clonidine 0.2 hs.-Benicar 40/12.5, 

colchicine 0.6 daily, is havmg some low back pain. Missed blood pressure 

meds past 2 days. 

OBJECTIVE: VS: BP 160/100. Lungs ore clear. CV normal. Abdomen 

benign. Extremities stable. Neuro stobie. 

ASSESSMENT: 

1. HTN. 

2.0A. 

PLAN: Clonidine 0.2 was given. Clonidine 1/2 tablet in the morning, one at 

night. Benicar 20/12.5, colchicine 0.6. FlU in 2 months or prn. 

Permanent Subcommittee on Investigations 

EXHIBIT#le 

317 
260 

-

__ ...... <wIf vnc..."-rl .... " .• _. 

PA 

DATE: 1210512007 

SUBJECTIVE: History of hypertension, gouty arthritis. On clonidine 0.2, 

Benicar 40/12.5, colchicine 0.6 daily, Lortab 7 nightly. Doing well, no chest 

pain, shortness of breath, PND, orthopnea. Echocardiogram showed ejection 

fraction 55%. 

OBJECTIVE: VS: Stable. Weight 161, blood pressure 190/90. Lungs are 

clear. CV normal. Abdomen benign. Extremities - Stable. Neuro stable. 

ASSESSMENT: 

1. Hypertension, uncontrolled. 

PLAN: Add Lopressor 50 mg 112 tablet bid, discuss side effects, colchicine 

0,6 daily, and clonidine 0.2. FlU in 2 months or prn. 

V 

Permanent Subcommittee on Investigations 

EXHIBIT#lf 

320 
261 

PATIENT: 

DA TE: 01130/2006 

SUBJECTIVE: Patient complaining of poor appetite. Hx of hypertension. On 

clonidine 0.2. Benicar 40/12.5, colchicine 0.6 mg daily, Lortab 7 nightly. 

Doing well, no chest pain, SOB. 

OBJECTIVE: VS - Weight 158. BP 150/80. Lungs are dear. CV normal. 

Abdomen - benign. Extremities - Stable. Neura stable. 

ASSESSMENT: 

1. Hypertension. 

2. Gout. 

PLAN: Put on Periactin 4 mg q day, clonidine 0.2 one in the morning, one at 

night, Benkar 40/12.5, colchicine 0.6 daily. Lopressor bid. Follow up in 6 to' 

8 weeks or prn. Lab data next time. 

r /\. 

EXHIBIT #1 
262 

- - PATIENT: 

DATE: 05/07/2008 

SUBJECTIVE: Hx ofOA, HTN. On clonidine 0.1, Benicar daily, Lortab 7, Lopressor 

bid. Doing better. 

OBJECTIVE: VS: Stable. LUNGS: Clear. CV: Nonnal. ABDOMEN: Benign. 

EXTREMITIES: Stable. 

ASSESSMENT: 

1. OA. 

2. HTN. 

PLAN: Conlin clo liine 0.2, Benicar daily, colchicine 0.6, Lortab 7 RIg daily, 

Lopressor bid. IU' 6 weeks, awaiting disability. 

Permanent Subcommittee on Investigations 

EXHIBIT#lh 

305 
263 

SOCIAL SECURITY ADMINISTRATION 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

TRANSCRIPT 

In the case of Claim for 

p Supplemental Security Income 

(Claimant) 

(Wage Earner) (Leave blank 

in Title XVI Cases or if name is same as above) 

(Social Security Number) 

APPEARANCES: 

Baarinq Bald 

at 

(City, State) 

on 

May 28, 2008 

(Month, Day, Year) 

by 

Vincent P. Intoccia 

(Administrative Law Judge) 

ill] P Ed iaimant 

Attorney for Claimant ................ , Vocational Expert 

Permanent Subcommittee on Investigations 

EXHIBIT#li 

342 
264 

INDEX OF TRANSCRIPT 

In the case of: 

Claimant 

Testimony of commencing 

Account Number 

.$ !OJ 

Page 

2 

343 
265 

(The following is a transcript in the hearing held before 

Vincent P. Intoccia, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social securi~~ May 28, 

;~~~r~~y S~~:~r dEl Alabama tiM . ~he T~:s~l~f,~~~n s~~~a~as represente bv . Attorney. A so present was 

[ Vocational Expert.) 

(The hearing commenced at 11:27 a.m. on May 28, 2008.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: We'll go ahead and open the claim of4l1l1l1l1l1l1l1l1l1lilf 

Social Security NUrnberL"1I1I1I1I1I12&1I~ Claimant's present, her 

representative, } ---------- (Phonetic). We have 

---------.-_ ~ as the VE. And we'll let the record show that 

this is actually an e-file hearing but it's a little different in that 

this case is unpulled or unworked. So although we have everything 

hopefully in the right place as far as the, the record, we don't have 

any numbers on these exhibits since they're unpulled. And in addition 

we also have some new exhibits from Bourne (Phonetic) Regional, goes 

into the F Section. We also have a De Qui Sequi that goes into the 

D Section. Any objection, question, comments about any of those 

exhibits, 

ATTY: No, sir, Your Honor. 

ALJ: We'll go ahead then and admit into the record starting with 

the section entitled Payment Documents Decisions. We have two 831 

forms, both received at 1/19/07. The next section is Jurisdictional 

Documents Notice.s. We start out with r ------ s resume, it1s 

receipt dated 5/23/08 through the concurrent L442 form, receipt dated 

1/19/07. In the current Development and Temporary we have no exhibit. 

Non-disability Development, we'll scan in the De Qui Sequi after the 

344 
266 

2 

hearing. The Disability Related Development, we have a medication 

form undated, receipt dated 5/23/08 through the Field Office 

Disability Report, the 3367, receipt dated 12/4/06. The Medical 

Records, we start out with -______ __ receipt date 5/23/08 through .the 

CE from ._-------- (Phonetic), receipt dated 1/19/07. 

(Exhibits, previously identified, were received into evidence and 

made a part of the record thereof.) 

ALJ: Did you have a separate opening, 

ATTY: No, sir. 

ALJ: And I don't have any questions for •••••••• unless 

you do? 

ATTY: I don't. 

ALJ: Swear you in, J~"----------- Can we enter the traditional 

stipulations for the VE? 

ATTY: Yes, sir. 

ALJ: Is there anything else you need to know, Doctor? 

VE: No, sir. 

(The Vocational Expert, -------------------- sworn, testified as follows:) 

having been first duly 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q Could you identify the jobs that ~erformed 

during the period at issue by job title, exertional, and skill level? 

A Yes, sira She worked as a II light, unskilled. 

Q No transferable skills? 

A No, sir. 

Q Consistent with the DOT? 

A It is. 

345 
267 

3 

Q Let's assume a hypothetical individual, same vocational 

profile as~d let's assume someone with a full range 

of sedentary. Could Someone in that situation do that one past job? 

A No, sir. 

ALJ: Than"k you, Doctor. Questions, 1------

ATTY: No, sir. 

ALJ: You've had the opportunity to look over the ALJ Bench 

Decision Check Sheet? 

ATTY: Yes, sir, I have. 

ALJ: Any objection, question, comment? 

ATTY: No, sir. 

ALJ: We'll go ahead and admit that into section A of the claim 

file. We'll have to scan it in after the hearing. And based upon a 

review of the available evidence of record it appears that a wholly 

favorable Bench Decision can be issued in this particular claim 

pursuant to Grid Rule 201.01. There are no other jobs that the 

Claimant can perform that exist in the national and/or regional 

economy in significant numbers based upon her Residual Functional 

Capacity of a full range of sedentary, as coupled with her vocational 

profile during the period at issue. She's fully insured for Title II 

purposes through December 31st, 2007. And her onset date is 

November 22nd, 2006. In addition a more detailed explanation is also 

found within the ALJ Bench Decision Check Sheet, which is adopted by 

346 
268 

4 

reference herein. This concludes the hearing. Thank you. Thank you, 

Ma'am. 

CLMT: Thank you. 

(The hearing closed at'11:39 a.m. on May 28, 2008) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcr __ ' , , ony recorded at the hearing 

held in the case of before Administrative Law 

Judge Vincent P. Into C1a. , 

347 
269 

\..,\!.1<'ci' Refer IIiIL_--- Office of Disability Adjudication and Review 

3381 Atlanta Highway 

Montgomery, AL 36109-2746 

Date: IJUN 1 7 2008 

NOTICE OF DECIsteN - FULLY FAVORABLE 

I have made a fully favorable decision in your case. My decision is based on your period of 

disability, disability insurance benefits. and supplemental security income applications filed on 

November 22,2006. The component responsible for processing my decision must decide that 

you meet the non-medical requirements for supplemental security income payments. 

I announced the basis for my decision at the hearing held on May 28, 2008. I adopt here those 

findings offact and reasons. 

To summarize briefly, I found you disabled as of November 22, 2006, because of gouty arthritis, 

hypertension, urinary tract infections, and osteoarthritis so severe that you are unable to perform 

any work existing in significant numbers in the national economy, 

If you want more information about my decision, you or your representative should file a written 

request for this information at any local Social Security office or a hearing office. Please include 

the Social Security number shown above on your request. If you ask for it, we will provide you 

with a record of my oral decision at the hearing. 

This Decision is Fully Favorable To You, 

Another office will process the decision and send you a letter about your benefits. Your local 

Social Security office or another office may first ask you for more information, If you do not 

hear anything for 60 days, contact your local office. 

The Appeals Council May Review The Decision On Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do so. 

To do that, the Council must mail you a notice about its review within 60 days from the date 

shown above. Review at the Council's own motion could make the decision less favorable or 

unfavorable to you. 

If You Disagree Witb The Decision 

EXHIBIT #1' 

199 
270 

If you believe my decision is not fully favorable to you, or if you disagree with it for any reason, 

you may file an appeal with the Appeals Council. 

How To File An Appeal 

To file an appeal you or your representative must request the Appeals Council to review the 

decision. You must make the request in writing. You may use our Request for Review form, 

HA-520, or write a letter. 

You may file you, request at any local Social. Security office or a hearing office. You may also 

mail your request right to the Appeals Council, Office of Disability Adjudication and Review, 

5107 Leesburg Pike, Falls Church, VA 22041-3255. Please put the Social Security number 

shown above on any appeal you file. 

Time To File An Appeal' 

To file an appeal, you must file your request for review within 60 days from the date you get this 

notice. 

The Appeals Council assumes you got the notice 5 days after the date shown above unless you 

show you did not get it within the 5-day period. The Council will dismiss a late request unless 

you show you had a good reason for not filing it on time. 

Time To Submit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider with your 

request for review. 

How An Appeal Works 

Our regulations state the rules the Appeals Council applies to decide when and how to review a 

case. These ru les appear in the Code of Federal Regulations, Title 20, Chapter III, Part 404 

(Subpart J) and Part 416 (Subpart N). 

I 

If you file an appeal, the Council will consider all of my decision, even the parts with which you 

agree. The Council may review your case for any reason. It will review your case if one of the 

reasons for review listed in our regulations exists. Section 404.970 and 416.1470 of the 

regulation list these reasons. 

Requesting review places the entire record of your case before the Council. Review Can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, !he Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law 1 udge for a new decision. 

If No Appeal And No Appeals Council Review 

200 
271 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed only 

under special rules. 

If You Have Any Questions 

If you have any questions, you may call, write or visit any Social Security office. If you visit an 

office, please bring this notice and decision with you. The telephone number of the local office 

that serves your area is (334) 875-0587. lis address is Social Security, 120 Executive Park Lane, 

Selma, AL 36701. ( ~ ~ 

v~- Administrative Law Judge 

JUN 1 7 2008 

Date 

cc;~-

-

201 
272 

IN THE CASE OF 

----- (Claimant) 

(Wage Earner) 

SOCIAL SECURrry ADMINISTRATION 

Office of Disability ildjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

(Social Security Number) 

I approve the fee agreement between the claimant and her representative subject to the condition 

that the claim results in past-due benefits. My determination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise accepted. I neither 

approve nor disapprove any other aspect of the agreement. 

YOU MA Y REQUEST A REVIEW OF THIS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tel! us that you disagree' with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

: 

Regional Chief Administrative Law Judge 

SSA ODAR Regional Office 

Suite 20t10 

61 Forsyth Street S W 

Atlanta, GA 30303 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement.' If so, please write directly to me as the 

deciding Administrative Law Judge within 15 days of the day you are notified of the amount of 

the fee due to the representative. Your representative also has 15 days to write me ifhelshe does 

not agree with the fee amount under the approved agreement. 

202 
273 

You should include'the social security number(s) shown on this orde 

send us. 

cc: 

Vincent P. [ntoccia 

Administrative Law Judge 

iJUN 1 72008 

Date 

203 
274 

Oral Decision Script 

After entering this wholly favorable oral decision into the record of hearing, I may issue a 

written decision that incorporates the oral dec,ision by reference. However, I may not incorporate 

by reference my oral decision ifI determine that it is necessary to change the oral findings or 

rationale in any way after today's hearing. If a change is necessary, I will issue a full-length 

written decision. 

On November 22, 2006, the claimant protectiyely filed a Title II application for a period of 

disability and disability insurance benefits. The claimant also protectively filed a Title XVI 

application for supplemental security income on November 22, 2006. In these applications, 

disability is alleged beginning on November 22, 2006. These claims were denied initially and 

the claimant filed a request for hearing on March 8, 2007. 

I am holding a hearing on May 28, 2008, in Selma, AL. ,-'-----, an impartial 

voc'ational expert, has also appeared. The claimant is represented by " a nonattorney representative. 

The issues are whether the claimant is disabled under sections 216(i) and 223 of the Social 

Security Act; whether the insured status requirements of sections 216(i) and 223 of the Social 

Security Act are met; and whether the claimant is eligible for supplemental security income 

based on disability under sections 1602 and I 614(a)(3)(A) of the Social Security Act. 

, ' 

The claimant has been disabled under tlie Social Security Act since November 22, 2006, the 

alleged onset date of disability. 

The claimant met the insured status requirements of the Social Security Act on this date. 

The claimant has not engaged in substantial gainful activity since the established onset date. The 

claimant has not worked for payor profit after this date. 

The claimant has the following severe impairment(s) or combination of impairments: gouty 

arthritis, hypertension, urinary tract infections, and osteoarthritis. 

The claimant does not have an impairment or combination of impairments that meets or 

medically equals one of the listed impairments in 20 CFR Part 404, Subpart p. Appendix I. 

The claimant has the residual functional capacity to perfonn less than the full range of sedentary 

worle. 

The claimant has past relevant work but the claimant's residual functional capacity is 

204 
275 

inconsistent with the demands of this work as,actually and normally performed, Accordingly, 

the claimant is unable to perform past relevant work, 

Once the claimant has established that she has no past relevant work or cannot perform any past 

relevant work because of her impairments, the burden shifts to the Commissioner to show that 

there are jobs existing in significant numbers in the national economy which the claimant can 

perform, consistent with her medically determinable impail1l1ents, functional limitations, age, 

education, and work experience, 

The claimant was of advanced age on the date disability is established, 

The claimant has a limited education, 

The claimant has an unskiIled work background, 

Considering the claimant's age, education, work experience, and residual functional capacity, no 

jobs exist in significant number in the national economy that the claimant could perform, This 

conclusion is based on direct application of Medical-Vocational Rule 201.01. 

Based on the application for a period of disability and disability insurance benefits protectively 

filed on November 22, 2006, the claimant has been disabled under sections 216(i) and 223 of the 

Social Security Act beginning on November 22,2006, 

Based on the application for supplemental security income protectively filed on November 22, 

2006, the claimant has been disabled under section l614(a)(3)(A) of the Social Security Act 

beginning on November 22, 2006, 

The component oflhe Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments, and if eligible, the amount and the months for which payment will be made. 

205 
276 

Claimant Name: 

1.1_ "2.l... 

Application Da'te: e: __ Hearing Dat~; ~"""'28-q 

Date ·Last Insured: (1- 3/~ 07 Date First Insured: 

!:stablishec Onset· Da<e: 1/ - 2..2.. -(J " / 

Prior Application _Reopened _Not Reopened N/A 

Prior Application Date(s): T2 ______ SSI ____ _ 

Da~e of Ini~iai Determination: T2 __ ~ ______ SSI ____ _ 

Reason for Recpening: Wi thin One yea.r Grounds for reopening at any time 

Good caus~/new and ma1:erial e'\Tidence (within 2 or 

years) ./ 

__ Work After Onset %ne 

__ UWA 

__ TWP ISee 20 C. F.R. §§ 404.1592 (d) {2l (iii) and (iv). J 

__ Not SGA ________________________________________ _ 

Severe Impairment (s) (singly or in combination): 

Impairment: (s) MEET Listing: ~ ____________ N/A 

Impairment{si EQUAL Listing: ~ _______ ME __ NIP .. 

Testimony/ ______________________________________________ _ 

.~.::;;; c~.....,...,.~~.: 

----------------------------------------~-------

I.T".terrogatorie:~ : 

~./J --------0-

207 
277 

Me~.tal. Impai.:::-ment. JI.nalysis: ____ /for List.ings, __________ _ 

Restriction of Activities of Daily L'iving None Mild Moderate Marked Extreme 

Di..f·ficul ties Maintaining Social Functioning None Mild Mcde:rate Marked Extreme 

'Difficul-cies Maintaining Concentration-Pace None Mild Moderate Marked Extreme 

!pisodes of Decompensation NonE! One or 'two Three 'Fou:: or More' 

Part C Limit-'ns (2 yrs med. hist. &. more \han"minirn21 limii:ationl (12.02, 12.03, 

12.041 Yes No 

..,.,...,..-___ Residual disease process with marginal adjus'Cment so that minimal 

changes cause 

decompensation 

_-,-.,..--;-_Cu!:'rent history l+years in highly supportive living arrangement with 

continu~ng 

need for same 

_____ Repeated episodes of decompensation, each of extended duration 

12.06: Specify limitations: 

Residual Func'Ci0-GF1 Capacity/Physical - Exertional and Non-exert.ional 

,Limitations+l ~sed __ Lt. _ Med·. __ Hvy. 

Men~al Residual Func1:ional Capacity+2: ~. ~ 

__ SEE p.s ATTACHED HEREIN: ___ +l __ N/A ane __ -2 __ N/A. 

·Past Re levant 'Wo::-k! 

-/-, ._------.,.. .. -----._ .. -.-._-

_Vr_,Uln<nSI)(llled No t.ransferable sr..ills/ ___ Serni-skilled No 

Transferable skills. _____ __ Semi-skilled _. __ Skilled 1 __ Transfezable Skills 

No"C Material 

Medica:"-Vocational Rule 

208 
278 

Medical-Vocational Rule f. __________ Framework VE Tes~imony No Jobs 

Social Security Rulin; .... -# _________________________________ -'-____ _ 

Rat.ionale for Decis·ion (Include assessrne!1t of credibility and medical source 

Recommend Representative Payee ________ N...:......:..I_it.l-_______________ _ 

Medical reexamination in ~yearIS) Other recommendations: _____________________________ ~ ____ _ 

Evidence at Workers Compensation Claim/Payment/Disab' it.y Insurance Paymen~/VA 

Benefits/Disabili~y Retirement ___________ ~~~ __ ~ ______________ __ 

~-------

Fee Agreement P.pproved. Representative Name: ----------~ 'r -'-

~ee Agre~rnent Denied. Reason: __ -L!VJ-/~Jt~.-----------__ ------------------

209 
279 

210 
280 

IN THE CASE OF 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability AdjudicatIon and Review 

DECISION 

CLAIM FOR. 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

(Social Security aber) 

JURISDICTION AND PROCEDURAL mSTORY 

This case is before the undersigned on a request fOT hearing dated January 9, 2009 (20 CFR 

404.929 et seq. and 416.1429 et seq.). The evidence of record supports a fully favorable decision; 

therefore no hearing has been held (20 CFR 404.948(a) and 416. 1448(a». The claimant is 

represented b" , an attorney. 

The claimant is alleging disability since Augu~ 15, 2008. 

The issue is whether the claimant is disabled under sections 216(i), 223(d) and 1614(a)(3XA) of 

the Social Security Act. Disability is defined as the inability to engage in any substantial gainful 

activity by reason of any medically detenninable physical or mental impairment or combination 

of impairments that can be expected to result in death or that has lasted or can be expected to last 

for a continuous period of not less than 12 months. 

With respect to the claim for a period of disability and disability insurance benefits, there is an 

additional issue whether the insured status requirements of sections 216(i) and 223 ofthe Social 

Security Act are met. The claimant's earnings record shows that the claimant has acquired 

sufficient quarters of coverage to remain insured through December 31,2012. Thus, the 

claimant must establish disability on or before that date in order to be entitled to a period of 

disability and disability insurance benefits. 

After careful review of the entire record, the undersigned finds that the claimant has been 

disabled from August 15,2008 through the date of this decision. The undersigned also fmds that 

the insured status requirements of the Social Security Act were met as of the date disability is 

established. 

APPLICABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

Permanent Subcommittee on Investigations 

EXHmIT#2a 
281 

Page 2 of6 

disabled (20 CFR 404. 1520(a) and 416.920(a)). The steps are followed in order. If it is 

determined that the claimant is or is not disabled at a step of the evaluation process, the 

evaluation will not go on to the next step. 

At step one, the undersigned must determine whether the claimant is engaging in substantial 

gainful activity (20CFR 404.1520(b) and 416.920(b)). Substantial gainful activity (SGA) is 

defIned as work activity that is both substantial and gainful. If an individual engages in SGA, 

she is not disabled regardless of how severe her physical or mental impairments are and 

regardless of her age, education, or work experience. If the individual is not engaging in SGA, 

the analysis proceeds to the second step. 

At step two, the undersigned must determine whether the claimant has a medically determinable 

impairment that is "severe" or a combination of impairments that is "severe" (20 CFR 

404.1520(c) and 416.920(c)). An impairment or combination of impairments is "severe" within 

the meaning ofthe regulations if it significantly limits an individual's ability to perform basic 

work activities. If the claimant does not have a severe medically determinable impairment or 

combination of impairments, she is not disabled. If the claimant has a severe impairment or 

combination of impairments, the analysis proceeds to the third step. 

At step three, the undersigned must determine whether the claimant's impairment or combination 

of impairments meets or medically equals the criteria of an impairment listed in 20 CFR Part 404, 

Subpart P, Appendix 1 (20 CFR 404. 1520(d), 404.1525, 404.1526, 416.920(d), 416.925, and 

416.926). If the claimant's impairment or combination of impairments meets or medically 

equals the criteria of a listing and meets the duration requirement (20 CFR 404.1509 and 

416.909), the claimant is disabled. If it does not, the analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the undersigned must first 

determine the claimant's residual functional capacity (20 CFR 404. 1520(e) and 416.920(e)). An 

individual's residual functional capacity is her ability to do physical and mental work activities 

on a sustained basis despite limitations from her impairments. In making this finding, the 

undersigned must consider all of the claimant's impairments, including impairments that are not 

severe (20 CFR 404. 1 520(e), 404.1545, 416.920(e), and 416.945; SSR 96-8p). 

Next, the undersigned must determine at step four whether the claimant has the residual 

functional capacity to perform the requirements of her past relevant work (20 CFR 404. 1520(f) 

and 416.920(f)). lethe claimant has the residual functional capacity to do her past relevant work, 

the claimant is not disabled. If the claimant is unable to do any past relevant work or does not 

have any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation process (20 CFR 404. I 520(g) and 416.920(g)), the 

undersigned must determine whether the claimant is able to do any other work considering her 

residual functional capacity, age, education, and work experience. If the claimant is able to do 

other work, she is not disabled. lfthe claimant is not able to do other work and meets the 

duration requirement, she is disabled. Although the claimant generally continues to have the 

burden of proving disability at this step, a limited burden of going forward with the evidence 

shifts to the Social Security Administration. In order to support a finding that an individual is 
282 

Page 3 of6 

not disabled at this step, the Social Security Administration is responsible for providing evidence 

that demonstrates that other work exists in significant numbers in the national economy that the 

claimant can do, given the residual functional capacity, age, education, and work experience (20 

CFR 404. 1512(g), 404. 1560(c), 416.912(g) and 4i6.960(c)). 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant's date last insured is December 31, 2012. 

2. The claimant has not engaged in substantial gainful activity since August 15, 2008, the 

alleged onset date (20 CFR 404.1520(b), 404.1571 et seq., 416.920(b) and 416.971 et seq.). 

3. The claimant has the following severe impairment(s): cervical spondylosis, 

fibromyalgia, tension headaches, migraine headaches and history of depression with 

anxiety (20 CFR 404.1520(c) and 416.920(c)). 

The above impainnent( s) causes more than minimal functional limitations. 

4. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 

1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926). 

The claimant has the following degree oflimitation in the broad areas of functioning set out in 

the disability regulations for evaluating mental disorders and in the mental disorders listings in 

20 CFR, Part 404, Subpart P, Appendix 1: mild restriction in activities of daily living, mild 

difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, 

persistence or pace, and no episodes of decomp~ation, each of extended duration. 

5. The claimant has the residual functional capacity to perform sedentary work as 

defined in 20 CFR 404.1567(a) and 416.967(a) except for those job functions that are 

outside of the parameters of I Issessment as noted below. 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404,1529 and' 416.929 and SSRs 96-4p and 

96-7p. The undersigned has also considered opinion evidence in accordance with the 

requirements of20 CFR 404.1527 and 416.927 and SSRs 96·2p, 96-6p and 06-3p. 

'! _ shows a history of treatment of the claimant On October 30, 2008, the 

claimant was treated for and diagnosed with chronic tension headaches and fibromyalgia. 

J..- _. _ • ~ • pain specialist, reflects treatment of the claimant since 2008. He provided 

claimant with cervical injections due to cervical spondylosis. On February 16,2009, he opined 

that claimant can lift andlor carry up to ten pounds occasionally or less frequently; sit for three to 
283 

Page 4 of6 

four hours during an 8-hour workday; and stand and walk for two to three hours during an 8-hour 

workday. -=- tated that the claimant is unable to perform pushing and pulling 

movements, climbing and balancing, bending andlor stooping movements or reaching. He 

opined that pain is present to such an extent to be distracting to the adequate performance of 

daily activities or work. It is also noted that physical activity, such as walking, standing, sitting, 

bending, stooping, and moving of extremities greatly increase pain to such a degree as to cause 

distraction from task or total abandonment of task. He further stated that the drug side effects 

can be expected to be severe and limit effectiveness due to distraction, inattention, drowsiness. 

Medical records from J _ • neurologist, also reflect history of migraine headaches and 

depression with anxiety. 

After considering the evidence of record, the undersigned fmds that the claimant's medically 

determinable impairments could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity, persistence and limiting effects of these 

symptoms are generally credible. 

The State agency medical consultant's physical assessment and psychological consultant's 

mental assessment are given little weight because another medical opinion is more consistent 

with the record as a whole and evidence received at the hearing level shows that the claimant is 

more limited than determined by the State agency consultants. 

Pursuant to 20 CFR 404.1 527(dX2) and 20 CFR 416.927(dX2) and Social Security Ruling 96-2p, 

generally more weight is given to the opinions from treating sources. If the treating source's 

opinion on the issue of severity of impairment is well supported by medical evidence, it is given 

controlling weight. Further, the Eleventh Circuit has held that an Administrative Law Judge 

must accord substantial weight to the opinion of the claimant's treating physician unless good 

cause is shown to the contrary. Broughton v. Heckler, 776 F.2d 960 (11th Cir. 1985). In this 

case, 1 .; 'pinion is supported by medical evidence. 

6. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 

416.965). 

The demands of the claimant's past rele;vant work exceed the residual functional capacity. 

7. The claimant was a younger individual age 18-44 on the established disability onset 

date (20 CFR404.1563 and 416.963). 

8. The claimant has at least a high school education and is able to communicate in 

English (20 CFR 404.1564 and 416.964). 

9. The claimant's acquired job skills do not transfer to other occupations within the 

residuai functional capacity defined above (20 CFR 404.1568 and 416.968). 
284 

Page 5 of6 

10. Considering the claimant's age; education, work experience, and residual functional 

capacity, there are no jobs that exist in significant numbers in the national economy that 

the claimant can perfonn (20 CFR 404.1560(c), 404.1566, 416.960(c), and 416.966). 

In determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual functional capacity, age, education, and work experience in 

conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. 

If the claimant can perfonn all or substantially all of the exertional demands at a given level of 

exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" 

depending upon the claimant's specific vocational profile (SSR 83-1J). When the claimant 

cannot perform substantially all of the exertional demands of work at a given level of exertion 

andlor has nonexertional limitations, the medical-vocational rules are used as a framework for 

decisionmaking unless there is a rule that directs a conclusion of "disabled" without considering 

the additional exertional andlor nonexertional limitations (SSRs 83-12 and 83-14). If the 

claimant has solely nonexertional limitations, section 204.00 in the Medical-Vocational 

Guidelines provides a framework for decisionrnaking (SSR 85-15). 

If the claimant had the residual functional capacity to perform the full range of sedentary work, 

considering the claimant's age, education, and work experience, a finding.of"not disabled" 

would be directed by Medical-Vocational Rule 201.28. However, the additional limitations so 

narrow the range of work the claimant might otherwise perform that a fmding of "disabled" is 

appropriate under the framework ofthis rule. This conclusion is supported by Social Security 

Ruling(s) 96-8p. 

11. The claimant has been under a disability as defined in the Social Security Act since 

August 15, 2008, the alleged onset date of disability (20 CFR 404.1520(g) and 416.920(g». 

DECISION 

Based on the application for a period of disability and disability insurance benefits protectively 

filed on September 26, 2008, the claimant has been disabled under sections 216(i) and 223( d) of 

the Social Security Act since August 15, 2008. 

Based on the application for supplemental security income protectively filed on September 26, 

2008, the claimant has been disabled under section 1614(a)(3)(A) of the Social Security Act 

since August 15, 2008. 

The component ofthe Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the non disability requirements for these 

payments, and if eligible, the amount and the months for which payment will be made. 
285 

Page 6 of6 

Medical improvement is expected with appropriate treatment. Consequently, a continuing 

disability review is recommended in 18 months. 

Charles A. TIligpen 

Administrative Law Judge 

October 15, 2009 

Date 
286 

SSN: 

PHYSICAL SUMMARY NAME: 

DATE 12ftl8120OS 

Case rating: 02 

35 yo woman alleges intractable migraine. TP neurologist I ~ indicates Cl prescribed 1.5 g. 

Keppra and Inderal160 mg daily. lnderal started one year ago. In the past 10 monthsl CI has obtained a 

2 month supply of Inderal and there is no indication in the pharmacy print out of Cl ever obtaining the 

Keppra. These drugs are intended as preventive therapy and body of evidence in MER indicates very 

poor compliance in treatment Cl was due back for follow up 9/08 and as of '10/23/08 receipt ofTP 

records Cl had not returned fOT follow up. 

!8! THESE FINDINGS COMPLETE THE MEDICAL PORTION OF THE DISABILITY DETERMINATION 

SIGNATURE 

PAGE 1 OF 1 

SPBCIALTY 

20 

Permanent Subcommittee on Investigations 

EXHmlT#2b 
287 

ioeial Security AdMinistration 

EXPLANATION OF DETERMINATION NCD -'o-fClel..."t 

INDIB 

The evidence listed was used in evaluating your claim. Additional 

reports were not obtainable~ 

~;:;""~-- ="-: l t 

... \ 

t Received 10/29/08 

ort Received 10/20/08 

Report Received 10/23/08 

ort Received 10/23/08 

t Received 11/05/08 

eport Received 10/21/08 

Report Received 11/05/0B 

In addition to the reports listed, information that you and others 

provided about how your condition(s) affects your ability to function was 

considered. 

We have determined that your. condition is not severe enough to be 

considered disabling. In deciding this, we considered the medical 

records, your statements and how your condition affects your ability to work. 

You state that you are disabled because of migraines and depression. It 

has been determined that your medical condition does not Significantly 

affect your ability to carry out most routine activities. Since your 

ability to work is not significantly affected, you do not meet the 

requirements for disability benefits. 

If your condition gets worse and keeps you from working, write, call or 

visit any Social Security office about filing another application. 

11 NCD 

Permanent Subcommittee on Investigations 

EXHIBIT#2c 
288 

U'-l ·C.O-c.,UUO c.c. • .::.O ,I'WlI' 

"SlJRAHCE STATEMENT P"nted, 1Iedn"day, oetob., ,9, 2008 '0'06[" AH 

::::~t Date 8eglnning 06/0112007, EMU'lg 10/l9IZ008 000 l r:l:x # Dotto" Dr-LIg HOC Qty Writtl!n fill Datil! Rl!fH~ Pnc't' Tax 

:!!.=!li'~===fI'IlO::1~="::=~====III;::;!!!!!!!~="======="""'''':S;O:U;:::::::!!'~--'''='''===;:ee!!!!!:===~====",=====;:;::;:::~~!!!!r"== _ ===~!!!!!! 

P<lgc 1 

166345t1 ALPRAZQUM TABS .Z5I4G 00781-106'~'0 6lI 06/14/2007 06/14/l007 0 ""'''''.51 0.00 

lMUl'al'le(! '11 'CIIS Auti-oorillJtiOl1 number! Q71654WM3004999 

185736S _.~T HYDROCOD/ACET 7.5/500 (60) 00603-3~-,6 30 OS/17/Z007 06/22/Z007 1 "**fI*"'4.10 0.00 

Insl,l'f"at'lco #'1: BCas. Authoriut'ion 1'U.JttJef'! 07173S240Aa7OQ1999 

, .... n AlPRAZOlAN 0.5HG GENEVA 00181-1017·10 60 0711 [){2007 07'/10nOO7 0 ..... ·*"*5.09 0.00 

tnsurol'1Cc '"h 8CBS AutnQrj:r;atfon nLll!l~r: D7191&13a:ll$W06999 

H!I'736S '-- ~YOROCOD/AC£T 7.5/500 (60) 0061l3~3882·Z8 30 05/1712007 07{161Z007 2 .. ...-4.10 0.00 

InsUrlillCt: Jill: Bcas Al.Ithcri:r;at;«I nunber: D7197'QS3652000m 

1863450 e,_' ALPitA20lArtl TABS .25HC Q0781-1061~10 60 06/11,/2007 OH161Z007 1 --*fl4.57 0.00 

rnsur(l~e 1f'I; BeBS Authorization ~r; 071914955825003999-

18>7366 

- AIlIBIBJ ell: lZ.SfIUi H.BLETS 00024-5521-Z1 30 05/1712007 07119/2007 Z 130.25 0.00 

"'7363 - IICll 1~.5MG CAPSIA.ES. OD591·0347'~01 30 05t17/lOtI7 07{25/ZQ(J7 1 .... -"'7~10 0,00 

JnsLll"'n"e~ I,n: .cas A~"QT'iZ:Qtion Il\mIbcr; 07206'149741005999 

1868912 AlPRAZOtAM 0.5JItC CENEVA 00781-1077·10 60 07{1012007 07/3012007 1 "---·S~09 0.00 

Il'\Surane~ .1: .CiS Authoriutian IU1tcr: 07'2116096B08rms999 

187'578:$ -. ~YDROCODCWE: & APAP 11;l/'HIOMG OOS91-0540-0l 30 08/08/2007 OO(08/20()7 o ""ff*.~.'O 0,00 

InsurDl"Ie:o !!.111: Be" Aut,"-ortzation runbe:r: Om0516n97006999 

1875782 MAXALr 11lolG TAB (12 IS) 00006-0267-12 9 08/0812007 08/0812:007 0 ..... ~3.66 0.00 

lru:uraneo *1: Be" Avthorizatlon ~r! on2'O~~1001~99B 

1876714 

- PRI:I1ETIfAZINE 25JotG*GEKEVA 00591-5307-10 30 08flln007 08/1312007 o fI ....... '3.70 0.00 

InsurantI' it1: ates Authotl2:BtiW1 Nrlbrtr: 01:2;:5429643900299'9 

1BSmS 

- HYDltOt'OD/AcET 7.5/500 e6tl) 0~3·38B~·ze JO ()5!11!ZQ07 08/17!i!00T 3 """~'.10 0.00 

1 /lSUrllnc.c '"; BCes. Auti)orization I'IUIlber: onm04796TCl05999 

1663450 _T ALPWoLAM T.eas .Z5JIIG 60781·1061·10 6{1 06/14/ztl07 08/1112007 2 "''''-'.57 0.00 

Insurone.1! 1I!1: BcaS Aut.horh.ation I"!1J'I't.er: 07229305025900;;999 

1857365 

- HYtlROCOO/ACET 7.5(500 ·(60) 00603·ssaZ-Z8 30 05./171'2007 09/04120()7 4 "."·**'.10 0.00 

Insurance '1! BCSS Autf1cri18tfon I'!LImber! 072~767'2S"06006999 

186l4S0 -.( AlPAAZOLAM TASS .Z5MG 00781-1061'10 60 06/14/2001 09/06f~QQ7 3 "'· ...... 4.57 0.00 

IMLJI"BnC1! tl1~ BcaS ALJt,"-Drlz&tiOl'l rtumben 072'i95184440003999 

H'8349Z ., ZONISANIOE" CAP 100MG. 6CIS05-2S47-01 .so 09/08f2007 09/08/2007 

0 ..... ?U

7

\ 

0.00 

In,Urpl'lCfl "1: 0"'9 AuthoriZQtiOl"l nurDer: On5155?'144Z()Q49'99 

1885098 

- Jm)ROro!l/AC£t 7.5/$'00 (60, 00603-JOII2-2/I 30 1:19/14/2007 0911412007 0-........ 4.'0 0.00 

InsurollCc 111: eCEJS A\.IthorizatiOl"l I1UIIber; OnS731W98005999 

lSS509t HTOROI(YZIHE 50MG TA~ 15t14-0083·()i. 60 09/14/2007 09/lot{2007 0""""''''15.00 O.OQ 

Irosur.,!1'I;o 41: PCBS AlJth.orlzatiOf"l number: 0n575115861000m 

,"""Z - ALPRAZot.Al1 1J.5KG GENEVA OOnn'1077-10 60 0711012007 09/2312007 2 "'·.rs.09 0.00 

Insur::lnt:t! ",: BCBS Author;zat;on nl.lllbc:r: 07U6,$1249430069fX! 

'85736$ , __ HYt\ROCOtI/ACET 7.5/500 (60) OD603-3882-Z8 3tl 05/17/~o.o7 09/,0/2007 5"'**""**4.10 0.00 

t nsUrenee #1: Bess AythorfZBtlon n1.Bllber; 07Z6651Z6158007999 

1890684 

- 20lPlOEfll 10MC TABS 60505 -2605-08 15 10/05/2.001 10/05/2007 Q 69.50 '.00 1883492 

- ~!SAMJUE CA~ 100MG 60505-2'5''''·01 60 09/0el2OO7 lD/11{2:007 1 .. .".. ... "21.47 0,00 

InSur,\lMe 111: acas Author-h.atfQn nl.lllben On8445n241D04999 

18631,.50 C'- AlPRAZolAM TABS .25MG 00781-1061·10 60 06J14/~OO7 10111/2007 6 --""'4.57 D.DO 

In~Ut"!III'IO~ ",: B"" Auth.orization number! 07:2B1r4573876DOsm 

Permanent Subcommittee on Investigations 

EXHIBIT#2d 
289 

page' ,2 IIi5URANCf STATeMENT Printed: Wednesday. october 29, 2008 10!06!~1 AM 

:!~_~=~ 1892555 

Ins.L.lronc:~ 1t1: 

__ 

tJess 

__ • ~~==~~~~".1~: 1895429 =-.:. J 

InsuroflQl": 11'1: Bces 189125$ ____ .LAN 

,.m5~ 

1898662 

JI'1S\,II"Ulce ,,: BCBS 

1901016 L ~H 

190;104_ 

J/'tSuranc:e 'h s= 19026% 

Insurllncl:l tl1: Beas 

1907'911 -----.. 

In&urAnee '"; Bess 

1901'912 ------ In!!u1"&ne(! "1 ~ SCas 

'9"926 __ 

Insuranec 61: Bess 

19,2929 - JnsurDnco:" #1: BeeS 

1914074 __ 

InsuronC-1'! ",: BCDS 

191<929 - Insu""nc:c 1t1: Bcas 

1912928 

Jnsurar.ee .-1: -BtaS 

192,"017 

1909Z0T -J 

trY5'lJrll!/'lO(! 11!1: BCSS 

m1935 -.~ 

InSurMCc 1$1: Bess 1912928 _ 

InsurDnee "1: BtSS 

1'937417 ,....-, 

Insur3l'lC~".H BteS 

1937924 .-I' 

1909Z07 

1 M-1Jra~ #1 ~ BCBS: 

"~1107 

[muranc-I:' tt1: -BCIlS. 

'943267 .".-

HYDAOCOO/ACEI 7.51500 (60) 30.0912B/2007 10/12/2007 

Authoriution nurrbel"'e 072855178532001999-

H'PR,OCOOONE & APAP 1()/~rwMG 0059'~D540·05 30 lOllY2D01 10/ll/1007 

Author!:ration T'LII!ber: 0729;6706973006999 

PROPRANOLOl LA 6OMc. CI\P$ .!i9S84-02e2~n1 30 10/3012007 10/30/2001 0 --"l~.OO 

Authori!ation m.IIIIber: 07303471002500T999 

MAGMESIIJII! OXIOI; "00filG 685M-0006'12 60 1'0/3012007 10n.o;'2007 0 9.75 

HYDROCOOJACET 7.~/500 (60~ 1Q 11/osnOcT 11!0~/2007 0 ·-2.70 

AutP'lDT"iz.stiQn nuubc:r: 073094,3.01130000999 

TEMAZEPAM 1SMG CAP$ (15) OOl7&-4010'01 30 11/1312007 11113/2007 0 23.75 

MtDl!OCOO/ACET 7.5/500 (6(1) 00603~3862428 30 1V13nD07 1V13/2:007 0 .... ···4.10 

AutMGI"izlitiOl"l nl.Jll'b2n 0711~~01155COS999 

HYDROCOOI,AC:i;T 7.5/500 (60) 0061:l3"3882·2B 

Autnorlutiot'l NRIIberl 0712430264~03099 

PROPRANOl.Ol LA l20MG CAPS 49884-0329·01 

AutP'lorization number: 073454498960002999 

M{(iRAMAL HS 4MG.fML 8t:T • 00181·0<:45-03 

Author;uti on I'U1Iber: 073"S'5CllftgOO1W7 

HYO~OtOC:lfAJ:ET 7.5!500 (60) 00601-33I;IZ·ze 

A1Jthortzaticn r1LII!be-r: 08002517555OO0S999 

AMOXltllUN 500Hi; C4ps· 633M-M5~-0~ 

AutP'lorir.ation rvtber: 080025176666007999 

Pot LA TABS 60,58-0260-01 

AUtl'10l"i:f:atiol1 number; 08007357682'007999 

.AHOXJCILLIN 500MG ~'" 633~·0655"OS • 

Authoriutlon f1IJItbc-r;; oa01452309S8IJU6999 

ItTOROroD/ACH 7.5/5.00 (60) 006C:3-3882.~2a 

Autltor'iz13tlon nurrnr: OB~151a98S:5005999' 

TEHAZEPAM 1'"0 tAPS OS) 00378-4010-01 

IMITREX O.5/IIL 25 REFll.l. OO'7J~047B·00 

.t\uthorizDtion nl.mlber: 0804~079684001999 

30 1112012007 '1I2tl1lO07 0-* ..... 4,10 

30 12/10/2007 12J111lO07 0 ..... • ... 15.00 

1 12110/2007 1211'12007 o -"**63.76 

30 Oll02{2tl08 01{02l2008 0 ............... '.31 

21 01/0212.008 01(02/2008 0·---"'3.85 

14 01{01!20OS 01l07/Z0OB o *"***7.29-

21 01{OZIZOoe fJl/1412OOB 1 -".**3.es 

10 01/0Z/ZOOS 01 r2212M! 1 **-'"'*4.3' 

lO OVOSI2008 Ol!08/ZODB a 23.50 

1 12/'512007 02!11/200a 0 ............. 35.80 

AHOXIL/ClAV 875/12:5 TABS 6330't'OS09-01 14 OZ/18/2006 OZ/18/aJOO 01'''''''''15.00 

Authori!-:tItioo n~r: 080496318981006999 

NYDROeoD/AtET 1.5/5.00 (60) 00603-3M2·zS 30 01{02120OB 02t:z1!ZQOO 2 .... " .... ·'.11 

Authorization I"IUIfIber: 08052295'318007999 

HYOROCOD/ACET 7 .5/~00 (60) 006D3-J882 .. ZS 28 0l/U/2OOa 03/261Z00B 0 -·",".1~ 

Authorization number; 08086l9111.48002999 

PHENTERI'lIU1E Hel '0 MG 

IMITREX O.~Ml ZS RH1LL 

00185-5000-01 

00173 .. 0478·00 ' 

Authorizotion ~r! 080886696070004999 

PflENTErUUNE "Cl 30 MG 00l6S-SODO-01 

OOXYCYClINE 10DMG CAPS "'. 001T2-29M-70 

Author;ution 1"4JIIIber: 08108382:0S3900Sm 

15 03/2tVZOClS 1;13/28/2008 0 19' .~Q 

1 U""Z007 03/28/2'008 1 *'"'***37,86 

,~ 04/161Z00B D4/16/~008 1;1 15.22 

20 04111/Z008 04/17/2008 0 !I"",,-u*3.76 

HYDRGC"ODON'E/APAP SI500 00591~0l49'05 16 04/17/2008 04/11'/2000 0 .. • ..... ·1.'1 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

'0.00 

0.00 

0.00 
290 

Paogo 3 JNSURANCE $TAiEm:NT Printed: wednEl5'~y, OCtgber 29, 2008 10:06:21 AM 

patient: •••••• 

Statement 

On", HOC ~ty Wrjnen Fit t DaU lief; II prir:e , .. "'==.,!!'"!S:~F,..==~~ ..... ,.=#=e=-..",=""===""===:::~=-="'==;;=~===:=;;:;:=====;;i:~::=====-~=C=:iII.!I!~= .. ==,.=III"'="''''=='''=::''''' .... ''"'''''''= lnsvl'M(:.C '1, 'CBS AUthoriution nurCer: 08108383795401]1999 

194861, 

- ClONUfPAfIII O.5MG TABlE;TS OQ093·~·'0 20 O~/orl2OOll Oj/07!200S 0. "u***3.76 0.00 

Ir't$.uroncr. .1; .eBS Autl1or-lzation !'UPl:;lI:r. 1)812&4196144002999 

1949001 

- TE!Q.ta-AM 30 "G 05) OO7B'-220~'01 12 05/08/2008 (l5"/08/Z0OS 15_00 O.DC 

1948999 ~ SUTAl/ASP/CAr 50/325/40 TABS 0014]'-17&5·01 12: ~/08/~ 05/08/2mJB 0 ...... --5.30 O.DC 

lnsurDnee II, ~ BCgs AuthoriZ;Jtion nurrbflor: oe.1Z9~55673a04999 

19503Z4 

- tNNOpRAN XL 1ZOMa CAPSULES 6S726·0~1·'0 30 05/13/20'" 05/1312008 0 .. ...-50.00 O,DC 

1 nsutaneeo H1: BeBS Authcr-iz.lltlon nuobtr: 081347U1J757"OOJ999 

19516611 ClOAAZEPAM 1MG TA8!,ETS 00£l'13·0S.3J~10 30 05/19/2008 05/19/2IlOS 0"-"**5.49 0.00 

Jr'lllurem:1'" '1; Bees A1J~hQrlletiol'l nUIllb'er: 08140672'1151001999 

1~166B Cl~AZEPAM '"Ii TABLETS 00093-('833'10 30 05;1912008 06/11/2008 '--5.49 0.00 

Ir'!$,urer'lct"! !lt1: BesS Authorlutton I'\IJIIIben 0816J31OB045002999 

1956631 ,- MEPERTDINE SOKt (60) 00054-4595·25 12: ·06/17/20C8 06/17/Z0oa 0 .......... ·7.54 0.00 

.fl$l,IIrom::c .",: BesS Authorization I"II.JmbQr! 0616951410040099Q9 

195032, IUIrIOPRAN Xl UOMG !:APSLIlE$ b!in6~0251·1D 30 05/WZOO8 o6m,.008 1--50.00 O.DC 

J ","!.Irsnee #1: Be"" Authorizatiot'l I'UlIber: 08177401030000b999 

1949001 ,- lEMAZEPAM 30 ItIG (15) 00781~2202·-o1 12 OS/OS{2008 M/~Bf'1008 1'5.00 0.00 

19620<0 

- *lYDROCOO/AC'ET l' .5(501) (60) 00603·~~2B 21l 07/01/2008 01101/2008 o -'*1t1f~.54 0.00 

InSu.l'el\eCl tt1: Sees Auth<lrfz~tfon I"IU1bt-r~ 001l3J.6168lr640osm 

1962038 CLClHAzEPM lMG TAB.LeTS 00093-083>·10 3CJ 07/tl1/20OS 01/D1{2008 0-"'''''''-5.'9 O.DC 

IMurancr. .,,: BCBS AuthDdro.Hon m,m~t; OtllB36rro'9S0a3999 

1962040 

- HYDROCoD/4C!T 7.51500. (M) 0Q601-38$l·Z6 20 07J01{2OM OT{14/l0OS 1 <tI'lHu5.54 0.00 

Tm1,l1':;IrlCC ,,: seas Autttorilatiol'l nuJIIbe.r: 08196S684'01Dt11999 

1_ - AlPRAZOlAM TABS lHG GENEVA 007B1·1079·10 60 07/21/2008 07/21/2rJOe 0'-'---&.15 0.00 

Il'\Cura"co .it BCDS A,uthMtzatfOrl I'\1...nber: 08203620S6n008999 

1966680 

- H.CT~ Z11'11i 0061l3'3B56-3Z 30 07/21/2008 07{21{2008 0"-"'*4.38- 0.00 

lM~al'\Ca fit,: BCeS AuU'lorll:.1Jtfon t\I.JI!Iber! 0820362'l004700~ 

.966683 

- }/'(D~otoO/At:ET 7.~!SOO (60) 00603-JS8Z-2B 20 07!21{20C\3 07{31/2008 o ..... -"'3.54 0.00 

I nsur(lner. '1 : aCBS Authodt,.otiorl ~r: 082137037t1nOO7999 

''''~ - KYDItOt"IJO!,II.CET 1.5/500 (60) 00603-3882-28 20 07l2112rJOS OB/13/lOM 1 "'"'-3.S' 0.00 

insurance 1f1: BeBS Authorization I'IU:IIber: 082266649714001999 

19'6682 - ALPRAZOLAM r ABS 1MG G~EVA ·007$1~1079-10 60 07/21/2006 03/22J2Il08 , 11' ... .....-&.15- O.DC 

Insuianca #1 ; .cas Autilor;lt1tion nUJltxlr: 082357023385001999 

'975513 

- TOBRADI;X 3.5G 0 0 00065·0648·35- , "'1Z'rf2!108 OBIZ1IZOOS 0-----30.00 0.00 

IMl.lraneo. 1\11 ~ BCBS Authorit..atlon nunbor: 082406n'06S006:999' 

976US ~ ..... HYDRotOC/ACET 7.51500 (60) 00603~3aa2"28 20 OS/19/2008 08/.29/2008 0··-3.54 0.00 

lnsur::JnC~ 1f1: Bces Autttoriut"ion nlJll'ber! 082426298331008999 

9'6682 

-- ALPIlAlOlA/II TABS 1MG GeJEVA 00781-1079-10 60 J;lr/Z1{20DS 09/Z3/2000 2 ....... 6.15 0.00 

lnsvran=~ 111; Be .. AuthgriZ;8tlM number! 0821176190396003999 

~6Zl 

-- HYDROCOD/AC"£T 7.5/500 (60) 00b[]3 -38B2. 28 20 09/25/21lM 0912'12DC8 0-.... ·"3.5' 0.00 

tn-s.u!'~1'tC1l .1J seQS Autltoriz.atiOl"t number: 08U96175451001m 

982= I(YOROCOD/ACET 7.5/500 (60) 006Cl-3882-28 20 09t25!20DS 10/lJ/20M 1 "w·"-J.S4 0.00 

InsUtenee 81: Be.S Author12<:!tion F'IIJIC)ei: 082974442845007999 

9666112 AlPR.AZOLA'" TABS 1MQ GENEVA 007S1~10T9*'0 60 D7/Z1[2008 10/~/ZOD8 3 --"''""6.15 0.00 
291 

Doctor 

InsurancC! '1: Bess 

1990{l66 

Ph,qr!1l3Cist: 

StorC'~ 

Fooeral twt JOt 

s~vice Provider 

UISURANtE SiA,f!M£NT Printrrdt Uedl\esday. Oetobltr 29~ 2008 10!D6:21 AM 

Drus HDe Qty I.Irittlm fit l Datu RefHl Price lox 

AutllOl'iutlon rnmd;Ierillllll •••••• ,· 

IOlPIDEPI 10MG TASS «lSDS-2605""OO 2"0 10/2.1/2008 10/27/200B 0 \5.00 

A 

Tohls '978.07 $0.00 

.:. 
292 

PSYCHIATRIC REVIEW TECHNIQUE 

Name iN 

NH (If different from above) iN 

I. MEDICAL SUMMARY 

A. Assessment is from: to 

B. Medical Dlsposition(s): 

1. o No Medically Determinable Impairment 

2. a Impalrment(s) Not Se\(.ere 

3. o Impairment(s) Severe But Not Expected 10 LaSl12 Months 

4. o Meets Listing 

5. o Equals Listing 

6. o RFC Assessment Necessary 

-

Form Approved 

OMB No. 0960-0413 

II'IUI 

-

(C~e Listing) 

(CijeListing) 

7. o Coexisting Nonmentallmpalrment(s) that Requires Relerral to Another Medical Specialty 

8. o Insufficient Evidence 

C. Cetegory(ies) Upon Which the Medical DispoSition'is Based: 

1. o 12.02 Organic Mental Disorders 

2. 012.03 Schizophrenic, Paranoid and Other Psychotic Disorders 

3. 181 12.04 Affective Disorders 

4. 012.05 MentalHelardalion 

5. ~ 12.06 Anxiety~Related Disorders 

6. 012.07 Somatolorm Disorders 

7. o 12.08 Personality Disorders 

8. 012.09 Substance Addiction Disorders 

9. 012.10 Autism and Other Pervasive Developmental Disorders 

18! These findings complete the medical portion of the disability determination, 

MCtpC's Signature pate12/09/200B - - MC/PC's Printed Name 

ipermanen~~;~~~ o;~:estigations I. Code - - 37 

Form SSA~2&06..aK (06.2001) Destroy Prior Editions 
293 

II. DOCUMENTATION OF FACTORS THAT EVIDENCE THE DISORDER 

A. 12.02 Organic Menial Disorders 

o Psychological or behavioral abnormalities associated with a dysfunction of the brain ... as evidenced 

by at least one of the following: 

1. 0 Disorientation to time and place 

2. 0 Memory impairment 

3. 0 Perceptual or thinking disturbances 

4. 0 Change in personality 

5. 0 Disturbance in mood 

6. 0 Emotional lability and impairment in impulse control 

7. 0 Loss of measured intellectual ability of at least 15 IQ points from premorbid levels or overall 

impairment index clearly wtthin the severely impaired range on neuropsychological testing, e.g., 

the Luria·Nebraska, Haistead·Rettan, etc. 

o A medically determinable impaIrment is present that does not precisely satisfy the diagnostic criteria above, 

Disorder ___________________________ _ 

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of this Impalmnent: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, Consultanfs Notes). 

Form SSA·2506-BK (06-2001) ef (6-2005) (2) 
294 

B. 12.03 Schizophrenic, Paranoid and Other Psychotic Disorders 

o Psychotic features and deterioration that are persistent (continuous or intermittent), as evidenced by 

at least one of the following: 

1. 0 Delusions or hallucinations 

2. 0 Catatonic or other grossly disorganized behavior 

3. 0 Incoherence. loosening of associations, illogical thinking, or poverty of content of speech 

~ associated with one of the following: 

a. 0 Blunt affect, or 

b. 0 Aat affect, or 

c. 0 Inappropriate affect 

4, 0 Emotional withdrawal andlor isolation 

o A medically determinable impairment is present that does not precisely satisfy the diagnostic crit.ria above. 

Disorder _____________________________ _ 

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of this impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, Consultanrs Notes). 

Form SSA·2506-BK (06-2001) ef (6-2005) (3) 
295 

C. 12.04 Affective Disorders 

o Disturbance of mood, accompanied by a full or partial manic or depressive syndrome, as evidenced by 

at least one of the following: 

1. 0 Depressive syndrome characterized by at least four of the following: 

a. 0 Anhedonia or pervasive loss of interest in almost ali activities, or 

b. 0 Appetite disiJJrbance with change in weight, or 

c. 0 Sleep disturbance, or 

d. 0 Psychomotor agitation or retardation, or 

e. 0 Decreased energy, or 

1. C1 Feelings of guilt or worthlessness,"or 

g. 0 Difficulty concentrating or thinking, or 

h. 0 Thoughts of suicide, or 

i. [J Hallucinations, delusions or paranoid thinking 

2. 0 Manic syndrome characterized by at least three of the following: 

a. 0 Hyperactivity, or 

b. 0 Pressures of speech, or 

c. 0 Flight of ideas, or 

d. 0 Inflated self-esteem, or 

e, rJ Decreased need for sleep, or 

f. 0 Easy distractibility, or 

g. 0 Involvement in activities that have a high probability of painful consequences which are not 

recognized, or 

h. 0 Hallucinations, delusions or paranoid thinking 

3. 0 BipOlar syndrome with a his10ry of episodic periods manifested by the full symptomatic picture of 

both manic and depressive syndromes (and currently charaClerized by e~her or both syndromes) 

f8l A medically determinable impairment is present that does not precisely·satisfy the diagnostic criteria above 

Disorder Depression wi anxiety per TP 

Pertinent symptoms, signs, and laboratory findings that substimtiate the presence of this impairrnem 

(explain in Part IV, Consuhanl's Notes, if necessary): 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, Consultanrs Notes), 

Form SSA-25O&-BK (06-2001) ef (6·2005) (41 
296 

O. f 2.05 Mental Retardation 

o SigniftcanHy subaverage general intellec1UaI functioning with deficits In adaptive functioning 

in~ially manWested during the developmental period; i.e., the evidence demonstrates or supports 

onset of the impairment before age 22, whh one of the following: 

f. 0 Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, 

dressing, or bathing) and inability to follOW Instructions such that the use of standardized measures 

of Intellectual functioning Is precluded' 

2. D A valid verbal, performance, or full scale !Q of 59 or Jess'*' 

3. 0 Avalld verbal, performance, orfull scale 10 of 60 through 70 and a physical or other menial 

impairment imposing an additional and slgnfficant work·related lim~ation of function' 

4. 0 A valid verbal, performance, or full scale 10 of 60 through 70' 

o A medically determinable impairment is present that does not preCisely satisly the diagnostic criteria above. 

DiM'da' __________________________________________________________ __ 

Pertinent symptoms, signs, and laboratory findings that substantiate thB presence of this impairment: 

*NOTE: items t, 2, 3, and 4 correspond to lislings f2.05,4; 12.058, f2.05C, and 12.050, respectively. 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, ConSUltants Notes). 

Form SSA·25O&-BK (06-2001) at (6-2005) (5\ 
297 

E. 12.06 Anxiety-Related Disorders 

o Anxiety as the predominant disturbance or anxiety experienced in the attempt to master symptoms. 

as evidenced by at least one of the following: 

1. 0 Generalized.persistent anxiety accompanied by three of the following: 

B. 0 Motor ten sion, or 

b. 0 Autonomic hyperactivity, or 

c. 0 ApprehensIve expectation, 

d.D Vigilance and scanning 

2. 0 A persistent irrational fear of a specific object, activity or situatlon which results in a compelling 

desire to avoid the dreaded object, activity, or snuatlcn 

3. 0 Recurrent severe panic attacks manifested by a sUdden unpredictable onset of intense apprehension, 

fear, terror, and sense of impending doom occuning on the average of at least once B week 

4. 0 Recurrent obsessions or compulsions which are a source of marked distress 

5. 0 Recurrent and intrusive recollections of a traumatic experience, which are a source of marked 

distress 

1m A medically determinable impairment Is present that does not precisely satisfy the diagnostic criteria above. 

Disorder Anxiet¥ dx: rx' d Xanax from TP 

Peninent symptoms, signs, and laboratory findings that substantiate the presence of this impairment: 

o Insufficient evidence to SUbstantiate the presence of the disorder (explain in Part IV, Consultanfs Notes). 

Form SSA-25Q&.BK (06·2001) ef (6·2005) (6) 
298 

F. 12.07 50matofonn Disorders 

o Physical symptoms for which there are no demonstrable organic findings or known physiological 

mechanisms. as evidenced by at least one of the fallowing: 

1. 0 A history of multiple physical symptoms of several years duration beginning before age 30. that have 

caused the individual to take medicine frequently, see a physician often and alter /He patterns 

signtHcantly 

2. 0 Persistent nonorganic disturbance of one of the following: 

B. 0 Vision I or 

b. 0 Speech.or 

c. 0 Hearing, or 

d. 0 Use of a limb, or 

e .. 0 Movement and its control (e.g .. coordination disturbances. psychogenic seizures. akinesia. 

dyskinesia). or 

f. 0 Sensation (e.g.,diminished or heightened) 

3. 0 Unrealistic interpretation of physical signs or sensations asseclated with the preoccupation or belief 

that one has a serious disease or Injury 

D A medically determinable impairment is present that does not precisely satisfy the diagnostic criterIa above. 

D~or~r __________________________________________________________ __ 

Pertinent symptoms, signs. and laboratory flndings that substantiate the presence of this impainnen!: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV. Consultanfs Notes). 

Form SSA-2508-BK 106-2001) ef (6-2005) m 
299 

G. 12.08 Personality Disorders 

o Inflexible and maladaptive personality traits which cause either significant Impairment in social or 

occupational functioning or subjective distress, as evidenced by at least one of the following: 

1. 0 Seclusiveness or autistic thinking 

2. 0 Pathologically Inappropriate suspiciousness or hostility 

3. 0 Oddities 01 thought, perception, speech and Dehavior 

4. 0 Persistent disturbances of mood or affect 

5. D Pathological dependence, passivity, or aggressivity 

6, 0 Intense and unstable interpersonal relationships and impulsive and damaging behavior 

o A medically determinable impairment is present that does not precisely satisfy the diagnostic criteria above. 

Disorder _____________________________ _ 

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of this impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain In Part IV, Consultan~s Notes). 

Form SSA-2506-6K (06·2001) ef (6,2005) (8\ 
300 

H. 12.09 Substance Addiction Disorders 

o Behavioral changes or physical changes associated with the regular use of substances that affect the 

central nervous system. 

If present, evaluate under one or more of the most closely applicable listings: 

1. 0 Listing 12.02-0rganio menial disorders' 

2.0 Listing 12.04-Affective disorders' 

3. 0 listing 12.06~Anxiety-related disorders'" 

4. 0 Listing 12.08-Personality disorders' 

5. 0 Listing 11.14-Periph eral neuropathies' 

6. 0 Listing S.OS-L1ver damage' 

7. 0 Listing 5.04-Gastritis· 

8. 0 Listing 5.08-Pancreatitis· 

9. 0 Listing 11.02 or 11.03-Seizures· 

o A medically determinable impairment is present that does not precisely satisty the diagnostic criteria above. 

Disorder _____________________________ _ 

Pertinent symptoms, signs, and laboratory ~ndings that substantiate the presence of this impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, Cansultanfs Notes). 

NOTE: Items 1,2,3,4,5,6,7,8, and 9 correspond to listings 12.09A, 12.098, 12.09C, 12.09D, ROBE, 12.09F, 12.09G, 12. 

9H, and 12.091, respectively, If items 1,2.3, or4are checked, only the numbered items in subsections !lA, IIC, liE, or IIG 

fthe form need be checKed, The first block under the disorder heading in those subsections should not be checked, unless 

evidence substantiates the presence of the disorder separate from the substance addiction disorder, 

Form SSA-25O&-I!K (08,2001) .f (6-2005) (9) 
301 

I. 12.10 Autistic Disorder and other Pervasive Developmentsl Disonders 

o Qualita~ve deficits in the development of reciprocal social interaction, In the development of verbal and 

nonverbal communication skills, and In imaginative activily. Often there is a markedly restricted repertoire 

of activities and interests, which frequently are stereotyped and repet~lve. 

1. 0 Autistic disorder, with medically documented findings of all of ttle following: 

a.D Qualitative deficits in reciprocal social Interaction 

b.O Qualitative deflcits in verbal and nonverbal communication and in imaginative activity 

c. 0 Markedly restricted repertoire of activities and interests 

2. 0 Other pervasive developmental disorders, with medically documented flndings of both of the fol/owing: 

8.0 Qualitative deficits in reciprocal social interaction 

b. 0 Qualitative deficits In verbal and nonverbal communlca tion and in Imaginative activity 

o A medically determinable impairment is present that does not precisely satisfy the diagnostic criteria above. 

Dsorder __________________________________________________________ ___ 

Pertinent symptoms, signs, and laboratory findings thaI substantiate the presence of this Impairment: 

o Insufficient evidence to substantiate lite presence of lite disorder (explain in Par'! IV, Consultanfs Notes). 

Form SSA-2506-BK (06-2001) ef (6-2005) (10) 
302 

III. RATING OF FUNCTIONAL LIMITATIONS 

A. "BII Criteria of the Listings 

Indicate to what degree the following func1lonallimnations (which are found In paragraph B of listings 12.02-

12.04, 12.06-12.08 and 1210 and paragraph 0 of 12.05) exist as a result of the individual's mental disorder(s). 

NOTE: Item 4 below 15 more than a measure of frequency and duration. See 12.00C4 and also read carefully 

the instructions for this section. 

Specify the listing(s) Q.e .. 1202 through 1210) under which the nems below are being rated 

12.04. 12.06 

FUNCTIONAL 

LIMITATION DEGREE OF LIMITATION 

None Mild Moderate Marked" Extreme' Insufficient 

1. Restriction of Activnies Evidence 

of Daily LMng 0 I:!i:I 0 0 0 0 

None Mild Moderate Marked" Extreme' Insufficient 

2. Difflcunies in Maintaining Evidence 

Social Functioning l&1 0 0 0 0 0 

. None Mild Moderate Marked" Extreme'" Insufficient 

3. Difflcunies in Maintaining Evidence 

Concentration, Persistence, 0 181 0 0 0 0 or Pace 

One FOUr" 

or or Insufficient 

4. Episodes of None Two Three" More Evidence 

Decompensation, l&1 0 0 0 0 Each of Extended Duration 

·Oegree of imrtation that satisfies the functional criterion. 

Form SSA-2506-BK (06·2001) ef (6-2005) (Ill 
303 

B. "c" Criteria of the Listings 

1. Complete this section ~ 12.02 (Organic Mental), 12.03 (Schizophrenic, etc.), or 1 2.04 (Affective) applies 

and the requirements in paragraph B of the appropriate listing ·are not satisfied. 

NOTE: Item 1 below is more than a measure of frequency and duration. See 12.00C4 and also read 

carefully the instructions for this section. 

o Medically docume~ted history of a chronic organic mental (12.02), schizophrenic, elI:. (12.03), or affective 

(12.04) disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do 

any basic work activity, with symptoms or signs currently a1tenuated by medication or psychosocial support, 

and one of the following: 

1. 0 Repeated episodes of decompensation, each of extended duration 

2. 0 A residual disease process that has resulted in such marginal adjustment that even a minimal 

increase in mental demands or change in the environment would be predicted to cause the individual 

to decompensate 

3. 0 Current history of 1 or more years' Inability to function outside a highly supportive living arrangement 

w~h an Indication of continued need for such an arrangement. 

181 Evidence does not establish the presence of the "Cl' criteria 

o Insufficient evidence to establish the presence of the 'C' criteria (explain in Part IV, Consultanrs Notes). 

2. Complete this section ~ 12.06 (AnXiety-Related) applies llM the reqUirements in paragraph B 01 listing 

12.06 are not satisfied. 

o Complete inability to function independently outside the area of one's home 

IX! Evidence does not establish the presence of the "C' criterion 

o 'nsufficient evidence to establish the presence of the ·e" criterion (explaJn in Part IV, Consultanfs Notes). 

Form SSA-250&-8K (06-2001l ef (6-2005) (12\ 
304 

IV. 

yrs of education alleges depression. HIe skilled work. as a 

Reportedly rx'd Xanax from TP, no professional MH tx. 

feelings of depression because can't work anymore or do what she used to 

physical condition. Xanax, helps wi sx, not seeking professional MH 

lives wi family, takes care of kids and husband, problems sleeping hie of 

allegations, problems wI personal care due to physical, no reminders for 

mes prepares sandwiches but doesn't cook, doesn't do chores, only go 

necessary I can go out alone and does drive, can pay bills and manage 

la"ce'unts, like to read, spends time wI others when they come by, regularly goes to 

doctor, no problems getting along wi others, problems wI memory/concentration, 

't know how long can pay attention, finishes what is started, follows 

lnstlru"tj.onlS very well, handles stress and changes very well 

11/19/07 TP flu didn't note any MH 

or m~ds, but gave dx of depression wI anxiety. Similar dx made on 

7121/06 note showed clmt rx'd Xanax 1 mg. 7/25107 flu noted 

taking Xanax for nerves. 

depression. ADLs reflect limitations based primarily on physical 

with minimal independent mental limitations or complaints noted. Clmt 

depression and anxiety from TPs, no professional MH tx. It appears that 

complaints are overwhelmingly of a physical nature;therefore, there is no 

further MH development. Her mental health hx doesn't appear to 

icantly affect her current functioning. 

Form SSA·25Of!.BK (06'2001) ef (IH005) (13) 
305 

Section 223 and section 1633 of the Social Security Act authorize the information requested on this form. The 

information provided will be used in rilaking a decision on this claim. Completion of lhis form is mandatory in 

disability claims involving mental impairments. Failure to complete this form may result in a delay in 

processing the claim. Information furnished on this form may be disclosed by the Socia! Security 

Administration to another person or govemmenia! agency only with respect to Social Security programs and to comply with federal laws requiring tbe excbange of information between Social Security and another agency. 

We may also use tbe information you give us wben we match records by computer. Matching programs 

compare our records with those of other Federal, State, or local government agencies. Many agencies may use 

matching programs to find or prove that a pernon qualifies for benefits paid by the Federal government. The 

law allows us to do this even if you do not agree to il. 

Explanatloos about these and other reasons why information about you may be used or given out are available 

in Social Security offices. If you want to leam more about this, contact any Social Security office. 

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U. 

S.C. § 3507, as amended by Section 2 of the Palfirwork Reduction Act of 1995. You do not need to answer these questions unless we display a vaJ10ffice of Management and Budget control number. 

We estimate that it will take about 15 mmutes to read the instructions,gather the facts, and answer the 

questions. SEND OR BRING THE COMPLETED FORM TO YOUR 

LOCALSOCIALSECURITY OFFICE. To lind the nearest office, call 1-800-772·1213. Send 

flI11£ comments on our lime estimate above to: S5A, 6401 Security Boulevard, Baltimore, MD 

2J235-6401. . 

Form SSA-25O(HlK (06-2001) ef (6-2005) (14) 
306 

~ 

~\.SoEC'u: 

SOCIAL SECURITY ADMINISTRATION 

\JYrf~~ Refer To Office of Disability Adjudication and Review I,,...,, 4344 Carmichael Rd 

Suite 200 

Montgomery, AL 36106-3730 

Date: April 23, 2010 

Notice of Decision FuUy Favorable 

I carefully reviewed the facts of your case and made a fully favorable decision on your 

application(s) for a period of disability, disability insurance benefits, and Supplemental Security 

Income filed on October 22, 2008 and October 22, 2008. I stated the basis for my decision at 

your hearing held on April 9, 20 10. I adopt the findings of fact and reasons that I gave at the 

hearing. Please read this notice of decision. 

I found you disabled as of January 23,2007 because of partial complex seizure disorder; sleep 

apnea disorder; lumbar disc disease; bursitis, right shoulder; headaches; depression; asthma; and 

morbid obesity so severe that you cannot perform your past relevant work or other work existing 

in significant numbers in the national economy. 

It is my recommendation that a medical reexamination be completed in 24 months to determine 

if you still meet the requirements for disability. 

If you would like more information about my decision, I can provide you with a record of my 

oral decision. You must ask for this record in writing. You may mail or bring your request to any 

Social Security or hearing office. Please put the Social Security number shown above on your 

request. 

Another office will process my decision and decide if you meet thenon-disability requirements 

for Supplemental Security Income payments. That office may ask you for more information. If 

you do not hear anything within 60 days of the date of this notice, please contact your local 

office. The contact information for your local office is at the end of this notice. 

If You Disagree With My Decision 

If you disagree with my decision, you may file an appeal with the Appeals Council. 

How To File An Appeal 

To file an appeal you or your representative must ask in writing that the Appeals Council review 

my decision. You may use our Request for Review form (HA-520) or write a letter. The form is 

Form HA-L82 (03-2010) 

Permanent Subcommittee on Investigations 

EXHIBIT#3a 
307 

---- Page 2 of3 

available at www.socialsecurity.gov. Please put the Social Security number shown above on any 

appeal you file. If you need help, you may file in person at any Social Security or hearing office. 

Please send your request to: 

Time Limit To File An Appeal 

Appeals Council 

Office of Disability Adjudication and Review 

5107 Leesburg Pike 

Falls Church, VA 22041-3255 

You must file your written appeal within 60 days of the date you get this notice. The Appeals 

Council assumes you got this notice 5 days after the date of the notice unless you show you did 

not get it within the 5 -day period. 

The Appeals Council will dismiss a late request unless you show you had a good reason for not 

filing it on time. 

What Else You May Send Us 

You or your representative may send us a written statement about your case. You may also send 

us new evidence. You should send your written statement and any new evidence with your 

appeal. Sending your written statement and any new evidence with your appeal may help us 

review your case sooner. 

How An Appeal Works 

The Appeals Council will consider your entire case. It will consider all of my decision, even the 

parts with which you agree. Review can make any part of my decision more or less favorable or 

unfavorable to you. The rules the Appeals Council uses are in the Code of Federal Regulations, 

Title 20, Chapter III, Part 404 (Subpart J) and Part 416 (Subpart N). 

The Appeals Council may: 

• Deny your appeal, 

• Return your case to me or another administrative law judge for a new decision, 

• Issue its own decision, or 

• Dismiss your case. 

The Appeals Council will send you a notice telling you what it decides to do. If the Appeals 

Council denies your appeal, my decision will become the fmal decision. 

The Appeals Council May Review My Decision On Its ~wn 

The Appeals Council may review my decision even if you do not appeal. If the Appeals Council 

reviews your case on its own, it will send you a notice within 60 days of the date of this notice. 

Form HA-L82 (03-2010) 

See Next Page 
308 

Page 3 of3 

When There Is No Appeals Council Review 

If you do not appeal and the Appeals Council does not review my decision on its own, my 

decision will become frnal. A frnal decision can be changed only under special circumstances. 

You will not have the right to Federal court review. 

If You Have Any Questions 

We invite you to visit our website located at www.sociaisecurity.govto find answers to general 

questions about social security. You may also call (800) 772-1213 with questions. If you are deaf 

or hard of hearing, please use our TTY number (800) 325-0778. 

If you have any other questions, please call, write, or visit any Social Security office. Please have 

this notice and decision with you. The telephone number ofthe local office that serves your area 

is (334)875-0587. Its address is: 

Enclosures: 

Social Security 

120 Executive Park Ln 

Selma, AL 36701-7734 

Tracy S. Guice 

Administrative Law Judge 

April 23, 2010 

Date 

Form HA-L15 (Fee Agreement Approval) 

cc: 

Fonn HA-L82 (03-2010) 
309 

IN THE CASE OF 

(Claimant) 

7 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

Period of Dis ability, Disability Insurance 

Benefits, and Supplemental Security Income 

(Social Security Number) 

I approve the fee agreement between the claimant and her representative subject to the condition 

that the claim results in past-due benefits. My determination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. I neither 

approve nor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REVIEW OF TIDS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also bas 15 days to write 

us ifhe or she does not agree with tbe approval of the fee agreement. Send your request to this 

address: 

Ollie Garmon 

Regional Chief Administrative Law Judge 

SSAODARR0 

Suite 20tIO 

61 Forsyth Street S W 

Atlanta, GA 30303 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement If so, please write directly to me as the 

deciding Administrative Law Judge within 15 days of the day you are notified of the amount of 

the fee due to the representative. Your representative also has 15 days to write me if he/she does 

not agree with the fee amount under the approved agreement. 

Form HA-Ll5 (03-2007) 

See Next Page 
310 

Page 2 of2 

You should include the social security number(s) shown on this order on any papers that you 

send us. 

cc: 

Tracy S. Guice 

Administrative Law Judge 

April 23, 2010 

Date 

Form HA-Ll5 (03-2007) 
311 

-

;. --

PATIENT: I 

DATE: 02106/2007 

~ ---~---

,......~--

SUBJECTIVE: Patient who is post·excision of infected hernia mesh per. 

_Havin_9 some lower abdominal pain, urinary symptoms. occasional 

some nosebleed. H* of HTN. Does a lot of lifting at work. 

OBJECTIV.E: VS: Stable. HEENT: TMs normal. Nares normal. Pharynx 

normal. Lungs are clear. CV normal. Abdomen benign. Extremities normal. 

Neuro stable. 

ASSESSMENT: 

1. UTI 

2. Status post abdominal hernia. 

3. Allergic rhinitis. 

PLAN: Accuhist LA nightly, continue Zestoretic 20/12:5. Add Macrodantin 

with meals. Increase fluids, complete Bactrim. FlU in a month or prn. 

Permanent Subcommittee on Investigations 

EXHIBIT#3b 
312 

Nov-li-200B 12,42.. Frem- HS5 P.DSI/O;2 F-B18 

DISC!IAR<l1! StlMIIlUly 

9ISCHARGE SUMMARY 

Jatient:~a~I~!!!!! ___ Attendi':"g: 

Admi9Bign Wite- _ 01/23/2007 Room·#, 

~!~~ R.213 

~r. ••• Sex, F Age, 39Y HSC, MED RACE, B 

I eel 

I 

jDATE OF DICTATION: 01/29/2001 10:11:30 

!?AT!!: OF DISCHARGE: 01/29/2007 

HOSPITAL COURSE: This 39-year-old female: earne to us with severe eD1Q,.st;ne 

~a1n and t-enderneae. Sha underwent incisional hernia. repair with 

had aches, pain, chills, and fever and noe getting any better. 

~aparot.omy. We removed the mesh which \lias infected wich MRSA and marJced 

fil:>rosi", The fil:>rous tiso"" ""'. deil:>.1d"d, alld ehe mesh .emovec:l, She received IV Vancomycin during the hospital course. She WiaS:; afebrile 

release. She was sent home on Septra an additional 10 days. She had 

significant improvement. in her ~reoperative pain statuS. The WOW'ld was clean and dry ~ s~apleB were still in. she is to follow up it.!. t.he ot'fice wit.hin 

~ days, She is released home on iron tablets and Percocee f:oX' pain p.r.n(l 

~.5 mg. lS t.abl.etB. \: 

I .; 

~lNAL DIAGNOSIS: Infected incieional hernia with mesh of MRSA :' 

! jt 

DICTATING PHYSICIAN, 

~ I 

I 

! 

i ••••••••• i!')10 peI "LIVE* (pcr; OB Dat:.abase COCW) 

Run, 11/1.3/08-13 '43 by ~ . 

Permanent Subcommittee on Investigations 

EXHIBIT#3c 

" i; 

!i 

Ii 

Ii 

;: 

EXIIIBITNO.2F 

PACE: 11 OF 92 

Page or 2 
313 

PATIENT: a 

DATE: 07/2212009 

EXHlBrrNO.9F 

PAQE: SOF 1 

SUBJECTIVE: History of hypertension, asthma, sleep apnea disorder, seizure disorder. 

She was involved in MV A a couple of weeks ago secondary (0 seizure. Been on Dilantin 

100 b.i.d., having shoulder, neck, low back pain. She has not worked in 2 years. 

OBJECTIVE: Vital signs - Stable. Lungs are clear. CV nonnaJ. Abdomen benign. 

Extremities - stable. L Spine tenderness LS-S I. Right shoulder tenderness AC joint. 

ASSESSMENT: 

I. Hypertension. 

2. Asthma. 

3. Sleep apnea. 

4. Obesity. 

5. Status post MVA with shoulder pain. 

6. SeizUl'e disorder exacerbation. 

7. Bursitis, right shoulder. 

PLAN: D/C the Percocet. Inerease Neurontin 300 mg boi.d., Hydrochlorothiazide 2S riJg 

d.H~'"' ,. 6 _""- 'h<" """"'0 'P"y" d"'bili~. 

Permanent Subcommittee on Investigations 

EXHIBIT#3d 
314 

d a 

SUBJECTIVE; A 3Oyoyl complaining of pain and swelling abdominal aria. 

Hx of ventral hernio in the past. . 

OBJECTIVE: VS: Weight 215, down 15 pounds. lungs are clear. CV 

normal. Abdomen obdominal mass. Extremities normal. Neuro stable. 

ASSESSMENT; 

1. Recurrent ventral hernia. 

PLAN: CT abdomen, pelvis. Referral to C. lett for management. Percocet 

for pain management. FlU in a week. . ... 

or- -

Permanent Subcommittee on Investigations 

EXHIBIT #3e 
315 

.. 

Referring Source: _, 

EXHIBIT NO. SF PAOE:"') OF 11'1 

V, A: No Correction Left eye __ Right "fe __ Wilh Correction Left eye _' __ RighI "fe __ 

Progress Note 

03106109 ......- Patient is here ~is using her CPAP machine every night. She reports that she is feeling 

more alert and awake. She is still having the headaches, hQwever. She is diagnosed with migraine headaches. 

She bas gained 2 lbs. since her last visit and now she is at 288 lb •. 

Physical Exwnination: Motor power and coordination are normal. Patient is morbidly obese. 

Asli .... ment: 1. ObstruCtive sleep apnea syndrome. 

2. Migraine headaches. 

?lan: 1. I will keep her on the CPAP machine as is. She is on a pressure of7cm. 

2. I will start her on Topumax SOmg qhs to be increased in ooe week to 50mg bid. Hopefully the Topumax 

will help the headaches and that will also help her to lose weighL 

J. Follow-up with me in one month for re~aluation. 

WWF 

Permanent Subcommittee on Investigations 

EXHIBIT#3f 
316 

· , 

DIdIo: 

Rar~ Source: ' -

Soa .. .:e or 1Ib&wy: v.uCIIl 

Rdb!1>mtyl 000cI 

SU'XP EVALIIA'nO:S 

Cbld CompJaiDt: Saorillil aDd ~nsaliDI. ofilrea:lhitla of ahaut 10·IS years dunttion. 

H~ ofPresut lI!Deas: Thill is a 4(l.y_.·Dld lady who hu heen experieociDg snoring 

anclc.esw:lou oi~ clazillibersloepc"ertbc past 10·15 years. Her9Jll>.ring b loud 

and in m:m~r.~ollt 1f:~ n.!~ HPr 5!:fIrD!g :9 'r,1p.rt!~ t-y lTiDOdes of C~o?I! <11 

bJeatiWJ.&. I'8tle.ut sowclim". nulk:w U::I\ ~~ cI:Iokes 1br sir. She goes to bed betWeen 

9:00 aM 10:0(1 pom !!Irl ~ up batween 5$) 81>-1 6:(>1) a.m. UpoIIlJ\\fakeniDg she does not feel rr&eohed .. t all. In tbe momins .:'" ~.I ,I,V&)'. expariomcea __ hos thIIt are 

de.scrl1led to be in~"e temples and preSll<'l'~ In IlSUIIe. DuriDi tho daytime she is sleepy 

and!lred. She bas" blghcbEJ1C8 ofdozin$! offwhile~~ttinQ andreadina. _1ChIna T.V .• 

u a)WSea.ger ill 1I.a 10r an lIt."III' wIlI'.;)U1 .. bn:lJl, IO:loi. \\4~' i)iaiI; =wn to It.-slir. rlu: 

af\erGcul) "?bu. ~'ir~ permit. Sb(. r..i:S II 1I1Cn.:ro!: cb'l=C [! f do>:ing oft sitting 

inacfl VI,. ; ,. t. publio pJace. slliuS and ta1ki~ 10 8OmC1jM, aDd sltIina quicdy after lunch 

wilt.· • .:.-:.r::x-.'IOI. Shew a mild dLaru:c ofdozmgol! mule in a car slopped for a few 

Jl>iDIIICI ~.~:d!k. Plllicnt fopor.s that she: ~,ol .. muwr·..,hi~c acdl1cllt 3·4 weekS aso 

becau!" :-'.'l rcll G.l1=p. She: I!ec.",d cl'ft.b .. ~ uiI t.i~l!.m<!. PlniIl!lIl!.\!10 1>!1.. ~r.~ 

over thy· ••• <;! ~~1I ;" .. :T w hI! :11"'" irritJohJ" -heIl_ a=.mI oe1f. She _ to be more 

Iorgz:l6.£ =.:j III times dllOritlldeli wbcn all!:' utes up. Her weisIU has progressiwly 

increa5cO. In the past twO yt".111':; alone abe h.Is.wlded :iO-lOO Ibs. She was 110 lbs. in 

bigh sell .• .,1. II!Id DOW she Is ~19 ,ti Ibs. Tht'''';5 110 ~'IY of C8IlIpl6xy, lUIl1:olep:iy, sleep 

pam1ySjs, CIt byP!l8GO;9c haJi;x.I;lIIcion:;. 1:J:ll'C; i9 also I ~ history of oral or nasaJ 

sa:gerie'l. 

R"'~ .r s,.--. , No ']I>,~tmn3llttribut'.l'; to CV. ('1. QU. pWmoDlU)'. hematological, 

or J'!'~"JIlrr'.c. S~~.::.,_ 

PreYI(>lta MedQlll'\!ltory: T.h-..:-e is a :':..t. <7 ,fb}'ptuIIlllSIOD that is Nlauvely well 

wrrtrollecl. 

Medlcauoua: ProVC!ltil lIIbel:r; Plover': rG Hyzaar. 

A11truyl NKDA. 

Social HIstory: Doe!< Dot smoke, dMk. "'f ,:huo;c drugs. 

lNtll .. __ E_XHiiiioiiiIiiiiB_IT_#_3-'_"'B~::E' 

EXHJBITNO.8F 

PAGE: 5 OF 1. 
317 

;NImIf!; ..-

Date: 08119108 

PJF20t3 

Family HltfOrYl NOD..:ontrlbutory. 

Pby.leal EDIIDl:UtiODI 

·~\. 

Vital Signs: Weight 279.81bs. Heiallt 5'2 ~". BP 128180. PR 84hnin, RR 201mill. 

Genenl Appc:IIlImOC:: In DO acute distress. PBllent IB morbidly obesl\. 

H.E.ENT: No nasai p"1yps. DO OOI\iUnCtivitis. Mallampari i.!l grade IV. 

Nock: No brWlS. supple. Neck ciJcum!crcncc is I S.5in. 

LUDg5: CI_1IDd n:sonaul. No wbeeziD8 OJ rbonclU. 

Hear.: N"rm~i 1;1 • .';2, Ii:. ~urm""" p1ln!"', or h!'o:!ve. 

AlxIome:n: Soft with no tendem:ss or heparosplenomcgaJy.· Bowel sounds are heard. 

Lymphatlcs: N<; l\,wilti ~ 

EmemJlies: No deformities, edema, clubbing, or cyanosis. 

1'1""",.. EulIzlllattoa: 

Mental SI8lW: Palieltt is aVv1lke. alezt, aui ~ri~!!.d::·:. !J.%lll.:aag.: aul5pL~~ •• ,". !l(;;;na!. 

Cto.a1o~ ~:~ ',....mt~ 

(:!lTT. 

II: Puodl are nonr.::!. ·.is~"9l i'ir~.i. an. full in all qlllldnlnts. 

m.l\I end VI: Extraoeular mDvemer~ = m=! In s!l directlont with DO nysugmw. 

V: F:cllll src."1dianill :OO?D'a\ IDllll dlvisiollS (VI. '/'. ~1·;~). 

vn- No facial wcakne!!' '" 1O)!'~"'"'""'TY 

Vb ... ,;_--W to.ftna~ .~...:... 

[.: ':11:: ~:0lL\f': r".·!!OJ.1·i, AI:i1 gl~ 

Y.:. ;;~ 7~·d·w.ulS Sler..·,,·;e:-!r.~,as:ojd. 

Y.:J: ":'Ollf.!!' iJ :!'. -::idliAc Q;'" ,h.. Y·' .. ,., weal, . .,." ufOpll)' ;r fr.u.l .. :u1atiou. 

~,,,t(/ !-/l'·:of.": ~'! t'l.:.r';I1J:.,:ht t!'. 

[,"l~' a: ""~ ~'l~··t".'. 'T'r.::~ 8··~ ~c·,,:,,;,,~)1~4. 

!',U:L':~/ -:,~: ! llL'~ !lW!."ka'.:t: (C :.~:J1~d;, ligld: t;r;l.:':b,;" llibl"~!irrn. S~ ~::J'riticn !!t!!\.¥ .. 

C.::.\tG!atiJ .. : V~·\·.'t.eblc ~jq", 10 nose and becliU shins e~ bilaterally. 

Gail: UlIlUMIkabie. 

AI.I·:.:ilU .. 1 '.nil oiU."SC";: 

1. Oh!r!lClh~ sieep apnea &'lIUom~. TI.i'.! is su}lJ'Oncd by t' ... , ~lt'S hi.~ry of 

.,."rift!!', ceas&rlon of bnlathiJlg. ,mri daytllllO slc~p""""" . 

. 2. Hypem:nsim1. 

91/L~ :Ell"'; 

EXHlBrT NO. IF PAGE: 6 OF 18 
318 

.. _ .... 

Name,"'_ •• D~,-0&·t9/()8 

1'&8= 3 of3 

PIIm: 

~1f8l! 39\fd 

1. I disellSSed with the palioDt Ibe above. r discussed with her Ileep apnea and bow 

IlHoI. wiD iaI;naooo h"l' filA. uCllcvcJuplDiI b)JIerIen&lon. hee:t l1!J:Il:le IlIl;1cckes. 

2. (asb!d her DDt to drive if sh" feci:! Hleep), rot 1IlJ. She need> til be very csuti.J1I& ill 

drivillg, ~I)' M d!~ IMt ~dmt!l1M> h«!. 

3. She _ adviocd to IOM~. 

4. The pOlysomuollrSDl was cilicussed ilDd palient was agreeable to m.VlO one. 

S. (ffhe poJ)'l'IoDln08J'8m shows evidence of sleep apnea, tbtn patient will be brougb: 

baa fot I.CPAJ' litrotian swdy. 

6. (will sec h:or aJ\r.r lhe sleep studies are performed. 

, ..... Dlplumlla. AmOriOa:l&lord of~ 8l1li New,,!;)&!' 

tllpIomaIa. ~ So"'" =fSloop ModIcIao 

EXHIBJrNO.8F 

PAGE: 70F18 
319 

SUBJECTIVE: History of HTN. previously been on Zestoretic ZO/IZ.5'but 

this has been causing dizziness. 

OBJECTIVE: VS: Stable. Lungs are clear. CV' normal. Abdomen benign. 

Extremiti~s - stable. Neuro stable. 

ASSESSMENT: 

1. Anemia. 

Z. HTN. 

PLAN: DIC the Zestoretic. Low dose HCTZ 1/Z tablet daily. Concerned 

about ~n. encourage exercises. FlU in a month or prn. 

f--__ ...;,;;.~..:. 
320 

1:' ---_'_'_' 

--

_.-_--_-_-;;,;.;;..;;,. ... 

-------------~~----------- PATT"=""'" 

OA TE: 10/2212008 

SUBJECTIVE: History of sleep apnea syndrome. Having some low bock pain 

radiating to t~e right leg. Interested in obesity surgery. Feeling depressed. 

OBEJCTIVE: Morbidly obese female. No acute distress. Vital signs stable. Pharynx 

normal. Lungs are clear. eardiovascular normal. Extremities .. stable. 

ASSESSMENT: 

1. Low back pain. 

2. Radiculopathy. 

3. History of asthma. 

4. Sleep apnea disorder. 

PLAN: Pepcid 20 daily, Ventolin 2 puffs q6 hours. X-ray lumbar spine. Put on 1200 

calorie diet. FlU in a month. 

[/'- G-------

Permanent Subcommittee on Investigations 

EXHIBIT#3i 
321 

-

PATIENT: ••••• 

DATE: 1212312008 

SUBJECTIVE: History of persistent low back pain. No response to the Naprosyn. 

On Percocet. 

OBJECTIVE: Vital signs stable. Lungs are dear. Cardiovascular is normal. 

Extremities - stable. Neuro intact. 

ASSESSMENT: 

1. Lumbar disk syndrome. 

PLAN: MRI lumbar spine. Percocet b.i.d. Obesity counseling as well. She is 

morbidly obese. NO,improvement. Follow up in a month. Exercise as tolerated . 

• ~ ~ -'.M,,,h. 

Permanent Subcommittee on Investigations 

EXHIBIT#3j 
322 

------

r --____ -~.I';E 

PA 

DATE: 01126/2009 

SUBJECTIVE: History of osteoarthritis, pan and stiffness. History of CPAP 

disorder, using CPAP machine. Been on Percocet for pain. 0'; Paxil for 

depressio"!. She desires obesity surgery. She has not lost any weight since 

starting. . 

OBJECTIVE: VITAL SIGNS: Stable. Weight 289. Blood pressure 130/80. 

LUNGS; Clear. CV: Normal. ABDOMEN: Benign. EXTREMITIES: Stable. 

ASSESSMENT: 

1. Morbid obesity. 

2. Hypertension. 

3. Sleep apnea disorder. 

PLAN; Neurontin 100 b.Ld., continue hydrochlorothiazide daily. CPAP as 

directed. Follow up here in a month's time. Referral to obesity clinic. 

Dr 

Permanent Subcommittee on Investigations 

EXHIBIT#3k 
323 

ALABAMA DISABILITY DETERMINATION SERVICE VOCATIONAL RATIONALE FORM 

ClAIMANTNAME:..-..-

Date of Birthc ______ 

DISABILITY SPECIALIS1. _____ -

J. GENERAL ClAIM INFORMA TJON 

ClAIM.". 

EXHIBIT NO. 13E PAGR:10P'3 

A. RATIONALE IS FOR: 

~ 1. Current Evaluation C 2. Date Last Insured ______ _ 

C 3. Projected After 12 Months ______ _ 

L: 4. Other: 

B. AGE: 

(Sf: 1. Younger Individual (Up to 49) C 2. Approaching Advanced Age (50-54) r': 3. Advanced Age (55-59) r 4. Approaching Retirement Age (60-M) 

C. EDUCATION: 

C 1. llIiterateiNo English 

C: 2. Marginal (6 years or less) 

r 3. Limited (7-11 years) 

fg 4. High School (12 years or more) 

n. PAST RELEVANT WORK 

r A. The claimant has no past relevant work experience. 

C 1. The claimant has a severe. impairment, is of advanced age or older and has a limited education. 

This fits the special adverse vocational profile. (POMS 0125010.001 B.Z.) 

c·.' B. The limitations outlined in RFCtMRFC dated ___ _ are consistent with the physicaV 

menial requirements of the claimant, past relevant work as a: 

C 1. as the job was actually performed AND/OR 

[,"~ 2. as the job is usually performed in the national economy 

DOT # 

t>.i( C. J. The claimantls past relevant work as actually performed would be ruled out due to limitations 

outlined in RFClMRFC dated 01/13/2009 

RFC LIMITATIONS THAT RULE OUT lOB 

Stand and walk about 4, Lift/carry 20/10, unskilled work 

Stand and walk about 4, Lift/carty 20/10, unskilled work 

Stand and walk about 4, Lift carry 20/1 0, u ""killed work 

2. The claimant's past relevant work as usually performed in the national economy would be 

ruled OIlt due to limitations outlined in the RFCtMRFC dated _________ _ 

DOT # 

A. 299.167-010 

B. 355.674-014 x3 

C. 355.674-014 

D. 

E. 

F. 

G. 

RFC LIMITATIONS THAT RULE OUT JOB 

See above. Unskilled work 

See above. Unskilled work 

See above. Unskilled work 

Permanent Subcommittee on Investigations 

EXHIBIT #31 
324 

AINU 

ClAn. 

EXHJ8IT NO. 13E $,..,'0 •• 

C D. The claimant's past relevant work as a is a combination of two or more 

different jobs. Iv; such, the job is de.termined to have no direct correlation to ODe occupational title in the 

national economy (D.O.T.). The claimant'. description regarding the physicallmental demand. of this job are 

Iherefore accepted a. ~iven. (ITEM H.C.I must be completed.) 

C E. Reasonable attempts to document all of the claim anI's past relevant work have been unsuccessfuL 

Review of tbe vocational information already in file supports the claimant's ability to perform 

other work, step 5. (Reference: Prototype Operatin~ Instructions, Section III. C. 9.) 

Additional Rationale Comments: 

Ill. OTHER WORK 

A. RFCIMRFC Assessment(.): Maximum Work Capacity 

r 1. No Exertional Limitations C 2. Heavy Work Range 

8

: 3.Medium Work Range 

, 4. Light Work Range 

•. ' S. Limited Light Work Range IX 6. Sedental)' Work Range 

t·, 7. Le.s Than A Full Sedental)' Work Range 

-, 8. Skilled Level Work 

. 

' 9. Semi-Skilled Level Work 

, 10. Unskilled Level Work C 11. Unskilled Work Requirements Not Met 

Date(s): 12/3/08 1/13/09 

r B. The restrictions as outlined on C RFC or C· MRFC dated would preclude tbe claimant 

from performing the basic requirements of C sedentary OR r unskilled work due to: 

r:"i c. The claimant has acquired skills from past relevant wor~ but the issue of transferability of those 

skills to other jobs is immaterial. Job citation of occupations the claimant could perform is 

located in Ill. Be D. The claimant has acquired skills from relevant past work that are transferable to other jobs. Please 

refet to the vocational analysis in file. 

~ E. The claimant has not acquired h.nsferable .kill •. The overall vocational pmtlle remains favorable 

for work adjustment to other jobs. Examples of jobs this claimant can perform include: 

JOB TffiE!DOT# 

1. Hander in 683.687-018 

2. Lens Inserter 713.687-026 

3. Cuff Folcer 685.687-014 

SfRENGTHiSKlll LEVEL 

Unskilled/sedentary 

Unskilledisedentary 

Unskilled/Sed ental)' 

Affirmative evidence of job existence is confirmed by the appropriate reference material which 

documents a significant number of individuals are employed in the primary industries wherein 

Ibese iobs are found. 
325 

DISAB [LITY SP M"'W::.:~EXHIIIITNO.13! CLAn #GE' 'OF 3 

r F. The claimant has a severe upper extremity impairment that causes aD partial OR r major loss of 

tbe use of the Cleft ORC rigbt upper e..memity. Given the claimant's age of and the 

absence of any transferable sk:iUs~ such restrictions 3S indicated by the RFC dated 

would not preclude the claimant from adjusting to other unskilled types of work invoivmg elemental" 

handling functions, non~complex clerical or customer service and simple machine tending work. 

These job functions include such activities as welding, assembling, inspecting and sanding/finishing. 

These jobs are found' throughout the national economy in numerous work settings. 

r:, G. This claimant's age is within a few dayslweeks of a higher age category and using that higher age 

category would result in a favorable determination. The following factOI(s) will justify use of a 

hi!\her aile category: 

C 1. Englisb literacy is minimal. 

I .. , 2. The ability to communicate in English is marginal. 

L 3. The requirements for meeting an educadonallevel are marginal. 

C.) 4. There are multiple years of unskilled wolk in an isolated industry. 

L: S. There are impairments, in addition to primary impairment(s), that were considered in the 

RFC assessment but did not significantly impact on the occupational base of the 

exertionallevel established by the RFC assessment. 

r H. The claimant r HAS r HAS NOT acquired skills from past work activity. The overall 

vocational profile is not favorable for work adjustment to otber jobs because: 

IR I. Vocational Rule Number: 201.28 

r 1. Rule is met and directs a decision of r Disabled OR r Not Disabled 

~. 2. Rule provides the framework for a decisiou of C' Disabled OR If< Not Disabled 

Additional Rationale Comments: 

SIGNATURE: 

01/13/2009 
326 

April 6, 2010 

Faith Disability Advocacy Program 

2533 Broad Street 

S~!ma, Alabama 3670 I 

PHYSICAL CAPACITY EYALUAnON 

Dear SirlMadam: 

EXHISITNO.lef 

PAGE:40FI4 

At your request, I did a disability physical capacity evaluation for I Fin 

my office on Apri! 6,2010. She is a 42-year-old young lady with history of partial 

complex seizure disorder, major depression, sleep apnea disorder, lumbar disk syndrome 

and chronic.bursitis, right shoulder. Also, history of 

2007. She spent 10 yellI'S working 

Part-time she was a home health aide 

started having problems witb hernias, 

2006, surgery for hernia done had a 

had become infected and had 

has history of lumbar disk disease since about 2008. 

third procedure done by 

10 be taken down. The 

CURRBNT MEDICATIONS: Include hyd~hlorothiazide for blood pressure. She is on 

Prestige 50 mg daily for <;iepression. She is on VentoHn 2 puffs q.6 hours and Advair 

100f50, one puff b.Ld. for asthma. She is on Topamax 50 mg b.Ld. ror partial complex 

seizure disorder. She has CPAP equipment, setting of 8 nightly. For her lumbar disk 

disorder. she is on Percocet 5 mg b.Ld., Flexer;! 10 mg b.Ld, She is on Midrin p.r.n. for 

migrdine headaches. 

Unfortunately, this pleasant young lady is 100% disable<!. Please do r~fer to the physical 

capacity evalualion form. 

If I can he of further assistance to you, rleasc do not hesitate to conlact me. 

Permanent Subcommittee on lnvestigations 

t>d Wd6S : to 0 t01: 00 • "dt! EXHIBIT#3m 
327 

Thank you, 

....--------------_.- ." 

a 

EXHIBIT NO. lor 

PAGi: 50F 14 
328 

Faith Disability Advocacy Program 

2533 N. Broad St 

Selma, AJ 36701 

Doctor: _____ _ 

Doctors Mediatl Source OveraU Opinion for Disability: 

ell,"?? J:c ?~~ b-7)<I/ 

/ 

Physical Capacity Overall Opinion for Disability: 

~ .. 

Docton Signatun:, ___________ _ 

EXHIBIT NO. 10F 

PAGE: 10F 14 

.1;" 
329 

SXHIBlTNO.l0F 

PAGE: i OF 14 

PHYSICAL CAPACITIES EVALUATION FORM (PCE) 

____..._ SSN ;. b 

PI~ rotnplete thI: following i1I=ms based on your clinical c:valUllliion of the claimant and 

other results. Any item that you do not believe you can answer shQuld be xmuked NlA 

(nQt answerable). . 

In terms oj an eight (8) hmJr worlrday. -~ibna1ly~ '" W .... 33%; 

"F1"eIp(l!11t1y":o 34%-66%; and "ColflimlmJsly" '" 67'Yo·JOO% 

L Claimut can lift: 

Never Omlsionally Frequentf;y eontmBOll.S1y 

A.) Up to Sibs ( ) H ( ) ( ) 

B.)6-10lbs (,,-,) ( ) ( ) ( ) 

C.) 11-20 lbs (~) ( ) ( ) ( ) 

D.) 21·25lbs d ( ) ( ) ( ) 

E.) 26-5.0 lbs ( ) ( ) ( ) 

F.) 51·100 Ibs d ( ) ( ) ( ) 

G.} 101-150 lbs ( ) ( ) ( ) ( ) 

n. Claimant em 121'1)': 

Never OttasionaJJy Frequently ContiltuousIy 

A.) Up to SIbs ( ) V) ( ) ( ) 

B.) 6-10 Ibs (--) ( ) ( ) ( ) 

C.) 11·20 Ibs (..-) ( ) ( ) ( ) 

D.)21-lS 100 

~ ( ) ( ) ( ) 

E.) 26-50 1bs ( ) ( ) ( ) 

P.) 51·100 lbs ( ) ( ) ( ) 

G.) 101-150 lbs U ( ) ( ) ( ) 

ill. CIalnwlt em 1!Jt hands fur: 

Never o-iouUy Frc:qUQltly QmUnuoasly A.) Simple gmsping 

Right ( ) H ( ) ( ) Left ( ) .1--) ( ) ( ) B.) Pushing & pulling 

of ann controls 

Right k--1 ( ) ( ) ( Left ~A ( ) ( ) ( C.) Fine llllIIlipuIarion 

Right ( ) n ( ) Left ( ) *-y;; ( ) 

7 
330 

Page 2 

EXHIBIT NO. 1 Of 

PACE: i Of 14 

CLAIMANT-..tI!!!!!!!!!I ____ --- SSN~~~.7 

lV. Claimant Cln lISe feet for: 

Never 

A) Pushing & pulling 

of leg controls 

Right (<)' 

Left U-. 

V. OaimaDt is able to: 

Never 

A}Stoop , 

B.)CItllWh n C.)Knee1 

D.)Cmwl H 

E.) Climb (--1 

F.) Balance (~ 

G.) Reaching (ovedlcad) ( ) 

--

Never 

A) UlIJIf\'h;cIed heisJIl$ (.-. ) 

B.) Being aroundmachfnery .L---) 

Co) ~11> IIJiIIIa>d (...--} 

changes in 1e!npera1I.ue ( ) 

and humidity LJ 

OeeasionaIlf Freque.atly 

( ) 

( ) 

OeessiODaDy FrequeJJtJy 

( ) ( ) 

( ) ( ) 

'( ) ( ) 

( ) ( ) 

( ) ( ) 

( ) ( ) 

( ) ( ) 

Occasiol1a.lly Frecpeu.tIy 

() () 

() () 

{) () . () () 

() () 

va Clahuut is able to stand pd/or 1't'lIlk: {with normal bn:aks} 

-

~ less than 2 hours in an 8-hoIIr workday 

- at letlSt 2 hours in an 8-bour worlalay 

Continuously 

( 

( 

Cou6DuousJy 

( ) 

( ) 

( ) 

( ) 

( ) 

( ) 

( ) 

CODtinuOlUly 

( ) 

( ) 

( ) 

( ) 

( ) 

= - about 6 hours in an 8-honr workday medically reqm..-ed hand-beld assistive device is ne::essary for arnbulation ' 

7 
331 

P8€83 CLAlMANT_ 

vm. CWmalltiuhle to sit: (with normal breaks) 

never = less tlum about 6 holllS in an 8-hour workday _ about 61K1uts in an a..haur workday . 

EXHISfT NO.l0F 

PAGE: 10 OF 14 

~ periodically alternate sittiDg and standiug to relieve pain or discomfort 

See 

Hear 

Speak 

Temperature ExtreoleS 

Noise 

I)ust 

Vibral:ion 

. HumiditylWetness 

Fumes, odcIs,. cl1emicals, gases 

Physician's SigJmtlm_-'-_______________ 

~. _ 

Date H...-6 'to 

7 
332 

EXHIBITNO.1DF 

PAGE: 11 OF 14 

... ~..,_.~ ... _. __ . i'~:.f;-se; __ "' __ _ 

~Zj., 

~!.. 

s. l"amP;ttt..-ms: h~m'l!C:O",pi<;:l:l.<f'e~.:!=~~~:flfO'.Jr::>"'~!s:''>=..~~&;· 

l~o C<.""" .. ~ ~ ~ 

• 
333 

(The following is a transcript in the hearing held before 

Tracy S. Guice, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on April 9, 

2010, at Montgomery, Alabama, in the case of I., Social 

Security Number The Claimant appeared in person and was 

represented by ~_. Also present were ~---------- Medical Expert; ; • - , Vocational Expert.) 

(The hearing commenced at 10:32 a.m. on April 9, 2010.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: -- case of ••••• 

CLMT: ••••• 

ALJ: •••• t'm sorry ..... Social Security number 

••••••• Good morning. 

CLMT: 

ALJ: Is it~ You're certainly right. Thank you so much for 

correcting that because that would have been the wrong number to have 

placed on there. Social Security nUmberls&2l--1I1I1I1I1F 

CLMT: Right. 

ALJ: Thank you, .......... II. My name is Tracy Guice, I'm the 

Administrative Law Judge with the Office of Disability Adjudication 

and Review assigned to this case. I note for the record """lIllIIl~) is 

present along with her representative, Also 

present is a friend of ." ••• 1, ......... _ We have as our 

hearing reporter today, --r--' Our medical expert is 

l-"'''''='''J,...,_~_::,_:-:: __ ::_::_:-:,-and our vocational expert is 

--~:'::":::--------- All testimony today is going to be taken by 

oath or affirmation. What that means is I'm going to swear you in and 

it's going to be necessary for you to testify truthfully and full. 

CLMT: All right. 

Permanent Subcommittee on Investigations 

EXHIBIT#3n 
334 

2 

ALJ: If for some reason you don't understand a question, please 

ask me to repeat it or explain it to you. Now I will tell you that 

--~~--~L~si--"Job as OUr hearing reporter is to make sure she takes 

notes about the hearing and also run recording equipment. That's why 

the mics are in front of you. 

CLMT: Yes, ma'am. 

ALJ: However, we can't take a notation or make a recording if 

you're just going to nod your head to respond to questions. So you do 

need to give me verbal responses and also keep your voice up so that 

we do get that recording of the hearing. E . would you like 

to waive a formal reading of the issues? 

REP: Yes. 

ALJ: Have you and your client looked at the evidence in the 

record? Do you have any objection to that evidence? 

REP: I have an objection to the evidence that they only used the 

basic information of obesity --

ALJ: You need to, you need to bring the mic just a little bit 

closer. Now what were you saying, you have an objection 

REP: That they only looked at obesity and the asthma issue based 

on what I saw in the records --

ALJ: Okay. 

REP: -- as their -- to make their decision. 

ALJ: And I have the full authority to look at everything, 

including the most recent evidence that you brought in. 

REP: Right, thank you. 

ALJ: Okay. I'll note that for the record. Before I read the 
335 

3 

evidence into the record, let me tell you that I'm not bound by the 

prior unfavorable determination made at the initial level. I'm not 

bound by their decision, but I am bound by Social Security laws and 

regulations. So when I issue my decision, it's based on all the 

evidence in the record as well as testimony I take at this hearing. 

This is a fully electronic file. It consists of lA through 4A, IB 

through 13B, ID through SD, IE through 17E, and IF through 9F. 10F is 

a more recent request for an on-the-record disposition, including an 

evaluation performed by indicating that the claimant 

had significant limitations as previously noted in the record. 

(Exhibits lA through 10F, previously identified, were received 

into evidence and made a part of the record thereof.) 

ALJ: All right, ....... r----------__ ~~ , also 

411111111111"1 in case you say anything, I would like for you to be 

under oath. So would all of you raise your right hands please. 

(The Claimant, .... lIlIlIlIlIlIlIlIlItaving been first duly sworn, testified as follows~ 

EXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q All right. still have that 

correct address for you. 

A Correct. 

Q Telephone number still ........ .

A Correct. 

Q All right. You're alleging you became disabled January 23rd of 

2007. Have you worked since that date? 

A No, mafam. 

Q Are you working now? 
336 

4 

A No, ma'am. 

Q What's the highest grade in school you completed? 

A 12th. 

Q Okay. You have some jobs in the past where you did some work 

as al •• t ~_,and ~_._ •. Any 

other jobs that you would have performed in the.past 15 years-that I 

didn't name? 

A No. 

Q , okay. ., is there anything 

about her past work I need to ask her before you can testify? 

VE: No, rna' am. 

ALJ: Okay. 

BY ADMINISTRATIVE LAW JUDGE: 

Q I'm understanding that you have a combination of 

medical issues, including you've had some issues with headaches, but 

you more recently had some seizure issues, is that correct? 

back. 

A That's correct. 

Q You've been treated by j, a neurologist, correct? 

A That's correct. 

Q You've also had some a~thma problems. 

A Correct. 

Q Shortness of breath with exertion, okay? 

A Yes, ma'am. 

Q You've also had some problems with osteoarthritis in your 

A And right shoulder. 
337 

5 

Q Okay, in your right shoulder you have burs~tis, correct? 

A Correct. 

Q Sleep apnea, you've been diagnosed with sleep apnea? 

A Yes. 

Q All right. You've also had some depression issues, is that 

correct? 

A Correct. 

Q All right. And more importantly you've had some blood pressure 

issues, hypertension? 

A Yes. 

Q All right. And how much, how much do you currently weigh? 

A 276. 

QAnd how tall are you? 

A Five feet. 

Q Okay. I notice today you came to the hearing using a cane. Did 

someone prescribe that fO.r you? 

A I use a cane because my back locks up on me. 

Q okay. 

A And when my back locks up on me, I have a hard time getting 

around. So I mentioned it to my doctor. 

Q And did they recommend that you get a cane then? 

A Yes. 

Q Okay. Did they prescribe it for you? 

A He.didn't prescribe it, but he told me I could just buy one. 

Q And they instructed you to use it? 

A Yes. 
338 

6 

Q Okay. Let me ask you a couple questions about your functional 

abilities. Can you lift and carry anything over 10 pounds without a 

problem? 

A No. 

Q Are you able to sit, stand or walk for a prolonged period of 

time? 

my 

A No. 

Q Does even sitting bother you for a long period,of time? 

A Yes. 

Q What happens? 

A When I sit for a long period of time, I start to have pain in 

Q In your back? 

A in my lower back. I have to get up, move for a little 

while, then sit back down, turn in different positions. Put something 

behind my back. 

Q And let me just ask you this. It looked like 

actually put you on some seizure medication, is that true? 

A That's true. 

Q Has that medication helped you? 

A A little bit, yes and no because I still have episodes. 

Q Do you live alone or with anyone? 

A Me and my son live together in --

Q How old is your son? 

A He's four. And my daughter 

Q Are you the primary caregiver for him? 

has 
339 

7 

A Yes. 

Q Do you have to have help taking care of him? 

A Yes. My daughter --

Q Who comes over and helps you? 

A My daughter, she moved back in. 

Q Okay. So does your daughter also help you with your household 

chores? 

A Yes. 

Q Do you have a driver's license? 

A I do. 

Q Do you drive? 

A Not now. 

Q Why is that? 

A Because of the seizures. 

Q You had some episodes where you had staring spells, and then 

you also had an episode where you actually passed out, or blacked out, 

is that correct? 

A Yes. 

Q Is that a yes? 

A Yes/ ma'am. 

Q okay. Anything further you want to tell me that I haven't 

asked you? 

A No, along with that, you know, when I have them I have the -

after I have them, you know, I have the wet pants and stuff like that. 

Q You lose control. I did read that in the record. Okay. All 

right, well thank you."IIIIIIIIII"~ I will tell you that based on 
340 

8 

what I see as evidence in the record along with what 

report was in lOF, that I'm going to find that her maximum residual 

functional capacity is for less than a full range of sedentary. I do 

however have two experts here and I need to get their testimony on the 

record before I can read my bench decision checklist into the record, 

okay? All right, let's go to , ---------

(The Medical Expert, 

testified as follows:) 

first. 

having been first duly sworn, 

EXAMINATION OF MEDICAL' EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q --______ r, you've been sworn in. Could you state your full 

name for the record, pleas-e. 

A 

Q Does the resume in the record accurately reflect your 

professional qualifications? 

A Yes. 

Q Have you had any social or professional contact with the 

claimant or her friend,1I ...... "" .. ~ 

A I have not. 

Q ~illElI.lIlIlIlIlI~kny objections? I'm going to ask you for both 

experts, for Do you have any objections 

to their presence and testimony or professional qualifications? 

REP: (INAUDIBLE) 

ALJ: Is that a no? 

REP: No. 

ALJ: Okay. 

BY ADMINISTRATIVE LAW JUDGE: 

Q D ____________ {ou're familiar with social Security laws, 
341 

9 

regulations including the adult listings, is that correct? 

A Yes, Your Honor. 

Q Have you been present during the claimant's testimony and also 

reviewed the evidence in the record? 

A I have. 

Q I want you to do two things for me. Based on your education, 

experience and training, could you identify for me the claimant's 

mental impairments and state whether they meet or equal a listing? 

A She has a.history of chronic major depressive disorder, deemed 

to be moderate in 2008 with a brief episode of anti-depressant 

medication prescribed by her family physician. There is no ongoing 

mental health treatment for that. 

Q Does this meet or equal a listing based on your education, 

experience and training? 

A It does not meet or equal the 12.04 listing, Judge. 

Q When we look at the B criteria, could you give me those 

limitations with regard to your education, experience and training and 

review of the record? 

A Well, this would be for that time period because there's 

nothing current. 

Q Correct. 

A No impairments maintaining activities of daily living. 

Moderate impairments maintaining concentration, persistence and pace. 

Mild to moderate impairments maintaining social functioning with no 

episodes of decompensation present. 

Q All right. Would the claimant, in your opinion, be able to 
342 

10 

perform work activity that involved complex instructions, or would she 

be reduced basically to unskilled type work? 

A There is not information in here that indicates that she would 

not be able to perform complex tasks. 

Q But given -- if you also --

A If you take the combination of everything, that would probably 

be difficult, yes. 

Q Okay, all right. Any questions for 

REP: (INAUDIBLE) 

ALJ: Okay. Is that a no? You have to say -

REP; No. 

ALJ: -- just a little bit louder so we do get a recording of 

your testimony. 

REP: No. 

(The Vocational Expert, -_ .. ' -----------

duly sworn, testified as follows:) 

having been first 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q J ___ --- you've been sworn in. Could you state your 

full name for the record please. 

A 

Q Does the resume in the record accurately reflect your 

professional qualifications? 

A Yes, it does. 

Q Have you had any social or professional contact with the 

claimant or her friend'1IIIIIIIIIIIIII 

A No, mat am. 

Q Have you reviewed the evidence in the record with regard to 
343 

11 

the claimant's work history? 

A Yes, I have. 

Q Could you identify for me the claimant's past work with regard 

to the past 15 years, job title, skill and exertional level? 

A She's worked as a.IIIIIIIIIIIII~', which is light and on the 

lower end semiskilled range. It has an SVP:3. She's also worked as a 

11111111111111 both ••••••• s well as 1~1I ••••• rrlhe Dictionary of 

Occupational Titles describes that work as medium, semiskilled. She 

functioned at the medium, semiskilled range in the 11&2&211111111111 

then at the heavy, semiskilled range in the 

Q All right. 

A °' •••• 11 •• 11.1, m sorry. 

And 

Q I would for you to -- for hypothetical number one to consider 

an individual of the claimant's age, education and vocational 

experience.' Who is not able to engage in work activity on a regular 

and consistent basis for eight hours a day, 40 hours a week, or 

maintain' concentration for two-hour periods during an eight-hour 

workday. First, would such an individual be able to perform any of the 

claimant's past work? And if not, would there be other jobs in the 

regional or national economies? 

A No to both questions. 

Q Any questions for 

REP: No, no,t at this time. 

AL~~based on the evidence in the record, your 

testimony and the testimony of the experts, I'm going to issue a fully 

favorable bench decision. I will read this checklist into the record 
344 

12 

and it will become your decision in this case. You will receive a 

notice in the mail confirming everything that's happened here today. I 

will, after I read it into the record, provide it to your 

representative. You may review it, and state whether you 

.have any objections thereto. Then you'll need to give it back to me 

because it will be scanned into the record after this hearing and go 

,in as Exhibit SA. 

This is the case off •••••• I'm not going to say your first 

name correctly. 

CLMT: ...... 

ALJ: ~ ••• I. I'm so sorry .••••••••• Social Security 

numbe~ay's hearing date is April the 9th of 2010. The 

claimant filed applications for Title II and Title XVI on October 22nd 

of 2008. Her alleged onset date is January 23rd of 2007, and her date 

last insured for Title II purposes only is March 31st of 2012. The 

claimant has a . combination of impairments as noted in the record. 

Partial/complex seizure disorder, sleep apnea disorder, lumbar disk 

disease, bursitis of the right shoulder, headaches, depression, 

asthma, and morbid obesity. As noted, the claimant does not meet or 

equal one of the listings. Dr testified the claimant would not 

have restrictions of daily living, but had moderate limitations or 

restrictions of maintaining social functioning and concentration, 

persistence and pace. The combination of the claimant's impairments 

result in a maximum residual functional capacity for less than a full 

range of unskilled sedentary work. This is based on the combination of 

her impairments with consideration under Social Security ruling 0201P, 
345 

13 

and that's the ruling of obesity. When you have someone who is 

morbidly obese with a 55.8 body mass index, you look at how the other 

functioning systems of their body are affected by their size, or their 

weight. 

REP: Right. 

ALJ: In this case we have a seizure issue, we have hypertension, 

we have a lumbar disk issue, we also have asthma. So when you look at 

all those in combination, it begins to erode the occupational base 

under 968P and 9P which are Social Security rulings of which you could 

work. And this was the testimony provided by the vocational expert. He 

identified your past work as light, medium and heavy, and semiskilled. 

However he indicated there would be no jobs that you could -- you 

could not return to your past job or any other jobs given this 

residual functional capacity I've outlined. I'm also going to 

recommend a medical re-evaluation in 24 months. I have approved the 

fee agreement with 

, I'm going to let you come up here and look at this. 

It is handwritten and I do apologize for that. I type much better than 

I write something out. You can review it. Everything that I've read 

into the record is identified in that checklist. If you have any 

objections to the checklist, you need to state them now. If not, we're 

going to have that scanned in. You'll need to give it back to me and 

I'll scan it into the record after this hearing. It will go in as 

Exhibit SA. And we're allowing. the opportunity to review 

the bench checklist. Any objections? 

REP: No objections, Your Honor. 
346 

14 

ALJ: Okay. All right, you'll need to give it back to me if 

you're concluded. Anything further you or your client would like to 

add on the record? 

CLMT: No. 

REP: No, Your Honor. 

ALJ: All right. Thank YOU,~ for being patient with 

us. 

CLMT: Thank you. 

ALJ: And coming and providing your testimony. And with nothing 

further to add, then we'll close the hearing and go off the record. 

(The hearing closed at 10:47 a.m. on April· 9, 2010.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcrfBtio.p. if the tel3.timony recorded at the hearing 

held in the case of .. ••• ,I. before Administrative Law Judge 

Tracy S. Guice. -. --" 
347 

Social Security Administration 

Supplemental Security Income 

Notice of Disapproved Claim 

. 120 EXECUTIVE PARK LN 

SELMA AL 36701 

Date: Septembe_..;r.2.'1I2.0.0.S ••• Claim Number:. 

• Application Filed * 

August 13, 200S 

* Type of Claim * 

Individual-Disabled 

You cannot get Supplemental Security Income (SSI) for the reason given 

below. 

Why We Can't Pay You 

• We find that you have resources worth more than $2,000.00 for 

August 200S on. 

For you to receive SSI payments, the resources that you own cannot be 

worth more than $2,000.00 for August 200S on. We call this amount the 

limit on resources. 

Resources are the things that you own such as cash, stocks, bank 

accounts, certain types of life insurance, buildings, and land on which 

you do not live. We do not include as resources the home in which you 

live, one car used for transportation and some other things. 

• We explain on the last page of this letter how we decided that you are not eligible for SSI because of resources that are over the limit. 

Permanent Subcommittee on Investigations 

SSA-LS030 EXHIBIT#4a 
348 

MIJMuui Page 2 ·of 5 

How You May Be Able To Receive SSI 

Although your resources would prevent you from receiving· payments, you may 

still be able to receive 55! while you are trying to sell your resources if all of 

the following are true. 

• The value of cash, including savings, and other things you have that can easily be changed into cash is less than $1,911.00. 

• You have other things that cannot easily be changed into cash and 

these things make your resources too high. Examples of such things are a buildIng or land on which you do not live. 

• You will sign a written agreement which allows you to receive 55I 

payments while you are trying to sell the property that causes your resources to be over the limit. 

• You agree to repay any 55! payments which you receive while trying to 

sell the property. 

If you think all of these are true about you, and you want to receive 55I 

payments, please contact the local 50cial 5ecurity office. 

Information About Medicaid And Other Benefits 

• An agency of your 5tate will advise you about the Medicaid program. 

If you have any questions about your eligibility for Medicaid or need 

immediate medical assistance, you should get in touch with the 5tate 

agency which handles eligibility for medical assistance. 

• You may want to contact your local public assistance office to find out 

if you qualify for payments from them. 

You Can Review The Information in Your Case 

The decisions in this letter are based on the law. You have a right to review 

and get copies of the information in our records that we used to make the 

decisions explained in this letter. You also have a right to review and copy 

the laws. regulations and policy statements used in deciding your case. To do so. please contact us. Our telephone number and address are shown under the 

heading "If You Have Any Questions." 

Things To Remember 

• Because you are not eligible for the reasons given above, we have not 

determined whether or not you are disabled. 

• If at any time in the future you think you qualify for payment, please 

contact us immediately about filing a new application. The earliest 

month for which we can pay you is the month after you file a new application. 

SSA·L8030 
349 

Page 3 of 5 

If You Disagree With The Decision 

If you disagree with the decision, you have the right to appeal. We will 

review your case and consider any new facts you have. 

• You have 60 days to ask for an appeal. 

• The 60 days start the day after you get this letter. We assume you got 

this letter 5 days after the date on it unless you show us that you did 

not get it within the 5-day period. 

• You must have a good reason for waiting more than 60 days to ask for an appeal. 

• To appeal. you must fill out a· form called "Request for 

Reconsideration." The form number is SSA-561. To get this form, 

contact one of our offices. We can help you fill out the form. 

How To Appeal 

• Ca'e Re·iew. You have a right to review the facts in your file. You can give Us more facts to add to your file. Then we'll decide your case again. 

You won't meet with the person who decides your case. This is the only 

kind of appeal you can have to appeal a medical decision. 

• Informa' Conference. You'll meet with the person who decides your case. You can ten that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to 

help explain your case. 

Please read the enclosed pamphlet, "Your Right to Question the Decision 

Made on Your SSI Claim." It contains more information about the appeal. 

If You Want Help With Your Appeal 

You can have a friend, representative or someone else help you. There 'are 

llFoUP' ~ £!!!! he'p YQ!! fin' ~ repre4entati' ~ or • i4 ~ YQ!! free '~.~. '~lce' 

.:... YQ!! 'ua~ There are also representatives Who do not Charge unless you 

win your appeal. Your local Social Security office has a list of groups that can help you with your appeaL 

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it. 

SSA·L8030 
350 

s 

09/02/2008 

Page 4 of 5 

New Application 

You have the right to file a new application at any time. but filing a new application is not the same as appealing this decision. If you disagree with 

this decision and you file a new application instead of appealing you might 

lose some benefits. or not qualify for any benefits. So. if you disagree with 

this decision. you should ask for an appeal within 60 days. 

If You Have Any Questions 

For general information about SSI. visit our website at www.socialsecurity.gov on the Internet. You will find the law and regulations about SSI eligibility 

and SSI payment amounts at www.socialsecurity.gov/SSIrules/. 

For general questions about SSI or specific questions about your case. you 

may call us toll-free at 1-800-772-1213. or call your local Social Security office 

at 334-875-0587. Our lines are busiest early in the week and early in the 

month. so if your business can wait. it's best to call at other times. We can answer most questions over the phone. You can also write or visit any Social 

Security office. The office that serves your area is located at: 

SOCIAL SECURITY 

120 EXECUTIVE PARK LN 

SELMA AL 36701 

If you do call or visit an office. please have this letter with you. It will help us answer your questions. Also. if you plan to visit an office. you may call 

ahead to make an appointment. This will help us serve you more quickly 

when you arrive at the office. 

We are sending you a pamphlet which contains important information you 

should know. The pamphlet is called "Your Right To Question The Decision 

Made On Your SSI Claim." 

Enc1osure(s): 

Pub 05-11008 

SSA-LB030 

Paul D. Barnes 

Regional Commissioner 
351 

09/02/2008 

Page 5 of 5 

HOW WE FIGURED YOUR INELIGffiILITY FOR August 2008 ON 

You are not eligible for SSI for August 2008 on because your resources are worth more than the $2,000.00 resources limit. On the first day of August 2008 

you owned the following items which count toward the resources limit. 

Your Resources That We Count 

1995 CHEVROLET Truck 

1995 PONTIAC Truck _ 

Your Resources T\lat We Count 

SSI Resources Limit for an Individual 

Amount Over the Resource Limit 

IMPORTANT REMINDERS 

$2,000.00 

$2,200.00 

$4,200.00 

-$2,000.00 

$2,200.00 

We counted only the resources listed above. We generally do not count the 

value of a home, one' vehicle, and a burial fund of up to $1,500.00. Contact 

your local Social Security office if you have questions about how we determined the value of your resources or wish to report that the value has 

changed. . 

If your resources shown above are reduced below $2,000.00, you may become 

eligible for SSI benefits. If you give away or sell resources for less than they are worth, you could be ineligible for SSI for up to 36 months. Contact your 

local Social Security office for information about how disposing of resources affects eligibility for SSI. 

SSA·LB030 
352 

Social Security Administration 

RETIREMENT, SURVIVORS, AND DISABILITY INSURANCE 

Notice of Disapproved Claim 

DATE: 09/26/2008 

Claim Nu.mll~CS""1I1I1I1I1I1I WE's Number: 

Telephone: 

We are writing about your claim for Social Security disability benefits 

Baaed on a review of your health problems you do not qualify for benefits on thia claim. This is because you are not disabled under our 

rules. 

We have enclosed information about the disability rules and more details 

about the decision on your claim. 

ABOUT THE DECISION 

Doctors and other trained staff looked at your case and made this decision. They work for your State but used our rules. 

Please remember that there are many types of disability programs, both 

government and private, which use different rules. A person may be 

receiving benefits under another program and still not be entitled under 

our rules. This may be true in your case. 

I~ YOU DISAGREE WITH THE DECISION 

If you disagree with this decision, you have the right to request a 

hearing. We will review your case and consider any new facts you have. 

A person who has not seen your caae before will look at it. 

* 

* 

* 

* 

13 

You have 60 days to ask for a hearing. 

The 60 days start the day after you get this letter. We assume 

you got this letter 5 days after the date on it unless you show 

us that you did not get it within the S-day period. 

You must have a good reason for waiting more than 60 days to ask 

for an appeal. 

You have to ask for a hearing in writing. We will ask you to 

complete a form HA-SOl-U2, called "Request for Hearing." You may 

contact one of our offices or call 1-800-772-1213 to request this 

form. Or you may complete this form online at: 

http://www.socialsecurity.gov/diaability/appeal. Contact one of 

our offices if you want help. 

CAR 

Fo,," SSA-L443-U3 (7-93) Dest['oy Prior Edithms 

Permanent Subcommittee on Investigations 

EXHIBIT#4b 
353 

__ .'1 

'....,1 •• 

Social Security Administration 

RETIREMENT, SURVIVORS, AND DISABILITY INSURANCE 

Notice of Disapproved Claim 

* In addition, you should complete a "Disability Report-Appeal" to 

tell us about your medical condition since you filed your claim. 

You may contact one of our offices or call 1-800-772-1213 to 

request this form. Or, you may complete this report online after 

you complete the online Request for Hearing. 

Please read the.enclosed pamphlet, "Your Right to Question the'Decision 

Made on Your Social Security Claim." It contains more information about 

the hearing. 

NEW APPLICATION 

You have the right to file a new application at any time, but filing a 

new application is not the same as appealing this decision. If you 

disagree with this ·decision and you file a new application instead of 

appealing: 

* 

* 

You might lose some benefits, or not qualify for any benefits, and 

We could deny the new application using this decision, if the facts 

and issues are the same. 

So, if you disagree with this decision, you should ask for an appeal 

within 60 days. 

IF YOU WANT .HELP WITH YOUR APPEAL 

You can have a friend, lawyer, or someone else help you. There are 

groups that can help you find a lawyer or give you free legal services 

if you qualify. There are also lawyers who do not charge unless you 

win your appeal. Your local Social Security office has a list of 

groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hire 

someone, we must approve the fee before he or she can collect it. And 

if you hire a lawyer, we will withhold up to 25 percent of any past 

due Social Security benefits to pay toward the fee. 

OTHER BENEFITS 

Based on the application you filed, you are not entitled to any 

other benefits, besides those you may already be getting. In the 

future, if you think you may be entitled to other benefits you will 

need to apply again. (THIS SECTION DOES NOT APPLY TO YOU IF YOU 

HAVE ANOTHER SOCIAL SECURITY CLAIM PENDING.) 

13 CAR 

Foro SSA-L"3-U3 (7-93) DastNJY Pdar Editions 
354 

Social Security Administration 

RETIREMENT, SURVIVORS, AND DISABILITY INSURANCE 

Notice of Disapproved Claim 

IF YOU HAVE ANY QUESTIONS 

If you have any questions, you may call us toll-free at 1-800-772-1213 or call your local Social Security office at the number shown on page 

1. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at: 

120 EXECUTIVE PARK LANE 

SELMA AL 36701 

If you do call or visit an office, please have this letter with you. 

It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly. 

Enclosures: 

SSA Pub. No.OS-100S8 

Explanation of Decision 

Disability Rules Factsheet 

13 CAR 

Regional Commissioner 

630 For. SSA-L443-U3 (7-93) 

Destroy Priar Editicn:;l 
355 

Social Secu .. ity Administ .. ation 

RETIREMENT, SURVIVORS, AND DISABILITY INSURANCE 

Notice of Disappr-oved Claim 

RULES FOR SOCIAL SECURITY DISABILITY 

You must meet certain rules to qualify for Social Security disability 

benefits: 

FOR DISABLED WORKER'S BENEFITS: 

You must have the required work credits and your health proble~s 

must: 

* 

* 

keep you from doing any kind of substantial work (described 

below), and 

last, or be expected to last, for at least 12 months ·in a 

row, or result in death. 

FOR DISABLED CHILD'S BENEFITS: 

You must be age 18 or older and your health problems must: 

* 

* 

* 

begin before age 22 or you must become disabled again within 

7 years after the month that your earlier period of disability 

ended, and 

keep you from doing any kind of substantial work (described 

below), and 

last, or be expected to last, for at least 12 months in a row, or result in death. 

FOR DISABLED WIDOW'S, WIDOWER'S OR SURV·IVING DIVORCED SPOUSE'S 

BENEFITS: 

You must be at least age 50, and your health problems must: 

* 

* 

* 

13 

keep you from doing any kind of substantial work (described 

below), and 

last, or be expected to last, for at least 12 months in a row, 

or result in death, and 

have started before the end of a special period. 

The special period starts with the latest of: 

***the month your spouse died, or ***the month your Social Security benefits as a parent ended, 

or 

***the month your earlier period of widow(er)'s disability 

ended. 

The special period ends at the close of the 84th month (7 

years) after the month it started. 

CAR 

For. SSA-L443-U3 (7-93) 

Destroy Prior Editions 
356 

Social Seeul"lty Administl"ation 

RETIREMENT, SURVIVORS, AND DISABILITY INSURANCE 

Notice of DlsapPl"Oved Claim 

INFORMATION ABOUT SUBSTANTIAL WORK 

Generally, substantial work is physical or mental work you are paid 

to do. Work can be substantial even if it is part-time. To decide 

if your work is substantial, we consider the nature of the job 

duties, the skills and experience you need to do the jOb, and how 

much you actually earn. 

Usually, we find that your work is substantial if your gross 

earnings average over $830 per month after we deduct allowable 

amounts. This monthly amount is higher for Social Security 

disability benefits due to blindness. 

Your work may be different than before your health problems began. 

It may not be as hard to do and your pay may be less. However, 

we may still find that your work is substantial under our rules. 

If you are self-employed, we consider the kind and value of your 

work, including your part in the management of the business, as 

well as your income, to decide if your work is substantial. 

NON-ENGLISH SPEAKING INFORMATION 

If you do not speak English, or do not speak English well, we 

will provide you with an interpreter at no cost to you. Or, 

you may wish to bring your own interpreter with you such as 

a friend or family member. If you want us to provide an 

interpreter, please tell us ahead of time. 

13 CAR 

For-III SSA-L443~U3 (7-93) 

Destroy Prior Editians 
357 

>ocial Security Administration 

EXPLANATION OF OETER"INATIOH CAR 

The evidence listed was used in evaluating your claim. 

ved 09/23/08 

tative Exam 09/10/08 

We have determined that your condition is not severe enough to keep you 

from working. We considered the medical and other information, your age, 

education, training, and work experience in determining how your 

condition affects your ability to work. 

You state that you are disabled because of high blood pressure, a bad 

back, arthritis in your knees and hand, acid reflux, eye problems, and 

chest pain. The evidence shows that you have some restrictions. Your 

restrict;~~s prevent you from performing your past work as a 

~~~-~~ ~~~ as you describe this work. However, your restrictions do 

not preclude you from performing that type of work BS it is normally 

performed in the national economy. 

If your condition gets worse and keeps you from working, write, call or 

visit any Social Security office about filing another application. 

I1 CAR 
358 

FORM APPROVED 

"1?'60.0431 

PHYSICAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT 

PRIMARY DIAGNOSIS: 

HTN o Date 

SECONDARY DIAGNOSIS: 12 Months After Onset: 

(Date) 

PRIVACY ACf NOTICE, The information requested on this form is authorized by Section 223 and Section 1633 of the 

Social Security Act. The information provided will be used in makicg a decision of this claim. Failure to complete this form may 

result in a delay in processing the claim. Information furnished on this form may h«; disclosed by the Social Security 

Administration to another person or governmental agency only with respect to Social Security programs and to comply with 

Federal laws requiring the exchange of information between Social Security and other agencies. 

PAPERWORK REDUCTION ACf: This information collection meets the requirements of 44 U.S.C. § 3507, as amended by 

Section 2 of the Paperwork Reduction Act of 1995. You do not nc::cd to answer these questions unless we display a valid Office 

of Management and Budget control number. We estimate that it win take about 20 minutes to read the instructions, gather the 

facts, and answer the questions. You may send comments on OUT time estimateobove to: SS'A,6401 Security Blvd.~ Baltimore, 

MD 21235-6401. Send ~ comments relating to our time estimate to this address, not the completed/onn. 

LIMITATIONS: 

For Each Section A - F 

...... Base yo ur conclusions on all evidence in file (clinical and laboratory findings; symptoms; observations, 

-~ lay evidence: reports of daily acti'lltles; etc.). 

_ ... Check Ihe blocks which reflect your reasoned judgement . 

........ Describe how the evidence substantiates your conclusions (ette specific clinical and laboratory 

-~ findings, observations, lay evidence, etc.). 

-... 

-~ 

Ensure that you have: 

o Requested appropriBte trealing and examining source statements regarding the individual's capacities 

(D122505.000ff. and DI 22510.00Off.) and that you have given appropriate weight to treating source 

conclusions (See Section III.). 

o Considered and responded to any alleged limitations imposed by symptoms (pain, fatigue, etc.) 

attributable, in your judgement, to a medicaDy detenninable impairment Discuss your assessment of 

symptom-related limttallons in the explanation for your conclusions in A - F below (See also Section II.). 

• Responded to all ail€!lations of physlcallimhaUons or factors which can cause physical Hmhatlons. 

Frequently means occurring one-third to two-Ihirds of an S-hour workday (cumulative, not continuous). 

Occasionally means OCCUlTing from very little up 10 one-third of an S-hour workday (cumulative, not 

continuous). 

Permanent Subcommittee on lnvesti ations Continued on Page 2 

Fonn SSA-4734-BK (02·2008) et (02,2008) 

(Formarty SSA-4734~U8 U&e prior editions) 

EXHIBIT#4c 
359 

EXHmrr NO. If t e 

A. EXERTIONAL UMITATlONS 

o None established. (Proceed to section B.) 

1. Occasionally lilt and/or carry Qncludlng upward pulling) 

(maximum) - when less than one-third of the time or less than 10 pounds, explain the amount ~ime/pounds) in item S. 

o less than 10 pounds 

010 pounds 

18120 pounds 

050 pounds 

o 100 pounds or more 

2. Frequently lilt anct/or carry Qncludlng upward pulling) 

(maximum) - when less than two·thirds of the time or less than 10 pounds, explain the amount (Ume/pounds) In ~em S. 

o less than 10 pounds 

18110 pounds 

025 pounds 

o 50 pounds or more 

3. Stand and/or walk (w~h normal breaks) for a tolal ofo less than 2 hours in an a-hour workday 

o at least 2 hours in an a·hour workday 

lSI about 6 hours in an B-hourworkday 

o medically required hand-held asslstive device is necessary for ambulation 

4. S~ (wHh normal breaks) for a total ofo less than about 6 hours in an 8-hour workday 

181 about 6 hours in an a·hour workday 

o must periodically alternate sitting and standing to relieve pain or discomfort (If checked! explain in 6,) 

5. Push and/or pull (Including operation of hand and/or foot controls) -

lSI unlimited, other than as shown for lift and/or carry 

o limited in upper extremities (describe nature and degree) 

o limited in lower extremities (describe nature and degree) 

6. Explain how and why the evidence supports your conclusions in Hem 1 through 5. 

CHe the specific faCls upon which your conclusions are based. 

59 YOF 

9/08 MED CE PE: 132/83 171#, NL HABITUS, WD, NAD, MUSCLE TONE AND STRENGTH NL wlo 

ATROPHY OR ABNL MOVEMENT, CNS INTACT, MOToR STRENGTH SYM WID OBVIOUS WEAKNESSES. 

SENSATION INTACT-BIL TC LIGHT TOUCH AND PAIN, OBSERVED DEXTERITY WID ATAXIA OR 

TREMOR, Ol'Rs FULL/SYM-BIL, GAIT COORDINATED lIND SMOOTH. 

MSf{: FROM ALL 4 EXTs; cIs, TiS, T/c/L SPINE, Lis ALL WNL/rnOM wI EXCEPTION OF LIs 

WAS ELICITED BY EXTREME ROM; KNEES, WRISTS ALSO FROM, NO PAIN NQTl!:D. NEURO-MOTOR 

.,.10 ANY DYSFUNCTION; PREFERENCE FOR R-HANDEDNESS OBsERVED, NO INVOLUNTARY MOVEMENTS 

Continu ed on Page 3 

Form SSA-4734~8K (02-2008) ef (02-2008) Page 2 
360 

EXHIsrr NO. 'F F 

6. Continue (NOTE: MAKE ADDITIONAL COMMENTS IN SECTION IV) 

WERE SEEN. ABLE TO WALK ON TOES/HEELS W/O TROUBLE. BUE-FROM; NL BALANCE, GAIT AND 

STANCE, AND REFLEXES; 515 BIL UE/LE; PSY WNL. ASSESS/PLAN: NEEDS SOME PHYSIOTHERAPY FOR 

LBP AND WRISTIKNEE PROBLEMS. HER REFLUX AND ASTHMA ARE WELL CONTROLLED 

7/18-20/08 Dlc DX CP--MI Rio, UNCONTROLLED NTN; NONCOMPLIANCE; ARTHRITIS. PE: 178/95, 

WDWN, NAD, COARSE BS W/O CRACKLES AND WHEEZING; RRRi, NO PEDAL EDEMA, HAS A L-CALF HEJU.,ED 

WOUND; EKG-NSR. ASSESS: CP--ADMT TO RIO MI; MALIGNANT HTN; NONCOMPLIANCE; HIO GERD 

B. POSTURAL UMfTATIONS 

o None established. (Proceed to section C.) 

Frequently Occasionally Never 

1. Climbing F ramp/stails ~ a 0 0 - ladder/rope/scaffolds ~ 0 0 181 2. Balandng ... a 0 0 3. Stooping ~ a 0 0 4. Kneeling ~ 181 0 0 5. Crouching ... a 0 0 6. Crawling ... a 0 0 7. When less than two-thirds of the time for frequently or less than one-third for occasIOnally, fully descrtbe and 

. explain. Also explain how and why the evidence supports your conclusions in nems 1 through 6. Cite the 

specific facts upon which your conclUsions are based. 

Continued on Page 4 

Form SSA-4734·BK (02.2008) sf (02-2008) Page 3 
361 

C. MANIPULATIVE UMITATIONS 

181 None establish ed. (Proceed 10 section D.) 

LIMITED 

1. Reaching all directions (Including overhead) ----------I~ 0 2. Handling (gross manipulation) • 0 3. Fingering (fine manipulation) ~ 0 4. Feeling (skin receptors) • 0 

I!!!XHlBrT NO. 3f 

UNLIMITED 

o 

o 

o 

o 5. Describe how the actMtles checked 'limned' are Impaired. Also, explain how and why the evidence supports 

your conclusions In nem 1 through 4. Cite the specl1ic facts upon which your conclusions are based. 

D. VISUAL UMITATIONS 

181 None established. (PrOC~ed to section E.) 

LIMITED UNLIMITED 

1. Near acuity --------------------------.~ 0 0 

2. Far acuity ----------~---------------~ 0 0 3. Depth perception -----------------------~ 0 0 

4. Accommodation -----------------------..00 5. Color vision ------------------------~~ 0 0 6. Reid of vision ~ 0 0 7. Describe how the laculties checked "limned" are impaired. Also explain how and why the evidence supports 

your conclusions in Hems 1 through 6. ene the spectllc facts upon which your conclusions are based. 

MED CE, VISION L-20f30 R-20f30-40 OU-20fSO 

Cantin ued on Page 5 

Form SSA-4734-BK (02-2008) ef (02-roOO) Page 4 
362 

E. COMMUNICATIVE UMITATfONS 

1m None established. (Proceed to section F,) 

UMITED 

. EXHI8ITNO.3f" , 

UNLIMITED 

1. Hearing • 0 0 2. Speaking • 0 0 

3. Describe how lhe faculties checked ·Iim~ed' are impaired. Also, explain how and why Ihe evidence suppons 

your conclusions In hems 1 and 2. elle Ihe specffic facts upon which your conclusions are based. 

F. ENVIRONMENTAL UMfTATfONS 

o None established. (Proceed to secMn 11.) 

UNLIMITED 

1. Extreme cold ----------+ .0 2. Extreme heat .0 3. Wetness -----------I~ ~mI 

4. Humld~ -------------------~ 

S. Noise ------------I~ 

~mI 

~mI 

6. Vibration -----------I~ .mI 7. Fumes, odors. 

dusts, gases, 

poor ventilation, 

etc, 

8. Hazards 

(machinery, 

heights, etc.) 

.mI 

.0 

AVOID 

CONCENTRATED 

EXPOSURE 

mI 

mI 

0 

0 

0 

0 

0 

0 

AVOID EVEN 

MODERATE AVOID ALL EXPOSURE EXPOSURE 

0 0 

0 0 

0 0 

0 0 

0 0 

0 0 

0 0 

0 mI 

9. Describe how these environmental fadorn impair activ~les and Identify hazards to be avoided. Also, explain 

how and why the eVidence suppons your conclUSions in ~ems 1through 8. ~e the specific fadS upon which 

your conclusions are based. 

Continued on Page 6 

Form SSA-4734-BK (02-2008) af (02·2008) PageS 
363 

9. COntinue (NOTE: MAKE ADDITIONAL COMMENTS IN SECTION IV) 

a.SYMPTOMS 

For symptoms alleged by the claimant to produce physlcallimHatlons, and for which the following have not 

previously been addressed In sac1ion I, discuss whether. 

A. The symptom(s) is attributable, in your judgment, to a medically detenninable impairment. 

ElFI'nmn:e as P'AOE:eOF8 

B. The severily or duration of the symplom(s), in your judgment, Is disproponlonate to the expec1ed severity or 

expected duration on the basis of the claimanfs medically detenninable impainnent(s). 

C. The severity of !he symptom(s) and Hs alleged effec1 on func1ion is consistent, in your judgment, wnh the total 

medical and nonmedical evidence, including statements by the claimant and others, observations regarding 

activHIes of daily living, and alterations of usual behavior or habHs. 

ALSO SEE A6 

MDla HAVE VEEN ESTAB FOR CP, HTN, GERD, I\STHMI\, AND PROBS wi LOW BACK, WRIST, AND 

KNEE wlo ANY SIG. LRoM 

ADLS REVEALS MOD LIMITlATIONS DUE TO PAIN AND REQUIRES SOME ASSISTANCE: HOWEVER, 

SIS APPEARS TO BE PARTIALLY CONSISTENT WI FINDINGS 

Continued on Page 7 

~SA-4134~BK (02-2008) af (OO.20OS) Page 6 
364 

EXHIBn'NO.3f 

III. TREATING OR EXAMINING SOURCE STATEMENT(S) 

A. Is a treating or examining source statement(s) regarding the claimant's physical capacities in file? 

181 Yes o No (Includes situations in 

which there was no source 

or when the source(s) did 

not provide a statement 

regarding the clalmanfs 

physical capacities,) 

S, If yes, are there treating/examining source conclusions about the claimant's limitations or restriclions which are 

signnicantly different from your findings? ' 

DYes !XI No 

C, If yes, explain why those conclusions are not supported by the evidence in file. C~e the source's name and the 

statement date, 

S.j '~"----____ :C:R 9/10/06 CE "SHE CAN PERFORM PoLL ACTIVITIES WID 

ASSISTANCE. SHE NEEDS TO Hl\VE SOME PHYSIOTHERAPY FOR HER LOWER BACK PROBLEM AS WELL 

AS WRIST KNEE PROBLEMS. HER REFLUX PROBLEM AND ASTHMA' ARE WELL CONTROLLED. 

MSS ACKNOWLEDGED 

Continued on Page 8 

Form SSA-4734-BK (02-2008) ef (02-2008) Page 7 
365 

EXHIBITNO.'P' 

IV. ADDITIONAL COMMENTS: 

aD THESE FINDINGS COMPLETE THE MEDICAL PORTION OF THE DlSABILl1Y DETERMINATION. 

MEDICAL CDNSULTANrS SIGNATURE: MEDICAL CONSULTANrS CODE: DATE: 

Form SSA-4734-BK (02-2008) af (02-2008) PageS 
366 

• e· EXHlBrrNO.4F 

PAGE: 40 OF as 

Excuse Fro@SChOOI 

patient's.d .. • ••••••• llii~-:-___ ~_· ___ _ Patient has been under my care since: -'0"'2=----=0,,'_-_0::...'7<-___________ _ 

Patient will be unable (0 attend work/school starting: a Z - 01- 0 7 

Patient's anticipll1ed return date is, -'0 ..... 1<'-"......;'''';.'''-"-''0'-'1'-____________ _ 

Reason: -L-Injury _. _Illness ___ Maternity 

Is reason work related: V Yes No 

Briefly describe injury or illness: MV"~/.PL6 

.TOG FIIJJ- ON ,I<' ,z,- 0" 

~~--------------

Compliments of 

ESSY-(O-tatCB 

NIRAVAM" € 

(.lp'.lDlam oraI~ disintegrating tablels) 

0.25 In;' 0.5 mg • 1.0 In; ·2.0-mq 

~ ~--'--~ 

Permanent Subcommittee on Investigations 

EXHIBIT#4d 

OJ." 01- 07 Dale Signed 

g 
367 

CATE 0; ADMISSION: 07/18/200B 

CATE or !)!SC~.ARGE: 07/2012008 

FINAL ·Dr:t.GNOSIS 

1. Chest paln--myoeardial infarction tl.!l.d out. 

2. lJ"co~troll.~ h~-pe=tenaion. 

J. Nonoompliance. 

4. A.rth.iH •. 

DISCHARG. CONonIO~: Improved. 

DISCIIARGE DIE'l': !.ow-in/low-cholU!erol. 

DISCHARG~ .IICT!'IITY: l\. tol,~.t.d. 

~ II l. rJffL;I{fJO U:JO j.IIII 

• 

, 

~B OISCHAAGE D.~rE: 07/20/2008 

OISCHARG~ M3:DICATIONS: Clonidi". 0.1 m, p.o. t.Ld., Popeld 20 III. 1',0. 

c.l.d." l10trin 400 m!l p.o. t.i.d. for 3 d.ys, vlc;odin 5 one tablet p.o. 

q.6h. p.r.n. 

The pati.r,t will b. follewed U? >lith ____ • nona to two week!. 

HOSfITIU. CO~RS;:' This i."' .. r-old black female who used to have a 

hlatory of hypnton,ion .ud D _ 10 her poy.ici.n. She apparentLy 

presented to the EPo with eolllPlaint of frontal ch •• t pain, b"t patient also 

ccmplalned of pain a.ll over her ~d.YI lIlt;.luding back, bilet~u'al rib~1 and 

lower eKtremitie.. rho patient initially was found te ttave uncontrolled 

hy?ertensicn with 5P 176/95. The patient has been taking blood pre.sure 

medieatior~ for C(U,:lte eome -:i:le. The patient "'as admitted. for treatrnen,&. 

1ater, the patl.n~ had 1 96t$ of negaUve 2KGa lr.cI tropenin 1 and 

an1!i-hype;rtenslvQ medica.tion was adjl.;:lte.c1. On t.l':.e di'l!charr.]8 diY, 'the 

patient felt much better. Motrin h •• been 9i.e~ for chronic arthridc 

pAin. The patient's pail'!. seems t'c be improving. the patient ';las than 

ecnJidltec ':0 be stable /or di,e:u-=qe l:ld wi.11 need t:;l have close 

outpat:ie~t follow .... 1Jp. Detailed instructions were given. Discharge time 

spent. \\'a5 31 minute5. 

Permanent Subcommittee on Investi ations 

ExtWAiol.l5 

PAOE: 47 OF M 

:atier. & " £3.1.12, l::::E~XH~~IB~I~TJ#~4~e::::J'''''''''''~~-
368 

200B-Jul-20 12:56 PM 

T:DATE: 07/18/2008 19:52 

D:DUE: 01/18/200811:35 

JOB t: ll4076 

EX....,l£:' .lO PAGE: 48 OF B8 

pAGE: J 

MRtlilJ'LEl a . 
369 

EXHIBIT NO. IF PAGE: S OF 10 

Date 

~~ of Service: 09/1012008 

Reason For Visit 

Disabled secondary to Hbp, back pain, arthritis in kneeslhand, acid reflux,eye problem. 

HPJ 

DC NP is here for disability determination secondary to 

I).HEADAC..-....P complains ofa headache. LOCATION;~.. . 

QUALITY I CHARACTER: Patient describes symptoms as dull. Patient reports symptoms are getting wo~e. 

SEVERITY: Moderate 

DURATION 1 ONSET: Symptoms staned about 20yea" ago. 

TIMING: Sudden onset 10 times per Month 1 MODIFYING FACTORS: Symptoms are triggered by nothing. Symptoms are relieved by nothing. 

ASSOCIATED SYMPTOMS: Vision Changes, Photophobia 

2)GERD 

QUALITY I CHARACTER: Her S)mptoms are getting worse. 

SEVERITY: Moderate 

DURATION 1 ONSET: Symptoms started 3 years ago. 

TIMING: The S)mptoms are intermittent. They occur after meals. 

MODIFYING FACTORS: The S)mptoms seem to improye with upright posture, antacids. 

ASSOCIATED SYMPTOMS: Wheezing and chest discomfort in the presternal area and radiating towards throat. 

3)ASTHMA : She has had no interval significant asthma episodes or ED yisits. 

QUALITY 1 CHARACTER: Symptoms haye been better recently. 

SEVERITY: Mild She is rarely using her rescue inhaler. 

DURATION 1 ONSET: Patient has bed astluna symptoms I times over the past week. 

TIMJNG: Wheezing occurs 10 times -permnonth. Wheezing does not cause patient to wake from sleep. 

MODIFYING FACTORS: Symptoms are triggered by nothing. they get relieved by OTC meds. She takes meds for 

cold and cough and her wheezing subsides. 

ASSOCIATED SYMPTOMS: None. 

4)HYPERTENSION: The patient presents with or hypertension. 

QUALITY I CHARACTER: Patient reports symptoms are stable. 

SEVERITY: Home blood pressures haye been greater than 160/100. 

MODIFYING FACTORS: 

~~Patient has not been fo1lowing a reduced sodium diet. 

She is nol gelling edequate exercise. 

She is nol taking antihypertensiye medications correctly. because she has no money. 

ASSOCIATED SYMPTOMS: none 

Permanent Subcommittee on Investigations 

EXHIBIT#4f 
370 

MR~ 

pati~ 

S)BACK PAil . ompl.ins oflowb.ok pain. 

LOCATION: Pain does not radiate. 

QUALITY I CHARACTER: Patient describes pain as dull. Patient repons pain is getting worse. 

SEVERITY: Moderate Rates pain on a scale of 1-10 as 5. 

DURATION I ONSET: Patient has had back pain for 3 years 

CONTEXT: Pain at rest. 

EXHIBrr NO. 2F PAGE: 60F 10 

MODIFYING FACTORS: Symptoms are triggered by bending, lUfting. Symptoms are relieved by rest. Recent 

injury? no 

ASSOCIATED SYMPTOMS: None. 

she said that there is 4-5 disc prolapse for which I didnt have documentation from her records which i have. 

6)KNEE PAIN: The patient complains of pain in the left knee. 

LOCATION: She states !he pain is over the patella, diffuse. The pain does not radiate. 

QUALITY I CHARACTER: The patient describes the p.in as dull. Patient repons the pain is getting worse. 

SEVERlTY: Moderate Rates pain on a scale of 1-10 as 5. 

DURATION I ONSET: Patient has had knee pain for 3 years. 

MODIFYING FACTORS: The pain is worsened by weight bearing, walking, climbing stairs. The pain is relieved 

by rest. [injury? no 

ASSOCIATED SYMPTOMS: None. 

7) She has bilateral wrist pain. She has a trigger finger in n ring finger. she cannot work with that hand because she 

gets pain if she works more with that hand. she cannot make a fist after some time as per history. ,be has simil.r 

problem with rt hand. no injury repertad. 

She is following 7 oontgomery.She is taking vicodin 51500for pain, donidineO. I mg tid, mieardis het 

for hyper lens ion and omeprazole for acid reflux problem. 

PersooalHx 

Behavioral history: No tobacco use and no previous history of smoking. 

Alcohol: Not using alcohol. 

Drug use: Not using drugs. 

Habits: Not eXen:lsing regularly. 

Home environment: The racial background is black. 

Education: The highest level of education achie_ed: completed some college. 

Work: Occupation Teacher aid. 

Activities: Activities nothing much i be hurting to much. 

Religious affiliatiOlJ: Religion: Methodist. 

Marital: Single. 

PMH 

History ofhypenension (401.9). 

History of asthma (493.90). 

History of arthritis (716.90). 

FamilyHx 

Hypertension 

Heart disease 
371 

Asthma 

Diabetes mellitus. 

Anhritis 

Migraine headache. 

PSH 

Neg. 

Allergies 

No Known Drug Allergy. 

ROS 

Syslemic symptoms: no general body aches and pains. 

Head symptoms: No head symptoms. Headache present 

Eye symptoms: none 

Otolaryngeal symptoms: No otolill),ngeal symptoms. 

Cardiovascular symptoms:·heart bum with acid reflux. presternal pain.hypertension. 

Pulmonary symptoms: no SOB orcoughing history of asthma 

Gastrointestinal symptoms: No gastrointestinal symptom, 

Genitourinary symptoms: No genitourinary symptoms 

Endocrine symptoms: No endocrine symptoms 

Musculoskeletal symptoms: low back pain pain and pain at the wrist biiaterally.Knee pain. 

Neurological symptoms: No neurological symptoms 

Psychological symptoms: none 

Skin symptoms: No skin symptoms. 

Vital Signs 

Recordedby", - on 10 Sep2008 08:50 AM 

BP: 132/83, RUE, Sitting, 

HR: 74 blmin, R Radial, 

Weight: 171 lb. 

Physical Exam 

EXH&arT'NO.1F 

PACoE: 7 OP' 10 

GENERAL APPEARANCE: Normal habitus. Well developed, well groomed. Appears stated age. No acute distress. 

Color good. 

MENTAL STATUS: Appear.; alert and oriented. A !feCI appropriate. 

SKIN: Skin color and turgor nonnal. No suspicious lesions, masses, rashes, or ulceration5. Nails and hair appear 

normal. ' 

HEAD: Normocephalic. 

EARS: External ear wlo scars, masses, or lesions. Externalaudilory canal intact, clear, and wlo lesions. TMs intact 

with nonnallight reflex and landmllTks. Acuity to conversational tones good. 

EYES: PERRLA, extraocular movements intact. Lids wlo defect, conjunCliva and sclera appear nonnal. Fundi wlo 

papilledema, hemorrhage, exudates, or arterial abnormalities. 

NOSE: Nasal muODsa and turbinates pink. septum midline, no lesions. 

MOUTH: Teeth in good repair. Gums pink wlo lesions. Normal appearing mucosa, palate, and tongue. 
372 

UI:FI":-":UUO 

EXHIBf'T NO. 2F PAGE: 8 OF 10 

OROPHARYNX: Moist wlo exudate, erythema, or swelling. 

NECK: Symmeb"ic, trachea midline. Thyroid nontender wlo enlargement or masses. Carotid pulses nonnal with no 

bruits. No cervic.llymphadcnopatily. 

BREASTS:deferred as no complaints 

CHEST: Respirations unlabored with nonnal diaphragm.tic excursion. Chest wall symmetric with no 

masses. Breath sounds clear bilaterally w/o wheezes, rubs, rales, or rhonchi. 

CV: Nonnal precordium and PMl wlo lifts, heaves, or thrills. Normal 51 and S2 wlo murmur, rub, gallop, orclick. 

Capillary refill within 2 seconds. No edema, clubbing, or cyanosis. No varicosities. Radi.l, femoral, dorsalis pedis, 

and posterior tibial pulses full and symmetrical. 

GIl ABDOMEN: Abdomen soft with normal bowel sounds. No guarding or rebound. No palpable masses or 

tenderness. Liver and spleen are wlo tenderness or enlargement. No aortic widening. No inguinal adenopathy. 

GU:deferred as no complaints 

RECTAL: deferred as no complaints 

MS: Muscle tone and strength normal for age, wlo atrophy or abnormal movement. 

NEUROLOGICAL: Cranial nerves II-XII intact. Motor strength symmetrical with no obvious weaknesses. 

Superficial sensation intact bilaterally to light touch and pain. Observed dexterity wlo ataxia or tremor. Deep tendon 

reflexes full and symmetric bilaterally. Gait coordinated and smooth. 

no need of stick or cane for assisitance, 

Musculoskeletal system: 

Genersllbilateral: A range ofmo;ion evaluation was performed of extremity(s) (FROM in all 4 ext). 

Musculoskeletal system: 

Active flexion of the cervical spine 90 degrees 

Active extension of the cervical spin. 75 degrees 

Active cervical spine rotation to the right 90 degrees 

Active oervical spine rotation to the left 90 degrees 

Active cervical spine lateral flexion to the left 45 degrees 

Active oervical spine lateral flexion to the righl45 degrees 

Cervical spine showed no tenderness on palpation 

Cervical spine showed no instability 

Cervical spine showed no weakness 

Thoracic Spine: 

Generallbilaterar: 

Thoracic spine had a normal appearance 

Thoracic spine exhibited no spasm of the paraspinal muscles 

Thoracic spine exhibited no instability. 

Thoracolumbar Spine (Motion): 

Generallbilateral: 

Thoracolumbar spine demonstrated full range of motion 

Thoracolumbar .pine pain was not elicited by motion 
373 

Thoracolumbar spine showed no instability 

Oenerallbilateral: 

Active lumbosacral spine rotation to the left 60 degrees 

Active lumbosacral spine rotation to the right 60 degrees 

Active lumbosacral spine lateral flexion to the left 30 degrees 

Active lumbosacral spine lateral flexion to the right 30 degrees 

Lumbar I Lumbosacral Spine (Motion): 

Generallbilateral: 

Lumbosacral spine demonstrated full range of motion 

Lumbosacral spine flexion was normal 

Lumbosacral spine extension was normal. 

Lumbosacral spine pain was elicited by extreme range of motion. 

wrist: 

Dorsiflexion- 60 degrees biloteral 

palmar flexion: 70 degrees bilateral 

radial deviation: 20 degrees bilateral 

ulnar deviation: 30 degrees bilateral 

Knees: 

flexion: 150 degrees bilateral 

extension: 0 degrees bilateral. 

Neurological: 

Motor. 

A motor exam demonstrated no dysfunction 

A preference for right-handedness was observed 

No involuntary movements were seen 

PI able to walk on toes and heels without trouble. 

Upper ext: Full range of motion of anns, hands and fingers 

Balance: Normal. 

Gait And Stance: Nonn.l. 

Reflexes: Nanna!. 

Muscle Strength: 

Upper Ext. 

ua:.q~:uo a.m, 

EXHlBrrNO. IF PAGE:90F18 
374 

Bilateral shoulder and forarm FlexlEx! 5/5 

Bilateral Shoulder abduct/adduct 5/5 

Bilateral internallexternal rotation at shoulder 5/5 

Bilateral supinate/pronate 515 

Lower Ext: 

Bilateral Hips f1ex/extlabductladduct 5/5 

Bilateral lower legs flex/extend 5/5 

Bilaternl ankles dosilplantar flex 5/5 

Psychiatric Exam: Mood and affect congruent and was normal 

No assistive devices uses 

Results 

SELMA In House Eye E""", 10 Sep 2008 03:33 PM 

• Both Eyes are 20/50, 10 Sep 2008 

- Left Eye OS: 20130 

- Right Eye 00: 2013040. 

Assessment 

• Visit: to issue a certificate of disability (V6S.0 I) 

Orders 

SELMA In House Eye Exam. 

Plan 

EXHlBI'T NO. 2F PAGE: 10 OF 10 

She can perform an activities without asistance. she needs to have SOme physiotherapy for her lower back problem as 

well as wrist and knee problems. Her reflux problem and asthma are well controlled. 

Level of Senice 

Established oUlpatient minim.l service 99211 

Signature 

Signed By: C; - 09/10120088:54 AM CST. Signed By:' ____ ': 09/10/2008 5:32 PM CST. 
375 

I IPI)O,,",' _ pe",on, ::::==?~=_ .... __ ""'~-: 

InI.~anaA~' 

to act •• my ",presentative in con_lio" with my elaIM(.) or ... ertId rloMI"'under: 

Q' , 1'1tlo II , ./XI rille XVI 0 TItle XVIII 0 r~l. VIII 

(RSDU (SSI) rMedlcorll Covat8ge) . (S"B~ 

ThIQ,Ptl'ton may •• ntiroly in mv pi"" ... rnalea anV requllSt or gIvo any no!lce; g~ or dn!w Ollt .VI~hC. '" IlItol'ftlHion: OOt h'llorl1\*f)on, WId ,e,,,,;,,e any notice In con"IIOtion v;ith my pending clelm(Sl or ..... "cd rig~I('I. 

I, c:: " • horel>y lceopt ,,,, abo~ IPPOinmlOl>t. , CII!li1y flltt I 

hava-I"ro.! boOn .... ~ or'PiOiiibittld Iroin ~ ""0111 the ~ioI Security Adminimnrtion; that I am n" 

dlsqllllilfied Irom ",p",Hndll!llha oJaimant os • """..nl or former officer or emDloVH 01 the United Statts; and tI>It 

I wiU 1\01 ClIO'go at eollKt .nv 100 fa' tile ,eproso",all ..... Von if. third party willl>ay the 1"" ..... 1.$$ ~ h., beetI 

.~j)ftWed itt aeeMl!lalW:e wftJ, thl:' tawa end rule, roof..,.d to. on me re:VOf'" side ~f ttl., repreant.ltlve"s r;::opy 01' this 

loti'll. ~ I Qeclde no. to charge or .00Io<:t. I ... lOt the "p"MnlOlion. I will no,lfy \he Social SoQu~1Y Admlrlllcra1ion. 

(Completion 01 Po", Ifl •• \tOII .. thl40 ",qm~nl.1 

Check one: aq. I am an .nomov, 0 I.M a __ nev who b eIIalblolll ... ""1",, d/ttc, f .. DOyrnom. 

o I am no, ... lntO""y MG , am inoft;ll>lo 10 .eceivo dinrc:ll~o payment. , 

, ,,"lie boon dlllwN<I or .... Hnde<! f •• m • court or bar to which f w"" prev1ou$ly admr.w.t to P.lc:tIce u an 

"norneV. 0 yU rNO I I ~_ been d"qu"~'od from II'Irtlcipalillg in or oPPCIlrinll 1>01 ..... Foderal program at ago....". 0 YES 0i!I NO 

WAIVER OF FEE I ... ive my righi',. char!!" al'ld co"_ • foe unClef _ ... 2Q8 ond 1~31(cIH21 01 the Social s8eurilY Act. I 

releue my oIient (Ihe cIolmantl itom any .. bligatlons. con""eNol,or o"'o",,;.e. which .... v lit ...... d to "'0 lor 

.. rvice, I haw provided In connection willi", elient's cfllim(a III ~rteQ rightlst. 

WAlVEII Of DIRECT PAVM£NT 

by AnolllOV or Non-Atto~ ElgII>le to _'ye Direct PIIym ... t 

, "'"""" .... 1'( wry rIgII\ ~ ~ peymom Of • fOit fra ... tile _hold ".. .. dIr • ..-eM. 0 .. _&, CllOIIbIlIIV 

hIIou"" ... '" _1'IOmentDI ....urIty Incomo ".11._ of My ellent (tho clallIWIll. , ... not -.. ..., rigllt to ........... fee !!!!!!!Ovll_ to .... _. fee mow lralftl!!lY _".6 third _. ' 

COPY 

Oa.!ttroy "",,, EditionB 

EXHIDIT#4 
376 

FEEAGR~ 

tt£S FOil SERVICES 

: 

EXItIBITNO.3B 

PAGE: lOFl 

My representative and I understand that fOT a fee to be payable. the SocW Seeurity 

Adntin.is1ntion (SSA) most approve lilly fa: my ~'e dlarges or coJlccts mm 

me fOT services my representative providl!$ in proc:eedings berbre 55.0\ in connection ",ill!. 

my claim(s) for henefits. 

We agrce lbat ifSSA favorably decides thcclaim(s). hill F~' my~tativea fee 

eqUll! to the 1=0(25 percent of the past-<iue benefits resulting from lilY claim($), 

ho~er fee is not to ex~ $~JOO.OO. 

[For concUI'I'e!lt Titles IJ and XVIbcncfitsJ We undexstand that Social Security pI!St-due 

benefits are the to1B.l amount of money to which r [and my auxiJiaxy beIlefiticiary(ics)] 

become ~titled through the month before the montll SSA cffi::ctuates a favorable 

adl'llinistnltivc deten:ninati.on Or clecisiol) 0Jl. my Social Sec~· cl.ai.aI and that 

SUpplemental Security income (5S!). past-dut benefits are !he iIJtal amollllt of money for 

which I become eligible through !he IDOIlIh SSA effectuaics a fln'OI2lble administmive 

detennina%ion or cieci,qOll on my SSI claim. 

I will pay the ~ of obtaining any medical records,- or reimburse my representative for 

lillY expendituresmade Oft my behaJf(except for postage and Slalionmycosts). We have 

borh received signed copiC-5 of this agR:Cment. 

","_~ __ -""J • 

DATE: lojlblot 
377 

NH ____ _ February 3, 2010, 08:27 

PAGE 1 

UNIT:. __ 

REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE 

On October 10, 2008, we talked with you and completed your REQUEST FOR HEARING 

for SOCIAL SECURITY BENEFITS. We stored your REQUEST FOR HEARING information 

electronically in our records and attached a summary of your statements. 

What You Need To Do 

o Review your REQUEST FOR HEARING to ensure we recorded your statements 

correctly. 

o If you agree with all your statements, you may retain the REQUEST FOR 

HEARING for your records. 

o If you disagree with any of your statements, you should contact us within 

10 days after the date of this notice to let us know. 

MY NAME ISS ............ .., 

MY SOCIAL SECURITY NUMBER IS 

I REQUEST A HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE. I DISAGREE WITH THE 

DETERMINATION MADE ON MY CLAIM FOR DISABILITY-WORKER OR CHILD BENEFITS BECAUSE 

MY CONDITIONS HAVE NOT IMPROVED. I AM UNABLE TO MA INTAIN GAINFUL EMPLOYEMENT. 

I AM 59 YEARS OLD AT THIS TIME. 

AM SUBMITTING ADDITIONAL EVIDENCE WITH THIS REQUBST. 

I WISH TO APPEAR AT A HEARING. I UNDERSTAND THAT AN ADMINISTRATIVE LAW JUDGE OF 

THE OFFICE OF DISABILITY ADJUDICATION AND REVIEW WILL BE APPOINTED TO CONDUCT 

THE HEARING OR OTHER PROCEEDINGS IN MY CASE. I ALSO UNDERSTAND THAT THE 

ADMINISTRATIVE LAW JUDGE WILL SEND ME NOTICE OF THE TIME AND PLACE OF A HEARING 

AT LEAST 20 DAYS BEFORE THE DATE SET FOR A HEARING. 

IT COULD BE ESPECIALLY USEFUL IN MY CASE SINCE THE ADMINISTRATIVE LAW JUDGE 

WOULD HAVE AN OPPORTUNITY TO HEAR AN EXPLANATION AS TO HOW MY IMPAIRMENTS 

PREVENT ME FROM WORKING AND RESTRICT MY ACTIVITIES. 

Permanent Subcommittee on Investigations 

EXHIBIT#4h 
378 

NH ___ _ 

February 3, 2010, 08:27 

PAGE 2 

AM REPRESENTED BYY~~~~~~~~IIII WHO IS AN ATTORNEY. 

MY PHONE NUMBER ISt 

DATE October 10, 2008. 
379 

4It--- -

g;.tN1CAL ASSESSMEJS! OF Pb~ EXl-UBfTHO.4f 

PAGE: as OF ,. 

PAm~~ 

PlellSC 8lI5WU the following queslio.n5 lIS tbcy' rc'Iatl c to the patient named above 

aa;ording to your best judgment. '. . 

I. To what Clttcnt is pain of significance in ~c Ircatm~~is patient? (circle 

letter ,~ 

A B. 

Pain is 110t present w s. significant degree. 

2. 

A 

No increase in pain 

whatsoever. 

Pain is present but does 

not prevent functionin 

w every-day activities 

or wone. 

B. 

Some increase but /)ot 

to such an extent as to 

prevent adequate 

functioning in such 

tasks. 

3. To what extent will the prescribed medl,l .. "-Il.I..II~(lNL."'t"<'U 

work? (circle lett\:() 

A .n. 

Should be able to 

pl<fibm'l full job 

duties without any 

decease'in'work 

effectiveness. 

4. 

No 

Comments: I 

'.,,, tl~':S Date: D;- Db.-{O 

D 

alient will be 

otally (l!!;tri cted 

and unable to 

function at II 

productive level of 

worll.. 

-~ ~O 
380 

(The following is a transcript in the hearing held before 

Vincent P. Intoccia, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on January 7, 

2010, at Selma, Alabama, in the case of t, Social Security 

Number ~h~ rlaimant appeared in person and was 

represented bv - .. _ -:"". Attorney. Also present was 

-----~_ .:'".:'".::'.:-." Vocational Expert.) 

(The hearing commenced at 8:44 a.m. on January 7, 2010.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: The claim o~I ___ """""" .......... ~pcia1 Security Number 

'e Her Attorney is also here, 

We have as a VE today. We 

have two new paper exhibits we're going to have to scan into the 

e-fi1e. The first one is from' (Phonetic) and 

that will be Exhibit 4F. The second one is from 

G,~ (Phonetic). And that will be Exhibit SF. _ Any objection, 

question, comments about any of those exhibits? 

ATTY: No, Judge, 

ALJ: We'll go ahead and admit into the record then Exhibit lA 

through lOB, through 5D, through 9E, through SF. 

(Exhibits, previously identified, were received into evidence and 

made a part of the record thereof.) 

ALJ: Did you have an opening? 

ATTY: Judge, we believe this Claimant would meet Grid Rule 

201.06 based on the fact that the Claimant is over the age of 55 and 

there's significant job adjustment after the age of 55, 

ALJ: Okay, And I really don't have any questions for401l1l1l1l ... 

unless you do? 

ATTY: No, Judge. 

ALJ: Swear you in, Doctor? Can we enter the typical 

EXHIBIT #4' 
381 

2 

stipulations for the.VE? 

ATTY: Yes, sir. 

ALJ: Is there anything, Doctor, you need to know? 

VE: . No, sir. 

(The vocational Expert, _ sworn, testified as follows:) 

having been first duly 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q Could you identify those three jobs that •••••• I>'.erformed 

during the period at issue by job title, exertional, and skill level? 

A Yes, sir. She has worked as a It's 

considered light work by DOT standards and is skilled at an SVP:6. 

The DOT is .......... .. The other, another job is •••••••• I as 

in Roman Numeral I, light work in exertion, skilled at an SVP:6. The 

DOT number is ....... F.. And then a •••• 1 light work in 

exertion, unskilled at an SVP:2 and the DOT is ~S1."""IIIlI. 

Q And there's transferable skills with job one and two? 

A Yes, sir, from the skilled jobs there's -- they're 

transferable down to sedentary. 

Q And at age 55, Doctor, would it be true there'd be 

significant vocational adjustment? 

A I would believe so. Yes, sir. 

Q And there's no transferable skills, of course, with a 

courier? 

A Correct. 

Q Everything's consistent with the DOT? 

A It is. 

Q Let's assume a hypothetical individual, same vocational 
382 

3 

profile as •••••• during the period at issue. Let's assume that 

such an individual could perform a full range of sedentary work 

activity and then let's superimpose on top of that the pain assessment 

by otherwise set forth at Exhibit SF, dated 

1/6/2010. If we superimpose those non-exertional limitations by the 

pain on top of the, the full range of sedentary work activity, could 

someone under those facts and circumstances go back to any of those 

three jobs or any other jobs? 

A No, sir, neither. 

Q What stands out to you, Doctor? 

A Well, on ___ ....., .. s"'e ........ _"!'_ pain assessment he, on, on the first 

and second factor he gave a, a C and a D. D says pain is present and 

found to be intractable and virtually incompacitating to the 

individual. On the, the second factor he also listed a C and a D. 

D says the increase of pain to such an exten~ that bed rest and/or a 

medication is necessary upon physical activity. And then the third 

factor, the, he indicated a, a C evaluation. To what extent will side 

effects impact upon the ability? The drug side effects can be 

expected to be severe and,to limit effectiveness due to distraction, 

inattention, and drows·iness, etcetera. So thilt wO,uld preclude 

employment. 

ALJ: Thank you, Doctor. Questions, 

ATTY: No, Judge. 

ALJ: Did you have a closing? 

ATTY: No, Judge. 

ALJ: And you've had the opportunity to look over Exhibit 2A --
383 

4 

ATTY: Yes. 

ALJ: -- which is ALJ Bench Decision Check Sheet? 

ATTY: Yes, Judge. 

ALJ: Any objection, question, comments? 

ATTY: No, Judge. 

ALJ: We'll go ahead and admit that into the record as 

Exhibit 2A. And after review of the available evidence of record it 

appears that a wholly favorable Bench Decision can be issued in this 

particular claim. This claim is a Title II Claim. It was filed 

8/13/08. The onset date's listed as 8/15/07. There's under SGA work 

activity in '08, which is not preclusive of going through the rest of 

the sequential evaluation process steps. Essential, .......... is 

entitled to a Step Five finding within the framework of Grid Rule 

201.06 and also is correlated with the testimony of the Vocational 

Expert enlisted during the hearing who, after classifying the jobs she 

performed during the period at issue, was requested to assume a 

hypothetical individual, same vocational profile as~lIlIlIlI~ He 

was then requested to assume a full range of sedentary work activity 

and then superimpose non-exertional limitations and restrictions from 

one of the treating physicians otherwise found in Exhibit SF, dated 

1/6/2010. He was then presented with two questions.. Number one, 

could someone return to any of those past jobs and number two, if not, 

could they perform other jobs. He testified in the negative 

essentially based upon the combination of pain and side effects set 

forth at Exhibit SF. And as such ~ been disabled since the 

onset date. It's noted that although transferable skills exist at 
384 

5 

jobs one 'and two, per the VE there is significant vocational 

adjustment at age 55 and, as such, Grid Rule, the framework of Grid 

Rule 201.06 still applies. And this would be further associated with 

Social Security Ruling 82.41 that permits such. This concludes the 

hearing procedure. Thank you, ~\£ZIIIIIIII~ 

ATTY: Thank you, Judge. 

CLMT: Thank you. 

(The hearing closed at 9:13 a.m. on January 7, 2010.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcription of tie testimony recorded at the hearing 

held in the case of before Administrative Law Judge 

Vincent P. Intoccia. 
385 

Office of Disability Adjudication and Review 

4344 Carmichael Rd 

Suite 200 

Montgomery, AL 36106·3730 

Date: January 25,2010 

NOTICE OF DECISION FULLY FAVORABLE 

I have made a fully favorable decision in your case. My decision is based on your period of 

disability and disability insurance benefits application filed on August 13, 2008. 

I announced the basis for my decision at the hearing held on January 7, 2010. I adopt here those 

findings of fact and reasons. 

To summarize briefly, I found you disabled as of August 15,2007 because of arthritis; obesity; 

hypertension; GERD; asthma; degenerative disc disease L4-L5; spinal stenosis; and glaucoma so 

severe that you are unable to perfonn any work existing in significant numbers in the national 

economy. 

If you want more infonnation about my decision, you or your representative should file a written 

request for this infonnation at any local Social Security office or a hearing office. Please include 

the Social Security number shown above on your request. If you ask for it, we will provide you 

with a record of my oral decision at the hearing. 

This Decision is Fully Favorable To You 

Another office will process the decision and send you a letter about your benefits. Your local 

Social Security office or another office may first ask you for more infonnation. If you do not 

hear anything for 60 days, contact your local office. 

The Appeals Council May Review The Decision On Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do so. 

To do that, the Council must mail you a notice about its review within 60 days from the date 

shown above. Review at the Council's own motion could make the decision less favorable or 

unfavorable to you. 

If You Disagree With The Decision 

Permanent Subcommittee on Investi ations 

EXHIBIT#4k Fonn HA-L82 (03-2007) 
386 

Page 2 of3 

If you believe my decision is not fully favorable to you, or if you disagree with it for any reason, 

you may file an appeal with the Appeals Council. . 

How To File An Appeal 

To file an appeal you or your representative must request the Appeals Council to review the 

decisidn. You must make the request in writing. You may use our Request for Review form, 

HA-520, or write a letter. 

You may file your request at any local Social Security office or a hearing office. You may also 

mail your request right to the Appeals Council, Office of Disability Adjudication and Review, 

5107 Leesburg Pike, Falls Church, VA 22041-3255. Please put the Social Security number 

shown above on any appeal you file. 

Time To File An Appeal 

To file an appeal, you must file your request for review within 60 days from the date you get this 

notice: 

The Appeals Council assumes you got the notice 5 days after the date shown above unless you 

show you did not get it within the 5-day period. The Council will dismiss a late request unless 

you show you·had a good reason for not flling it on time. 

Time To Submit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider with your 

request for review. . 

How An Appeal Works 

Our regulations state the rules the Appeals Council applies to decide when and how to review a 

case. These rules appear in the Code of Federal Regulations, Title 20, Chapter III, Part 404 

(Subpart 1) and Part 416 (Subpart N). 

If you file an appeal, the Council will consider all of my decision, even the parts with which you 

agree. The Council may review your case for any reason. It will review your case if one of the 

reasons for review listed in our regulations exists. Section 404.970 and 416.1470 of the 

regulation list these reasons. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law Judge for a new decision. 

If No Appeal And No Appeals Council Review 

Form HA-L82 (03-2007) 

See Next Page 
387 

- Page 3 on 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed only 

under special rules. 

If You Have Any Questions 

If you have any questions, you may cali, write or visit any Social Security office. If you visit an 

office, please bring this notice and decision with you. The telephone number of the local office 

that serves your area is (334)875-0587. Its address is Social Security, 120 Executive Park Ln, 

Selma, AL 36701-7734. 

Enclosures: 

Form HA-Ll5 (Fee Agreement Approval) 

cc: ------

----

Vincent P. Intoccia 

Administrative Law Judge 

January 25, 2010 

. Date 

Form HA-L82 (03-2007) 
388 

EXH'lBrrNQ,ZA 

PAQE: 20F5 

DIB 

Claimant 

Application 

Name: 

Date: Hearing 

SSN: 

Date: 

~ 

I - 7 - 2.4 /'1/ 

S8I Application Date: IIf 4 DWB Application Date: 

Date LastIns~: Q-30- 219/'0 Established Onset Date: 8-()-{) 7 

EOD is !E(<\.OD 0 Amended AOD 0 Current Appl. Date 0 ~rior Appl. Date 

(SSI ani)') (SSIOnly) 

o Prior Application 0 Reopened 0 Not Reopened 

Prior Application Date(s): T2 T16 

Jeason for Reopening 0 Within one ye.,- 0 Good cause 0 Grounds for reopening at any time 

[B'WorkAfterOnset OUWA cgNotSGA OTWP "" 

Se,'ere Im~zment(~ (singly or in combination): 1ffl...'/1I /L,' f,.s . tJ t I??, . 0 . 

11. ~ j/t. (;'i-fJ)-/f:;-'rv.. W>. d--; f)t)tJ t.£{- '-S'j' 5f":'" I 5fp<.~;s;/t if'" co ... t4. 

o Impairment(s) MEETS Listing # 

o Impairment(s) EQUALS Listing # 

o Child is Functionally Equal to Listings 

Mrk Extr Mrk E:Itr 

DOL Mquiring and Using Information 0 0 4. Moving about and Manipulating objects 

o 0 2. Attending and Completing Tasks 0 0 5. Caring for Self 

o 0 3. Interacting witb Otbers 

Mentallmpainncnt Analysis (part B) 

o 0 6. Health and Physical Well-being 

Restriction of Activities of Daily Living 0 None 

Difficulties Maintaining Social Fupctioning 0 None' 

Difficulties Maintaining Concentration-Pace 0 None 

---...... o Mild o Moderate 

o Mild 0 Moderate 

o Mild 0 Moderate 

o Marked o Extreme 

o Marked o Extreme 

o Marked o Extreme 

Episodes of Decompensation o None 0 One or Two 0 Three 0 Four or More 

Mental Impairment Analysis (part C) 

o 11.02,12.03, or 12.04 wl2 yrs med. history & more than minimal limitation & 

o Residual disease process wi marginal adjustment so that minimal changes cause decomp. 

o Current Ox. 1 +years in higbly supportive living arrangement wI continuing need for same 

o Repeated episodes of de~ompensation, each of extended duration 

o 12.06 (inability to function independeotly outside area of home) 
389 

FORMA.PPRQVe: 

ONBNo.09800!01 

MENTAL RESi.DliAL FUNCTIoNAL CAPACITY ASSESSNfENT 

ASS~SSMENns FOR: 

12.05 18!. Current Evaluation 012 Months After Oriset: 

18! Date Last 03/31/2005 Insuled: (Date) 

o Other: to __ -=-.,.,--_- Dllle (Date 

I. SUMMARY CONcLusioN's . This section is for rei:O[,Jing,s;:irl]jnary conclusions derived fmm. the 611idence in file. Each mental activity is 10 be 

evi!lualed wi1l'iin the oo~lei!tohlie,indMdtial's capacity 10 sU~laJ.iilh~t activity over a normal wor1<day and workweek, 

on an ongoing basis. P'lIiiileo-expJ;:.hallon of Ihe degree of Iim.hatleR for each category (A through Dj, as well as:'BAY 

other asseSsment infOllA!I)IOn·:Y9u.qeel)i,.app;"priate. Is to be reci;>reJed In section III (Functional Capacity 

Assessment), .' 

If.ratlng cat!lgory 5 Is 

needed io 'make th 

fUnctional ca~if{ COMPLETESECTiOi'fiIC 

Not 

speclf:Yin Section ILl.he evidence that is , •• '. dOcume'nted tliatno'a~urate 

. pmeniis necessary, bUt DO}IO!' 

No Evidence Not Ratable 

Significantly Moo:er9tely Mar1<edly oi Umnation in on AVWliible 

Llm~8d LImned Limtted this Category Evidence 

A. !.illil.EflSIAt,lQINI::lAND MEMOBY 

1. The ~!ity .tor~_~rriber locations and 

work·like procedures. 1.18· 2,0 3. D 4, 0 5.-g 

2. The abiltty to undeista"!l and remem- 1.Qll 2·0 3. D 4. 0 5·0 ber va"" short ,U'd.siliiple Instrdctlons. , 3. The ability to unde",tand an.dremem- 1.0 2. 0 3. !8! 4. 0 5.0 ber detailed. instructions. 

B. SUSTAIl'llEO.OOIllQEI'ITBAIJQ~At,lC! ~EElSISIElliCE 

4. The abil~y to carry out very short and 

simple i""t~ctions. 

1. r8l 2.D 3. D 4. 0 5. 0 

5. The abilrty to carry out detailed Instruc- 1.0 2-0 3. ~ 4.0 5. 0 tio.n!? 

6. The ability to maintain attention and 

. concenlratlortfot-runemted.perlruts .... 1·J7fL 2~q. .3.g . 4.0 . .. 5: 9 7. The abllny to perform activ~ies wilh.ln a 

scheelule, maintain ,eglilar attendance, 1.~ and be punctual wtthln customary toler· 2. 0 3·0 4·0 5.0 

ances. 

8. The abil~y to sustain an ordinary routine 

wff~oUt.special supervisio~. 1.~ 2. 0 3. D 4. 0 5. 0 

9. The abiltty to work in coordination wtth 

or proximtty to others wtthout being dis· 1·18 tracted by them. 2. 0 3. D 4. 0 5. 0 

10. The ability 10 make simple wor1<-related 1. l8! 2. 0 3. 0 4·0 5. 0 decisions. 

Fo<mSSA·4134-F4-SUP (102004) eI (10200< 

Use Prior Editions Permanent Subcommittee on Investigations 

EXHIBIT#5a 
390 

Not No Evidence Not Ratable 

Sign!1icantly Moderately Mark!ldly of llmttation in on Available 

llmited Um~6d Umtted this category Evidence 

Continued- SUSTAINED CON"ENIBAIION 

ANO PERSISTENCE 

11. The ability to complete a normal work~ 1.1'&1 20 30 4·0 50 day and workweek without interruptions 

from psychologiCally based symptoms 

and to perform at a consistent pace 

without an unreasonable number and 

length of rest perioos. 

C. ~QQltI~ INI§AACTIDN 

12. The ability to interact approprlatety with t·O 2. I8t 3·0 4·0 5.0 the general public. 

13, The abmty.to ask simple questions or 1. §jl 2·0 3·0 4. 0 5·0 request assiStance. 

14·, The ability to accept instructions and 

respond appropriately to criticism from 1. I&! 2.0 3·0. 4:0 5. 0 

supervisors. 

15. The ability 10 gel along .,;thooworkers 

or peers without distracting them or 1.~ 20 3.0 4·0 5.0 exhibiting behavioral extremes. 

16. The ability to maintain socially appropriate behavior arid to adhere to basic 1. IRl standards of neatness and cleanliness. 2.0 3. 0 4. 0 5.0 

D. AQAPWIDN 

17. The ability to respond appropriately to 1. I&! 2. 0 3·0 4. 0 5·0 changes in the work sening. 

18. The ability to be aware of normal haz, 1.~ 2. 0 3. 0 4.0 5.0 arcls and take appropriate precautions. 

19. The ability to trevel in unfamiliar 1·181 2·0 3. D 4·0 5·0 places or use public transportation. 

20.The ability to set realistic goals or make 1 ~ 

plans independerttly of others. .' 2·0 3. D 4·0 5·0 

II. R!:r.4ARKS: If y.ou checked box 5 f.orany .of the preceding items.or if any.other documentati.on deficiencies 

wereJOO.Dli~e_d. YOu.M-UST.sp.ej;ify .what.add»io.r.taLdQC_un:teJltalioJJ.is.ne..El.dJ!d..J;.tte . .lbejt!3in-'J~n:tb.e(J» .• iil6 

well as any other specific deficiency, a:nd indicate the development to be undertaken. 

o Continued on Page 3 

Form SSA~4734-F4"SUP (10·2Q04} ef (1 0-2004) 
391 

o Con~nued on Page 4 

III. FUNCTIONAL CAPAciTY ASSESSMENT 

Record the elaboratiqns on the preceding cap,seities in this section, Complete this section ONL V after the SUMMARY 

,CONCLUSIONS section has been completed. Explain your summary coriclusions in narrative form. Include any information which 

clarifies limitation or function. Be especia!ty careful tQ explain conclusions'tt-at differ from those of treating medical sources or from 

the"individuars allegations. 

~:k p~:;~~ only simple tasks with routine supervision. Can relate on a superficia~ 

o Continued 'on Page 4 

o THESE FINDINGS COMPLETE THE MEDICAL PORTION OF THE DISABILITY DETERMINATION. 

MEDICAL CONSULTANT'S SIG~ATURE DATE: r:. ._-' ~.-~ .. -Form SSA.4734·F4..sUP (10·2004) - c -20(4) 
392 

Continuation Sheet - Indicate section{s) being continued, 

Privacy Act Notice: The information requested on this forin is authorized by Section 223 and Section 1633'oftbe Social Security 

Act. ~e ~fonna?on p,royid~;.wi11.bc ~e~ in ma1?-ng ~ dedsion o~ thi_s claim, FallUJ~ t~ ~~~l,et~, thlsJ?rm ~y restilt in a delay in processIng thc:..claLm. InformatIon furnished on this funn may be dlsclOsed by the Soctal Secunty AdmlnIstratlon'to another person 

or goveromental agency only with respect to Social Security progmms and to comply with federal laws requiring the exchange of 

information bc:.tween Social Security and other agencies. 

Paperwork ReductioD Act: This irnormation coll«tion meets the requiremelili; of 44 U.S.C. § 3507, as amended by Section 2 of the 

Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and 

Budget control number. We estimate that it will ~ke about 20 minutes to read the instructions, gather the facts> and answer the 

questi~ns. Yo.1t ~nay sen:J. CO~ DI!' o.ur ~ f!.:Stima~e. ~,e ,to:, ~J 1}38 ~~ l!ui?d~g, Baltimore, A!D 212~.?-6401. Send Q!!!J! comments relaJing to our time estimate to this aJiJTess, not the compreted form. 

Form SSA-4734~F4·SUP (10-2004) ef (10-2004) 
393 

.-·PSVCHtATAICRI!VII!W·1'I!!CHN1QUE 

jSN 

MEDICALStJ,MMAflY . 

Form ApprI:Ived 

OMS No. 096~13 

A. Assessment is from: ____ ..:0:.;:5:.:./.::0.::1:.../::.2 0:::0~2,-___ to ______ c=:u~r"'r~e:!n"t'_ ___ _ 

B. Medical Disposition(s): 

1. 0 No Medically Determinable Impairment 

2. 0 Impairment(s) Not Severe 

3. D Impairment(s) Severe But Not Expeded to Last 12 Months 

I'" 4. 'O"Meets Ustin~' ---"----_ ----~-- ------- (C~e Listing) 

5. 0 Equals Listing' ____________________ _ (C~e listing) 

6. ~'.FOlFC}~:55essJ":lent Nece~sary 

.. 7. 0 Coexisting Nonmentallmpalrment(s) thatRequlres.Re1erral to Another Medical Specially 

8. 0 in~sufficient-Ellid~nce 

C. Category{i~) Upon Which the Medical Disposition is.Basi.d: 

1. 0.'12.02 Organic Mental Disorders 

2. 0 12.03·Schizophrenic, Paranoid and Other Psycno~c Disorders 

3. 0'12.04 Affective Disorders 

4.. f8i 12.05 Mental Retardation 

5.. 0,2.06 AnXiety-Related Disorders 

.... _ (:i, D12.Q?.SgrTl~~~_Il1JQJs_<:"ders. 

7. 0. 12.08 perso~ality Disorders 

8. 012.09 Subslance Addiction Disorders 

9. 0 12.10 AUtism and Other Pervasive Developmental Disordero 

o These findings complete the meCllcal portio~ of the disability determination. 

MC/PC's Signature ,.-f 

MC{PC's Printed Name Code . 

_______________ .Permanent Subcommittee on InvestigationJI ___ J. _____ ~_ 

Fo"" SSA·25<)6.BK (06·2001) D_oy Prior Ed''''''' I EXHmIT #5b I 
394 

II .. DOCUMENTATION OF FACTORSTliAT EVIDENCE TliE DISORDER 

A. 12.02 Organic Mental Disorders 

o Psychological or behavioraJ aonormalities associatsd with a dysfunction of the brain .,< as evidence"d 

by alleasl one of the 'following: 

1. 0 Disorientqtion to time and place 

2. 0 Memory impairment 

3. 0 Perceptual or thinking disturbances 

4. 0 Change in personality 

.5. 0 Disturbance in mood 

6. 0 Emotional lability and impairment In Impulse control 

7. 0 Loss of measured intellea1u~I·abiHty·ojat least 151Q points frompremorb·ld levels or overall 

impair:ment index clearty wHhin ttieseverety impaired range on neuropsychological jesting, e.g.,' 

the Luria-Nebraska, Halsiead~Rettan, etc. 

o A medically determinable Impalfl11ent Is present that does not precisely satisfy the diagnostic criteria above. 

D~oroer ____________ ~------------------------------~----------

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of th~impairment: 

o InsulficiEm! evidence to substantiate the presence of the disorder (explain in Part IV, Consultanfs Notes). 

Form SSA-25O&-BK (06-2001) ef (6-2005) (2) 
395 

B. 12.03 SChlzoplir4lilc, Paranoid and other Psyc'hOtic' Disorders 

o Psychotic features.and deterioration that are persistent (continuous or intermittenQ. as evidenced by 

at least o~e Q! the 1011o";n9: 

1. 0 Delusions or hallucinations 

2. 0 Catatonic or other grossly disorganized behavior 

3. CJ Incoherence. loosening 01 associations. illogical thinking. or poverty of content of speech 

if· associated ";th one 01 the 101l0";Rg: 

a. 0 Blunt affect. or 

b. 0 Flat affect. or 

c. 0 Inappropriate affect 

4. 0 Emotional withdrawal and/or isolation 

o A medically determinable impairment is presenUhat does not precisely satisfy the diagnostic criteria aboVe. 

D~order ______________ ~ ______ ~ ____ ~ ____ ~~ ____________________ ___ 

Pertinent.symptoms. signs. and laboratolY findlngs·that substantiate the presence of this impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain In Part IV. Consultanrs Notes). 

Form SSA-2506-BK (06-200 1 I ef (6,2005) /3) 
396 

C. 12.04 Affective Disorders 

o Disturbance of mood, accompanied by a full or partial manic or depressive syndrome, as evidenced by 

at leasl one of the following; 

1. 0 Depressive syndrome characterized by at least four of the following; 

a. 0 Anhedonia or pelVasive loss of Interest In almost all activities, or 

b. D.Appetite .disturbance with change in weight, or 

c. 0 Sleep· disturbance, or 

d. 0 Psychomotor agitation or retardation, or 

e. 0 Decreased energy, or 

1. 0 Feelings of guilt or worthlessness, or 

g. 0 Difficulty concentrating or thinking, or 

h. 0 Thoughts of suicide, or 

o Hallucinatio.ns. de!usions or paranoid thinking 

2. 0 Manic syndrome characterized by at least three of the following; 

a. 0 HyperactiVity, or 

b. 0 Pressures of speeCh. or 

c. 0 Flight of ideas, or 

d. 0 Infiated self-esteem, or 

e. 0 Decreased need for sleep, or 

f. 0 Easy distra?tibillty, or 

g. 0 Involvement in activities that have a high probability of painful consequences which are not 

recognized, or 

hJ:'1 Hall~?'-"a.ti~!'s" ~e.!.u~l<'.I1.s. or l:',,~~ld thl~~i."-L _ . 

3. 0 Bipolar syndrome with a history of episodic periods manifested. by the full symptomatic picture of 

both .manic and depressive syndromes (and currently characterized by e~her or both syndromes) 

o A medically determinable impairment Is pre~ent that do~s not preCisely satisfy the diagnostic criteria above 

Disorder _____________________ .,-_______ _ 

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of this impairment 

(explain in Part IV, Consultant's Notes, W necessary); 

o Insufficient evidence to substantiate the presence of the disorder (explain In Part IV, Consullan1s Notes). 

Form SSA-2506-BK (06·2001) ef (6,2005) (4) 
397 

D. 12.0S,M"nfaI.Retardation 

o Significantly subayerage general intellectual functioning with deficits In adaptive functioning 

inijially manWested during the developmental period; i.e., the evidence demonstrates or suppo~s 

onset of the Impairment before age 22; wnh' one of tM fallowing: 

1.0 Mentallncapeclty'evidenced by dependence upon others for personal needs (e.g., toileting, eating, 

dreSSing, or bathing) .and inability to follow Instructions suCh that the use of standardized measures 

of intellectual functioning Is precluded' 

2.0 A valid verbal, periormance, or full scale'IQ of 59 or less' 

3. OA vaiid verbal, periormance, or full scale IQof 60 through 70 and a physical or other mental 

imp;3irment Imposing an additional and significani work-related Umijalion of function' 

4. 0 A valid verbal, performance, or full scale IQ of 60 through 70* 

.~ A medlcally"determlnable impafrmenns present that does nOt precis~1y satisfy the diagnostic criteiiaabov9. 

Disorder Learning Disorder t bo~_derline. i~te:llectual functioning 

Pertinent sym~toms, signs, and laboratory flMlngs that substantiate the presence of this impairment: 

"NOTE: Items 1, 2, 3, and4correspond to listings 12.05A, 12.058, 12.05C, and 12.tlSD, respedively. 

o Insufflcient"evidence to substantiate·the presence of the disorder (explain in Part IV, Consultanrs Notes). 

Form SSA-2506-BK (06-2001) ef (6-2005) (5) 
398 

o Anxiety as the-predominant disturbance or anxiety experienced in the attempt to master symptoms, 

as eviden,~, by 8t1e,0111.on8 of t~,e foUowing: 

I, 0 Generalized persistent anxiety accompanied by three of the following: 

a. 0 Motor t~nsion., or 

b; 0 Autonomic hyperactivity, or 

c. 0 Apprehensiye expectation, 

d, 0 Vigilance and scanning 

2. 0 A persistent irratio'nal fear of a speciiic object, activity or situation ~hich results In a compeillng 

d";ire to avoid the dreadeQ~biec1, acliv~y, or s~uation 

3, ,0 Recurrent se.ere'panlc,attacks manifested by a sudden unpredlclable'onset of inlense apprehension, 

fear, terror, arids~-se 'iif impe'riding doom 6ccuri'ing"on the averageof al teast once,a week 

4. 0 Recurrent obse.ssions or cQmpulslons which are a source of marked- distress 

5. 0 Recurrent and Intrusive recollections of a traumatic eXperience, which are a source of marked 

distress 

o A medically determinable impairment Is pre'se~t that do~s not precisel~ satisfy the, diagnostic criteria above. 

D50rder __________________________________________ ~~ ______________ _ 

Pertinent symptoms, signs, and laboratory findings that substantiate the presence of this 'impairment 

o Insuffiqient evidence to substantiate the presence oftha disorder (explain In Part IV, Consultanrs Notes), 

Form SSA,2506-BK (06'2001) ef (6-2005) (6) 
399 

F. 12.0"7cSomatofonn·Oisorders 

o Physical symptoms for which there are no demonstrable organic findings 0; known 'physiological 

mechalJjsms, as evidenced by at least one of Ihe fo.1lowi~g: 

1. 0 A hisfpry of multiple physical symptoms of several years duration beginning before age 30, that have 

caused Ifte indMduallo take medicine frequently, see a physician aften and aller I~e patterns 

significantly . 

2. 0 Persistent nonorg,mic disturb~nce of one of the foliowing: 

a.D Yision, or 

b.O Speech,or 

c: 0 Hearing, or 

d. 0 Use of a limb, or 

e. O'Movement and its control (e.g., coordination disttirbances, psychogenic seizures, akinesia, 

dyskiiiesia), or ' 

f. 0 Sensation (e.g., diminished orheightened) 

3. 0 unrealistic interpretation of physical signs or sensations associated with the preoccupation or belief 

that. one has a serious dlseasa.or InjUry 

o A medically determinable impairment Is present that does not pr.ecisely satisfy the diag.nostic criteria above. 

D~ord.r __________________________________________________________ __ 

Pertinent symploms, signs, and l,aIboratory lindings that substantiate the preSence of this impairment: 

o Insufficient evidence to. substantiate the presence of the disorder (explain in Part N, Consultants Notes), 

Form SSA·2506-BK (06·2001) ef (6'200~) m 
400 

o Inflexible and maladaptive personality traits which cause either significant Impairment In social or 

occupational functio.ning.Q~ s.y.b.jeclive distress. as evidenced by at least on.e of the following: 

1. 0 Seclysiveness or autistic thinking 

2. 0 Pathologically inappropriate suspiciousness or hostility 

3. 0 Oddities of thought, perception, speech and· behavior 

4. 0 Persistent disturbances of mood or affect 

5. 0 Pathological dependence, passivity, or aggresslvity 

6, 0 Intense and unslable interpersonal relationships and impulsive and damaging behavior 

o A medically deler:nln.able impairment is present ihatdoes not precisely satisfy the diagnostic criteria above. 

D~o~er ______________ ~ __________________________________________ ___ 

Pertinent symptoms, signs. and laboratory findings that subslamiate the presence of this impairment: 

o Insufficient evidence to SUbstantiate the presence of the disorder (explain in Part IV, Consultanfs Notes), 

Form SSA-2506-BK (06-2001) ef (6-2005) (8) 
401 

·.H. 12:09'Substance 'Addictlon Disordel'S 

o Behavioral changes or physical changes associated with the regular use of substances that affect tne 

central nervous system. 

If presem, evaluate under one or more of the most closely appUcabie listings: 

1. 0 Usting i 2.02-0rganic mental disorders' 

2. 0 Listing 12.04-Affective disorders" 

3. 0 Listing 12>oe~Anxiety-related disorders· 

4. 0 Usting 12.08-Personallty disorders' 

5.0 Usting 11.14-Peripheral neuropathies' 

6. D listing 5.05~Liver damaQ:e* 

7. 0 Listing 5.04-Gastritis· 

8. 0 Listing 5.08-Pancreatitis" 

9. 0 listing 11.02 or 11.03-Seizures· 

o A medically determinable impairmen't is present that does not precisely satisfy the diagnostic criteria above. 

________ ________________________________________________ _ 

Peninent symptoms, signs, and laboratory findings that substantiate the presence of this Impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Pan IV, Consullanfs Notes). 

NOTE: Items 1,2,3,4,5,6,7,8, and 9 correspond to listings 12.09A, 12.09B, 12.09C, 12.09D, 12.09E, 12.09F, 12.09G, 12. 

9H, ~ 12.091, respectively. 'If ite'ms 1! 2, 3,'or 4 are 9he6ked, only,the numbered. items in subsections iTA, IIC, liE, Dr IlG 

f ,the form need ~ checked. The first block under the djsorde~ heading in thbse.subsections should not be checked; u'nless 

e e\lidence SUbstantiates the presence of the disorder separate from the substance addjction disorder, 

Form SSA-2500-BK (06-2001) ef (6-2005) (9) 
402 

o Qualitative deficits In !he development of reciprocal soclallnter~cti6n, in the development of verbal an,d 

nonverb,al commun'ication skills, and in imaginative activity. Often there, is a mal1<edly restrided repertoire 

of aaiViiles and intereSts, which frequently are sterootypoo and repetitive. 

1. 0 Autistic disorder, with medically documented findings of all of the following: 

a. 0 Quallta:tive deficits in reciprocal social interaction 

b. D· Qualitative deficits In verbal ruid nonve~al commu'nication and In imaginative activity 

c.o MarKedly restricted repertoire of activities and Interests 

2. 0 Other pervasive developmental disorders, With medically documented findings cit bo!h of the following:, 

a. 0 Qualitative defidts in reciprooal social interaction 

b.O Qualitative deficitS in verbal and nonverbal communication 'and In imaginative activity 

o A medically determinable Impeirment is present that does not pr~isely 's:atisfy the diagnostic criteria above. 

Osorder ________ ~~ ____________ ----------------____ --____________ _ 

Pertinent symptoms, signs, and labomtory, findings that ,sub,stantiate the presence of this Impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain In Part IV, Consultan!s Notes), 

Form SSA·2506-BK (06,2001) ef (6·2005) (10\ 
403 

"III: RATING OF FUNCTIONAL LiM"TATIONS 

-.. -

A. 'B' Criterfa ofthe Listings 

Indicate to what degree ihefollowing functionallimhations (which are found in paragraph B of listings 12.02-

12.04, 12.06--12.08 and 12.10 and paragraph D of 12.05) exist as a resuH of the individual's menial disorder(s): 

NOTE: Item 4 below is more than a measure offrequency and duration. See 12.00C4 and also read carefully 

the instructions forthis' section. 

~~~~ the listing(s) (I.e., 12.02 through 12. 10) under which the kerns below are'being rated _____ _ 

FUNCTIONAL 

liMITATION OEGR.EE OF liMITATION 

None Mild Moderate Marked' Extreme> Insufficient· 

1. Restriction of Activnies Evidence 

of Daily living 0 ~ 0 0 0 0 

None Mild Moderate Marked' ExJreme' Insutllciant 

2. Difficuhles in Maintaining Evidence 

Social Functioning 0 0 ~ tJ 0 0 

None Mild Moderate Marked' Extreme· Insufficient 

3. Difficuhles in Maintaining Evidence 

Concentration, Persistence, 0 0 18 0 0 0 or Pace'. 

one Foul" 

or or Insufficient 

4. Episodes .of None TWo Three' Mo'rEi Evidence 

Decompensation, l&1 D 0 0 0 Each of Extended Duration 

.- . - .... - ,_ .. - -. -- .• .. -.-- ... ... ----" -, -- -_. - " .. -

·Degree of fi'nilation that saii!!lf!eS the functional criterion. 

Form SSA-2506-BK (OS-ZOO 1) ef(6-2Q05) 1111 
404 

B. "e" criiirii!oH!ie'UStings" .. " --' . "._ .. " ....... -

1. Complete thi~ s~cti~n ~ 12.02 (Organic Mental). 12.03 (SchIZophrenic. etc.). or 12.04 (Affective) applies 

and the requirements in paragraph B of the appropriate listing are not satisfied. 

NOTE: It0011 b.elow is more than a measure of frequency and duration. See 12.00C4 and also read 

carefolly. the .instructions for this section. 

o Medlcally.documented hiStory of a chronic organic mental (12.02)., schl:zophrenic, elr:. (12.03), or affective. 

(12.04) di~ord!lr of 1\tleast'2 years' duration that has caused mora than a mlnlmalllmHatlon of abilHy to do' 

any basic woikactivHy, w~h symptoms or signs currently a"eouated by medication or psychosocial support, 

and one 01 the'following: 

1. 0 Repeate9 episodes of decompensation, each of ext-ehded·duration 

2. 0 ~ !e¢iduaHjjsease process that ha~re~ulted in syc~, m.arginal,adj!,stment that even a minimal 

.iricrease .in:m.eotill demands or change in the e",,ironment would be predicted to cause tbe .individual. 

tQde.;.;l1'lp~i!l 

3. D Current-history oft or more years' Inability to function outside "·.hlghly supportive living arrangement 

w.hh ari' indication of continued need for such an' arrangement. . 

o E~idence d6e.~ not establish the presence of the "Gil criteria 

o In~ufflcie~i ~vldence to establi~h the pre~en~e of the "C" crit~ria. (explain In Part IV, Consultant's Noles). 

2. Complete this section ~ 12.06 (Anxiety·Related) applies ill!\! the requirements in paragraph B ollisllng 

1 ZOO are not satis!i6d. 

o Complete inability to function independently outside the area olone's home 

o Insufficient evidence to establish the presence of the "e" criterion (explain In Part IV I D?nsultant's Notes). 

Form SSA·2500-BK (06-20011 eJ (6'200S) (121 
405 

IV,., COt:!SULTIWf'S NOTES 26 years old alleges poor readin'i! .pel~ing, developmenta.1 delay _"".<I learning ." dlsotaer. -No known mental Health treatment past or current. Ce exam shows verbaj--

scores of 66, performance of 78 and full scale of 69. claimant retain ability to 

do simple work. 

Form SSA-2500-8K (06-2001) ef (6-2005) (131 
406 

Se<;Hon 223 and:!;"ctioil..;i:Q(l3 oHhe Social Seauity Act authorize the information requested on tbis form. The- - information_pro'lided_w.ill_be. used.in making a.decision.oJl..t:his-cJajm,..Gomplotion of tbis tom·is· mandatory· mdisability claims involvingmental impainnents. Failure to complete tbis fonn may result in a delay in 

Il'r?",lSsing the,.clai(ll. Iniofi!Iation furnished on this fOfl!l·may be disclosoo by the Social Security 

inj§tj:;ljionJQ !lI1Q.tj!!,r P!lfl!On or governmental agell,}, oll.ly.ll'itb. re.~ct to Social Security pr<).grams and to mply with federal laws requiring the 'exchange of information between Social Serurity and another agency. 

We may also use the infonnation you give us when we match recorcis'by computer. Matching programs 

compare. our records with th,ose of other Federal, State, or local government agencies. Many agencies may use 

matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The 

law allows us to do this even if you do not agree to it. 

Explanatioos about these and other reasons why infonnation about you may be used or given out are available 

in Social serurity offices. If you want to learn more about tbis, contact any Social Security office. 

Paperwork Reduction Act Statement -·This infonnation collection meets the requirements of 44 U. 

S.C. § 3507, as amended by Section 2 of the Paperw.orkReductioD- Act 00995. You do neit need to 

answer. these. que~~ruis onless. we display . .a.v.alid Office.p~Ha~l!iem,eIiI aml Budget control nuIIlber. 

We estnnate tha)',t will.ta:k;e. about 15 nunutes to read .tI)~ IllSlroctlOns, gather the facts, and answer the 

questions .. ~E,NQ:ORl.U~JN_G TIlE COMfLET~:l'l)!ijI1.JQ'yOUR. 

: LOCALSO€lAIiSE€URfTY:OFFlCE; To fln<nfie ndrest office, call1·.800·772~1:213.Send 

. f»lls!. cotTi/triMs on Our time'estimate above to: SSA, 6401 &'dirity BoUlevard, Baltimor-e, MD nllia~ . . - . . 

Form SSA-25CJ6..BK (06-2001) of (6-2005) (14) 
407 

:1 

PSYCHOLOGICAL EVALUATION 

. I. 

AGEI .. 2!i~' 

~~_II¥ING:'~tl'l DATED:OF REPORTa:-, ....".~ . 

Taday's telilinl1 and intorVj;w~nd!»'lt was ~femd by !he DiuI1illtyDe~IItiOD 

DIVision of !he Oldehotl'la De_liiitofRchabUitati~n Servi. 'I'I\e' Wecluler Adult 

Intelligence Scalc-lbird'Ediii9i1:tW:;MS Ill) testing arid bri~ mentalSlatiJ5e~ 

interview were oollciuoteci o ... M ciijiJlii!jliUt.bMls Irt a priyaj.e J,mce enyi~. The 

chul1UUIl came wone lo'the Interview' Slle drove but she lIollllfil . 

TIle ~\alm8nt18 a 2(j.;~~_-ol¢ 

olioN Iii biiild. 

w8$ below average .. 

Motor .l,ehavior· WIllI 

the "Ialmant, 

Tho: gWmtntt:qmp\eted !he i:i~;gmde. in high "',,?~1. she _ \11 :~~Iil! ed~tiQn 

. P. 5 ·0 t"'. e4 

~::"'.'a1~~ ..• '~~S:~~:::~~~~at~,sbtves:!:=:=. The job endld baiaUse shewastold;shc WIl!II'j iii rut the JO~.· . 

Physical and medi~lplUblemBini:l11dcbypettensiOll. She i~ alsn cuTrerrtly ptCgmlIlt. She 

is. suppoMdto tak<:medleationfor b~msion bUt she dOe,.n'l . 

Mental8lld emotional pfubl~lI1i.aredl!!lCl'ibed by bet MClt~oshel~ ~ andretantoo. 

She dOes nOt II!iC a1oohillor4tug$: Slie' W!18 in trouble witiitliepOiicC'wn~ She II!IiIII 

friend _.BCCU.'OO orrihopliffing.Sbe Ih9lighflhe Mend wa.~ gtilllg to'jSay fOT the 

merclumdiso:. She em'! get8torig wlth.he.. brother and'has tried to hlirtlilm. 

She WI!8 Ilbl~ to corr~t1Y write her l1iIme.age andlOdll)"s dale. Ii!'!' ~ was tuUy 

e.:.Mprthlmsible. . 

Alfeet and hchllvior were observed \0 lxI t8itly ~all\le, fidgety II!Id senOUll. She Was 

cooperatiye with the examlnel. At~tio:n ~ fOliWlid. BffortonJ ~i9atim\ were good. 

Results areillterpn:tCd IIlrbeing Vli1ld; :Observalionsuf adIIJitive bclia'ii6r i!Jld 

~HOnaJ jlYlils~iilrff.;r Of~llUIf Is c6liStSfent'Mih\ihC-obtained TQ ~re. . 

The "biimWlt is judged to be incaPable of handling lillY awarded bcAoiillin 1\ rellpOlIlIible 

manner. 

Permanent Subcommittee on Investigations 

EXHIBIT#5c 
408 

~11:34AM -"'98:55 AM '.~~-' 

The 9laimlllrt's oumnt 'evel of intellectual functioning was at the lap of the 

EXTREMELY WW nmge, as reflected by a FuJI Scale IQ 8C!)1e of 69 on the W AJS-m. 

The VerbiiI [Q Ift;OlC of66 \VII! In the EXTReMELy LOW nmge. The Perfonnance 

(Viaual-MotiJr) IQ 8COnI of'S was ill the BORDBRLINE ranlle. 'I'herc was a not quite 

significant difforence of twelve points between the Verb&! aiId'PerfOrnllnce [Q 1ICOm. Subtcst SCOres ranged from 3 to 9, slightly abovelhe average range ofvanallUlty. 

DSM IV Diqaosis 

AAls J: Learning Disurder NOS 

Axis II: None 

AxIs 01: HypenenaLon. ~cy 

Axis IV: Oc>I:ujni\ional; Parililial 

Axis V: GAl' " 4S 

P. 6 

.... 05 
409 

Social Security Administration SSA-4268 

EXPLANATION OF DETERMtNATION 

N~PF Cb8!,~ll!Ikw," , W/E's NAME (IF COB or S"-I)!.. ,",' "it CLAIM TYPE 

.-:.:.::::::: ___ ~-.:_:::::.;:!L ____ ~~~ _________________ ~~~_:::.::::~_:.. ___________ ~~ __________ _ 

26 years old alleges poor 'reading and spelling skills, developmental delay and learning disorder. Claimant 

received a Mental PRTF and MRFC assessment for simple work, 

---1." Permanent Subcommittee on Investigations , ..... _, _h"-. X[ EXHIBIT #5d 
410 

(The following is a transcript in the hearing held before 

Ralph L. Wampler, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, ~"II~IIII" May 13, 2008, at Oklahoma City, Oklahoma, in the case of ... 73. I Social Security Number I III The CIa mant 

~pp~ared in person and was represented by ._ •. Also 

present was Medical Expert.) 

(The hearing commenced at 8:38 a.m. on May 13, 2008.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: We'll go on the record. 

HA: We're on the record. 

ALJ: , as you know, we're unde.r a short timeframe, so 

what 

ATTY: Yes, sir. 

ALJ: The documents here in the file have been marked for 

identification as Exhibits 1A.through 7F. I propose to receive these 

into evidence. Any objections to their admission? 

ATTY: No objections, Your Honor. 

ALJ: Let the record show that Exhibits lA through 7F are 

received into evidence. 

(Exhibits 1A through 7F, previously identified, were received 

into evidence and made a part of the record thereof). 

ALJ: Thank you. I'm going to take the medical 

expert's testimony first and see where we are in this case. 

ATTY: That's fine, Your Honor. 

(The Medical Expert, n ----~----., having been first duly sworn, testified as follows:) 

EXAMINATION OF MEDICAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q n~~ state your name and occupation, please. 

A ' ~.' (Phonetic). I'm a licensed clinical psychologist. 

Permanent Subcommittee on Investigations 

EXHIBIT#Se 
411 

2 

Q And you've been furnished with a copy of the medical 

documents, have you not? 

A Yes, I have. 

Q What do those documents show the Claimant suffers from? 

A This individual has a diagnosis of mild mental retardation and 

a diagnosis of a learning disorder. It's my opinion that she meets 

12.05. 

Q 

A 

12.05. Okay. Now, can you address the B criteria (Phonetic)? 

Yes, Your Honor. In restrictions of daily, daily living 

activities, I believe there's a mild restriction. 

Q Uh-huh. 

A In maintaining social functioning, I believe there is a 

moderate limitation. 

Q Uh-huh. 

A In maintaining concentration, persistence, or pace, there's a 

marked to extreme restriction. 

Q Okay. And then episodes of deterioration? 

A I don't have -- Your Honor, she's living in a pretty 

restricted environment 

Q Uh-huh. 

A -- and, and not doing things that are, are causing these to 

occur and I don't have any I have very limited documentation, 

actually, but I don't have documentation. 

Q Okay. 

A So, I'd just say I don't have enough information. 

Q NOW, she 'alleges that she became disabled May 1st of 2004. 
412 

3 

Was she at that level of severity at that time? 

A Yes, Your Honor. This is has been a lifelong issue. 

Q Okay. Would you recommend a payee? 

A Yes, I would. 

Q Okay. 

ALJ: ____________ -- I don't see a need of going any further unless 

there's something you want to call to my.attention. 

ATTY: No, Your Honor. I'm· happy. 

ALJ: All right. I'll take the matter under advisement. The 

hearing is closed at 20 -- 19 minutes till 9:00. Thank you, and you 

all are excused. 

CLMT: Thank you. 

(The hearing closed at 8:41 a.m. on May 13, 2008.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

~:~dc~~p~~~ec~~:n~~dption of the testimony r~~~~~:dA~i~~~t~:~f~:gLaw 

Judge Ralph L. wamP1J¥? 
413 

IN THE CASE OF 

'SOCIAL s£cuRI'rv ADMiNISTRATION 

office otblsabflity Adjudication linef ReView 

DECISION 

CLAIMFDR 

-------

Period ofDis~ility, Disability Insurance 

Benefits, and Supplemental Security Income 

(Claimant) .7 ' 

. ···:·t·"",,~"'··;··: 

(Wage Earner) 

This case is before the 1!Iidetsigned on a renne''','''T 

appeared and testified at itilearing held 

'.-: "-, aniiliparti31~edi~j' e··,·q·)t. on. ;;,"'"SO .. l1l':l'e."",{l.a. Lnt:.m;anug. 

represented by: . an attorney:. 

The claimant is alle~g <;Iisabili!)i'since May 1,2004. 

The decision on·the claimant's prior Title I!'application 

reopened and revised. The·initial ~i:letermillation on ilie 

withm 4 years ofiiii:'filiriiditte of'iheturrentappllcations 

is 

being 

issued. 

established. New and materiillevidencehas been '. et seq.), The 

d\=Cision on the prior 'ritle XVI appJication has not been reopeneil be~use the current 

applications were not filed within 2 years of the notice of irnti!i!.determination (20 CPR 416.1488 

el seq.)." .. . , 

The issue is whether the claimant is disabled under sections 216(i), 223(d) and 1614(a)(3)(A) of 

. the Social Security Act. Disability is defined as the inabiiity to engage in any substantial gainful 

activity by reason of any medically determinable physical ~r mentai'impairment or combination 

of impairments that call b,e,ex,pe~t~ II:' result in death or t~!i' has lastep or can be expected to last 

for a continuous period of not less than 12 months. 

With respect to the claim for a period of dislibility and disability insurance'benefits, there is an 

additional issue whether the inSured status riiquirementsof:sections 216(i) and 223 of the Social 

Security Act are met. The claimant's earnings record shows that the claiml!!lt has acquired 

sufficient'quarters of coverage to 'remain'insured through Mar~10j)'S:Thus;theclairilant 

must establish disabiIiiy on or before ihat date in order to be erltiiied to 'a period of disability and 

disability insurance benefits. . . 

Permanent Subcommittee on Investigations 

EXHIBIT#5f 
414 

I. Pag!: 2 of7 

Afkt. careful-re:v.iew of the entire r.eoor-d-,--the-undersi·gned finds that the claimant-has been 

disabled from May 1,2004 through the-da*e:-ef-this decision. The undersigned·also finds· that the 

insured status requirements of the Social Security Act were met as of the date disability is 

established. 

APPLICABLE'LA W 

Under the authority of the Social SeCurity Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404.1 520(a) and 416.920(a». Thesteps are followed in order. If it is 

determined that the claimant is or is notdisabliXI at a step of the evaluation process, the 

evaluation will liot go on to the next step. 

At step qne, the undersigned must lletermine whether the claimant is engaging in substantial 

gainful activity (20 CFR 404. I 520(b).and 41.6~920(b». Substantial gainful a~tivjty(SGA) is 

defined aswor}C activity that is both substantiiil and gajnful. If an ind'lvidlu{~J),gagesin SOA, -

she is not disabled regardless of how severe her. pliy$jeal or mental imp!litrrients <!fe~nd 

regardless of,her, age; education, and workexpeaetiGe: ·Ifthe individual is not eagaging in SGA, 

the analysiS'l'toceeds to the second step.: 

ALstep two,the undersigned must determine w~dher the claimant has a medically determinable 

hnpairment that is "severe" or a combinatien.ofimp . .urments that is "severe" (20 CFR -

404.1 520(c) and 416.920(c». An impairment or cOmbination ofimpaiments is "severe'; within 

the meaning of the regulations if it sigriiff6ahtly Iiffiitsan individual's ability to peoOlm basic 

workactiviiies. If the c1aimant.does net-hav!} a-seYeFIl~lldically det-errninable.imp4i;£nieFlt or 

combination of impairments, she is not elisibled, If-Ih!! claimant has a severe imPairinent or 

combination of impairments, the analysis preceeds to .·the third steP. . 

At step three,.the undersigned must detemline whether the claimant's impairment or combination 

of imp~nnents meets or medically equals.,thNritefi8.of an impairment li$~ m ~() CFRPart 

404, Subpart P, Appendix I (20 CFR 404.i520(~),.404.152~. 404.1526,416.9iO(d),416.925, 

and 416.926). If ihe claimant's impairment or ,combination ·of i,rr.yairn)e"t.~ myets or,medically 

equals the criteria of a listing and meets the duration requirement (20 Cr· l, ..04.1509 and 

416.909), the claimant is disabled. ·Ifit does not; theanaIysis proceeds to the·nextstep. 

Before considenng step four of the sequential evaluation process, the undersigued must first 

determine the claimant'sresidual functi{)mil'-capac,i,ty (20 CFR 404.1.!i20(e)'lindA16~92@(e»., An 

ihdividual's residual functional capacity is herabilHy;!o do physic~]'and-mentarworkaCtivities 

'on asiislliineifbliSii; de~pifeTimitanoils-fiOmnerlmplitfirients:'Ii'-max:iniitiIs1inding;:iJle' . 

undersigned must consider all of the claimant's imparrm.ents, including impairments that are not 

severe (20 CFR 404. 1520(e),404.1 545, 416.920(1:), and 416.945;SSR ~6~8p). 

N ext, the undersigued must determine at step foin- whether the c1aimant,Ji.1\S the residrial 

functional cap'acity to perform the requirementS of her past relevant work (20 CFR404.1520(f) . 

and 416.920(f)). If the claimant haS the residual functional capacity to do her past relevant work, 

See Next Page 
415 

Page 3 of7' 

. . ~. . 

.!be ~Wm,m{j~M:t..\litliD~\iP:~(tljl::Glai~~t.is \lll~ble_iQd.9;l¥1y':pa&lri:levant work or does not 

have any past releY'ant ~6rk, the lIllaiysisproceeds to the fifth and laSt step. 

At the last step'Qft1\.e·s~li!,uential'eyall:latien precess (Ze·GFR,4Q4.15ZGfg) and 416.9ZO(g));the 

undersign.edii1ll~t il~te~r~\i.vii.~il\ef the d.aimarit is able 't:pqP'arlY'otll'et' work considel1ng her 

residual fun6tion.aH,;il'l~~ib'; ~e,¢lluCation, and wQrkeX,p~~'!-~e' If the claimant is able to do 

other work, sfie is,riot,ais.~~~: lfthe c11jimanf isnQt ablet6i4'6,other work and meets the 

duration requireme~t,sheis diSl!bled. Although the clair!}3J)tge"erally continues to haVE: the 

burden Qfprov.mgdis!l1]i'Hty aLthisstep, a limited btitdenofgolng,forwardwith the.evidence 

shifts to tlfe SocialS~iyAarnfrusfi'~tion. lri{)rder'fo scip,port'afindiiig that an individUal is 

not disabled at this step, the'Soclal Security Administtation i~ re~ponsible for providing evidence 

that demonstratesthaJ6tii~ WQr!felCislS i!lsjgnifiCl\J'ltntjihben; tn th,epaiional economy that the 

claimant can.do,given·tlle i:esiajlalfl!ncti'oilal capacity, age, :education; and work experience 

(20 CFR 404.1512(g),4'04)5q()@; 416.~12(g) andAf~:9.M(Ci)j. --, . . .', 

~~~~F>~f~~}<jA<:T.AND':C~~(,;y,!s.tf)~Sf>F LAW 

" . ·After carefui-considi:riltiGri.Gt-th.E}-~ntire-reooFd,·the undmigned,makes,the·.foUowingfindiAgs: 

1. The clsiirrtant's·datela~t:in~~ied.is Mal'ch 31, fOQS. 

2. The';laintant:l,tas-!IQteitgllc~~!nSuhstaDtial gai!!-(1l1 at;tiVijy since May I, ZO,O~,the 

-aUeged-oDnt1tat'etZO'CFR40~:t5iO(b); 404.1571 'iatq., 416:9toM and 4t6.911 et seq.). 

3. Theclahrtanthai,t,hefoUowillg seve .. e ilOpairmell~(s): mentlllr.etardatioJ;l (ZOCFR 404.r520(c)'1i.nd416,9~9(c». '. . ,.,. • " , 

4. The sey.erity~Hhe~lQll!Dt?S U1e~tal·r.e~a .. 4atiOIl;U1eet5Jhe'cliteria of seI!TIon(s} iZ.05 

of 20 crn Raft 41i4, sUbpiiftP; Appendix I {iO CFR4'04:i~iO(d).'and 416~92ri(d». . ,.r." .' . .. _ .. , 

[n ma)dng this finding,; the undersigned considered all symptotrtilirtdtheextent to which these 

s~ptomS can reasoriilply pe'accejJ.too as consistent Witliihe 6~jective ;nerlicalevidence and 

other evidence, bas~ on ttie reqmremen!$ of2{l eFR 404.15~9 and 4 1'6:929 and SSRs 96-4p and 

96-7p. The undersigned has also considered dpinion evidenCe in accordance with the 

requirements of20'CFR'404.1527 and 416:927a.rtdSSRs 96"2p, ~6·5p,.96-6p and06.3p. 

A psychological evaluation was np,'fm.".,,0£1 ------.. and is 

-shown'betow:- - ... - .,'. --- , ._;;:;.,.:J!,!=~.:J_ 

See Next Page 
416 

Page 4 of7 

-1i - - 's .. ----Wi imltViGW- -_._- -·-·-wiiCerred by me Piia6UttYDi~ 

Dl~Oii:: Okt&bOmiDe=lt~~OlI Service.. iIiO W~I~ A8Ult 

IntcUiaence SCIIle-lbird .lidilion (W AI8 III) ~ and brief mm181 status exlUll 

in~eW were c.ondudcd on lID OutpatlcntbGsisUl u priWIt mJiee eJlvi~. The 

clairnanl caiDe alone to the IQterview;Shc draw but she 1(Ot 10Jil. 

~e~bu' isa 26;-yoar-oId;,ai :-::,~ltiL~ ':~he. Sbe~~ iD

Hcr

· ~ ~ 0 .... 80·01 lid. She iii pregnant and ttet~ iII:dl,lC·t c ODd of~. ·1PQOiJU1II 

was.belowaverage-. Dre$$'WIlS -.oiled, PoStlmt~ ~kable. Gail waa~. 

Motor behavior Y/JS Kstless and fidgety. Ambulallun WQ$ UCl8SSiJ1ed. The inf~t was 

the claimant. 

Thecu.i.man\ oomplecled the It'J gra4e in higb~~1. She wi, \Il specia1~ 

c~ allthrouab scho\>l. She .,i'le:v~ ~ married. Sbe lives with ·bet,. clliIdreft,. 

~~'::W~~:C::~L:~~I:;~~i!~·Iea$·thMtOnCWeCL 

Ph)ist,ut~ IIltdl~probIeri1B_I~~:~~iQJl.. ~ ill,-I~ c~1y ~~ _ She 

is BIqI.pGa6I1 ~ take metJ~tioD·1'o{ hy.pcJ\t:n5lon but she docsn'l - . . 

M •. aildernOti<M1a\ problema art~be4.by ~ II1Oth$' os bei~ Ct'OYa9dreiamed. 

S~ ~ 00' WIe ~horOf dnlgs. Shll wisatn.i:rOublc wiUt the "liCe wbcD shiilid a 

friend were accWiedofahoplifting; -Shc·tboQSbUhe.fricnd WaS ~1O·j)py·fur·_ 

m~&e. S~ ctw'H~et alo.s!i.~~J#~~ IUId bas t~clho bt.in film. . 

She ~~ble w correctly 'M'Iteher name... age mdtollay'll diill:!. Hilt Speech was ~)' 

etJ~ensible. . 

AJJ~lU}d ~lt.vlor were observed to be fe&l)'~a'IVe;.I1dJetY aNI -:us, ~ Was 

cooperative with the exam1n.el •. Atl$l\tiOn~ rocusea Effdrlimd ·nu;uVlliion • good. 

RUW\i'-are InterpT'ClCd asbelns valid.' ObileMlions uradilpttve behavior *i\d 

imerpetsonal style suggest a leVd ~f 1'wl.ctiOnlDg that is conslstetrt With ~ ollcalned.'1Q ~. 

The claiructt 11 Judged. to be i~le or handling lIlY awarded beDet'i:UI m a mpolllrible 

manner. 

See Next Page 
417 

Page 5 of7 

, ' 

--~-------- -;-- - , . , 

·Thedaj~t·1 '1~ftfvQl:of,nteJrecCtuat"fuitCfioiilij was ~dhe klp ofdie .EXTRE1\f~LY w,w,: " ' '!'etl~ bn FUll;, '.' . ! JSCOl'e of 69, ontl;le WAlS-nt 

1lIf Vf.i&fVlri tbtFXllU~MtILY, " ' , .,11tcJ~etfonnauce 

,z!u~:·r ,', ~u~~t:=:.~·,~:: ,:=~~= Subccst ~'ra,ng' ,m-:3"fu19~ sllgbfiy' &bon the av~'riutgc of~-

OSM IV 1>tfi!!g.is, 

Mis 1: ~Djsprder NOS 

A1dt IJ: ~~'", 

Axis'W: Hf.Ij' ':~f$i Axis IV: , '-,'; 

'Axis V: 

, rrih,tlfP!~gist.{CIihk:al) 

.. +.---

cHU:':~~, Ot.t.~!!. 

11'1 \"Our opinion iIr the ~dGllt abl.' to lIIAl\qe ",eUt pa)'lllellt8 ill hla/bclrOlftl illte>:68t9 

YB8_, ___ _ ,~ ,)( 

, I ' 

... ____ L.._ .. 

See Next Page ' 
418 

j 3 ( 'J !'"age 6 on 

l1li)1' NO t;V(ae(1Ce '10.01 f1SI!'Q18 

SignlflCanUy Madera/ely Markedly 01 UinDalion ill otI Aw8ab1e UmI1ed Uinlled Umlled 1hIs category Evtdence 

A. UND.E.8SIAIl!l2fNG'ANQ MEMORY 

I, The ability 10 remember locations and 1·,8 2,0 . wor\<·Hke procedures, 3r. ..... 4, 0 5.0 

2. The abllily 10 understand and rernem· 

~ 1. ® 2·0 3.0 4.0 5·0 very short and.lmple Inslrocllons. 

3. The ablllly 10 undelSland and iemem· 1·0 20 3, a 4·0 s.O bet delailed Insl~lons. 

8. 5!'!sIeJt:lIEIl CONCENTBAIIQt:lI ~ ~BSl.S.l::EI':IC 

4. The abilily 10 carry out very short and 

Gimple instllldlons. 1. r&j 2·0 3·0 4·0 a, 0 

5. The ability 10 carry out de/ailed Instruc- 1·0 2·0 3.B 4.0 5. 0 

r I estified at the hearingthaqhe C1mrnailt's irnpainnent has met thecrit~ria of Listing 

nose all of her life. The. eyjdenceshOWs that the claimant was insPccia\ education has a' 

verbal IQ'of 06,a learning disorder; aniLtiDAFof 45. The'undersignea concUrS with. 

tssessment. . 

After consid; the eviden'7 ofrecord, ttie ?ndersigned finds thatth.e cIaiDlant'smedical1y 

detenninablelmpainnent(s) couldreasoTJ8plY be expected tojlroduce the all~ge<l syirlptoms, and 

that the claimant's siatements concerning'the il)tensity, persistcnceand limitfngeffects of these 

symptoms are genenillycredible.· . 

The State agency medicai opinions l)Ie given little weight because·evidiince received at the 

hearing .Ievel shows that the 'claimant is more limited than detennined by' the State agency 

consultants. Furthermore, the Slate agency:consuitants didnol ad'equately consi'der'tbe 

claimant's subjective complaints or the cOmbiried effect ofth'eclil!martt's .impairments. 

5. Theclilimant hils been under a disability, as det'"med in the S.oclal Security Act, from 

May 1,2004 through a,t least the datI! of this decision (20 CFR 404.1520(d) and 416.920(d)). 

DECISION 

," ',., 

';lrL~~lthe·tl~:t~fiu!~t!aiWe~iiOk!~~!d~d~-~e~~::!Mf6~~~~~%~~~h~~cf~ 8~cufityAct beginning on May 1,2004. 

'r~ on the. application for~upplementaI se~ty. .income,.protectively filed .. onj_.:]'C 

the claimant has been dIsabled under section J6I4{a){3){A) ofthe SOCIal Se'Cunty Act 

D:i:ginning on May I, 2004. 

See Next Page 
419 

Page 7 of7 

The' componenr art)re"Social'Security Administration responsible for authorizing supplemental 

secllrity income' wi!l advise the claimant regarding the nondisabiIity requirements for tbese 

payments, and if eligible, the amount and the months for which payment will be made. 

A determination to appoint a representative payee to manage paymenll! in the claimant's interest 

"~~ol~ .. 0c? 

.... "'L. ~~ 

, italph L Wampler 

U,S.Administrative Law' Judge 

RLW/DAW 
420 

~ 

~s~v' . 

SOCIAL SECURITY ADMINIS],!UT10N 

~-;;.Jflf~.1 Refer To: n I . Office of Disability Adjudication and Review 

sTt' 301 Nw 6th St 

3rd Fioor West 

Oklahoma City, OK 73102 

Date: 

APR 252MB 

NOTICE OF DECISION - FULLY FAVORABLE 

I have made the enclosed decision in your case. Please read this notice and the decision . 

carefully. 

This Decision is Fully Favorable To You 

Another office will process the decision and send you a letter about your benefits. Your local 

Social Security office or another may first ask you for more infonnation. If you do not hear 

anything for 60 days; contact your local office .. 

The Appeals Council May Review The Decision O~ Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do 

so: To do that, the Council must mail you a notice about its review within 60 days from the 

date shown above. Review at the Council's own motion could make the decision less 

favorable or unfavorable to you. 

If You Disagree Witb The Decision' 

If you believe my decision is not fully favorable to you, or if you disagree with it for any 

reason, you may file an aJlpeal with the Appeals CounciL 

How to File an Appeal 

To file an appeal you.o~ your representative must request that the Appeals Council review the 

decision. You must make the request in writing. You may use our Request for Review fonn, 

HA-520, or write a letter.' . 

You may file your request at any local Social Security office or a hearing office. You may 

also mail your request right to the Appeals Council. Office Of Disability AdjUdication and 

Review, 5107 Leesburg Pike, Falls Church, VA 22041-3255. Please put the Social Security 

number shown above on any appeal you file. 

Permanent Subcommittee on Investigations 

EXHmIT#6a 
421 

Page 2 of3 

, Time to File an Appeal 

To me an appeal, you must me your request for review within 60 days from th~ date you get 

this notice.' ' 

The Appeals Council assumes you got the notice 5 days after the date shown abov~ unless 

you show you did not get it within the 5-day period. The Council will dismiss a late request 

unless you show you had a good reason for not fIling it on time. 

Time to Submit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider with your 

request for review. .' 

How im Appeal Works 

Our regulations state the rules the Appeals Council applies to decide when and how to review 

a case. These rules appear in the Code of Federal Regulations, Title 20, Chapter Ill, 

Part 404 (Subpart J). 

If you file an appeal, the Council will consider all of my decision, even the parts with' which 

you agree. The Council may review your case for any reason. It wiD review your case if one 

of the reasons for review listed in oUr regulation exists. Section 404.970 of the regulation lists 

these reasons. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law Judge for a new decision. 

If No Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a·final decision that can be changed 

only under special rules. ' 

See Next Page 
422 

un Page 300 

If You Have Any Questions 

cc: 

If you have any questi~ns, you may call, :write or visit any Social Security offi~e. If you visit 

an office, please bring this notice and decision with you. The telephone number of the local 

office that serves your area is (405)605-3000. Its address is Social Security, 2615 Villa Prom, 

Shepherd Mall, Oklahoma City, OK 

, 

73107. 

U.S. 

ce 

Administrative 

K. Hiltbrand ~ 

Law Judge . 
423 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

(Social Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the Administrative Law Judge on a request for hearing dated January 12, 

2007. The claimant appeared and testified at a hearing held on March 20, 2008, in Oklahoma 

. City, Oklahoma. - ~ an impartial vocational expert, also appeared at the 

hearing. The claimant is represented by L an attorney. 

The claimant has amended the alleged onset date of disability to January 1,2007, on advice of 

counsel (Hearing Testimony). . 

The issue is whether the claimant is disabled under sections 216(i) and 223(d) of the Social 

Security Act. Disability is defined as the inability to engage in any substantial gainful activity by 

reason of any medically determinable physical or mental impairment or combination of 

impairments that can be expected to result in death or that has taSted or can be expected to last 

for a continuous period of not less than 12 months. . 

There is an additional issue whether the insured status requirements of sections 216(i) and 223 of 

the Social Security Act are met. The claimant's earnings record shows that the c1a;mant has 

acquired sufficient quarters of coverage to remain insured through December 31,2009. Thus,. 

the claimant must establish disability on or before that date in order to be entitled to a period of 

disability and disability insurance benefits. 

After careful review of the entire record, the Administrative Law Judge finds that the claimant 

has been disabied from January 1,2007 through the date of this decision. The Administrative 

Law Judge also finds that the insured status requirements of the Socia,! Security Act were met as 

of the date disability is established .. 

APPLICABLE LAW 

Under the authority ofthe Social Security Act, the Social Security Administration has 

established a five-step' sequential evaluation process for determining whether an individual is 

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I) Page 2 ofB 

disabled (20 CFR 404.1520(a». The steps are followed in order. If it is detennined that the 

claimant is or is not disabled at a step of the evaluation process, the evaluation will not go on to 

the next step. . 

At step one, the Adniinistrative Law Judge must determine whether the claimant is engaging in 

substantial gainful activity (20 CFR 404. I 520(b». Substantial gainful activity (SGA) is defined 

as work activity that is both substantial and gainful. If an individual engages in SGA, she is not 

disabled regardless of how severe her physical or mental impairments are and regardless of her 

age, education, and work experience. If the individual is not engaging in SGA, the analysis 

proceeds to the second step. 

At step two, the Administrative Law Judge must determine whether the claimant has a medically 

determinable impairment that is "severe" or a combination of impairments that is "severe" 

(20 CFR 404.1 520(c». An impairment or combination of impairments is "severe" within the 

meaning of the regulations if it significantly limits an individual's ability to perform basic work 

activities. If the claimant does not have a severe medically determinable impairment or 

combination of impairments, she is not disabled. If the claimant has a severe impairment or 

combination of impairments, the analysis proceeds to the third step. ' 

'At step three, the Administrative Law Judge must determine whether the claimant's impairment 

or combination of impairments meets or medically equals the criteria of an impainnent listed in 

20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1 520(d). 404.1525, and 404.1526). If the 

claimant's impainnent or combination ofimpairments meets or medically equals the criteria of a 

listing and meets the duration requirement (20 CFR 404.1509), the e1aimant is disabled. If it 

does not, the analysis proceeds to the next step. 

Before considering step foUr of the sequential evaluation process, the Administrative Law Judge. 

must first determine the claimant's residual functional capacity (20 CFR 404. I 520(e». An 

individual's residual functional capacity is her ability to do physical and mental work activities 

on a sUstained basis despite limitations from her impairments. In making this fmding, the 

Administrative Law Judge must consider.all of the claimant's.impairments, including 

impairments that are not severe (20 CFR 404.1520(e) and 404.1545; SSR 96-Bp). 

Next, the Administrative Law Judge must determine at step four whether the claimant has the 

residual functional capacity to perfonn the requirements of her past relevant work (20 CFR 

404. I 520(f). If the claimant has the residual functional capacity to do her past relevant work, 

the claim'ant is not disabled. If the claimant is' unable to do any past relevant work or does not 

have any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation process (20 CFR 404.1520(g», the Administrative 

Law Judge must determine whether the claimant is able to do any other work considering her' 

residual functional capacity, age, education, and work experience. If the claimant is able to do 

other work, she is not disabled. If the claimant is not able to do other work and meets the 

duration requirement, she is disabled; Although the claimant generally continues to have the 

burden of proving disability at this step, a limited burden of going forward with the evidence 

shifts to the Social Security Administration. In order to support a fmding that an individual is 

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6 &: Page 3 of8 

not disabled at this step, the-Social Security Administration is responsible for providing evidence 

that demonstrates that other work exists in significant numbers in the national economy that the 

claimant can do, given the residual functional capacity, age, education, and work experience 

(20 CFR 404_1512(g) and 404.1 560(c»_ 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideratio~ of the entire record, the Administrative Law Judge makes the 

following findings: -

1. The claimant's date last insured is December 31,2009. 

2. The claimant has not engaged in substantial gainful activity since January 1,2007, the 

amended alleged onset date (20 eFR 404.1520(b) and 404.1571 et seq.). -

3. The claimant has the foUowing severe impairments: status post_right rotator cuff 

repair times two with postoperative pain in the right shoulder, neck, arm, and elbow; and 

cerVical degenerative disc disease (20 CFR 404.1520(c». 

The above impainnents cause significant limitation in the claimant's ability to perfonn basic 

work activities. -

4. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one of the listed impairments in 20 eFR Part 404, Subpart P, 

Appendix 1 (20 eFR 404.1520(d». 

5. After careful ~onsideratio~ of the entire record, the Administr~tive Law Judge finds 

that the claimant has the residual functional C!lpacity to perform light work as defined in 

20 eFR 404.1567(b). She can occasionallY lift and/or carry 20 pounds and frequently lift 

and/or carry 10 pounds. She can stand and/or walk (with normal breaks) about 6-bours of 

a-n 8-hour workday and sit (with normal breaks) 6 hours of an 8-hour workday. Her 

residual functional capacity for light work is diminished by significant nonexertional 

limitalions, in that sbe bas posturallimitatiDn~ of occasionally climbing, balandng, 

stooping, kneeling; crouching, and crawling. She is limited in the right hand and arm as to 

grasping and fmgering in any work-related activities. She must avoid all concentrated 

exposure to unprotected heights and dangerous moving machinery. Additionally, she has a 

moderate to severe level of pain and fatigue affecting her ability to work in a competitive 

environment. 

In making this fmding, the Administrative La~ Judge considered all symptoms and-the extent to 

which these symptoms can reasonably be accepted as consistent with the objective medical 

evidence and other evidence, based on the requirements of 20 CFR 404.1529 and SSRs 96-4p 

and 96-7p. The Administrative Law Judge has-also considered. opinion evidence in accordance 

with the requirements of20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. ' 

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Page 4 of8 

The claimant's statements concerning her impairments and their impact on her ability to work are 

generally credible in light of the medical history, the reports of the treating and examining 

practitioners, the findings made on examination, her description of her activities and lifestyle, 

and the claimant's demeanor at hearing. The Administrative Law Judge finds that the claimant 

has an impairment that is r~onably expected to produce the type of pain and other 

symptomatology she alleges. The claimant testified she has an II th grade education. The 

claimant stated that she is unable to work due to chronic pain in her right shoulder, arm, hand, 

and neck. She stated that her pain continues to get worse eve}l though her physician has 

increased her pain medication. She testified that she has a TENS unit on her ann for pain. Her 

medication causes severe headaches and dizziness. The claimant denied most activities at the 

hearing and expressed frustration at her limited activities. 

The medical evidence reflects that the claimant was injured on the job while working as , 

_ on November 29, 2003. The claimant was seen by Dr. -:-- _ - and 

had an MRI scan of the shoulder in June of 2004. The study showed a complete tear of the 

rotator cuff. Dr. - reconlmended surgery for rotator cuff repair as well as a subacromial 

decompression (Exhibit 10F). 

In July of2004, the claimant underwent a surgical procedure on the right shoulder and had a 

repair of the rotator cuff, a subacromial decompression, and a resection of the ligament (Exhibit 

3F). Postoperatively, she had complaints of pain in her right arm, forearm and thumb. In August 

of2004, the claimant was treated with physical therapy and placed on Bextra (Exhibit 9F). She \ 

contiilUed to complain of the radiating pain down into the forearm and hand. She also 

complained of pain in the right side of the neck. The claimant stated that she had difficulty 

trying to lift, twisi, push, or pull (Exhibit 2F). . 

The claimant continued to have chronic pain and limited mobility of her right shoulclpr ~ncl 

developed adhesive capsulitis. The claimant was evaluated by Dr. • in 

January of2005, who recommended an EMG study. In November of2005, it was noted that the 

EMG study within ~ormallirnits (Exhibits 7F, 10F, and 18F). 

The claimant continued to have difficulty with some crepitation and pain. The claimant 

underwent a second arthroscopicalJy assisted open repair of the rotator cuff in March of200S. 

Surgery revealed a recurrent tear in the rotator cuff (Exhibit 3F). Postoperatively, the claimant 

received physical therapy, but continued to have pain in the shoulder, the neck, the arm, the 

forearm, and the hand. Physical therapy was discontinued in JWle of2005 after it was noted to 

irritate the claimant's symptoms. A report dated July 27, 2005, noted residual nerve pain around 

the extremity and the supraclavicular neck area radiating down the forearm and into the median 

nerve distribution. This included the thumb, index, and long finger consistent with cervical 

radicular distribution (Exhibit I IF). 

The claimant was re.e~a1uated by Dr. ~on November 3, 2005. The claimant had a MRI 

scan of the cervical spine that showed some degenerative changes at C4-5, C5-6, and C6-7. The 

scan revealed bUlging discs with central stenosis (Exhibit I5F). A bone scan in December of 

2005 showed mild increased uptake noted around the right shoulder which could be attributed to 

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4('S Page 5 ofS 

post surgery. In January of2006, the claimant was sent to physiCal therapy and was prescribed 

Gabitril. The claimant also underwent stellate ganglion blocks without benefit (Exhibit 7F). 

A MRI of the right elbow on May 19,2006; showed slight degenerative changes at the ulnar 

joint with mild tendinopathy of the common extensor tendon (Exhibit SF). A MRI of the right 

shoulder on May 19; 2006, showed chondromalacia of the superior portion of the joint and 

degenerative tearing of the glenoid labrum (Exhibit l5F). In May of 2006, it was noted that the 

EMG study was non-diagnostic for radial tunnel syndrome (Exhibit 7F). 

On October 23, 2006, the clajmant was evaluated by ~ _ " -, in . 

connection with her workers compensation claim. The claimant continued to complain of pain 

and weakness in the shoulder, forearm, elbow, and hand. Upon examination, tenderness was 

present in the brachium, olecranon, and epicondyle. Scarring consistent with surgery was noted 

with some atrophy. Tenderness was present about the shoulder with some crepitation. Mild 

tenderness was present in the wrist. :... , , illed that the claimant was temporarily 

totally disabled and in need of additional medical treatment: He stated that the claimant should 

be evaluated for pain management on an ongoing basis (Exhibit 20F). 

The claimant was referred'to ., in January of2007 for oain management. 

placed her on Relafen, Zanaflex, Lyrica, and Ultram. I ~_J also prescribed a 

TENS unit. The claimant was seen several times in follow-up by 1'-1 and had her . 

medication regimen changed and altered during her course of therapy. r - prescri bed 

Naburnetone, Lyrica, Lortab, and Tizanidine. I - also prescrihed a strict home exercise 

program (Exhibits 14F and 2IF). ' 

On September 13, 2007, the claimant was seen by r p • •• _ • • • . ., in connection 

with her workers compensation claim. It was noted that the claimant continued to have chronic 

pain in her neck, right arm, shoulder, and hand. the claimant was unable to reach behind her 

back or lie on her shoulder. Upon examination, the right shoulder had surgical scars. There was 

limited flexion in the shoulder to 110 degrees, abduction 80 degrees, extension 15 degrees, 

adduction 15 degrees, external rotation 50 degrees, and internal rotation 30 degrees. There was 

tenderness to palpation of the shoulder and the shoulder was wealc. Physical examination of the 

cervical spine revealed flexion 25 degrees, extension 20 degrees, rightlleft lateral flexion 15 

degrees, right rotation 30 degrees, and left rotation 40 degrees. There was tenderness to 

palpitation of the paraspinous and trapezius muscles bilaterally. . "'_'" 4Jpined that the 

claimant had sustained permanent and total economic disability for the performance of ordinary 

manual labor or for any job for which she was qualified by reason of past work experience. He 

stated that if she was not vocationally retrained, then' she would be permanently and totally 

disabled. : stated that the claimant would require continued pain management 

(Exhibit 17F). 

On October 4, 2007, - added an addenduin to his repOrt. He stated that the claimant's 

right arm pain was of sufficient severity that RSD was considered as being a cause. 

stated that RDS was ruled out, but that the claimant may have sympathetically mediated pain 

syndrome. He also noted the claimant had degenerative and bulging discs in her cervical spine. 

He recommended that the claimant undergo a discogram (Exhibit 17F). 

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p » Page 6 of8 

On January 23, 2008, the claimant was evalUated by - 'D. 1 

recommended an updated MRI of her cervical spine (Exhibit 22F). 

After considering the evidence of record, the Adminis~tive Law Judge finds that the 'c1aimant's 

medically determinable impairments could reasonably be expected to produce the alleged 

symptoms, and that the c!aimant's statements concerning the intensity, persistence and limiting 

effects of t~ese symptoms are generally credible. 

On April 20, 2005, the claimant was released to return to light duty work with a 25 pound lifting 

restriction. It was also recommended that the claimant go to pain management (Exhibit 10F, 

page 32). On July 6, 2005, the c1aimanfwas released to return to light duty work with a 25 

pound lifting·restriction, restricted reaching, and no repetitive movements with the right hand. It 

was also recommended that the claimant go to pain management (Exhibit 1 OF, page 32). 

Subsequently on July 27,2006, the claimant was' released to return to light duty work with a 10 

pound lifting restriction and no repetitive movements with the right hand. It was also 

recommended that the claimant go to pain management (Exhibit·1 OF, page 33). The 

Administrative Law Judge considered these opinions, but gave them slight weight since they 

were related to the times of claimant's surgeries. Light work was the most recent status in the 

record, and the Administrative Law Judge found this was consistent with the medical evidence of 

record (Exhibit 10F). The Administrative Law Judge included this in the residual functional 

capacity assessment. 

The Administrative Law Judge considered the opinion of the treating physician,) r - 's·assessment was that the claimant had multi-level cervical discogenic syndrome with 

right upper radicular pain. He noted that the claimant needed pain management in the form of 

maintenance to manage her eoisodes of severe pain (Exhibit 21 F). The Administrative Law 

Judge considered : mvv.~_ S opinion and assigned it full weight since it was consistent with, 

the evidence of record. The State agency medical opinions are given little weight because J 

" - ; opinion is more consistent with the record as a whole and evidence received at the 

hearing level shows that the claimant is mo~e limited than determined by the State agency 

consultants. Furthermore, the State agency consultants did not adequately consider the 

claimant's subjective complaints. ' 

The objective medical evidence of record since January 1,2007, support the claimant's 

allegations generally, and more specifically support the existence of the limitations reported. 

The Administrative Law Judge is persuaded that after.considering the claimant's complaints of 

pain, it is reasonable to conclude that she is limited to the exertional requirements of no more 

than light work activity, with the additional nonexertionallimitations cited above. Moreover, the 

Administrative Law Judge is pel1'uaded that secoiidary to chionic pain, the claimant suffers from 

a moderate to severe level of pain and fatigue affecting her ability to perform in a competitive 

work environment. 

6. The claimant is 'unable to perform any past relevant work (20 CFR 404.1565). 

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& Page 70f8 

The vocational expert testified that the claimant's past relevant work is classified in the 

Dictionary of Occupational Titles illQI) as a cake decorator, skilled work (SVP of 6), and is 

described as light work in the DOT, and medium work as actually perfonned; counter sales and 

hand packaging, described as light, semi-skilled work (SVP of 3); and an accountant, described 

as sedentary, and skilled work (SVP of 8). At the hearing, the vocational expert responded to 

hypothetical questions of the Administrative Law Judge. She testified that based upon the 

claimant's residual functional capacity, the demands of the claimant's past relevant work exceed 

the residua! functional Capacity. Accordingly, the Administrative Law Judge' finds that the 

claimant is unable to perform any past relevant work. 

7. The claimant was a younger individual age 18-49 on the established disability onset 

date (20 CFR 404.1563). 

8. The claimant has a limited education and is able to communicate in English (20 CFR 

404.1564). 

9. The claimant's acquired jOb skills do not transfer to other occupations within the 

residual functional capacity defined above (20 CFR 404.1568). 

10. Considering the claimant's age, education, work experience, and residual functional 

capacity, there are no jobs that exist in significant numben in the national economy that 

the claimant can perform (20 CFR 404.1560(c) and 404.1566). 

In determining whether a successful adjl.\Stment to.other work can be made, the Administrative 

Law Judge must consider the claimant's residual functional capacity, age, education, and work 

experience in conjunction with the Medical·Vocationai Guidelines, 20 CFR Part 404, Subpart P, 

Appendix 2. If the claimant can perform all or substantially all of the exertional demands at a 

given level of exertion, the medical-vocational rules direct a conclusion of either "disabled" or 

"not disabled" depending upon the claimant's specific vocational profile (SSR 83-11). When the 

claimant cannot perform substantially all of the exertional demands of work at a given level of 

exertion and/or has nonexertional.limitations, the medical-vocational rules are used as a 

framework for decisionmaking unless there is a rule that directs a conclusion of "disabled" 

without considering the additional exertional and/or nonexertionallimitations (SSRs &3-12 and 

.83-14). [fthe claimant has solely nonexertional limitations, section 204.00 in the MedicalVocational Guidelines provides a framework for decisionmaking (SSR 85-15). 

If the claimant had the residual functional capacity to perform the full range of light work, a . 

finding of "not disabled" would be directed by ruJe'202.18. However, the claimant's ability to 

perform all or substantially all of the requirementS of this level of work has been impeded by 

additional limitations. To determine the extent to which these limitations erode the unskilled 

light occupational base, the Administrative Law Judge asked the vocational expert whether jobs 

exist in the national economy for an individual with the claimant's age, education, work 

experience and residual functional capacity. The vocational expert testified that given all of 

these factors there are no jobs in the national economy that the individual could perform. 

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c --_'-_.-_.---.. -'-

_ Boon! allncIepomdcat /Itodicd s..mu- AmaicauCollqoal~ __ 

_ OIIeqIadlkColl<pof~IIIII_ .. _ 

__ CdIIqe ofOine<lpllbie 1'I11III1 PIIysioimo 

............. ........,. at DIasbIGqo Ewloall •• P\IJIIdas 

----dW 

RE: Claimant 

Insured: 

Claim Number: 

DlInjury: 

DearJ-.. ---

October 24, 2007 

..--

November 29, 2003 . 

The above person was re-examined in the office today. She has previously been 

examined in this office on October 25, 2004, for the evaluation of injUries which she stated 

occUlTed on November 29,2003, while working for . in 

EXHIBIT NO. ~9F 

PAGE:20plo .... :- .? ~ .. 

Edmond, as I The historY was given by the claimant. She stated at 

approximately noon, she was standing on+two (2) to three (3) step stepllldder. She stated 

she was on the second step stocking boxes $ I She statal5he was on the last 

box 8IId she shoved and pushed it with her hanll over her head and she felt a "pulling 

sensation" in her right ann to her right shoulder. She stated she completed her shift and she 

reported this injury to her supervisor, She stated she continued working through May 11, 

2004. She dalied seelcing medical rteatment and she continued worlcing. She stated she 

thought she had just pulled a muscle in her right shoulder. She stated she continued lifting 

boxes and buckets of icing, weighirig furry (40) pounds, which made the pain in her right 

shoulder worse. She stated she was examined by J • • .A Edmond, on her own, on 

May 11,2004, for examination of her right shoulder and he also sent her to an eye physician 

for blurring of her left eye. She stated laboratory testing was petfonned on May 12,2004, 

and she was sent for x-rays of her right shoulder at a differenr facility which w= obtained on 

Permanent Subcommittee on Investigations 

EXHIBIT#6b 
431 

2 ; . L. ELL lis/Page 2 

EXHIBIT NO. 19F 

a different day. She stated Vioxx, Flexeril, and another medication, the name of which she PAGE: 3 OF 10 

cannot recall, wen: prescribed and she was taken off work for one and one-half (1 1(2) weeks. 

She stated she was !old the laboratory testing was ·nonna! but she does not know the results of 

the x-rays. She stated she remained offwork. She stated she followed up with J - 00 

May 14,2004, and she was referred to' •. in Edmond, and she was 

continued otfwork through May 20, 2004. SHe stated she remained offwork. She stated she 

rerurned to wot\ on May 21, 2004, and she worked through May 24, 2004, and she took a 

leave absence so she could find out whal: was wrong with her right shoulder. She stated she 

returned to -.~ on May 25, 2004, and she was continued off work and medications 

were prescribed. She stated she remained offworlc. 

She stated on a date she cannot recall, she was examined b~ . -. and x-rays 

were obtained of her right shouldef but she does not know the results. She stated an MlU of 

her right shoulder was recommended and she was continued off work. She stated she cannot 

recall ifmedications were prescribed. She stated on June 8, 2004, an MRI ofber right 

shoulder was perfonned at TPG MRl North in Oklahoma City. She sta.ted she returned to 

r - on June 14,2004, and the MRl was reviewed and she was told she had a tom 

rotator cuff. She stated surgery was reeonunended to her right shoulder and she was 

continued off work. She stated on July 20, 2004, outpatient surgery was performed to her 

right shoulder by r ----tt' at the Notth Surgery Center in Oklahoma City. She stated she 

was n:leased from the hospital and her right ann was placed in a sling and m.edicarions were 

prescribed and she was continued off work. She stated she followed up with - r one 

(I) week after surgery and then weekly due ~"pain in her right thumb. She stated a Medrol 

Dose Pal<: was prescnbed and she was continued off work. She stated she had no 

improvement with her right thumb with the Medrol Dose .Pale and no improvement with the 

surgery to her right shoulder. She stated she returned to D - and Neurontin was 

prescribed, which kept th.e pain down in her right thumb, right index finger, right long finger, 

and right foreann. She stated she had been having these symptoms since July 20,2004, after 

she received a nerve block in her neck. She stated r: - r recommended physical 

th~py. She stated on August 12,2004, she began physical therapy to her right shoulder at 

Metro Hand Rehabilitation three (3) times a week to the present, consisting of heat and ice 

daily, ultrasound, different exercises, and pulling exercises, with improvement. She stated 

she is able to move her right ann further. She states she bas no relief of the pain in the 

fingers of her right hand or heJW.ight forearm. She stated the Neurontin is helping with the 

pain. She stated on October 1", 2004, she was released to return to work'byJ 1 on 

light duty with no use of her right upper Cldremity, She stated she did not return to work 

because her employer would not allow her to return to woMbeCause they needed a release 

and she then took family medical leave. She stated her last appointment with . _ r was 

October 18,2004, and she was continued in physical therapy. She stated she WIIS told her 

right shoulder was frozen by , md he reeomm.mded manipulation under anesthesill 

but this has not been scheduled She stated she was off work because_will not 

allow her to rerum to work on light duty. She stated her next apPOintm~"--­

was in six (6) weeks. She stated she was evaluated by . on October 5, 

2004, at the suggestion of her momey. She stated she had seen no other physicians for 

treatment as a result of this injury. She denied re-injuries to he.r right shoulder. She denied 

medical treatment to her neck or back. 
432 

•••••• 'Page3 

EXHIBIT NO. 19F 

She stated she cannot raise ber right arm above her head due to pain in her right PAGE: 4 OF 10 

shoulder. She stated she had pain in her right shoulder on lifting ten (10) to fifteen (IS) 

pounds, twisting and turning her right arm, and on pushing and pulling. She stated she had 

numbness and tingling in her right forearm. She stated she had "popping and locking" in her 

right shoulder.· She stated she had occasional "sudden pain" in her right shoulder. She stated 

she had pam in her right shoulder which r&dimes into her right ann. She denied radiation of 

pain from her right shoulder into her neck. Sbe stated her right hand swells occasionally. 

Sbe mted she had "stabbing pain" in her right palm. She stated she had numbneSs and 

tingling and pain in her right index and long fingers and right thumb. She stated she had 

''popping'' in the knuckle of her right long finger and OCC3$ional "popping" in her right wrist 

and right elbow. She stated she had pain in the right side of her neck. 

She denied complaints to her upper back. 

On today's exiunination, • I StateS since laSt being examined in this office she 

continued to follow up with , -. She states in Novanber of 2004, at the North 

Surgery Center : _ r perfOImed manipulation to the right shoulder under anesthesia. 

She states she continued to follow up with __ T and medications were prescribed. She 

states she does not recall what if any treatment ~ received. She states in January of2005, 

--- performed an EMG of the right upper extremity. She states she was seeing 

,_IS for pain management. She states on March 7,2005, she followed up with; 

and an arthroscopy to the right slioulder was recommended She states on March 24, 2005, at 

the North Surgery Center ,-r performed an arthroscopy to the right shoulder as an 

ol.llpalient. She States she continl.led following up with - dl1d she was told he did 

not want her back into physical therapy, but he cOntinued to prescribe medications, she was given instructions on a home exercise prognun, and she was told she could return to work on 

light duty. She denies returning to work on light duty due to pain iII heT right shoulder. She 

states she continued to foUow up with' ~_ who rCl:omrnended she unclergo physical 

therapy at Metro Hand Rehabilitation two (2) to. three (3) times a week for approximately one 

(1) month with therapy consisting of hot and cold packll and ultraSOund with minimal relief 

un1il June of2ooS. She states in June 0[2005, physical therapy was discontinued due to 

aggravation or the symptO!1lS in her right shoulder. She stHtes she c:ontinued following up 

with for examinations of her right shoulder. 

She states on November 3,2005, she followed up with _ 15 and an MRl of the 

cervical spine was recommended. She denies the MRI being perfoxmed. She states on 

November 11,2005, r _.lJerformed an EMG of her right upper extremity. She states, 

on a date she cannot recall, . - recommended ganglion blocks to the right shoulder. 

She states in January of2006, she received two (2) ganglion blocks. She states she continued 

to follow up with.- I and he recommended physical therapy, a bone scan, and 

medications were prescribed. She denIes attending physical therapy. She ~at Edmond 

Medical Center she had a bone scan performed. She states she followed up with : 

after the bone ~ but she does not recall the results. She states she continued following up 

with 1. -::=-~ for pain managematt She states on May I, 2006, she followed up y,jth .~ 

I ~d she WlIS continued on medications, she was referred for an orthopedic hand 

evaluation, and an MRI of the right shoulder was recommended. She states on May 19, 
433 

1Il ... ---.... · 'Page 4 

EXHIBIT NO. 19F 

2006, at lPQ Open MRI an MRl of the right shoulder was pe!formed. She states in July of1lAGE: 5 OF 10 

2006, she was released by ............. and she was released with restrictions. She denies 

medical treatment from July 7, 2006 through October 23.2006 due to taking care of her 

. ailing mother .. She states on October 23, 2006, she· was examined by , - per 

Court order. and pain management was recommended. 

She states on January 22, 2007, she was examined by L :, per Court 

ortier, and an MRl oime right shoulder was recommended, she was given instructions on a 

home exercise program, and medications were prescribed. She states on January 30, 2007, at 

Medical Plaza Imaging an MRI was perfurmed of her right shoulder. She states she 

continued following up with ~ ----.:....-: and he adjusted her medications. She denies an 

MRI being reviewed with her. She states on July 9, 2007. she followed up with, ----

and her medications were adjusted, ~ontinued her in her home exercise prog.am, and she was 

told she could rerum to work with restrictions. She states on September 13,2007, she was 

eXamined by - ror an evaluation, on referral from her attorney. She states, to her 

Icnowledge, she has seen no other physicians for treatment as a result oithis injury. 

She states she has pain in the neck with turning her head to the right and the left. She 

states she has pain in tile neck with rotating her head backwards. She denies pain in the neck 

with moving her head forwards. She states she has headaches one (J) to two (2) times a 

week depending on her activity leveL She states the headaches begin in her neck and radiate 

through th.e entire head. She states Excedrin migraine helps relieve her headaches. She sates 

she has pain which radiates into her right extremity. She states she has numbness and 

tingling in the right Upper exttemity. She states she has locking, clicking, and popping in her 

neck. She denies other complaints to her neck. 

She states she has pain i.u me tight snouIder with raising her arm above her head. She 

stares she has pain in the right shoulder with lifting a can of vegetables. She states she has 

pain in the right shoulder with. ttirning or twi~ at the elbow. She states she has pain in the 

riMtsh,oulder with pushing and pulling. She states she has numbness and tingling in the 

right shoulder. She states she has popping. clickhlg, and locking of the right shoulder. She 

denies other complaints to me right shoulder. 

She denies worldng for an employer since hE!r injury. She denies graduating high 

school. She states the highest grade she completed '<'.U eleventh gxade~ ~il~~~.?h!l did 

ntH complete her QED. She denies college, trade school, vo-tech, or military training. '-

c-stle states she worked for I from May of 2000 until May of2004 as ~ 

She states she mixed icing, iced cakes. decorated them, wodcing customer s~ took cake orders. and put away stock. She states the most she had to lift was 

fifty (50) pounds. She states prior to that, she worked at the. from February of 

1999 until November of 2001. She states her jobs did overlap. She states she had two (2) 

jobs at one (1) point. She states she worked there as ~ where she did computer 

rum. entry and typing. She states there was no heavy l~ed. She states prior to that, 

She_rked at' m May of1996 until February of 1999 where she worked 

as a icing cakes, decorating them, and she worked in customer 

servIce g s es, took cake orders, put away stock. and the most she lifted was fifty 
434 

• Ii . fl . 'Page 5 

EXHIBIT NO. 19F 

(50) pounds. She states prior to that, she worked at lib • from 1995 to 1996 where she9AGE: 6 OF 10 

worked as l'r with the samejob description as . She s~riorto 

.1h.at.,.She.w,onced for • 5 1& from Pebrualy of 1993 until May ofl995 as a_ • I 'i1h the sarnejob descriptions as ,Ib £522 dI 

She denies any injuries, major illnesses, or diseases that have caused her 10 have any 

permanent disabilities or impaionent that were caused by injuries or diseases not related to 

any job she bas ever had. She states she is presently under the care of, --for pain 

management. She states she visits him every 1hree (3) mon1hs refills on her pain medication 

and for medication adjustments. She states she is taking Lyrica 150 mg two (2) times daily 

and the side effects an; she feels dizzy and fuzzy. She states she takes Tizanidine 4 mg tIuee 

(3) times daily and the side effects are dizziness and fuzziness, Nabumeto.ne seventy-five (75) 

mg two (2) tim.es dally and side effects are dizziness and fuzziness, and Lortab 20 mg every 

eight (8) hours and 1he side effects are dizziness and fuzziness. 

She denies any disabilities to her arms, hands, legs, or feet that is constant and 

demonstrates a pronounced physical defect She states she can drive a car for approximately 

thirty (30) minutes and she can sit for approximately one (1) hour, stand for about fifteen (15) 

minutes, and walk about fifteen (15) minutes. She states she can lift anywhere from five (5) 

to ten (10) pounds with ber left hand. She states she does not mow the lawn and her brother 

mows it for nero She denies being able to take care of a small flower or vegetable garden. 

She states the shaky motion and roto-tilling and the upkeep of it cause pain in her right 

shoulder. She states she could babysit or take care of a preschool child. She states she could 

not fish or hunt. She states she has tried fishing and she could not reel a fish in due 10 pain in 

her right shoulder. She states she cannot shoot a gun due to pain in hcr right shoul!.!er, She 

denies· being able to participate in any a1hletic event She states 1he motion jars her shoulder 

causing pain. She states she can vacuum if she is using her left hand. She states she could 

perform any kind of hobbies such as collecting pig figurines. She states she bas oot been 

involved in any accident or any illness requiring some type of medical treatment or attention 

since the date of her last injury. She states she cannot work because she has to do everything 

with her left hand. She states she =ot write a few lines with ner right hand. She states she 

eats with her left hand and she is able to wash hel' hait. She states she tilts her head forwatd 

and washes it with her left hand. She states she does not fix her hair and snc wean; no 

makeup. She states she is able to pull her pants up by herself with both hands. She states she 

cleans herself with her left hand. She states she is living with her mother and brother on one 

(1) acre of land in Edmond. She states they have some livestock and her mo1her cares for 1hf: 

animals. She states she does her laundry u:iing bom her right and left hand. She stales she 

can load and unload a dishwasher. She states she can cook primarily wi1h her left hand. She 

states she can make her own bed. She states she can drive if she uses her left hand only to' 

drive and"shift into gear. 

She states an average day for her consists of getting up around 7:00 or 8:00 a.m. She 

states she does not usually eat for breakfu.st. She states she imm~iately gets up to go to 1he 

oothrooro.. $be $ires afterwards she goes to the kitchen for eitheta glass of milk, pop, or 

coffee. She states she then goes to the couch, twos on the television, and adjusts to watch it. 

She ,states she smo~ ~tely one (I) pack of cigarettes per day and she goes outside 
435 

iIIS_----_.lI1f11Page 6 

k h . S . h h h EXHIBITNO.19F to smo e eac time. ~.e states she SIts on er porch. S estates s e usually eats crackers fOPAGE'1 OF 10 

lunch and then goes back to watch television unless she has a doctor's appointment. She . 

states shi, also do crossword searches. She states either her mom or her brother make dimer. 

She stat~if she stays with a friend they go out to eat and then straight back home. She states 

she goes to bed around 10:30' p.m., and she averages ~proximately four (4) hours of sleep. 

She denies prior injuries or medical treatment to her right shoulder. 

PAST MEDICAL HISTORY: 

This person states she has an eleventh grade education. Sbe d~es completion of a 

GED. She denies college, trade school, or vocational training. She denies military service. 

She denies hobbies. She is divorced with one (1) child. She denies the US1: of alcohol. She 

smokes one (1) package of cigarettes per day. She denies the \l'le ofrecreaticnal drugs. She 

denies drug allergies. Current medicaticn is Lyrica, Tizanidine. Nabumetone, Lottab, and 

Excedrin Migraine. Past cccupations include cake decomor and accounting. Sbe is 

presently unemployed. She has had a fracture of her left clavicle. She has had surgeI)' to her 

xi gbt shoulder and a D & c. She has been hospitalized for one (1) childbirth. She denies 

motor vehicle accidents with injury. She states she had an on-the-job iJ1jury to her left index 

finger in the 1980's, while working for I C. She denies receiving an award of 

permanent disability for this injury. She deni.es other on-the-job injuries or other claims 

pending. 

PHYSICAL EXAMINATION: 

Phyoical examinationrcvcals a forty-three (43) year old white female, 5'5 112" in 

height, weighing one hoodred forty-three (143) pooods. Temperature is 98.1 degrees, pulse 

is 64, respirations are 16, and blood pressure is 120/80. 

Musculoskeletal examination reveals no Paravertebral muscle spasms or dysmetria of 

the cervicothoracic spine. 

Range of motion of the cervicotboradc spine was perfonned with a minimum of 

three (3) meawrcrnenrs which were within the pennitted variability. Of these, the maximum 

range of motion was used to calculate the percentage of impainnent, if any. 

Examination of the cervicothoracic spine reveals flexion of fifty (50) degrees and 

extension is sixty (60) degrees. Right and left side bending is fony-five (45) degrees. Right 

and left rotations are eighty (80) degrees. 

Examination of the right shoulder reveals forward flexion of one hoodred fifty" (150) 

degrees and backwanl extension offifty (50) degrees. Abduction is one hoodred fifty (150) 

degrees and adduction is forty (40) degrees. Internal rotation is seventy (70) degrees and 

external rotation is sixty (60) degrees. There is no crepitation noted. 
436 

EXHIBIT NO.19F 

ElIamination ofthe right elbow ~eals flexion on one hundred forty (140) degrees PAGU OF lD 

arul extension of zero (0). Pronation is eighty (80) degrees and supination is seventy (70) 

degrees. 

Examination of the right wrist reveals extension of sixty (60) degrees and palmar 

flexion of sixty (60) degrees. Radial deviation is twenty (20) degrees and u1nar deviation is 

thirty (30) degrees. This ~n is noted to have a negative Tinel's ahd Phalen's signs. 

Neurological examination reveals deep tendon reflex.es to be 214 bilaterally of the 

biceps and triceps. Cranial nerves ll-XlI 3:(e grossly intact Hand grip is twenty (20) pounds 

on the right and sixty (60) pounds on the left. Sensory pinpoint sen:;ation is intact in the 

upper extremities with a decreased sensation on the right side on. the right a.-m. She states she 

is right hand dominant. 

M~as~en!5 of the biceps are twenty-six (26) centimeters on the right and twentyfive (25) centimeters on the left. The forearms measure twenty-two (22) centimeters on the 

right and twenty'~lne point nve (21.5) centimeters on the left. 

There are arthroscopic scars noted about the right shoulder, and a five (5) centimeter 

scar on the lateral aspect of the right shoulder. 

X-rays were obtained of the ceMcal spine. AP,lateral, and both oblique views 

reveal no radiograpbic abnormality. 

X-rays were obtained of the right elbow. AP and lateral views reveal no rad.io~hic 

aQoormality. 

X-rays were obtained of the right shoulder and are compared with previous films of 

October 25, 2004. AP views, in internal and extetnal rotation. revealed there were two (2) 

pins in pJace through the superior lateral aspect of the humeral bead consistent with a 

previous rotator cuff tear. There was no other ra(ljograpbic abnonnality. X-rays obtained on 

today's examination :reveal interval removal of one (1) of the pins preViously noted in the 

humeral head. There is no other significant interval change. There is no otha radiographic 

abnomiality noted. 

, 

l have reviewed the folloWing mIcimiiltlciri oneXaiIiination ofUctober 25:-200'f: 

A history and physical dated May II, 2004, signed by F --:------

a radiology report dated May 11, 2004, signed by Loffice no~ ~d May 11,2004, May 14,2004, from .1 ... ___ ..,.,. )ffice, 

a laboratory report dated May 14, 2004, 

a medical repon dated May 27,2004, signed by ( -:"":.J _. __ . __ , 
437 

8 

office notes dated May 26,2004, from r -

a patient information form dated June 1, 2004, 

a patient questionnaire dated June 1, 2004, 

a,medical report dated J\Ulc I, 2004, signed by f ----__ ..;..;~ 

a return to work note dated June I, 2004, signed by:'" ----

EXHIBIT NO. 19F 

PAGE:90F 10 

an MRl from 1I •••• datc::d June 8,2004, signed by ...,..----__ -

office notes dated J\Ule 14,2004, signed by ..;;...;----

a return to work note dated JUDe 14.2004, from) ---- office, 

a return to work note dated June 25, 2004, from .;;,'---- s office, 

an operative report fromll •••••• B1ed July 20,.2004, 

office notes datCd July 22. 2004, signed by 1-, 

office note:! dated July 28, 2004, signed by 1 

office notes dated August i 0, 2004, signed by J ---

, a note frornl •• August 12.2004, 

progress notes dated August 12,2004, signed by F __ ~~:--.,.-. __ ---

August 12, 2004 through September 10,2004, from' ••••• 

a medical report dated October 5, 2004, signed by '-_-, ----,-.( -.,-,._-., 

a Form 9 dated October 12,2004. 

DISCUSSION: 

•••• , was observed leaving the office today unlocking her truck door and 

opening it with her right arm. She was also observed extending her right ann to place a bag 

into the right front passenger seat. She was observed utilizing both of her iUIIlS to steer the 

wheel of her vehicle. 
438 

OPINION: 

In my sustained sixteen (16) percent peunanent partial 

impairment to the body as a for injuries to the to the right ~houlde!: as a result of her 

above stated accident and resulting swgery. 

In my opinion, -bas sustained no permanent partial impainnent to the 

cervicothoracic spine, ri~, or right hand as a result of the above stated accident. 

In my opinion, has sustained no consequential injury to the 

EXHIBlTNO.19F 

PAGE: 10 OF 10 

cervicothoracic spine therefore no permanent partial impairment to the cervicothoracic spine 

as a result of the above stated accident. Furthermore, it is my opinion, she has sustained no 

permanent partial impainnent to the right ann or right hand as a result of the above stated 

accident. 

In my opinion, , Fperiod of temporary total disability has long since ended, 

and she may return to empJoynlent. She is in no further need of medical care Or ccnti;nuiJJg 

medical maintenance. . 

In my opinion, based on age, education, Il'aining, and work e..-<perience, is 

not permanently and totally disal:>led or in need of vocational rehabilitation, 

I declare under the penalty of pexjwy th<lt 1 have exarnin,ed this repon and all 

mtements contained herein, and fO the best of my knowledge and belief, they are true, 

correct and complete. 

CBP:bg 

I0240707.doc 

.~ Very troJyyours, 

r _____ 

~ -

The _c compu!OIi ... on: _ upon ... d ... in _____ !he _COlI Medical Associ"",,'. Go/dqro'N 

FWIIuotfooI ifP_l ___ !hecxco:ptionof_~an4inq>aimtt:111""_byd1ea.;cIcs. 1lIcFiftbEllilion 

lllltiiized forinjurico """"""aJla-J ... 2.8.2001. ThefounltEdttionisu1ilize<llll:irUllrics~aJIa-_~ I. 1993. Thedlw 

Editian, _ ~ lilli_lOr iftjUIj .. 0<Wl'rin3 fron\l""""l' 1.lm .. ()dcber 31.1993. 1lIcs-.! Edition ~ ",,1ized Iilf iJljuria 

"""""",,fmm_borl,I984.,Decomberl, i988.1lIcfjrstE4itionblJ\l'~lOrj.jurico"""","ngJulyl. ImlOOc:!oberJl, 1984, 
439 

FEB-IS-OT 11 :45 

Patient: 

Soc. Sec. II: 

D.to of BIrth: 

Servlce Location: 

~ Transcription 

Service Date: 912212005 

Injury Date: 912212005 

Employ&r: 

Olctat&d By: 

HIS P.012l014 HOi 

Service 101/ : Diagnosis: 840,9 Sprain Of Unspecifle<l Site Of Shoulder 

COMPLAINT: . 

is a 3 employee of ' - who complains about his 

whiCh was injured on 09/2212005 9:45:00 AM. 

STATEMENT: 

slates :·Slipp~d coming down hand rail injurying right shOulder, right knee 

neck." 

Signs: SP: 124/80. P: 98. R: 14. T: 98.2 degrees F orally. 

No known allergies .. 

tions: None 

Last ietanus vaccination was in June 2005. Time:2:61 PM by: M M. 

OF P~ESENT ILLNESS: 

was in his usuj'li state of health until this injury. Injury occurred about 5 

ago. Injury occurred when he feli as above. Previous treatment this injury: 

Previous injury this e~tremity: Two surgeries right shoulderand arthroscopy 

He denies previous neck injury. Remaining orthopedic history: 

MhrosCClOV left shoulder and left knee. 

Past medical, surgical. 

specifically denies a history of diabeles. ulcers, liver disease, ·renal 

deficiency or glaucoma. There is no exercise Induced chesl pain or 

Afebrile at ~ome. Complete and detailed ROS otherwise non·contributofY. 

YVeU developed, well nourished. well hydrated. In no acute 

Alert and oriented times three. cooperative. Appropriate dress and manner. 

Recorded in N~rses Nates and reviewed by me. 

air movement. Breath sounds clear in all fields. 

v"'KUIA\~: Regular rate and rhythm without munmur, rub, click or gallop. 

pIlRIP'HEHA.L VASCULAR: Pulses distal to Injury Intact. No cyanosis, clubbing or 

Motqr and sensory function distal to Injury grossly Intact. 

~eletal exam. Remllinder is unremarkable. 

AL: 

swelling; discoloration or deformity. Full ROM of neel<. No areas of 

le.,riP,rnA"" or spasm .. Trachea midline. No adenopathy, thyromegaly Dr meningeal 

Dictated By: ! PA-C 

Permanent Subcommittee on Investigations unscrlption Prfnted Pate: 0212512001 

EXHIBIT#7a 
440 

FEB-15-Dr 11 :45 FROII9/22/2005 

912212005 

T-li5 POi!lO!4 HOS 

-',PA-C 

840,9 Sprain Of Unspecified S~e or Shoulder 

No swelli'lg, discoloration or deformity, Full range of motion. No 

tl>r,dem,,"s or spasm, 

I ,Ma\ure scarS. No swelling, discoloration or deformity, Deoreased 

of Motion: Abduction: 120 degrees without pain. Flexion: 120 degrees 

Impin~emenl tests: Positive. Stability tests: Nesative. Rotator 

Negative. Bicipital strum, Speeds and Vergasons: Negative 

Mature,scars, Normal galt. No swelling, discoloration or deformity, 

of motion of hip and knee, Moderate crepltance. Tenderness at the 

line. Ballotment negative. LacHmans negative, McMurrays test 

.is stable to varus and stress. 

Interpreted in 

Interpreted In the clinic by me. Retained orthopedic hardware 

with surgical history, 

x-ray: Inl;"rpre1ed In the office, Patellar spurring. No acute boney 

Abrlorrn::!Ii'1v 

The findings, treatment and natural course of the diagnosis were 

Patient quesllons were answered, SatiSfactory unQerstanding was noted, 

",,'n"'-"'Tlrl'J.<:· 

medicati9n as follows: 

po aiD, Cyclobenzaprlne 10mg po TID, ultram 50mg po Q4-6h pm pain 

muscle rub. Expected benefits and potential side effects of the 

dispussed, The patient was advised to take the medication as 

it is ~mpleted. 

Dictated By: ~ PA-C 

Last Updated By: Quanssd TmnsOliplion Prtnted Dilte: C2l2Q12OO1 

© T986· 2001 CO!1C&1'11r8 HaaIll'l.5lNlolJ&, me . .Ar1 Alllnl"~' fa,," ftm,ollf.on 01llol: 00U05I2GDII 
441 

FEB-15-0r 11 : 45 

Patient: 

Sac. Sec. 11; 

Date of Birth: 

Service Location: 

91';!I200~ 

91221200~ 

• 

1-195 P.n14!0J4 HOe 

PA·C 

SOl'llice 10#: 840.9 Sprain Of Unspecified Site Of Shoulder 

: II is my o~inion that the above injury is 'more likely than nat directly 

activities. The employer has been so advised. 

log record~ble: YES 

penalty of pe~ury that I have examined Ihls report and all 

sttlternell\S contained herein, and to the best of my knowledge, I believe they are 

correct and complete. 

Dictated By: "~,, PA-C 

Laat updated BV: qus!lssd Tl":2I,n&erlptian Printecl o;ata: 021"....512007 

(:,I1lr.i5. 2go? Cwlt"'nLns"AII!\~~ 1m: "1!f{)QI'I\I;~seT'ollld. f'''"''Rotvt.lClnDilw.,IMIIISlZDOI 
442 

FEB-25-0T 11:43 

Patient: 

Soc. Sec. #: 

Date of Birth: 

FRO~ 

101612005 

912212005 

T-395 P. 005/014 HOB 

Service Location: ---,DO 

Service 10 # : 840.9 sprain Of Unspecified Site Of Shoulder 

EF COMPLAINT: i Is a employee of ----- who oomplains about his 

which waS injured an 9/22/2005 9:45:00 AM. 

STATEMENT: 

slates :"Slipped coming dawn hand rail injuring right shol.llder, right knee 

neck." 

Sign~: SP: 144/86. P: 100. R: 16. T: 96.8 degrees F orally. 

vilals were taken at: 11 :37 AM by: C M. 

returns for a r~check for the injury stated above. 

OF PRESENT ILLNESS: 

been working within the duty restrictions. He feels the paltern of 

is about thO' same.. The pa~ent has had the MRI done. 

Shoulder: 

ShOulder demonst~tes no abnormalities on appearence. . 

Decreased ROM of shoulder noted to abduction, flexion, crOSSing to opposite 

with inlernal ~otation with pain to bath passive and active ROM 

of the sho~lder reveals positive Impingement 

of the shoulder is positive for tendemess at deltoid area and 

1 LAS REPOR'f: 

840.9. 

Dictated By: -', DO 

r~n5ctlptlon PrintDd Dale; 0212512007 
443 

F EI-15-01 II : 43 FROM-

- HIS P.006/014 H06 

Patient: 

Soc. Sec. #: 

Dat. of Sinh: Agee 

Service Location: CMC - OKe-South 

Service 10 #: _ 

m"rl;~,otir," as follows: 

1 lablel PO tid with food 

Exercise progrpm as instructed. 

of force. 

FOR EVALUATION: Friday 1011412005 

Dictated By: 

10/6/2005 

9/2~005 

-.00 

840.9 Sprain Of unspecified Site Of Sho~lder 

Last Updated E!y: boyerga Transcription 

4:11996-2007 Ccne=nll":ll-lUlftS_I:I!r.a.~!CAllRlQnI'I'IO$Il(\o= I'Gf'I'IR".n.ll:inl»:l.,~ 
444 

I 

FEB-IS-D7 11 :42 

P~tlent: 

Soc. Sec. #: 

Date af Blnh: 

FROM1011412005 

912212005 

T-3i5 P.OOl/o14 HDS 

Service Location: . 

Service ID # : 

'.00 

840.9 Sprain Of Unspecified Site Of Shoulder 

COMPLAINT:, 

is a . employee of - • 

which was ImJureJ on 09/22/20059:45:00 AM. 

who complains about his 

STATEMENT: 

stales :"Slipped coming down hand rail injuring right sMulder, right knee 

neck." . 

OF PRESENT ILLNESS: 

Ilas been wo~king within the duly restrictions. He states that his right 

is flne. but his right shoulder is slill hurting. 

Shoulder: 

• Shoulder demonstrates no abnormalities on appearance. 

- Decreased ROM of shoulder noted to abduction, Hexlon. crossing to opposite 

with intema) relation with pain to both passive and active ROM 

of Ihe .hQUlder reveals positive impingement 

I of the sroulder is posttlve for tenderness at deltoid area and 

area 

- Normal sensory f~nc~on noted. 

Shoulder strain. ~40.9. 

Shoulder tenosynovitis. 726.10. 

instructed to lcontinue their previous medications as prescribed. 

Exercise progTam as instructed. 

Dictated ay: DO 

14;18:06 Lut Updated By: ~B('Qa T~fl5crtptlon Primed Data: OZa5l2007 

e 1m· 20dt 0cm0:nIt .. Haallll5aN~. Inc:. Ali Rlgl~B Ret;DMHl. f!otTII ~1II1or't O,/;lO: 114/UII/lIlOO 
445 

fEB-25-01 11 :43 fROIr 

Patient: 

Soc. Sec. II: 

Date of Birth: 

S~rvice Location: 

Service 10 # : 

--" Hi5 P.004/014 HOB 

Transcription 

S.Nlco Data: 

Injury Date: 

10m player: 

Dictated By: 

Diagnosis; 

10114/2005 

9/2212005 

DO 

e40.9 Sprain Of Unspecified She Of Shoulder 

REFERRED TO: • MD as soon as possible. 

patient was instrqcted to return to the clinic as needed. 

Dictated By: ,0 

Last Updated By: boyerga lran&crlpJ:lon 

(!j) 1~' 1OQ7 Con~I{nI-je:lIltl.s.W:tI~.Ii\e.NlAli1l\'R8H('WlCl I'OMl'fllh'llOtonOlto;1i4lO1Ifi1/Dli 
446 

January 24. 2006 

PATIENT: 

CLAIM: 

EVALUATION: 

SSN: 

EMPLOYER: 

001: 

DOE: 

DearMs._ 

prOgress 

& 

09/22/05 

01/24/06 

This is a progress report on ••••• who was reevaluated in my office on 

January 24. 2006. 

CHIEF COMPLAINT: Neck pain. right-shoulder pain, and right-arm pain. 

BRIEF HISTORY: This is was injured while actively 

employed and on the job on an extensive evaluation. the 

patient was found to have symptomatic cervical spondylosis at C6-7. After failure to 

respond to aggressive medical management, the patient underwent an anterior cervical 

microdiscectomy and fusion with instrumentation at C6-7 on December 30, 2005. He 

has done well. The numbness in his hands has totally abated. His neck and right·arm 

radicular pain have abated. The patient still has headaches but, in general. is very 

pleased with the results of surgery. 

PHYSICAL EXAMINATION: There is no evidence of an active radiculopathy or 

myelopathy. 

RECOMMENDATIONSITREATMENT PLAN: The patient is recovering from his recent 

cervical disc fusion with instrumentation. He is also scheduled to undergo rightPermanent Subcommittee on Investigations 

EXHIBIT#7c 
447 

PATIENT: 

CLAIM: . 

January 24. 2006 

Page 2 

8b}37 I:; 2 851~~B4:! 54 

'i 

shoulder surgery by Dr. i t _ in the near future. I feel that he will be able to 

undergo shoulder surgery in approXimately one month. 

WORK STATUS/RESTRICTIONS: The patient is temporarily totally disabled. He tells 

me that there is no light-duty work available for him on his job and that he has to go 

back to work with "no restrictions." 

ANTICIPATED MMI: One to twa months. 

"' declare under penalty of perjury that t have examined all statements contained herein. 

and to the best of my knowledge and belief they are true, correct. and campi ete." 

Yours mast sincerely. 

--_._-... M.D. 

SP:em 

Enclosure: Farm 5 

c: 

Dictated: 01124/06 

Transcribed: 01/25/06 
448 

·,-'S, M.D.,: - \ ,M.D., 

M.D., 

{OWl 142-:: • FOX(40517~9.· 

February 28,2006 

PATIENT: 

CLAIM: 

EVALUATION: 

SSN: 

EMPLOYER: 

001: 

DOE: 

Dear Ms. Feleyn: 

DischargE! 

-. 

09/22105 

02128106 

This is a discharge summary on , The patient was reevaluated in my office in 

neurosurgical consultation on February 28, 2006. 

CHIEF COMPlAINT: Neck pain, right-shoulder pain, and right-arm pain. 

BRIEF HISTORY: This a . twhO was injured while actively employed and 

on the job on September 22. 2005. After an extensive neurosurgical evaluation and failure to 

respond to conservative therapy, the patient underwent an anterior cervical microdiscectomy 

and fusion with instrumentation at C6-7 for symptomatic cervical spondylosis at C6-7, which I 

feel was made symptomatic by his on-the-job injury. The patient has had excellent results from 

his surgery and. at present, has no symptoms of an active radiculopathy or myelopathy. 

REVIEW OF SYSTEMS: Not contributory. 

PHYSICAL EXAMINATION: The patient has good range of motion of his head and neck in 

flexion, extension, and lateral bending. He has excellent strength and sensation in his arms and 

legs. He has normal reflexes and no long-tract signs. 

X-RAYS/DIAGNOSTICS: Posto'perative cervical spine x-rays sRow good stability at the C6·7 

level and excellent instrumentation at this level, as well. 

Permanent Subcommittee on Investigations 

EXHIBIT#7d 
449 

PATIENT: ___ 

CLAIM: _ 

February 28. 2006 

Page 2 

IMPRESSION: Status post anterior cervical microdiscectomy and fusion with instrumentation at 

C6-7 for cervical spondylosis atthis level. made symptomatic, by history. by an on-the-job injury 

of September 22. 2005. 

PLAN: The patient should continue his home exercise program and Is to stay active. 

WORK STATUSIRESTRICTIONS: The patient can return to gainful employment at any time. 

He will be on a 25-pound permanent weight restriction in lifting, be_din ,pulling, tugging, etc. 

The patient tells me that he has decided not to retum to work as a in the future. , , 

MMI: Has been attain~ as of February 28, 2006. 

This is a final disposition. 

"I declare under penalty of pe~ury that I have examined all statements contained herein, and to 

the best of my knowledge and belief they are true, correct, and complete." 

Yours most sincerely • 

..", 

M.D. 

SP:em 

Enclosure: Form 5 

c: 

Dictated: 02128106 

Transcribed: 03101/06 

.' 

-
450 

March 27,2006 

PATlENT: 

CLAIM: 

SSN: 

EV ALVA TlON: Progress Renort 

EMPLOYER: 1---~-

DOl: 9122105 

- -~~"t":'EJC:l5054 

,M. 

This is a follow-up orthopedic. report on the above patient. 

_is following up for right shoulder arthroscopy and debridement. He reports "I feel great". I can tell a 

"bl'g"difference. He has no pain or popping reported. His wounds are benign. He is only six days 

following the surgery. Physical therapy for a couple of weeks recommended. Anti-inflammatories. I 

will recheck him in a month. 

WORKSTATUS: Restrictions for his shoulder for now are ten pounds lifting and ten pounds pushing 

and pulling. No work overhead or above chest. No cmwling or climbing. 

ANTICIPATED MM}: Possibly four to six weeks. 

"I declare, under penalty ofpeljury, that 1 have examined the statements contained herein, and to the best 

of my knowledge and belief, they arc true, correct and complete." 

sH.D. o 

'ntb 

cc: 

EXHIBIT#7e 
451 

Ip 

Marchi,' 2006 

PATIENT; 

CLAIM: 

SSN: 

EVALUATION: Progress Report 

EMPLOYER: 

DOl: 9/22105 

This is a follow-up orthopedic report on the above patient. 

_is here to discuss surgery. The patient has continued difficulty in his right shoulder. He had a 

surgery on his neck and that has given him significant improvement ofrus neck problems and also some 

improvement on his shoulder. He continues, however, to struggle with shoulder range of motion, strength 

crepitus and pain. We talked about there being some degenerative changes on his shoulder and we will 

not be able to alleviate all ofrus symptoms. The idea of any further surgery for the shoulder would be to 

stage the shoulder, do debridement, lavage and hopefully improve his symptoms and hopefully buy him a 

few more years of improved symptomatology. He very much wants to proceed with that surgery. He is 

left hand dominant. He thinks that he can protect the right shoulder and continue 10 be fairly functional, 

post opemtively. Scheduling was initiated some time in the next few weeks for his right shoulder 

arthroscopy, debridement and indicated procedures. 

WORK STATUS: Restrictions fOT his shoulder for now are ten pounds lifting and twenty pounds 

pushing and pulling. No work overhead. 

ANTICIPATED MMI: Approximately three to four months post operatively. 

"I declare, under penalty ofperjury, that I have examined the statements contained herein, and to the best 

of my knowledge and belief, they are true, correct and complete." 

"6 

,M:'D. 

{nIb 
452 

....... , ... 054 

May 22. 2006 

PATIENT: 

CLAIM: 

SSN: 

EY ALUATION: Prol!Tess Rennl'l 

EMPLOYER: 

DO!: 9/22105 

This is a follow-up orthopedic report on the above patient. 

~is following up for his right shoulder. Railge'ofm?tion is steadily improved. He is doing very well. 

""!re'has one hundred and seventy degrees of forward flexion. Abduction to one hundred and ten. External 

rotation is forty fiv·e. Internal rotation is sixty. He is reporting no pain. Slight crepitus. The patient has 

reached maximum medical improvement. He is released today without restrictions in regards to his 

shoulder. He will take over the counter anti-inflammatories on an as needed basis. 

WORK STATUS: No restrictions. 

ANTICIPATED MMI: Today. 

IMP AIR.\lENT RATING: This rating is in accordance with the AMA Guides to the Evaluation of 

!,ermanent Impairment, Fifth Edition. Relative to the patient's injury and subsequent surgery and 

apportioned to pre-existing degenerative changes, he has a three percent impairment to the whole body 

based upon his shoulder. 

"I declare, under penalty ofpc:rjury, that I have examined the statements contained herein, and to the beSt 

of my knowledge and belief, they are true, correct and complete." 

~------~--~~M~.~D-.-V·----------

'ntb 

cc: 

Permanent Subcommittee on Investigations 

EXHIBIT#7f 
453 

SOCIAL. SECURITY NOTICE 

From: Social Security Administration 

Date: February 21. 2007 

Claim Number: ••••• 

Claim for: DIS 

We are writing about your claim for Social Security disability benefits. Based on a review of 

your health problems you do not qualify for benefits on this claim. This is because you are 

not disabled under our rules. 

We have enclosed information about the disability rules and more details about the decision 

on your claim. 

ABOUT THE DECISION 

Doctors and other trained staff looked at your case and made this decision. They work for 

your State but used our rules. 

Please remember that there are many types of disability programs, both government and 

private, which use different rules. A person may be receiving benefits under another 

program and still not be entitled under our rules. This may be true in your case. 

The following reports were used to decide your claim: 

;.10 evidence received 02106/2007 

: MD evidence received 02/06/2007 

Additional reports were not obtainable .. 

We have determined that your condition is not severe enough to keep you from 

working. We considered the medical and other information, your age, education, 

EXHIBIT #7 
454 

training, and work experience in determining how your condition affected your ability 

to work. 

You said that you are unable to work because of neck and shoulder injuries. 

The medical evidence shows the following: Although you have pain and discomfort in 

your neck and shoulder, you can move them well enough to do some types of work. 

Medical evidence does not show any other impairments which keep you from working. 

We realize that your condition keeps you from doing any of your past work, but it does not 

keep you from doing other work which is less demanding. Based on your age,. education 

and past work experience, you can do other work. 

If your condition gets worse and keeps you from working, write, call or visit any Social 

Security office about filing another application. 

In addition, you are not entitled to any other benefits based on this application. If you 

applied for other benefits, you will receive a separate notice when a decision is made on 

that claim(s). 

IF YOU DISAGREE WITH THE DECISION 

If you disagree with the decision, you have the right to appeal. We will review your case 

and consider any new facts you have. A person who did not make the first decision will 

decide your case. 

• You have 60 days to ask for an appeal 

The 60 days start the day after you get this letter. We assume you got this letter 

5 days after the date on it unless you show us that you did not get it within the 5-

day period. . 

You must have a good reason for waiting more than 60 days to ask for an appeal. 

• You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-

U2, called "Disability Report-Appeal". You may request this form online at 

http://www.socialsecurity.gov/online/ssa-561.pdf. Contact one of our offices if you 

want help. . 

• In addition, you have to complete a "Reconsideration Disability Report" to tell us 

about your medical condition since you filed your claim. You may contact one of 

our offices or call 1-800-772-1213 to request this form. Or, you may complete this 

report online at http://www.socialsecurity.gov/disability/recon. 

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your 

Social Security Claim." It contains more information about the appeal. 

NEW APPLICATION 

You have the right to file a new application at any time, but filing a new application is not 

the same as appealing this decision. If you disagree with this decision and you file a 

new application instead of appealing: 
455 

you might lose some benefits, or not qualify for any benefits, and 

we could deny the new application using this decision, if the facts and issues are 

the same. 

So, if you diSagree with this decision, you should ask for an appeal within 60 days. 

IF YOU WANT HELP WITH YOUR APPEAL 

You can have a friend, lawyer or someone else help you. There are groups that can help 

you find a lawyer or give you free legal services if you qualify. There are also lawyers 

who do not charge unless you win your appeal. Your local Social Security Office has a list 

of groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hire someone, we must 

approve the fee before he or she can collect it. And if you hire a lawyer, we will withhold 

up to 25 percent of any past due benefits to pay toward the fee. 

OTHER BENEFITS 

Based on the application you filed, you are not entitled to any other benefits, besides 

those you may already be getting. In the future, if you think you may be entitled to other 

benefits you will need to apply again. 

REQUIREMENTS FOR DISABILITY BENEFITS 

DiSABILITY INSURANCE BENEFITS 

To be considered disabled, a person must be unable to do any substantial gainful work 

due to a medical condition which has lasted or is expected to last for at least 12 months in 

a row. The condition must be severe enough io keep a person from working not only in 

her or his usual job, but in any other substantial gainful work. We look at the person's 

age, education, training and work experience when we decide whether s/he can work. 

The condition must be disabling at a time when the person meets the earnings 

requirement. If you were not disabled when the earnings requirement was met, we have 

enclosed a leaflet which explains the earnings requirement and tells how Social Security 

credits are earned. 

DISABLED WIDOW OR WIDOWER BENEFITS 

To be considered disabled, a widOW, widower or surviving divorced spouse (age 50 to 60) 

must have a physical or mental condition severe enough to keep a person from working. 

The condition must have lasted or be expected to last for at least 12 months in a row. 

The person's disability must start: 

not less than 7 years after the month of death of the wife or husband, or 

for a widow, widower, or surviving divorced spouse, formerly entitled to 

mother's or father's benefits not later than 7 years after the month those 

benefits ended, or 

r 
456 

for a widow, widower, or surviving divorced spouse who was previously 

disabled and who becomes disabled again, not later than 7 years after the prior 

period of disability ended. . 

CHILDHOOD DISABILITY BENEFITS 

Childhood disability benefits may be paid to a person age 18 or older if the person has a 

disability which began before age 22 or within 84 months of the end of an earlier period of 

childhood disability. The condition, whether physical or mental, must be severe enough to 

keep the person from doing any substantial gainful work. We look at the person's age, 

education and previous training when we decide whether he or she can work. In addition, 

the condition must have lasted or be expected to last for at least 12 months in a row .. 

OTHER IMPORTANT INFORMATION 

Definitions of disability are not the same in all government and private disability 

programs. Government agencies must follow the laws that apply to their own disability 

programs. A finding by a private organization or other government agency that a person 

is disabled does not necessarily mean that the person meets the disability requirements of 

the Social Security Act. 

IF YOU HAVE ANY QUESTIONS 

If you have any questions, you may call us toll free at 1-800-772-1213. We can 

answer most questions over the phone. You can also write or visit any Social 

Security Office. Th~ office that serves your area is located at: 

SHEPHERD MALL 2615 VILLA PROM 

OKLAHOMA CITY, OK 73107 

If you do call or visit an office, please have this letter with you. It will help us answer 

your questions. Also, if you plan to visit an office, you may call ahead to make an 

appointment. This will help us to serve you more quickly. 

KLF/kif 

Enclosure: 

SSA PUb. No. 05-10058 

Form SSA-L443-U2 

Ramona Schuenemeyer 

Regional Commissioner 

DO 783 
457 

NH __ _ 

REQUEST FOR RECONSIDERATION 

June B, 2007, 09:08 

PAGE l 

UNIT:~ 

On March 22, 2007, we talked with you and completed your REQUEST FOR 

RECONSIDERATION for SOCIAL SECURITY BENEFITS. We stored your REQUEST FOR 

RECONSIDERATION information electronically in our records and attached a 

summary.of your statements. 

What You Need To Do 

o Review your REQUEST FOR RECONSIDERATION to ensure we recorded your 

statements correctly. 

o If you agree with all your statements, you may retain the ~EQUEST FOR 

RECONSIDERATION for your records. 

o If you disagree with any of your statements, you should contact us within 

10 days after the date of this notice to let us know. 

MY NAME IS 

MY SOCIAL SECURITY NUMBER ISIIIIIIIIII~ 

I REQUEST A RECONSIDERATION. I DISAGREE WITH THE DETERMINATION MADE ON MY CLAIM 

FOR DISABILITY-WORKER OR CHILD BENEFITS BECAUSE I AM UNABLE TO WORK 

HAVE NO ADDITIONAL EVIDENCE TO SUBMIT. 

I AM REPRESENTED By ••••••• , WHO IS AN ATTORNEY. 

Permanent Subcommittee on Investigations 

EXHIBIT#7h 
458 

NH __ _ 

MY PHONE NUMBER IS ••••••• 

DATE March 22, 2007. 

June 8, 2007, 09:08 

PAGE 2 
459 

SOCIAL SECURITY ADMINISTRAnoN 

FUNCTION REPORT - ADULT 

How your iflnesses, Injuries, or conditions limit your activities 

Form~ 

OMII No. 0!I60=0881 

For SSA Use Only 

Do nat_In 11118 box. 

Related SSN 

NumberHolder ________ _ 

[ 

1. 

\ 

\ 

---1 

4. yl.. .. n uA roME TELEPHONE (N there is no telephone number where you can be reaChed, 

please gJv6 us a daytime number where we can leave a.message for you.) 

~O~rNUmber o Message Number ·0 None 

o Boarding House [J Nursing Home 

5. a. ~ do you nile? (Check one.) 

E::f House 0 Apartment 

o Shelter 0 Group Home o Other (W7Jat7) ...... -----------

b. With whom do you U~ (Ch8c/c one.) 

o Alone C With Family 0 With Friends 

o Other (Describe relationship.) ____________________ _ 

SECTION B - INFORMATION ABOUT DAILY ACTIVITIES 

6. Describe what you do from the time you wake up until gOing to bed. 

Permanent Subcommittee on Invc!itigations 

EXHIBIT#7i 

orm SSA-337HJK (9-2004} eI (09-2004) Page' 
460 

7. 00 you take care of anyone else such as a wifelhusband, children, grandchildren, 

parents, friend. other? 

If 'YES,' for whom do you care, and what do you do for them? 

8. 00 you take care of pets or other animals? 

eyes 

eyes 

If 'YES," what do you do for them? ____________________ _ 

9. Does anyone help you care for other people or animals? ~es [J No 

If "YES: who helps, and what do they do to t!e1p? _ry!.:...:¥-.~W=.:;:·,fL.:~~..!If::.....:Df>==-"'i.:.:J.:.4~v(::..!---C..~...:e..:....\'-p.:...:s==-­

v-J.-t'''-- OLi( +lJ.->O GolS 

11. Do the Dlnessas, injuries, or conditions affect your sleep? 

If "YES," how? m />Se. I rJ ' 

Sleep mOfe.-~tJ fJb::.tI: 1- Ivvf5 IJ[ ~'l... t.:>HOo* uJAk.,./J vp . / fJlJ~'7 >7 .7 

12. PERSONAL CARE (Check here g'tt NO PROBLEM with personal care.) 

a. Explain how your illnesses, injuries, or conditions affect your ability to: 

Dress tJONe:.... 

Bathe I> /v "" t:.-

Care for hair NO N~ 

Shave . il0 'r-Je... 

Feed salf 010 rJ l!./ 

Use the tOilet _...crJ>LO~N:..:t..-:::::._ _________________ _.",----

""'" C.4t vJAt K s-t.>No\ Sri ob",,1 J{ Q ·1o~1 Pd;od 

FOnnSSA-3373-11K(9-2004~~:.r:ti~) !Jd-boJ /hi page2~ 
461 

b. Do you need any special reminders to take care of personal 

needs and grooming? Dyes 

If 'YES,' what type of help or reminders Bre needed? _______________ _ 

c. Do you need help or reminders taking medicine? eyes 

If "YES: what kind of help do you need? ___________________ _ 

13. MEALS 1 a. Do yoU prepare your own meals? J Yes [J No 

If "Yes." what kind of food do you prePj!lre? (For exal)ll1le~sandwiches, (razen dinners, or complete 

meals with several cour.;es). '3AniR.,.i.c.h>S l:::fQs."J 0;"I*,C9 

I . 

How often do you prepare food or meals? (For exsmple, daily, w88kly, monthly.) 

Oe" \ i 

How long does it take you? ~ yr) ~ lY J h5l' 

Any changes in cooking hsbits since the illness, injuries, or conditions began? 

. '('J of- '::> 0 M " ell\. 

b. If'No," explain why you cannot or do not ~repare me~ls .. r?i crl E e- d()i1..E) f')p:,-tof: =±::h s c.o9 \l) I\J cq \ 1.\ OJ( he)V.s~ 

14. HOUSE AND YARD WORK 

a. List household chores, both indoors and outdoors, that you are able to do. (For example, 

cleaning, laundry, household nspairs, ironing, mowing, etc.) --------;:=7'T":"'nf"ll::.--

~~~ ~ 

b. How much time does it take you, and how often do you do each of these things? 

z.... 0 (' --1i",e-S A ~ 

c. Do you need help or encouragement doing these things? []Yes 

If "YES: what help is needed? ______________________ _ 

__ ~ .()08 ES.flL898 Page 3 
462 

d. Ify~udon'tdohouseoryill"dWOr1<.exPlainwhynot. Cktbrs .s,.;~ :::rGJ;J+ &tJt/. 

Pu$"- PVli ~.J~ /;.£t- ov=e..r IS-Io e.s ~ £.\/e/' 

15. GETTING AROUND . 

a. How often dO you gO outside? _--j7f-:e1::::...L_~..:...;.=~f\")...:.:.tl~·,,-L- _____ -t-_______ _ 

If you don't go out at all. explain why not. I~(" +he... 1!9 cOl 

b. When going out. hOW)Ii'""YOU travel? (Check al/ that apply.) 

o Walk EJ'Orive a car 0 Ride in a car o Ride a bicycle 

o Use public transportation 0 Other (Explain) _______ .....,,,./::;... ___ _ 

c. When going out. can you go out alone? Ei'?es 0 No 

If "NO: explain why you can't go out alone. __________________ _ 

/ 

d. 00 you drive? ONo 

If you don't drive. explain why not. ____________________ _ 

16. SHOPPING 

a. If ~ any shopping. do you shop: (Check all thaI apply.) 

EJ In stores 0 By phone [] By mail [] By computer 

b. Oescribe what you shop for. R~ (51t'--Ac/ll¥ c.J~rusf..C!'\.S ~(.I ~ 

C. How often do you shop and how long does it !eke? Not Ve-.cy larJ"i ~ A II 

17. MONEY 

a. Are you eble to: 

Pay bills 

Count change 

ONo 

[]No 

Handle e savings eccount 

Use a checkbook/money orders 

[]No 

[]No 

Explain eU"NO' answers. _______________________ ....., 

Fonn SSA-3373-BK (9-2004) at (09-2004) Psge4 
463 

b. Has your ability 10 handle money changed since ONo the illnesses, 

injuries, or conditions began? 

If ·YES,· explain how the ability to handle money has changed ..... fl..:.:..,..'-',,'-'<U=-....;I'J'--'-O+..:....-"We=::;..:...~'-"-·_ 

S.,...!Cie,/X.JJ""'}' 9-.!-2--41-" rJot 1'Y\l£."- rneN<.-j ~\Nj :rJ 

18. HOBBIES AND INTERESTS 

a. What are your hObbies,tfnd interests? (For example, reading, watching TV; sewing, playing spOl1s, 

etc.) TV 

b. How often and how well do you do these things? -'g~I/.:e.'"'{...;"f/-.;:oI...:...:.A:,y~ ________ _ 

I 7 

ese.activities since the illnesses, injuries, or conditions began . 

. S t:l wtliM CA'<"'l 

19. SOCIAL ACTIVITIES 

a. Do you spend time with others? (In person, on the phone, on the computer, etc.) 

If "YES: describe the kinds ~fthings you do With others~J.<. yJ l (JrJ 

--fo ff2.1 wcA'S Etc. 

Do you need 10 be reminded to go places? Dves 

How often do you go and how much do you take part? ______________ _ 

Do you need someone to accompany you? Ef2:G ONo 

ann SSA'-337s.8K (~2004l 81 (00-2Oftl L 1 I) 0 E) ! (: S 8 i. B 9 £I PageS 
464 

c. 00 you have any problems getting along with family, friends, neighbors, 

Dr others? Dyes 

If 'YES,' explain. ____ ~ ______ .....:. _______________ _ 

20. a. Ci:k any of the follOwil]6 items that your IIIn ses, injuries, or conditions affect: 

. ing I!f ""king StaIr Climbing D~n erstanding 

i atting lSY~ng D Seeing' D OIlowing Instructions 

nding [3"Kneeling D,tlemory Using Hands 

E? sfunding DTalking . 8' Completing Tasks D Getting Along With Others 

iii'ReaChing D Hearing D Concentration 

Please explain how your illnesses, injuries, or conditions affect each of the items you checked. (For 

exampls, you can only lift [/low many pounds], or you can only walk [/!ow far]) 

IS-hl 7.S Lb$ f?eS+1l.;z:rk..f:r fOr LxC-/ +!2p1"'\. q"'*>0 Afn.H= Il B\:pc.:./G 

b. Are you: D Right Handed? ~ Handed? 

c. How far can you walk before needing to stbp and rest? 11 b d-I- 1\ (3 \0( .6, 

If you have to rest, how long before you can resume walking?;...,.S",-tr.:..;.,..:.:.,; :..::N:..:Yk'-!.>..... .t$~ _____ _ 

d. For how IDng can you pay attention?·--lA:1..::c..J:::::..;l':·~!.5~~ _______ -:=T/:--_=_ e. Do you finish wihat you start? (For example, a conversation, 8'YeS 0 No 

chores, reading, watching a movie) J 

f. How well do you follow written instructions? (For example, a recipe)_oojf",D""O",. ,..;.. _______ 1 

g. How well do you follow spoken instruCtions? -"+'"'' ,..,tu.,: .... J:::!.. ___ --, _________ -t I 

Fonn SSA-3373-8K (9-2004) ef (09-2004) Page ~ 
465 

h. How well do you gel along with authority figures? (For example. police, bosses, landlords or t~~} __ ~~ __ ~ __________________ ~ ____________________ __ 

<P...-f-.mHave you aver. been fired or laid off from a job because of problems getting 

along with other people? 

Clves 

If "YES." please explain. _____________________________________ _ 

If "YES.· please give nama 01 employer. ----------~----------7"',.._--­

How well do you handle stress? 0 K A S qoc:J A s. \"rest ?~\ "'-.J 

k. How well do you handle changes in routine? =:r=-r ...~=_-'-I-I-'-~:.=-'---'.-f-'-IO.:;....__'_.c...;._'___'__'__'_""7--

Have you noticed any unusual behay~ or fears? Ves Cl No 

If"YES."pleasuxplaln.I I1'\- "-b+- ~-<.IClC- ±I!lpe't l'\)bo{ifr Not be-'''''l 

J!jbb 70 !-kIf SlIf{# J)tvhir>1llvA- 1>11 ~ PIe, 1J(eJ{.. -IIe/Prw

r tnt:.- / 7 

21. Do you use any of the following? (Check an that apply.) 

Cl Crutches Cl ~ C Heating Aid 

C Walker If BracelSptlrlt C GlassesiContact Lenses 

Cl Wheelchair Cl Artificial Umb Cl Artificial Voice Box 

C Other (Explain) ____________ ---,,....-___________________ --'-

Which of these were prescribed by a doctor? --'&!.A..JIV"'-"t.>€--=--II ________________ _ 

When was it Prescribed?--'-fjf-"-'--'-hr .... "-'-_-C_· .... .J,""'!. ... I~~.u~Jt/I<-____________ _ 

When do you need to use these aids? -"8t~..::'€.;..:0f+'-. ~~--'Otl=--="''''J ________________ __ 

Page 7. 
466 

SEcnON D - REMARKS 

Use this section for any added Information you did not show In earlier parts of this form. When you· 

are done with this section (or If you didn't have anything to add), be sure to complete the fields at the 

bottom of this page. . 
467 

November 9. 2007 

Office of Disability AdJudicaion & Review 

-

~~~~homa em OK 73102 

, Senior Attorney Advisor 

Re:_ 

"SSN_ 

Dear_ 

," " 'l\/IlilliDg Address: 

~, EIVE£:? 

--.. " ~J.h NOV'l 6 Zoo7 ~:~~:::;~~_ 

OHA OKLA. CITY OK 

' ..... 

Enclosed please find an original document showing that •••• does wish to have a heating in 

reference to his Social Security Disability claim. 

Please ignore the prevlous notification that he wished to waive his right to a personal appearance. 

We will be ready for a hearing whenever the office has prepared the necessary forms and set the malter 

for hearing. 

However, due t. age and his medical condition: f would request that you as Senior Attorney 

please review th61l1e for the possibility of an on the record favorable decision. 

Please review said file and if Yjio.ullifiii'"idii'hiia.t it meets the criteria, I would ask that you do so and return a 

favorable decision on behalf at. 

Thank you for your assistance. 

~ ~ 

Enclosure 

EXHIBIT #7' 
468 

~ 

,.vl-4tc" SOCIAL SECURITY ADMINISTRATION 

\J)!; Refer To: Office of Disability Adjudication and Review 

301 Nw61hSt 

3rd Floor West 

Oklahoma City, OK 73102 

Dale: DEC 2 6 2001' 

NOTICE OF DECISION - FULLY FAVORABLE 

J have made the enclosed decision in your case. Please read this notice and the decision 

carefully. 

This Dedslon Is Fully Favo~bIe To You 

Another office will process the decision and send you a letter about your benefits. Your local 

Social Security office or another may first ask you for more information. If you do not hear 

anything for 60 days, contact your local office. 

The Appeals Council May RevieW The Decision On lis Own 

The Appeals Council may decide 10 review my decision even though you do not ask it to do 

so. To do that, the Council must mail you a notice about its review within 60 days from the 

date sho~n above. Review at the Council's own motion could make the decision less 

favorable or unfavorable to ·you. 

If You Disagree With The Decision 

If you beJieve my decision is not fully favorable to you, Of if you disagree with it for any 

reason, you may file an appeal with the Appeals Council. 

How to File DO Appeal 

To file an appeal you or your representative must request that the Appeals Council review the 

decision. You must make the request in writing.' You may use our Request for Review fonn, 

HA-520, or write a letter. 

You may file your request at any local Social Security office or a hearing office. You may 

also mail your request right to the Appeals Council, Office afDisl/bmW Adiudiclltion I/nd 

Re\;eW. 5107 Leesburg Pike. Falls Church, VA 22041-3255. Please put the Social Security 

number shown above on any appeal you file. 

see NextP e 

EXHIBlT#7k 
469 

J(lNj' Wa)'rtt! WltJla<:e ( •••• 

Time to rile an Appeal 

To file an appeal. yotJ must rue your !e4tJest for review within 60 days from the date you get 

Ihlsnotke. 

The Appeals Council assumes you got the notice 5 days after the date sho\m above unless 

you show you did not get ,it within the 5-day period. The Council will dismiss It late request 

unless you show you had a good rea50n for not filing it on lime. 

Time to SUbmit New ~vidence 

You should submit any new evidence you wish to the Appeals Council to consider wlth your 

requ(lst for review. 

How an Appeal Works 

Our regulations stale the rules the Appeals Council applies to decide when and how to review 

11 case. These rules appear in the Code of Federal Regulations, Title 20, Chapter Ill, 

Part 404 (Subpart J). 

If you file an appeal, the Council will consider all of my decision. even the parts with \"ruch 

you agree. The Council may review your case for any reason. It 'i\-ill review your case if one 

of the reasons for review listed in our regUlation exists. Section 404.970 of the regulation lists 

these reasons. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. The Council may 

also send it back. to an Administrative Law Judge for a new decision. 

If No Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed 

only under special rules. 

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470 

cc: 

I 

H'f(jIJ MII"1l !ill)' qUesti(jjj§, ytili IDay ca1J, Wfite ttl' visit jjJjY Sooittl S~utit)lllifice. tf'ytlU visit an office, 1llem brlflg this ootiee Illid deel§ltlll with )lUU, 'l1ul telephone numbef of !be lllcll1 

office that serves your area is (40S)60S·3000. Ita address Is Social Security, 261 S Villa Prom. 

Shepherd Mall, Oklahomlt City, OK 7~107' . / r7 . -..(,.~ -.. ~. W. Huward O'Bryan. Jr. (0453) 

United States or America 

Administrative Law Judge 

Federal AdminIstrative Judiciary 
471 

IN TIlE CASE OE 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Offire of DlnbJlHy Adjudication slid Review 

ORDER or ADMINISTRATIVE LAW JUDGE 

CLAIMFQB 

Period of Dlsabillty and Disability Insurance 

Benefits 

-,.---,-.....,.....,...---- (Social Security Nwnber) 

I approve the fee agreement between the claimant and his rep;esentative subject to the condition 

that the claim results in past-due benefits. My detennination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. 1 neither 

approve nor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REVIEW OF TIDS ORDER AS INDICATED.BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. 1£50, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, Jm 

Regional Cbief Administrative Law Judge 

SSA ODAR Regional Ofc 

Rm460 

1301 Young 81 

Dallas, TX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

represeo1ative under this approved fee agreement. If so, Illease write directly to me as the 

deciding Administrative Law Judge withiri- ] 5 days of the day you are notified of the amount of 

the fee due to the representa:!ive. Your representative also has 15 days to write me if he/she does 

not agree with the fee amount under the approved agreement. 

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472 

Page::! of:! 

Vau should illelude the Boo/Ill !recutity number(!i) slwW/1 (jfi Ihis 111111)' pllpets th~t y(m 11 

Eend us. -t ~~ \A, 

W. Howard O'BQ-8I1, Jr. (0453)-

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 

DEC 2 8 2001 

Date 
473 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMlNISTRA TION 

Office of Disll.bility Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits I 

NOcial Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the undersigned on a request for hearing dated July 19,2007 (20 CFR 

404.929 et seq.). The evidence of record supports fUIl!l:W~ml1~~!I1J.!!!L 

heari1l!( has been held (20 CFR 404.948(a)). The claimant is represented 

an attorney. 

The claimant is alleging disability since September 22, 2005. 

The In .. is whdhcr!he d~mant ~ dis.bJ«l und<r occti .... 216(0 and 223(d) ortho Social Security Act. Dlnbility is defined .. tho iMbility to 

~ in my.$Ubstantid gainful a::tivity by ~asoo cfan)' medUJly dc:taminable fbysical Oi' mcnlal fmpairment orcm:nbination cfimpairtttent3 

thilt can bec:xpec1Cd to rt:SUItin dellh or lhaJ:~!.ante! urt31. becxpcc1cd P WI (01' aCCf'ltinuous pc:riod ofnotfeMlhan 12 r1WI1rM. 

Tb:te is anadditicmal ~ v."hrtbcffle inJoredsuws requimnenrs of ~ 216(1) and 223 oft1w:Social Security Act ~met. The dahnomt's 

oaminp ,"""",hmoo /haI1h<: d ....... has lla!"in>!>UfficinoI quutm orro''''''8''<0 mnoin imurcd tbtougb DcoemhcsJI, U)\o. Thus, !he 

da:imMt must e:stahlish disBbility on or bo:rorc thlld.il:e in order to be enlilJed to a period of disability and disability insurant(: benefits. 

After c=ful =iew of !he cntir< .. oord, !he undcrsjgn«l finds Ihallh< claimam has b.en disabled from Septermer 22. 200S through the dote of 

th:i3 deGisioo... The tmdersigned also nnds thlll the insured stabls fc.qu:iremerts oftbe Social Seaarity Act wen:: met ~ of the date disabiHty is 

established. 

APPLICABLE LAW 

Under the authority of the Soci1l Security Act. the SocbJ Security Admini!UUlon has tstabtish~4 fi"e-sttp sequcntitll cvduaion pl'OCC65 for 

dcttnnining wbc::lher:&rl individual is disabled (20 CFR 404. 1520(a», The StepS srt followed in order. lfit is dC'temlincd Jha1 the claimant is 01' is 

not dismled at. step offlc c-valuation process. the evaluation will not go on IOlhe next step. 

At step one. the ~igped rrwst determine ,,'bcthc:r the c1atTllmt is engaging in substantial ~nful adi."ity (20 eFR 404JS2O{b». Suh$1aDriaJ 

gainfuleaivity (SGA) is defined BS wort aCl:rvfty thd: is both substantiG1 and gainful. Ifan indi"idual engages in SOA, he Is I\Otdisabled 

1 't'1lleU of1he Soclol SeCUfrt ACI \, >dmlnistmd by Ibe SoemI S.curit)' lIdn\iniSU!l1ion. nu. II 1lPpean in the Unltod stmes Cod • ., 11401-

433_ subchapter II, ehoplor 7, Tille 42. btllrll.:...w ,sa.g,,./Ol' 1!"I!l~.lia&UlitleOU02QQ b!m11 ' 

2 1O Cod< ofFm.ral Rqul.Ii ... Ch.1lI (4-1416 ,ditlOD) Itdlon ~.!U8: Dtddlng. ""50 ..rlb .. t •• onl Msring _",.n 

od.,I.I" ... ti .. ls" j~ •• (a) iJ<cu;"" .. 1w1l~faw>r<Ib". Jrlb ... i<1<ncr b the hearing tewtd lOlJlPO!1S' finding!n t.-.o' ofJOU and.! the 

parde:s on eve!,.. Issue. f1c: Admmistmive Uw Judg:may blUr: ahelTirlg decision widtout holding an cmtJ hearing, , .. 12 

See Next Page 
474 

,.gilfdj~ 6tkIJW l<'Im Hlil ~liyslCiif iff ffiEHliil Impalfffienullh!l!ld regDldf." otHlssge .• d~wioti; iIId,.tJtI< !xjl<fle!lCli. ltike iit:liliiduiil Is Ii(j( EiigMgit!g iH SOA; !Ii!> Iiilely.i. /H1lctedS t8 fie geedHd llip. 

AI stCjj tw~, tHE utitl~tSlgH,d !iiUlI dell!ffilirtt wtielh.t il1e. tI.ltltllllliils ~ !iiedioalljl delcffilfHBlJI. itJ1jliiffillril thaI" ",..m" tit t ""HiflIHll!J~H or lliijl.ihn.Hfs Ih .. Is "§!!.~" (1~ CF/I. 4()U§2(J(t)j, Art IHiPalfltl<Ht ~I co!iiflIIi3lIi1" of IlIipillittienl,I. ",ev,"'" IOllklft Ihe _iHg tif the ft:gulailhill iril.lgtlilittliltly liliiiiS iffiiIldIVidUW'! liflility lb j1trfrlffl! ~1I!i~ Woft scd.llia. ltlk, dslillatii doe. nil! hlilie. stilet< medicallY tI~ft!Htiihab!e Itnlli/Jffiiel1l Ofcom&i1UIfidR d( ifij~~ftB; h, " not dlsBlJj!d, IfIhE <I;J1!Ii!Itl hlila !e"t! IJIIjlilifli.rtl at ,,,HiltlnMlon df 

Iliipliiftli<!iif5, the lIMly,l. pto&!eds U1ffi! dlltt! *" 

At, sttlf! IlriEt,IIl€!J1Iiltf'J/gilsd fItIJsl tlt<fffilllns wli,fIlst the Eli!JjjIlltf', ilfj~aJHI!ent CIt foM,'llil!tllitj oi'IHljl!fihtj'his tl!t!eU ofmedi ... Uy "lull, lit efflff.l~ drlrllljjj~llIlf!1enplSl/;~1fl10tPIt i'1iI41l4, llli!;jhllil', Ajlf!.ndl~ I (M t'l'lt 41l4.l ilO(d); 404.lsi§,dIld 4tJ4.f5i:6J Ittl16 eI'.lfflBht', Ijjj~liIIffl!ftI tit wffl!ll/llJtlun dt Iffljlliifflj~HUi IlllJets dt tmldbafly tquJtf. th.lflll!ti. or. jj,tlhg I!ild tMets tfle duHIII(itl ",~ij/l'<lfjel1l (ill GI'It 4d4.jjll!lj,Ill. tiuiiIWIl is dlglbled, It if 6601; Hti411ie Mlidy.l< jjfdOlod.I6Jlte"t!>! ,t~, 

ll<rdfe flltI§itktfflll ~eti toul 6{ikI! !i!'ljOOititil mluilflmi ~I~, tlw llildef>i(liltid tliIIiilllfsl tfetefffl!ftc m •• laJltWlt', re;ldutlJ 1\m.u~niiI'i$d€itjJ 

(10 eF~ 4iJ,j,H10{e;).' Aft hldi.idiJllJ', ",.ldOO runEHBfllfl c!ljlllCily i. hiUllillty kI da p/ty!iciilliid liietl£i/ \o;bff ICHVi~!,§ oft Ii ''''Illlri''' billil ~ IittiHiili6'tl§ from his iffljialfffiffltl, In jjjruft~ tid, firtdm~1 the ilildmlgtlfd iliUM C<lfi§idu III Mille 1i1.iI1WII'.llfljl!jfffi.,ds, in<ludlllg 

ilftji"lfffletUJ! tlttK It! fttj( §t\'tfli (20 cl"il,4ll4. f~2d(e18tld 404.1s45; §§It ~§~), 

t4t~I. Ill, Ulldefslgtt.!d tillt!l deltfltjiftl! II ~tI/l (<lUI wttet1fellli .. l.llfl"ft( ko; th. mlduw NHtUdflid caplltlty I<J ~~tlOfttjIh< re~Ulf~fliOfils of hi. 

flIl!I fiift¥MI_1<(lOejik 4Il4.U2tl(l)), 1(1fle~~Il!llllt hlIl tIi, re;iduaf littleti.,ud .. ~.ellJl todli hi. p1l!llltlevartt w(Jl'k, me flaJlIWlt Ii Mt dlilsbted, Ulhe .!simam (f unallie I<) do IrIl' VI1!{fiitt\-lnl\O;.,fl: Of cm§llmhavd IOl)I ~"II'1!I'VlII!t wOtk, l1e Mllly&i! ptil~ds (0 !hi> nM mid tllll 

IU!p, 

Al tilt IlStlkp oftflo "qu<ntl.I •• II ... flon preotu (20 CI'1\ ~04,Ulll(g», Ih< .., •• nlglled IfjU,! dtlfrmine Wlttlhcl the ... 1_1 ~ IIlde 1<1 do MY 

mhof wor!( ..,."ierln£ hI< ",ldual ,,,,,,tlo",, c"I'""I!)" .ge •• .wOlfI"fl, .. d "'Otk "p"tionce. lithe dilmanl I, ab!. Co do ""''',",Ork. helUWI, 

dlMibt«i UtIJe ",11IIIJlI II nalobl. '" do ofIler wor1t w meets Illedunltlon h:qulrtln'n~ he If dllllbltd. AlthouBh the <1.1_1 gen.ll!1ty OOItdnUCt to h ... die burden ,,(proving dlslllllhy "'thll st.p, IUmlt.d burd .. orflOi'g fOMUd with"" eVld""", thlft! 10 the S",,1al Se.urity AdmlnlwaLlon. In order to ''l'port • flndlrtlllhai an Ind!.·lduall. not dls""14d "' thl • • t.~, tho Scoial B •• wity Administration (. re'po""bI. rot provldlrtg evld.~ Ill .. dtmonstrlUt filii o!lter wotk .... IS i> .lgnlJitan' numi>m In Ill, "111100,1 economy !lui tho ,lal""",! can do, given the , ""ldiJIIJ ""u:!fcmll "OPacity, age, cd_fion. and work "p<rl<n"" (20CFR 404. 1512(g) and 404.lS6V(c». 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant's date last iosured Is December 31, 2010. 

2. The elaimant has not engllged in lubstantilll gllintul activity sinee September 22, 2005, 

the aUeged oJlJlet dde (20 CrR 404.1520(b) and 404.1571 ef seq.). 

4. The claimant does not have an Impairment or combination oClmpalrments that meets 

pr medically equal$ one ofth.e listed impairments lu 20 eFR Part 404, Subpllrt P, 

Appendix 1 (2{) CFR 404.1S20(d». 

S. After careful cOll!llderation of the entire record, the undersigned fUlda that the 

claimant hag the residual fundlonal capacity to perform sedentary work euept the record 

shows the claimant Is functional below the sedentary level Cor any sustained, continual or 

regular activity. 

In making this finding, the undersigned eonsidered all symptoms atld the extent to which these 

symptoms can reasonably be lICcepled as consirrtent with the objective medical evidence and 

See Next Page 
475 

oth(!t tNldence, bll.!l(!d 011 the r(!qulfM1ert!~ elf 20 CPR 404.1529 and SSRs 964p I!J1d 9&0 'p. The 

UJ1derslgrted litIS also wt1!)ldcroo opit1iol1 evldcNce In acc:otda.t1De with the requitemeuts of 

:W CFR 404,1527I111d SSJU 96.2p, 96.5p, 96·61' and O(J.3p. 

REFERRED TO: • MIl IIUOOI1IJ rmtlb1t. 

poIitnl w.s iM~ 10 re\ut1'IlO 1". dlnlc IS needed, 

See Next Page 
476 

------- -- Pnge4 of? 

• 

"~UlltTAl1OO§ 

o ~ eMillll4d. (I'Wl6d 1; ~ It) 

I. ~lII/lyrllIM)drMlf'(~~~ 

t-~m)· _1tIof kin __ oIlIlo liN ~ _11><0', 10~ ~ thO ",",",iii #INIpdOIlll., klllM1 I\. 

C ~ fIA/IlO p..urxli 

ClOpoiMIjU 

II fO ~UIId. 

CGO~""d. 

o 100 pouf1d1 " ""''' 

2. P'equ.l1ll1r lift Mdl6rtollTY 0tIdudI~ I.IpOIItd ~ 

~.~m) • _" 1m I1U1t1I1W)..hflds ti II>e (tn. cit 1IIt.IhA'lIO potrIdt. f):p\IItIlM amoun! ~l" .fm 11 

CJ '"" ~ 'O~. 1:1110 pcl<ItId. 

D~IIO"M' 

LJ GO _do 01 ..... 

3. Slone! an11>r 0AIk """ nonTIII ~"" olGW 01· 

o IoH ..." 2 hoItllit!:In a·hDliI -OV 

C .. -.~ ~.., .. " ... .....,' .. -r 

l:II_ute"" ......... 8-1lOUI_ay 

O_""",""ulJod~.ldu __ ls_""'r"'_ 

4. $If /Will """,'1Itu1cl) tor. I<Ul 04 • 

OlrH'- __ IG"""'o"' •• ~~ 

aa """,d """'0 .. on """ ""dld.,- o "",.1 portodlcal\' alll'mll. lilting __ ;., , ...... po;" '" dlr.orr.lotL (H oI>rlc.d •• q>!oln In e ~ 

6. f>1IOh and/or pili ~ """,mlon otioond andforl00t C<IfMlIS) • 

1m ,.,1im'1od."", .. II>M .. _ tll ~ftandloro."., 

o IimIlo:Iln _ O>Itemilleo (G_M~ ""!II', and dogreG) 

CJ n.-tO<! 1ft _, .. v.mlles (d'_~ MMI .. "" Ma'OG) 

II. Elrpfa"_i!IIdwhylllo~llUptio.b"""~"'.O!Mltht<>v;l!lS. 

CIItI ... spocifle fadI upon oIUcft l""" COI1CIu!IDns .. #IIaHd. 52 vea. old "it" u ¥ .. r. 01 od .. ""tl"" .11oGlllll noek ... .<\ .... utd.t l"iurh.. lIP a/. alr:rocUac.etOCJ W fa.lob vltll in'tJ"'tt!l.tltaUaI'i At c .... ? ~ arthrOlooj2f of rJ,h'C; .~~ld..,r. .. .. s jl&-C II.~ po4~cn.~ renr-lcdOf'l" of 2!11 Uldt)4. bttndhtg~ 

1"'l1lJ>~, tu~-:lntI, .te. HfII._ rl~ht ._16 .. "..,r .. ..," aCH with < .. "Ito" and no 

pejnt AOL'a- lnd1.cr.aee M it able 'Co f.Ot"form hh own pcJ'rraru.l earo) prep.ft.t"cfI .1ft1l'll'J 

... lI; doll lalJ.Adl'Yf dtlv •• and has. uHp probltlH due t;b .rm p.llie, ~ ~b« ... 'VI't:!on 

.ha'lttf tl\ .. t; ho .,.,UC7d .10"J1 al\d d'eUkrllu. snd oho" tubbod. ttL, na-ct .. 

........ 

Various physicians, treating and non-treating, have written that the claimant suffered from 

various medical problems and that the claimant has significant work restrictions. 

See Next Page 
477 

WhIle th~ fitldll1g that II I'el'llllfi l.'i "disabled" undef the fif(jvlllitltl~ or the Sodal Sceurliy Act is lilt 

Issue te§etvoo 1(:1 the Ctlmmls§itlfjet"3 (SSl{ 96-51'1), tlplfiiOl1S frtlm atly mediC!l.l soUfCe (jfi IsstJes 

feserved to the Cottlml~~I(jfi1!f mti§t liCV~f he Ig/l(Jfed, 

The !i4ludlllatof j~ requited ttl ~valWtfe fill eVld!!ffd/! 111 the ease teG<Jfd that It1sy have s bellrlng tlfi 

the deteffl1lrtatlon or dedsloll trf dls!!bl1lty, Itlcludlffg tlpirtiotl§ trottllt1edleat StlUfceg ahdut Issues 

resetved to the Comml!i5iml£:r, 

If the OOe reoord cant!!ins lilt opftuClll trom II medlt:al SOUft:e on an Issue fe!iefVM to the 

Cotnttlisstot1er, the adjudieator must evlllWtfe all the evidence in the case record to determine the 

extern to which the opinion Is supported by the reccrd. 

The fact that the claimant's treating physician, after extensive examinations and treatment, has 

formed such opinion as to the claimant's ability to. perform sustalncd work aotivity was 

precluded strongly suggests a significantly limited residual fum:tionlll capacity. 

Further, cons1dering the claimant's diagnoses and multitude of prescribed mediClltfons tried, the 

undersigned finds that treating physIcian! s opinion is well support and is not inconsistent with 

the other substantial c:vldence In the case record; thus, it is afforded controlling wclght (20 CFR 

404.1S27(d)(2) and SSR 96-21'), 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted lIS consistent with the objective medical evidence and 

other evidence, based on the requirements 000 CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-61' and 06-31'. 

After considering the evidence of record, the undersigned flllds that the claimant's mediclllly 

determinable impairmenl(s) could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity, persistence and limiting effeots of these 

symptoms are generally credible, 

The State agency medical opinions arc given little weight because other medical opinions are 

more consistent with the record as a whole and evidence received !It the hearing level shows that 

the claimant is marc: limited than determined by the State agency consultants. Furthermore, the 

3 Under 20 CFR 404.1521(0), ."",. WtJI!! lite not medical l!wcs ttg.iding the natur<! and severity of an IndividuaJ'j 

Iml'alrmen!(.} bUl are idmlnlM!(I~. nodlngo that an! dlspogltlye of. cu.; t •. , !hal wduld direct tho determInation Ot <Icd.I"" or disability. The folloWlna ore elCM1pll!S Mouch { • .ru •• : . . Whother an IndivIdual', Impalrmtnt(!) meets or Is ~ulV&lcnt In ,.verity to the requirement! of My 

Impalrment(s) In lIle H,ling!; 

What an Individual's RPC I.; • 

Whether an Individual'. RFC pre~en!s him t1r her from doing past r<!lovanl work; 

How the voeallortal rodors of age, ci:lucatlon. III1d work expcri __ 'pply; BIId 

Whc:!h.r an IndivldWlI Is "dlsablci:l' under the Ad 

The regulation, provlW lIta! the fu,al teSp<!llSibltltv for dedd;ng Issues ,uen as these Is reserved to to Commissioner. 33 

Sec Next Page 
478 

Page 60f7 

State agency consultants did not adequately consider the claimant's subjective complaints or the 

combined effect of the claimant's impainnenl~. 

6. The claimant is unable to perform any past relevant work (20 eFR 404.1565). 

The demands of the claimant's past relevant work exceed the residual functional capacity. 

7. The claimant was an individual closely approaching advanced age on the established 

disability onset date (20 CFR 404.1563). 

8. The claimant has at least a high school cdncation and is able to communicate in 

English (20 CFR 404.1564). 

9. The claimant's acquired job skills do not transfer to other occupations within the 

residual functional capacity defined above (20 CFR 404.1568). 

10. Considering tbe claimant's age, education., work cxperience, and residual functional 

capacity, there are no jobs tbat exist in significant numbers in the national economy that 

the claimant can perform (20 CFR 404.1560(c) and 404.1566). 

lit determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual fimctional capacity, age, education, and work experience in 

conjUnction with the Medical-Vocational Guidelines, 20 CFR Part 40:4, Subpart P, Appendix 2. 

If the claimant can perform all or substantially all of the exertional demands at a given level of 

exertion, the mcdical-vocational rules direct a concluSion of either "disabled" or "not disabled" 

depending upon the c1aimant's·specific vocational profile (SSR 83-11). 

When the claimant cannot perform. substantially all of the exertional demands of work at a given 

level of exertion andlor has nonexertiona! limitations, the medical-vocational rules are used as a 

framework for decision-making unless there is a rule that directs a conclusion of "disabled" 

without considering the additional exertional andlor nonexertiona! limitations (SSRs 83-12 and 

83-14). 

If the claimant has solely nonexertiona! limitations, section 204.00 in the Medical-Vocational 

Guidelines provides a framework for decision-making (SSR 85-15). 

Even if the claimant had the residual functional capacity for the·full range of sedentary work, 

considering the claimant's age, education, and work experience, a finding of "disabled" would be 

reached by direct application of Medical-Vocational Rule 201.14. 

11. The claimant has been under a disability, as dermed in the Social Security Act, from 

September 22, 200S through the date of this decision (20 CFR 404.1520(g» • 

. See Next Page 
479 

Petge '7of'1 

DEcrSJ.ON 

'SEISed (jn the application ((jf II period of disability IIlld dlSllblHty ifisurance benefits filed (jll 

Deeember 5,2006, the clalmetnt bas boon disabled U1Ider sediclns 216(1) Btld 223(d) oftha Social 

Security Act beginning on September 22, 2005, 

Medical improvement is expected with appropriate treatment. Consequently, !I Mntilluing 

disability review is recommended in 12 months. 

w~",,· Com",~." """ ""Y '" """"bl,, ~-:-=-c::--_;3L_/-:--=-:-=c--_a 

/ ~ O'BryBtl, Jr. (0453) 

United States of America 4Administrative Law Judge 

Federal Administrative Judiciary 

DEC 2 e 2007 

Date 

4 W .. lImr.rd O'Bry.n.Jr .. (04!3), UIII~!illattI: Actmltl"tntln La"Jud~ Soda! Sccurit)I AIjmIl:.!JtrIliIlIl, om~ (I( Adjudled{o" W. Rey{~. WlIo 1111)' "Ifl'ld!!' usc 

J$~hweDef~pcetldialofli.ect: ,USC .H6(Ii:):S~1aItolecfIhcAdminlm.siWi La'IVJudsl!u!' Social 5ecurir)'; ff;s;ltIyr Ctmpbrll461 U.s.OS,.7!, 103 S.CL 19.!l2. 

19!i1, 'S.UlS, 3, to, CCH, I 4.5t5(1913);1)fru y. tftc!dft 1111.1d JOl>, !fO. IGS,gJl,!. 219) lU (1Cd!. cw. t9B?)~ m F..2.d 1U2~ '104-105.14 S.S.R.S 

81199-90, CCH, 11.(111 (,tbCtr. t9S6),~1'.1IudI., 651 '::1dJU('thCIr.I9IU:~".~ 521 F.ldIl.(.(lf4Ch'. )97~){Achnlnt..t:n.ll.W! I...twJud8l!niUR 

~~.AfIrK.ordwtl.mclCm.lOtrept'lHtltl:d"rCQtllltef><BtdI.H.~"lJF.1dJn6,4,.sJts".(o.CCH'I..S,l2"'~tlIIClr.t!ia-lJ,~'I'.~1.H. 

P.l~214 (5IhClr. fo}lS};Iot4cfI y. Htddr;r.US f.2d rU".lDS,!,R..S. Ut.C'CH 1 f7.Bd9(IOlh err. 19S1),(A.dmWJtratI¥1I!t.z.vJud.AC IaDldevcloptWI IttOtCIfte/lU' 

dlliJ'ng1 tepf'tteried hy ~}l sodtl ~ry llulJnt 11423; SoclaI9«ui.ty Rt:gu11ltl0:!l( 10 ent f4 .104,Q.U 1i:lld411ii,1444, tft abo. 2(J CFR "~.9!CI. 4!J4 9'1.41/j.I4SD~ 

416.145I}sodtl Sfturi/j' Ad, II 3i>S(b) ed 16jl(eXI). 
480 

From: ~ •• IIILag.: 13/16 Dat.: 212412009 1:04:45 PM 

January 4, 2008 

F",,:('_' '- __ _ 

Fa>:: '';'' 

~-~.----

.F",,:'(~ 

Fax:'~-TV~ 

Re:..-

DOB~ 

Oem Docto,.: 

Board Certified Ju,.,/,,';iology 

.........,1111115. She was refem:d by'. _ ••. ' .lilt on her insurance =t1y 

and : •. __ ._ .s ber primary physician. She has Crolm's diagnosed April 2007. The patient is on 

R.micsde. . 

Her evaluation -lab, umemarlcable cac, B 12, and folate. 1ron low normal at 36 (35.180). CMP 

- unremarkable -Illicacid 2.2 (2.5.8.0). CPK of 42. SPE is unremarkable. 2S·hydrDltyviwnin 

o of.!J! (20·100). Normal hemoglobin Ale 0£S.2. Nonnal sed nile ofl9. Negative CCP, ANA, 

rheumatoid factor, CRP, and HLA·B27. . 

Biomarker profile done September 14, 2007 - (just prior to Remicade) wilh nannal TNF, 0...6, 

and !L·t7 cytokin ... 

Qojyjcal MRl is revicwed. Some cystic change in the nasopharyngeal soft tissues. C2·C3 with 

spurring with left nClD'oforamen nanowing. C3.C4 wilh spurring with spiaal steno~s, 

uncovertebrnl spurring, 8/ld moderate bilat=l neuroforamen narrowing. C4-CS with modcnlle 

spinal ,tenosis and uneovertebraJ spurring with moderate bilateral ne",oforamen narrowing. CS· 

C6 with mild spinal stenosis, disc bulge with uncovcrtebra] spurring, and moderate bilateral 

.euroforamen narrowing. C6-C7 . wilh disc bulge with spurring with mild spinal stenosis, 

uncovcrtebral spurring;'and' bilatCr1!~·neurofommcn·narrowing -·mild,· .. C? TI· posterior- ridging ...• 

with uncovertebral spurs and mild right and minimal left DCuroforamen narrowing. 

Lumbar MRl is reviewed .. L4·LS with left paracentIal rupture. Radiology notes this as small. I 

think this is a moderate disc rupture and there is dehydration at this disc. Facet arthritis and mild 

spinal stenosis are noU:d with mod=1e Deuroforarnen narrowing bilaterally. LS-S f djse dj.ease 

with fa«t Brthritis. Sacral nerve rool sleeves are noted. Left renal cyst. 
481 

b • 

0110412008 

PBgo:TwQ (2) 

FromlE •• ' Page: 319 o.te: ']f24flf»3 4:12:44 PM 

CAT 5C!!!! lumbar spine to evaluate for • pars defect. Schmorl's nad .. an: noted. IA-W with 

disc bulge with spinal .tenon, and nC\tr1)foramen nllmJMng. U·SI wilh spwring at the raoe\l with right .. ided spurring. SI joints with ~lcoarIhriti. <hang .. with gas degenention. Sacral 

none roolstccvcs incidentally noted. ASPVD i, also seen. 

She saw:":":-. He performed tlIrcc lumbar epidurals. She atill is lIaving pain. 

Her Crahn'si. a.tive with =ping and dian"" .. 

Reganting her li=ieade, I think .he is on 10 mgIks' e""'Y four weeks. 1-.... her next . 

week. She i. on Pcntasa and has had increased steroid'. 40 mgDfpredni,one. 

Regarding her joints, .he is baWl8 severe neck pain thai goca down in both upper ex1mllitics, 

especially on the left. TIt .... ie spine with pJin iD the midthmcie region. Lumbar spine bothers 

her. 31u: cannot sleep more than aD hour at • time. She has pain in !he baclc down the back ofher 

legs to the knees in the IA-U distnbution. She also bas pJin in the bullock orca. She carmot .it 

for ""'Y lang. 

EXAM: 

She has cervical spasm bilatenlly. TItora.:ie spi ... with some tenderness. Lumbar spine with 

tenderness bilaten1ly including the SIjoirrts. 

What is going 0111 

1. Irill_orr arthritis? Ibis is difficult to delonnine. I do not think.be has Rheumatoid 

Ar1hriti.. A consideration i. Crolm', SpondyloarthropathyJAokyJosing Spondylitis. I 

think she has ...... ailiiti. on ~-ray. Her fabere', t<stiJIg of the Sljoint w •• positivc an the 

left She has had luinhar cpidura\J;. She ha, not had an SI injection. J talked with -

I ~ today. He will see her and review tile cause of her nain wilh SI injectiOIlS. 

consider facet injections, lind then he will refer her to '~. Spine Orthopedics. It 

is hard to know if she bas an inflammatory process. She could still have sacroiliiti, eYEll 

w;th (01herwise) .",biliud Spcndyloarthropa1hy. I recommend continue Reinicade. She 

sec. r-.tat week. I called hi. office and f_.s will call me next week. 

2. Cervi.al dis<: diseaoe. ~ paliont with multilevel ~isC probl .... , especially at CS.c6 

with moderate spinal slena.i •. She bas nerve entrapmCDt bil.tcrany. Multiple ather area> 

with nerve entrapment. 

3. Lumbar spine - the patient has lA-L5 ruptured disc. I think this i. moderate. The disc is 

debydrated but the dl,e is dehydrated. I think this is very abnormal imd her pain 

disuibution goes along with IA-U. There i. overlap willllhe ""emma. jainl$ and the 

lA-LS disC. I think she will need 10-••• Spine Orthopedi ..... A , ___ "lI.fAci/itate. 

Ibis. We discussed smolcing cessation preoperatively. 

4. Steroid we - recently increased to 40 mg. 

5. OYN - per i ---.£ecenl vaginal discharge. 

6. RighI third MCP lesion - I think b<:nign and do not think inflammatory arthritis. 

7. Left third distal phalanx endochondroma - large - punue subsequently. 

8. Bilalcr1ll wrist abnorm.liti .. on x-ny with soapholun.te in.tabil.;ty. 
482 

FIOm: 4057026718 Page: ISM Dole: 21241200!j.j:Q4:45 PM 

0110412008 

P.g~ Three (3) 

9. Acrivity .tabU - she 

Ihere seven years as 

2001. She did not October 17, 2007. She calJed 

the ~m"" 1IuIt she had c ..... d working. Tho lut &ry o(work at September 6,2007. 1 wa. unable 10 write for dis.bility without seeing her. I think there was • miS\ll1denlBIuling 

where by r ~ felt I insll1lcted him 10 write this. She also had problmi getting htl' 

fo!Iowup scheduled until today. I IBlbd wit!. ~ today. The paticn1 Slales 1IuIt 

her work position has been e1iminat<d. 

10. ASPVD -noted on CAT scan films. 

J WIll ~Io supply SOIllC infonnation from her employer. J told.her 1hat I think she is best 

served working to maintain her activity le>el. HowCV<:r,.1le bas been of!' work. I r=mmcnd 

physical 1haapy regarding cesvica1, 1iIoracic, and IUIlIb", disc <lise ... and """",mitis for Ihroe 

weeks. To Whom It May ConCerti: The patient is W18ble 10 work WltiDul)l 4, 2008. Allhal 

time, she will have no "l'e$lrictjom;. 'reg!lt§t infO!1!!!!jIll! regarding employment and reassw 

January 10, 2008. 

She wiU come in the office January 10,2008, for review of her employment inConnation. I will 

see her hack in two monlho. Continue her lUlafm, Lartab, BIId Soma. SIllII:" was written today. 

Twenty.five tninutes spent with the patient today. 

Thanks. Will be in Iouch. 

Sincerely yours, 

(} .~ 

CClAAAJ>Noshi TmnscribelCD 

cc: 
483 

PATmNT: ~JS.T~e"F""-- START ()]1 CUtE.: 07l30l2008 

AGE/DO& .,~~!!~~ ______ __ PROVIDER: '"1 

MEDICAL Dc ~~ diIc cIiIC8ID(DDD). 

mORT·TERM GOALS: 

1. The paIil:Id. will be indcpcDdcut wI.Ib home a:mise pqram. 

1. The potim will mil: pain less 1han 611081 iD-. 

LONG-TERM GOAU: 

mCN: 

DAn; 011' ONSET: 

SEX: 

nOVIDERII: 

TREATMENT Dr. 

N/A 

1F712412OO8.Id:tJiCiil4>tU:' 

Female 

N/A 

Back ODd bIlaIml \qwer 

a&u:mity pain aM . dec:tw;ed I'unI:Iional 

mobUlly. 

1. 1bc patiaII will mil: pain less 1Iw141l0 It iD-. 

1. The pIIieIII will tqID!I pet{OaniDg 1mmdIy, batIDa.1IId zeatting CarcbjedaO!1 i_enhelva wilha1t ~am 

ofpaio. 

3. Thepalil:ld. will tqJOII1IIIt bavIna to n:pail:l<m Rlf_ dian e.ery2.5 JIIiIlInes widIcNllbeeuteltllllieD of paiD. 

PLAN OI'TREAt'MENT ('I'R&\TMFRrINTERVEN'llON): Ph)'llical. tbIIrI!pyfar1llerapo:ulic~. maaualdmmpy. 

aoc1l1lCldali1ics to ~ paiD BIll inaase 1Il'eDgIh. 

FREQUENCY IDURA. nON: 31im£s ptrweet 14 weeks. 

MEDICARE CEllTll1ICATION PERIOD: MIA, 

PRECAUl10NS I CONT.RAJNl)ICATIONS: NIA. 

PATIENTGOAL8: ''''801lao:kto wmk," 

PATIENT EDUCAnON NEEDS: lbIIpaIian was pt'CJ\'IIW wiIb ahame oaaclse pllJPllll. It WIll dlscussed wiIh ha' the 

impmtm:le or COIIIimJiD& wi1b 1!iI: QaCisa pmgnm1 CYI:I1 after dI3c:lIarp rmm Ihcmpy. 

t:----........ -- p----- ----

Permanent Subcommittee on Investigations 

EXHIBIT#8b 
484 

PATIENl': &lit zIP"' mCN: NlA 

RESULn OF EVALlJATION: PALI'ATION I V1SVALlNSPECtlON: '[bepaliempreseoll widulIlISdc dgblDess hi 

Ihc pll11lllpina1lumbarn:gion.Sbchadan ERSRaI TS 811dan BR.SR 811'8. PAIN: PaiD is 8110 81 it! wantml OJI08lils lieU; 

boIh _pIIliI:ntgr;e 1ft: widI pIiD awlica~!!!"mddmina BdIvIty. 'l'bIIpaIienI SI8Ic8 painlllmt'lluomd lA-LS 8Dd rm!iaIa 

110M! bath lowercnanitia III br:r feet. 10STtllIE I AUGNMENr: 1be pa!iall hasanelmlllld rigbl IhmIIder and pelvis 

wiIb iII:rased lonSosis. ROM I JOINT MOBO.lTY: W"ttIIiII nmmaIllmIIs. H_r.1bt palinldoes bave Ii&lIt baD\StIiIlal 

817S degnoes 011 Ibe rI&bt and 60 degtwl 0Ii.= Jeft suplDll. S1'RENG11I: Smmp Is S" In aD fOuz .... uemitics. 

llALANCE: Within DIlIIII8IlimitJ. GAlT: W"1Ihln I1D!JIlI! limiIB. SENSATION: Jma:c. SPECIAL TESTS: "/A. 

ADDmONAL FINDINGS: NIA. . 

TREATMENT PROCEDURES: 

1. EvaIuaUan. 

:z. ~1IIJ'CUdc exen:isco. 

3, Home eurt:ise pmgtlIIIl. 

CLINICAL IMPltESSION: The patic!ltpn:seall with badr. a!!d lmierexuanitypain VIiJh decalased t\maionaI mobility. 

REDAB1LlTATION POTENTlAL & DISCIIARGE PLAN: 'lbepatic:Qtiaa Sl~ I'Imak Jd:m:dtopbysicalthcnlpy 

with hmtIarDDD.Sbe in good Uabi1illllioncaadlda!ebadmprlarleveloffwla1onmd IlDivalioR. 1bB puIem will be 

dischaJged wileD goab an: mer or if IIhe fills to re:spond to 1benIpy, Sbe WIll lie dIscImge4 wiIb I heme eJte1dse prognm. 

PJ:wn cc: ] ____ _ 

FIle 
485 

From; 4057026718 Page: 8/16 Dats; 2124120091:04:44 PM 

... ·'VUUI",-", •• 1. 

Boord Certified Rheumalology 

July 31, 2008 

----~TimaJyCan:} 

Fax: (405) 945-5220 

• . - • - 3astroenlerOlogy) 

Fax: (405) 632-4073 

---~_~. --"'!. ,Jine Orthopedics) Fax: (405) 692-\632 

Dear Doctom: 

"'-'retums.'-'was last seen July 8, 2008. Sh~ is continuing to have lumbar ~ that 

radiates down"'ll!'rlarieg. Sbe sa'" -_ Tuly 24, 2008. She has bad cervical and lumbar 

epidurals. l:.'er pain has persisted in tile lumbar spine. 

Reglll'ding ber employment: Her last day of work was Septem~ 6, 2007. There was miscommunication amoug L _ and me reganling her ... ode situation. I) _ laced b ... 

off work approximalely September 6, 2007, to January 4. 2008. I wrote for disability from 

January 4, 2008 III1tiI July 4, 2008. She was to see I - before July 4, 2008 regarding spine 

disposition and his opinion of activity reslrictiDlU. Wben I saw ber OD July 8, 2008, I continued 

her disability, awaiting j opinion. 

Her pain is severe. She bas problems sitting and standing for more than to minutes at a time. 

Her Deck pain is better after ccr.rical epidural$. She does have some lower thoracic pain. 

EXAM: 

There is some cervical spasm. lboracic spine with some tendcriJess in the lower thonIcic regioo. 

Lumbar spine wilb tenderness left greater than right. Normal reflexes and strength in the lower 

extmnities. Knees with crepitus. 

, X-RAYS: 

Cervical spine, C4-C7 spurs, especially C5-C1. CS-C1 with disc disease and ncmoforameo 

impingement. Loss of lordosis. Lumbar spine, some facet IIItIuiti. U.S!. ASPVD. ~ pelvis is 

unremaricahle. 

Lumbar MRl is n:viewed. Left renal cyst is noted. Tl2-LI with right-sided ruptun>d disc. L1-U 

I think with right-sid£!i disc bulge. L2-L3 with tiu:et arthritis. L3-U dis<; bulge, facet arthritis, 

mild spinal stenosis, and mild Deuroforamcn impiogement. L4·LS with dehydl1lted disc, extruded 

diS(; to the left with severe neurofommeo impingement left greater IiwI righL LS-S I with ccutml 

disc and facet arthritis with spinal stenosis and bilatcn\l neuroforameo narrowing. Radiology 

doe$ 110' 1I01e ab1lOmwlllles at I12::l.1. 

EXHIDIT#8c 
486 

FI1llII: 4057026716 Page: 9112 Date: 212412009 4:06:17 PM .) '1 

'o71J1120'0S 

Page Two (2) 

What is going on? 

I. Lumbar dise disease with h:ft-sided Rlptwu\ disc at IA-LS. This developed sinc:e 

2. 

3. 

4. 

S. 

6. 

Sejrt.cmber 2007 lumbar MRJ. She: starts pbysicallbmpy and scies J ---::- leptcmber 

4, 2008. The L4-LS ntptured disc is Ialp. She has no neurologic deficit. 

Cervical disc disease. beuer with epidurals. 

Thoracit disc; disease - will get a tboraeic MlU. She bas right T12-LI with rupture on tb8ri~ . 

Crohn's, UDder ~ c:an:I. The patian is on Ranicade 8IId prednisone. 

Steroid DIe - ~tb Crobn's. She tMS' 20 mg tapering dow to 0 even' six 

weeb which cycles with her Remicade. 

Bilateral knee pain - will x-ray on foJlQWUp. 

To Whom It May Cow,,"," ne patient is ~e to "'2Ik IIDtii Septanoo.: 4, 2008. I will see her 

that day after slu: sees L ~~ t. At thiIl time, will x-ray her knees. 

11umks. Will be in touch. 

Sincerely YOUB, 

... CClAAAPI!U"",,p .. ' __ _ 

cc: 
487 

SOCIAL SECURITY NOTICE 

From:' Social Security Administration 

_. II,:':r4 

. Date: August 5, 200B 

Claim Number: ....... rte 

Claim for: DIS 

We are writing about your claim for Social Security disability benefits. Based on a review of 

your health problems you do not qualify for benefits on this claim. This is because you are 

not disabled under our rules. 

We have enclosed information aboutthe disability rules and more details about the decision 

on your claim.' . 

ABOUT THE DECISION 

Doctors and other trained staff looked at your case and made this decision. They work for 

your State but used our rules. 

Please remember that there are many types of disability programs, both government and 

private, which use different rules. A person may be receiving benefits under another 

program and still not be entitled under our rules. This may be true in your case. 

The following reports were used to decide your claim: 

We have determined that your condition is not severe enough to keep you from 

Permanent Subcommittee on Investigations 

XXX-))tJ3_S_ ":lliII ..... : Tn .... _ .. E~XH_I~B_I,;;,T_#_8d __ .. 
488 

working. We considered the medical and other information, your age, education, 

training, and work experience in determining how your condition affected your ability 

to work. 

You said that you are unable to work because of Crohn's disease and degenerative arthritis of 

the neck and lower back. 

The medical evidence shows the following: You have arthritis of your neck and back. 

While you are not able to move your neck and back as well as you used to, you are still 

able to do some types of work. While you have been treated for Crohn's Disease, this 

condition has not seriously affected your ability to work. Medical evidence does not show 

any other impairments which keep you from wo·rking. . 

Based on your description of the work you performed as an administrative assistant for six 

years and six months, evidence indicates you are capable of doing this type of work. 

If your condition gets worse and keeps you from working, write, call or visit any Social 

Security office about filing another application. 

In addition, you are' not entitled to any other benefits based on this application. If you 

applied for other benefrts, you will receive a separate notice when a decision is made on 

that claim(s). 

IF YOU DISAGREE WITH THE DECISION 

If you disagree with the decision, you have the right to appeal. We will review your case 

and consider any new facts you. have. A person who did not make the first decision will 

decide y,?ur case. 

• You have 60 days to ask for an appeal 

• The 60 days start the day after you get this letter. We assume you got this leiter 

5 days after the date on it unless you show us that you did not get it within the 5" 

day period. 

• You must have a good reason for waiting more than 60 days to ask for an appeal. 

• You have to ask for an appeal in writing. Wewill ask you to complete a form 

SSA-561-U2, 'called "Request for Reconsideration". You may contact one of our 

offices or call 1-800-772-1213 to request this form. Or you may complete this 

form online at hltp:/IWWW.socialsecurity.gov/disability/appeal. Contact one of our 

offices if you want help. . 

• In addition, you should complete a "Disability Report - Appeal" to tell us about 

your medical condition since you filed your claim. You may contact one of our 

offices or call 1-800-772-1213 to request this form. Or, you may complete this 

report online after you complete the online Request for Reconsideration. 

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your 

Social Security Claim." It contains more information about the appeal. 

NEW APPLICATION 

xxx-~ .. FT_. ____ '" 
489 

You have the right to file a new application at any time, but filing a new application is not 

the same as appealing this decision. If you disagree with this decision and you file a 

new application instead of appealing: 

• you might lose some benefits, or not qualify for any benefits, and 

• we could deny the new application using this decision, if the facts and issues are 

the same. 

So, if you disagree with this decision, you should ask for an appeal within 60 days. 

IF YOU WANT HELP WITH YOUR APPEAL 

You can have a friend, lawyer or someone else help you. There are groups that can help 

you find a lawyer or give you free legal services if you qualify. There are also lawyers 

who do not charge unless you win your appeal. Your local Social Security Office has a list 

of groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hire someone,we must 

approve the fee before he or she can collect it. And if you hire a lawyer, we will withhold 

up to 25 percent of any past due benefits to pay toward the fee. 

OTHER BENEFITS 

Based on the application you filed, you are not entitled to any other benefits, besides 

those you may already be getting. In the future, if you think you may be entitled to other 

benefits you will need to apply again. 

REQUIREMENTS FOR DISABILITY BENEFITS 

DISABILITY INSURANCE BENEFITS 

To be considered disabled, a person must be unable to do any substantial gainful work 

due to a medical condition which has lasted or is expected to last for at least 12 months in 

a row. The condition must be severe enough to keep a pe.rson from working not only in 

her or his usual job, but in any other substantial gainful work. We look at the person's 

age, education, training and work experience when we decide Whether s/he can work. 

The condition must be disabling at a time when the person meets the earnings 

requirement. If you were not disabled when the earnings requirement was met, we have 

enclosed a leaflet which explains the earnings requirement and tells how Social Security 

credits are earned. 

DISABLED WIDOW OR WIDOWER BENEFITS 

To be considered disabled, a widow, widower or surviving divorced spouse (age 50 to 60) 

must have a physical or mental condition severe enough to keep a person from working. 

The condition must have lasted or be expected to last for at least 12 months in a row. 

The person's disability must start: 

xxx-X .......... FiiiDFiiFiiI!' •• _--1I!IaI 
490 

not less than 7 years after the month of death of the wife or husband, or 

for a widow, widower, or surviving divorced spouse, formerly entitled to 

mother's or father's benefits not later than 7 years after the month those 

benefits ended, or 

'for a widow, widower, or surviving divorced spouse who was previously 

disabled and who becomes disabled again, not later than 7 years after the prior 

period of disability ended. 

CHILDHOOD DISABILITY BENEFITS 

Childhood disability benefits may be paid to a person age 18 or older if the person has a 

disability which began before age 22 or within 84 months of the end of an earlier period .of 

childhood disability. The condition, whether physical or mental, must be sev~re enough to 

keep the person from doing any sUbstantial gainful work. We look at the person's age, 

education and previous training when we decide whether he or she can work. In addition, 

the condition must have lasted or be expected to last for at least 12 months in a row. 

OTHER IMPORTANT INFORMATION 

Definitions of disability are not the same in all government and private disability 

programs. Government agencies must follow the laws that apply to their own disability 

programs. A finding by a private organization or other government agency that a person 

is disabled does not necessarily mean that the person meets the disability requirements of 

the Social Security Act. 

IF YOU HAVE ANY.QUESTIONS 

If you have any questions, you may call us toll free at 1-800-772-1213.· We can 

answer most questions over the phone. You can also write or visit any Social 

Security Office. The office that serves your area is located at: 

200NE 27TH 

MOORE, OK 73160 

If you do call or visit an office, please have this letter with you. It will help us answer 

your questions. Also, if you plan to visit an office, you may call ahead to make an 

appointment. This will help us to serve you more quickly. 

JCOljco 

Enclosure: 

SSA Pub. No. 05-10058 

xxx-~ e 

Ramona Schuenemeyer 

Regional Commissioner 

00792 
491 

From~ Page:3I16 Date: '1J24l'1.01:S 1:04:44 PM 

Board Certified Rhl!1D/llUology 

November 18, 2008 

~p ;,:g 

-..a com .. for followup. This accompani .. 

bj.d. #28 on October 29, 2008. She filled it 

After sccins- 1160 which was filled at 

#90. 

.) 

She used J -. 0xyC0ntin 60 mg and now takes OxyCcmIin 20 mg bH. At this 

OxyCDIIIiD dose, she dOes DOt !ICed to tapes off. She takes Lonab 10 mg.She resumed SlDDking. 

She quite smoking for Uuee monlha and bas .... umed. The patient i. postap. She is not CD a 

DODSIeroidaL She is off of prednisone. She re<eI.ed Remlcode NoVember 6, 2008, ror 

CrollD', by: _ wm-get with & ---:::- reganIiDJ Ranlaode. 

Will cIischarie the patiOlll for noocompliance. 

EXHIBIT#8e 
492 

SOCIAL SECURITY NOTICE 

NOTICE OF RECON.SIOERATION 

From: Social Security Administration 

Date: December 23, 2008 

Claim Numbe ...... _ .... 'II!lg~ ..... 

Claim for: DIB 

Upon receipt of your request for reconsideration we had your claim independently reviewed by 

a physician and disability examiner in the state agency which works with us in making disability 

determinations. The evidence in your case has been thoroughly evaluated; this includes the 

medical evidence and the add~ional information received since the original decision. We·find 

that the previous determination denying your claim was proper under the law. Attached to this 

notice is im explanation of the decision we made on your claim and how we arrived·at it. The 

reverse of this notice identifies the legal requirements for your type of claim. 

ABOUT THE DECISION 

Doctors and other trained staff looked at your case and made this decision. They work for 

your State but used our rules. 

P·lease remember that there are many types of disability programs, both government and 

private, which use different rules. A person may be receiving benefits under another 

program and still not be entitled under our rules. This may be true in your case. 

In addition to the reports we told you about in our first letter, the following reports were 

used to decide your claim . 

. '-_ evidence received 10/16/2008 

-------- evidence received 10/20/2008 

__ ~'=":"~~_----evidence received 1 0/06/2008 

.---. E ENT REHAB SVCS evidence received 10/27/2008 

_Ivirl .. n,~" received 11116/2008 

r=,,, ____ received 11/19/2008 

Permanent Subcommittee on Investigations 

XXX··Jlll __ - .liIft._I •• EXHffiIT#8f 
493 

You said that you are unable to work because of Crohn's disease, cervical degenerative disc 

disease, bilateral neuroforaminal stenosis, lumbar degenerative disc disease, and arthritis. 

The medical evidence shows the following: Your Crohn's disease has responded well to 

treatment. You are recovering well from your back operation and should be able to return 

to work within twelve months. Medical evidence does not show any other impairments 

which keep you from working. 

Based on your description of the work you performed as administrative assistant for 6 

years, evidence indicates you will be capable of doing this type of work as it is generally 

performed. 

IF Y,OU DISAGREE WITH THE DETERMINATION 

If you believe that the reconsideration determination is not correct, you can request a 

hearing before an administrative law ju'dge of the Office of Hearings and Appeals. If 

you want a hearing, you must request it no later than 60 days from the date you 

receive this notice. You may make your request through any Social Security office. 

As part of the appeal process, you also need to tell us about your current medical 

condition. We provide a form for doing that, the Disability Report - Appeal. You may 

contact one of our offices or call1-BOO-772-1213 to request this form. Or, you may 

complete the report online at http://www.socialsecurity.gov/disability/hearing. Read 

the enclosed leaflet for a full explanation of your right to appeal. Readthe enclosed 

leaflet for a full explanation of your right to appeal. 

IF YOU WANT HELP WITH YOUR APPEAL 

You can have a friend, lawyer or someone else help you. There are groups that can 

help you find a lawyer or give you free legal services if you qualify. There are also 

lawyers who do not charge unl~ss you win your appeal. Your local Social Security 

Office has a list of groups that can help you with your appeal.' . 

If you get someone to help you, you should let us know. If you hire someone, we 

must approve the fee before he or she can collect it. And if you hire a lawyer, we will 

withhold up to 25 percent of any past due benefits to pay toward the fee. 

NEW APPLICATION 

You have the right to file a new application at any time, but filing a new application is 

not the same as appealing this deCision. You might lose benefits if you file a new 

application instead of filing an appeal. Therefore, if you think this decision is wrong, 

you should ask for an appeal within 60 days. 

This decision refers only to your claim for benefits under the Social Security Disability 

Insurance Program. If you applied for other benefits, you will receive a separate 

notice when a decision is made on that claim(s). 

If you have qu~stions about your claim, you should get in touch with any Social 

Security office. Most questions can be handled by telephone or mail. If you visit an 

office, however, please be sure you have this notice with you. 

In addition, you are not entitled to any other benefits based on this application. If you 

XXX-); \p lAW .FilailllFiiIIFi!tU ••• _;t",jiliMiQ~I~T.II~--
494 

have applied for other benefits, you will receive a separate notice when a decision is 

made on that claim. 

Summarized below are legal requirements for the various types of disability claims: 

DISABILITY INSURANCE CLAIM 

To be' considered disabled, a person must be unable to do any substantial gainful 

work due to a medical condition which has lasted or is expected to last for at least 12 

months in a row. The condition must be. severe enough to keep a person from 

working not only in his or her usual job, but in any other substantial gainful work. We 

look at the person's age, education, training and work experience when we decide 

whether he or she can work. 

DISABLED WIDOW (WIDOWER) CLAIM 

A widow, widower, or surviving divorced wife (age 50-60) must meet the disability 

requirement of the law within a specified 7'-year period. A person may be considered 

disabled only if heor she has a physical or mental impairment that is so severe as to 

ordinarily prevent a person from working. The disability must have lasted or be 

expected to last for a continuous period of at least 12 months. 

CHILDHOOD DISABILITY BENEFITS 

Childhood disability benefits may be paid to a person age 18 or older if the person . 

has a disability which began before age 22 or within 84 months of the end of an 

earlier period of childhood disability. The condition, whether physical or mental, must 

be severe enough to keep a person from dOing any substantial gainful work. We look 

at the person's age, education and previous training when we decide whether he or 

she can work. In addition, the condition must have lasted or be expected to last for at 

least 12 months in a row. 

WKE/wke 

Enclosure: 

SSA PUb. No. 70-10281 

..... 

Ramona Schuenemeyer 

Regional Commissioner 

xxx-)@'5G -"Itbiiniisiii-iiiillill .... ~ 

00792 
495 

April 21 , 2009 

ADMINISTRA nVE LA W JUDGE 

OFFICE OF DISABILITY ADJUDICA nON AND REVIEW 

STE 300 FEDERAL CAMPUS 

301 NW6TH ST 

OKLAHOMA CITY OK 73102-3026 PLSE SHOW TO ALJ 

ORSTAFFATTY 

RE:".==~ SSN:"" 

Dear Judge: 

Please find enclosed a physical evaluation completed by L. _ _ _ ___ .~ and rehab 

notes dated-March 12,2009 from -Ill Outpatient Rehab_ Please add this medical 

infonnation to the Exhibit file_ The claimant respectfully requests a case review for a 

favorable on-the-record decision. 

The claimant is a 53.year old individual with a high school education and a past work 

history as an administrative assistant. She stopped working on September 5, 2007 due to 

degenerative disc disease, crohn's disease, arthritis, and anxiety_ After the claimant 

sopped working on September 5, 2007, she received short tenn disability from her 

employer until February 2008 and then long tenn disability started. Long tenn disability 

started in March 2008 and the claimant received approximately $1618.00 on a monthly 

basis. 

_..-:. ______ .. : ______ ls"the claimant's treating rheumatologist. She completed the 

enclosed physical capacities dated March 18, 2009 indicating the claimant cannot 

perfonn the requirements of even sedentary work. The claimant needs to alternate her 

sitting and standing at will throughout the day_ She cannot use her hands adequately for 

simple grasping, fine manipulation, and repetitive motion tasks. The claimant can 

lift/carry occasionally up to 5 pounds but should never lift/carry over that amount. r - writes the claimant is in constant pain and her condition is chronic and 

incurable. The claimant requires daily pain medication and prolonged periods of rest due 

to fatigue and pain. l---.fwrites the claimant has chronic pain and inflammation in 

the joints, diffuse musculo-skeletal pain which is causing fatigue, inability to concentrate 

and Dotential absences from a job due to disease exacerbation. The pain, according to 

_ _ would be disabling to the extent that it would prevent the claimant from 

working full time at even a sedentary position. 

EXHIBIT #8 
496 

RE: SSN.1III11 'I:=P:::?S~ • LIB' 

Page2 

The notes from J ..... __ ,","::, : Rehab, dated March 12,2009, indicate the claimant has 

-bilateral hand pain, bilateral foot pain, low back pain, thoracic pain, and hip pain. The 

claimant cannot perform normal ADLs at home, including vacuuming, unloading 

dishwasher, or doing laundry. -

a 5 _ 7 R respectfuJly request that controlling weight in your decision be given to the 

opinion of her treating rheumatologist, [ in accordance with Section 

404.1 527(d) and SSR 96·2p. 

The claimant's unpairments cause her to have liinitations of function that would preclude 

her from performing her past relevant work or any work on a sustained basis. She has 

limitations that would preclude an individual from being able to perf orin even sedentary 

work over the course of a normal 8-hour day or Ii 40-hour-work week. According to 

SSR96-8p, a finding of disabled is warranted when an individual is unable to sustain 

work performance over the course of the normal workday or workweek. 

We respectfully request your review of the enclosed medical infonnation and thoughtful 

consideration 

I can be of any 

of 

assistance 

a favorable 

or 

on-the-record 

answer any questions, 

decision 

please 

in __ ___ 

contact 

_ 

me at 

~ 

_____ 

Sincerely, 

Representative 
497 

'd:.\. s£cv 51 t. SOCIAL SECURITY ADMINISTRATION 

I ,I 

.t'. ,= 

Office of Disability Adjudication and Review 

SSA ODAR Hearing Office 

301 N. W. 6th St. 

3rd Floor West 

Oklahoma City, OK 73102 

Date: May 21-, 2009 

NOTICE OF ATTORNEY ADVISOR DECISION - FULLY FAVORABLE 

, As a result of an additional review, we are able to make a fully favorable medical decision and 

find that you meet the medical requirements for disability benefits. The onset of your disability is 

established as of September 5, 2007. 

Therefore, it is not necessary to have your case decided at the hearing level by an Administrative' 

Law Judge. 

This Decision is Fully Favorable To You 

Another office will 'process the decision and send you a letter about your benefits. We have 

not yet made ~ ~ecision about w~ether you meet ~e nonmedical requirements, bilt we willf . 

make that deCISIOn soon. You wIll soon get a nottce about the amount of your payments If'you 

meet the nonmedical requirements. 

If you agree with our revised decision, you need take no fuither action and your hearing 

request will be dismissed. 

IrYou Disagree With The Decision 

If you disagree with our revised decision, you may request that the Office of Disability, 

Adjudication and Review proceed with your pending request for hearing. Your request should 

be made in writing and filed within 30 days from the mailing date of this notice. Your request 

may be filed with any Social Security office. 

IrYouHave Any Questions. 

If you have any questions, you may call, write or visit any Social Security office. If you visit an 

office, please bring this notice and decision with you. The telephone number of the local office 

that serves your area is (405)799-0702. Its address is Social Security, 200 N. E. 27th, Moore, 

Permanent Subcommittee on Investigation...s Fonn HA-LJ 0 (03-2007) 

EXHmIT#8h 
498 

:B. i!3 2IiZt PH I! 110,. 

-

Enclosures: 

Fonn HA·LlS (Fee Agreement Approval) 

Decision Rationale 

cc: 

Page 2 of2 

Elaine D. Benda 

Senior Attorney Advisor 

Form HA-LlO (03-2007) 
499 

IN THE CASE OF 

<12imant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ATTORNEY ADVISOR 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

lapA 1..-

(Social Security Number) 

I approve the fee agreement between the claimant and her representative subject to the condition 

that the claim results in past-due benefits. My"detennination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. I neither 

approve nor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REVIEW OF THIS ORDER AS INDICATED llELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of.the fee agreement. Send your request to tbis 

address: 

Regional Cbief Administrative Law Judge 

SSA ODAR Regional Office 

Room 460 

1301 Young St. 

Dallas, 'IX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement If so, please write directly to me as the 

deciding Attorney Advisor within 15 days of the day you are notified ofthe amount of the fee 

due to the representative. Your representative also bas 15 days to write me if he/she does not 

agree with the fee amount under the approved agreement 

Form HA-L15 (03-2007) 

See Next Page 
500 

urI Page 2 0{2 

You should include the social security number( s) shown on this order on any papers that you 

send us. . 

Elaine D. Benda 

Senior Attorney Advisor 

May 21, 2009 

Date 

Fonn HA-L 15 (03-2001) 
501 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of DiSability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

BenefIts 

LP 

(Social Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

The claimant," . .; n I!I" 0, filed an application for disability insurance benefits on June 

23,2008. She alleged an inability to work, beginning September 5, 2007, due to Crohn's 

disease, neck and back problems, and arthritis .. The claim was denied initially and on . 

reconsideration. The matter is now properly before the undersigned on a timely request for 

hearing. AI and : <..; ;.r nonattorneys, represent the claimant in this matter. 

The general issue is whether the claimant is entitled to a period of disability and disability 

insurance benefits under sections 2l6(i) and 223 of the Social Security Act. The specific issue is 

whether £ . . is under a disability, which is defmed a~ the inability to engage in any 

substantial gainful activity by reason of an impairment expected either to result in death or last 

for a continuous period of at least 12 months. In resolving these issues, the provisions of Social 

Security Rulings 96-1 p through 96-9p and thdr underlying rt:gulations have been carefully 

considered and applied where applicable. 

There is an additional issue pertaining to insured status. Infonnation contained in Ms ; 

earnings record reveals that she has acquired sufficient quarters of coverage to remain insured at 

least through December 31, 2013. 

CONCLUSION 

After giving careful consideration to all the evidence, the undersigned concludes that a favorable 

decision is warranted without the need for testimony, thus, no hearing has been held. The 

documentary records support a fmding that since September 5,2007, the claimant has had 

medically determinable impairments, namely degenerative disc disease ofthe cervical, thoracic, 

and lumbar spines, Crohn's disease, obesity, and chronic pain, that impose significant restrictions 

on her ability 10 perform basic work activities. Although these impairments do not meet or equal 

any listing, singly or in combination, they do result in a residual functional capacity for less than 

See Next Page 
502 

Page 2 of7 

! full range of sedentary work. Given such a residual functional capacity, the claimant is unable 

Lo perform her past relevant work, and considering her age, education, work experience, and 

residual functional capacity, she is not able to make an adjustment to work that exists in 

significant numbers in the national economy. For this reason, the undersigned finds the claimant 

nas been under a disability since September 5, 2007, and she may receive appropriate disability· 

insurance benefits by virtue of her application ofJune 23, 2008. 

APPLICABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404. 1520(a)). The steps are followed in order. If it is determiried that the 

claimant is or is not disabled at a step of the evaluation process, the evaluation will not go on to 

the next step. . 

At step one, the undersigned must determine whether the claimant is engaging in substantial 

gainful activity (20 CFR 404. 1520(b)). Substantial gainful activity (SGA) is defined as work 

activity that is both substantial and gainful. Ifan individual engages in SGA, she is not disabled 

regardless of how severe her physical or mental impairments are and regardless of her age, 

education, and work experience: If the individual is not engaging in SGA, the analysis proceeds 

to the second step. 

At step two, the undersigned must determine whether the claimant has a medically determinable . 

impairment that is "severe" or a combination of impairments that is "severe" (20 CFR 

404. 1520(c)). An impairment or combination of impairments is "severe" within the meaning of 

the regulations if it significantly limits an individual's ability to perform basic work activities. If 

the claimant does not have a severe medically determinable impairment or combination of 

impairments, she is not disabled. lfthe claimant has a severe impairment or combination of 

impairments, the analysis proceeds to the third step. 

At step three, the undersigned must determine whether the c1\limllnt's impairment Or combination 

of impairments meets or medically equals the criteria of an impairment listed in 20 CFR Part 

404, Subpart P, Appendix: I (20 CFR 404. 1520(d), 404.1525, and 404.1526). If the claimant's 

impairment or combination ofimpairments meets or medically equals the criteria of a listing and 

meets the duration requirement (20 CFR 404.1509), the claimant ·is disabled. Ifit does not, the 

analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the undersigned must first 

determine the claimant's residual functional capacity (20 CFR404.1520(e)). An individual'S 

residual functional capacity is her ability to do physical and mental work activities on a sustained 

basis despite limitations from her impairments. In making this finding, the undersigned must 

consider all of the claimant's impairments, including impairments that are not severe (20 CFR 

404.1 520(e) and 404.1545; SSR 96-8p) . 

. See Next Page 
503 

Page 3 of7 

Next, the undersigned must determine at step four whether the claimant has the residual 

functional capacity to perform the requirements of her past relevant work (20 CFR 404.1 520(f). 

If the claimant has the residual functional capacity to do her past relevant wotX, the claimant is 

riot disabled. If the claimant is unable to do any past relevant work or does not have any past 

relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation process (20 CFR 404. 1 520(g», the undersigned must 

determine whether the claimant is able to do any other worle considering her residual functional 

capacity, age, education, and work experience. If the claimant is able to do other work, ·she is 

not disabled. If the claimant is not able to do other work and meets the duration requirement, she 

is disabled. Although the claimant generally continues to have the burden of proving disability 

at this step, a limited burden of going forward with the evidence shifts to the Social Security 

Administration. In order to support a rmding that an individual is not disabled at this step, the 

Social Security Administration is responsible for providing evidence that demonstrates that other 

work exists in significant numbers in the national economy that the claimant can do, given the 

residual functional capacity, age, education, and work experience (20 CFR 404.1512(g) and 

404. 1560(c». 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant's d.ate last insured Is December 31, 2013. 

2. . The claimant has not engaged in substantial gainful activity since September 5, 2007, 

the alleged onset date (20 CFR 404.152O(b) and 404.1571 et seq.). 

Any amounts received since the alleged onset date are from shori-term and long-term disability 

payments from the claimant's former. employer. 

3. The claimant has the following severe impainnent(s): degenerative disc disease of the 

cervical, thoracic:, and lumbar spines,Crohn's disease, obesity, and chronic pain (20 CFR 

404.1520(c». 

An impairment is "severe" within the meaning oftbe regulations if it imposes significant 

restrictions on the ability to perform basic work activities. If an impairment is "not severe," it 

must be a slight abnormality or combination of slight abnormalities that has no more than a 

minimal effect on the ability to do basic work activities (SSR 96-3p). 

4. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one ofllie listed impairments in 20 CFR Part 404, Subpart P, Appendix 

1 (20 CFR 404.1520(d». 

5. The claimant has the residual functional capacity to perronn less than a full range of 

sedentary work (20 CFR 404.1567(a). 

See Next Page 
504 

Page 4 of7 

The undersigned must next determine the claimant's residual functional capacity, a term which 

describes the range of work activities the claimant can perform despite her impairments. In 

assessing the claimant's residual functional capacity, consideration must be given to subjective 

allegations. In evaluating subjective complaints, the undersigned must give careful consideration 

to all avenues presented that relate to such matters as: 

1. The nature, location, onset, duration, frequency, radiation, and intensity of any pain; 

2. Precipitating and aggravating factors (e.g., movement, activity, environmental conditions); 

3. Type, dosage, effectiveness, and adverse side-effects of any pain medication; 

4. Treatment, other than medication, for relief of pain; 

5. Functional restrictions; and 

6. The claimant's daily activities 

(20 CFR 404.1529). In evaluating th~ claimant's subjective complaints,the undersigned also 

considered Social Security Ruling 96-7p and Luna v. Bowen, 834 F.2d 161 (10th Cir.1987). 

Social Security Ruling 96-7p discusses a two-step analysis in evaluating pain. Step one requires 

a determination of whether there is a medically determinable impairment that could reasonably 

be expected to produce the individual's pain or other symptoms. The adjudicator should proceed 

to step two on! y if such an impairment exists. At step two, the adjUdicator must evaiuate the 

intensity, persistence, and limiting effects of the individual's pain and other symptoms to 

determine the extent to which the symptoms limit the claimant's ability to do basic work 

activities. 

The .claimant's statements conceriling her impairments and their impact on her ability to work are 

generally credible in light ofthe reports ofthe treating and examining practitioners, the fmdings 

made on examination, the degree of medical treatment required, and her description of her 

activities and life style: r ' I says she experiences difficulty walking, standing, and 

sitting for extended periods oftime due to s'evere pain in her back. She says she has difficulty 

lifting and carrying anything heavy due to severe pain in her back. She says her fmgers go ' 

'numb. She says'her neck and back pain radiates into her arms and legs. She says she is easily 

fatigued with minimal physical exeruo~ i) • s.~s she has difficulty falling and staying 

asleep, and she awakens frequently during the night due to pain. She says she never feels fully 

rested when she wakes up in the morning. She says that she must take frequent breaks while 

attempting to do housework. She says that virtually all movement worsens her pain. The 

claimant has impairments that are reasonably expected to produce the type ofpain and limitation 

she alleges. 

The record shows that the claimant has a history ofCrohn's disease, which is now apparently 

stabilized on medications; however, she continues to experience diarrhea several times a dl!-y. 

See Next Page 
505 

.. fSi!Hl' "dilItS: tiIJ Page 5 of7 

The medical record mentions that the claimant's diffuse joint pain may be related at least in part 

to her history of Crohn' s disease. 

Objective testing documents multiple abnormalities throughout the claimant's spine. There is 

disc bulging with varying degrees of spinal stenosis throughout the cervica~ thoracic, and 

lumbosacral spines. She has participated in conservative treatment that has included physical 

therapy and epidural steroid injections; however, none ofthls has resulted in significant relief. 

She had 14·5 laminectomy discectoiny on October 14,2008, and while this may have helped 

some, it is documented in the treating records that she continues to have chronic and constant 

low back pain that requires daily pain medications. The record also states that the clamant is five 

feet nine inches taU, and during the relevant period, her weight has been over 200 pounds, which 

equates to a body mass index of 30 or higher. The undersigned fmds that the' combined effects 

of obesity with the claimant's other severe impairments is greater than the effects of each of the 

impairments considered separately. 

1)--, _~offis the claimant's treating rheumatologist She completed a physical 

capacities evaluation on March 18,2009, indicating the claimant cannot perform the 

requirements of even sedentary worle r _ .. opines that the claimant needs to alternate 

her sitting and standing at will throughout the day. She cannot use her hands adequately for 

simple grasping, fine manipulation, and repetitive motion tasks. The claimant can lift/carry 

occasionally up to five pounds but should never lift/carryover that amount 0-- Ifwrites 

the claimant is in constant pain, and her condition is chronic and incurable. The claimant 

requires daily pain medication and prolonged periods of rest ~ue to fatigue and pain. ;_ ... ~ ..... ---"" 

writes the claimant has chronic pain and inflammation in the J~ints, dlffuse musculoskeletal pain 

which is causing fatigue, inability to concentrate and would have potential absences from a job 

due to disease exacerbation. The pain, according to C. "_"~'" would be disabling to the 

extent that it wOlild prevent the claimant from working full time at even a sedentary position. 

The undersigned fmdsthat r _____ . s opinion is supported by medicaUy acCeptable clinical 

and laboratory diagnostic techniques and not inconsistent with the other substantial evidence in 

the record; therefore, it is entitled to controlling weight (SSR 96-2p). 

As per Social Security Ruling 96-6p, the undersigned aiso considered the opinion of the State 

agency medical consultants at the earlier detennination levels. Based on additional evidence 

received into the record at the hearing level, the undersigned fmds that the claimant is more 

limited than was earlier thought The State agency medical consultants did not adequately 

consider the combined effect of the claimant's impairments or her credible complaints of pain. 

The undersigned fmds that the claimant retains the residual functional capacity to perform the 

demands ofJess than a full range of sedentary work. She can lift/carry five pounds occasionally, 

and she can sit less than six hours and stand/walk less than two hours total during an eight-hour 

day. She needs an option to alternate positions between sitting, standing, and lying at will. She 

cannot push, puJl, or reach frequently or repetitively, and she cannot lise her hands frequentiy or 

repetitively. Due to chronic prun and fatigue, her ability to maintain concentration, persistence, 

and pace to any activity is diminished, and she cannot perform work involving attention to detail 

or exercise of independent judgment Due to chronic pain and fatigue, her overall endurance and 

See Next Page' 
506 

• t 11&10}4 Page 6 of7 

stamina for activity is diminished, and she requires the ability to take frequent unscheduled rest 

breaks throughout the day. 

6. The claimant is unable to perform her past relevant work (20 CFR 404.1565). 

The undersigned fmds that the aforementioned residual functional capacity would preclude the 

claimant from performing her past relevant work as an administrative assistant or information 

collector, as these jobs required her to remain in one static position for extended periods without 

interruption, to use her arms frequently or repetitively, and to perform work ,involving attention 

to detail, and her past relevant work did not allow for frequent and unscheduled breaks. The 

demands of the claimant's past relevant work exceed her residual functional capacity. 

7. The claimant is an individual closely approaching advanced age for an purposes of this 

decision (20 CFR 404.1563). 

Bo~the claimant was 51 year~ old on the date of alleged onset of disability and 

~n~, , , ' 

8. The claimant has the equivalent of a hlgh school education (i.e., GED) (20CFR 

404.1564). 

9. The claimant has not acquired any skills from past relevant work that would transfer 

to other work within her residual functional capacity (20 CFR 404.1568). 

10. Considering the c1~antts age, education, work experience, and residual functional 

capacity, there are no jobs that exist In significant numbers in the national economy that 

the claimant can perform (20 CFR 404.1S60~c) and 404.1566). 

If Y F were capable of performing a full range of sedentary work, a finding of 

"disabled" would be reached by application of Medical-Vocational Rule 201.14. As a fmding of 

"disabled" can be made on the basis of the exertionallirnitations alone, it is unnecessary to 

consider the further effects of any 'uonexertionalliIiLitations. Considering the claimant's age, 

education, work experience, and residual functional capacity, the undersigned finds that the 

claimant cannot make a vocational adjustment to work existing in significant numbers in the 

national economy. A fmding of "disabled" may be reached by application of the abovementioned rule. 

11. The cl~t has been under a disability as defined in the Social Security Act since 

September 5, 2007, the alleged onset date of disability (20 CFR 404. 1520(g»). 

As the symptoms that prevent the claimant from working have been present since September 5, 

2007, a conclusion will be reached that she has been under a disability beginning on that date. In 

accordance with a finding that the claimant has been under a disability beginning September 5, ' 

2007, she may receive appropriate disability insurance benefits by virtue of her application of 

June 23,2008. 

See Next Page 
507 

L Olt t K_ Page 7 of7 

DECISION 

It is the decision of the undersigned that, based on the application filed on June 23, 2008, the 

claimant is entitled to a period of disability commencing September 5, 2007, and to disability 

insurance benefits under sections 216(i) and 223, respectively, of the Social Security Act. 

Elaine D. Benda 

Senior Attorney Advisor 

May21,2009 

Date 
508 

03/12/2009 14:54 TEL ... • ... · ...... _ ... 

t 

DR: 

RE: ':ill1III1!I.1!!I- SSN: 

HOllE OFFICE 

PHYSICAL CAPACITIES EVALUATION 

~OO4l008 

IMPORTANT: Please complete the following ttems based on your dlnical evaluaHon. other testing resuUs;cllent 

discUSSions and/or medica! treatment. My item that you believe you cannot answer should be marked NlA (Not 

Available). 

In an S-hour wort< day. patient can (circle full capacity for each activity): 

TOTAL DURING ENTIRE 8-HOUR DAY (Note: If Ihe combIned number of hours of sitting. 

slandlnglwalking does not add up to eight hours, II will be assumed patient cannol maintain body 

poslure cons_nt with full·tlme work) 

A. sa B. StandIWalk 

(No. hrs.l: (No. hro.): 

leBSIh~ 

lellSlh~ 

2 3 4 5 Sormore 

2 3 4 5 Sormore 

Does your patient need an opportunity to aUemate sitting and standing at will throughout the day? 

YES-X- NO __ _ 

Petient can use hands adequately for the following; (" /fI. -f //17 £:S ) 

Simple GrasPing Pushing & Pulling fine Manipulation 

RIGHT: 

LEFT: 

YES 

YES 

NoL 

NO...)C,. 

YES...jL NO __ 

YES~ NO 

YES __ N02L,. 

YES __ NO.lC-.. 

Patient can use hands for ~ motion task. (writing. typing. assembly. etc.) 

LEFT: YES N0.x... RIGHT: 

PatIent can use feet for repetitive movements as In operating fO,ot control.: 

YES 

B!ID:II 

NO~ 

l.ffi 

YES __ NO-k 

Permanent Subcommittee on Investigations 

EXHIBIT#8i 

YES 

YES 

NO.jL 

NO-X-
509 

03/1212009 14: 64 TE:Io' .. ___ .. ROllE OFFICE 141005/008 I 

DR: r .... ~ ------- RE: F smelt 

SSN: XlO(o ? 118 

NOTE: IN TERMS OF AN 8-HOUR WORK DAY, "OCCASIONALLY' refers to up to 33% of the day; 

"FREQUENTLY"' 34% ·100% 

Patient can lift/carry. 

A. 0 to 5 Iba. 

e 6 to 10 Ibs. 

C. 11 to 20 Ibs. 

D. 21 to 50 Ibs. 

E. 51 to 100 Ib". 

Patient Is able to: 

A. 

B. 

C. 

D. 

E. 

FG. 

Climb 

Balance 

Stoop 

Kneel 

Crouch 

Crawl 

Reach abolle 

shoulder level 

Restriction of activities involving: 

A. Unprotected heights: 

B. Being around mOiling machinei}': 

C. Exposure to marked changes in 

temperature and hUj)1ldlty 

D. Drilling automotive -equipment 

OCCASIONALLY FREQUENTLY 

~ 

OCCASIONALLY fREQUENTLY 

TOTAL ~ MODERATE MlLQ. 

E. Exposure to dust, fumes, end gases 

ADDITIONAL COMMENTS: 

7J,.-. r.....r .., u,.. ~ ~ ~I-iJo- .... J 

vtvPoW{/ ~ ~. ~ ~L-v I.: ~ PUt ~ ~1-~ ~ .. /l/- f-#~' 

~r 

=:--;:;::~;:-'-~' /, .::::: 

Physician's Signature '--------

PHYSiCAL EFFECTS OF PAIN 

~ lot: 'Ul-c>.S 

Date 
510 

03/1212009r@#54 j I £Jt HOllE OFFI CE 14l006/006 

DR: : ... ':!'"*-.-r.----- RE: • Jd ilee:iiiil r .... " 

SSN; xxx-xl a I 6 

Does the patient suffer from pain? 

YES....x- NO, __ _ 

If yes, is there a reasonable medical basis for this patient's pain? 

'(ES.~ NO 

Please describe: 

~-c-- ~ ~ ~-..6- U4- -(-4/71 "'r -~~ ~ r- wl.r£ t-lU<'7 r;--F/ ~?-iv . fp . ~ a-I jA"t-I>"M..- ~ '.f-. fr---

I 1"'& 2- p" tt.~ h(U4/~'-- _ 

Ir yes, Is the pain disabling to the extent that it would prevent the patient from working full time at even 

a sedentary position? 

YES-X- NO 

Physician's Signeture f b' ~/~ UJ.ot) Data 
511 

· From: unknown Page: 419 Date: 211312009 9:38:48 AM 

November 26, 2008 

DearThis is a 52-year-old woman with a history of Crohn's disease and inflammatory arthritis. The 

patient was diagnosed with Crohn's disease three years ago and for the last year she has 

been on Remicade 900 mg IV every six weeks. Her gastroenterologist is [_.l. He 

also gave her Pentasa and prednisone dn an as needed basis. The patient was receiving 

rheumatologic care with' - _ and she prescribed Celebrex 200 mg p.o. daily, 

OxyContin 20 mg p.o. bJ.d. and Lortab 10 mg every four hours and Soma 350 mg t.i.d. She 

decided to switch her care to another rheumatologist and that is why I see her today. The 

patient recently underwent surgery on her back, secondary to disk problems. Today the 

patient describes severe pain in her hips and her elbows. She requires pain medicatlons 

around the clock. She denies red, hot joints today. She denies.a history of inflammation in 

her eyes or psoriatic skin disease. Her mother has psoriatic arthritis and two of her sisters 

have Crohn's disease. . 

Her physical examination today was remarkable for minimal tenderness to palpation of the 

back. I removed her spinal brace to examine her. I could not appreciate any evidence of 

synovitis or dactylitis in the peripheral joints of the upper or lower extremities. ~ut, she has 

tendemess to palpation of the elbows with preserved range of motion. The patient will 

continue taking the Remicade administered by [ .;;;::'/1 < I refilled her pain medications 

today and we will see this patient back in three moni ,:.. . 

Sincerely, 

NMI~rq 

Electronically signed by - ___ -1"21 on 1210212008 09:42:42 

Cc: • --________ __ 

Permanent Subcommittee on Investigations 

EXHIBIT #8.i 
512 

. J:lD\IIII)' 22, 2009 

7 

F"",,; unknDwn Page: 319 Date; 2I1312OC19 9:38;48 AM 

Do you have other paUents who 

need help wllh SSDI? 

Busy heallbc:are plVriders use: 

AllsupCares.com 

a ; DEAR. I -------

1_ rcprescntiIIg your p<IIiCllliD "clorimCar S<>ci:d Security DisnbililylMediclre Benellls IOOl is under 

appeal 10m pnt>Wo.o!; a timely approwl. aCbeDc!i1s nm:! DdditiOll1ll information is need£d 10 docwneat the 

""tient'. medi;.>l file, which iD:ludcs the lallowiq: 

Office notes. X-ray repOfti;, IIJId lestlDgs frnm 11.1008 'ro PltESEN'f 

KDclosed q~re r!be lJCes the patieJU!imed~). 

&closed far your file is tbc AuthOlbaticm far lWease aC Canlideatiallnlommiion. ~yin,; 1 h:we bocn 

lIppointed 1he PDtiClll'~ R~alive and ClItillcd to obIain coofidantin1 medical records. 

Bec ... .., timJ.Dl; i. soaiti<::d to Ibis proe=, a prompt, bxed response wouldbc yently appreciated. PJease 

fax Ih1s InformadaD with a copy aC aar noqu •• t to (618) 236-8554. If yoa h:we :my qucstiOJlS, plAsecnll 

(800) 903-3558. }u, Allsup spccinlisl will c;ont;act you i11lwQ wcob 10 illquiR 011 tho sklln •. Tbililk you 

for youe nsmtaDCe.. . 

1----- Soci:Jl Security Consnlbn! 

Enclosun: 

Rmived Time Jan. n 2009 8: Permanent Subcommittee on Investigations 

EXHIBIT#8k 
513 

1 e _ Sib 

IN£Ncs co: ZZZAP:mA ; 1_ SEX: II 

Date ofScrrice: 07/24/_ Dodor: 1 

BlllmdOll 07/29/2006 arOJ:I1 JmI ------MD O/v·1NlTIAL 

The oplnioua e:xpmsed ben:in arc stated within a _able degree of medical e¢ainty. 

MHWIMDIvdb 

-

11111 

Permanent Subcommittee on Investigations 

WII "l):17 ... __ E .. XHiiiiiiiii .. IB.I.T.#.8 .. 1 __ • 

Paa>2 a£2 

... c. ncnn 1.,1'\0( nlr;an ~nI\7·7n·Qa.l 

:WOJ~ 
514 

wiS! 

DOl 't' J 

n.J'"'''' U"'I"'R co: ZZZAP.1'NA 

Dille ofSerrice: 07/24/2008 Doctor: 1 

Blltmd 1/1/07/29/2008 .,OJ:59 pm 

CBIEF COMPLAINT: Low baclc pain, leA leg pain, 

• SRX; F 

<J/V·lN1TIAL 

mSTORY OF PRESENT Jl.LNESS d laB • '. a Slyear old female with a ODe year hlltory of low back 

pain and left leg pain, She haa bad her MRI and Bhe has had threovi.11I ofphyalcal thmpy with no lrigntl\cant 

relict She has had three epidura\steroid iiijectionain her lumbar spine withoUt any significant ",lior. Shc 

complains or low bod< pain as 70% orhor COnlpJalnb IIIId 30% loft leg and hlp pain, Tho lea and hip pain ;, 

wo,,", at nigh~ She hu no pain increased with cougjliog or sneezing,and no bowel or bladder dysI\Inctlol1. She 

has 8 out of 10 wom day pain and Billing or leaning over Increases ber pain, 

PAST MEDICAL msrORY: Crone's, hypertension. obulty, 

l' A8T SURGICAL HISTORY: Hernia repair, earpaI tuMeI release, tuballigatioll. 

OCCUPATIONAL mSTORY: She is a S I year old female who II cUrrent!y on dlJablllly, She works for l1li 

architectural finn, 

CURR!NT MEDICATIONS: Ramicade. 

ALLERGIES: Codeine; 

SOCIAL mSTORY; She i. a SI year old divorced female withllchildr8n over !heage of 18, She does not 

.moke at present. Sbequltono month ago, She does not drink alcohol but lit. drtnku 12 ~ups ofcoffoe a day, 

PHYSICAL ~AnON: Thl. is a well nourished, well developed 104 pound female, She ambulates In a nOrmlll heelltoe, toeltoe, beeUhee\ galt with lewlhlpa, pelvlil IIId ahouldel'l, normal earonal and aag1t!al contours to the c ..... leal, thonlclo and lumbar ""ino, Shu haa SIS molor oImIgih In her lower _illea. no Ions tracI 

. f1nding3, no clonus, Shc h .. a negative straight leg raising examlnltion In a seated position !lid sllgjllly reduced 

range of motion by app=imately 10% in all planes. 

X·RA YB: Plain radiographs and MRl Wille miowod, Site hu some slight degenerative c,hanges 8t JA.S and 

LS-SI. She has some mild spinal stenosis with 8 disc herniation more prominent on the left II L4-S, 

PLAN: We disound with her that due to the lack of exIeruIive physleaJ thmpy. we would Uko to try at least 

another four week coune of physIcal therapy and If abe continuos to have significant severe !OVI back paIn and 

leg pain, we may dlscuaa surglcallnterventlon at her n=KI mectJna l!tIuIt I. &0 !nd!ca~ At the termination of 

our meeting, she aaIced about her atalus on disability, She saw she can't siL It appeara that she can't work right 

now and abe is going to continue to follow up with _In lllgards to treatment for this. 

I'1lgs lofa 

11/01 
515 

DOOll':==::-- SP.X: P 

INSURANCE CO: ZZZAE'INA 

DateofSemcel 09/04/2008 Doctor.l -------- EuluttiOM 09/01/2008 aJ 01:28pm 

'1 O/V.l'OLLOWUP 

, (? return9 today. Sbe bill had three epidullli steroid injections ane! physical \lieraP)'. She continues to 

complain of significant bunock and left leg pain, unresolved by the Il\Iccdons for any extended period of tima. 

PLAN: After a thorough discussion ofChe risks and benefits of surgical intervention, abe wauld Uke to proceed 

with a lumbar laminectomy decompreasiYII PlIICedure with In silll tllsion to see ifthla wm help with bar lower 

ememh}' pain. She Inay eventually RQulre alazgor lurgicallntorvcalloQ If .h. Is unnnpanslve 10 thl,. We will 

&De her-blU:k fer Itor pre-aperative history and physical. All the risks and beneflll uf SU$I)'were discussed with 

her,lncluding hoort atIIIck, stroke, infection, neurologic iI\Iury, death, puralysl&. We will proceed with a lumbar 

laminectomy dccump!eSSlve procedure allA·' on !he left. 

This p.atienl Wl9lMfuattd by both __ . _ .......... ~ •. _._. and! - _. ___ -=" }:A.oC. 

The opinions oxp!Uged h.",in are lltaled within. reuonabl. d.". of medical certainty. 

MHWIMDlvdb 

co: .... 

Permanent Subcommittee on Investigations 

ilici 

IWI'O:t~:8 ... __ E_XH_I_B_I_T_#_8_m __ .. 

P.~ I ofl 

nc;;nn • .1"" ntr:gn I:nn,.~,.n·Dil.l :II; 
516 

11/"1 

XR SPINE 11J1EW 

Hlablry. 1.amIM=in1. 

E. Hi 1111;;: 

Sarvlae: IPS 

FIndIng.: Single lntrao~1Iriw VlO'lt of Ihllumbanplnl!br /ocallza1!onlaVal ehow8 

IUl1llalllllllllnmanlB at LIIlawL . 

EledIonkllOy 61;ned by: 

IAPIy.lIfh......., ••• ___ • 

Permanent Subcommittee on Investi ations 

wV.,lm:g EXHIBIT #8n 

..... ..---............ _ .. : ncnn I~IW nll':an ~nn".?n.o"J 

""~ 
517 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits . 

(Social Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

On October 13,2006, the claimant filed an application for a period of disability and disability 

insurance benefits, alleging disability beginning November 1,2004. This Claim was denied and 

is now before the undersignedl Administrative Law Judge, W. Howard O'Bryan, Jr., on a 

timely written request for hearing filed on June 25, 2007 (20 CFR 404.929 et seq.). The 

evidence of record supports (20 

CFR 404.948(a». The claimant is represented 

The issue is whether the claimant is disabled under sections 216(i) and 223 (d) of the Social 

Security Act. Disability is defined as the inability to engage in any substantial gainful activity by 

reason of any medically detenninable physical or mental impainnent or combination of 

impainnents that can be expected to result in death or that has lasted or can be expected to last 

for a continuous period of not less than 12 months. 

There is an additional issue whether the insured status requirements of sections 216(i) and 223 of 

the Social Security Act are met. The claimant's earnings record shows that the claimant has 

acquired sufficient ·quarters of coverage to remain insured through December 31, 2009. Thus, 

I 1 Who mil»presiib:: 5 usc )36(b); Powm. aftht presidiaa Gffieer:' usc 'l6(c); Sprcill -roteof'thc AdminiW'ltive Law Jlldge ia Social Security: Decider"" CampbeD 

461 U,S. 4Sa. 471. JOJ S.C\. 19S1, i9~. 1 S.s.R.S. 3, 10, CCH, J4,.515 (198J)'DiI:cB .. Reddct. 811 F.2d 506, S10.1C-SS,R!. 279.183 (10lb Cir. 19t7)~ 

793 F,ld7Ol, 704-705. 14 S5RS. 87. 19--90.CCH, 17,071 (SChCir, 1\JI6.).~ ... .!!!ai!-6S1 F,2d.S13{'1d!C",.1981):~v.~S21F,2d214(3rd dr. 

197.5) (Admirrls.tr.ative l.awludpmUltdPeJoprullm:ordwbcscdainwll:DOtreprt:t.erlkdbyCOlDlId);BullIU,~ 731 F.ld 12f6.. S.s..R.S. 340.CCH' 1~324 

('th eir, J9B4).IBJJ.rl'.1IAkJK. 7S4 P.2d174 (Bihar. 1985);J!!IdI!!" H«kler.1J5 F.ld 1314. 20 S.S.R.S. US, CCH, 17.808 (JOthCit". 1917), (Adminimdw Law)~ 

mmtdeYelop full ra:m4eVCIifclaimI:D!o1cprt:XD1dby c:omud);SoWI. Stcarity lWlina 11-"13, SccUlS=::rity ~mD lOCFR §§ .404.944 lind 416.1444._'-' W<:n, 

404.9"', 404.9S1,416.1450 and416.1451; Scx:i&I Scaail)' Ad, §§ 3OJ(b) Ind 16l1{c)(J). J 

1 20 Code of Feden) RrgU.latioDs Cb. 111 (4-1-06 edition) .section 404.948: btdding. caR without an oral bearing before a:a 

administntivt law judge. (0) Decision wholly JQt;OI'able. lfthe evidence illhc hearing record supports 8 finding in mor of you and aJ the 

partics 0r1 c:very issue., the Administrative Law Judge may issue ahearing decision without holding m1 oral hearing, "_ I 

Permanent Subcommittee on Investigations 

EXHIBIT#9a 
518 

Page 2 ofl4 

the claimant must establish disability on or before that date in order to be entitled to a period of 

disability. and disability insurance benefits. 

After careful review of the entire record, the undersigned finds that the claimant has been 

disabled from November 1, 2004 through the date of this decision. The undersigned also finds 

that the insured status requirements of the Social Security Act were met as of the date disability 

is established. 

APPLICABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404. I 520(a). The steps are followed in order. If it is determined that the 

claimant is or is not disabled at a step of the evaluation process, the evaluation will not go on to 

the next step. 

At step one, the undersigned must determine whether the claimant is engaging in substantial 

gainful activity (20 CFR404.1520(b». Substantial gainful activity (SGA) is defined as work 

activity that is both substantial and gainful. "Substantial work activity" is work activity that 

involves doing significant physical or mental activities (20 CFR 404.1 572(a». "Gainful work 

activity" is work that is usually done for payor profit, whether or not a profit is realized (20 CFR 

404.1572(b). Generally, if an individual has earnings from employment or self-employment 

above a specific level set out in the regulations, it is presumed that he has demonstrated the 

ability to engage in SGA (20 CFR 404.1574 and 404.1575). !fan individual engages in SGA, he 

is not disabled regardless of how severe his physical or mental impairments are and regardless of 

his age, education, and work experience. If the individual is not engaging in SGA, the analysis 

proceeds to the second step. 

At step two, .the undersigned muSt determine whether the claimant has a medically determinable 

impairment that is "severe" or a combination of impairments that is "severe" (20 CFR 

404.1 520(c». An impairment or combination ofimpairments is "severe" within the meaning of 

the regulations if it significantly limits an individual's ability to perform basic work activities. 

An impairment or combination of impairments is '<Pot severe" when medical and other evidence 

establish only a slight abnormality or a combination of slight abnormalities that would have no 

more than a minimal effect on an individual's ability to work (20 CFR 404.152 \; Social Security 

Rulings (SSRs) 85-28, 96-3p, and 96-4p). If the claimant does not have a severe medically 

determinable impairment or combination of impairments, he is not disabled. If the claimant has 

a severe impairment or combination of impairments, the analysis proceeds to the third step. 

At step three, the undersigned must determine whether the claimant's impainnent or combination 

of impairments meets or medically equals the criteria of an impairment listed in 20 CFR Part 

404, Subpart P, Appendix 1 (20 CFR 404. 1520(d), 404.1525, and 404.1526). If the claimant's 

impairment or combination of impairments meets or medically equals the criteria of a listing and 

meets the duration requirement (20 CFR 404.1509), the claimant is disabled. If it does not, the 

analysis proceeds to the next step. 

See Next Page 
519 

Page 3 ofl4 

Before considering step four of the sequential evaluation process, the undersigned must first 

determirie the claimant's residual functional capacity (20 CFR 404.1SZ0(e». An individual's 

residual functional capacity is his ability to do pbysical and mental work activities on a sustained 

basis despite limitations from his impairments. In making this finding, the undersigned must 

consider all of the claimant's impairments, including impairments that are not severe (20 CFR 

404. 1520(e) and 404.1545; SSR 96-8p). 

Next, the undersigned must determine at step four whether the claimant has the residual 

functional capacity to perform the requirements of his past relevant work (20 CFR 404.1 520(f). 

The tenn past relevant wor~ means work performed (either as the claimant actually performed it 

or as it is generally performed in the national economy) within the last 15 years or 15 years prior 

to the date that disability must be established. In addition, the work must have lasted long 

enough for the claimant to learn to do the job and have been SGA (20 CFR 404. 1 560(b ) and 

404.1565). If the claimant has the residual functional capacity to do his past relevant work, the 

claimant is not disabled. If the claimant is unable to do any past relevant work or does not have 

any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation process (20 CFR 404.1520(g», the undersigned must 

determine whether the claimant is able to do any other work considering his residual functional 

capacity, age, education, and work experience. If the claimant is able to do other work, he is not 

disabled. If the claimant is not able to do other work and meets the duration requirement, he is 

disabled. Although the claimant generally continues to have the burden of proving disability at 

this step, a limited burden of going forward with the evidence shifts to the Social Security 

Administmtion. In order to support a finding that an individual is not disabled at this step, the 

Social Security Administration is responsible for providing evidence that demonstmtes that other 

work existS in significant numbers in the national economy that the claimant can do, given the 

residual functional capacity. age, education, and work experience (20 CPR 404.1512(g) and 

404. 1 560(c». . 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following fmdings: 

1. The claimant meets the insured status requirements of the Sodal Security Ad througb 

December 31,2009. 

2. Tbe claimant bas not engaged in substantial gainful activity sinee November 1, 2004, 

tbe alleged onset date (20 CFR 404.1520(b) and 404.1571 et seq.). 

Vocational Information 

javascript:hideShowData ViewSection(%22Jobs WorkedintheLast15years%22) 

~ Jobs Worked in the Last 15 years . 

Job Title 

1. RETAI SALES 

Type of Business 

STORES 

See Next Page 

From 

1973 

To 

2004 
520 

Page 4 of! 4 

javascript:hideShowDataViewSection(%22Ticket/Programlnformation-initialLeve1%22} 

~ TicketlProgram In/ormation. !nitiaJ Level 

Participate in Ticket program or No 

another program? 

iavascript:hideSho~DataViewSection(%22Ticket!ProgramlnfonnationReconsiderationLevel%22) . 

8 TicketiProgram In/ormation - Reconsideration Level 

Participate in Ticket program or No 

another program? 

javascript:hideShowDalaViewSection(%22TicketlProgramlnformation-HearingLevel%221 

@ TickeVProgram In/ormation - Hearing Level 

Participate in Ticket program or No 

another program? 

javascript:hideShowDataViewSection(%22AdditionalRehabilitationlnformation%22) 

rs Additionlll Rehabilitation In/~rmation 

Working now? No 

Stopped working because: I WAS FIRED FROM MY JOB 

Stooped working when: 11/0112001 

AUeged Impairments: Knee problems. hip c, mental problems 

3. The claimant bas the following severe combination ofimpairments: 

Allegation( s) 

javascript:hideShowDataViewSectiQn(%22Impairments,LimitationsandPain-initiaILevel%22) 

I!Ilmpairments, Limitations and Pain -Initilll Level 

Alleged Impairments: Knee problems, hip c, mental problems 

L. .. I CAN NOTPHYSICAL Y STAND FOR LONG. I AM 

ImItations: DEPRESS, . 

Pain/Other Symptoms: Yes 

Impairments First Bothered: 1110112004 

Height: 6' 

Weight: 265 Ibs. 

javascripthideShowData ViewSection(%22EtTecton Work-lnitiaiLevel%22) 

l:!l Effect on Work. Initial Level 

Ever Worked: Yes 

See Next Page 
521 

Page 5 of14 

Working Now: No 

When Stopped: 11101/2001 

Stopped Working Because: I WAS FIRED FROM MY JOB 

Work After First Bothered: No 

javascript:hideShowDataViewSection(%22Impainnents,LimitationsandEffectsReconsiderationLevel%22) 

~ Impairments, Limitations and Effects - Reconsideration Level 

Any Changes in Condition: Yes 

Ch . C d'f Continuing knee and leg problems as well as back and leg 

anges In on I Ion: complications. 

Date Occurred: 10/0812006 

Any New Illnesses or Injuries: No 

Any New Limitations: 'Yes 

New Limitations: depression worsen 

Date Occurred: 10/08/2006 

How Condition Affects Ability to Housebound. No interest in anything. I am able to handle bills 

Care for Personal Needs: and finances. 

How Daily Activities Changed: less active 

Work Since Original Claim No 

Filed: 

Submitting New Evidence: No 

Reason Appeal Requested: I AM NO LONGER ABLE TO WORK AND HOLD A JOB. 

javascript:hideShowDataViewSection(%22Impairments,LimitationsandEffectsHearingLevel%22) 

~ Impairments, Limitations and Effects - Hearing Level 

Any Changes in Condition: No 

Any New Illnesses or Injuries: No 

Any New Limitations: No 

How Condition Affects Ability to i can ~arely functio~. io:' becoming more house bound and 

Care fi P nal Ned' reclUSIve. I'm slacking In number of personal needs, do not or erso ,e s. assoc with friends, stay to my self, extreme fatigue and pain. 

How Daily Activities Changed: i cannot drive 

Worked Since Filing For N 

Reconsideration: 0 

Submitting New Evidence: No 

Reason Appeal Requested: I CANNOT WORK. 

(20 CFR 404.1520(c). 

See Next Page 
522 

Page 6 of14 

The above combination of impairments causes significant limitation in the claimant's ability to 

perform basic work activities. 

4. The severity of the claimant's affective (mood) disorders (2960), anxiety related 

disorders (3000), hepatitis C, disorders of batk discogenic and degenerative (7240), knee 

and leg problems, obesity and hyperalimentation (2780), etc., etc., etc., meets the criteria of 

section(s) 12.04, 1.04A, 12.06, Social Security Ruling 02-01p, etc., etc., etc., 0(20 CFR Piut 

404, Subpart P, Appendix 1 (20 CFR 404.1S20(d». 

The record shows the claimant· is funciiona12 below the sedentary level for any sustained, 

continual or regular activity3. . 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404. I 527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

Prior Claim Information 

Prior Claim Filed: No 

Observations 

javascript:hideShowDataViewSection(%22InterviewInformation-InitialLevel%22) 

~ Interview Information - Initial Level 

Interview Conducted: Face-ta-face with claimant 

javascript:hideShowDataViewSectionC%220bservedClaimantDifficulties-InitialLevel%22) 

~ Observed Claimant Difficulties - Initial Level 

2 Residual functional capacity is the claimant's ms1timum remaining ability to do sustained work.8d.j'Yitics in an ordinary work setting on a 

"'Bular and continuing basis. A "regular and continuing basis" meanseig!1l(8) hour.; a day. for fi •• (5) days (i.e, fany (40) hours) a wt:d< or an <qui .. len! work schedul< (Social SeClUity Ruling 96-8p) .. The claimant must h .. e boob the mental and physical aballics to perform sUS!ained 

work activities. Since the evidence SUpp01"l"i. 8 finding tlmt the claimant has had a substantial loss afability to meet dle demands of basic work 

related. activities on a sustained. bub, the unskilh::dt sedentary occupll1ional hllK is significantly eroded and a finding of disability is justified 

under Social Serurity Ruling 96-9p. 22 

3 Social Seccuily Ruling 96-8p proyid~ that a finding of dimbled is appropriate whCftC\lC' there is BI1 inabnity 10 persist B1 work~likc \aSks f~r 

1hc full t;;OUISe of II! 8-hour workday or Soda)' workWtck. Clearly, the claimant's medically dclCrminable seve!: impairments preclude Ibc: 

claimant Itom engaging in substantial gainful activity on 8""ular and continuing basis. Soclll Src:urily Ruling 96.9p stipulBleS thOl .. 

individual Who has tile residual fiIn<tionai ""I'IIOity for less than a full ""'ge of sedanlllry wale should be considered disabled iftlleir restrictions would signifltaJllly erode the occq>OIional base for sedentary """'- The claimant is markedly. funaionally limited. llws. a finding of disabled is 

wammted. Mediul·V..,atio.al Rule :101.00 (til APIleadiI 1, Suhpart ... Regulldonl No.4 may be used asllle m.mework for tile decision_ It 

directs. finding of disabled. Social Securil)' Rullug 8S-IS and Social Seetlrll)' RaHug !IIi-9p hoth stipul ... tha1 an indiridual must, on. 

sustained basis, be able to understand. remember and carTY out simple instructions; make Simple wmk~retated decisiom~ respond appropriately to 

supervision. coworkers, usual work:siuBtions and to deal wilh changes in a routine work: setting. A substantilllioss arability to mcd!..l!I..J!91. or 

lhcsc basic work-rdatcd activities would sevcrdy limit the potential occupational base for all age groups ani warrant a finding ofdisablcd. 

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523 

Hearing: No 

Reading: No 

Breathing: No 

Understanding: No 

Coherency: No 

Concentrating: No 

Talking: No 

Answering: No 

Sitting: No 

Standing: No 

Walking: No 

Seeing: No 

Using hand(s): No 

Writing: No 

Page-7 of 14 

Ob . I DID NOT NOTICEANYTHING THAT COULD 

servatlons: CONTRIBUTE TO TIDS CASE. 

javascript:hideShowDataViewSection(%22InterviewJnformation-ReconsiderationLevel%22) 

~ Interview Information - Reconsideration Level 

Interview Conducted: No contact with claimant 

Education Infonnation 

javascript:hideShowDataViewSection<%22Edu"cationInfomiation%22) 

EJ Education Information 

Highest Education Level 2 f II 

" " Completed: YeB!S 0 co ege 

When Completed: 1990 

javascript:hideShowDataViewSection(%22LanguageInformation%22) 

ffi Language Information 

Speaks and Understands English: Yes 

Reads English: Yes 

Writes More Than Name in y 

English: es 

Medications 

javascript:hideShowData ViewSection(%22MedicationInformation-InitialLevell ot3-

CIT ALPRAH%22) 

EI Medication Information - Initial Level (1 of 3) - CITALPRAH 

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524 

- Page 8 of!4 

Name: CITALPRAH 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: DEPRESION 

Side Effects: NA 

javascript:hideShowDataViewSection(%22Medicationinfonnation-lnitialLeveI2of3-

HydrocodonewitbAP AP%22) 

~ Medication InforllUltion - Initial Level (2 of 3) - Hydrocodone with APAP 

Name: Hydrocodone with APAP 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: PAIN 

Side Effects: NA 

javascript:hideShowDataViewSection(%22MedicationInformation-InitiaILeveI30f3-

rbuprofen%22) 

~ Medication Information - Initial Lev~1 (3 of 3) - Ibuprofen 

Name: Ibuprofen 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: PAIN 

Side Effects: NA 

iavascript:hideShowDataViewSection(%22Medicationlnforrnation-ReconsiderationLevellof3-

hydrocodone%22) 

El Medication Information - Reconsideration Level (1 of 3) - hydrocodone 

Name: hydrocodone 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: pain 

Side Effects: respitory problems 

javascript:hideShowDataViewSection(%22Medicationlnformation-ReconsiderationLeveI2of3-

ibuprofin%22) 

~ Medication InforllUllion - Reconsideration Level (2 of 3) - ibuprofen 

Name: ibuprofen 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: inflammation and pain 

Side Effects: fatigue 

javascript:hideShowDataViewSection(%22Medicationlnformation-ReconsiderationLeveI30f3-

triaminic%22) 

~ Medication Information - Reconsideration Level (3 of 3) - Tr;om;nic 

Name: Triaminic 

. Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: pain 

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525 

Page 90f14 

Side Effec~: none 

javascrim:hideShowData VjewSection(%22M edicationInfonnation-HearingLevell of4-

CIT ALPRAH%22) 

ffi Medication Information - Hearing Level (1 of 4) - CITALPRAH 

Name: CITALPRAH 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: DEPRESION 

Side Effects: NA 

javascript:hideShowDataViewSection(%22Medicationlnformation-HearingLeve120f4-

hydrocodone%22} 

I!l Medication Information - Hearing Level (1 of 4) - hydrocodone 

Name: hydrocodone 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: pain 

Side Effects: respitory problems 

javascript:hideShowDataViewSection(%22MedicationInformation-HearingLeve13of4-

methacaro boarol%22) 

[3 Medication Information - Hearing Level (3 of 4) - methacarohoarol 

Name: methacaroboarol 

Prescribed By: VETERANS ADMIN HOSPITAL 

Reason: pain 

Side Effects: drowsiness 

javascript:hideShowDataViewSection(%22MedicationInformation-HearingLeveI4of4-

tramidol%22) 

~ Medication Information - Hearing Level (4 of 4) - tramidol 

Name: tramidol 

Prescribed By: VETERANS ADMIN HOSPlT AL 

Reason: pain 

Side Effe-ets: drowsiness 

Sources 

javascript:hideShowDataViewSection(%22DisabledPersonsInformation-InitiaILevel%22) 

f3 Disabled Person's Information - Initial Level 

Alleged Impairments: Knee problems, hip c, mental problems 

L' " I CAN NOT PHYSICAL Y STAND FOR LONG, I AM 

ImitatIOns: DEPRESS , 

Alleged Onset Date: 11/0l/2004 

Filing Date: 10/13/2006 

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526 

javascript:hideShowData ViewSection(o/022DisabledPersonslnformationReconsiderationLevel%22) 

~ Dis~bkd Person's InforllUltion - Reconsideration Level 

Any Changes in Condition: Yes 

Page 100fl4 

Chang , Co d'ti Continuing knee and leg problems as well as back and leg es m n Ion: complications, . 

Date Occurred: 10/0812006. 

Any New Illnesses or Injuries: No 

Any New Limitations: Yes 

New Limitations: depression worsen 

Submitting New Evidence: No 

Reason Appeal Requested: I AM NO LONGER ABLE TO WORK. AND HOLD A JOB. 

javascript:hideShowDataViewSection(%22DisabledPersonslnfonnation-HearingLevel%22) 

f!l Disabled Person's Information - Hearing Level 

Any Changes in Condition: No 

Any New Illnesses or Injuries: No 

Any New Limitations: No 

Submitting New Evidence: No 

Reason Appeal Requested: I CANNOT WORK. 

javascript:hideShowData ViewSection(o/022VETERANSADMfNHOSPIT AL lof!. 

InitialLeve1%22) 

ffi VETERANS ADMIN HOSPITAL (1 of 1) -Initial Level 

Source Type: Hospital/Clinic 

. Source Name: VETERANS ADMIN HOSPITAL 

921 NE 13TH 

Address: OKLAHOMA CITY, OK 73104 

Outpatient First Visit: 2000 

Outpatient Last Visit: 2006 

Reason for Visits: ALL MY MEDICAL NEEDS 

Treatment: AS NEEDED 

Medications: Hydrocodorie with APAP, Ibuprofen, CITALPRAH 

javascript:hideShowData ViewSection(%22VETERANSADMINHOSPIT AL 1 ofl- . 

HearingLevel%22) 

~ VETERANS ADMIN HOSPITAL (1 of 1) - Hearing Level 

Source Type: Hospital/Clinic 

Source Name: VETERANS ADMIN HOSPITAL 

Address: 921 NE 13TH 

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527 

OKLAHOMA CITY, OK 13104 

Outpatient First Visit: 3/2001 

Outpatient Last Visit: 3/2007 

Reason for Visits: all medical issues 

Treatment: meds 

Page 11 ofl4 

Medications: CIT ALPRAH , hydrocodone , methacaroboarol , tramidol 

Onset 

javascript:hideShowDataViewSection(%220nsetDates%22) 

~ Onset Dates 

Alleged: 11/01/2004 

javascript:hideShowData ViewScction(%22Claim Information loft-Initial Level%22) 

~ Claim Information (l of 1) -Initial Level 

Type: DIB 

Number Holder SSljI :::::~. Number Holder Name 

First Insured: 10/0112004 

Last Insured: 1213112009 

iavascript:hideShowData ViewSection(%22Claiml nformation 1 of] -ReconsiderationLevel%221 

~ Claim Information (J of 1) - Reconsideration Level 

Ty~ 

Number Holder SS], 

Number Holder Name 

, 

2 

javascript:hideShowData ViewSectionf%22Claimlnformation 1 ofl-HearingLeveI%22) 

E!l Claim Information (1 of 1) - Hearing Level 

Type. 

Number Holder SSl' 

Number Holder Name II 

javascript: hideShowData ViewSection(%22ImpairmentsEffectOn Work%22) 

@ Impairments Effect On Work 

Impairments First Bothered: 1110112004 

Work After Above Date: No 

When Unable to Work: 11101/2004 

Ever Worked: Yes 

Working Now: No 

Stopped Working: 11101/2001 

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528 

Stopped Working Because: I WAS FIRED FROM MY JOB 

Work After First Bothered: No 

Reconsideration - Worked Since N 

. You Originally Filed: 0 

Hearing - Worked Since You N 

Filed for Reconsideration: 0 

Page]2 of 14 

javascript:hideShowDataViewSection(%22Miscellaneouslnformation-lnitialLevel%22) 

8 Miscellaneous In/omu#ion -Initial Level 

Closed Period: No 

Various physicians, treating .and non-treating, have written that the claimant suffered from 

various medical problems and that the claimant has significant work restrictions. While the 

finding that a person is "disabled" under the provisions of the Social Security Act is an issue 

reserved to the Commissioner4 (SSR 96-5pl), opinions from any medical source on issues 

reserved to the Commissioner must never be ignored. The adjudicator is required to evaluate all 

evidence in the case record that may have a bearing on the determination or decision of 

disability, including opinions from medical sources about issues reserved to the Commissioner. 

If the case· record contains an opinion from a medical source on an issue reserved to the 

Commissioner, the adjudicator must evaluate all the evidence in the case record to determine the 

extent to which the opinion is supported by the record. 

The fact that the claimant's treating physician, after extensive examinations and treatment, has 

fonned such opinion as to the claimant's ability to perfonn sustained work activity was 

precluded strongly suggests a significantly limited residual functional capacity. Further, 

considering the claimant's diagnoses and multitude of prescribed medications tried, the 

undersigned finds that treating physician'S opinion is well support and is not inconsistent with 

the other substantial evidence in the case record; thus, it is afforded controlling weight (20 CFR 

404.1527(d)(2) and SSR 96-2p). 

In making this finding. the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the Objective ·medical evidence and 

other evidence, based on the requirements of 20 CFR 404.1529 and SSRs 96-4p and 96-7p, The 

undersigned has also considered opinion evidence in accordance with the requirements of 

io CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-Jp. 

4 Under 20 CFR 404.1527(e), some issues are. not medical issues regarding the nature. and severity of an indi~iduaYs 

impairmcnt(s) but are administrative findings that are dispositive of a case; i.e., that would direct the. determination or decision of 

disability. TIle following are examples of such issues: . 

Whether an individual's impainncnl(s) meets or is equivalent in severity to the requircmen~. of any 

impainnenl(s) in the listings; 

What an individual's RFC is; 

Whether an individual's RFC prevents him or her from doing past relevant wor!<; 

How the vocational factors of age, education, and wor!< experience apply; and 

Whether an individual is "disabled" under the Act 

The regulations provide that the Onal responsibility for deciding issues such as these is reserved to the Commissioner. 44 

See Next Page 
529 

Page 13 of14 

After considering the evidence of record, the undersigned finds that the claimant's medically 

determinable impainnents could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity, persistence and limiting effects ofthese 

symptoms are generally credible. 

The State agency medical opinions are given little weight because other medical opinions are 

more consistent with the record as a whole and evidence received at the hearing level shows that 

the claimant is more limited than determined by the State agency consultants: Furthermore, the 

State agency consultants did not adequately consider the claimant's subjective complaints or the 

combined effect of the claimant's impairments. 

The Administrative Law Judge affords greater weight to the opInIOn of the exanumng 

(nontreating) source. This opinion is well supported by medically acceptable clinical and 

laboratory findings, and is consistent with the record when viewed in its entirety. The State 

agency consultants did not consider all of the claimant's impairments contained in the medical 

evidence of the record. The State agency consultants failed to consider the combined effect of 

all of the claimant's impairments as required by the regulations. The State agency did not 

adequately consider the entire record, including the statements of collateral sources. The State 

agency did not adequately consider the entire record, including the subjective complaints and 

other allegations of the claimant. 

5. Tbe claimant has been under a disability, as defined in the Social Security Act, from 

November 1,2004 through the date of this decision (20 CFR 404.1520(d». 

DECISION 

Based on the application for a period of disability and disability insurance benefits filed on 

OClober 13,2006, the claimant has been disabled under sections 216(i) and 223(d) ofthe Social 

Security Act beginning on November I; 2004. . 

Medical improvement is expected with appropriate treatment Consequently, a continuing 

disability review is recommended in 12 months: 

A det;;mnination to appoint a representative payee to manage payments in the claimant's interest 

is recommended. . 

See Next Page 
530 

~::~9 W. Howard O'Bryan, Jr. (0453) .. 

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 

OCT 22 2001 

Date . 
531 

Health Summary Printed on Oct 31, 2006 

rtNDrnGS: 

The liver measures 16.3 em in length and demonstrates no 

focal parenchymal abnormality. The gallbladder is normal in size 

and wall thickness and demonstrates no pericholecystic fluid and 

no intraluminal echoes. The common bile duct is not dilated, 

measuring 4 mm in diameter. The kidneys measure in length 11.2 

em in the right and 11 em on thE! left. Both kidneys demonstrate 

normal cortical thickness and echogenicity. The spleen measures 

14 em in length. No intraperitoneal free fluid is demonstrated. 

Impression: 

1. No FOCAL HEPATIC ABNORMALITY IS DEMONSTRATED BY 

SONOGRAPHY, HOWEVER, ULTRASOUND IS REIATIVELY INSENSITIVE FOR 

DETEC'TION OF OCCULT HEPATIC MASSES COMPARED TO cr. 2 . SPLENOMEGALY. 

Alp, RCV GENe 2B ON WEEK 20 OF 'l'REATMENT 

1. Patient having some depression. Denies Sl/H!. ••••• to evaluate 

today. 

2. Continue ribavirin 400mg bid, pegasys lBOmcg/wk. 

J. Last date of meds 1/6/05 

4. RTC GI LIVER 1/13/05 w/ CBCXT, CMP, TSH, Hev QUAL, 

5. Instructed pt to go to ER if S1/HI occurs. 

Signed by; lest Phann.D. 

Clinical Pharmacy Specialist 12/16/2004 14:05 

12/15/2004 11,13 Title: MHC BIOFEEDBACK 

Length of Visit; 60 minutes 

Arrived: On Time 

Appearance: Alert, oriented X4, Neatly dressed, groomed, Cooperative, Cheerfull 

51/H!: Patient did not report any SI/HI Ideation. 

Session: #6 

Diagnosis: Anxiety NoS 

Type of Session: 

BIOFEEDBACK 

OTHER 

Temperature: Left 

Sensor Placement: Left middle finger I distal pad. 

VISTA Electronic Medical Documentation 

Page 374 
532 

Health Summary Printed OnOcl 31, 2006 

Pulse 

Sensor Placement: Left index finger, distal pad. 

Skin Conductance 

Sensor Placement: Left thenar eminemce and hypothenar eminence. 

Respiration 

Sensor Placement! Chest band acrose the xyphoid process. 

'l'8STING" RESULTS: 

Temperature L :Be9innin9 temperature was approximately 91.9 degrees F, ending 

temperature was approximataely 92.75 degrees F. A peak temperature of 

approximately 92.85 degrees F was achieved approximately 16 minutes into the 

session. Total temperature change was lese than 1 degree did not 

achieve the target temperature of 93 degrees F. 

Respiration: Beginning raw respiration was approximately 3040, ending 

respiration was approximately 3010 with a peak recorded at approximately 3190 

and the lowest level at approximately 2890. Beginning respiration rate ..... as' 

approximately 7.5 breaths-per-minute (bpm), ending respiration rate ..... as 

approximately 15 bpm. A peak rate was recorded at approximatelY 18 bpm and the 

"SllloIllWllleilstiliriiaiit~e recorded ..... as approximately 1.9 bpm. The slowest rate .was due to 

• 10lding his breath during some of the PMR exercises. Average bpm 

ra.te appears to be approximately 13 bpm.k.in Conductance: Beginning level 

approximately 9.4 micromhos, ending levey 5 micromhos. A peak level ..... as 

recorded at approximately 12.8 micromhos. 

Pulse: Beginning pulse amplitude was approximately 1165, ending pulse 

amplitude was approximately 1065 ..... ith a pe,ak. level recorded at approximately 

1190 adn the lowest recorded rate ..... as approximately 930. Real-time imagery sho ..... s 

peak-to-peak pulge amplitude bet ..... een 400-450 most of the session. 

Testing session length: 19 min. 

Number of epochs: 95 

Testing today consisted of a 2-minute pre-testing baseline followed by 

approximately 15 minutes of Progressive Muscle Relaxation (PMR) 

exercises followed by a 2-minute post-testing baseline. 

Overall SignificanceUpon arrival, I. retold his story of losing his job about 5 ..... eeks ago 

and ho ..... much struggle he has been haying over this. He is extremely anxious 

over this because of it'B cyclic nature and for what he ..... as terminated over. As 

of this time, he is drawing unemployment and he has enough money saved up to get· 

by on. 

I.e., ......... as not able to raise his temperature by a full degree today but hig 

Page 375 
533 

Health Summary Prtnted On Oct 31. 2006 

beginning temperature was over 91 degrees to start with. He was able to reduce 

his skin conductance by nearly 50t but it is still vezy high since target level 

is less than 1 an "! ended with a 5" . Peak-to-peak pulse amplitude was 

very good today usually 1n t. e range of 450-500 per real-time imagezy, All 

recorded parameters are highly suggestive of an individual in a very relaxed 

state and lowxiety. After today' session, I asked I hoW' he felt and he 

said "Great." 

plan: is to continue PMR exercises a minimum of ] times daily and 

~nclude a slowed breathing technique with the,n. Breathing exercises should be 

kept to a maximum of 5 minutes pe session to preclude becoming overly tired. 

These exercises should be done in conjucntion with daily routines to help make 

them become a habit easier. S was also given a copy of a Guided Imagery 

audio cassette that he can biten to whenevere he feels he is getting stressed. 

RTC 1 week. 

RTC; Dec 22,2004@09:00 

Signed by: /es/ I M. Ed. 

PSYCHOlDGY TECHNICIAN 12/15/2004 ll: 45 

Receipt Acknowledged by: /es/ PhD 

PSYCHOLOGIST, ADM.iNISTRATIVE 12/16/2004 11:42 

DIRECTOR AMHC 

Digital Pager: 62/504 

12/09/2004 16:57 Title: PC PSYCHOLOGY 

HCV SUPPORT GROUP NOTE 

12/09/04 

1000 - 1130 

Today1s group focused on stress/anxiety management. Reviewed various relaxation 

techniques and discussed ways members cope with stress/anxiety. Discussed the 

role of cogilitions mediating the relationship between our experiences and our 

emotions. Reviewed the importance of monitoring and challenging our automatic 

thoughts. 

Patient reported that he has experienced increased distress during past week. 

He suggested that it was related to him losing his job several weeks ago. 

Discussed his change in activity level and routine as one contributor to his 

distress. Patient also stated that he has not been using relaxation techniques 

that have been helpful in the past. Discussed increasing his behavioral 

activation and utilizing stress management techniques. 

Affect and mood WNL. Good participation in group. No SI or HI indicated. 

PATIENT NAME AND ADDRESS (Mec:hanlcallmprindng, IfavaUable) VISTA Electronic Medical Documentation 

Page 376 
534 

Progress Note Printed On Oct 31, 2006 

Will generate Voc. Rehab consult. 

Patient is not judged to be dangerous to himself or others at this time. 

Post 

leg~,,~~,,""1I1I1I1I1II Doctoral Fellow 

Signed: 01/07/2005 08:00 

les/ Ph.D. 

DIRECTOR. HEALTH PSYCHOLOOY CLINIC 

Cosigned: 01/11/2005 16:14 

TITLE: MHC Biofeedback. 

DATE OF NOTE: JAN 05, 2005@13:01 ElI."TR¥ DATE: JAN 05. 2005@13:01:40 

AUI'HOR: EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

length of Visit: 60 minutes 

Arrived: On Time 

Appearance: Alert, oriented X4, Neatly dressed, groom~d, Cooperative, 

Cheerfull, Calm 

SI/HI: Patient did nO,t report any S1/H! Ideation. 

Session: 

Diagnosis: AnXiety NOS 

Type of Session: 

BIOFEEDBACK 

OTHER: Review 

All • _ wanted to do today was talk. We reviewed the different 

relaxation techniques he has been taught and he stated that he feels 

comfortable with them. 

He stated that he hag been having difficulties with simply not wanting 

to do anything and nothing even interested him anymore. He will get 

his last Interferon injection this week and he is hoping that after 

that injection wears off that he will be able to per8ue an interest. 

He is 9till unemployed but has been in contact with his former employer 

and may be involved in an investigation of his former supervisor. He 

stated that he can I t even get the energy to apply for a. job right now. 

(MedlBnlcallmprtntfng,lf lNallable) 

Paoe 83~ 
535 

Progress Note Printed On Oct 31, 2006 

_'-"has started going to the YMCA. and swimming laps twice a week 

tLow.~el good but it wears me out quite easily. I> Also, his 

sleeping habits are not providing him with the energy he feels he needs 

and he does not wake up refreshed. He is not sure if it is a side 

effect of the Interferon or not. 

We talked about his goals, both short and long range. He has not taken a look 

at them, since he initially wrote ,them down. We talked about the possibility of 

. taking a class either at the college. vo-tecQ or community center. Nothing 

discussed appealed to _...... We talked about the difficulty with getting 

somewhere if you never start and that almost any start in any direction is 

better than no start at all. I mentioned the possibility of a time management 

course or self improvement self-help book. •. ~ stated that as an 

adolescent, he and his family had been in Europe and he had learned to speak a 

foreign language that he can no longer converse fluently in and there may be a 

possibility of taking a class or self-study. 

Plan:., ~ is to continue with his Progressive Muscle Relaxation, 

Ereathing Tecpr.iques and Visual Imagery as often as he wishes for the 

next two weeks. He is to also look at his short term and long term. 

goals and select one from each that he feels he can motivate himself 

with and outline what it will take to reach those goals. RTC 1 week. 

R'I'C: Jan 12. 2005@09: 00 

/es/ M. Ed. 

PSYCHOLOOY TECHNICIAN 

SLgned, 01/05/2005 13,19 

Receipt Acknowledged By: 

01/11/2005 15,17 les/ 

TITLE: PC PSYCHOLOOY 

PhD 

PSYCHOLOOIST, ADMINISTRATIVE DIRECTOR AMHC 

D1\.TE OF NOTE: DEC 23, 2004@14:24 ENTRY DATE: DEC 23, 2004@14:24:21 

AUTHOR, EXP COSIGNER, 

URGENCY: STATUS: COMPLETED 

Hev SUPPORT GROUP NOTE 

12/23/04 

lOOO - 11.30 

Today's group focused on: 

1) Patients reflecting on what they had gained or learned while on treatment. 

2) Patients' plans for the holiday. 

3) Majority of group focused on sleep management. Reviewed and discussed 

sleep hygiene. Patients also given written materials on sleep management to 

PATIENT NAME AND ADDRESS (Meehanlc:allmprlnllng. if &'WaDable) VISTA Electronic Medical Documentation 
536 

Health Summary Printed On Oct 31 • 2006 

hydrtherapy and non W'eight bearing exercises . referred to PT for aS8istive dev.ice 

and possible cortisone intraarticular inj in Arthritis clinic. 

3Mood disorder: On citalopram 10 mg qd, Btable no si/hi. 

Flu visit in one year. 

Signed by: les/ M. D. 

Primary Care Physician 02/09/2005 14 :38 

Todays Vitals 

SP 122/75 

HR 79 

Wt 255.6 Lbs 

Title: ADDENDUM 

Ref: PC GENERAL NOTE Dated: 02/09/2005 14:25 

signed by: jes/ .1 M.D. 

Primary Care Physician 02/09/2005 14:45 

Title: MHC BIOFEEDBACK 

Length of Visit! 60 minutes 

Arrived: On Time 

Appearance: Alert, oriented X4, Neatly dressed, groomed, Cooperative, Calm 

S1/H!: Patient did not report any S1/H! Ideation. 

Session: #7 

Diagnosis: Anxiety NOS 

Type of Session: 

8 IOFEEDBACK 

OTHER 

s: arrived today very upbeat and quite talkative. We talked about 

his goals and plans on how to accomplish them. He is quite goal oriented but 

needs to make definite plans. 

He has completed his Interferon inj ections and stated that he is feeling better 

but did not realize how llUlch impact the injections W'ere having on his moods and 

energy level. He stated that he is going to the YMCA three times weekly and to 

the VA Health Wing twice a week. He also said that there was a program at the 

VA Health Wing on Fridays that he wanted to try . 

••••• alked a long time regarding hie goals, things he has done in the 

past and mistakes he feels that he has made. We discussed the problems with 

playing the "Would have, could have, Should have done" game and IIWhat if I! 

Me 

EXHIBIT#9d 
537 

Health Summary PonIed On Oct 31, 2006· 

. scenarios. I encouraged him not to second guess himself but remember that the 

·decisions ha has made were done with a limited amount of information and he di.d 

the best he could at the moment. I reminded him that if he does not make a 

decision regarding a goal, he accomplished nothing toward that goal. I urged 

him to find a "burning desire ll for his motivation and keep it in front of him at 

all times: 

Lastly, we talked about the last time that had any fun. He stated 

that it has been a long time and that he has given' up a lot of the things he 

used to do that he enjoyed. I encouraged him to set aside Bome time each week 

for fun. 

He said that his energy level wanes in the early afternoons but is fine in the 

mornings. His mornings are quite full every day and he is slowly trying to 

expand into the afternoons. He 19 cC!llcerned that if he goe9 on a job interview 

in the afternoon that he will not be up to his full potential and not make a 

favorable first impression. We discussed the possibilities of moving the 

interviews to the morning or reducing his morning activities for the day of the 

interview to preserve more energy for later on in the day. 

A: . is a well developed, well nourished 50 ylo WM in NAn. He is 

alert and oriented x3. Eye contact was excellent throughout the seas ion, 

thoughts were goal directed. Speech patterns were good and he was able to 

express himself without difficulty. He has completed all of the relaxation 

exercises I teach and bas demonstrated that he is capable of using them with 

good results. He has identified both short term and long term goals but is 

having difficulty making decisions on an action plan to satisfy those plans. 

Plan: is to practice all of his relaxation techniques a minimum of 

3 times daily for the next 3 months. He is to include them with his daily 

routines to help him remember to do them and increase the likelihood of making 

them habits. He is to continue working with Sezvice Officers for his disability 

and continue his job searche. He has stated that he has enough money to last 

him for three months but I reminded him how quickly the time passes and how long 

it. takes to get paid once employed. He is to develope some immediate goals and 

steps to accomplish them and try to find something to use for motivation toward 

fulfilling those goals. 

RTC: May 11,2005@10:OO 

Signed by: les/ • M. Ed. 

PSYCHOLOGY TECHNICIAN 02/09/2005 15:35 

Receipt Acknowledged by: /es/ , PhD 

PSYCHOLOGIST, ADMINISTRATIVE 02/14/2005 08:29 

DIRECTOR AMHC 

Page 354 
538 

Health Summary PrlntedOn Oct31,2006 

Digital Pager; 62 016 

04/14/2005 15:49 Title: PC PSYCHOI.DGY 

HCV SUPPORT GROUP NOTE 

04/14/05 

1000 - 1130 

Genotype: 

Length of TX: >3 months out 

Today's group focused on: 

Review of confidentiality. information about Therapeutic 

Recreation to veterans. rested in activitie9 offered, and 

several members commented about how they found Therapeutic Recreation useful. 

Remainder of group focused on discussing how various members are dealing 'with 

HCV's impact on phYSical health, psychological health, and "relationships. 

Members were encouraged to remain active and to explore alternative activities. 

Affect and mood WNL. Limited participation in today' 9 group due to needs of 

other group members. No suicidal or homicidal ideation were indicated . 

••••• 'was supportive of other group members facing crises. He shared that 

he has found exerciSing in the VAts health wing very beneficial. Reports that 

he continues to exercise and to spend time volunteering. 

OX: HCV 

Depression due to general medical condition (HCV) 

Plan: 

Return to group in one week, 04/21/05. 

Patient is not judged to be dangerous to himself or others at this time. 

Signed by: /es/ ... 

psychology Intern 04/14/2005 15 :54 

Co signed by: /es/ Ph.D. 

Psychologist 04/15/2005 11,04 

Page 338 
539 

Progress Note Pnnted On Oct 31, 2006 

AtrrHOR: 

URGENCY: 

HCV SUPPORT GROUP NOTE. 

04/21/05 

1000 - 1130 

Group Facilitator: 

EXP COSIGNER": 

STATUS: COMPLETED 

I Ph.D., psychology Fellow 

Genotype: 

Length of TX: 13 weeks out 

Today' 9 group focused on! 

1) Patient's checked in and reported on 1?ow they have been coping. 

2) 'Discussed how treatment can directly and indirectly affect relationships, 

Several group members shared how the treatment process has affected their 

relationship with their spouse. Discussed the need for patients to work on 

communicating their needs and giving feedback to family and support system. 

3) Discussed patient's use of a l'higher power" (faith, religion, spiritual) in 

coping with difficulties associated with HCV treatment. 

Affect and mood WNL. Moderate partiCipation in today's group. No 9'uicidal or 

homicidal ideation- was indicated. Supportive of other group members . 

• _ reported that he has continued to increase his level of activity. He 

suggested that he still is not able to concentrate and sustain focus like he 

would like, He continues to look for employment and participate in upward bound 

program. 

ox: HCV 

Depression due to general medical condition (HCV) 

plan: 

Return to group in one week, 04/28/05. 

Patient is not judged to be dangerous to himself or others at this time. 

/es/ 

Post Doctoral Fellow 

Signed: 04/21/2005 15 :48 

/es/ _ .. " ___ , Ph. D. 

Ph.D. 

DIREcroR, HEALTII PSYCHOLOGY CLINIC 

Cosigned: 04/25/2005 09:02 

Paae609 
540 

Health Summary Printed On Oct 3 1, 2006 

since completing his Inteferon treatments. 

Temperature change was not as significant as it should have been but he is under 

some stress as he is job hunting. He did not reach his target of 93 degrees F. 

Heart rate was very steady throughout the seasion, respiration was average and 

he was able to decrease his rate to approximately B bpm for several minutes 

today. Peak-to-peak pulse amplitude decreased over the entire session. _ 

~tated that he was distracted from the music by sounds from within the 

room and sounds from the adjacent room and hallway. 

Because of the high levels of pulse amplitude, peak-to-peak pulse amplitude, 

blood volume, steady heart rate and decrease in skin conductance'~ •• IIJI. 

displays the ability to relax and reduce his overall anxiety level significant.ly 

while doing his relaxation techniques. 

Plan: is to continue to practice all of his relaxation methods a 

minimum of 3 times daily. He needs to include them with his daily activities to 

help make them a habit. He understands the need for practice. RTC PRN 

RTC: Will call if needed. 

Signed by: les/ !J M. Ed. 

PSYCHOLOGY TECHNICIAN 05/11/2005 14,52 

Receipt Acknowledged by: les/ " PhD 

PSYCHOLOGIST., ADMINISTRATIVE 05/19/2005 15:18 

DIRECTOR I1MHC 

Digital Pager: 62/504 

05/05/200513:46 Title: PC PSYCHOLOGY 

HeY SUPPORT GROUP NOTE 

05/05/05 

1000 - 1130 

Group Facilitator: 

Genotype: 

Length of TX: 

Ph.D., Psychology Fellow 

M.A" Psychology Intern 

15 weeks out 

Today' 51 group focused on: 

Brief check in regarding patients' past week. status of their treatment, and how 

they are coping with treatment, There was much discussion on how treatment 

affects one' 9 patience and irritability, thus affecting interactions .with family 

and others. Discussed the need to remain cognizant of how treatment is affects 

VISTA Electronic Modlcal Do.cumentatlon 

EXHIBIT #9 Page 334 
541 

Health Summary PrinledOn Oct31,2006 

one and discuss this with family and others. Conducted guided imagery exercise 

in session. 

Affect and mood WNL. Moderate participation in todayls group. No suicidal or 

homicidal ideation was indicated. Supportive of other group members. 

reported that during the past week he experienced two occasions where 

he felt somewhat depressed. He stated that he was able to challenge hig 

negative thoughts and reframe his situation, thus elevating his mood and 

continuing to move forward. He reported that he continues to stay very active 

and revealed that he has applied for employment at the VA. 

ox: HCV 

Depression due to general medical condition (HCV) - improved 

plan! 

Return to group in one week, OS/OS/05. 

Patient is not judged to be dangerous to himself or others at this time. 

Signed by: !es! Ph.D. 

Post: Doctoral Fellow 05/05/2005 13 :59 

Di~ital Pager: 62319 

Cosigned by: !es! ph.D. 

DIRECTOR, HEALTH PSYCHOLOGY CLINIC 05!13!2005 

Digital pager: 62 076 

04!28!2005 14,03 Title: PC PSYCHOlDGY 

HCV SUPPORT GROuP NOTE 

04!27!05 

1000 - 1130 

Group Facilitator: 

+ " Ph.D .• Psychology Fellow 

+, M.A., psychology Intern 

Genotype: 

Length of TX: 14 weeks out 

Today's group focused on: 

16: 00 

Group was open to allow patients to bring spouses, family members, and other 

supportive people in their lives. Discussion focused around the impact of RCV 
542 

Progress Note Printed On Oct 31 • 2006 

Comment: DOES NOT TAKE SHar 

Okl-Pneumovax: 

Patient declined pneumococcal vaccine at this time. 

Con'tmen t! UNDER AGE RANGE 

Ok-1-Tobacco Use Screen: 

Patient was screened for tobacco use at this encounter. 

Patient reports no tobacco use during the past year (12 month!:!) . 

Continued cessation encouraged. 

/es/ . LPN 

LPN 

signed: 05/17/2005 10:45 

TITLE: PC PSYCHOLOGY 

DATE OF NOTE: MAY 12, 2005@16:5B ENTRY DATE: MAY 12. 2005@16:58:49 

AUTHOR: ! EXP COSIGNER; 

URGENCY: STATUS: COMPLETED 

Hev SUPPORT GROUP NOTE 

05/12/05 

1000 - 1130 

Group Facilitator: 

Genotype: 

, Ph.D. I Psychology Fellow 

M.A" psychology Intern 

Length of TX: 16 week.s out 

Today's group focused on: _____ from Vocational Rehab spok.e to tbe group about opportunities 

available to veterans. Discussed the ways in which HCV treatment may limit 

veteransj they may need to seek. out new employment opportunities. Group memberS! 

also check.ed in, discussing physical side effects and the impact of RCV on 

relationships. The group also welcomed a new member. 

Affect and mood WNlr. Moderate participation in today's group. No suicidal or 

homicidal ideation was indicated. Supportive of other group members. 

Pt states that he continues to volunteer at the VA, participate in the Upward 

Bound program, and to challenge his negative thoughts!. He was active in giving 

advice to a new group member. He believes that HCV treatment i9 still impacting 

his life 4 months post-treatment. 

DX, HCV 

Depression due to general medical condition {HCV} - improved 

PATiENT NAME AND ADDRESS (M8(;hantc.allmprlntlng, IhymllablB) VISTA Electronic Medical Documentation 

'-:-"~-'··-·:~""·-·"·I I EXHIBIT #9h Page 603 
543 

Progress Note Printed On Oct 31, 2006 

Plan: 

Return to group in one weeki 05/19/05. 

Patient is not judged to be dangerous: to himself or others at this time. 

/e9/ 1 

Psychology Intern 

Signed>: 05/12/2005 17:00 

/es/ 'I Ph.D. 

Psychologist 

Cosigned: 05/13/2005 09:01 

TITLE: MHC Biofeedback 

DATE OF NOTE: MAY 11, 2005@14:13 ENTRY DATE: MAY 11, 2005@14:13:37 

AUTHOR: EXP COSIGNER: 

URGENcY: STATUS: COMPLETED 

Length of Visit! 50 minutes 

Arrived: On Time 

Appearance: Alert, oriented x4, Neatly dressed, groomed, Cooperative, Calm 

Sr/HI: Patient did not report any Sl/H! Ideation. 

Session: #10 

Diagnosis:' Anxiety l'lOS 

Type of Session; 

BIOFEEDBACK 

OTHER: Native American Indian Flute music 

Temperature: Left 

Sensor placement: Left middle finger, distal pad 

Pulse 

Sensor placement: Left index finger I distal pad 

Skin conductance 

Sensor Placement: Left thenar eminence and hypothenar eminence 

Respiration 

Sensor Placement: Chest band across the xiphoid process 

TESTING RESULTS: 

Temperature L :Beginning temperature was approximately 89.9 degrees F, ending 

VISTA Electronic Medical Documentation 
544 

Health Summary Printed On Oct 31, 2006 

05/1.9/2005 13:37 Title: PC PSYCHOLOGY 

Hev SUPPORT GROUP NOTE 

05/19/05 

1000 - 1130 

Group Facilitator: 

Genotype: 

), Ph. D., psychology Fellow 

____ M.A" psychology Intern 

L'ength of TX: 17 weeks out 

Today' 9 group focused on: 

Discussing physical and emotional effects of HCV treatment. Group members 

"checked inll with one another' and offered support. Discussed HCV treatment as 

an opportuni'ty to make positive changes in one's life. Discussed the importance 

of continuing to engage in pleasurable and productive activities, even when 

activity.level Tm.lst be limited. Began discussion of stress management 

techniques. Group appears to have bonded and members are checking on one 

another. 

Affect and mood WNL. Moderate p~rticipation in today's group. No suicidal 

homicidal ideation was indicated. Supportive of other group members. 

Pt states that he has gotten much of his strength & energy back following 

treatment, although he still struggles with lack of energy from time to time. 

Pt continues to volunteer at the VA. He was supportive of other group members 

today, offering advice and hope regarding the end of treatment. Brought fruit 

and vegetable snacks with him and ate those throughout group. _ 

volunteered to call group members this week to remind them of the group's neW' 

meeting room. 

DX: HCV 

Depression dUe to general medical condition (HCV) ~ improved 

Plan; 

Return to group in one week, OS/26/05. 

Patient is not judged to be dangerous to himself or others at this time. 

Signed by: /es/ 

Psychology Inte:pl 05/19/2005 14 :20 

Cosigned by: lesl . ~, Ph.D. 

psychologist OS/20/2005 13:36 

Page 330 
545 

P rog ress Note Printed On Oct 31,2006 

lest ph, D, 

Psychologist 

Cosigned: 06/17/:200514:04 

Receipt Acknowledged By: 

06/17/2005 15,24 lest " ph.D. 

Post Doctoral Fellow 

TITLE: PC PSYCHOLOGY 

DATE OF NOTE: JUN 09, 2005@14:5S' ENTRY DATE: JON 09. 2005@14:56:0:2 

AUTHOR; EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

V SUPPORT GROUP NOTE 

06/09/05 

1000 - 1130 

Group Facilitator: 

, Ph.D., Psychology Fellow 

M.A., psychology Intern 

Genotype: 

Length of TX: 20 weeks out 

Today's group format was open, allowing patients to discuss difficulties they 

have been experiencing as well as treatment accomplishments and successes. The 

group members were quite verbal in sharing their experiences. Much discussion 

focused around one group member' 9 struggles during the past week and her 

decision about whether or not to continue treatment. 

Affect and mood WNL. Moderate participation in today's group. _ reports 

that he has been feeling good and has made progress on his home projects, No 

suicidal or homicidal ideation was indicated. Tried to be supportive' of group 

members in distressi however/ gave So good deal of advice during today's group. 

ox: HCV 

Depression due to· general medical condition (HCV) - improved 

Plan, 

Retl:lrn to group in one week, 6/16/05. 

Patient is not judged to be dangerous to himself or others at this time. 

lest 

EXHIBIT #9' Page 598 
546 

Progress Note 

CHIEF t ORTHCYl'IC I...AS 

Cosigned: 06/23/2005 08:20 

TITLE: PC PSYCH:0LOOY 

Printed On Oct 31, 2006 

DATE OF NOTE: JUN 16, 2005@11:58 ENTRY DATE: JUN 16, 2005@11:59:11 

AlJI'HOR: EXP COSIGNER: 

URGENCY, STATUS, COMPLETED 

RCV SUPPORT GROUP NOTE 

06/16/05 

1000 - 1130 

Group Facilitator: 

M.A., psychology Intern 

Genotype: 2 

Length of 'I'X: 21 weeks out 

Content of Group: 

Discussed confidentiality and welcomed a new group member. Members nchecked 

inll regarding their experiences coping with HCV and HCV treatment. Spent some 

time discus9i~communication in relationshipSi;-:. and cOlf1IIlon gender differences in 

commWlication. Group members -were very verbal' during today'g discussion. Next 

week's group is open for members to include supportive friends and family 

members, 

•

' ffeet with upbeat mood. Moderate participation in today's group. 

reports that he continues to volunteer 25 hrs per week, but he is too 

t re to look for a job. Supportive of other group members. No suicidal or 

homicidal ideation was indicated. P lWlteered to call an absent group 

member to remind him of next week's open group. 

DX: HCV 

Depression due to general medical condition (HCV) - improved 

Plan: 

Return to group in one week, 6/23/05. 

Patient is not judged to be dangerous to himself or others at this time. 

le./ 

Psychology Intern 

Signed: 06(16/2005 12:09 
547 

Prog ressNote Printed On Oct 31. 2006 

Adequate lighting is available, Standing up slowly 

DispositionUrgent Care -- LSO 

/es/ .. STAFF NURSE 

Signed: 06/25/2005 19:56 

00/25/2005 ADDENDUM STATUS, COMPLETED 

2053 TORADOL 30 MG GIVEN IM IN THE RIGHT DELTOID AS ORDERED BY DR. VINCENT. 

/ee/ IN 

RN 

Signed, 06/25/2005 20,56 

TITLE; PC PSYCHOLOOY 

DATE OF NOTE: JUN 23, 2005@14:32 ENTRY DATE: JUN 23, 2005@14:32:22 

AUTHOR: EXP COSIGNER; 

URGENCY: STA'l'lTS: COMPLETED 

HCV SUPPORT GROUP NOTE 

06/23/05 

1000 - 1130 

Group Facili'tator: 

Ph. D., psychology Fellow 

M.A., psychology Intern 

Genotype: 

Length of 'l'X.: 22 weeks out 

Content of Group: 

Today' 9 group format was open for members to bring family/friends who support 

them during treatment. Members "checked inn regarding their own 

p~ogre5s and introduced family members. Discussed relationship issues. Also 

discussed the ways in which not being able to work can affect self-esteem, 

redefine roles in relationships, and can contribute to emotional distress. 

Group members discussed the benefits of coming to group and they were encouraged 

to seek social support as they go through treatment. 

Bright affect with upbeat mood. Moderate participation in todaylg group. 

_ continues t<? complain of fatigue. It was pointed out to him that his 

schedule is now quite busy and this may account for his fatigue. Supportive of 

other group members. No suicidal or homicidal ideation was indicated. 

OX, HCV 

Permanent Subcommittee on Investigations 

EXHIBIT #91 
548 

Health Summary Printed On Oct 31, 2006 

Signed by: leg/ .i'- I Ph.D. 

Post Doctoral Fellow 07/25/2005 18:32 

Digital Pager: 62319 

Cosigned by: /es/ Ph.D. 

DIREC"l'OR,' HE!U/l'II PSYCHOLOGY CLINIC 07/26/200511,J.4 

Digital pager: 62 076 

07/19/2005 11,45 Ti t Ie: PC GENERAL NOTE 

Pt comes as walk in with pruiritic rash arms for few days likely starting after 

exposure to out, door plants .O/E afebrile, VSS1lungs clear ,heart RRR, skin show 

intense erythema flexure surfaces of upper and forearms with slight blistering 

and vesicles,no apparent signs of infection.Imp Contact Dermatitis. Plan: Start 

Methylprednisolone dose pack, Hydroxyzine tabs and Hydrocortisone topical 

application. 

Signed by: /es/ • M.D. 

Prima:cy Care Physician 07/19/2005 11:49 

07/14/2005 10:45 Title: PC PSYCHOLOGY 

HCV SUPpORT GROUP NOTE 

07/14/05 

1000 - 1130 

Group Facili tater: 

[, Ph.D., Psychology Fellow 

Genotype: 

Length of TX: 6 months out 

Content of Group: 

During today'9 group there was much discussion and questions regarding life 

after HCV treatment. Several of the members have just finished treatment and 

had questions regarding how they will feel and chances of HCV relapse. 

Patients who have completed treatment were encouraged to continue attending 

group while they make this transition. Discussed how patients have made a 

significant investment in their health and future and encouraged them to 

continue making positive health choices! abstain from alcohol and drugs; tobacco 

cessation; proper qiet and exercise; etc. 

VISTA ElectronIc MedIcal Documentation 

Permanent Su~committee on lnvesti ation~- '. 

EXHlBlT#9m 

Page 318 
549 

Progress Note Printed On OCl31, 2006 

FOR X-RAYS. 

/e9/ 

RN 

sig~ed: 08/13/:2005 19::21 

TITLE: LIVER CLINe T~EPHONE NOT 

DATE OF NOTE: AUG 11. :2005@17:00 ENTRY DATE: AUG 11, :2005@17:00'::2:2 

AUTHOR: EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

PATIENT H}U) LAB DRAWN TO CHECK HEP C VIRAL LOAD 6 MONTH AFTER TREATMENT. LAB 

DRAWN 7/14/05. CALLED HOUSTON VA. RESULTS FAXED WHICH SHOWED liND Hev RNA 

DETECTED. II NOTIFIED PATIENT OF RESULTS. KEEP GI LIVER FELLOW APPT 8/1B. PT 

VERBALIZED UNDERSTAN'OING OF PLAN OF CARE. 

/es/ ' Pharm.D. 

Clinical Pharmac:y Specialist 

Signed: 08/11/:2005 17 :02 

TITLE: PC PSYCHQLOOY 

DATE OF NOTE: AUG 11, 200S@12:36 ENTRY DATE: AUG 11, 2005@12:36:26 

AUTHOR: EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

Rev SUPPORT GROUP NOTE 

08/11/05 

1000 - 1115 

Group Facilitator: 

Ph. D., psychology Fellow 

MS, psychology Intern 

Genotype! 2a 

Length of TX: :2 9 weeks aut 

Content of Group: 

Patient·s checked in and reported on the status of their treatment and general 

coping. Today patient'S completed a pen and paper CDC Hepatitis Knowledge 

Assessment. After completion each question was reviewed and discussed. 

Discussed the importance of being knowledgeable about .Hepatitis and how this 

directly relates to treatment as well as being able to talk with others about 

HC'V status. 

_reported that he is doing well and discussed his physical activity as 

.. ___ E_XH __ IB_I_T_#_9n ____ ~( .... 
550 

Progress Note Printed On Oct31, 2006 

well as active participation in VA programs such as volunteering and Up Ward 

Bound program, 

Bright affect with upbeat mood. Moderate participation in today's group. 

Supportive of other group members. No suicidal or homicidal ideation was 

indicated. 

DX: HCV 

Depression -" stable 

Plan: 

Return to group in one week, OB/18/05. 

Patient is not judged to be dangerous to himself or others at this time. 

/es/ Ph.D. 

Post Doctoral Fellow 

Signed: 06/11/2005 12:40 

/es/ Ph.D. 

DIRECTOR, HEALTH PSYCHOL<X:Y CLINIC 

Cosigned: 08/16/2005 10 :11 

TITLE: PC PSYCHOL<X:Y 

DATE OF NOTE: AUG 04, 2005@12:26 ENTRY DATE: AUG 04 , 2005@12:26;:31 

AUTHOR: EXP COSIGNER': 

URGENCY: STATUS: COMPLETED 

HCV SUPPORT GROUP NOTE 

OB!04!05 

1000 - 1115 

Group Faci Ii tat~r ~ 

Ph.D., Psychology Fellow 

., MS, Psychology Intern 

Genotype: 2a 

Length of TX: 2 B weeks out 

Content of Group: 

Today had new group member as well as addition of F as co group 

facilitator. Therefore each member introduced themselves and shared their 

treatment history and current progress. Majority of group was spent discussing 

new members adjustment to treatment and currents stres90rs. Group discussion 

PATIENT NAME AND ADDRESS (Mec:h8.JlkoalImprlntfng,If av.n.b~r VISTA Electronic Medical Documentation 

'111· ----
551 

Consult Request Printed On Oct 31, 2006 

Inter-faci 1i ty Information 

This is not inter~facility consult request. 

Status: 

Last Action: 

COMPLETE 

COMPLETE/UPDATE 

Facility 

Activity Date/Time/Zone Responsible Person Entered By 

-~;;~-;~~~- ~~;---- -~~i;~i~~ -~~ ~~~- -----5------- -~------- n ___ ------. - -. 

PRINTED TO 08/24/05 14 ,54 

NURS PRT-ID LASER 

COMPLETE/UPDATE 

Note# 6588"192 

08/29/05 10,49 

Note: TIME ZONE is local if not indicated 

TITLE: THERAPEUTIC RECREATION CONSULT 

• 7 

DATE OF NOTE:" AUG 29, 2005@lO:39 ENTRY DATE: AUG 29, 2005@10:39:32 

AtrrHOR : EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

INITIAL EVALUATION 

PART I: PERSONAL INFORMATION 

1. OX: Mood Disorder 

2. AGE: 50 

3. MEDICAL HX: Hep C, Depression, bad knees and left ankle 

4 • OCCUPATION: 

5. RESIDENCE: 

6 . LIVING ARRAl<GE'MENT:S, OKe 

PART II: LEISURE HISTORY: 

1. PREVIOUS LEISURE INTERESTS: painting. sketching, making things, reading, 

exercising and carving 

2. CURRENT LEISURE INTERESTS: working with Upward BOWld, exercise, work on the 

house, movies, reading, computers, volunteering and water aerobics 

3. COMMUNITY INVOLVMENT: gets out daily 

Page 87 
552 

Consult Request Printed On Oct 31, 2006 

4, SOCIAL SUPPORTS; friends and people at the VA 

5. PERCEIVED BARRIERS; health 

PART III: ASSESSMENT: 

1. LEISURE STRENGTHS: Veteran reports several previous and current leisure 

interests and states he has a good social support system. 

2. LEISURE WEAKNESSES: Veteran reports problems with depression. 

3. PATIENT GOALS: Iljoin the stick class" 

PART IV: TREATMENT PIAN 

Veteran has been actively involved in the exercise clinic and would 

now like to expand hie involvement with this clinic through the stick 

class. 

Veteran will attend group Tuesday and Friday 0800~1000. 

Veteran will engage in the stick making process and complete walking 

stick. 

Veteran will a,ctively.participate in social interaction ~ith peers at 

least three times each session. 

/es/ CTRS 

THERAPEUTIC RECREATION SPECIALIST 

Signed: 08/29/2005 10 :.49 

Current PC Provider: 

Current PC Team: ORANGE TEAM 

CUrrent Pat. Status: Outpatient 

Primary Eligibility: SERVICE CONNECl'ED 50t to 100\ 

order Information 

To Service: 

From Service:. 

AUDIOLOGY CONSULT 

ORTHOTICS LAB (HD."DERSON) IB100 

Requesting Provider: ... 1 , 

Service is to be rendered on an OUTPATIENT basis 

Place: 

Urgency: 

orderable Item: 

Consult :. 

consultant·s choice 

Routine 

AUDIOLOGY CONSULT 

Consul t Request 

VISTA Etectronlc Medical Documentation 

Page 88 
553 

Consu It Req uest 

Inter-facility Information 

This is not an inter-facility consult request. 

Status: 

Last Action: 

COMPLETE 

COMPLETE/UPDATE 

Prlnted On Oct 3 1, 2006 

Facility 

Activity Date/Time/Zone Responsible Person . Entered By 

CPRS RELEASEJ) ORDER OS/17/0516,01 

PRINTED TO REHAB PRT-04 08/17/05 16 :01 

SCHEDULED 08/22/05 10,55 

veteran has appt. on 9-2-05 

COMPLETE/UPDATE 

Note#; 66~394,O 

09/02/05 15,33-

Note: TIME ZONE is local if not indicated 

TITLE: PHYSICAL THERAPY OUTPATIENT CONSULT 

DATE OF NOTE: SEP 02. 2005@15:18 ENTRY DATE: SEP 02, 2005@15:18:57 

AUTHOR: EXP COSIGNER: 

URGENCY:- STATUS: COMPLETED 

REFERRAL SOURCE: PC (Raf iq) 

REASON: chronic LBP 

DIAGNOSIS AND/OR SIGNS & SYMPTOMS: chronic LBP 

SUBJECTIVE: Vet reports that his c/c is flspella like almost blacking out that 

started after numerous fallg n . Reports about a month ago his (L) knee and ankle 

gave out on him and he fell onto his left side and since that time has 

experienced a IIsubliminal u type sensation of dizziness that is getting worse and 

he is concerned with driving. Has· had l:Iis ea+s checked and nothing and no 

infection, this cleared by ENT. Describes a sense" of vertigo that happens with 

numerous activites but not anyone thing tends to set this off. Denies any type 

of whiplash type inj ury but has had a hx of C4 ~5 cervical disectorny about 15 

years ago? Denies any significant neck or low back pain but says that he is 

involved" with Therapeutic Recreation 5 times a week here doing comprehensive 

abdominal ex 1 s, stretches as well as he personally doing swimming ex at the 

local YMCA 5x/week. Says he has to exercise or "I can't move"; weight has stayed 

about the same. PCP working up his current c/o's with xrays, ENT consult, has an 

appt. with Neuro in October, 

rVAMC 

EXHIBIT #9 
554 

Consult Request Prlnted On Oct 31, 2006 

OBJECTIVE: amb to dept. (I) using std cane, alert Ox4:. 

AROM and motor grossly WNL' s, denies any radicular neck or LBP. 

No nystagmus noted, (-) Rhomberg in sta,nding", 

Vet did report a few times of the dizziness during this appt. especially after 

getting up from supine position, rolling his trunk toward the (L) but no 

head/trunk consistent movement to set off these subjective c/o' 9. 

EDUCATION (ITEMS DISCUSSED): discussed role of nervous as well as 

muskuloskeletal systems. Reviewed vets current ex program and encouraged 

continued compliance. 

VETERAN RECEIVED 45 MINUTES OF PHYSICAL THERAPY 

INTERVENTION . 

PT EVAL (97001)xl 

EDUC (97535) x 2 

ASSESSMENT: Vet without significant neck: or back pain currently but chief 

complaint appears to be diz:ziness since falling approx. 4 weeks ago. He is 

participating in appropriate ex. group with TR for previous low back: and neck 

pain, encouraged continued compliance. Agree with consult for Neurology to 

hopefully aBses source of dizziness. 

PLAN: discontinue PT, no identifiiable PT goals, encouraged continue compliance 

with TR exercise groups. 

/e9/ 

PHYSICAL THERAPIST 

Signed: 09/02/2005 15:33 

Receipt Acknowledged By: 

09/02/2005 16:04 /es/ M.D. 

Primary Cart:: Physician 

...... ====== ....... "'======== .. "''''====== .. ====''' ... END = ... "''''',..".''''''''== ... ===='''==== ..... =='''' ... == ........ ===0.''''= 

Current PC Provider: 

Current PC Team: ORANGE 'l't:AM 

Current Pat. Status: OUtpatient 

Primary Eligibility: SERVICE CONNEc:.-rBD 50t to lOot 

Order Information 

To Service: NEUROLOGY OUTPATIENT CONSULT 

From Service! PC ~ MOD 

Requesting Provider: J 

service is to be rendered on an OUTPATIENT basis 

Place: Consultant' 9 choice 

VISTA Electronic Medical Documentation 

Page 94 
555 

Health Summary 

{ }Discharge from Clinic 

Veteran does agree with current progress 

report.· 

Signed by, /es/ MI!R 

Printed On Oct 31, 2006 

ART THERAPIST 01/11/2006 11,28 

01/05/2006 12:00 Title: PSYCHOLOGY - BEHAV MED 

HCV SUPPORT GROUP NOTE 

1000 - 1130 

Genotype: 2a 

Length of TX: COIT!Pleted 

Content of Group: 

~11.~.~ttended RCV support group, as scheduled. Today's group was 

joined by 2 new members. Good group discussion and educattr regarding the to 

physical and psychological effects of the RCV treatment. _ continues 

be an active and important participant in the group and its discussion. He i6 

positive and encouraging of others and appears to benefit from the social 

interaction. 

A, 

Low suicide risk at this time 

Axis I: Major Depressive Disorder 

Axis II: Deferred 

Axis III: HCV, in remission 

Axis IV: Resolving problems with health 

Axis V: GAP.,. 70 

PLAN: RTC in one week. 

Signed by: lest «<, ph.D. 

PSYCHOLDGIST 01/23/2006 14:13 

Digital ?ager: 63-162 

01/04/2006 11:13 

PART I: PROGRAM 

Ti t le: THERAPEUTIC RECREATION/ CAT OPT PROGRESS NOI'E 

ATTENDED: 

( ) Arts/Crafts 

( ) Creative Writing 

{ lDrumming 

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EXHIBIT #9 lAMe 
556 

Progress Note Printed On Oct 31.2006 

PT came today wit~ c/o rash lower legs after he went out on his farm. The rash is 

pruiritit. 

OlE afebrile, VSS, lungs clear, herat RRR, abd 90ft non tender, a maculopapular 

erythemaou8 rash lower legs with 'excoriations .The rash is consistent most 

likley with acute cantact dexmatitis due to poison ivy exposure. 

IMP Contact dermatitis 

PLAN:Medrol dose pack and hydroxyzine.RT prn. 

lest . I. M.D. 

Primary Care Physician 

Signed: 07/13/2006 16:35 

TITLE: LIVER CLINIC NOTE 

DATE OF NOTE: .nn. 13, 2006@14:21 ENTRY DATE: Jm... 13, 2006@14:21:3B 

AUTHOR: EXP COSIGNER: 

URGENCY: STATUs: COMPLETED 

•• ~ LIVER CLINIC NOTE Has ADDENDA ••• 

cc: FlU Hep C post·treatment 

HPI: The pt is a 51 yo wm. with a hx of Hep C, 2B diagnosed in 6/03. He was 

treated for 24 weeks with IEN/Ribavirin in 2004 and has experienced SVR, last 

Hev RNA undetectable in 12/05. He is convinced he is still experiencing liver 

complications/symptoms from the Rep C. He reports chronic fatigue, "liVer pain II , 

n/v, intermittent dark stools, and dark urine all of which he attributes to his 

liver. He states that his symptoms are "definitely due to hepatitis. II 

The pain is located in the R back under his ribs. It can occur any time 

day or night, but is dramatically worSe with eating fatty foods which he avoids 

currently. The pain is not exacerbated by anything else and is relieved by 

increasing water intake. The black stools have been occurring for -B months 

intermittent ly. He also reports occasional scant BRBPR. He has been taking 

NSAIDs for knee pain for many months but has stopped them for the past 4 weeks. 

He denies hx of PUD, no prior endoscopy, no heartburn/dysphagia, no wt loss. 

PMHx: Hep C, 28- treated in 2004 with SVR 

Hep B- cleared, now surface ab positive 

Syphilis 

PSurgHX! multiple knee surgeries and L ankle repair 

appendectomy 

SocKx: quit smoking in 19BO 

no alcohol or drug use 

Meds: tramadol 

EXHIBIT#9r 

VAMC 

Page 456 
557 

Health Summa Prlnled On Od 31,2006 

The right kidney measures 11.8 em in length and the left kidney 

measures 10.7 em in length. Both kidneys are sonographically 

normal. The spleen measures 12,9 em in length and is 

unremarkabl e . . 

Impres s ion: 

1. Splenomegaly 

EGD OB/06 

Impression: Hiatus hernia. 

Colonoscopy 08/06 

Papulous gastropathy. Biopsied. 

Normal examined duodenum. 

Impression; - Hiatus hernia. 

- Papulous gastropathy. Biopsied. 

- Normal examined duodenum. 

ASSESSMENT, 

51 yo WID with a hx of Hep C, 28 diagnosed in 6/03. Pt treated for 24 weeks with 

IFN/Ribavirin in 2004. Referred by PCP for complians of Mliver pain ll • current 

pain is not related to Liver. Seems like secondary to spinal stenosis va 

raqicular pain vs muscular pain. Need to rio above. However as clearly mentioned 

is not GI related. 

PLAN/RECOMMENDATIONS! 

1. F/u with PCl? for w/u of radicular pain. 

2. Continue pain medications as needed. 

FOLLQW·UP: 

Schedule patient for a follow-up appointment in this clinic: 

None 

Schedule the following tests prior to the next appointment ~ 

None 

Place the patient on the schedule for the following procedure (s) : 

None 

Signed by: lest M.D. 

RESIDENT PKYSICIAN 09/21/2006 15: 29 

Digital Pager: 327-9149 

09/21/2006 15,35 Ti t Ie : ADDENDUM 

Ref: LIVER CLINIC NOTE Dated: 09/21/2006 14:4B 

Pt seen. Long discussion. His pain IS NOT liver related. He has radicluar pain 

at about tIl and hyperalgesia along that dermatome. Trigger point injections 

from anesthesiology might be helpful. He has fatigue which he ascribes .to a side 

effect of interferon 18 months later even though we cured his virus. He is 

Page 153 
558 

Health Summary Printed on Ocl31, 2006 

clearly poorly conditioned cardiovascular wise and needs to start exeercising to 

reverse his fatigue rather than obsess about ·18 months ago. he need not return 

to liver clinic. 

Signed by: /es/ ,-t.D. 

09/21/2006 13,05 

Patient Age: 

Vital Signs: 

Blood Pressure: 

Pulse: 

Respirations: 

Temperature: 

Pain: (Scale 0-10) 

Height: 

Weight: 

BMI: 

Staff Physician 09/21/2006 15:39 

Analog Pager; 63-64.8 

Digital Pager: 63-648 

Title; SPECIALTY CLINIC NURSING NOTE 

51 

115/73 (09/21/2006 13 :0') 

68 (09/21/2006 13 :0') 

18 (09/21/2006 13 ,04) 

99'F [37,2 CJ (07/13/200615,58J ° (09/21/2006 13,04) 

72 in [182.9 em) (07/13/2006 15:58) 

26'.91b [120.4 kgJ (09/21/200613,0<) 

36.0 

List items the patient would like to discuss with the provider today: 

Patient here for flu, alert and ambulatory. 

Signed by: leal W',RN 

STAFF NURSE 09/21/2006 13 :06 

09/21/2006 09:50 Title: THERAPElITIC RECREATION DC NCYr! 

Veteran has not participated in Therapeutic Recreation exercise clinic for over 

90 days due to major medical change. As a result of lack of attendance 

contact, 

veteran is discharged from this clinic at this time. He will require a new 

consult from his PCP if he would like to attend in the future. 

Signed by: jesl CPRP 

Recreation Therapist 09j 21/2 006 09: 51 

Analog Pager: 62599 

09/20/2006 16,03 Title: PC GENERAL NCYrE 

51 years old wm veteran wi th hx of DJD sjp bilateral knee surgery with residual 

pain knee jts and hips, chronic pain L heel due to a detatched calcaneal Spur 

comes to clinic today for flu and requets a stronger pain medication as Tylenol# 

VISTA Electronic Medical DOCUmentation 
559 

October 16, 2006, 11:33 

PAGE 1 

SG-SSA-16 

UNIT: 5GOOOO 

APPLICATION FOR DISABILITY INSURANCE BENEFITS 

I APPLY FOR A PERIOD OF DISABILITY AND/OR ALL INSURANCE BENEFITS FOR WHICH I AM 

ELIGIBLE UNDER TITLE II AND PART A OF TITLE XVIII OF THE SOCIAL SECURITY ACT, 

AS PRESENTLY AMENDED. 

MY NAME ISIIIIIIIIIIIIIIII .... ' MY SOCIAL SECURITY NUMBER I·~lllllllll"I1'" 

MY DATE OF BIRTH IS .......... .

AM A CITIZEN OF THE UNITED STATES. 

DO NOT HAVE AN UNSATISFIED FELONY WARRANT(S) . 

I DO NOT HAVE AN UNSATISFIED FEDERAL OR STATE WARRANT(S) FOR VIOLATION OF 

PROBATION OR PAROLE. 

I BECAME UNABLE TO WORK BECAUSE OF MY DISABLING CONDITION ON November 1, 2004. 

I AM STILL DISABLED. 

NO PREVIOUS APPLICATION HAS BEEN FILED WITH THE SOCIAL SECURITY ADMINISTRATION 

BY OR FOR ME. 

MY U.S. MILITARY SERVICE DATES ARE AS FOLLOWS: 

START DATE 

May 19, 1975 

END DATE 

September 19, 1975 

I AM NOT ENTITLED TO NOR DO I EXPECT TO BECOME ENTITLED TO A PENSION OR ANNUITY 

BASED IN WHOLE OR IN PART ON WORK AFTER 1956 NOT COVERED BY SOCIAL SECURITY. 

THE SOCIAL SECURITY ADMINISTRATION AND THE STATE AGENCY REVIEWING MY CLAIM DO 

HAVE MY PERMISSION TO CONTACT MY EMPLOYER(S). 

I HAVE NEVER MARRIED. 

Permanent Subcommittee on Investi ations 

EXHffilT#9t 
560 

• 

October 16, 2006, 11:33 

PAGE 2 

SG-SSA-16 

I DO NOT HAVE ANY CHILDREN UNDER AGE 18; AGE 18-19 ATTENDING ELEMENTARY OR 

SECONDARY SCHOOL FULL TIME; OR AGE 18 OR OVER AND DISABLED BEFORE AGE 22 WHO 

MAY BE ELIGIBLE FOR SOCIAL SECURITY BENEFITS ON THIS RECORD. THIS INCLUDES 

CHILDREN WHO MAY OR MAY NOT BE LIVING WITH ME. 

I UNDERSTAND THAT I MUST PROVIDE MEDICAL EVIDENCE ABOUT MY DISABILITY, OR 

ASSIST THE SOCIAL SECURITY ADMINISTRATION IN OBTAINING THE EVIDENCE. 

I UNDERSTAND THAT I MAY BE REQiJESTED BY THE STATE DISABILITY DETERMINATION 

SERVICES TO HAVE A CONSULTATIVE EXAMINATION AT THE EXPENSE OF THE SOCIAL 

SECURITY ADMINISTRATION AND THAT IF I DO NOT GO, MY CLAIM MAY' BE DENIED. 

I AUTHORIZE ANY PHYSICIAN, HOSPITAL, AGENCY, OR OTHER ORGANIZATION TO DISCLOSE 

ANY MEDICAL RECORD OR INFORMATION ABOUT MY DISABILITY TO THE SOCIAL SECURITY 

ADMINISTRATION OR TO THE STATE DISABILITY DETERMINATION SERVICES THAT MAY 

REVIEW MY CLAIM OR CONTINUING DISABILITY. 

I AUTHORIZE THE SOCIAL SECURITY ADMINISTRATION TO RELEASE ANY INFORMATION ABOUT 

ME TO A PHYSICIAN OR MEDICAL FACILITY PREPARATORY TO AN EXAMINATION OR TEST. 

RESULTS OF SUCH EXAMINATION OR TEST MAY BE RELEASED TO MY PHYSICIAN OR OTHER 

TREATING SOURCE. 

I AUTHORIZE THAT INFORMATION ABOUT MY DISABILITY MAY BE.FURNISHED TO ANY 

CONTRACTOR FOR CLERICAL SERVICES BY THE STATE DISABILITY DETERMINATION 

SERVICES. 

I AGREE TO NOTIFY THE SOCIAL SECURITY ADMINISTRATION OF ALL EVENTS AS EXPLAINED 

TO ME. 

I AGREE TO NOTIFY THE SOCIAL SECURITY ADMINISTRATION: 

-- IF MY MEDICAL CONDITION IMPROVES SO THAT I WOULD BE ABLE TO 

WORK, EVEN THOUGH I HAVE NOT YET RETURNED TO WORK. 

-- IF I GO TO WORK WHETHER. AS AN EMPLOYEE OR A SELF-EMPLOYED 

PERSON. 

-- IF I APPLY FOR OR RECEIVE A DECISION ON BENEFITS UNDER ANY 

WORKERS' COMPENSATION LAW OR PLA1'I (INCLUDING BLACK LUNG. 

BENEFITS FROM THE DEPARTMENT OF LABOR), OR OTHER PUBLIC 

BENEFIT BASED ON DISABILITY. 

IF I AM CONFINED TO A JAIL, PRISON, PENAL INSTITUTION, OR 

CORRECTIONAL FACILITY FOR CONVICTION OF A CRIME OR I AM 

CONFINED TO A PUBLIC INSTITUTION BY COURT ORDER IN 

CONNECTION WITH A CRIME. 

THE ABOVE EVENTS MAY AFFECT MY ELIGIBILITY TO DISABILITY BENEFITS AS 

PROVIDED IN THE SOCIAL SECURITY ACT, AS AMENDED. 

I AGREE TO NOTIFY THE SOCIAL SECURITY ADMINISTRATION IF I BECOME ENTITLED TO A 

PENSION OR ANNUITY BASED ON EMPLOYMENT AFTER 1956 NOT COVERED BY SOCIAL 

SECURITY. OR IF SUCH PENSION OR ANNUITY STOPS. 
561 

October 16, 2006, 11:33 

PAGE 3 

SG-SSA-IS 

B~NEFITS TO A STEPCHILD TERMINATE THE MONTH AFTER THE MONTH THE WORKER AND THE 

STEPCHILD'S PARENT OBTAIN A FINAL DIVORCE. THEREFORE, IF A STEPCHILD BECOMES 

ENTITLED ON MY RECORD, I AGREE TO NOTIFY SSA IF THE STEPCHILD'S PARENT AND I 

SUBSEQUENTLY DIVORCE. 

MY REPORTING RESPONSIBILITIES HAVE BEEN EXPLAINED TO ME. 

REMARKS: 

I HAVE REVIEWED MY EARNINGS STATEMENTS AND THEY ARE CORRECT AS POSTED. 

THE EARNINGS LIMITS HAVE BEEN EXPLAIN TO ME AND I UNDESRTAND IT. ALL 

MY QUESTIONS REGUARDING THIS LIMITS HAVE BEEN ANSWERD. i DO NOT EXPECT 

TO EARN OVER MY LIMIT. I WAS NOT ABLE TO WORK DUE TO MEDICAL PROBLEMS 

FROM 1990 TO 1999. 

I KNOW THAT ANYONE WHO MAKES OR CAUSES TO BE MADE A FALSE STATEMENT OR 

REPRESENTATION OF MATERIAL FACT IN AN APPLICATION OR FOR USE IN DETERMINING A 

RIGHT TO PAYMENT UNDER THE SOCIAL SECURITY ACT COMMITS A CRIME PUNISHABLE UNDER 

FEDERAL LAW BY FINE, IMPRISONMENT OR BOTH. I AFFIRM THAT ALL INFORMATION I HAVE 

GIVEN IN CONNECTION WITH THIS CLAIM IS TRUE. 

----......... 

SIGNATURE DATE ______ __ 
562 

FROM : JAMES P METCALF, M. D. FAX NO. 405 528 3644 

• M.D. 

a 

CLAIMANT: 

SSN: 

CASE NO.: 

...... 

121206C 

PHYSICIAN: 

LOCA110N: 

DATE OF EXAM: De~ierU, 3.0

. T 

TYPE OF .EXAM: comprehensive Inlemal Medicine examination 

SOURCE OF HISTORY: TIle patient. 

REVIEW OF RECORDS: VA Hospital. 

Dec. 13 2006 02:13PM P2 

CHIEF COMPLAINT: Chronic bilaleral knee pain, left ankle pain, n9Clc: pain, md low back pain. 

HISTORY OF PRESENT ILlNESS a 62-year-dd, whHe male who has had numerous bilateral knee surgeries. He had surgeries in 1987, 1988, 1989, 1~O, 1991, and 1992. 

In 1992 he·also had a tendon repair of the left ankle. In 1994 he had an autofloblle accident and 

had an anterior cervical diSkeCtomy. 

He also has had an Injury to his lower back. 

At the present lime, the patient has chronic pain in both knees and the left ankle He ambulates with 

crutches. He states that he can ambulate around the house without his crut( hes. 

He has chronic pain in his Jaft anlde with standing and walking. 

He has chronic pairl in hie neek and back. He wears a TENS unit. He has pain in the arms and 

hands and legs and feet and has dec(eaSe sensation in all or his extremities. 

PAST MEDICAL HISTORY: Injury to WliS.\$ and head. appendectomy. 

REVIEW OF SYSTEMS: Decnaased vision, difficulty hearing, syphiUs, pt pllc ulcer disease. 

hepatitis Band C, and chest pain; I filled out a chest pain questionnaire. 

EDUCA nON: Fourteen years. 

SOCIAL HISTORY: Single. no children. He does not smoke and does not d ink alcohol. 

WORK HISTORY: Sales, construction, store manager, bookkeeping, garage \\ orker, telemar1<eter. 

His last job was about two years aQ!l working in retan sales at Burlington Clo hing. 

MEDICATIONS; Hy(lrocodona, ibuprofan, \ramadol, Uthopram, elodolac. 

Permanent Subcommittee on Investigations 

EXHmIT#9u 
563 

FROM : JAMES P METCALF, M. D. 

Dr •• ,12: i' 

Page Two 

ALLERGIES: None. 

PHYSICAL EXAMINATION: 

FAX NO. 405 528 3644 Dec. 13 2006 02 :14PM P3 

GENERAL APPEARANCE: While male who appears to be about 

his stated age. He is IIlert and oriented. He answers all questions approl·rlately. He has no 

cognitive disorder. He is unkept and malodorouS. He has chronic pain bellE vi01ll. 

HEIGHT AND WEIGHT: S', weight 250 pounds. 

BLOOD PRESSURE: 130/84. 

PULSE: 72 and regUlar. 

RESPIRATION: 16 and regular. 

SNELLEN EYE EXAM: Wllhout glasses right eye and left eye 201200. Wl1I1 9 asses right eye and 

left eye 20/20. 

HEENT: The tympanic membranes and otic canals are clear. The pharynx s clear. The pupils 

react to light I could not visuallu !he fundI. The neck has no nodes. The thy oid is not enlarged. 

CHEST: The chest is clear to ausCIJltalion. 

CARDIOVASCULAR SYSTEM: The heart has a regUlar rhythm without mu mur. There are no 

carotid bruilS. Peripheral pulses are normal. Tllere is no pretibial edema. 

ABDOMEN: The abdomen Is obese and nontender. The liver is not enlarge :I. 

SPINE: The cervical spine has extreme loss of range of motion in all planes. f'here is tendemess 

bilaterally. 

The lumbar spine has extreme loss of range of motion in aD ptane&. There is Ie 1demess bilaterally. 

He is wearing a TENS unit 

EXTREMITIESIRANGE OF MOTION: The patient rasbicls range of mQtion in Ills shoulders to the 

point that the exam could not be performed. He exlvblts chronic pain wl1h alb mpl$ to manipulate 

the shoulders. The elbows, wrists, and fingers have nannal rang .... of motion. There is a 3/5 grip 

in each hand which is normal. 

I could not do ranga of motion testing on the hips and knees. The patient cor lplained of extneme 

pain with movement of his legs. He was able to flex his knees about 10 to 20 dE grees. He was able to sit with his legs ovar the edge of the table at 90 degrees. He has numero IS aurgical scars on 

both knees. The ankles have normal ranges of motion. 

NEUROLOGICAl EXAM: Cranial nelVes II through XII are Intact. CerebePar Ind motor funeHons 

are normal. Deep landon reflexes are equal. Thene is stocking decrease se ,sallon of the lower 
564 

FROM :. JAMES P METCRLF, M. D. FRX NO. 405 52B 3644 Dec. 13 2006 02: 14PM P4 

extremities Bnd sleeve/glove decrease sensation of the upper extremities. 

MOTOR STRENGTH/MUSCLE TONE: The patient has adequate muscle stre 19th and tone in the 

upper and lower extremities insofar as it could be tested. 

STATION AND GAlT: The patient could not heel, toe, or tandem walk. He amb Jlatas in the hallway 

al aboul half the nannal pace and uses autches. He can ambUlate wiltloul I ,is crutches. 

CLINICAL IMPRESSION: 

1) SIP multiple bilateral knee 6urgeries. 

2) Chronic bilateral knee pain secondary 10 #1. 

3) SIP surgery on left ankle with chronic tendinitis/arthritis of the left anke. 

4) SIP surgery on cervical spine with chronic neck pain. 

5) ChroniC low back pain. 

6) Hepatitis 9 and C by history. 

7) Chest pain of unknown etiology. 

CliNICAL ASSESSMENT: The Patienl has nonnal speech and hearing. He t as nannal cognitive 

function. He has adequals dexteril5' of his hands and fingers and adequate gr p strength. He has 

extreme loss of range,of motion of his neck and baek. I could not do range of 1,'1Otion testing on his 

shoulders, hips, or knees. He ambulates in the hellway at about half th. normal pace. He 

ambulates with foreann crutches; He can ambulate WiIIIouIthe crutc:Iles. ThE patienl has chronic 

paln behaviors. 

I observed the patient In the parking lot. He drives a smali trad'rtional VolksWaj reno . He was able 10 

get into Ihe Volkswagen without difficulty. This required flexlOg his knees 10 ·11 leasl 90 degrees. 

He fastened his seat bell and turned his head 90 degrees 10 the right to look 01 er his right shoulder 

to back out He had na trouble using hislelt shoulder to slam ~r door. 

':.M.D. 

df 
565 

Social Security Administration 

NAME OF CLAIMti 

EXPlANATION OF DETERMINATION 

W/E's NAME (IF COB or 

DWB) 

SSN 

SSA-4268 

CLAIM TYPE 

DIB 

hepatitis C & mental problems. He has the residual functional capacity to 

& to stand/sitlwalk 6 hrs in an 8 hr workday. One of his past 

he lifted 50 Ibsoccasionally. He cannot do the job as he 

describes it. In the is Sales Attendant, 299.577-D1 0, which carries a light strength rating. He has 

the residual functional capacity to do this job as it exists in the national economy. 

CFS/cfs 

Permanent Subcommittee on Investigations 

EXHIBIT#9v 
566 

SOCIAL SECURITY NOTICE 

~OTICE OF RECONSIDERATION 

°rom: Social Security Administration 

" " " "" 

Date: DeCember 21,2007 

Claim Number: ••••• 

Claim for: DIS 

Upon receipt of your request for reconsideration we had your claim independently reviewed by 

a physiCian and disability examiner in the stale agency which works with us in making disability 

determinations. The evidence in your case has been thoroughly evaluated; this includes the 

medical evidence and the adqitional information received since the original decision. We find 

that the previous determination denying your claim was proper under the law. Attached to this 

notice is an explanation of the decision we made on your claim and how we arrived at it. The 

reverse of this notice identifies the legal requirements for your type of claim. 

ABOUT THE"DECISION 

Doctors and other trained staff looked at your case and made this decision. They work for" 

your State but used our rules. . 

Please remember that there are many types of disability programs, both government and 

private, which use different rules. A person may be receiving benefits under another " 

program and still not be entitled under our rules. This may be true in your case. 

In addition to the reports we told you about in our first letter, the following reports were 

used to decide your claim. 

S evidence received 09/2412007 

MD evidence received 11/2612007 

DO (OKe) evidence received 12/06/2007 

INFORMATION SUtlMITTED BY YOU IN FILE evidence received 121312007 

We have determined that your condition was not disabling on any date through 

03/31/05, when you were last insured for disability benefits. In deciding this, we 

studied your records; including the medical evidence and your statements, and" 

£ ill Permanent Subcommittee on Investigations 

EXHmIT#10a 
567 

considered your age, education, training and work experience in determining how 

your condition affected your ability to work. 

You said that you were unable·to work because of acquired immune deficiency syndrome, 

joint pain with neuropathy, a'sthma, allergies and anxiety. 

The medical evidence shows the following: Although you sometimes had problems with 

asthma and allergies, you were able to breathe adequately most of the time. While your 

joint pain and neuropathy caused discomfort, you could still move around and walk well 

enough to do some types of work. Your anxiety kept you from doing stressful and complex 

work, but you could do simple, routine work. Although you had tested positive for HIV, the 

medical evidence does not show you had any disabling effects. Medical evidence does 

not show any other impairments which kept you from working on or before the date you 

were last insured for disability benefits. 

We realize that your condition kept you from doing any of your past work, but it did not 

keep you from doing other work which was less demanding. Based on your age, 

education and past work experience, you could have done other work prior to the date you 

were last insured for disability benefits. ' 

IF YOU OISAGREE WITH THE DETERMINATION 

.If you believe that the reconsideration determination is not correct, you can request a 

hearing before an administrative law judge of the Office of Hearings and Appeals. If 

you want a hearing, you must request it no later than 60 days from the date you 

receive this notice. You may make your request through any Social Security,office. 

As part of the appeal process, you also need to tell us about your current medical 

condition. We provide a form for doing that, the Disability Report - Appeal. You may 

contact one of our offices or caU1-800-772-1213 to request this form. Or, you may 

complete the report online at http://www.socialsecurity.gov/disability/hearing. Read 

the enclosed leaflet for a full explanation of your right to appeal. Read the enclosed 

leaflet for a full explanation cif your right to appeal. 

IF YOU WANT HELP WITH YOUR APPEAL 

You can have a friend,lawyer or someone else help you. There are groups that can 

help you find a lawyer or give you free legal services if you qualify. There are also ' 

lawyers who do not charge unless you win your appeal. Your local Social Security 

Office has a list of groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hire someone, we 

must approve the fee before he or she can collect it. And if you hire a lawyer, we will 

withhold up to 25 percent of any past due benefits to pay toward the fee. 

NEW APPLICATION 

You have the right to file a new application at any time, but filing a new application is 

not the same as appe'aling this decision. You might lose benefits if you file a new 

application instead of filing an appeal. Therefore, if you think this decision is wrong, 

-----_ .. 
568 

you should ask for an appeal within 60 days. 

This decision refers only to your claim for benefits under the Social Security Disability 

Insurance Program. If you 'applied for other benefits, you will receive a separate 

notice when a decision is made on that claim(s). 

If you have questions about your claim, you should get in touch with any Social 

Security office. Most questions can be handled by telephone or mail. If you visit an 

office, however, please be sure you have this notice with you. 

In addition, you are not entitled to any other benefits based on this application. If you 

have applied for other benefits, you will receive a separate notice when a decision is 

made on that claim. . 

This decision refers only to your claim for benefrts under the Social Security Disability 

Insurance Program. If you have not already received a decision about your payments 

under the Supplemental Security Income Program, you will receive a separate notice 

shortly. 

Summarizea below are legal requirements for the various types ot disability claims: 

DISABILITY· INSURANCE CLAIM 

To be considered disabled, a person must be unable to do 'any substantial gainful wor!< due to a medical condition 

which has lasted or is expected to last for at least 12 months in a raw. The condition must be severe enough to 

keep a person fromwor!<ing not only in his or her usual job, but in any other substantial gainful work. We look at 

the person's age, education, training and work experience when we decide whether he or she can wor!<. 

DISABLED WIDOW (WIDOWER) CLAIM 

A widow, widoWer, or surviving divorced wite (age 50-60) must meet the disability requirement of the law within a 

specified 7-year period. Aperson may be considered disabled only it he or she has a physical or mental 

impaimnent that is so severe as to ordinarily prevent a person from worRing. The disability must have lasted or be 

expected to last for a continuous period or at least 12 months. 

CHILDHOOD DISABILITY BENEFITS 

Childhood disability benefits may be paid to a person age 1'8 or older if the person has a disability which began 

before age 22 or within 84 months of the end of an earlier period of childhood disability. The condttion, whether 

physical or mental, must be severe enough to keep a person from doing any substantial gainful work. We look at 

the Person's age, education and previous training when we decide whether he or she can work. In add~ion, the 

cond~ion must have lasted or be expected to last for at least 12 months in a row. 

DUdl 

Enclosure: 

SSA Pub. No. 70-10281 

~~~ sy-tOmB nw-r T 

Ramona Schuenemeyer 

Regional Commissioner 

DO 783 
569 

(The following is a transcript in the hearing held before 

Peter M. Keltch, Administrative Law Judge, Office of DisabilityAdjudication and Review, Social Security 

2009, at Oklahoma City, -in 

Jr., Social Security 

\?erson and was 

Medical Expert, 

(The hearing commenced at 11:15 a.m., on April 29, 2009.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: This is the case of ••••••••••••• Are you .S-_r 

CLMT: Yes, sir. 

ALJ: • ny name is Peter Keltch and 1'm a United States 

Administrative Law Judge. I'm here today to hear your case. You have 

filed two claims technically. I find some people don't even realize 

they have filed two claims. One of your claims is for Disability 

Insurance because when you work you paid in FICA or some form of tax 

and some of that money went into the Disability Insurance Trust Fund. 

And so you have paid for certain coverage of Disability Insurance. 

Unfortunately, the difference in your case for the most is, if I'm 

reading the outside of the folder correctly, you haven't paid in for 

quite a while, let's see, -look here, miscellaneous on disability, I'm 

showing here the date of last insured of March 31st of 2005. So, 

you're not currently insured from Disability. There's a, let me see, 

there's a requirement that you pay in a certain number of quarters and 

that when you become -- when you get down to the point that out of the 

last 20 quarters you had more non-paid quarters than paid quarters and 

your insurance expires. So, you apparently stopped paying in the 

first quarter in 2000. -I don't have any record of any payments in and 

Permanent Subcommittee on Investi ations 

EXHmIT#10b 
570 

2 

then that means that your insurance expired March 31st of 2005, which 

is fine if you are disabled as of the date you said, which was April ,,' 

15, 2003. So, if you're actually disabled in '0'3, then you still had 

coverage. However, if I ever find that you were not disabled until 

2006, '07, '08, '09, sometime later, then you wouldn't have any 

insurance coverage. So, that's a technical question on the coverage. 

SSI is the second claim. That's Supplemental Security Income. '" That' 

~s available for people who don't even have any insurance, or if they 

do have insurance it's not enough to bring them up to the minimal 

level, and Congr~ss has established a minimal level of income, which 

should be received by the agent and the disabled. And so, people are 

short of that and have low resources then they may get a Supplemental 

Security Income. It may be 100 percent of that amount. It may be 

something less than 100 percent of that amount to get up to that 

amount. Just like I'm say Supplemental. And if you're not covered by 

insurance and I find that you're disabled,after the'insurance ran out, 

you get 100 percent of the Supplemental Security Income up to that 

same level. So, these are tec'hnical coverage questions, but having 

gone through all that to explain to you that there are two questions, 

two claims with different things involved, one thing they have in 

common is the definition for Disability. You have to be disabled 

under our Rules before you can be considered disabled, either under 

the insurance program or the SSI program. And that apparently is the 

question. You applied and they looked at everything and said no, 

you're not disabled and turned down your claim. Then you don't agree 

with that and therefore you have requested a hearing and that this 
571 

3 

stage I will start over. I will look at all the records they looked 

at. I'll look at all the records, which may have been added to the 

file since then. In fact, sometimes I get records after the hearing 

and I look at those. I listen to the testimony. I didn't have any 

testimony. This is the first time you've been able to tell your story 

personally to someone who actually has the authority to decide your 

case. 

CLMT: Yes, sir. 

ALJ: And I'm an' independently motivated Administrative ,Law 

Judge. I don't have a quota. I don't have any, you know,like every 

now and then they talk about traffic tickets, you know, cops 

supposedly have a quota, the issue so many tickets and so on. I don't 

have anything like that. 

CLMT: Yes, sir. 

ALJ: 'I just decide these cases one, by one the way I think they 

ought to be decided. 

CLMT: Yes, sir. 

ALJ:, Okay. I haven't decided your testimony. I have an expert 

witness at the table with you. He"s a vocational expert. He's an 

expert on jobs. So, he can tell me what it took to do your 'past work. 

He can tell me if you have skills from that work and so forth. And 

then I'm going to have a medical expert on the telephone, Dr. 

'honetic) whose an internal medicine doctor in Oklahoma 

City and he has examined the medical records we were able to send to 

him and he's going to tell me what he found with them. So, it's a 

whole new mix of evidence. So, as you can see I just start over. 
572 

4 

CLMT: Yes, sir. 

ALJ: I just start over and look at the whole picture. Now, the 

first question is the admissibility of the proposed Exhibits. We 

have an Exhibit file in electronic form and the proposed Exhibits are 

up to 4A, lSB, 4D, 14E and lSF and then today there is some more 

medical from the in New Castle, which has been 

brought in and my doctor won't have seen this. I don't know whether 

it will affect his testimony if he were to see or not see it. There's 

nothing about it, I'll tell him about it if I see anything in here 

that means something to me and we'll just have to see how that goes. 

Also, I have an appointment for a different representative. Let's 

see, the medical will go into the F's, so that will be 16F but we have 

a new representative and it appears that ............ is in the same 

office as the one that we already had on the file, which is Mr. 

Higgins. 

CLMT: Yes, sir. 

ALJ: And that's an interesting thing., I've never seen that. 

Waiver of the Fee you signed that and that I waive my right to charge 

and that you emphasize that Mr. 1 

there is an attorney fee. 

is to remain beneficiary if 

ATTY: Yes, sir. We haven't had any trouble with it yet. There 

may be different way to do it though. 

ALJ: I just never had seen it. I don't know. A lot of times 

we'll just have a deal where they -- we get a whole new 1696 and a 

whole new P Agreement and the other one says well technically he 

withdraws. Actually, up here -- oh I see, I'm appointing and it says 
573 

5 

the name of the principle representative. My main representative -- I 

think this works. is my main representative. I 

think that works. Is he an associate or a partner in the same firm? 

ATTY: Just in the same firm. I do ~ost of his hearing now, 

actually. 

ALJ: Okay. Where is Ingram, Texas? 

ATTY: It's right next to Fort Worth, Texas, a little bit West. 

ALJ: A little' West? 

ATTY: ,Yes. 

ALJ: Okay. I've been to Fort Worth many times and we also cover 

Wichita Falls. 

ATTY: Oh really. 

ALJ: out of this office, but Ingram didn't ring a bell with me. 

ATTY: It's -- I mean its just West. 

ALJ: You probably go into Fort Worth then for any hearings? 

ATTY: Yes, sir. 

ALJ: Well, if you ever get any in the area served by Wichita 

Falls, then you'll end up seeing one of us. We're trying to get a 

permanent site down there now so that we can use our video equipment 

for remote teleconferencing in Wichita Falls, but we don't have-it 

yet. So, we get to drive down to Wichita Falls and go to the Federal 

Building and we have a really rotten room on the 4th floor next to the 

alley somewhere, but we go down there in person to hear things in 

Wichita Falls so I, you know, I've heard of Verna and then I've heard 

of Childress and I've heard of --

ATTY: Sure. 
574 

6 

ALJ: -- what's the town directly south? It's kind of on the 

South edge, there's a town of some size there and we have people from, 

that's that, you know, it's provided that by what the Social Security 

District Office covers. So, that area of the District Office gets 

attached to a hearing office. Well, anyway I digress. Let me call 

the doctor. Well; no, first of all we were ,admitting all these and 

then you have a brief and' technically that will be a part of Exhibit, 

or be part. So, we have all those things to add to the file and you 

don't have any objection, I guess to any of the proposed Exhibits? 

ATTY: No, sir. I did have one question for you. 

ALJ: Yes. 

ATTY, I'm just curious as to which Exhibit Family Medicine 

is? They weren't really labeled on my CD . 

ALJ: • Family Medicine. Okay. I have a Family 

Practice, 14F, which covered October 24, 2008 to February 17, 2009. 

ATTY: That's the one. Thank you. 

ALJ: 14F. And then we have a: lSF, which is t ••••••• 

M.D., one page 4/22/2009. 

ATTY: Yes, sir. 

ALJ: I suppose that could be a letter. 

ATTY: It sure is. 

ALJ: I think,it's an abdominal study. It's like 

Family Practice. All right. We'll admit everything then. 

(Exhibits, previously identified, were received into evidence and 

made a part of the record thereof) . 

ALJ: Let me get the doctor on the phone so I can swear everybody 

in. You remember on Animal Farm all animals were equal except pigs 
575 

7 

were more equal. All of us are equal except doctors. They're more 

equal. 

ME: Hello? 

ALJ: m this is Judge Keltch. 

ME: Okay. 

ALJ: We're calling on the case of •••••••••• ., 

ME: Okay. 

ALJ: And I'm getting ready to swear in the witnesses. Do you 

have any objection to taking an oath? Is the other gentleman going to 

testify? 

ATTY: No, sir. 

ALJ: All right. If all of you will take the oath of the witness 

at the same time? 

(The Claimant, •••••••••••• ' having been first duly sworn, testified as follows:) 

EXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q Let me ask you some routine things ,.,.. -.. Now your 

address is now, is it still ................ .. 

A Yes, sir. 

Q Is the phone number still & 

A Yes, sir. 

Q This says you were born , no strike that, 

.. 

A Yes, sir. 

Q And I guess that hasn't changed? 

A No. 

Q And so you're now 337 
576 

8 

A Yes, sir. 

Q You had a high school education and then it says also another 

year of college? 

A Yes, sir. 

Q Where was that? 

A I went to _and then 

Q And then you went to III ••••••• , Did you complete that? 

A Yes, sir. 

Q Did you become a 

A Yes, sir. 

Q Do you have a license? 

A Yes l sir. 

Q All right. And so you have that specialized training? I 

assume that the coll~ge was general subjects? 

A Yes. 

Q You didn't complete a degree --

A No, sir. 

Q -- or certificate there? 

A NOt sir. 

Q All right. Is that what you've been doing most of your work 

career being a 

A Until I got ill,' yes. 

Q Do you still do -- did you d and so on? 

A No. 

Q No? Okay. Now, let's see. You live in an apartment? How 

many are in the household? 
577 

9 

A Two. 

Q And they are who? 

A Myself and my friend_ 

Q _ who is with you today? 

A Yes, sir. He's who takes care of me. 

Q Do you have income now from any source? 

A No. 

Q How are you living? 

A He supports me. He buys my medications. 

Q If you get your benefits do you and he have an agreement that 

you're going to pay him back some money? 

A Yes, sir. 

Q I'll tell you a little secret about that. If you go in, if 

you're approved and they say now where've you been living and if you 

say I've been having a free apartment, they say oh well we'll deduct a 

third off of your benefits because you didn't have any rent to pay. 

But if you go in and say I've been living with a friend and I'm going 

to pay him back, then they give you the full check. I mean it's 

between you and him to pay him back if he's been paying the rent and 

bills. 

A Yes, sir. 

Q Just a little trick to remember. 

A Yes, sir. 

Q If you 99 in there and say well I've just been provided a 

place to stay and they say oh well for Supplemental Security Benefits 

then you don't get it, or the check. 
578 

10 

A Yes, sir. 

Q You knew that didn't yOU? 

ATTY: Yes, sir. 

Q So, I'm assuming you have an agreement probably do that? 

A Yes, sir. 

Q All right. We have findings ,alleged and found by the State 

Agency, symptomatic HIV infection. Also, they noted an anxiety 

related disorder. I reviewed the folder and from what I saw I felt 

that it would be helpful to have a medical expert look over this 

record and let me know what was going on. But ,first, let me ask you 

~e.".' •••• Ilt, do you know how many Exhibits you received, because I 

think there's some here you may not have received? 

ME: I have generally, let me look, I've got through -- well, 

I've gotten everything permanently, I think through 13F. 

ALJ: 13F? 

ME: I believe that's right. I'm looking. 

ALJ: Well, 14F --

ME: I've got 14F, yes. 

ALJ: -- 14F is the records from October 

24th 'OB to 'February 17th '09 and that's a doctor here in Oklahoma 

City, ,. ipsr • and he says 'he's treating the peripheral 

neuropathy. I think he's a family practice doctor, is that right? 

CLMT: No, he is a pain management doctor. 

ALJ: He's a pain management doctor, okay. Well, the record says 

. Family Practice, so that's why I said Family Medicine. And there's 14 

pages there of his office notes: I'm screening through it to see if I 
579 

11 

see any test results or anything. He says chronic pain syndrome and 

neuropathy. It said he was getting some improvement from treatment. 

That was back in January of this year on the pain, but apparently is 

still constant and difficult to describe, shooting, stabbing, burning 

and needles. And he was refilling his medication and he was having 

bad side effects from the medication, dizziness, fatigue, nausea and 

vomiting. Compliance good, takes the medication as directed, follows 

up as corrected, but he was agitated and anhedonia, decreased interest 

in socializing affect and a tendency towards indeciveness and 

depressed mood. The last item would be, nope it's not in the other 

one. sometimes I go from oldest to newest and then sometimes from 

newest to "oldest. Let me see, the last thing would be February 17th 

of this year, peripheral neuropathy, and then we have a letter from 

the doctor, which is 15F, and it says _ Family Practice, 

Drive in Oklahoma City and it's a short letter and it's 

from April 20th, just a little over a week ago. Regarding the above 

patient, he's been a patient of mine for the last six months. He has 

a severe disabling form of, it's says performed neuropathy, I think 

that should be peripheral, but anyway, neuropathy related to HIV. I 

understand that he has applied for Disability and agree that he is an 

acceptable candidate and is not capable of working at this time. So, 

that's a conclus{on that this treating doctor has shared with us. And 

then I have some 24 pages of records from the Clinic in Newcastle, 

which have just been submitted and I'm not -- you don't have them, so 

we're not going to go' into ,a lot of that at this time. 

(The Medical Expert, 

testified as follows:) , having been first duly sworn, 
580 

12 

EXAMINATION OF MEDICAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q Let me hear from you doctor as to what you did find and what 

you were provided with respect to severe medically determinable 

impairments of lit 

A Okay. 

Q Go right ahead. 

A As a matter fact Judge, I've been looking while you were 

talking through things and I do not have anything beyond.12F. 

Q 12F? 

A Yeah. The index on this thing is not in correct order, so I 

had to go through the whole document, A, B, C, D and E, there wasn't 

an F. 

Q Let me tell you then, 13F is another one page letter. This is 

from the Clinic in Newcastle, it's signed by 

M.D. He says, to whom it may concern, •••••••• has been a patient 

of mine since 2004. He has severe, he has severed, I think that means 

suffered, from severe depression, as well he has the complication of 

HIV disease, which has led to multiple other difficulties. He is on a 

large number of medications, many of which have side effects. He has 

severe peripheral neuropathy from the AIDS disease or the medications. 

He suffers from many abdominal complaints and chronic diarrhea, as 

well as fatigue secondary to the medications as well. It is my 

opinion he cannot maintain gainful employment, nor would he be capable 

of sitting for additional training or education. If I can be of any 

further service, please contact me here at thlr' . I 7 

I quess that's Newcastle, Tuttle and wh~re? 
581 

13 

CLMT: In Moore. 

ALJ: M09re is the third city? 

CLMT: I think. 

ALJ: Mustang, could maybe. I don't know what the Tri Cities 

are, you got me. I know Newcastle and Tuttle are not far apart. So, 

you've got me. It's a catchy thing Tri City. 

BY ADMINISTRATIVE LAW JUDGE: 

Q But anyway, all right doctor with that additional -- that's 

another conclusionary letter from Dr. 

treated me since I was born. 

who's a family doctor who's 

A Okay. Well, in here I'm looking at -- I looked at all the 

things you told me with the diagnosis of AIDS. If you go by the 

manual, basically AIDS is a disease that becomes a cycle when you 

start having complications. Because most of the times in the manual 

have to do with secondary infections, stapholaxoid and all of them 

comes close to what I saw through the number was 12F, is that he has a 

lot of diarrhea and that is one of the things the listings call for 

diarrhea for one month or longer resistant to treatment. The Dr. 

_ (Phonetic) who did his Social Security evaluations said 

basically, it just says that has no authorization for major 

complications and'there's both physical exams from Dr. 

(Phonetic) saying peripheral neuropathy and that is basically current 

because I have not gone through this looking for it. He do~s have Dr. 

has done in during his times, which was done in July of 2004 and 

approximately at that time, he had basically had blood work done in C4 

was 18 and his CD8 was 49 and this is high. Normally, that you have 
582 

14 

acne disease when you go help yourselves which are CD4's are high and 

as the disease progresses you tend to get lower and lower and 18 is 

normal, 49 was the CDS and that's when they reset over 100,000 doctors 

of the virus would share. Would share basically means that they're 

going to just fails are close to more mild. The only other real 

sensation to that here is Dr. ; gave him a prescription on 

8/16/07 for a walker, which, you know, goes' with the severe 

neuropathy. That is not really a physical exam that shows what his -

what that means by severe neuropathy. Though what they haven't talked 

about a walker basically, of course, if you read the manual, that 

severe neuropathy means difficulty getting around and they said he was 

able to walk. As a matter fact, when doctor, of course this was two 

years ago, when Dr. (Phonetic), he says he's able to walk 

around without a walker. So, you know, we really don't know that 

except there's a note in here that Dr. ) had given him a 

prescription for a walker to help with his pain and mobility. And 

he's obviously having pain and I think he's honestly got some active 

disease with an 124 [sic] and not a viscosity S and· not a C4. So, in 

other words I'm not in touch when they're saying the guy is disabled 

because of HIV, which is fluky although he said it. He just doesn't 

have the -- he's had a lot of infections most of them have responded 

to treatment. He said, for example, he said Bell's Palsy, which is 

usually caused by a virus and that clears up this is what is not good. 

NOW, Dr. agai~ and I looked up that times when he had -- he 

describes severe fatigue and diarrhea and fatigue is almost every 

single visit in Dr. ·'s place. On 4/19/0'7, he had diarrhea, 
583 

15 

9/01/06, one 11/10/06, 9/16/05 he had diarrhea and then so basically 

he's had diarrhea multiple times where, and you know diarrhea in the 

colon is a certain amount. And I really think that usually the cell 

count has to do with at least probably disabled. And I think you'd 

have to pay attention to what the two doctors said about his ability 

to perform and I don't think he's able to perform with what he has. 

Not work again bears a close resemblance to what Dr. saying that 

he neither could raise his arms very much and that would impair his 

inability to be a hairdresser. 

Q Well, he comes in today with his walker and when was it 

prescribed by the doctor? When was he given a prescription for it? 

:'\.-

A says 8/16/07 in other·~oi~s. two years ago. 

Q When did you have to start using an assisted device, a walker 

a cane or something to get about? 

CLMT: My medicirie makes me forget exact dates. It was right 

around 2005 when I started getting really bad and falling and that's 

when I started using it. 

ALJ: What did the -- now, he says the doctor prescribed it in 

'07, was that just for insurance or something to pay for it or what? 

You're saying you are using it? 

CLMT: Actually, I was using what -- I was using a cane for a 

little while and then when he prescribed me the walker then I got it 

as soon as he prescribed it. 

ALJ: All right. Do you use it all the time? 

CLMT: All the time. 

ALJ: Even at home? 
584 

16 

CLMT: No. At home I try to use my cane because I don't have a 

lot of room in between doorways and stuff. 

ALJ: To maneuver? 

CLMT: Yeah. 

ALJ: Okay. But why was the '03 date the alleged onset date, is 

that when you really thought you couldn't work anymore? 

CLMT: That's when I started to get -- that's when I started 

vomiting at work, losing my bowels at work. And that's -- I was doing 

a haircut I remember I was doing a haircut and I cut myself an bled on 

someone and it terrified me. 

ALJ: Yes. 

CLMT: That I would infect them. 

ALJ: Because you already knew you were positive at that point? 

CLMT: Yes. 

ALJ: Yes. 

CLMT: And I was afraid that I would infect them. 

ALJ: Do you work in Texa's? I was just curious --

CLMT: I'm sorry. 

ALJ: -- because if we have this fine young lawyer here protects 

us. I thought maybe you'd be down in Texas working or something. 

CLMT: No, sir. Worked online. 

ALJ: Online? And then you've -- so, you've been in· Oklahoma the 

whole time? Where did you work when you were working? 

CLMT: I had my own .a -, ALJ: You had your own business? And where was it located? 

CLMT: Me and my mom opened up '_in Moore. 
585 

17 

ALJ: In Moore. Okay. So, that was a going business? 

CLMT: I was very outgoing. I loved to work, now I can't. I 

want to so bad, but I can't. 

ALT: ' How do you spend your days? 

CLMT: In bed or on the couch. 

ALT: All right. --., you have some questions. 

ATTY: I do, Your Honor. 

EXAMINATION OF CLAIMANT BY ATTORNEY: 

Q Mr . •• iii. when did the frequent nausea and diarrhea start for 

YOU? Was that in 2003? 

A It started then and started getting real bad so I quit 

working. 

Q Okay. And when was that? 

A When I started using my walker. 

Q So, 2005? 

A Yeah. 

Q Okay. Did you ever have issues with not making it to the 

bathroom in time, or going in your pant? How frequently did that 

happen? Was it a weekly occurrence, a monthly occurrence? 

A It happens, probably a couple times a week. 

Q Okay. Was it the same back then as well? 

A Yes. 

Q Okay. Were you having any difficulty or any problems with 

headaches back then? 

A Yes, sir. I've had headaches ever since I was 1I. 

Q Okay. So, when did they become disabling? 
586 

18 

A When I got my walker, that's when I started getting really bad 

and everything started hurting. 

Q Okay. Has your fatigue just as bad back then as it is now or 

has it gotten worse? 

A I can't walk from my bed to my couch without getting weak. 

Q Okay. 

A I mean and that's maybe seven feet and I mean and I get winded 

walking up the stairway just even to get inside the building I had to 

sit down because I was winded. 

Q Okay. Do you have any difficulty bathing or showering? 

A I have to have help. A_ Q Who helps you? 

Q When's the last time you've been able to get a 'bath or a 

shower unassisted? 

A I can't take a bath, I usually take a shower. I have a chair 

that I put in my shower and it helps, 

Q Okay. How long have you had to use that? 

A Pretty much ever since I had the walker. 

Q, Okay. 

A Because I can't -- I lose my balance and I fall. 

Q Okay. Are you having any trouble sleeping? . 

A I have really bad insomnia. I'm on two different kinds of 

sleeping pills. I mean one of them works for my nerves, I think, I 

guess I'm not sure. I take Seroquel and some I have the bottle 

man, I can't --
587 

19 

Q Would you describe -- do you have, other than your leg pain, 

your neuropathic pain, do you have just a general sense of or feeling 

of almost flu like symptoms, just body aches? 

A I have like I have the flue all the time. All the time my 

legs feel like I've been,beaten with a baseball bat. My feet they 

feel like there's needles' just sticking in them and I mean if I don't 

have my walker that the pain gets so intense that I just fall. 

Q' Okay. Are you having any sweating problems? 

A I have severe night sweats where I'm supposed to wear a pain 

patch and I have such severe sweats that the patch just comes right 

off. 

Q Okay. And I'm not going to ask you too many more questions. 

Before you got your walker, what do you feel was your most severe 

symptom that was keeping you from working? 

A The nausea, the vomiting. just feel overall sick. 

Q Okay. And when you did, vomit was that a daily occurrence 

A Yeah. 

Q was it a monthly occurrence? Okay. 

A It was daily. I mean I take like 15 pills -- 15 different 

kinds of pills a day. I mean it's just fighting off hoping that I get 

my anti-nausea medicine in my system before I get out of the restroom 

and it's in my system where I'll puke. 

Q Okay. And when's the last time that you left your house 

unaccompanied by someone else? 

A A few years. 

Q, When you do leave the house you go with somebody,.' correct? 
588 

20 

Who do you go with? 

A I don't drive. 

Q Who do you go with and where do you go? 

A ... takes me to my doctor's appointment and my mom takes me 

to the grocery store. 

Q Okay. How often are you able to get out and go to the grocery 

store with your mom? 

A Once a month. 

Q Okay. Is that kind of to just get out? 

A Yes. She said maybe it would be good for me if I get out. I 

mean they have those carts that you can ride. 

Q Sure. okay. Thank you very much Mr ...... 

ATTY; No further questions, Your Honor. 

ALJ;, Doctor I've still got you on the phone and it's occurred to 

me that we may not need you anymore this morning. That we need to ask 

you. anymore questions today. 

ATTY: I just have one question for him, Your Honor. 

ALJ: The doctor? Okay. 

ATTY: tll •••• 11 is it possible to have severe AIDS or HIV 

related symptoms and have 'an extremely a relatively CD4 count. 

ME: I think you could have anxiety, yes. Because as I don't 

think CD4 has to do with your ment-al- stat-e .'- I think he's had real 

anxiety. Now, I have a question for him. Has he has been -- ever 

been on anti retroviral therapy? 

CLMT: Retro -- what's that? 

ME: I don't find it in his chart by the way. 
589 

ALJ: Did the doctor fail? 

ATTY: Yes. 

21 

ME: The real H-A-A-R-P is real good -- be good medicine for him. 

CLMT: Yes. 

ALJ: You were on that? 

CLMT: I do take it now. 

ME: I can't -- I haven't found it in the records. 

ALJ: Well, he says he takes it now. Who's prescribing that? 

CLMT: 

ALJ: Dr. 

taking that. 

he says is prescribing that for him and he's 

ME: Well, I didn't find it in his notes and I looked 

specifically for it, but his notes are a ·lot of them are handwritten 

and he sometimes change route and works there. 

CLMT: Atripla is what I take. 

ALJ: What? 

CLMT: Atripla. 

ALJ: Well, he's in fact looking at his pill bottles, or pill 

bottle to see what the e~act stuff is. So" I kind of missed that 

myself. What do you have there Mr. 

CLMT: A-T-R-I-P-L-A. 

ALJ: A, A what? 

CLMT: Oh, I'm sorry. A-T-R-I-P-L-A. 

ALJ: A-T-R-I-P-L-A, Atripla. 

ME: Yeah, that so much I know. 

ALJ: Yeah. 
590 

22 

ME: Taking -- that's to try to counteract certain virus accounts 

that he has see. 

ALJ: Yes. 

ME: But those new blood runnings tell me I couldn't find in his 

chart because he had been starting them then and that's pretty common 

when you have a -- higher count if, than you actually had if he's 

being on it and obviously you'll find it. 

ALJ: Okay. 

ME: But hearing that still goes with what I said. I think he 

has acute days-and I think he's basically a problem because his CDS 

count is higher than the CD4. 

ALJ: All right. Anything else-from the doctor before I let him 

go? 

ATTY: No, Your Honor. 

ALJ: I guess these are the three cases you had today doctor, 

right? 

ME: 

ALJ: 

ME: 

ALJ: 

ME: 

That's correct. 

Well, okay then we won't talk to you for a while. 

I'll talk to you tomorrow. 

Thank you. 

okay. 

ALJ: Okay. The doctor's testimony has been favorable to the 

claimant. 

REEXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q Can you handle your own money? 

A He handles everything for me he takes care of me. 
591 

23 

Q So, you may need help. That's something you need to go over 

with the PO then. I didn't know if your friend would help you handle, 

your mother, who, but somebody may need to help you if you're so sick 

you can't hardly manage those things. 

A Yeah. He takes care of everything for me. 

Q What about --

A If it wasn't for him 

Q is this apartment on the ground floor? Otherwise, you'd 

have a heck of a time. 

A I wouldn't be able to get upstairs. 

Q How'd you get in the building today? 

A It was so hard. 

Q Which ramp did you come up or sidewalk? 

A We drove around a couple times, I couldn't find an entrance, 

so I there was a ramp and I just started walking up that and I had 

to stop twice walking up the r~mp and I don't have a -- and a man came 

outside with an umbrella and just helped me walk in side. 

Q We warned them 'before we moved to this building, this was not 

a handicapped friendly building. That cited one of' at least the 

Rehabilitation Act that applies to Federal buildings. A long ramp has 

actually got six ramps and litt'le platforms or flat spaces in the 

kingdom. So, that's their trick, you understand what I'm --

A Yeah. You've to be able to stop. 

Q It's only 187 feet from the sidewalk level to the front door, 

but it's actually six ramps and each ramp is short enough to meet the 

Rehabilitation Act. 
592 

24 

ATTY: And they've got that that huge one the size of a football 

field coming up the front. 

ALJ: Yeah. And on the west -- on the east end they've got more 

steps and they had so many people falling on the steps and they took 

those out and put in another ramp and it's only got a couple of ramps, 

but again because it's got two ramps and step and a landing and the 

planning that they set out that gets by. Write your congressman. 

Write your senator. 

CLMT: Yes, sir. 

ALJ: I hope you never have to come up here again to think about· 

the other people that are following you. I just help people, put that 

on the record, because it's disgusting. I was a union rep and we 

negotiated over details and I said, this is not going to· be good and 

they said well its not affecting the employees. In other words, why 

do you care about it, you're representing the employees, the judges, 

doesn't affect what you do. I said well as a matter of fact it does 

affect me with my bad heart number one. Number two, are you telling 

me I shouldn't be concerned about our claimant's that are coming to 

these hearings on crutches, walkers, wheelchairs. Now, what kind of 

people do you think we are.· Do you know who we deal with? Oh, I got 

upset about that. 

ATTY: What was their response? Obviously, they didn't listen. 

ALJ: No. No. I'm still not happy about it. Well, anything 

else I need to ask. Can you get out to any socializing events with 

people, like. go to a church service --

CLMT: I get too sick. I get too scared that I'm going to lose 
593 

25 

my bowels. 

ALJ: -- family dinner or anything like that? 

CLMT: My parents live in Moore and they come to my house every 

once in a great while, but I mean I don't get out. 

ALJ: I just kind of realized is this address is that Purcell? 

That's in Purcell. Okay. I want to see if that's a neat area. 

CLMT: It's beautiful over there. 

ALJ: I have so much stuff I'd have. to have a big house. I think 

because I have so much stuff, because you sometimes get wedded to your 

stuff. Okay. I think we've covered everything today. Anything els·e 

counselor? 

ATTY: No, sir. 

·ALJ: All right then we'll close the hearing. 

(The hearing closed at 11:54 p.m., on April 29, 2009.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcription of the testimony recorded at the hearing 

held in the case of· t , before Administrative Law 

Judge Peter M. Keltch. 
594 

88/2512888 13:8'.1 TRICIlV FlIMILY CLINI 

Aupst II, 2001 

To Wbom II May Can!:era: 

~ 

iqboalaplliealof'!IIiIIO"'lD04. He ... lCftRdiom_ . "'....u. be bu .. COAIpI/cIdoa ofmv ~ wbldl bu 1_10 multiple ..... ~. 

He it QII • ",lIIIIIIlItr <:I mecficItimw. ....,. of wbicIt line Iide eIIecI& )fa baa __ 

periPbiril ~ 80m De AIDS diJeaao Of_~. He IIIfin IitJm IIIBD)' 

abcIoraiIW compIlIiaIi ud c:Dunic ....... ...n. 6Iip -.cat.ytalbc 

meditaIioIII a welL 

It ia my apiIIiaa ... _!IIIimIitI piaIid ~ _ would lie be capable of 

oitti!III for addIIiomIlrIiaisII or cducIIlon. 

ffl-. bDof'SIIJ Puthtl'M¥ice, pIeae CIlIIIaI:* me bin 11_ 

MD. 

Permanent Subcommittee on Investigations 

EXHIBIT #10c 
595 
596 

Electronically signed by provider on 1012512008 11:10:02 PM 

Printed on 031041200S at 12:11 pm. 

SUBJECTIVE: 

.cCl.. 

He is 8 new patient. 

Problam to ba addressed: Peripheral neuropathy: 

This is the first visit to thia office fo, thle p,oblem. The symptome started mote than 5 years ago. The symptoms. 

however, started worsening 3 years ago. The affected body Qr8a is the trunk and extrematiea diffusely, He . 

characterizes the symptoms as moderate to severe in intenstty. CO"atBnt~ aching. aharp, and numbness and 

tingling. He ratsl his pain overall at a 9 with 1 being mild and 10 baing 8evBre~the worst pain the patient has aver 

Eucperiencad. Aggravating factors include movement in general. Prior work-up has included tile following! a CT 

scan. an MRJ, and an X-ray. There have been no previous episodes. His current primary physician ts Dr. 1 . 

. Hls previous physician W89 Dr. t n. The patient 'S refered by Dr. ' "" 

I\QS.:... 

CONSTITUTIONAL: Positive for tatigue. feve,. night sweata and unintentional waight gain. Negative for chills or 

unintentional weight loss. 

EYES: Positive for use of glalNS or contma. Negative for blurred vision. 

E/N{T; Positive for nassl congastion,and frequent rhinonhse. NegativB for ear pain, diminished hearing, 

hoarseness, sore throat or tooth pain. 

CARDIOVASCULAR: Positive fo, diuina... Nagetiva for chest pain, palpitations or tachycardia. 

RESPIRATORY: Positive fo, chronic cough. dyspnea and fraquent w ..... zing. Negative for hemoptysis. 

GASTROINTESTINAL: Positive for abdominal pain. acid ,.fI". symptoms,ano,..le. abdomlnel bloat!ng. diarrh.a 

and heartburn. Negative for constipetton. hemorrhoids or melena. 

GENITOURINARY: Nagative tor unprotected inta,course and impotence. 

MUSCULOSKELETAL: Positive for arthralgi ••• bsck pein, joint atlffne •• and myelgilis. 

IN.TEGUMENTARY: Positive for ,.sh. Negative for acne. atypical mole!s), extremely dry skin, jaundice, proritls or 

wort!.). 

NEUROLOGICAL: Positive fo, dluines. and heedaches. Negative for fainting. 

HEMATOLOGICILYMPHATIC: Positive for easy bruising. Negative for excessive bleeding. history of blood 

transfusion or lymphadenopathy, 

ENDOCRINE: Positi~e for temps,atu,a intolerance. end polydipSia. Negative for hair loss or polyphagia. 

ALLERGICIlMMUNOLOGIC: Positive fo, .8asonelallargie. and rl8k tacton! fo, HIV. Negative for perennial 

nllergies or rreQuent URI·type illnesses. 

PSYCHiATRIC: Positive for anxiety, depre8sion. feeilngs of. stress. difficulty concentrating and sleep disturbance, 

Negative for suicidal thought,S. 

P~HJstorvISQci~ 

fnt Medical Hi9tor~ 

Aid.1 HIV 

Hyperlipidemia 

Perlphe,al Neuropathy 

Shingles 

Page 5 of 31 
597 

CURRENT MEDICAL PROVIDERS: 

"'Imary care provide. 

Interventional Pain M ment: Dr. 

Syrgical HistoryHamorrhoid S. 

Family History: 

Flfther: Conge8tive Heerl FaIlure; CAD; Myocardial Infarction 

Moth.r: Carotid Artery Stono.is; Congestive Helrt Failure; Myocardial Infarction 

Occupation: Unemployed 

Marital Status: Married (by common law) 

Children: None 

hbaccolAlcohollSuDplemelllL. 

Tobacco: Cig.reltes; Currently smok •• 112 pack per day. 

AlltuuifII.;.. 

Compazine: 

fmitfex.; 

Promethazine HCI: 

.cu.rmnt Medications; 

Alripla 600mgI200mgI300mg Tablat Taka 1 tablot's) by mouth dally 

lipitar SOmg Tablet Take 1 labletls) by mo·uth daily 

Tricor 145mg Tablet Take 1. tableUs) by mouth daily 

Acyclovir 400mg Tablet Take 1 tablat!s) by mouth qid for 6 days 

Albuterol 90mcg/l actuation Oral Inhalar 2 puffs pro 

Norco 1 Omgl325mg Tablet 1 tableUs) by mouth 5. a day 

Promethazine HCI 50mg Tablet Take 1 tablet(s) by mouth q 4 to 6 hr 

Trazodone HCI 

Xanax 2mg Tablet 

OBJECTIVE: 

V.itm; 

euuelll;.10/24/200B 9:25:26 AM 

Wt: 231 lb. 

BP: 120176 mm Hg; P: 67 bpm; R: 16 bpm 

GENERAL: wall developed; weI! nourished; well groomed; no apparent diotress . 

EYES: lids and conjunctiva afe norm"'; PERRL; 

E/NfT: ·normal nose; normal ex-ternal auditory canals and tvmpanic membranes; Oropharynx! normal mucosa, 

palate, and postarior pharvnx; . 

NECK: Neck is supple with full range of motion; No Iymphademopathv; thyroid is normal to palpation; 

RESPIRATORY: normal reBpiratory rate and paltern with no dlatre •• : rlionchi heard throughout: diffuse expiratory 

wheezes 

CARDIOVASCULAR: normal rale: regular rhythm; normal Sl and S2 heartsounds with no S3 or S4 

GASTflOINTESTINAL: normal bowel sounds; no masse. or tendamess: no organomBgaly; 

MUSCULOSKELETAL: Le!JS show dlmlnishad sens.tlon hips down. hyperalgaa'. pr.eont .... w.n. Trace edema 

bilaterally. Ha usas a walker. He can burBly gat up on the .um.tabl •• Diminshad 8.nolftlon from knees down 

SKIN: no ulceration •• lesions or rashes; no peripheral e.tramity adema; 

Page 6of31 
598 

PSYCH: mental status: alert and oriented x 3; appropriate affect and demeanor; recent and remote memory are 

intact; good insiglit ar:"d judgement; ) 

ASSESSMENT: 

957.1 

729.5 

272.2 

307.42 

Neuropathic pain 

Leg pain 

Mixed hyperlipidemia 

Chronic insomnia 

ORDERS: 

I!IItiIi..fww.w!:_ 

Refill of: Norco 10mgl325mg Tablet Take 1-2 tabletCs) by mouth Q6h prn pain #180 (One Hundred and Eighty) 

tablet{s) Refills: 0 

Chantix 1mg Tablet Starter pack 0.5mg bid x 10 days then lmg bid #1 (One) packet(s' Refills: 0 

PLAN: 

Neuropathic pain 

RECOMMENDATIONS: 

Will contlnu~ current opiate management and (ncro ••• LoFteb to up to 6 daily until we .ee what lowering ;,tatins 

does to myopathy 

Pain management recommendirtions: 

Continue the following medications at the dosage on tho medication list: Ly,lca. 

Leg pain 

MEDICA nONS; See prescription. ordered today on madication list 

Refill 01 medication lor this problem which b pre •• nt in the medication list was given today. 

FOLLOW UP:' Sc.hedule a fonow-up eppointmsnt In 3 weeks. 

Mixed hyperiipidemla 

RECOMMENDATIONS: 

I told him to go ahead and cut Llpltol end tricor. Di$CUI8 with _ further about diocontinuing ot changing to 

Vytorln. Would lika to 8ee whet ba8eline pain is off statins 

Chronic insomnia 

RECOMMENDATIONS: 

Seroquel samples given for anxiety and sleep. TItrate as necessary 

Triel of Chanti!lt for smoking cessation. 

~iJl1iQ[ls:.. 

Refill of: Norco 10mgl325mg Tablet Take 1-2 tablet(s) by mouth q6h pm pain #180 (Ono Hundred and Eighty) 

l_bleHs) Refills: 0 

Chantix 1mg Tablet Starter pack 0.5mg bid. 10 days then 1mg bid #1 (One) packet(s, Refin.: 0 

Page 70f31 
599 

Office/Outpatient Visit 

Visit Date: Thu. Nov 13. 200809:57 am 

Providor: • MD (Supervisor: 

location: --,,=amilv Medicine 

. ~ MD; Assistant: 

Electronically signed by provider on 11/13/200808:42:53 PM 

Printed on 03104/2009 at 12:11 pm. 

SUBJECTIVE: 

~~ 

He is an establl.hed patient. Ho is,hora to fol!ow up on the fonowing: foot pain and log pain. 

I:IfJ:.. 

1013 

Hi. symptoms a,e about the same. He feels as though the symptoms ar. not controUad .t this point. H. 

chsracto,i2o. the foot pain a. moderate In intonaity. He rat •• his pain overall at a 8 with 1 baing mild and 10 

being severe. the wo",t pain tha potient h •• ever experlanced. He needs tha follOwing medicetion rafilla: Norco. 

Th. following are medication chenges from the le.t visit: Saroqual fa, .Ieep Bnd changing tricor and stuting to' 

Vytorin. Patient stBt.S tha Saroqusl samples thet ware given to him worked graet. He Is .'eeplng betler. Patient 

does state thet he feel. Ilks he I. coming down with flu lika symptoms. He doe'an't ,eport much chonge aince 

chenging form StatinslTricor to Vytorln, Ha dee. look quita 8 bit batlar. He reports much Improved .Ieep slnca 

taking Seroquel at bedtime. Ha and'his Blgnlficant othar get significant feBlculit. rashe. which is present teday. 

Past MedIcal History I Famllv Hiltory I Socl~ 

euUWIicai History: 

Aid./HIV 

'Hyperlipidemia 

Peripheral Neuropathy 

Shingla. 

CURRENT MEDICAL PROVIDERS: 

Primary car. provider: Dr._ 

Interventione' Pain Manegemer,t: Dr.~ 

HemolThoid Sa: 

Father: Congestive Heart faUure: CAD; Myocardial Infarction , i, Mother: Carotid Artery Stanoo"; Cong""tlvo Hurt Fallur.: Myocardial infarction 

s..o.ci~1 HistoryOccupation: Unamployed 

Marita' St.tus: Married (by common lawl 

Children: None 

IlIIu!l<&lI1AlCQhgllSupDlemvntll: 

Tobacco: Cigarettes; Cumintfy smokes 1/2 pack per day. , 

AJltmin;_ 

Cornpazine: 

frnitrex: 

Page 80f31 
600 

Office/Outpatient Visit 

VI.lt Date: Thu. Nov 13. 2008 09:57 am 

Provider: MO (Supervisor: 

locatlon:"-"emily Medicine 

MD; Assistant: 

Electronically signed by provider on 11113/2008 08:42:53 PM 

Printed on 03/04/2009 at 12: 11 pm. 

C.UWIll~ 

Chantix lmg Tablet Starter pack 0.5mg bid X 10 days than lmg bid 

Atripla 600mg/2,oomg/300mg Tablet Take 1 tablaHs) by mouth daily 

Lyric. 150mg Capsules 1 cap three times daily by mouth for narva pain 

Norco 10mg/325mg Tablet Take 1·2 tablaHs) by mouth q6h pm pain 

!l.cyclovir 400mg Tablet Take 1 tablatto) by mouth qid for 6 days 

Albuterol 90mcg" actuation Orel Inhaler 2 puffs prn 

Promethazine HCI 50mg Tablet Take 1 tabletlsl by mouth q 4 to 6 hr 

Trazodone HCI 

Xanax 2mg Tablet 

Atropine Sultate OAmg Tablet 

Saroquel 100mg T ablat 1 tab at badtime 

Suboxone 2mg/0,5mg Tablets. Sublingual 1 tab daily under the tongue for pain too b. started 

OBJECTIVE: 

,Y.i111la;, 

C.1ille0!;.11113/2008 10:08:02 AM 

WI: 2351bs 

BP: 118/BO mm Hg: P: 100 bpm 

GENERAL: wall developed; well n'ourishad: well groomed; no apparent dlstlllss 

EYES: lids and conjunctiva are normal; PERRL; 

2013 

EINIT: nonmal nose; normal extemal auditory canals and tympanic membranas; Oropharynx: normal mucosa, 

palate, and posterior pharynx; 

NECK: Neck is supple with full range of motion; No Iymphaqemopathy; thyroid is normal to palpation: 

RESPIRATORY: normal respiratory rata and panern with no distress; normal braalh sounds with no ralas. rhonchi. 

wheezes or rubs; . 

CARDIOVASCULAR: normal rate; regular rhythm; normal S1 and S2 heertsounds with no S3 or S4 

GASTROINTESTINAL: normal bowel sounds; no masses or tenderness; no organomegaly; 

MUSCULOSKELETAL: leg. show dlminlahed aan.atlOn hlpa down, hvperalgesla PIlIaont as well. Trace edame 

bilaterally. He .00$ • ",alker. He con baraly gat up on the a.am table. Oimlnshad .an&ation from knaes down 

SKIN: mild folliculitis change. on the upper arme; no parlph .. al extremity edema: 

PSYCH: mental status: alert and oriented x 3; appropriate affect and demeenor; recent and remote memory afB 

intact; good insight and judgament; 

ASSESSMENT: 

356.8 

307.42 

957.1 

704.8 

PLAN: 

Peripheral neuropathy 

Chronic insomnie 

Neuropathic pain 

Folliculitis 

Page 9 of31 
601 

Office/Outpatient Visit 

VISit Data; Thu, Nov 13, 200809:57 am 

Provider: I MD (Supervisor: ••••• MD; Assistant: ....... .. 

location~Famlly Madicina 

Electronically sign ad by provider on 11/131200808:42:53 PM 

Printed on 03104/2009 at 12:11 pm. 

Paripheral neuropathy 

Pain management recommendations! 

Suboxone/Subutex expleined in depth including the tollowing; 

1. Sublingual route 01 deUverv. 

2.. Off label use for pain managemant. 

3. 't is I ••• addictiva In natura than treditional narcotics end weaning off is po.alb'e. 

Follow up lor Suboxone/Subulax induction at the patiant's earliest convience. 

Will add MS Contln and waan lortab aftar he i. on Suboxona 

futWiJUiollS.:-

3013 

Sub axone 2mglO.5mg Tab·'ets, Sublingual I tab dailv under the tong.ue for pain #30 (ThirtV) tableT!s) Refills: 0 

Chronic insomnia 

Pafn managem~nt recommendations: 

Continua the following medications at tha doaage on tha medication liot: Saroqual. 

Nauropathic pain 

RECOMMENDA nONS: 

Kaap follow ups with Dr._ 

Pain management recommendations: 

TitrataLyricel0 maximum affective do .. somawhere batwaen 200-350mg dally divided TID. Monitor for B1deeffects including dizziness, blurred vision, fatigue, and lag swening. 

Folliculitis 

RECOMMENDATIONS: 

Use bactrim as prescribad for fo/licurrl$ and usa low dose bleach solution is bath watar. 

Page 10 of 31 
602 

Office/Oulpatient Visit 

Vi.it O.t.: Mon. Dec 22.200808:19 am 

Provider: MD (Supervisor: .U ...... MD; A.sistant: ....... ,

location:-'=amify Medicine 

Electronically signed by provider on 12/22/2008 08:59:22 AM 

Printed on 0310412009 at 12:11 pm. 

MEDICATIONS: 

R.f~1 of medication for this problem which i. pr .. ent in the medication list was given today. 

LABORATORY: Lab. ordsred Include the following: 

Urine Toxicology Screening·Te.t Code 2126 

Pain management recommondations: . 

No changes in Subaxone/Subutox therapy at this time. Continue current medication dosing schedule. 

A pain management contract was filled out by the patient today. He is in agreement of the contents. 

3af3 

UDS positive for THe and he admits ocassional U8S, especially since being out of pain medication. UDS must be 

clean next visit. he understands 

FOLLOW UP: Schedule 8 'oHaw-up visit in 1 month. CslI prior with new or worrliloma symptoms 

frwaiJUjons.;. 

Refill of: Suboxone 2mg/0.5mg Tablets. Sublingual 1 lab daily under the longue for pain 1130 /Thlrly) lablal(sl Refills: 0 . 

Refill of: Norco 10mg/325mg Tablet Take 1-2Iablells) by moulh q6h prn pain #180 (One Hundred and Eighty) 

tablells) Refills: 0 

Oc.!!m:... 

80101 Urine Toxicology Scroening; To.t Code: 2126 (xl0) 

Chronic' insomnia 

MEDICATIONS: 

Refill 0.1 modlcstion lor Ihls problem which is prellent In tho modication '1St we. givon today. 

~ .. 

Refill of: Seroquel 200mg Toblel 1 tab ., bedlime #30 IThirty) I.blet(s) Refills: 6 

Page 11 of31 
603 

Office/Outpatient Visit 

Visit Dote: Man, Jan 19, 200908:17 .m •••••• Provider: MD (Supervisor: MD; Assistant: ......... .

location~amily Medicine 

Electronically signed by provider on 011191200909:40:27 AM 

Printed on 0310412009 at 12: 11 pm. 

SUBJECTIVE: 

~ 

1 of 4 

He is an established patient. He Is here to follow up on the following: Peripheral neuropathy and chronic pain 

syndrome. 

hPJ.:... 

Problem to be eddressed: Chronic pain syndrome symptoms: 

His symptoms ere improving. The chengo in condition is due to tho following: due to increase in dose of peln 

mods. His chronic peln syndrome is n.orly controlled at this point. He rotea his pain overall ot 0 3 with 1 being 

mild and 10 .belng savere, the worst pein tho pationt has over experionced. He cheracteriz •• the chronic peln 

syndrome as modorsts In intonsity, constant, ju.t painful ond difficult to descrlbo, shootinglstabbing, burning, ond 

needl.s. Tho potiont noeds tho lollowlng medications rafillad today: poin medication. Suboxone. Currently he i. 

taking tha following do.o of Suboxono: 2mglO.5mg 118 tab 4 time. per day.' The following ara medication 

changes lrom the last visit: Vytorin has baen addad. He has been exporlenclng the following odvorse madicatlon 

sido .. ffect.: dizziness, latigue, neusea and vomiting. Compllancs with treatmont hal been good; he takes hi. 

modicatlon a" directad and follows up as directad. Depre •• ion screening Is positive lor Agitation, anhedonia 

(decreased interest in SOCiBnling and sell ). tendency towards indecistveness. depressed mood and noticing mDod 

8.winga v.f/ Subo~on8. HBVI.ng GI difficulties & woukf like referr" for.e;ndoscope ~ was, :scheduled in the past 8t 

never done. . 

Put Macneal History I Family History I SocIal History' 

Past Medical Hlstoa;.. 

Aidsl HIV 

Hyperlipidemia 

Periph,aral Neur~8thv 

Shlngl •• 

CURRENT MEDICAL PROVIDERS: 

Prlmarv care provider: Dr. __ 

Interventional Pain Management: Dr.-. 

,Syrgical HJst0ry; 

Hemorrhoid Sx 

f.amily HistoryFather: Congestive Heert Failure: CAD: Myocardiallnfafction 

Mother: Carotid Artery Stonosis: Conge.tlve Heart Falluro: Myocardlallnlarction 

Social HlltOry· 

Occupation: Unemployad 

Marital Status: Marrlad {by common lawl 

Chlldr.n: None 

Page 12 of 31 
604 

Office/Outpatient Visit 

Visit Date: Mon. Jan 19. 2009 08: 17 am 

Provider: MD (Sup.rviso" ••••• MO; Assist.nt .••••••• 

LocBtion~amilY Medicine 

Electronic.lly signed by provider on 01/19/2009 09:40:27 AM 

Printed on 03/04/2009 at 12: 11 pm. 

to~/~upp!em.nt.; 

TObacco: Cigarettes: Currently smokes 112 pack per day. 

A!IalgUts: _ 

Compazine: 

Imltrex: 

l&t!:1Hl1..MlIiIieDtilmJ.;. 

SUboxone 2mg/0.5mg Tabiets. Sublingual 1 tab daily under the tongue for pain 

Chantix lmg Tablet St.rter pack O.Smg bid x 10 days then lmg bid 

S.roquel 200mg Tablet 1 tab at bedtime 

Atripia 600mg/200mg/300mg Tabl.t Tak. I tabletts) by mouth daily 

Lvrica 150mg Capsules 1 cap three times daily by mouth for nerve pain 

No,co 10mg/325mg Tabl.t Take 1-2 tabletie) by mouth q6h pm pain 

Becl,im OS Tablet 

Atropine Sulfate 0.4mg Tablet 

Acyclovir AOOmg Tablat Take 1 tabled.) by mouth qid for 5 day. 

Albutarol 90mcgl1actuatlon Oral Inhaler :2 puff. pm 

Promethazine Hel SOri1g Tablet Take 1 tablet(s) by mouth q 4 to 6 hr 

Xanax 2mg Tablet 

OBJECTIVE: 

Cur.Clllll.i..l /19/2009 B:21 :30 AM 

Wt: 230 Ibs 

BP: 136/98 mm Hg; P: 120 bpm 

GENERAL: wall daveloped; wen nourished; well groomed; no apparent distress 

EYES: lids and conjunctive are normal: PERRl; 

20f 4 

E/NIT: norma' nose; normal ex1arnal auditory canals and tvmpanlc membrB"e8~ Oropharynx: normal mucosa. 

palate. and posterior pharynx; 

NECK: Neck i. supple with full range of motion; No Iymphademopathy: thyroid Is normal to palpation; 

RESPIRATORY: normal respiratory ,ate and panarn with no dl.tr ... ; normal breath sound. with no ,ales. monch!. 

whe8zes or .rubs; 

CARDIOVASCULAR: normal rale: ragular rhythm; normal S 1 and S2 heart.ound. with 'no S3 or S4 

GASTROINTESTINAL: normal bowel sounds: no masses or tandem.s.; no OIganomeg.ly: 

MUSCULOSKELETAL: legs show diminished .on.ation hlp. down. hyparalgesia preoont as woll. Trace edam a 

bilaterally. He' uses B walker. Dimin$hed senaation from kneee down 

SKIN: mild folficulitis changes on the upper .rms: no peripheral extremity edeme; 

PSYCH: mantal status: alert and oriented x 3; appropriate affect and demeanor; recent and famote memory are 

intact: good im~ight and judgement; 

ASSESSMENT: 

338.4 Chronic pain syndrome 

307.42 Chronic insomnia 

Page 13 of31 
605 

Office/Outpatient Visit 

.-.. 

Visij Dale: Mon. Jan 19.200908:17 am ...... .. Provider: MD (Su·pervisor:tI MD; Assistant: ••••••• 

location: .... Femily Medicine 

Electronically signed by provider on 01/19/200909:40:27 AM 

Printed on 03/04/2009 at 12:11 pm. 

957.1 Neuropathic pain 

787.02 Nausea 

PLAN: 

Chronic pain syndrome 

Pain managemen.t recommendations; 

3 of 4 

Will start tho following diuretic for peripheral edema control: A1dactazida to be inltated for perlpharai adama. It 

was discussed that multiple medications used in pain menagement can cause perIpharal edema especially when 

used in combination.. . 

Durayesic patch will be started at this time and titrated accordingly. Monitor for side·affects •• dlacus!I8d. 

FOllOW UP: Schadula 8 follow·upvlsi! In 1 'month. Ca~ prior with new or worrisoma symptoms. 

&e~=, 

Ouragesle 12mcgihr Transdermal Patch Apply 1 patch{es) to upper torso as directed every 48 hours as needed 

for pain #3,(Three) 5 patch box Refills: 3 

Chronic inaomnia 

Pain management' recommendations: 

As sleep hygiene is essential to good pain control. he is to continue curra~1t sJeep madication. 

E=l;tiJlIillns;.. 

Alprazolam 1 mg Tablets. Extended Rele'ase 3 tablets by mouth daily for anxiety #90 (Ninety) tablet(s) Refilis: 0 

Aldactazide 50mgl50mg Tablet Taka 1 toblet(s} by mouth dally for fluid retention. This is a diuretic. 1130 

IThirty) tablet(s} Refills: 6 

Neuropl!lthlc pein 

Pain management recommendations: 

The following medications are to be continued 88 listed on the current medication Rst In the chart or 88 directed: 

lyrica. . 

Nausea 

RECOMMENDATIONS: 

Trial of Reglen for chronic severe neuses and GERD. 

FOllOW UP: Schedule a follow-up visit In 1 month. Call prior with new or worrisome symptoms. 

prescriptions: 

Page 14 of 31 
606 

Office/Outpatient Visit 

Visit Oala: Man, Jan 19, 2009.08: 17 am 

Providor: taMD (Sup.rvisa" ••••• MD; Assistant: ....... l1li loc8tion;~Bmily Medicine 

Electronically signed by provider on 01 'I 912009 09:40:27 AM 

Printed on 0310412009 at 12:1 I pm. 

4014 

Reglan 10mg Tablet Take I tablet(s) by mouth 4 times daily lor nausea. Before each meal and bedtime #120 

(One Hundred and Tw.nty) tableUs) Refills: 1 I 

Zotran 4mg Tablet 1 tab every 4 hr. as needed for nausea #90 (Ninety) tablet!s) Refills: 3 

Page 150f31 
607 

-

OfficefOutpatienr Visit 

Vi,it 08te: Tue. Feb 17. 200908:18 am 

Provider: I MD (SuperYisor: ••••• ,MD; Assist.nt: ••••••• Locetion: __ Family Medicine 

Electronically signed by provider on 02/171200909:06:57 AM 

Printed on 0310412009 a, 12:11 pm. 

SUBJECTIVE: 

~. 

He i. an establish.d p.tiant. He is her. for follow up. 

Problem to b •• ddr •••• d: P.ripheral n.uropathy symptoms; 

10f3 

His symptoms BrB warBa. He characterizes the peripheral neuropathy al moderata to savere in intenahy. He rates 

his pain ov.rall .t a 9 with I being mild and 10 being •• v.re, the wo",t paln the patient h.s ever •• perlanced. He 

needs the following medication refms: Norco. Seroquel. Xal1ex. Patiant wou1d nka to dlacuss changing his 

Fentanyl patch or Incr.asing it. it doe. not ••• m to be doing anything for the patient. He stat,.' he had a a verv 

b.d month with his pain. H. was also told to d.cr •••• his Xen .. from 2mg tid to Xane. XR lmg bid end i. not, 

doing wall with this. Pallent state. he i. more nauseated this month. hi •• tomach medications .,a not halping and 

sometime. feel. it makes It wor.e. Patient would like to discuss Marino!. He Can get it for free with his through. 

state prgram. 

pgst.M!!dil<Dl Hi&ll!l'l.l.£Ami1yJlli~I!!.HIB1l>n':.. 

. Put.Mmli<:AL\futru:y,;" 

Aids' HIV 

Hypernpia.m,la 

PeriPheral Neuropathy 

Shingles 

CURRENT MEDICAL PROVIDERS: 

Primary cere provider: Dr.~ 

Interventional Pain Manegoment: Dr.-. 

Hemorrhoid Si 

Father: Congestive Haart Failure; CAD; Myocardial Infarction 

Mother: Carotid Artery Stenosis; Congestive Heart Failure; Myocardiaf Infarction 

Occupation: Unemployed 

Marital Status: Married {by common lawl 

Child,en: None 

Tobacco,A\cQhoIlSypplaments: 

Tobacco: Cigarene.: Currently smoke. 1/2 pack per day. 

~ 

CompBzine: 

Page 16 of31 
608 

Office/Outpatient Visit 

VIsit Date: Tue. Feb 17. 2009 08: 18 am •••••• Proyidar: • MD (Superyisor: MD; Assistent: ...... .. 

l(Jcation:~amily Medicine 

Electronically signed by provider on 02117/2009 09:06:57 AM 

Prin\ed on 03104/2009 et 12: 11 pm. 

Imitrex: 

CIIlIIJl.IMet!icatjoos: . 

Aldactazide 50mg/50mg Tablet Take 1 tablet(s) by mouth dally for fluid retention. This is a diuretic. 

Alprazolam 1 mg Tablets, Extended Release 3 tablets by mouth daily for anxiety 

20f 3 

Duragesic 12mcg/hr Transdermal Patch Apply 1 patchles) to upper torso as directed every 4B hours as needed for 

pRin 

Reglan 10mg Tablet Take 1 tablet(s) by mouth 4 times daily for nausea. Before each meal and·bedtime 

Suboxone 2mg/0.5mg Tablets, Sublingual 1 tab daily under the tongue for pain 

Zafran 4mg Tablet 1 tab every 4 hrs as needed for nausea 

Chanti" lmg Tablet Starter pack 0.5mg bid x 10 days then lmg bid 

Seroquel 200mg Tablet 1 tab at bedtime 

Atripla 600mg/2oomg/300mg Tablet Take 1 tabletlsl by mouth deily 

l yrica 150mg Capsules 1 cap three times daily by mouth for nerva pain 

Norco 1 Omg/325mg Tablet Take 1·2 tablet!ol by mouth q6h prn pain 

Bactrim DS Tablet 

Atropine Sulfate O.4mg Tablat 

Acyclovir 400mg Tablet Take 1 talil.t!s) by mouth qid for 5 days 

Albuterot'90mcg/l actuation Oral Inhaler 2 puffs prn 

Promethezine Hel 50mg Teblet Take'l tablet!s) by mouth q 4 to 6 hr 

X.nax 2mg Teblet 

OBJECTIVE: 

~=t;".2117/2009 8:29:54 AM 

Wt: 230'lbs 

SP: l1BI89 mm Hg;. R: 18 bpm 

GENERAL: wolf developed; wall nourished; well groomed; no apparent diatro .. 

EYES: lids end conjunctiva are normal: PERRl; 

NECK: Neck is supple with fuR range of motion; No Iymphademopethy; thyroid is normal to palpation; 

RESPIRATORY: normal respiratory rate and pattern with no dis" •• e; norma! breath sound. with no rales. rhonchi. 

wheezes or rubs; 

CARDIOVASCULAR: normal rate; regular rhYlhm; nonnal 51 and S2 heartsound. with no S3 or S4 

GASTROINTESTINAL: normal bowel sounds: no m ..... or tandema .. ; no orgonomagalv; 

MUSCULOSKELETAL: Legs show diminished .ensation hips down. hyperalgesia pre. ant .a well. Trace edema 

bilateralfy. He uses 8 wetker. Otminshad sensation from knee. down 

SKIN; mild folliculitis changes on tho upper .rms; no periph.ral extremity adema; 

PSYCH: mental status: alert and oriented x 3; appropriate affect and demeanor: recent and remote memory arB 

intact: good insight and judgem~nt; 

AsseSSMENT: 

356.9 

787.02 

338.4 

Peripheral neuropathy 

Nausea 

Chronic pain syndrome 

Page 17 of 31 
609 

Office/Outpatient Visit 

Vish Oa'o: Tuo. Fob 17. 200908:18 am 

Providor: MD fSupervi.or: ••••• MD; Assi.tant; ...... .. Location: ",Family Medicine 

Electronically signad by provider on 02/17/200909:06:57 AM 

Printad on 0310412009 at 12: 11 pm. 

729.5 Foot pain 

PLAN: 

, Peripha'" neuropathy 

MEDICATIONS: 

We will consider Marinol for nausea If patient has 2 months of cl •• n urin. drug Icreen •• 

Pain management recommendations: 

30i 3 

The foUawing medications are to be continued as tiatad on the ourrent medicatfon list in the chart or 89 directed: 

Fantanyl. NorCQ~ Saroquel. and XanaK. 

No changes in Subo.Kona/Subut8.K therapy at this timB. Con1inuB current medication dosing schedule. 

FOllOW UP; Scliedule 0 follow-up viSit in 1 month. Can prior with n ..... or .... orri.om •• ymptoms. 

~'<tillt.iwls;_ 

Refill of: Alprazolam 2mg Tablets, Extsnaed Ralease 1 lab by mouth twic. daify for anxiety #60 (Sixty) tabletfs} 

Rafills: 0 

Nausea 

RECOMMENDATIONS: 

Call if the increase in Zot,e." does not help with his nauaea. 

~cms:.. 

Refill of: Zolran' 8mg Tablet Take 1 t.blet(s} by mouth tid #90 (Ninety} tablet(s) Refills: 3 

Chronic pain syndrome 

RECOMMENDATIONS: 

PI asked about t.~l1o.t.rone inj.ction. for foligua and hi •••• drIve. He is having his blood work faxed to U6 and 

we will conskier injections pending the review of his lab work. 

et=!J!tign.s:... 

Refill of: Duragesic 25mcglhr Transderm.1 Patch 1 patch every 48 hours for pain #3 <Three} 5 patch box Refills: 

o 

Refill of: Suboxone 2mg/0.5mg Tablets. Sublingual 1 tab daily under the tongue for pain #30 (Thirty} tebletls} 

Refills: 0 

Refill of: Norco 10mg/325mg Tablet Take 1-21ablat(6) by mouth q6h prn pain #180 (One Hundred and Eighty} 

tabletls} Refills: 0 

Page 18 of 31 
610 

_ Family Clinic: 

PATIE;o.IT 

.\IEDIC.\L HISTORY" PROGRESS NOTES DIACNOSTIC PRO • 

• 7 ••••••• · August 16,2007 

s: 

0: 

A: 

P: 

The 32.year old palient comes in reporting his peripheral neuropathy is sc .... cre. He is almost leary eyed. He cannol even 

finish one person~5 haircut He feels frustrated and sad. His right shoulder hurts so bad he cannot lift it (lver his head or 

past midlme. His left shoulder has fuU range ormation. He replns thai: he bas nausea almost continuously. He is not 

sure if"'" PHENERGAN is working. He has tried OXYCONTrN AND AVINZA in the past. The ROBAXIN caused 

nausea and vomiting. He isjllSt VCI')' upset today. Denies feYer, chills. nausea,. vomiting. or diarrhea. Past medical 

history extensively reviewed and placed in chart. 

General: Alert and oriented and in no apparent distress.. HEENT entirety within normal limits. Funduscopic exam 

benign. Neck supple without adenopalhy. mega1)' or bruil ChestIHean: Regular rate and rhythm without murmur, tub 

or gallop. LI:'"SS are clear to auscultation. Extremities: No rashes. clubbing. C)'8nosis or edema. Abdomen is diffusely 

tend.er with no guarding or rebound. NonnOBClive bowel sounds. Neuro intact.. Decreased range of motion. passive: and. 

active pain to his right shoulder. Decreased strength to hand grip. 

I. Peripheral neuroplllhy. 

2. AIDS. 

3. Neuropathy. 

4. Nausea and vomiting. 

S. Reportedly degenerative bone dlsease. 

I. PHENEROAN SO mg one tablet p.o. q. ,o. hours. L YRiCA 75 mg b.i.d., XANAX 2 mg q. eight houn, 

2. 

3. 

LORT AD 10 mg q. fow- to .ix hours. I have .. Iked 10 him abou1longer ecting products ODd b)'ing """" .. some 

point in the~. 

f will g() ahead and write for bim a walker. We will.sec ifth~ walker does not help him with his mobility and 

decrease some: of his p.in. 

Follow up over the ne>! three to rour weeks. f • •••• M.D. lei. 

Permanent Subcommittee on Investi ations 

EXHIBIT #10e 
611 

Office/Outpatient Visit 

VI.~ Dat.: Man, Jan 19, 200908:17 am ..... .. Provider: MD {Supervisor: MD; Assistant: •••••• 

Location:~ami'y Medicine 

Electronically signed by provider on 011191200909:40:27 AM 

Printed on 03/0412009 at 12: 11 pm. 

SUBJECTIVE: 

CC:.. 

10f4 

H. is an established patiant. He I. here to follow up on tha following: Peripheral nauropathy and chronic pain 

s.vndrome. 

I:IPI.:... 

Problem to be eddr •••• d: Chronic pain syndrome symptoms: 

Hi •• ymptoma .ra improving. Tha chang. In condition Is due to tha following: dua to incr • .,a in dose ot p.ln 

mod.. His chronic pain syndrome is n •• rly contron.d at thi. point. Hit ratBl hi. pain overall at a 3 with 1 being 

mild end 10 ,being severe~ the worst pain the patient has 8v8r GltP8riancad. He characterizes the chronic pain 

syndrome as moderate In intensity. constant, jl.l8t painful and difficult to describe, shootinglstabbing, burning" and 

n •• dla.. Tha p.tient naad. tho following medicatlona ratHfad today: pain medications Suboxon.. Currantly h. i. 

taking the following do •• 01 SuboKona: 2mg/O.5mg 118 t.b 4 times par dsy.· The following ara medication 

changa. from the I •• , visit: Vytorin has been eddad. He h •• baan exparlanclng the folloWing advar •• medication 

sida .. flect., dizzlne •• , fatigue, nausea and vomiting. Compliance with " •• tment h •• been good; h. takes hi. 

medication as directed and fof'ow, up 8S directed. Depression screening 18 positive for Aglt8tion~ anhedonia 

(deCfBu;ed interest in socializing and sex 1, tendency towards ind8Cfsiveness~ depressed mood and noticing mood 

8,wings ~I Subollone. Havlng GI difficulties &. would like raferr.1 for.~ndoscopa • WBS, ,scheduled in the past &: 

never done. . 

Put Msdjcal Hilltgry I family H"torv I Spel., Hi.lory: 

Aid., HIV 

Hyperlipidemia 

. Periph.aral Neuropathv 

Shingl •• 

CURRENT MEDICAL PROVIDERS: 

Primary cara provider: Dr.-. 

Interventions1 Pain Management: Dr._ 

Sy~giQBI HIAtory; 

Hemorrhoid Sx 

family H!!nQry' 

Father: Congestive Heart Failure; CAD; Myocardial Infarction 

Molhe" Carotid Artery Stenosis; Cong.stiva He.rt Failure; Myocardial Infarction 

Sor;ial History· 

Occupation: Unemployad 

Marital St.tus: Married iby common law) 

Childran: Nona 

Permanent Subcommittee on Investigations 

EXHIBIT #10f 

Page 12 of 31 
612 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income' 

(Social Security Number) 

JURISDICTION AND PROCEDURAL mSTORY 

This case is before the undersigned on a request for hearing dated February 21, 2008 (20 CFR 

404.929 et seq. and 416.1429 et seq.). The claimant appeared and testified at a hearing held on 

AP.riI29, 2009, in Oklahoma City, Oklahoma.· Also appearing via telephone and testifyi~ 

~Reinhardt; M.D., an impartial medical expert. The claimant is represented bli...., 

~attorney. . 

The claimant is alleging disabilitY since April 15,2003 . 

. The issue is whether the claimant is disabled under sections 216(i), 223(d) and 1614(a)(3)(A) of 

the Social Security Act. Disability is defined as the inability to engage in any substantial gainful 

activity by reason of any medically determinable' physical or mental impairment or combination 

ofimpairments that can be expected to result in death or that has lasted or can be expected to last 

for a continuous period of not less than 12 months. . 

With respect to the claim for a period of disability and disability insurance benefits, there is an 

additional issue whether the insured status requirements of sections 216(i) and 223 bfthe Social 

Security Act are met The claimant s earnings record shows that the claimant has acquired 

sufficient quarters of coverage to remain insured through March 31,2005. Thus, the claimant 

must establish disability on or before that date in order to be entitled to a period of disability and 

disability insurance benefits. 

After careful review of the entire record, the UJidersigned finds that the claimant has been 

disabled from April 15,2003 through the date of this decision. The undersigned also finds that 

the insured status requirements ofthe Social Security Act were met as of the date disability is 

established. 

EXHIBIT #10 
613 

Page 2 of5 

APPLiCABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individmil is 

disabled (20 CFR 404. 1520(a) and 416.920(a)). The steps are followed in order. Tfit is 

determined that the claimant is or is not disabled at a step of the evaluation process, the 

evaluation will not go on to the next step. 

At step one, the undersigned must determine whether the claimant is engaging in substantial 

gainful activity (20 CFR 404.1 520(b) and 4l6.920(b)). Substantial gainful activity (SGA) is 

defined as work activity that is bbth substantial and gainful. If an individual engages in SGA, he 

is not disabled regardless of how severe his physical or mental impairments are and regardless of 

his age, education, and work experience. Tfthe individual is not engaging in SGA, the analysis 

proceeds to the second step. 

At step two, the undersigned must determine whether the claimant has a medically determinable 

impairment that is severe ora combination of impairments that is severe (20 CFR 

404. 1520(c) and 416.920(c)). An impairment or combination of impairments is severe within 

the meaning of the regulations if it significantly limits an individual's ability to perform basic 

work activities. If the claimant does not have a severe medically determinable impairment or 

combination ofimpairments, he is not disabled. If the· claimant has a severe impairment or 

combination of impairments, the analysis proceeds to the third step. 

At step three, the undersigned must determine whether the claimant s impairment or combination 

of impairments meets or mediCally equals the criteria ofan impairment listed· in 20 CFR Part 

404, Subpart P, Appendix 1 (20 CFR 404~1520(d), 404.1525, 404.1526, 416.920(d), 416.925, 

and 416.926). If the claimant s impairment or combination of impairments meets or medically 

equals the criteria of a listing and meets the duration requirement (20 CFR 404.1509 and 

416.909), the claimant is disabled. Tf it does not, the analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the undersigned must first 

determine the claimant s reSidual functional capacity (20 CFR 404.1 520(e) and 416.920(e)). An 

individual s residual functional capacity is his ability to do physical and mental work activities 

on a sustained basis despite limitations from his impairments. In making this finding, the 

undersigned must consider all of the claimant s imp'aimients, including impairments that are not 

severe (20 CFR 404.1520(e), 404.1545, 416.920(e), and 416.945; SSR 96-8p). 

Next, the undersigned must determine at step four whether the claimant has the residual 

functional capacity to perform the requirements of his past relevant work (20 CFR 404. 1520(f) 

and 416.920(f)). Tfthe claimant has the reSidual functional capacity to do his past relevant work, 

the claimant is not disabled. Tfthe claimant is unable to do any past relevant work or does not 

have any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation process (20 CFR 404.1 520(g) and 416.920(g)), the 

undersigned must determine whether the claimant is able to do any other work considering his 

residual functional capacity, age, education, and work experience. Ifthe c1aimantis able to do 

See Next Page 
614 

other work, he is not disabled. If the claimant is not able to do other work and meets the duration 

requirement, he is disabled. Although the claimant generally continues to have the burden of 

proving disability at this step, a limited burden of going forward with the evidence shifts to the 

Social Security Administration. In order to support a finding that an individual is not disabled at 

this step, the Social Security Administration is responsible for providing evidence that 

demonstrates that other work exists in significant numbers in the national economy that the 

claimant can do, given the residual functional capacity, age, education, and wor~ experience (20 

CFR 404.1 5 12(g), 404. I 560(c), 416.912(g) and 416.960(c». 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant s date last insured is March 31, 2005. 

2. The claimant has not engaged in substantial gainful activity since April 15, 2003, the 

iUeged onset date (20 CFR 404.1520(b), 404.1571 et seq., 416.920(b) and 416.971 et seq.). 

3. The claimant has the following severe impairment(s): HIV infection and anxiety 

related disorder (20 CFR 404.1520(c) and 416.920(c». . 

4. The severity ofthe claimant s impairment medically equals the criteria of section 14.08 

Human immunodeficiency virus HIV) infection 0(20 CFR Part 404, Subpart P, Appendix 1 

(20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926}. 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as co·Dsistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and 416.929 and SSRs 96-4p and 

96-7p. The undersigned has also considered opinion evidence in accordance with the 

requirements 000 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p. 

The evidence reveals the claimant has AIDS with painful peripheral neuropathy requiring pain 

medications (Exhibit 16F). Laboratory testing documents HIV infection (Exhibit SF). Treatment 

records also reveal the claimant experiences fatigue and gastrointestinal difficulties related to 

illness and medication side effects (Exhibit 16F). In April 2009, 5 M.D., indl.·cated the 

claimant has neuropathy related to HIV infection (Exhibit 15F; See also Exhibit 14F). . 

~.D., treats the claimant. Dr.~ records document AIDS, neuropathy, nausea, and 

vomiting (Exhibit 9F). Dr. _s records also document symptoms of anxiety for which 

medication has been prescribed and the need to be in an environment oflo.w stress or demands 

(Exhibit IF; See also Exhibit 8F). Likewise, Dr.~ records document symptoms of 

depression for which medication has been prescribed (Exhibit 8F). Dr ... s records also 

·docurnent prescription medication to treat headache pain. 

Consultative evaluation by Psy.D., in June 2007 yielded Axis I diagnosis of panic 

disorder with agoraphobia (Exhibit 3F). Consultative examination by 0.0., in 

December 2007 provided the following assessment: history ofHIV; nausea, vomiting, and 

See Next Page 
615 

Page 4 of5 

diarrhea; neuropathy; dizziness; and tobacco abuse (Exhibit 10F). The claimant s impairment 

medically equals listing 14.08. testi:fied the claimant has AIDS with a lot of 

diarrhea and abnormal CD4 and CDS levels. estified ""'-V.'V~~V""~O 

because of the complications such as secondary infections and 

claimant has repeated episodes of diarrhea, peripheral neuropathy, and 

stated the claimant has fatigue which is documented by Dr." s records on every 

He also noted the claimant has episodes of diarrhea which are documented. He also stated the 

claimant received a prescription for a walker in 2007: 

The claimant alleges disability due to AIDS with extreme diarrhea, vomiting, and joint pain. The 

claimant reported he has extreme fatigue as well as nervousness (Exhibit 2E). The claimant 

testified he used a cane before the walker was prescribed. The claimant stated he loved working 

at the hair salon he opened with his mother but he is unable to do so. The claimant testified the' 

frequent nausea and diarrhea began in 2003. The claimant testified he had fecal incontinence 

several times a week. The claimant testified he also has bad headaches an,d fatigue. The 

claimant stated he cannot walk from his bed to the couch without becoming winded. The 

claimant stated he had trouble walking into the building because he became winded. The 

claimant stated he cannot shower without assistance and has used a chair for quite some time 

because of balance trouble. The claimant stated he has insomnia for which he takes medication. 

The claimant testified he feels like he has the flu all of the time. He described intense pain in his 

legs with the sensation of needles sticking into his body. The claimant stated he has night sweats 

of such severity that his pain patch comes off. The claimant stated the nausea, vomiting, and 

feelings of sickness preclude him from working. The claimant stated he cannot drive. His 

mother takes him to the grocery store. He is also accompanied to doctor s appointments. The 

claimant stated he takes an anti-retroviral cocktail. The claimant stated he rarely leaves his home 

because he fears losing control of his bowels. The,c1aimant stated he has not left the house 

unaccompanied in a number of years. He spends his days in bed or on the couch. The 

claimant s medications include those prescribed for treatrrient.of AIDS, peripheral neuropathy, 

sleep, pain, nausea, and vomiting. 'Furthermore, he takes medications for asthma and infections 

(Exhibit 13E). The claimants treatment records substantiate his allegations. The symptoms the 

claimant alleges verbally and in writing are consistently documented in his treatment records. 

After considering the evidence of record, the undersigned finds that the claimant s medically 

determinable impairments could reasonably be expected to produce the alleged symptoms, and 

that the claimant s statements concerning the intensity, persistence and limiting effects of these 

symptoms are generally credible. While the medical evidence ofrecord is somewhat scant in 

correlation to the alleged onset date, the undersigned notes the claimant began falling and having 

fecal incontinence before quitting his business in the salon. The claimant testified he residues 

with a friend who pays for his medication with the agreement that he will reimburse the friend if 

benefits are awarded. The claimant stated he has memory problems due to his medications. 

While the State agency medical consultants physical assessments acknowledge HIV, peripheral 

neuropathy, fatigue, pain, and gastrointestinal distress, the opinions are given 'little weight 

because another medical opinion is more consistent with the record as a whole (Exhibit 4F; See 

also Exhibits 7F and 12F). Furthermore, the State agency consultants did not adequately 

consider the combined effect of the claimant s impairments. While severe impairments were 

See Next Page 
616 

Page 5 of5 

acknowledged, the State ,weey medical consultants failed to see the medical equivalence 

addressed b) rTF' . However, the State agency psychological consultants mental assessments, that the claimant has 

severe mental impairment, are given great weight because they are consistent with the record a~ a 

whole (Exhibit 6F and 7F; See also Exhibit II F). 

5. The claimant has been under a disability as defined in the Social Security Act since 

April 15, 2003, the alleged onset date of disability (20 CFR 404.1520(d) and 416.920(d». 

The medical evidence of record and the claimant s testimony suggest he may be physically 

incapable of managing or directing the management of his benefits. Appointment of a 

representative payee may be in the claimant s interest .as determined by the Social Security 

Administration. 

DECISION 

Based on the application for a period of disability and disability insurance benefits protectively 

filed on September 14, 2006, the claimant has been disabled under sections 216(i) and 223(d) of 

the Social Security Act since April 15; 2003. 

Based on the.application for supplemental security income filed on March 28, 2007, the claimant 

has been disabled under section 1614(a)(3)(A) of the Social Security Act since April 15, 2003. 

The component of the Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments, and if eligible, the amount and the months for which payment will be made . 

. lsi &~ r?f r?/taItA 

for Peter M. Keltch 

Peter M. Keltch 

u.s. Administrative Law Judge. 

July 15, 2009 

Date 

PMK:cjm 
617 

tJ- SEC i ~ SOCIAL SECURITY ADMINISTRATION 

t Refer To: a 117 n , 

l 

Office of Disability Adjudication and Review 

SSA ODAR Hearing Ofc 

301 Nw 6th St 

3rd Floor West 

Oklahoma City, OK 73102 

Date: October 28, 2009 

NOTICE OF DECISION FULLY FAVORABLE 

r have made the enclosed decision in your case. Please read this notice and the decision 

carefully. 

This Decision is fully favorable To You 

Another office will process the decision and send you a Je'tter about your benefits. Your local 

Social Security office or another may first ask you for more information. If you do not hear 

anything for 60 days, contact your local office. 

The Appeals Council May Review the Decision on Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do 

so. To do that, the Council must mail you a notice about its review within 60 days from the 

date shown above. Review at the Council's own motion could make the decision less 

favorable or unfavorable to you. 

If You Disagree With the Decision 

If you believe my decision is not fully favorable to you, or if you disagree with it for any 

reason, you may file an appeal with the Appeals Council. 

How to File an Appeal 

To file an appeal you or your representative must request that the Appeals Council review the 

decision. You must make the request in writing. You may use our Request for Review form, 

HA-520, or write a letter. 

You may file your request at any local Social Security office or a hearing office. You may 

also mail your request right to the Appeals Council, Orose of Disability Adjudkation and 

Review, 5107 Leesburg Pike, and Falls Chursh, VA 22041-3255. Please put the Social 

Security number shown above on any appeal you file. 

Permanent Subcommittee on Invest) aUons Form HA·L 76 (03·2007) 

EXHIBIT #11 
618 

.. -_a. I.'" Page 2 oD 

Time to File an Appeal 

To file an appeal, you must file your request for review within" 60 days from the date you get 

this notice. 

The Appeals Council assumes you got the notice 5 days after the date shown above unless 

you show you did not get it within the 5-day period. The Council wi!! dismiss a late request 

unless you show you had a good reason for not filing it on time. 

Time to Submit New Evid"ence 

You should submit any new evidence you wish to the Appeals" Council to consider with your 

request for review. . 

How an Appeal Works 

Our regUlations state the rules the Appeals Council applies to decide when and how to review 

a case. These rules appear in the Code of Federal Regulations, Title" 20, Chapter III, 

Part 404 (Subpart J) and Part 416 (Subpart N) . 

Tfyou file an appeal, the Council will consider all of my decision, even the parts with which 

you agree. The Council may review your case for any reason. It will review your case if one 

of the reasons for review listed in our regulation exists. Section 404.970 and 

Section 416.1470 of the regulation listthese reasons. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law Judge for a new decision. 

If No Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed 

only under special rules. 

You re Right to Representation in an Appeal 

You may have a lawyer or other person help you in any appeal you file with the Appeals 

Council. There are groups that can help you find a lawyer or give you free legal services if 

you qualifY. There are also lawyers who do not charge unless you win your appeal. Your 

local Social Security office has a list of groups that can help you with an appeal. 

If you get someone to help you with an appeal, you or that person should let the Appeals 

Council know. If you hire someone, we must approve the fee before he can collect it. And if 

Fonn HA-L76 (03-2007) 

See Next Page 
619 

Page 3 of3 

you hire a lawyer or a non-attorney who is eligible for direct payment, we will withhold up to 

25 percent of any past-due benefits to pay towards the fee. 

If You Have Any Questions 

If you have any questions, you may call, write or visit any Social Security office. If you visit 

an office, please bring this notice and decision with you. The telephone number of the local 

office that serves your area is J ; Its address is Social Security, 506 W Utah Ave, 

Chickasha, OK 73018-5852. 

W. Howard O'Bryan, JT. (0453) 

Administrative Law Judge 

Enclosures: 

Form HA-L15 (Fee Agreement Approval) 

Decision Rationale 

cc: 

Form HA-L 76 (OJ-2007) 
620 

IN THE CASE OF 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

~~-,-----­ (Social Security Number) 

I approve the fee agreement between the claimant and his representative subject to the condition 

that the claim results in past-due benefits. My determination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise accepted. I neither 

approve nor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REVIEW OF TmS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, RCALJ, Jurist Doctorate, Esquire 

Regional Chief Administrative Law Judge 

SSA ODAR Regional Ofc 

Rrn460 

l301 Young St 

Dallas, TX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement. If so, please write directly to me as the 

deciding Administrative Law Judge within 15 days of the day you are notified of the amount of 

the fee due to the representative. Your representative also has 15 days to write me if he/she does 

not agree with the fee amount under the approved agreement. 

Fonn HA-L 15 (03-2007) 

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621 

Page 2 of2 

You should include the social security number(s) shown on this order on any papers that you 

send us. 

W. Howard O'Bryan, Jr. (0453) 

Administrative Law Judge 

October 28, 2009 

Date 

Form HA-LI5 (03-2007) 
622 

IN THE CASE OF 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefitsi

, and Supplemental Security Income 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the undersigned;; on a request for hearing dated August 17, 2009 (20 CFR 

404.929 et seq. and 416.1429 et seq.). The evidence of record supports a fully favorable 

decision; therefOre no hearing;;; has been held (20 CFR 404.948(a) and 416.1448(a)). The 

claimant is represented bv Verle A Coon, a non-attorney representative. 

The claimant is alleging disahility since January 1,2007. 

The issue is whether the claimant is disabled under sections 2l6(1), 22J(d) and 1614(a)(3)(A) oftbe Social Security Act. Disability is defined as 

the inability to engage in any substantial gainful acrivi[y by reason of any medically detenninable physical or mental impainnent or combination 

of impairments that can be expected to result in death or that has lasted or can be e.xpected to last for a continuDus period of not less thaJ1 12 

months. 

With respect to the claim for a period of disability and disability insurance benefits, there is an additional issue whether the insured status 

requirements ofsec-tions 216(i) and 223 of the Social Security Ac-t are met. The claimant s eamingsrecord shows that the claimant has acquired 

sufficient quarters of coverage to remain insured through December 31, 2011. Thus, the claimant must establish disability on or beJore that date 

in order to be entitled to a period of disability and disabiliry insurance benefits. 

After careful review of the entire record, the undersigned finds that the claimant has been disab1ed from January 1. 2007 through the date of this 

dedsion. The undersigned alw finds that the insured status requirements of the Social Security Act were met as of the date disability is 

established. 

APPLICABLE LAW 

Under the authority of the Socia] Security Act, the Social Security Administration has established a fivl>step sequential evaluation process for 

determining whether an individual is disabled (20 CFR 404. 1520(a) and 416.920(9.)}. The steps are followed in order. 1flt is determined 1llat the 

claimant is or is not disabled"at a step oFthe evaluation process, the evaluation will not go on to the nut step. 

At step one, the undersigned must detennine whether the claimant is engaging in substantial gainful activity (2OCFR 404J520(b) and 

416.920(b». Substantial gainful acti .... ity (SOA) is deflOed as work actiVity that is both substantial and gainful. Ifan individual engages in SGA. 

he is not disabled regardless oFhow severe his physical or mental impairments are and regardless of his age,. education. or work experience. If 

the indiVidual is not engaging in SGA, the analysis proceeds to the second step. 

At step {Wo. the undersigned must detennine whether the claimant has a medically detenninable impainnent that is severe 01 a combination of 

impainnents that is severe (20 CFR 404.1520(c) and 416.920(c). An impainnent or combination or impairments is severe within the 

meaning or the regulations ifit significantly 1imits an individual's ability to perform basic work activities. If the claimant docs not have a severe 

medically determinable impairment or combination of impairments. he is not disabled. If the claimant has a severe impainnent or combination of 

impainnents. the analysts proceeds to the third step. 

At step three. the undersigned must determine whether the claimant s impairment or combination of impairments meets or medically equals the 

criteria of an impairment listed in 20 CfR Part 404. Subpart p. Appendix I (20 CfR 404.1520(d). 404.1525. 404.1526. 416.92O(d), 416.925, and 

See Next Page 
623 

- Page 2 oft I 

416.926), If the claimants impainnent or combination ofimpainncnts meets or medically equals tllc criteria of a listing and meets the dUQl,tion 

requirement (20 CFR 404.1509 and 416.909), the claimant is disabled. lfit does not, the analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the UJldersigned must first determine the claimant s residual functional capacity 

(20 CFR 4MJ520(e) and 416.920(e». An individual s residual function,e.1 capacity is his ability to do physical and mental work activities on 8 

sustained basis despite limitations from his impairments. In making this finding, me Ul1dersigned must consider all of the claimant s 

impairments, including impairments that are not severe (20 CFR 404. 1520(e), 404.1 545, 416.920(e), and 416.945; SSR 96-8p). 

Next. the undersigned must detennine at step four whether the claimant has the residual functional capacity to perl'orm the requirements of his 

past relevant work (20 CFR 404.1 520(f) and 416.920{f)). If the claimant has the residual functional capacity to do his past relevant work, the 

claimant is not disabled. If the claimant is unable to do any past relevant work or does not have any past releyant work. the analysis proceeds to 

the fifth and la·st step. 

At the last step of the sequential evaluation process (20 CFR 404.1 520(g) and 416.920{g). the undersigned must determine whether the claimant 

is able to do any other work considering 'his residual functional capacity. age. education. and work experience. If the claimant is able to do other 

work. he is not disabkd. If the claimant is not able to do other work and meets the durntion requirement, he is disabled. Although dle claimant 

generally continues to have the burden of proving disability at this step, a limited bunlm of going forward with the evidence shifts to the: Social 

Security Administration. In order to support a finding that an individual is not disabled at this step. the Social Security Administration is 

responsible for providing evidence that cicmonslrates that other work exists in significant numbers in the nationa1 economy that the claimant can 

do, given the residual functional capacity, age, education, and work ex:perience (20 CFR 404.1 SI 2(g), 404.lS60(c), 416.912(g) and 4l6.960{c). 

ALLEGATION(S) 

~Jmpail'me"ts. LimitQtion~ and Pain -Initial Level 

Alleged Impairments: 

Pain/Other Symptoms: 

Bad right hip. Bad right leg. Len shoulder injury. Diabetes. Neuropathv hands &: feet. Poor 

mLmory Blurred viflon in right eye. Dizziness 1-3 times a day Pain &: weakness in hip. leg 

shoulder. Neuropathy in hands and feeL Poor memory blurred vision right eye. Diuiness. Hlp leg shoulder paln diabetic neuropa/hy poor memory 

Unable to use my left Ill'm &: hand beclJRSt! ofoain de stiffness in shoulder. Numbness in mv 

hands which make it dimeult to grasp obiects & have nne manipulation. Neuropathy & 

pain in·my feet makes it diJ1icult to stand and walk (or anv length o(time. Poor memory 

makes it difficult to concentrate on a task & complete iJ In an acceptable period o(time & to 

fo/low lnstructicns. Blurry vision makes it difflcult to see. Dizziness makes it dimcult to do 

anything (or 10-10 min. 2-3 ti1lU!S a day. Pain in mv shoulder. arm and hands make it 

difficult to lift and carry ohieds use tools. and grasp ohil!cts. The pain in my hip and leg 

make it dimcult 10 stand. walk and sit (01' any length of time. It is very difflcuh 10 squat. 

bend. crouch and climb. 

lli 

=-menn- First Interfered With Ability to f1!.f!l..!ll!l! 

Height.' 5' 9" 

We;r:Jtt: 170Ihi. 

~~:~ l.i:rAb~:~:sWork;n;lJrie5. Condilio.,,! fu 

Su" For Emotional or Mental Conditio"s Yes 

That Limit Abilitvto Work: 

Client Remarks - 3368: 

~ E({ect on W~rk -Initial Le!)ei 

EveI' WOl'ked: 

Working Now,' 

When Stopped: 

Stopped Working Becllu.f;e: Becaun or my conditio" 

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624 

-- Page 3 of II Work Afler imDairmmt Firstlnte.rfered: ti!?. 

Ii) Impainnenls. Limitations and Effeds ~ Reconsiduation Level 

Any Changes in Condition: 

Changes in Condition: 

Date Occurred: 

Anv New lUnesses or Injuries: 

Anv N~w Physiwl or Mental Lirm/ations: 

Kg 

He has more anxiety. tightness ill chest. and more headaches 

l!lf!9.2. 

!i.e 

!i.e 

~:::on~;';';~:~ Affects Ability 10 Care for no change 

How DlJilvActivities Changed: 

Client Remarks ~ J441: 

Work Sfnce Original C/Qim Filed: 

SubmillingNew ElJidence: 

Reason Appeal Requested: 

!i.e 

!i.e 

liE IS TOO DISABLED TO SUSTAIN SUBSTANTIAL GAINFUL ACT IVIIT FOR AN 

EXTENDED PERIOD OF TIME BECAUSE OF HIS MEDICAL CONDITIONS 

~ ImpairmelJ1s. limitations and Effecb ~ Hearing Level 

Anv Changes in Condition: 

Changes in Condition: 

Dale Occu."ed: 

Any Nt:,., Illnesses or Iniuries: 

Anv New Phvsical or Mental Limilations: 

New Physical or Menial Limitations: 

Date Occurred: 

Kg 

Diuiness causes baianCL loss daily. di.r;,iness lasts (or 3()..60 minutes. Seizures occur 2 x a 

!!!!!!!!!1. 

5/19/09 

!i.e 

.l:'!i! 

Loss ofconcentratio1f and anxiety aJtock.s cause loss of memory and consciousness. 

5/19/09 

~:;:on~;;::~:~ Affects Abiliry to Carl! (or He needs help putting on his shirt because he can not lift his IJrms o"er his head. 

How DoilvActivities Changed: 

Client Remarks ~ 3441: 

W(Jrked Sin(,'e Filing For Reconsideration: 

SubmitlingNew Evidence: 

ReQSon Appeal Requested: 

!i.e 

In the future 

I AM TOO DISABLED TO SUSTAIN SUBSTANTIAL GAINFUL AC TIVITY FOR AN 

EXTENDED PERIOD OF TIME BECAUSE OF MY PHYSICAL AND MENTAL 

LIMITATIONS. 

See Next Page 
625 

Page 40fll 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant s date last insured is December 31, 2011. 

2. The claimant has not engaged in substantial gainful activityiv since January 1, 2007, the 

alleged onset date (20 CFR 404.1520(b), 404.1571 et seq., 416.920(b) and 416.971 et seq.). 

3. The claimant has the following severe impairment(s): Primary: DIABETES 

MELLITUSv (2500), etc., / Secondary: AFFECTIVE MOOD DlSORDERSvl (2960), 

Mental Retardation vii (3180), etc., etc., etc.,(20 CFR 404.1520(c) and 416.920(c». 

4. The above impairment(s) causes more than minimal functional limitations [ see below viii, i:I, \11.] 

" . 5. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one ofthe listed impairments in 20 CFR Part 404, Subpart P, Appendix 

1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926). 

The medical evidence of record from a mental prospective shows a 43 yo male alleging physical 

problems, poor memory. Mental status exam noted claimant oriented in basic spheres, of well 

below average verbal ability. Psychotic symptoms are not in evidence. Memory functions are on 

the weak side, probably consistent with general level of verbal ability. In delayed recall he holds 

2 of5 cities after a 6-minute interval. Immediate memory for digits is on the weak side. In simple 

tasks he retains adequate concentration as in counting backward from 20, which he performs 

accurately, but not at a fast pace. He has difficulty grasping instructions for serial 3s addition and 

cannot go past the fourth number which was a struggle taking 26 second. He is unable to perform 

serial 7 s subtraction. Asked toward the end of the exam to rate the degree of shoulder pain 

between I and 5 he replies that at the moment it is a 4 but up to that point he did not express any 

compliant. FO interviewer noted no problems with understanding, coherency, concentrating, 

talking or answering. Claimant shops for personal items, groceries, never used a check or saving 

account, can count change, fishes, spends time with friends in trailer park where he lives. 

The claimant has the following degree of limitation in the broad areas of functioning set out in 

the disability regulations for evaluating mental disorders and in the mental disorders listings in 

20 CPR, Part 404, Subpart P, Appendix 1: moderate restriction in activities of daily living, 

moderate difficulties in maintaining social functioning, moderate difficulties in maintaining 

concentration, persistence or pace, and one to two episodes of decompensation, each of extended 

duration. 

6. The claimant has the residual functional capacity to perform sedentary work as 

defined in 20 CFR 404.1567(a) and 416.967(a) except the credible evidence of record show 

the claimant is not functional at the sedentary level on a "regular and continuing" basis Iii. 

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626 ..• -

...... Page 5 ofll 

Physically speakingxiii, the medical evidence of record shows 43 yo male alleging bad r. hip, leg 

and pain, I. Shoulder injury, neuropathy. in hands and feet, diabetes, dizziness, blurred vision, 

poor memory. VITALS: 69.4, 181.2#, BP: 170/110, P: 87, R: 16, VA:B:20/25. CHEST: 

Respiratory excursions are unlabored and quite, lungs clear to auscultation. CARDIO: heart m, 

wlo murmurs, rubs, gallops or cliCks noted: ABD: soft, nontender w/normoactive sounds, no 

rebound tenderness, guarding or mass noted, no hepatomegaly, Ascites or abd Varices. 

EXTREMITIES: ROM of shoulder limiied, tenderness on palpation of subacromial bursa of bi! 

shoulders, no evidence of crepitus or effusion, ROM of elbows, wrists, hands WNL, no evidence 

of muscular atrophy or hypertrophy, ( ) Tinel s and Phalen s sign, grip 4/5 symmetrical bil., 

ROM of hips, knees, ankles WNL, knees do no demonstrate any evidence of crepitus or effusion, 

no evidence of dependent edema or varicosities. NEURO: CNS II XII intact, DTR s 

2+/syTnmetrical, no focal sensory deficits, Romberg s and Babinski (). 

MUSCULOSKELET AL:NML hand skills, fine tactile manipulation of objects nml, posture nml, 

ROM of axial spine in standing position appears WNL and wlo subjective discomfort, SLR ( ) 

in seated/supine positions bi!., heeVtoe walking nml bi!. GAIT: ambulates in a safe and stable 

gait at an appropriate speed wlo use of assistive devices. 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and 416.929 and SSRs 96-4p and 

96-7p. The undersigned has also considered opinion evidence in accordance with the 

requirements of20 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p. 

W AIS-IV given by Psychometrist 

9/15/2009 Full Scale IQ 72, Working Memory 71; Processing Speed 74; His overall thinking 

and reasoning abilities exceed those of only approximately 3% of individuals his 

age; may experience difficulty in keeping up with his peers in a wide variety of 

situations that require thinking and reasoning abilities; working memory better that 

approximately 3 % of his peers; Processing Speed he performed better than 

approximately 4% of his peers; 

DDD CE Exam, Dr. 

3127/09 

12 

13 

15 

Pain in both my shoulders and r can t raise my arms above my head; burning and 

tingling in both my feet and legs and I get dizzy ftom time to time; Diabetes 

Mellitus diagnosed in 2000, prescribed pills however he has not taken anything for 

this issue 

Work history is cross country truck driving, construction, and auto mechanic; BP 

1701110; range of motion of shoulders is limited; tenderness to palpation of the 

subacromial bursa of both shoulders; Grip strength 4/5 

Diabetes mellitus, untreated, essential hypertension, untreated; diabetic 

neuropathy by history; probable bilateral subacromial bursitis, acute and chronic 

Shoulder abduction left in supination 90/150; right in supination 90/150; left 

forward elevation 90/150; right forward elevation 90/150 

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627 

- Page 6 ofll 

DOD Mental Evaluation by Dr. l' 

5112/2009 Completed high school in special education; difficulty learning to read and required 

much individual attention forthe teacher; stopped work about 4-5 years ago because 

of pain in his shoulder; has a haunted look, talks in small voice and intonation is 

mainly flat; expresses himself in simple but direct terms;' indicated a depressed 

individual; well below average verbal ability, experiencing persistent shoulder pain 

and fatigue; describes fairly frequent strong heart palpitations, pain in the chest, 

which resembles attacks of anxiety; memory function is on weak side; immediate 

memory for digits on weak side; immediate recall of meaningful verbal material is 

much less than average; difficulty grasping the instructions for serial 3 s addition; 

not able to perform serial 7 s subtraction; attempting reverse recitation of the 

months reached October and cannot go beyond; scope of retained old information 

limited; cannot name any continents; judgment concerning social matters 

uninformed, slanted by impulsivity and excitement and erroneous; questioning 

concerning social relations brings out he has one trustworthy friend; fearful 

concerning his health; sleeps poorly; depressive disorder with pain, sub average 

verbal abHity,complaints of shoulder pain; Axis V: GAF 52 

MentalRFC 

5120109 Markedly limited: ability to understand and remember detailed instructions; ability 

to carry out detailed instructions; ability to interact appropriately with general 

public 

1. Basic Infonhation 

• is a 43 year 8 month old male who filed for concurrent Title II and 

Title XVI disability benefits with a protective filing date of March 4, 2009. He has an 

admirable earnings record which extends his insured status until March 31, 2011. .. 

~nas met his obligation to provide the available medical records in support of his 

contention that he is unable to perform work activity of Substantial Gainful Activity 

(SGA) magnitude in a competitive employment situation eight hours per day, five days 

per week, fifty weeks per year, (SSR 96-8p) and that his medical condition has been 

disabling since his onset date of January 1, 2007. His impairments Significantly limit his 

ability to do basic work activities, have lasted longer than twelve months and are not 

expected to improve. 

II. Determination of Disability 

LISTING OF IMPAIRMENTS §12.05C 

20 CFR 404.1526 states, For cases at the Administrative Law Judge or Appeals Council 

level, the responsibility for deciding medical equivalence rests with the Administrative 

Law Judge or Appeals Council. 

See Next Page 
628 

• F Page 7 ofll 

However. this equivalence must first have the input bv a medical expert appointed bv 

the Commissioner before the United States Administrative Law Judge is authorized to 

make a finding ofequivalencv . 

•••••• appears to have a mental condition which is equivalent to Listing 12.05C 

Mental Retardation with a Full Scale IQ of72 and other mental and physical impairments 

imposing additional and significant work-related limitations of function. 

The representative argues: • s equivalency to Listing 12.05C is argued using 

POMS §DI 24515.056(D)(c) which provides that slightly higher IQ s (e.g, 70-75) in the 

presence of other physical or mental disorders that impose additional and significant 

work-related limitations of function may support an equivalent determination. 

• I has a Full Scale lQ of 72 which falls in the 3'" percentile of individuals his 

age. He may experience' difficulty in keeping up with his peers in a wide variety of 

situations that require thinking and reasoning abilities. His Working Memorysubtest 

scored a 71, which is also in the 3'" percentile of his peers. He had difficulty with two 

tasks that demand mental control, that is, attending and holding information in short-term 

memory while performing some operation ofmanipulationx;v. 

The Social Security Consultative Examiner, who evaluated I P mental 

impairments, found weak memory function, weak immediate memory for digits, and less 

than average immediate recall of meaningful verbal materiaL He had difficulty grasping 

instructions to add by three s and was unable to subtract by seven s, He exhibited limited 

retained old information, was unable to name any continents, and had uninformed 

judgment concerning social matters." With this information it is our opinion that the 

Disability Determination Division might have approved this case if they had further 

developed it by directing a CE to administer the WAlS-IV examination, 

OTHER PHYSICAL AND MENTAL LIMITATIONS SECOND LEG OF LISTING 

§12.05C 

I • has severe pain in bilateral shoulders and is unable to elevate his arms beyond 

shoulder leveL The Social Security consultative examiner diagnosed probable bilateral 

subacromial bursitis which is acute and chronic. His grip strength was weak bilaterally. 

Range of motion examinati9ns of bilateral shoulders reveal 900 out of 1500 of abduction 

in supination and forward elevation.xvi F exhibits functional limitations as he 

requires help putting a shirt over his head, fixing his hair and trimming his beard:v;i 

The Social Security mental evaluation consultative examiner reports a had a 

haunted look, talked in a small voice and had flat intonation which indicated a depressed 

individuaL He described fairly frequent strong heart palpitations and pain in his chest 

which resembles attacks of anxiety. The physician evaluated him with a Global 

Assessment of Functioning (GAF) score of 52 which indicates moderate to severe 

symptoms and any moderate to severe difficulty in social or occupational functioning. 

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629 

Page 8 ofll 

III. Conclusion 

• E has an admirable work history in spite of his significant mental limitations. 

He worked jobs requiring physical labor ability until he was no longer able to perform 

these positions due to pain and loss of strength in his bilateral upper extremities. _ 

~does not have the funds or medical insurance to seek medical care, but there 

seems to be ample medical evidence that his condition is equivalent to Listings of 

Impairments § 12.05C. 

However, the United States Administrative Law Judge is not at liberty to make an 

equivalency finding without the opinion of a medical expert of record, which the record 

does not have included therein. Section 404.1526 

Accordingly, the United States Administrative Law Judge will conclude there is 

sufficient evidence by preponderance thereof to conclude that the claimant is functional 

below the sedentary level as provided in Social security Ruling 96-8p. 

It appears that his residual functional capacity (RFC) is significantly compromised, 

taking into account the severe mental impairments and mental limitations imposed, 

combined with the significant limitations of his upper extremities. These conditions 

would reasonably reduce the occupational base at a1l levels of functioning and the 

unskilled work base would be significantly eroded. Work activity at the SGA level, at an 

acceptable production rate pace, on a sustained basis, (SSR 96-8p) would reasonably be 

precluded and beyond his capability. 

TEST IS NOT THAT CLAIMANT IS ENTITLED TO THE BENEFIT OF 

DOUBT IN REGARD TO EACH DECISION MADE 

The representative argues that the claimant is entitled to the benefit of doubt in regard to each 

decision made herein which is not true. The test is by the substantial evidence rule. (See 

SSR 82-34c. Sections 216(i) and 223(d) (42 U.S.C. 416(i) and 423(d) The regulations used to 

make disability determinations under titles II and XVI of the Social Security Act were recodified 

effective August 20, 1980. See 45 FR 55566-55634 (1980) (recodified in 20 CFR 404.1501-

404.1598 and 20 CFR 416.901-416.996). The regulations cited in this ruling have been 

renumbered and rewritten as part of the recodification, but not substantively changed. See § 

404.1560-§ 404.1569 and Rule 202.10, Appendix 2, Subpart P of Regulations No.4.) 

The Court in Blalock v. Richardson. 483 F.2d 773, 775 (4th Cir. 1972), stated: 

The scope of judicial review by the federal courts is specific and narrow under §205(g) of 

the Act. That section provides that ' ... the findings of the Secretary as to any fact, if 

supported by substantial evidence, sha1l be conclusive .. .' The fact that the record as a 

whole might support an inconsistent conclusion is immaterial, for the language of § 

205(g) precludes a de novo judicial proceeding and requires that the court uphold the 

Secretary's decision even should the court disagree with such decision as long as it is 

supported by 'substantial evidence.' 

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630 

- Page 9 ofll 

The only time such a test of doubt is applied is in a criminal case where the claimant must be 

(ound guilty beyond a reasonable doubt. Certainly a Social Security Disability case is not a 

criminal case. and clearly ifany doubt had to be resolved in (avor of the claimant, the test 

would be even greater than that provided in criminal cases. In a civil case. the test is by 

preponderance of the evidence. certainlv not as strict a burden of proof as in a criminal case. 

A social security disability case is classed as a special proceeding and obviously the burden of 

proo[is closer to that ofa civil proceeding than it is to a criminal one. 

Accordinglv. the United States Administrative Law Judge must conclude that the claimant s 

representative assertions that all doubts must be resolved in favor ofthe claimant is simply put a 

misstatement o[the law. To so hold would amount to a determination that no hearing was even 

necessary as all doubt would have to be resolved in the claimant s favor. That is not the law. If 

the substantial evidence rule is dimcult to understand. many simply apply the preponderance of 

the evidence rule when arguing be(orean United States Administrative Law Judge. but it is noted 

that the courts apply the substantial evidence rule on appeal. 

The Act places the burden of establishing entitlement on the disability bene(it claimant. It 

does provide. however. (or consultative medical examinations that may provide needed 

medical evidence o[imp~irment. 

When a claimant has established that he or she has a serious impairment that prevents return 

to past relevant work, courts hold that the burden shifts to the Agency to establish that there is 

other work that a person with such impairments and the claimant s vocational characteristics 

can perform. 

These burden of proof rules are structured bv a sequential evaluation process that lays out (ive 

distinct stages in the determination. Stages one through (our lie in the zone where the burden 

is on the claimant. Thev include: (Ii the preliminary question whether. despite impairments. 

the claimant is. in (act. engaged in substantial gainful activitv, (2) the determination 

whether the claimant has an impairment of sufficient severity to interfere with the ability to 

perform work activities, (3) a comparison of the claimant s medical impairments with the 

listing o(numerous conditions warranting a conclusion of disability, and (4) a determination 

whether the claimant has the ability to perform past relevant. work. In stage five where the 

issue is whether there is other work that a person with the claimant s characteristics can do 

the burden is on the Agency but in any case covered br the Medical-Vocation Guidelines. the 

guidelines themselves may meet that burden. In cases not governed by the guidelines,' there 

must be other evidence. 

These (ive stages operate in sequence. Evidence that' would be relevant or even dispositive at a 

later stage will not prevent a contrary decision at an earlier one. The regulations layout this 

process in great detaiL Social Security Ruling SSR No. 86-8 provides explanation. 

Courts emploring the substantial evidence standard have developed other more specific 

burden of proof or evidentiary rules, such as rules according special weight to medical 

testimony or reports coming from the claimant s treating physician. 

See Next Page 
631 

~ .... ' Page 10 of 11 

It is certainly reasonable to conclude that. • mental impairments would interfere with 

his ability to focus on a task and complete it in an acceptable period of time. A decision that he 

is disabled as alleged is in full compliance with the intent and purpose of Social Security Law 

and Regulations. 

After considering the evidence of record, the undersigned finds that the claimant s medically 

determinable impairments could reasonably be expected to produce the alleged symptoms, and 

that the claimant s statements concerning the intensity, persistence and limiting effects of these 

symptoms are generally credible. 

The State agency medical consultants physical assessments and psychological consultants 

mental assessments are given little weight because the State agency consultants did not 

adequately consider the claimant s sUbjective complaints or the combined effect of the 

claimant s impairments. 

7. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 

416.965). 

8. The demands of the claimant s past relevant work exceed the residual functional 

capacity. 

9. The claimant was a younger individual age 18-44 on the established disability onset 

date (20 CFR 404.1563 and 416.963). 

10. The claimant has at least a high school education and is able to communicate in 

English (20 CFR 404.1564 and 416.964). 

11. The claimant s acquired job skills do not transfer to other occupations within the 

residual functional capacity defined above (20 CFR 404.1568 and 416.968). 

12. Considering the claimant's age, education, work experience, and residual functional 

capacity, there are no jobs that exist in significant numbers in the national economy that 

the claimant can perform (20 CFE. 404.1560(c), 404.1566, 416.960(c), and 416.966). 

In determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual functional capacity, age, education, and work experience in 

conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. 

If the claimant can perform all or substantially all of the exertional demands at a given level of 

exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" 

depending upon the claimant's specific vocational profile (SSR 83-11). When the claimant 

cannot perform substantially all of the exertional demands of work at a given level of exertion 

and/or has nonexertional limitations, the medical-vocational rules are used as a framework for 

decision-making unless there is a rule that directs a conclusion of disabled without considering 

the additional exertional and/or nonexertional limitations (SSRs 83-12 and 83-14). If the 

claimant has solely nonexertional limitations, section 204.00 in the Medical-Vocational 

Guidelines provides a framework for decision-making (SSR 85-15). 

See Next Page 
632 

Page 11 of 11 

If the claimant had the residual functional capacity to perform the full range of sedentary work, 

considering the claimant s age, education, and work experience, a finding of "not disabled" 

would be directed by Medical-Vocational Rule 201.28. However, the additional limitations so 

narrow the range of work the claimant might otherwise perform that a finding of disabled is 

appropriate under the framework of this rule. This conclusion is supported by Social Security 

Ruling(s) 96-9p. 

13. The claimant has been under a disability as defined in the Social Security Act since January 

I, 2007, the alleged onset date of disability (20 CFR 404.1520(g) and 416.920(g»). 

DECISION 

Based on the application for a period of disability and disability insurance benefits filed on 

March 4, 2009, the claimant has been disabled under sections 216(i) and 223(d) of the Social 

Security Act since January I, 2007. 

Based on the application for supplemental security income filed on March 5, 2009, the claimant 

has been disabled under section 1614(a)(3)(A) of the Social Security Act since January 1,2007. 

The component of the Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments, and if eligible, the amount and the months for which payment will be made. 

Medical improvement is expected with appropriate treatment. Consequently, a continuing 

disabilitv review is recommended in 12 months. 

A determination to appoint a representative payee to manage payments in the claimant s interest 

is recommended. 

W. Howard O'Bryan, Jr. (0453) 

Administrative Law Judge 

October 28, 2009 

Date 

Title II of the Socia! Security Act is administered by the Social Security Administration, Title 11 appears in the United States Code as §§401-43J, 

subchapter II, chapter 7, Title 42. hnp:llwww.sss.gov/OPHomelssactltitle02J0200.htmiii 

W. HowsrdO Bl"}1In,Jr .. (0453).UnitedStatesAdminUra~iveLawJudge,SociaISet:urilyAdministrationOffice of Adjudicatiorond Review. Whomay pruidc:5 USC 

S56(b);powcn;orthc prcsidingofficcr. S USCSS6(t;};Spccialro!coflhc Administrativd...awJodgcin SocialSecuriry:Hedderv. Campbell 461 U.S.458,471, 103 S.Ct.1952, 

1959, I S$.R.S.3, lO,CCH'V 14,585(1983)PlxORY Heckle); 8! I F,2dS06.510,16 S.S.R.S. 279,28) (IOtheir. I 987)Jamesv, Bowen 7'93 F.2d 702, 704-705.14 S.S.R.S. 
633 

Page 12 ofll 

87.89-90.CC'H' 17.071(5thCir. J986).~v. !!!ni!.6S1 F.2d51)(7IhCir. 1981);~v.~S27 F.2d2J4(3rdCir. t97S)(Admini'stnJtivd...awJudgemust 

develop rull m:ordwhcrt:dBjmanlnotn:p~cntcdby counsd);Bl.luct:, Kaney HCt"klc!;' 731 F.2d 1216,4 S.S.R.S.HO. CCH'i IS,J24(5th Cif. 1984),!!!!.!£.rv. ~ 754 

F.ld 274/8thCir. 1985):Jordanv. Hcckl« SIS F.ld 1314,20 S.S.R,S. IS8, CCH1 17.808 (IOthClr. 1987),(Administrativd...aw Judge mustdcvc}op full nx:ordeven if 

c1nimantrcp~cI'1tI:d!Jy t"ounsd)Social SccurityRulng 71-2); Socia! Sec:urilyRc:gulstiorLS20 CFR.§§ 404.944and -4 [6.1444,sec alsQ 20CFR404.950.404.951 ,416.1450800 

416.1451 :SocialSccurityAet. §§ 305{b}and J63 !(c}(l) 

iii 10 Code of Federal Regulations Ch. III (4-1..(16 edition) section 404.948: Deciding a tate wtthout an oral hearing before an 

administrative law judge. (a) .Decision wholly favorable. lrthe e:vidence in the hearing record s.upports a finding in favor of you and a1 the 

parties on every issue, the Administrative Law Judge may issue a hearing decision without holding an oral hearing: 

Vocational Information 

~Jobs Worked;" the Last 15 years 

Job Titte 

I. Forklift operator 

2. Manual Labor 

~ TickellProgi'am Information - Initial Level 

Type of Business 

Varlow 

Liquor/alcOOoJ 

Participate in Ticket program or another No 

program? 

~ TicketlPfogram Infol'monon ... Reconsideratwn Level 

Participate in Ticket program or another No 

program? 

~ Ticket/Program infortnatioll- Hearing Level 

Parttcipate in Ticket prl.lgram or another No 

program? 

~Additionallhformation 

Worktn.g now? 

Stopped working because: 

Stopped working when: 

No 

Because of my condition 

12131/1006 

From 

1990 

Unknown 

To 

2006 

one week 

Alleged Impairments: 

Bad right hlp, Bad right leg. Left 'Shoulder injuryt Diabetes, Neuropathy hands & feet, 

Poor memory, Blurred vision in right eye, Dimne5.s 2-3 times a day Pain & weakness in 

hip, leg, shoulder. Neuropatby In hands and feet. Poor memory, b!urred vision right eye. 

Dizzi'!ess. Hip leg shoulder pain diabetic neuropathy poor memory 

v 9.08 Diabetes mellitus. With: 

A. Neul"Opathy demonstrated by significant and persistent disorganlzadon of motor (unction in two extremlties resulting in 

sllstained dbturbance of gross and dexterous movements, or gait and Station (see II.OOC); or 

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634 

• L •• Page 13 ofll 

B. Acidosis occurring at least on tbe anrage of once every 2 months documented by appropriate blood chemical tests (pH or 

pCOl or bil::arbonate levels); or 

C. Amputation at, or above, the tarsal region due to diabetic necrosis or peripheral arterial disease; or 

D. Retinitis pl"'oliferansj evaluated under the visual impairment under the criteria in 2,02, 2.03, or 2.04. 

ML-1l00C provides: •.• PenisteDt disorganization or motor function is the fonn or paresis or paralysis, tremor or otber 

involuntary movements, ataxia and sensory disturbances (any Of all of wbich may be due to cerebellar, brain stem, spinal cord, or 

peripheral nene dysfundion) which may occur singJy or in various combination, frequency provides the sole or partial basis for decision 

in cases of neurological impainnent. Tbe assessment of impainnent depends on the degree of interference with locomotion andlor 

interference with the use of fingers, hands., and anns. 

ML-2.0Z provides ... Impairment of central visual acuity. Remaining vision in the better eye after best corrtttion is 20/200 or 

less. 

ML-2.03 provides ••• Contraction of the peripheral visual fields in the better eye. 

A.. To 100 or less from the point of fixationi or 

B. So the widest diameter subtends an angle no greater than 20°; or 

C. To 20 percent or less visual field effideRCY. 

ML-2.04 provides ... Loss of visual efficiency. Visual efficiency of the better eye after best correction 20 percent or less. (The percentage 

of remaining Visual efficienc.y = the product of the percent of remaining visual efficiency and tbe percent of remaining central visual field 

efficiency.) 

vi n.04 Affecti'ole disorders: Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. 

Mood refers to a prolonged emotion tbat colon the whole psychic life; it generally involves eithe ... depression or elation. 

The required le\'el of severity for then disorders are met when tbe requirements in both A and Bare satisfied, or when the requirements 

in C 8re satisfied. 

A. Medically documented persistence, either continuous or intennittent, of one of tbe following: 

I. Depressive syndrome characterized by at least four of the fonowing; 

a. Anhedonia or pervasive loss of interest in almost aU activities; or 

b. Appetite disturbance with change in weigbt; or 

c. Sleep disturbance; or 

d. Psychomotor agitation or retardation; or 

e. Decreased energy; or 

f. Feelings of guilt or worthlessness; 0 ... 

g. Difficulty concentrating or thinking; or 

h. Thoughts of suicide; or 

i. Hal1ucinations, delusion!, or paranoid thinking; or 

2. Manic syndrome characterized by at least three oftbe following: 

B. Hyperactivity; or 

b. Pn~ssure of speech; or 

c. Flight of ideas; or 

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635 

Page 14 of 11 

d. Innsted self-esteem; or 

e. Decreased need ror sleep; or 

f. Easy distractibility; or 

g. Involvement in activities that have Il high probability or painful consequences which are not retognized; or 

h. Hallucinations, delu.sions or paranoid thinldng; or 

J. Bipob.r syndrome with a history or episodic periods manifested by the rull symptomatic picture of both manit: and depressive 

syndromes (and currently characterized by either or both syndromes); 

AND 

B. Resulting in at least two orthe following: 

1. Marked restrictio,n or B(;.tivities of daily living; or 

2. Marked.difficu1ties in maintaining sodal runctioning; or 

3, Marked difficulties in maintaining concentration, persistence, or pace; or 

4. Repeated episodes or decompensation, each of extended duration; 

OR 

C. Medically documented history or a chronic affective disorder or at least 2 years' duration that ba~ caused more tban a minimal 

limitation of ability to do basic work activities, with symptoms or signs cu..-rently attenuated by medication or psychosodBI support, Bnd 

one of the rollowing: 

1. Repeated episodes or decompensation, each of extended duration; or 

2. A. residual disease pr4JCE:SS that has resulted in such marginal adjustment tbat even a minimal increase In mental demands or change in 

the envir4Jnment would be predicted to nuse the individual to decompensate; or 

3. Current history of J or more years' inability to runction outside a highly supportive living arrangement, with an indication or 

continued need (or such an arrangement. 

3 12.05 Mental retardation: Mental retardation refers hi significantly sub average general intelledual runctioning with deficits in adaptive 

functioning initiaJty manifested during the developmental period; J.e.., the evidence demonstrates or supports onset of the impairment 

before age 22. The required level or severity ror tbis disorder is met when the requirements in A, B~ C, or D are satisfied. 

A. Mental incapadty tvidenced by dependence upon others ror personal needs (e.g.t toileting, eating, dressing. or bathing) and inability 

to rollow directions, such that the use orstandardized measures 4Jr intellectual runctioning is precluded; OR 

B. A. valid verbal, perrormance, or full scale IQ or S9 or less; OR 

C. A nlid verbal, performance, or rull scale IQ or 60 through 70 and a physica1 or other meatal impairment imposing an additional and 

signific:ant work-related limitation or function; OR 

D. A. valid verbal~ performance, or full scale IQ of60 through 70, resulting in at least twoorthe rollowing: 

1. Marked restriction or activitles or daily living; or 

2. Marked difficulties In maintaining social functioning; or 

See Next Page 
636 

••• r .. __ s .. Page 15 oflI 

3. Marked difficulties in maintaining concentration, persistence, or pllce; or 

4. Repeated episodes of decompensation, each. of extended duntion. 

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637 

t __ Page 16 ofll 

viii 

MENTAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT 

NAME 

CATEGORIES (From lCofrfle PRTF) 

12.04 

I. SUMMARY CONCLUSIONS 

ASSESSMENT IS FOR: 

IE ClB"renl Evaluallon 

ODateLasl Insured: 

00lher. 

OCIAL $ECURITY NUMBER 

012 Months After Onset: 

10 ---::ff"'-,"---

This section 15 for recording summary conclusions derived from Ihe evidence In file. Eacll mental actI\ilty Is to be 

evalUated wllhln lhe context 01 tM indMdllars capadty 10 SlJS13!n lhat aCIMty o'Jer a nonnal worl«wy and woo1(WOOk. 

on en ongoing basis. Detailed Elxplanmlon 01 the dagr.., of limitallon for Bach caJagol)l fA through 0). as well as any 

other assessment Intonnatlon you deem approprtate, Is to be recorded In Sec!Ion III (Functlonal capacity 

Assessment). 

If rmlng cmegory 5 Is che<:ked for any ofthe1ollowlng Items. you Ml.!SI specllji In section II too evldel'C8lhat Is 

needed 10 make the _.s.menl. Ifyoo oonclUde 1hat the record is 60 inadequately dO«Jmel1led that no accurate 

funCiional capacity assessment can be made, indicate in Section 11 what development is nec.assary. but DO NOT 

COMPLETE SECllON Ill. 

Not No E\ildenco No! Ratable 

Signlicantly Moderately MarlIedly of Umilation in on Available 

Llm~ed L1mfted Limned this Category E\M6nce 

A. UNQERSIAMJINGANQ MEMORY 

1. The abllftyto rOOlOO1ber loca1lons and 1. !&! 2.0 3.0 4.0 5·0 _·lIke procedures. 

2. The ability to understand and remam- 1·1FJ 2. 0 3·0 4·0 5·0 her very shOll and simple InstructiOns. 

3. Th8 Abilftylo undersland and raman;. 1.0 2.0 3.18I 4.0 5.0 ber detailed instructions. 

El. l>!.l;rr~N!;Q GQ~~B8J]QM 8M2 e!;B&IST~E 

4. The ability to ClIIT'/ out wry shOll and 1. !&\ 2. 0 3.0 4.0 5·0 

E-Imple InstruClloT11l. 

S. The abil~y 10 cany oul detailed ;""'rue- 1·0 2.0 3.1&\ 4.0 5.0 lions-. 

a The abiltty to malntaln attention and 1. !&! 2. 0 3·0 4.0 5.0 concentration for ,,"'ended pertods. 

7. The ability 10 perform activfties within a 

I. jg( 2·0 3.0 4·0 5·0 schedule. maintain regular al:fendanC8. 

and be punctual WIthin customary tolerances. 

B. The ability to susIBln an ordinary lOudne 1.1&1 2·0 3·0 4·0 sO wilhoul special supervision. 

9. The a bll_y tD IIlOIk In coordination wHh 

or proxlmfty 10 others wfthout 1.18l I>Blng dis· 

Iracled by lhem. 2·0 3·0 4·0 5·0 

lU. The ability 10 make simple work-!elaled 

dec:isians. l.l8I 2.0 3.0 4·0 5·0 

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638 

Page 17 oflI 

;, 

Not No Evidence Not Aalable 

Signllicanijy Moderately Mar1<edly afl/mllation i~ on Available, 

Umlted Umned Umlled 1~ls Categol)' Evidence 

COI'lllnued- SUSTAINED gOtJQENTB,A,TIQN 

AND PERSISTENCE 

11 _ The ability to complete 8 no """,I "ork· 1·181 2·0 3·0 4·0 5·0 day and workwe&k whhout intenuptl-ons 

from psyohologjoolly """.d 51Impi:O<T<! 

and to perform at a <Xll19stent pace 

without an unr966onable. nul'T'ber and 

length of rest periods. 

C SOCIAL INTERACTION 

12. The ability to interact appropriately Vvith 1:0 2·0 3. 1m 4·0 5·0 the general public. 

13. The ability to ask simple questioro or 1.181 2.0 3.0 4.0 5.0 request assistance" 

14, The ability to accept instructk:>ns ard 

T89pond appropriately 10 er!tfdsm from 1·181 SUpervisoT5. 

2. 0 3. 0 4·0 5.0 

15. The ability to get along with cowcrkers 

or peers without distracting them or 1. (&1 2·0 3·0 4·0 -5·0 

exhibibng behavioral extremes. 

113. The dbilityto maintain sociaUy a,opr(; 

prime behavior 2lf1d to adhere to basic 1. 1m 2·0 3·0 4.0 50 standards of neatness a.r:1d cleanlineSS'. 

O. ADAPJATION 

17. The ability to respond appropriately 10 1.181 2.0 3. 0 4·0 5.0 changes in the wor\{ scUing. 

1 a. The ability to ba aware of normal hoz- 1.(&1 2,0 3. a,,1s and take appmprlale precau~ons. D 4.0 5. 0 

1 ~ The abUity to trallel in unfamiliar 1~ 2·0 3_ D 4·0 5_ 0 pla~as or usa public Iransponation. 

20;111e abilily to ~ reaDstic goal6 or make 1 jgJ 

plans Independently of othern. . 2·0 3.0 4.0 5.0 

III. FUNCTIONAl CAPACITY ASSESSMENT 

Record the elaberations on the preceding capacities in this section. Complete this section-ONLY after the SUMMARY 

CONClUSIONS section has been completed. Explain your summary conclusions in narrative form. Include any information Which 

c!ariiies Ijmitation or function. 8e especially oareful to explain conclusions that differ from those of treating medica! sources or from 

the individual's allegations. 

Claimant can perf ODD simple tasks with routine supervision, can relate to 

supervisors and peers on a superficia1 work basis, cannot relate to the general 

pub1ic 1 can adap~ to a work situation. . 

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639 

• a • ,i 

C. MANIPUlATIVE UMiTATIONS 

o None established. (Proceed 10 section D.) 

LIMITED 

1. Reaching all directions Qncluding overhead) ----------I~ jg 

2. Handling (gross manipulation) ~ 0 3. Fmgerlng (line manlpulaIlon) ~ 0 4. Feeling (skin recepto"') ~ 0 III Social security Ruling 96-8p reads in pertinent part: 

Page 18 of 11 

UNLIMITED 

o 

181 

181 

tgI 

Ordinarily. RFC is the individual's maximum remaining ability to do sustained work lIctivities in an ordinary work setting on a regular 

Bnd continuing basis. Bnd tbe Rife assessment must include a discussion of the individual's abilities on that basis. A "regular and 

continuing basis" means 8 hOUfS a day, rorS days a week. or an equivslentwork schedule. 

The combined effect of the claimant s symptoms results in physkallimitations which deprive the claimant of the- abUity to do sustained 

work activities in an ordinary work setting on a regular and continuing basis (SSR 96-8p). She c.annot engage in work activity 8 honn 

a day, for 5 days a week~ OT an equivalent work scheda.le (SSR 96-Sp). The Administrative Law Judge therefore concludes that there are 

no jobs existing within the national Konomy which the claimant can perfonn in an ordinary work setting on 8 regular and continuing 

basi~ that is: 8 hours a day, for 5 days a week, fir an equivalent work schedule (SSR 96-8p). 

PHYSICAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT 

PRIMARY DIAGNOSIS: 

OM, untreated 

SECONDARY DIAGNOSIS; 

xv Social Security Consultative Examination 

"i DOD Consultative examination dated 312712009 

,>oj Adult function Report dated 3/1312009 

See Next Page 

o Dale 

12 Months After Onset: 

(Date) 
640 

~ 

.\~\.. SEC&: 

SOCIAL SECURITY ADMINISTRATION 

~ IIljlU), Refer To I ..; ... ·15nJi. Office of Disability Adjudication and Review 

301 Nw 6th 8t 

3rd Floor West 

Oklahoma City, OK 73102 

Date: October 10,2008 

NOTICE OF DEOSION - FULLY FAVORABLE 

I have made the enclosed decision in your case. Please read this notice and the decision carefully. 

Tlds Decision is Fully Favorable To You 

Another 011lce will process Ihe decision and send you a letter about your benefits. Your local 

Social Security office or another may first ask you for more infonnation. If you do not hear 

anything for 60 days, contact your local 011lce. 

The Appeals Council May Review The Decision On Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do 

so. To do that, the Council must mail you a notice about its review within 60 days from the 

date shown above. Review at the Council's own motion could make the decision less 

favorable or unfavorable to you. 

Iryou Disagree With The Decision 

If you believe my decision is not fully favorable to you, or if you disagree with it for any 

reason, you may file an appeal with the Appeals Council. 

How to File an Appeal 

To file an appeal you or your representative must request thai the Appeals Council review the 

decision. You must make the request in writing. You may use our Request for Review form, 

HA-520, or write a letter. 

You may file your request at any local Social Security office at a hearing office. You may 

also mail your request right to the Appeals Council, Office of Disability Adjudication and 

Review, 5107 Leesburg Pike, Falls Church, VA 22041-3255. Please put the Social Security 

number shown above on any appeal you file. 

Permanent Subcommittee on Investigations 

EXHIBlT#12 
641 

Page 2 of3 

Time to File an Appeal 

To file an appeal, YOIl mllst file your request for review within 60 days from the date you get 

this notice. 

The Appeals Council assumes you got the notice 5 days after the date shown above unless 

you show you did not get it within the 5.day period. The COllncil will dismiss a late request 

unless you show you had a good reason for not filing it on time. 

Time to Submit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider with your 

request for review. 

How an Appeal Works 

Our regulations state the mles the Appeals Council applies to decide when and how to review 

a case. These mles appear in the Code of Federal Regulations, Title 20, Chapter III, 

Part 404 (Subpart J). 

If you file an appeal, the Council will consider all of my decision, even the parts with which 

you agree. The Council may review your case for any reason. It will review your case if one 

. of the reasons for review listed in our regulation exists. Section 404.970 of the regulation lists 

these rea.~ol1s. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. TIle Council may 

also send it back to an Administrative Law Judge for a new decision. 

UNo Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed 

only under special ru les. 

See Nell.'t Page 
642 

- Page 3 of3 

If You Have Any Questions 

cc: 

If you have any ql.festions, you may call, write or visit any Social Security office. If you visit 

an office, please bring this notice and decision with you. The telephone nUlllber of the local 

office that serves your area is (405)605-3000. Its address is Social Security, 2615 Villa Prom, 

Shepherd Mall, Oklahoma City, OK 73107. 

W. Howard O'Bryan, Jr. (0453) 

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 
643 

IN THE CASE OF 

(Claimant) d 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

I approve the fee agreement between the claimant and her representative subject to the condition 

that the claim results in past-due benefits. My determination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. 1 neither 

approve lIor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REV lEW OF THIS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, J.D. 

Regional Chief Administrative Law Judge 

SSA ODAR Regional Ofc 

Rm460 

1301 YoungS! 

Dallas, TX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement. If so, please write directly to me as the 

deciding Administrative Law Judge within IS days of the day you are notified of the amount of 

the fee due to the representative. Your representative also has 15 days to write me if he/she does 

not agree with the fee amount under the approved agreement. 

See Next Page 
644 

Page 2 of2 

You should include the social security number(s) shown on this order on any papers that you 

send us. 

/5/ 6)f~0!DaJJCd () 'r!iJ'1JIa;n, 

fi· 

w. Howard O'Bryan, Jr. (0453) 

Administrative Law Judge 

October 10, 2008 

Date 
645 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefitsl 

• & 

(Social Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the undersigned2 on a request for hearing dated August 25, 2008. The 

evidence of record supports a ["Up [aI'orable decisioll; therefOre 110 hearillg' has been held (20 

CFR 404.948(a». TIle claimant is represented by Terry Gllst, all attorlley. 

The claimant is alleging disability since June 1,2005. 

The issue. is whether the claimant is disabled under sectiollS 2 Hi(i) and 223(d) oflhe Social Seolflty Ad. Disability is defined 3S the inability to 

engage in any substantial gainful activity by reason of any medically determinable physical DC mentsl impairment or combination ofimpairments 

that can be expected to result in de.ath or that has lasted or can be expected to 1m for a continuous period of nol less !.han 12 months. 

There is an additional issue whether the insured status requirements of SC!;t1ons 216(i) and 223 of the Social Security Act are mel The claimant's 

eamings record shows that the claimant has acquired sufficient quarters of COVenlge to remain insured through June 30, 2009, Thus, the claimant 

must establish disability on or before that date in order to be entitled to a period of disability 2nd disability illSllrance benefits, 

After careful review of the entire record, the undersigned finds that the claimant has been disabled from June 1, 2005 through the date of tilis 

decision. The undersigned also finds that the insured status requirements of the Social Security Act were met as of the dale disability is 

established, 

Title II of the Social Security Act is admini51ercd by (he Social Scrurity Administrntion. Title II appears in the United States Code as §§401-43J, 

subchapter il, chapler 7. Tille 42. httP..Rw.W~,$~!l.!'QY1Q.P_liQmt;L!is_~~V.titl~_QlnI1QQJJJJJlttl 

2 

W. HOW2l'd O'Bryan, Jr •• (0453)., Ualted States IUmlnbtJ'IdJv. Lu:w JudI'!!, Stll:ia] Securiry Adm~iWn, Office of AdjudiCDiioTl IIlld Relliew. Who tn:ay pn'side: 5 USC 

556(b); Powm orthepn:JidlnR offiu.r; 5 USC 556((.), Sp~eioll role:: of the AdminiilntiY~ Law 1udJ;c in Socit!Stcurity: Hmdu v. Campbdl461 u.s 458,471,103 s.et t952, 

1959,1 S-S.R.~ J, lO~ CCH114 .. n:5 (lP'SJ);Dlxon .... H§kIer 811 F)d SM, 510, 16 S.S.R.S.l19.l8J (10th Cir, 1981) Jam,...- v. Bowm. 791 F.ld 701, 704·705,14 S.S.R.S, 87, 

89.90. eCli U 11,071 (jth Gr. 1986), ~ ". ~ tiSi F.1d 513 Oth CI£. 1981); ~ ¥.~, 527 F.2d 124 (lrd CII". 1975) (AdDlinismtivc Law Jud~ mu~t 

dcvdllP full reeC'l"~ where elaimant not rqweJcrrtcd by ellurucl); But. sec, ~ 7.11 F.2d 1216, 4 S.5.R.S- 340. CCH t 15.324 (5th Ca-, 19S4},!!.!u!g v.!:W!!!.tt. 754 

F.2d 274 (8th CiT. 198~); .A>rdan 'V, H«iO~. SJ' F.ld 1314, 20 S.S.R.s, 158, CCH 1117,808 (10th CIr. 19t17), (Adniinistntiw L_ Jude:' mun dcyeiop full record tV<tl if 

claimant rqm:~Tltcd by COlDl1d); ~~1 Security Rulinl71-2J; 5Dc~1 Security Rcgulatioru 20 CFR §§ 404~ and 416.1444. ste abo, 2DCFR 0104.950. 4Q.1.951, -'116.1450 II.Ild 

416.1451; SoWlScclU"ity Ad, §§305(1:.) and 1631(c)(1). 

l 20 Code of Feder.1 Regulatlon, Ch. 111 (4-1-06 edition) section 40.1.948: Deddlng a case without an .... 1 hearing before .n 

admlnlstr.dJve law Judge. (a) Decision wholly favorable. [f the evidence in the hearing record supports a finding in favor of you and al the 

parties on every issue, the Administrative Law Judge may issue Il hearing decision ~;thout holding an oral hearing. 

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Page 2 of 15 

APPLICABLE LAW 

Under the authority of the Social Sconity Act, the Social Sc.anity Administration has established a five~step sequential evaluation process for 

determining whctJler an individual is disabled (20 CFR 404.1 520(a»). The steps are followed in ordeL If it is determined thaLlhc claimant is or is 

not disabled at a step aflhe evaluation process, the evaluation will not go on to the next step. 

Al step _the undersigned must determine whether the claimant is engaging in substantial gainful activity (20 CFR 404.1 520(b)). SubstJlntial 

gainful activity (SGA) is defined as worl<. activity Ur.!l is both substantial and gainful. If an individual engages in SGA. she is not .i,abled 

rega rdless of how seve.re her physical or mental impainnents are: and regardl-ess of her age. education, and work: e}o,,'peri.ence. If the individual is 

not engaging in SGA. the analysis proceeds to the second step. 

At step two. the undersigned must determine whelher the daimanL has a medically detenninable impairment that is "sevt:re" or a combination of 

impairments that IS "'severe" (20 CFR 404J520(c)). An impairment or combination of impairments is "severe" within the meaning of the 

regulations if it significantly limits an individual's ability to perform basic work activities. If the claimant does not have a severe medically 

determinable impairment or combination of impairments, she is not disabled. If the claimant has a severe impairment or combinat!{}n of 

impairments, Ute analysis proceeds to llle third step. 

At step Ihree, the undersigned must determine: whether the daimant>s impairment or combination of impairments meets or medically equals the 

criteria of an im!J3.lrmentlisted in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 4Q4.1520(d). 404,1525, and 404.1~26). If the claimant's 

impairment or combination of impairments meets or medically equals !he criteria of a listing and meets l1le duration requirement (20 CFR 

404J509), the daim:mt is disabled. Ifit does not, the analysis proceeds to the nexr. step. 

Before considering step four ofthe sequmial evaluation process, the undersigned must fust detmnine the claimant's residual functional capadly 

(20 eFR 404.l520(e:)). An individual's rtsidual functional capacity is her ability to do physical and mental work activities on a sustained basis 

despite limitations from her impairments. In making lhis fir1ding. the ur1dersignc:-d must consider all of the claimant's impainnents, including 

impairments that Ilf' nol severe (20 CfR 404.1520«) and 404.1545; SSR 96.8p). 

Next. the undersigned must ddermine at step four ~ether the claimant has the residual functional capacity to perform the requirements of her 

past releV<lJ1t work (20 CFR 404, 1520(f)). [f the dalmant has the residual functional capacity to do her paSl relevant work, the claimant is not 

disabJed, If the claimant is unable to do any past releV1lnt work or does not have any past relev:ant work, the analysis proceeds to the fifth and last 

step. 

At the last step of the sequential evaluation process (20 CFR404.1520(g)), the undersigned must determine whether the claimant is able to do any 

other work (:onsidering her residual functional capacity, age, education,. and work experience. Jf the -claimant IS able to do other work. sbe is not 

disabled: If the claimant is not able to do other work and meels" the duration requirement, she is disabled. Although the claimant generally 

continues to have the burden of proving disability at this step. a limited burden of going forward with the evidence shifts to the Social Security 

Administration. 1n order to suppon. a finding that an individual is not disabled at this step, the Sodal Seonity Administration is responsible for 

providing evidence l1lat demonstrates that other work exists in significant numb~ in the national economy that (he claimant can do. given lht 

residual functional capacity. age, education, and work experience (20 CFR 404.15t2(g) and 4()4J~60(c))" 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant's date last insured is June 30,2009. 

2. The claimant has not engaged in substantial gainful activity since June 1, 2005, the 

alleged onset date (20 CFR 404.1520(b) and 404.1571 et seq.). 

3. The claimant has the foUowing severe impairment(s): Disorders of back4 disco genic 

and degenerative (7240), affective (mood) disorders (2960), etc., etc., etc.s, 

4 1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative 

disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root 0ncluding the cauda equine) or the spinal 

cord. With: 

A Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, fimitations of motion of the 

spine, Motorola's (atrophy 'Nith associated muscle weakness or muscle weakness) accompanied by century or reflex losses and, jf 

there is involvement of the low back, policystraightwleg raising test (sitting and supine): 

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Page 3 of 15 

OR 

B. Spinal arachnoiditis, confirmed by operative notes or pathology reports of tissue biopsy, Of by appropriate medically 

acceptable imaging, manifesled by severe burning or painful dysesthesia, resulting in the need for changes in position or posture 

more than once every two hours; 

OR 

C. Lumbar spinal stenosis resulting in pseudoc",udicalion, established by findings on appropriate medically acceptable 

imaging, manifesled by chronic no,," radicular pain and weakness, and resulting in inability to ambulate effectively. as defined in 

1.00B 2b. 

AII,g.;;on(s) 

E¥J ImpaintJelJ1s, LimitatiDnr and Pain w lniJW L~d 

Alleged Impairments: Disc degenerative disease. Depression. AnXielY. 

Limitations: I AM UNABLE TO SIT OR STAND FOR PERIODS OF T[ME. 

PainJOther Symptoms: Yes 

Impairments FirslIl1lerfered With Ab~rr~~ 05/3112007 

Height: 5' "" 

Weight: 200 Ibs, 

Ever Worked: Yes 

Working Now: No 

When Slopped: 0513112005 

Slopped Worlcing Because: I STOPPED BECAUSE OF MY DISABILITY. 

Work After Impairment First Interfered: No. 

Impairments, LIm/IaJi.ns wut EJJeelS - Recrmslr/uQJirJtl Level 

Ally Changes in Condition: Yes 

Pain in neck: is increasing; am '00<;.1.";0,. ~,,"ON to correct. Have scheduled EMG test with 

Dr. for Aug. 2nd to oCuina nerve in left arm and c.onsultation of the u.sults with Dr. 9th. New pain in left lower back 

Changes in Condition: and ldt leg has started; have an appl. Aug. 13the t() consult with 

concerning second opinion regarding Dr. and refemtl for alternative 

treatment for pain in lower back. including new left leg and left side. 

Date occurred: 0512007 

AIly New 1Hnesses or Injuries: No 

.A.!1y New Umitalions: Yes 

1 am still under the care of Dr. for depression and anxiety; some days I cannot 

fully function due to lack of sleep or sense offorebcxling. I Rm no< always self-motivated to 

accomplish simple tasks such as lightllouse work of ClTllIlds.1 can easily mi .. doctof 

appointments due to "dumb" things like locking myself Dill ofthe house, or simply forgelling 

. , . , whal day it is. My physicallimitalioll5 vary dep""ling on the pain levels; some day; I spelld 

New LmutatloTlS, most of my time on "home thel1lPY" SlIch as ice pa.cks and a tens machine prescribed by Dr. 

~I was confined to a ned; brace Which limited my driving for the past ,Ix wew; out 

offiustration I am "weaning" mysetffrom it It is not very convenient to be wiUlout the use of 

a car and that adds to the seru:e of uselessness. Severe headaches often result from neck pain 

and C'&1 Jead to nausea or incapacitation. 

Dale ()(curnd', 05/07 

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Page 4 ofl5 

How Condition Affects A~:o~Oa~::e:~ No effect 

My left hand continues to be numbed by the nerve being pinched.or damages, and J can't 

always usc it to it's full capability. My walking is now limited due to the nc:w pain in my leg, 

How Daily Activjties: Oianged: the pain begins shooting into my hip aJld the leg "gives" and 1 experience the sensation that it 

may snap or break, Sleeping is difficult. as I have to change posrtiotls frequently to give: relicf 

to my bad:.. I try to avoid taking Ambien as I do not 'NlUlt to become dependent 

I am appealing the denial of benefits based on my belief: Not all of the medical informaJ..ion 1 

provided was taken intQ consideration: my psychiatrisl, previous: neurosurgeon. and previous 

pain management physician were not listed IlS having entered cvitlcncc. While all medical 

Client Remarh ~ 3441: evidence may nOl be crucial, the file: should be complete to. base your judgment on ali facts. I 

also believe I should have the right to request a personal hearing; to make a fair asseSS"Jl:len! all 

interested parties should meet to discuss the details. 1 believe not all the taos can truly be 

'Written down and expressed, and you need to see and hear exactly what my daily life is like 

due to my physical conditions altius point in my life. 

Work Since Original Claim Filed: No 

Submittiug New Evidence: NQ 

Reason App,,1 Request'": I AM STILL DISABLED 

t¥J Impairments, LJmiJatJ"ns Ql1dFJTed:r - Hearing LeveJ 

Submitting Nt::w Evidence: No 

THE CLAlMANT WISHES TO APPEAL HER DATE OF ONSET. TH E CLAIMANT HAS 

Reason Appeal !\<quested: NOT WORKED SINCE 06101105. THE CLAIMANTS MEDICAL RECORDS SUB· 

STANTIATE THE 06101105 ONSET DATE. 

" ••••••• lrmyW.alL ... l Source Type: DoctorfHMorrhernpist 

Fir>l Visit: Oll1312007 

La~t Visit Q6/07/2007 

Next Appt: 0611812007 

Reason for Visits: depression 

Treaunent rntds and counseling 

Medkations: CYMBALTA 

•••••••• M [nidal LY-1'el 

Source Twe: DoctorfHMOITherapist 

Source Name: ........ MD 

,~MAN~ 

A~~ ............ 

Voice Phone: 405-736'-

First. Visit 0&11312006 

Last Visit: OSI0712oo7 

Ne,. Appt: ONGOING 

Reason for Visits: PAIN MANAGEMENT 

Treatment: MEDS 

Medical Tests: §QNE DENSITY 

Dale: 0610612007 

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649 

~~-ln/IJaIL"'d 

5(lurce Type: DoctorlHMOITherapist 

Serum Nwne: •••••••• MD 

MEDICAL RECORDS 

Last Visit: 05/3012001 

Next Appt as needed 

Reason for Visits: NEUROSURGEON 

TreaIment; MEDS 

Medications: ALEVE, ROBAXIN 

Medical Tests: MRI 

Body Part: SPINE 

Date: 05nOO7 t_ Levd 

Source Type: DoctorlHM:orrhcnapist ___ MD 

Last Visit: 05/0112001 

Next Appt: no 

Reason for Visil.s: pcp 

Treaunent: mcds 

Page 5 of 15 

M d

· t· . Ambit. Qlmj1gj!!.L LiPjlQ! •• M,Qilln.L l'~x.. flil<1l.t"-. SingyttiL XlInax , "a IOns. MlYAl!L.~.!KIZ.. IQfQ.MA2i.. YERAPAMlL 

Source Type: DoctorlHMOrrbcrapist 

Saurce Name: MD 

Address: OKLAHOMA CITY. OK 13112 

Voice Phone: 405.94~ 

First Visit: 08102107 

Last Visit: unk. 

N •• tAppl: 1lIlk 

Reason for Visits; EMG 

Tre,lment: EMG 

Medical T <sts: fMG 

Date: 08101101 

Reeonsl,u,.1i81l L<I'el 

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650 

SOUTee Type: DoclorlHMOfflll:'apisl Source Name: _. ___ ._.MD 

Address: ___ 

First Visil: 03/13/2007 

Last Visit: 07/19/07 

Ne>, Appt: 08116107 

Reason for Visits: She is treating me for depression and anxiety, 

Treatment: Verb.llhempy 

Medications: ~ 

•••• IRec.nsidoaJIOn L"'e! 

SOIIree Type: DoclorlHMOfrhmpisl 

SourCe Name: __ ._._ •• MD 

____ AIN MANAGEMENT 

AddrCSS-... 

Voice Phone: 405-736'-

First Visit: 08123/2006 

Last Visit: 05107 

NeXt Appt none 

Reason for Visils; Epidural injections fur pain in lower back right side. 

Treatment: Epidural injections 

Ruons/dufJ1ion Lt'Vel 

Source T}1"" [)oclorlHMOITherapist 

Source Name: 1 r-.m 

Voice 

F~st Visit: 05/0212007 

Last Visit: 05/30107 

Next Appl: 05/09107 

Reason for Visits: Numbness in left armlhand And pDin in nedc 

Page 6 ofl5 

Trea.tment: ~;:~~:;:i~;~~:~~e~S machine, neck brace, ENG test, MRI and X-mys to determine 

Medicalions: .(\)g.Y.E_. !l..QJl.i\X!.tl 

Medical TeslS: X:..!'!Y. 

Body Part: Head an<I neck 

Date: 05/09/07 

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Page 7 of 15 

The claimant has the following degree of limitation in the broad areas of functioning set out in 

the disability regulations for evaluating mental disorders and in the mental disorders listings in 

20 CFR, Part 404, Subpart P, Appendix I: mild restriction of activities of daily living; moderate 

difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, 

persistence or pace; and one to two episodes of decompensation. 

The claimant's mental impairment(s) does not satisfy the paragraph "C" criteria of the applicable 

mental disorder listing(s). 

4. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one of the listed impairments in 20 CFR Part 404. Subpart P, 

Appendix 1 (20 CFR 404.1520(d». 

5. After careful consideration of the entire record, the undersigned fmds that the 

claimant has the residual functional capacity to perform sedentary work as defined in 20 

CFR 404.1567(a) except the recol'd shows the claimant is fWlctional below the sedentary 

level for any sustained, continual or regular activity. 

First Visit: 1999 

Last Visit: 05/07/07 

Next Appt: 08/13107 

Reason for Visits: Primary care 

Trcaunent: All general ailments and specialized referrals. 

Med' , ,Arnbien. ~ l.JilllQL Medizine N:lso~x ~ Singuiair, XI:Inax. 

OCHUons. AlliiAll\... &1Ji.JJN~ tLGIZ., R!;JpM .• IQl'QMAx-' .. YJiMJ' .. A.MU .. 

t~~JJ' •••••••••• alm$lJleral101t Lellel 

(20 CFR4D4.l520(c». 

Source 

Voice 

Oulpatient First Visit: 05/09101 

OulpatieIt Last Visit: 0616107 

Reason for Visits: MRl. x~rays or other tests only_ 

, Treatment: testing 

Medical Tests: t?Qn~_Q_~!!$".iJY.~ 

Dale: 06/06107 

Medical Tests: MBJ.. 

Body Part: neck 

Dale: 05/09/07 

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652 

Page 8 oft5 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

____ M.D. 

Diplomat 

American Board of Psychiatry and Neurology 

American Board of Forensic Medicine 

American Board Analysts 

SOCIAL SECURITY DISABILITY EVALUATION REPORT 

NAME. 

SS~ 

CLAfM~ 

DATE OF BIRTH: •••• 

DATE OF EVALUATION: 04/12/2008 

IDENTIFYING INFORMATI01'~.II!!I" •• 1 is a fifty-five-year-old, Caucasian, married, 

unemployed female who comes in for a Social Secunty disability evaluation based on her mental 

health. Her identification was verified and the HIP AA form was completed before the interview. 

HISTORY £ & reports that she has degenerative joint disease of her cervical and lumbar 

spine, is in constant pain since 2002, caused her to be unemployed since 2005. TIlis is why she is 

seeking this disability benefit. 

Historically she had her first psychiatric treatment at the age oftwenty five. At that time she was 

treated with medication and counseling for depression. Since then until now she had not had any 

psychiatric hospitalization, never contemplated or attempted suicide, and denied substance abuse 

problem or treatment for it. Her mental heaIthcare is currently being provided by Dr. F •••• for the last about one and a half years and she is being treated for depression and 

anxiety (296.20 and 300.00) with medication and counseling. 

On specific questioning beports she is sad all the time for the quality of her current life; 

mad because she calUlol work or care for her'eiderly mom and ailing father-in-law, and anxious 

about what is coming nex1. Lately her appetite has been poor, resulting in a fifty pound weight 

loss. She is sleeping about four hours at night, which has remained unchanged of late; she has a 

difficult time in going to sleep hecause her racing mind will not calm down and her ears are 

ringing all the time; she has a difficult time ill maintaining her sleep because "anything and 

everything can wake me up", and depending on her night, her energy level and motivation are 

very variable. Spare time activity is working 011 scrapbooks or household chores. Social life 

involves church. Pleasure life involves watching television or listening to music. Sex life is 

"normal". Crying spells are intermittent in nature, anger may have explosive qualities, while she 

denies any death wish. PAST MEDICAL HISTORY: She reports to have degenerative joint 

disease of the lumbar and cervical spine, recurrent headaches, bronchial asthma, high cholesterol, 

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653 

Page 9 of 15 

GERD, hysterectomy, had Cervical disc surgery in 1994, 1995, and 2007, ulnar nerve 

replacement surgery on the left elbow, and gallbladder surgery. 

She reports to have been treated for Major Depression in the past, but never for Bipolar Disorder, 

Schizophrenia, Panic Disorder, or Post Traumatic Stress Disorder. 

Review of her medical records suggests Dr. has been treating her for Major Depression, 

recurrent and chronic pain syndrome. 

CURRENT MEDICATIONS: Cymbalta 120 mg daily, Wellbutrin SR 112 tablet twice daily, 

Xanax on a pm basis, Ambien on a pm basis and Topamax twice daily. Her other medications 

include Lipitor, Prilosec, Advil, Astelin, Singulair, and Verapamil. She reports that she "sneaks 

in" Lortab from time to time for about the last two years and lIses it for her pain management. 

PERSONAL HISTORY: She was born in and raised by both parents. 

She had an uneventful childhood and bachelor's degree in fine arts. She had her first job at the 

age of fifteen and last worked in 2005 when she was working as the office manager for four 

months, hated her boss, quit her job in 2005. Her first marriage ended in divorce after four 

months and is currently married to her second husband for the last twenty three years. She is 

living in Oklahoma City with her husband and is dependent financially on him. 

FAMILY HISTORY: She has one brother and one sister. Her sister had alcohol problem. Her 

father died of suicide at the age of filly and had alcohol problems. 

MENTAL STATUS EXAM: 2 a fifty-five-year-old Caucasian female who is 5'4" tall 

and 185 pounds in body weight and came in two miles from her home to my office driving her ... 

She looked much younger than her stated age, was reasonably well groomed, colorful in makeup 

and dress, jovial and did not appear to be in any acute distress. 

-Speech had hyper-verbal qualities, but not pressured. 

-Eye contact was 100%. 

-Thought process was full of circumstantiality and tangentially, but no LOA or FOr. 

-l1lOUght content was devoid of any perceptual abnomJalities. 

-Mood was reportedly sad, mad, or anxious. However, she denies any features consistent with 

panic attacks or manic episodes. 

-Affect was wide ranged and jovial. 

-Insight appeared to be intact. 

-Judgment has dependent and avoidant qualities. 

-Cognitive testing reveals she was alert, oriented x 3 with intact registration, concentration, and 

abstract interpretation, but she had minor impairment of short term memory (she could recoUeet 

two out of three names in five minutes). 

-Suicidallhomicidal ideas were denied today. DIAGNOSIS: 

Axis I (1) Mood Disorder secondary to General Medical Condition 

(2) History of Major Depression, recurrent Axis II Personality Disorder, NOS 

Axis III History of degenerative joillt disease of the lumbar and cervical spine, history of surgical 

treatment for her cervical spine x 3, recurrent headaches, bronchial asthma, and GERD 

Axis IV Problems with employment and health 

Axis V Current GAP: about 65-75 

Last Year's GAF: not available 

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654 

Page 10 of 15 

CONCLUSION: A Social Security Disability Evaluation was completed today fOle a 

& ed on clinical inteNiew and review of her limited medical record. Strictly from the 

psychiatric standpoint, I believe she will meet the DSM-IV TR criteria for Major Depression. 

This could be a primary disorder, as reported by ~ or from her chronic 

pain (Mood Disorder secondary to General Medi~ reasonably treatable 

psychiatric morbidity and can be aggressively treated with aggressive phannacotherapy, 

psychotherapy, cognitive behavioral therapy, and vocational rehabilitation therapy . ..... 

reports she stopped working in 2005 because of chronic pain on the one hand and she hated her 

boss on the other hand. It is beyond my expertise to comment if such voluntary unemployment 

and/or chronic pain can be a reason for long tenn disability or not. Based on my cognitive testing 

of today I found her to be reasonably intact and hence 

funds independently. M.D. 

School of Medicine - University of Oklahoma, Ok.la~lonJa 

55 year old female alleges depression, She has a history of depressive symptoms treated with 

meds. No history of hospitalizations for decompensation. Current MSE, the claimant reports 

sadness due to her quality of life because she cannot work and anxiousness about her future. Her 

appetite has been poor, has had sleep disturbance, very variable energy level and motivation. 

Crying spells are illtennittent in nature, anger may have ell:plosive qualities, while she denies any 

death wish. On exam she is jovial and did not appear to be in any acute distress. Speech had 

hyper-verbal qualities, but not pressured. Eye contact was 100%. Thought process was full of 

circumstantiality and tangentially, but no LOA and FOL. Thought content was devoid of any 

perceptual abnonnalities. Mood was reportedly sad, mad and anxious. Affect was wide ranged 

and jovial. Insight appeared to be intact. Judgment has dependent and avoidant qualities. 

Cognitive testing reveals she is alert, oriented X3 with intact registration, concentration and 

abstract interpretation, but she had minor impairment of STM. SIIHI was denied. Cognitive 

testing reveals she is alert, oriented X3 with intact registration, concentration and ab&tract 

interpretation, but she had minor impairment of STM. SIIHI was denied. Claimant can relate to 

others on a superficial work basis. Claimant can adapt to a work situation. 

55 year old female alleges DOD, neck pain, lower back pain, left ulnar nerve pain. Current 

evidence shows her sip 10107 cervical fusion and sip 10107 left ulnar nerve cubital tunnel 

decompression secondary to compressive peripheral neuropathy. 2/14/08 flu claimant decreased 

pinprick around old incision site on left elbow. Strength is intact at 515 in all major muscle 

groups. Reflexes are intact. C-spine x-rays show good stable nlsion construct. 

OfficelOutpatient Visit 

Visit Date: Tim. Aug 9.200711:23 am 

Provider: MD (Assistant: MA) 

Location: MD 

Electronically signed by provider on 0910312007 04:45:46 pm Printed on 0311212008 at 12:35 

pm. 

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655 

Page 11 of 15 

SUBJECTIVE: 

•••• S~; a 54-year-old female. This is a 2 months follow-up visit. Chief concern is neck pain 

and left upper extremity pain 

HPI: 9 3 eturned today for flu evaluation. She ha~ continued to have lifestyle limiting 

neck pain and L arm pain as well. She underwent a recent EMS which :.confirmed a left ann 

cubital syndrome without evidence of cervical radiculopathy. She also underwent a collar trial to 

evaluate concerns for adjacent segment disease at 04-5. 7-1. She had no clear changes in her 

symptoms while in the collar. Her pain continues to most aggravated with movement and activity. 

She has exhausted all reasonable conservative measures. She has no new problems. 

ROS: 

CONSTITUTIONAL: Positive for fatigue and night sweats. Negative for chills. fever, 

unintentional weight gain or unintentional weight loss. 

EYES: Positive for use of glasses or contacts. Negative for blurred vision, eye drainage, eye pain 

or photophobia. 

EINIT: Positive for ear pain. Negative for diminished hearing, frequent epitasis. hoarseness or 

sore throat. 

CARDIOVASCULAR: Positive for dizziness. Negative for chest pain, palpitations, pedal edema, 

tachycardia or varicosities. 

RESPIRATORY: Negative for recent cough and chronic cough. 

GASTROINTESTINAL: Positive for acid reflux symptoms. Negative for abdominal pain, 

anorexia, abdominal bloating. Hemorrhoids or melema. 

SENITOURI NARY: Negative for dysuria. Hematuria. frequent UTI's and nocturia. 

MUSCULOSKELETAL: Positive for back pain, joint stiffness and limb pain. Negative for 

Arthralgias or myalgias. 

INTEGUMENTARY/BREAST: Negative for acne, atypical mole(s), extremely dry skin. fungal 

nail infecti on, rash, breast mass and breast tenderness. 

NEUROLOGICAL: Positive for dizziness, headaches, memory loss, nausea, vomiting. 

paresthesias. tremor and weakness. Negative for ataxia. confusion, fainting, generalized pain, 

seizures, speech disorder or vertigo. 

HEMATOLOGICfLYMPHATIC: Positive for easy bruising. Negative for excessive bleeding. 

ENDOCRINE: Positive tor hot flashes, Negative for hair loss, temperature intoleranc~s or 

polydipsia. 

PSYCHIATRIC: Positive for anxiety, depression and sleep disturbance. Negative for mood 

swings. personality change or suicidal thoughts. 

Past Medical History f Family History f Social History' 

Past Medical History' 

Hyperlipidemia: Hypercholesterolemia; dx'd in 2006: 

Asthma: dx'd in 1994; 

Gastroesophageal Reflux Disease: since 2000; 

Rheumatoid Arthritis: since 2005; 

Migraine Headaches: since 2002; 

Depressionfanxiety 1995 

Surgical History: 

Cholecystectomy: laparoscopic: 2000: 

Hysterectomy: 1991: 

ACDF 1995.1992; 

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• • Page 12 of 15 

Foot surgery 2002: 

Family History' 

Father: Died at age 55; Cause of death was accidental death Tobacco! Alcohol/Supplements: 

Tobacco: Cnrrently smokes 1/2to 1 pack per day. 45yearspack.yearhistory. Non·drinker 

Current Problems: 

Am1pain 

Neck pain 

Immunizations: 

None 

Allergies: 

Keflex: 

Demerol HCI: 

Codeine Phosphate: 

Current Medications: 

Advair Diskus 100)50 Inhalation Powder Inhale 1 puff(s) bid 

Arabian 5mg Tablet Take 1 tablet(s) by mouth at bedtime pm 

Astelin 137mcgll spray Nasal Spray 2 spray(s) in each nostril bid 

Cymba Ita 60mg Capsules Take 1 capsule(s) by mouth daily 

Lipitor 20mg Tablet Take 1 tablet(s) by mouth daily 

Nasonex 50rncglactuation Nasal Spray 2 spray(s) in each nostril daily 

Prilosec 20mg Capsules. Extended Release Take 1 capsule(s) by mouth day 

Singulair lOmg Tablet Take 1 tablet(s) by mouth daily 

Topamax 50mg Tablet Take 1 tablet(s) by mouth bid 

Ultram 50mg Tablet Take 2 tablet(s) by mouth q 4 to 6 hr 

Verapamil HG 120mg Capsules. Sustained Release Take 1 capsule(s) by mouth daily 

Xanax 0.5mg Tablet 1 po qd pm 

OBJECTIVE: 

Vitals: 

Current: 8)912007 1l:25:52AM 

Wt: 208.81bs 

T: 98.3 F; BP: 116156mm Hg; P: 96 bpm: R: 14 bpm 

Exams: 

GENERAL: Patient is a well developed, moderately obese, female, in no apparent distress Head 

is norm cephalic and a traumatic. There is no evidence ofCSF. Otorhea. Rhinorrhea. There is no 

Battle Sign or Raccoon's eyes. There does not appear to be any facial a.~ymmetries. 

NECK: supple with atrophy of the para spinous muscles secondary to disllse secondary to her 

symptoms and the collar. CHEST: Chest rises equally and appears to be moving good air. 

EXTREMITIES: warm without significant edema 

NEUROLOGIC: The patient is awake, alert and oriented to person. place. time and situation. 

Cooperative with exam and mostly appropriate. There is no apparent communication deficits. 

Cranial nerves 2.1 2 appear grossly intact. Cerebellar fimction appears intact without 

aSYl1uuetries to finger to nose. Coordination arid gait are unremarkable. Continues to have 

decreased pp. 

Electronically signed by provider along the ulnar aspect of her L ann fi'om the elbow exiendillg 

to the 5tl1 digit and medial aspect of the 4th digit. She has atrophy along the ulnar aspect of her 

See Next Page 
657 

$ Page 13 of 15 

hand and 5th digit and continues to have weakness as previously described. Labrrest Results 

EMGINCS as previously described. No new films to review. See previous notes for imaging 

studies. 

ASSESSMENT: 

723.1 Neck pain 

354.2 Ulnar nerve neuropathy 

PLAN. S has perhaps two severe but different problems. She has lifestyle limiting neck 

pain with radiographic concerns of adjacent segment disease at C7-T 1 and perhaps C4-5 as well. 

She has exhausted all reasonable conservative measures. She underwent a collar trial for partial 

immobilization with unclear results. She will repeat this trial with a CTa prior to her ne:\1 visit. 

She also has a life style limiting L ulnar neuropathy with evidence on EMG of a cubital 

syndrome. She is will return as scheduling permits to discuss surgical options along with reo 

assessment of a collar trial. We discussed the findings in great detail and she expressed a good 

level of understanding. 

Various physicians, treating and non·treating, have written that the claimant suffered from 

various medical problems and that the claimant has significant work restrictions. While the 

finding that a person is "disabled" under the provisions of the Social Security Act is an issue 

reserved to the Commissioner6 (SSR 96-5p I), opinions from any medical source on issues 

reserved to the Commissioner must never be ignored. The adjudicator is required to evaluate all 

evidence in the case record that may have a bearing on the determination or decision of disability, 

including opinions from medical sources about issues reserved to the Commissioner. If the case 

record contains an opinion from a medical source on an issue reserved to the Commissioner, the 

adjudicator must evaluate all the evidence in the case record to determine the extent to which the 

opinion is supported by the record. 

TIle fact that the claimant's treating physician, after extensive examinations atld treatment, has 

formed such opinion as to the claimant's ability to perform sustained work activity was 

precluded strongly suggests a significantly limited residual functional capacity. Further, 

considering the claimant's diagnoses and multitude of prescribed medications u'ied, the 

undersigned iinds that treating physician's opinion is well support and is not inconsistent with 

the other substantial evidence in the case record; thus, it is afforded controlling weight (20 CFR 

404.1 527(d)(2) and SSR 96-2p). 

6 Under 20 CFR 404.1527(e), some issues are not medical issues regarding the nature and severity of an individual's 

impainnent(s) but are administrative fmdings that are dispositive of a case; i.e., that would direct the determination or decision of 

disability. The following are examples of such issues: 

1. Whether an individual's icnpairrnent(s) meets or is equivalent in severity to the requirements of any impainl1ent(s) in the 

listings; 

2. What an individual's RFC is; 

3. Whether an individual's RFC prevents him or her from doing pasl relevant work; 

4. How the vocational factors of age, education, and work experience apply; and 

5. Whether all individual is "disabled" under the Act. 

The regulations provide that the fInal responsibility for deciding issues such as these is reserved to the Commissioner. 66 

See Next Page 
658 

Page 14 of 15 

In making this finding, the undersigned considered all symptoms and the el\ient to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

After considering the evidence of record, the undersigned finds that the claimant's medically 

determinable impainnent(s) could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity, persistence and limiting effects of these 

symptoms are generally credible. 

The State agency medical opinions are given little weight because other medical opinions are 

more consistent with the record as a whole and evidence received at the hearing level shows that 

the claimant is more limited than detennined by the State agency consultants. Furthennore, the 

State agency consultants did not adequately consider the claimant's SUbjective complaints or the 

combined effect of the claimant's impairments. 

6. The claimant is unable to perfonn any past relevant work (20 CFR 404.1565). 

The demands ofthe claimant's past relevant work exceed the residual functional capacity. 

7. The claimant was an individual of advanced age on the established disability onset date 

(20 CFR 404.1563). 

8. The claimant has at least a high school education and is able to conununicate in 

English (20 CFR 404.1564). 

9. The claimant's acquired job skills do not transfer to other occupations Viithin the 

residual fWlctional capacity dermed above (20 CFR 404.1568). 

10. Considering the claimant's age, education, work experience, and residual functional 

capacity. there are no jobs that exist in significant nwnbers in the national economy that 

the claimant can perfonn (20 CFR 404.1560(c) and 404.1566). 

In determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual fimctional capacity, age, education, and work experience in 

conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. 

lfthe claimant can perform all or substantially all of the exertional demands at a given level of 

exertion, the medical-vocational mles direct a conclusion of either "disabled" or "not disabled" 

depending upon the claimant's specific vocational profile (SSR 83-11). When the claimant 

cannot perform substantially all of the exertional demands of work at a given level of exertion 

and/or has nonexertional limitations, the medical-vocational nIles are used as a framework for 

decision-making unless there is a mle that directs a conclusion of "disabled" without considering 

the additional exertional and/or nonexertional limitations (SSRs 83-12 and 83-14). If the 

claimant has solely nonexertional limitations, section 204.00 in the Medical-Vocational 

Guidelines provides a framework for decision-making (SSR 85-15). 

See Next Page 
659 

• Page 15 ofl5 

Even if the claimant had the residual functional capacity for the full range of sedentary work, 

considering the claimant's age, education, and work experience, a finding of "disabled" would be 

directed by rule 201.06. 

11. The claimant has been under a disability, as defined in the Social Security Act, from 

June 1, 2005 through the date of this decision (20 CFR 404.1520(g)). 

DECISION 

Based on the application for a period of disability and disability insurance benefits filed on May 

16,2007, the claimant has been disabled under sections 216(i) and 223(d) of the Social Security 

Act beginning on June 1,2005. 

Workers' Compensation offset may be applicable. 

lsi 6)f/OJ:l2umd () '@jf"CMV 

fl· 

W. Howard O'Bryan, Jr. (0453) 

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 

October 10, 2008 

Date 
660 

Social Security Administration 

eMF OF 5' Allum 

EXPLANATION OF DETERMINATION 

W/E's NAME (IF COB or 

DWB) im' e 

SSA·4268 

CLAIM TYPE 

DIB 

Medical vocational Allowance: Claimant is a 55 yof alleging degenerative disc disease, anxiety and depression. 

CLaimant's AOD was 06-01·05. This claim is being allowed due to a combination of mental and physical 

allegations. Claimant's current mental residual capacity keeps her from returning to her past relevant work as an 

accountant which is highly skilled. Claimant's PRW was as an accountant, per DOT, Accountant, 160.162-018, 

which is considered as sedentary work with a SVP of 8. Claimant did this job from 1992 until 06·05. She reports 

no other employment. Claimant currently has the physical residual capacity to do light work. She can lift 10 Ibs 

frequently and occasionally lift up to 20 Ibs. She can stand and or walk about 6 hours in an 8 hour workday. She 

can sit about six hours in an 8 hour workday. She has no other physical restrictions. Due to claimant's 

depression, anxiety and personality disorder, she currently has the mental residual capacity to do simple and 

some complex instructions. Clmt has more than a 12th grade education, turned age 55 on 11.07, cannot do 

her past work due to mental restrictions and is limited to light work physically. Using vocational rule 202.06 as a 

guideline, clmt is found to be disabled as of turning age 55. Borderline Age criteria were considered, but as all 

her impairments were considered in the RFCs, there were no additional adversities to indicate an earlier onset 

could be found. Onset is established as of 11.2007, the day she tumed 55. 

MMSljrs 
661 

SOCIAL SECURITY ADMINISTRATION 

DISABILITY DETERMINATION AND TRANSMITTAL 

OKLAHOMA em OK 73112 

" I 

SHEPHERD MA.l.L 2615 VILLA PROM 

OKLAHOMA em, OK 73107 

D DlS8btorc8StlSeOeM 

B PurP.8a,} 

" 

II 

DIS Fl 01"18 CDB·R COB·D RD-R RD-D RO P.R P.D MQFE 

IZIDD D D DDDDDD 

AFFECfIVE MOOD DISORDERS 

19. ClAIMANT 

A.l8J Penod MDisabl~ty 8.0 DIsability Poriod C. ~ Es!ab Beg 09/15/2005 AND 0 DCQntlnuts 

29.lTRIPAR NO 3Q. DISABILITY EXAMINER·DDS IS" DATE J2. P~YS1C!AN OR MEDICAL SPEC. SIGNATURE 

01 MMS OS/21/2008 1 D.O., H.P.H 12. 

"~ 

~-- report of 04-12.-08. Change in onset 

SREV,QE 131 SSAREPRESENTATlVE CODES 

35.BAS1S,-,vut: 

~3. DATE 

OS/21/2008 

He.SHe.CGOE 

12 

MULHPlEIMPAlRIIIENlS 

CoN~ICEREl) 

3l!l CQ\la!~{)"lIllll'tf 

~OIrS'>'[1I0·NO>lSEV"R' 

$SA sa DATE 

CODE 

Form SSA-8J1-C3 (Slag) Oper JRS o.tB OS/22/2008 Calle # 90067.q7 Dee AL D DECISION D CAS~ CONTROL 
662 

Social Security Administration SSA-4268 

EXPLANATION OF DETERMINATION 

NAME OF CLAIMANT W/E's NAME (IF COB or SSN CLAIM 1YPE 

--_____ m _______ .. _ ... __ ._._ ....... _ ... ~~!. __ .... ____ ._m. __ .m ....... _. __ .... _.t. ... __ ._._~~~ ...... _ ... _ ... . 

54 yo DIB female with 16 years of education alleges DOD, depression and anxiety. The mental portion of the 

claim was found to be non·severe. The physical portion of the claim was given an RFC for light work with limited 

use of the left hand. The claimant's PRW includes a position as an accountant, DOT 160.162-D18 81S which the 

clmt describes as sedentary on her application and as medium on the Work History Report. Therefore, the claim 

is denied to PRW both as the claimant describes it and as it is generally performed in the national economy. 

BNKlbnk 

\ 
663 

SCX:IAL SECURITY ADMINISTRATION 

DISABIUTY DETERMINATION AND TRANSMITTAL 1 OEST!NATfOI~ 'rODS CODE IH'UNGD'" <I SSN l B1ClitCD8NOW!lCLAlM) 

DDS 000 DRS OOB INTO 539 05/16/2007 , DO ~ 0 0 0 • 5 NAME AND ADDRESS OF CLAIMANT lmdude ZIP C(td_) 6, WE'S NAME III COB (tl OWe u.AIM) 

2 7. TYPE CLAIM (Tih II) OKLAHOMA cm r OK 73112. 018 Fl OW, COB-R CDB-D RD-R RD-D RD P·R poD MQFE 

[)9 0 0 0 0 0 0 0 0 0 8, TYPE ClAIM (Titif XVI) 

,0 csO oeD BID BSO ,,0 9. DATE OF BIRTH rO.?RIORAC ION 11 REMARK • PO 0 PTO DDS Received 06/15/2007 G Il ~'&ljf".mt),'rftFA\5M),lj'A%'f!~1I ZIP ""1 I D~'O CODE 

SHEPHERD MALL 2615 VILLA PROM 783 

OKLAHOMA CITY, OK 73107 

1300-aOF.H"RES!'iHTATIVE ,ROATE j lA. 0 Pr~$wnitive Dlsa ty 

IllB D'mp.;lirmqrlt 

DETERMINATION PURSUANTTO THE SOCIAL SECURITY ACT AS AMENDED __ "_0 '_lA_'M_AN_'_0I_SA_Bl_ED-,-___ --I16A, PRIMARY DIAGNOSIS BODY SYS, I 'CODE NO. ~6B. SECONDARY DIAGNOSIS 

01 7240 D Disabili:y 

_Ao __ '_"_"_-t ____ -I g~~:::ic ~ ~:~:NERAnVE 

s, 0 ~!~~:~ity 

17. DIARY TYPE 

_"_0 CAS-...:E-,-OC_";;CU..cNCc...N.:.'SS,,-AS:..;DEC;F;..;'''.:::..D '...;N"SE"'C...;I6'-"-'.":::":::'::.''':.::'':c',' __ --I19 ClAIMANT NOT DISABlED 

O N(tl o;sab for Cash Bene I 0 Dlsab lor CB~h Benefii 

A Pu~ B Purp s..g 

20. VOCATlOI'W. BACKGROUND 

22 REC-8AS!S CODE n. MED LIST NO 

H1 

10 liST ....... 

NO JIll" A 

27 RATIO~ ~~:"~~~~~~1fC4 

28 

OCCYRS 

AFFECTIVE MOOD DISORDERS 

111 VRACTION A SO AlJ Hear",>;! Appeals C()uoo! 

DO EoO 

A 0 P~n(td 01 DIsability B. D DIsability Per10d C. 0 Eslab Beg AND 0, 0 C(tntinues E o Term 

29 lTR/P,o,P' NO :)0. DlSAB!UTY EXAMlNER·DOS 131. DATE 

DB BNK _1 07{l31'1007 

".'oiiPHiiY~iii'iii"ii'iiD'iiMiED_' NAME !S1emp,Primor!ypt) 

I ~·ii'oiPHiiY.SI.ClAii'IiOiR "'EDICAl SPEC. SIGtlATURE .1- MD19 

3S.D.A.TE 

07/26/2007 

n8 SPEC. CODE 

19 

0 

M. REMARKS /..\ULnPL:lt.1PAlRMEI'lT5 c.GN5!DERED 

35. BASIS CODE j~.RtV.llEl. 137 SSA REPRESENTATIVE 

CODES I 

Oper TJF Date 07/2.6/2007 Cau t 8975329 Dee DE 

55A 38.0ATE 

CODE 

D DECISION D CASE CONTROl 
664 

ALl Bench Decision Checksheet - Print Version 

Claimant Name: SSN: 

DIB Application Date: October 18, 2008 Hearing Date: April 26, 2010 

,SSI Application Date: October 18,2008 DWB Application Date: 

Date Last Insured: March 31, 2008 Established Onset Date: March 12, 2008 

EOD is IZI AOD D Amended AOD D Current Appl. Date o Prior Appl. Date 

(SSIOnly) (SSIOnly) 

D Prior Application D Reopened D Not Reopened 

Prior Application Date(s): T2 T16 

Reason for Reopening D Within One year D G«ld cause D GroWlds for reopening at any time 

IZI Work After Onset DUWA IZI NotSGA DTWP 

Severe Impairment{s) (singly or in combination): Shattered ankle tibia fibula 3 plates 15 screws cyst, 

depression, anxiety, asthma, sinus problems, etc., etc., etc., 

ISJ Impairment{s) MEETS Listing # 

o Impairment{s) EQUALS Listing # 

D Child is FlUlctionaDy Equal to Listings 

MrkExtr 

l.02A, 1.06, etc., 

MrkExtr 

D D 1. Acquiring and Using Information D 0 4. Moving about and Manipulating objects 

D D 2. Attending and Completing Tasks D 0 5. Caring for Self 

D D 3. Interacting with Others D 0 6. Health and Physical WeD-being 

Mental Impairment Analysis (Part B) 

Restriction of Activities of Daily Living D None IZI Mild D Moderate D Marked D Extreme 

Difficulties Maintaining Social Functioning D None IZI Mild D Moderate D Marked D Extreme 

Difficulties Maintaining Concentration-Pace D None IZI Mild D Moderate D Marked D Extreme 

Episodes of Decompensation D None IZI One or Two D Three D Four or More 

Mental Impairment Analysis (Part C) 

Permanent Subcommittee on Investigations 

EXHlBIT#13 
665 

Page 2 of3 

o 12.02, 12.03, or 12.04 wI 2 yrs med. history & more than minimal limitation & 

o Residual disease process wi marginal adjustment so that minimal chang~ cause decomp_ 

.0 Current Hx. l+years in highly supportive living arrangement wi continuing need for same 

o Repeated episodes of decompensation, each of extended duration 

o 12.06 (inability to function Independently outside area of home) 

Residual Functional Capacity: 

o Full range of 0 Sedentary 0 Light o Medlum 

o Less than fun range of 0 Sedentary 0 Light o Medium (describe below) 

o Nonexertiona! only (describe below) 

Function by Function: The credible evidence of record show the claimant is not functional at the sedentary 

level on a "regular and continuing" basis. 

Rationale for Decision (Include Assessment of Credibility and Medical Opinions): See exhibits 13F through 

17F. 

o No PRW 0 PRW but Is unable to perform 

PRW: 0 unskilled 0 skilled/semiskilled but skills do not transfer to other occupations w/in RFC 

Claimant "disabled" based on: 

o DIrect application of Medical-Vocational Rule # 

o Framework of Rule # o based on VE testimony 0 based on SSR# 

o Section 204.00 Framework o based on VE testimony 0 based on SSR# 

o Recommend Representative Payee 

~ Medical reexamination in 3 t06 Months 

See Next Page 
666 

Page 3 of3 

months 

o Evidence of Workers Compensation Oairn/Payment 

!2J Fee Agreement Approved-Representative Name: •••••••••••••• 

o Fee Agreement Denied-Reason: 

DATE: Apri127,201O 

W. Howard O'Bryan Jr. (0453) 
667 

..»\.SECl:> . 

~_SOdC:I~AL~S~E~C~U.ru.T.Y .. AD~M=IN~I=S~T=~~TI=O=N~ __ ~~:;~~~~~~;:~~:: '\ IIlflt! Refer To: Office of Disability Adjudication and Review ~lST\\J' 301 Nw 6th St 

3rd Floor West 

Oklaboma City, OK 73102 

Date: April 27, 2010 

Notil;e of Decision -Fully Favorable 

carefully reviewed the facts of your case and made a fully favorable decision on your 

application(s) for a period of disability, disability insurance benefits, and Supplemental Security 

Income filed on October 18, 2008 and October 18, 2008. I stated the basis for my decision at. 

your hearing held on April 26, 2010. I adopt the findings of fact and reasons that I gave at the 

hearing. Please read this notice of decision. 

I found you disabled as of March 12,2008. Your impairment or combination of impairments is 

so severe that it meets the requirements of one of the impairments listed in the Listing of 

Impairments. 

If you would like more information about my decision, I can provide you with a record of my 

ora:! decision. You must ask for this record in writing. You may mail or bring your request to any 

Social Security or hearing office. Please put the Social Security number shown above On your 

request. 

Another office will process my decision and decide if you meet the non-disability requirements 

for Supplemental Security Income payments. That office may ask you for more information. If 

you do not hear anything within 60 days of the date of this notice, please contact your local 

office. The contact information for your local office is at the end oflhis notice. 

If You Disagree With My De~ision 

If you disagree wiih my decision, you may file an appeal with the Appeals CounciL 

How To Flle An Appeal 

To file an appeal you or your representative must ask in writing that the Appeals Council review 

my decision. You may use our Request for Review form (HA-520) or write a letter. The form is 

available at www.socialsecurity.gov. Please put the Social Security number shown above on any 

appeal you file. If you need help, you may file in person at any Social Security or hearing office. 

Please send your request to: 

Form RA·U2 (03-2010) 

See Next Page 
668 

Time Limit To File An Appeal 

Page 2 of3 

Appeals Council 

Office of Disability Adjudication and Review 

5107 Leesburg Pike 

Falls Cburch, VA 22041-3255 

,You must file your written appeal within 60 days of the date you get this notice. The Appeals 

... Council assumes you got this notice 5 days after the· date of the notice unless you show you did 

not get it within th<:t5-day period. . ! 

The Appeals Council will dismiss a late request unless you show you had a good reason for not 

filing it on time. 

What Else You May Send Us 

You or your representative may send us a written statement about your case. You may also send 

us new evidence. You should send your written statement and any new evidence with your 

appeal. Sending your written statement and any new evidence with your appeal may help us 

review your case sooner. 

How An Appeal Works 

The Appeals Council will consider your entire case. It will consider all of my decision, even the 

parts with which you agree. Review can make any part of my decision more or less favorable or 

unfavorable to you. The rules the Appeals Council uses are in the Code of Federal Regulations, 

Title 20, Chapter III, Part 404 (Subpart J) and Part 416 (Subpart N). 

The Appeals Council may: 

Deny your appeal, 

• Return your case to me or another administrative law judge for a new decision, 

• Issue its own decision, or 

• Dismiss your case. 

The Appeals Council will send you a notice telling you what it decides to do. If the Appeals 

Council denies your appeal, my decision will become the final decision. 

The Appeals Council May Review My Decision On Its Own 

The Appeals Council may review my decision even if you do not appeal. If the Appeals Council 

reviews your case on its .own, it will send you a notice within 60 days of the ditte ofthis notice. 

When There Is No Appeals CoUncil Review 

If you do not appeal and the Appeals Council does not review my decision on its oWn, my 

FOIm RA-L82 (03-2010) 

See Next Page 
669 

Page 3 of3 

decision will become final. A fmal decision can be changed only under special circumstances. 

You will not have the right to Federal court review. 

ICY ou Have Any Questions 

We invite you to visit OUT website located at www.socialsecurity.gov to find answers to general 

questions about social security. You may also call (800) 772-1213 with quest~ons. If you are deaf 

or hard of hearing, please use OUT TTY number (800) 325-0778. 

If you have any other questions, please cal~ write, or visit any Social Security office. Please have 

this notice and decision with you. The telephone number of the local office that serves your area 

is (866)331-2207: Its address is: 

Enclosures: 

Social Security 

2615 Villa Prom 

Shepherd Mall 

Oklahoma City, OK 73107-2468 

w. Howard O'Bryan Jr. (0453) 

Administrative Law Judge 

April 27, 2010 

Form HA-L15 (Fee Agreement Approval) 

cc: 

Fonn HA-L82 (03-2010) 
670 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

(Social Security Number) 

I approve the fee agreement between the claimant and her representative subject to the condition 

that the claim results in past-due benefits. My determination is limited to whether the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. I neither 

approve nor disapprove any other aspect ofthe agreement. 

YOU MAY REQUEST A REVIEW OF THIS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Telrus that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, Jurist Doctorate, Esquire 

Regional Chief Administrative Law Judge 

SSA ODAR Regional O(C 

Rm460 

1301 YoungSt 

Dallns. TX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement. If so, please write directly to me as the 

deciding Administrative Law Judge within 15 days of the day you are notified of the amount of 

the fee due to the representative. Your representative' also has 15 days to write me if he/she does 

not agree with the feT amount under the approved agreement. 

Fom HA-Ll5 (03-2007) 

See Next Page 
671 

Page 5 of2 

You should include the social security number(s) shown on this order on any papers that you 

send us. 

cc: 

W. Howard O'Bryan Jr. (0453) 

Administrative Law Judge 

April 27, 2010 

Date 

Fonn HA-L15 (03-2007) 

See Next Page 
672 

SOCIAL SECURITY ADMINISTRATION 

OFFICE OF DISABILITY ADJUDICATION AND REVIEW 

In the case of 

(Claim<tnt) 

TRANSCRIPT 

Claim for 

Period of Disability 

Disability Insurance Benefits 

Supplemental Security Income 

(Wage Earner) (Leave blank 

in Title XVI Cases or if 

name is same as above) 

(Social Security Number) 

APPEARANCES: 

Hearing Held 

at 

Oklahoma 

(City, State) 

on 

April 26, 2010 

(Month, Day, Year) 

by 

W. Howard O'Bryan, Jr. 

(Administrative Law Judge) 

the Claimant 

liil"~~,cfor Claimant tional Expert 
673 

INDEX OF TRANSCRIPT 

In the case of: 

Claimant 

Testimony of 111111111111111111111111' 

Testimony of 

Account NUn1ber 

£ 

Page 

commencing 6 

commencing 25 
674 

(The following is a transcript in the hearing held before 

W. Howard O'Bryan, Jr., Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on April 26, 

2010, at Oklahoma, in the case of Social Security 

Number • 5 II The Claimant appeared l.n person ailnldlwla~§ •••• 1 

represented EY I ••• tAttorney. Also present was ...... 

vocational Expert.) 

(The hearing commenced at 12:19 a.m. on April 26, 2010.) 

ALJ: -- record. Are we on? 

HA: We're on the record. 

Ol?ENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: All right, then. Since I've got'~andY, I'm not 

going to go through the usual opening statement. I'll just simply say 

that we have your claims for a l?eriod of Disability; Disability 

Insurance Benefits, as well as Supplemental Security Income. Now, 'the 

issues are the same issues that are on the notice, which Mr. smith 

could quote from memory if I asked him to. He's done this, like I 

say, a few hundred times before. I'm not .going to go through them, 

because it's already in the record, anyhow. The claimant is alleging 

an onset date of March 12, 2008. She is last insured on March 31, 

2008. We don't have an insured status problem to deal with, so long 

as we're dealing for with an injury before that date, anyhow, so 

that's it. I do notice that our first day of insurance, this is kind 

of strange, was January 1, 2008, which means that she was only insured 

for a period of approximately three months in there. That's a little 

unusual to have something like that. 

ATTY: That is unusual. 

ALJ: Isn't that, though? Well, at any rate, we have documents 

here, and they're marked up through l7F, and if there are no 
675 

2 

objections, I'll receive those into the evidence as Exhibits lA 

through 17F. Is that all right with you, 1111111111111 

ATTY: Yes". Your Honor. I will note, though, tha\, when I got her 

disc up, there was a 24 listed, 24F. 

ALJ: Okay, let's find out what wetve got here and see 

ATTY: Well, and so --

ALJ: - - what it is .. 

ATTY: when I tried to - -

ALJ, I'm showing here that we had some~additionah documents but 

that, for some reason, they didn't put a number on them. And let's 

see what we've got here now so I know what it is. I can put numbers 

on them, as far as that's concerried, I suppose. 

ATTY, Well, I'm not too concerned about that, Your Honor. The, 

the only thing was, I wanted to tell you that when I tried to open up 

24F, it said the shortcut had been -- was malfunctioning --

ALJ: Urn-hum. 

ATTY: and they asked me if I wanted to eliminate the 

shortcut. And I thought, well, I'll just open it up. Well, I 

eliminated the shortcut, and 24F went away. 

ALJ: Well, I'll tell you --

ATTY: So, I don't know what was in it. 

ALJ: -- I don't know what it is. Here's what I'm showing. I do 

show here something that's -- let's see. What ~fter 17F, what I 

show is three documents there, but neither one of them are shown as 

Exhibits. One of them is from the DDS which is a medical evaluation 

case analysis, and another medical evaluation case analysis which 
676 

3 

apparently -- let's just see what one of them says, just for the heck 

of it. Usually, what they say is, I agree with some~ing, you know. 

ATTY: Yeah. 

ALJ: Yeah. I reviewed all the medical evidence in the file,' and 

the assessment of 4/2/9 is affirmed as written. In other words, 

somebody just decided they -- they're saying they agreed with what's 

been done before. Then, we have another, which is a DDS disability 

worksheet, which is nothing more than just a sheet that indicates some 

of the activities that have gone on. It shows by the, by the date as 

to certain things there. Doesn't give us any information at all, if 

you want to be honest about the thing; at least, it doesn't give me 

anything that I could use in, in this case. The document that we have 

here which is probably the last one is the one that we received on 

June 5, 2009, which is -- covers a period from April 6, 2009 to 

June 1, 2009, and it concerns basically some insomnia, a follow-up on 

insomnia and anxiety problems from .......... 

, MD. 

ATTY: Urn-hum. 

ALJ: Now, the one before that is a medical assessment record 

from Clinic Orthopedic, et cetera, and it covers the period 

from November 3, 2008 to April 27, 2009, and we got --

ATTY: Urn-hum. 

ALJ: '-- that in the Office on June 2, 2009. 

ATTY: Urn-hum. 

ALJ: I see some items here, like a copy of evidence that's come 

from you where you're requesting that, and they don't give it an 
677 

4 

Exhibit number, because it wasn't anything of significance other 

than 

ATTY: Right. 

ALJ: -- the fact to be sure they sent something to you. And 

we've got some medical evidence of record from the 

$ which we got in on May 14, 2009, and let's see what it says. 

It doesn't show it as having an Exhibit number, but it will be 

admitted in here if -- anyhow, as - I'm not too sure why it doesn't 

have a number. Oh, I think I know why now. It's a bill. Yeah, 

that's part of it there. Oh, know, wait. There is some medical 

there. This has, has to do with a right bulbar wrist ganglion, and 

they excised that at the time. And it'll be included, of course, as 

an Exhibit here. They told about all the how they cut, cut it open 

and all that. I, I don't like to read those too well, because they're 

just bad, you know, kind of gory, you know. I just don't like -- I 

read them, anyhow. That's about what we've got here. We've got an 

awful lot of other things from (PHONETIC), and c...,., " -.. 

(PHONETIC), and (PHONETIC), and li£ii!@\!#."1 (PHONETlC), 

and 

ATTY: Urn-hum. 

ALJ: -- a whole bunch of things, , (PHONETIC), so -- but 

they'll all be admitted in the 

ATTY: Yes, Your Honor. 

--into evidence. Got a goodly amount of evidence here, 1F 

up through 17F, and I'm sure that we've got everything there. So, if 

there's no objections, we'll receive those into the evidence as 
678 

Exhibits lA through l7F. Is that all right? 

ATTY: No objections, Your Honor. 

ALJ: Okay, they're in the record, then. 

(Exhibits lA through l7F , previously identified, were received 

into evidence and made a part of the record thereof) . 

ALJ: Now, do you know of any reason right off the bat that we 

need to ,hold the record open? 

ATTY: I don't believe so, but she was nUdging me. I think maybe 

she 

ALJ: well--

ATTY: -- may have had some late medical --

CLMT: I had more surgeries. 

ALJ: Well, if they have some late, we can always -- I'll tell 

you what. Let's constitute it as ready, but we'll back up on that in 

case we get surprised here during the course 

ATTY: Okay. 

ALJ: of the hearing, and, and if it is, why, I can always 

depend on you to 

ATTY: You bet. 

ALJ: -- get it for me, and we'll get on here. But we'll get 

that done. Every once in a while, we have problems like that come up, 

and it's usually concerning well, usually, the attorney's kind of a 

little surprised, because they just find out that the claimant went to 

the hospital, or went to the doctor this morning, or yesterday, or 

something like that, you know, and we just don't have the 

documentation. Okay. Let's do that, then. All right. Let's go 

ahead, then, and take some testimony; but first, let me get down to 
679 

6 

the point of explaining. Ma'am, this is not anadversarial 

proceeding. It is inquisitorial. So, I probably will not be asking 

very many questions, because I leave that up to Counsel to do that. 

He knows the case better than I would, because I'm -- you know, 

obviously, he's had a chance to work on it. I've got a whole lot of 

cases before me, and I haven't had that chance. So, he'll be asking 

most all of the questions, and I'll try to be a good audience and take 

some notes on it. Now, if I ask any, it'll probably be for 

clarification only. It's not cross-examination, is what I'm trying to 

say. What you can do to help, and, of course, Counsel's probably 

already explained this to you, but just be sure to answe! the 

questions that he asks as truthfully as you can; and if you don't know 

the answer, just tell him you don't know, and he'll know what to do 

with that. He's an experienced man, and has been through this a few 

thousand times before. All right, let's take some testimony. 

Mr. Smith, would you go right ahead? 

ATTY: Okay. 

(The claimant, .. ~ ••••••••• ,,' having been first duly sworn, testified as follows~) 

EXAMINATION OF CLAIMANT BY ATTORNEY: 

Q Please state your name for the record. 

A 

Q And,~, how old are you? 

A Thirty-three. 

Q Could you state your birthday? 

A ? 

Q Are you married? 
680 

7 

A Yes. 

Q Do you have children? 

A Yes. 

Q Do they live with you? 

A Yes. 

Q And how old are they? 

A I -- my youngest is seven, the middle child is 12, and my 

oldest is 14. 

Q Okay. What kind of educational background do you have? 

A I have a high school diploma and 21 college credit hours. 

Q I see. Do you have any vo-tech training? 

A No. 

Q Military training? 

A ~. 

Q When was the last time that you worked? 

A I worked for approximately 30 days in the end of October of 

2009 to the end of November 2009. 

Q So, you worked for 30 days. How, how many hours did you work 

per week, or per day, or per month, however you want to describe it? 

A I worked no longer than a four-hour shift per day, and it was 

approximately eight to 10 hours, no more than 10 hours, a week. 

Q I see. Well, prior to that little stint right there, when was 

the last time that you worked? 

A 2006, in the summer of 2006. 

Q And what kind of work did you do there? 

A I worked in the hot food service part of .......... 
681 

8 

Q I see, worked in the kitchen? 

A Yes. 

Q And were you a server, or a cashier, or what did you do there? 

A There was no cashiering. I was cooking food, maintaining 

food, food temperatures, putting stuff out on the counters --

Q And how long did you 

A -- customer service. 

Q How long did you work there? 

A Approximately a month. 

Q A month. When was the last time you worked somewhere for 

longer than a month? 

A 2000 to 2001, probably. 

Q I see. And how long did you work at that job? 

A Approximately one year. 

Q And what did you do there? 

A I was a' ••••••• 

Q Prior to that? 

A Prior to that, I worked --

Q Do you recall? 

A About six months at •••••••• Z ••••• as a manager..:intraining. 

Q Did you do scheduling for other employees, and that kind of 

thing? 

A Yes, hired employees, scheduling, and personal training, 

cleaning of tanning beds. 

Q I see. And what year was that? 
682 

9 

A 1999. 

Q Urn-hum. And prior to that? Did, did you have employment 

prior to that? 

A Yes. 

Q Where did you work? 

A I worked at ...... 

Q What did you do at •••••• 

A I was a •••• f3.a.nd, and then, was promoted to ,~ •••• 

s 

Q How long did you do that job? 

A Approximately one year. 

Q Did you have a job prior to F 

A Yes. I worked at 

Q Uh-huh. 

A -- for approximately six months. 

Q I see. And were those job requirements what we -- what, what 

one would anticipate from a' •••••• 

A Yes. 

Q And prior to that, where did you work? 

A Prior to that, I worked fast food at •••••••••• 

Q And, and when was that job? 

A That started when I turned 16 to lB. 

and 

Q I see, okay. That pretty well describes your work history? 

A Yes. 

Q Were you working when you had your accident? 
683 

10 

A No. 

Q You weren't working? When, when did you have your accident? 

Why don't we talk about that for a minute. 

A March 12, 2008. 

Q And what happened to you? 

A I was putting some boxes up in the attic, and some Valentine's 

decorations, and was getting boxes down for Easter, and misstepped, 

and stepped into sheet rock, and landed on my right foot, and then hit 

my head. 

Q And what kind of injuries did you sustain? 

A Pilon fracture to the tibia fibula, and a shattered ankle. 

Q And did that require surgery? 

A Yes, more than one. 

Q Urn-hum. 

ALJ: I note here that she did shatter her ankle and tibula 

fibula. She's got three plates in there, and 15 screws, and she had 

some cyst problems since then. The reason I've gotten familiar with 

that, I just got through br~aking my leg, and I had the --

ATTY: Oh, my Lord. 

ALJ: -- my -- only mine wasn't as bad as hers. I had that they 

had to redo the joint there on mine, and they put five screws with a 

plate in the fibula side; and on the tibia side, why, they had to put, 

put two long screws in the thing to rebuild that joint, you know. In 

fact, that's the reason I'm using this right now, a little -- I've 

been very fortunate in that I, I was only off, oh, .about, oh, less 

than six weeks on the thing, and I've -- it's worked out very well for 
684 

11 

me. But she, she had a real bad job. She's got three plates, and 15 

screws, and a whole bunch of stuff, and has had some cysts, even, 

after that. 

CLMT: No --

ALJ: Go right ahead, though. 

ATTY: Okay. 

CLMT: -- I don't have those. They took those out --

ATTY: Right. 

CLMT: - - (INAUDIBLE) • 

BY ATTORNEY: 

Q Well, we'll let you tell, tell us about that, but -- so, you 

broke your ankle, you had surgery, and plates were applied? 

A Initially, I had an external fixator. 

Q Right. 

A And two weeks later, they went in and put in three plates and 

15 screws. 

Q In your ankle, in the joint? 

A In the ankle joint and the leg, the leg bones, tibia fibula. 

Q Uh-huh. And you've since had other surgeries, have you not? 

A Correct. 

Q How many surgeries have you had altogether? 

A I've had eight - just on my leg? 

Q Yeah. 

A On my right leg, I've had two surgeries. 

Q Two surgeries? 

A Three surgeries. 
685 

Q And the last one was --

A Sorry. 

Q -- to remove the hardware? 

12 

A The last one was to remove the initial three plates and 15 

screws, and fuse -- I don't know which is. the bigger bone of the leg, 

the tibia or fibula. But they fused the bigger of the leg bone to my 

top of my foot bone, because I have no ankle or cartilage left. And 

the other bone is just left free-falling from my knee, and I now have 

two plates and 16 screws. 

Q Is -- the bone that's free-falling, is it attached to 

anything? 

A The top of it's attached to my knee -- or --

Q But the bottom is not attached? 

A No, it's not. 

Q And when you say, fixated, so, your ankle's been fused? 

A Correct. 

Q So, your joint doesn't work at all? Well, I guess it works --

A I don't 

Q well enough for you to walk, but not in the normal way one 

would --

A I don't have range of motion left or right. I have some range 

of motion as far as flexiQn this way. However, I have to be very 

careful on it, and they forewarned me that I was really lucky to have 

the top of the foot bone left, that there CQuld be -- if I wear that 

down and have to have it fused to the bottom .of the foot bone, I will 

have no range of motion in it at all. 
686 

13 

Q I see. You mentioned you had other surgeries. What -- are 

they related to this? 

A There are other injuries 

Q Right. 

A -- not on the -- I was in a cast at the time with some of my 

other surgeries. 

Q I see. 

A And the cyst, the cyst is related to this. 

Q The cyst in the wrist, or 

A Correct, the right wrist. 

Q How about the - your left knee? What happened there? 

A My left knee, I'd had the last -- I'd had the fusion surgery 

in December 2009; and in February -- or, I mean, the fusion surgery in 

December of 2008.· And in February of 2009, I had a mishap in the 

·bathroom, and I was still in a cast on the right ankle, and my left 

ACL was torn, and the MCL was very strained. 

Q So, you had surgery for that, as well? 

A Two, two surgeries. 

Q Two surgeries on your ACL? 

A Urn-hum. 

Q Did they get that back to where it functions normally? 

A No. 

o I see. What kind of problems do you have with your ACL on 

your left knee? 

A I have swelling, limited range of motion, a lot of pain, 

popping, I can't climb or bend the same as before, I have --
687 

14 

Q With your left knee? 

A Yes. I have metal that pops from underneath the skin. I have 

swelling and fluid retention. 

Q They attached your ACL back with some sort of metal device? 

A Yes. It was a new device. And then, it required a second 

surgery, because the metal was actually starting to break through the 

skin, So they had to clip part of the metal off. 

Q I see. Do you have pain associated with your ankle? 

A Yes. 

Q Is it, is it constant? 

A It's every day, yes. 

Q Do you have good days and bad days? 

A Yes: 

Q How many good days do you think you have in a week or a month, 

however you'd like to describe it? 

A On a good week, three days. 

Q And so, the rest are bad? Is that what I'm hearing? 

A Yes. 

Q If you had to rate your pain level, on a good day, how would 

you rate it? 

A A four. 

Q If one being the least, 10 being the most? 

A A four. 

Q And how about on a bad day? 

A Seven and a half, eight. 

Q On those bad days, is the pain distracting? 
688 

15 

A Yes. 

Q Do you - would you describe it as debilitating? 

A Yes. 

Q Can you like read a newspaper on those days, and kind of 

report back to us what it says? 

A No. 

Q What kind of activity level do you have on a good day? 

A My -- low. 

Q Low? 

A Urn-hum. 

Q Do you do housework and that kind of stuff? 

A I load the washing machine, and I have a 4-pound dog. I feet 

and water her. 

Q Okay. How far can you walk? You know, on a good day, when 

your activity level's a little better, how far can you walk? 

A About four houses down from my house. 

Q Is that like -- could you put that in terms of blocks, or 

yards, or feet? 

A Blocks, it would be one-fourth of a block. 

Q About a fourth of a block? Do you have any kind of 

symptomology as a result of activity? Oh, does your pain level get 

worse with activity? 

A Yes. 

Q After activity, what do you do for kind of relief? 

A I have to lay on my back and elevate my leg above my heart. 

And I take medication. 
689 

Q Pain medication? 

A Yes, sir. 

16 

Q When you have -- when you are active, do you get any swelling 

with your ankle? 

A My ankle and my foot swell. 

Q Does it swell a little bit or a lot? How could you 

describe --

A No. 

Q that for us? 

A It swells, it swells grossly, to the point to where I cannot 

put on a regular shoe. 

Q Is it painful when it swells? 

A Yes. 

Q And for relief, you -- what do you do? 

A I have to lay on my back and have my foot elevated. 

Q For how long? 

A Approximately 30 minutes to two hours. 

Q Do you lay in bed, or on a sofa, or a recliner? How do you do 

that? 

A Either the couch or the bed. Typically, the bed now. 

Q Urn-hum. How about your left knee? Does it, does it give you 

trouble, as well, with activity? 

A Yes. 

Q Does it swell? 

A Yes. 

Q Does it become stiff and immobile? 
690 

A Yes. 

Q Is it painful? 

A Yes. 

17 

Q If we kind of go through the same scenario, scenario we did 

with your ankle, do you have good days and bad days? 

A Yes. 

Q How many good days do you think you have in a week's time? 

A With my knee? 

Q Urn-hum. 

A Probably four good days. 

Q Okay. Pain level, one to 10, one being the least, 10 being 

the most? 

A On a good day? 

Q Urn-hum. 

A On a good day, three. 

Q And· on a bad day? 

A six. 

Q As to the affected area of your ankle, do you ever have any -

what kind of sensations do you have? Do you have normal feeling in 

your ankle? 

A No. 

Q What, what kind of sensations do you have there? 

A Parts of my ankle and, and the leg are numb on the outside 

part. The inner ankle is very sensitive to touch, and has a damaged 

nerve. If it comes in contact with anything, it sends an electrical 

shock. I have a radiating, throbbing pain. Also, it becomes numb, 
691 

18 

especially when it swells and the circulations seems to be poor, it's 

numb, tingles like it's asleep. 

Q Is that every day? 

A Yes. That happens every day. 

Q Do you ever have cramping associated with this? 

A Yes, something like Charlie horses, especially in my foot. 

And I get muscle twitches in my leg. And also, I have a loss of 

feeling in my toes as far as flexing them up. 

Q How long does that last, usually, the cramping and so forth? 

A It could last for 45 minutes to three hours. Sometimes, it 

lasts all night long. 

Q And that's pretty well daily? 

A Yes, every day. 

Q How long do you think you can sit before you become 

uncomfortable or your ankle begins to swell or bother you? 

A Probably about 30 minutes. 

Q And if it does swell, what do you have to do? 

A If 

Q If your ankle swells up from sitting? 

A I have to elevate it 

Q Do you get any --

A above my heart. 

Q Do you get any relief from getting up and moving around? 

A No. 

Q How, how long can you stand before you become uncomfortable? 

A Fifteen to 20 minutes. 
692 

19 

Q Urn-hum. How about bending? Can you, can you bend over and 

pick things up off the floor? 

A No. Rarely. 

Q okay. 

A I might be able to bend over and pick up a piece of paper, but 

not every day. 

Q Repeatedly? 

A Rarely. 

Q If you had to do it repeatedly? 

A No, and I typically have to hold onto the wall. 

Q Why is that? 

A Because my gait and my balance are off, and I don't have the 

same ability to flex and bend in my knee or my ankle. 

Q Stooping? 

A No. 

Q How about lifting? Can you pick things up off the floor, like 

5 pounds, a 5-pound sack of flour? 

A I don't know, off the floor. Maybe from a table about this 

height. 

Q Uh-huh. 

A I haven't tried to pick up 5 pounds from the floor. 

Q Do you, do you try to avoid lifting? 

A Yes. 

Q Keeping things out of your hands? 

A Yes. The doctor's told me that I should only lift 5 to, at 

the most, 15 pounds, and I shouldn't be bending over to lift anything. 
693 

20 

Q I see. Climbing stairs probably eliminated? 

A Correct. 

Q Ladders out? 

A Correct. 

Q You mentioned you had a cyst in your right hand. Are you 

right-handed? 

A Yes. 

Q Has that affected your ability to manipulate, fine motor 

control, and so forth? 

A Yes. 

Q Can you handle a pen? 

A Yes, but I can't write for long periods of time, and there 'are 

some days when my hand's so cramped and closed that I wouldn't be able 

to write, type, open jars. 

Q Okay. Keyboard? 

A Keyboard. 

Q Okay. 

A Ten key. 

Q Well, you've had to put up with quite a bit through all of 

this, all these surgeries and your limitations. How has that affected 

you mentally? 

A I deal with a lot of depression, and anxiety, and guilt. 

Q Yeah? Do you ever have periods of depression where you kind 

of sit at home, and shut the windows, and refuse to talk to people? 

A I don't -- yes. 

Q How often does that occur? 
694 

21 

A Probably five days out of the week. 

Q Urn-hum. Have you ever had any crying episodes? 

A Yes, I have crying episodes daily. 

Q Daily? 

A Yes. 

Q How long do they last? 

A Thirty minutes to two hours. 

Q Are you taking any medication for that? 

A For the anxiety, I take Xanax. 

Q I see. 

A And I --

Q What kinds of things cause you to be anxious? 

A Being out in public places, being in crowded places, being in 

a vehicle that I'm not driving, being -- anywhere that I go, I'm 

constantly worried about, what if there was a fire? You know, how 

would I get out? And 

Q What about a crowd makes you --

A A crowd. 

Q -- anxious? What are you afraid of? 

A Being trampled over, or not being able to protect -- my oldest 

child is disabled, cerebral palsy. Being -- especially if he and I 

are out, and -- or just, something happened that 

Q I see. Are you afraid people will knock you over, bump into 

you? 

A Yes. Yes, I've been'bumped into, and fallen. 

Q You've said you're nervous when you're in a car. What - are 
695 

22 

you the same thing, or --

A I'm afraid of being in a wreck. I'm--

Q So -- but 

A afraid of not being able to -- I don't like not being in 

control of it. I get shortness of breath. I've had crying episodes 

in vehicles, panic attacks. 

Q What do you do when these things come over you? 

A I break out in hives, and cry, and --

Q Do you remove yourself? 

A try to -- yes. I try to go back to my house, to my 

bedroom, specifically, as soon as possible. 

Q You said that you can drive. So, you don't have any 

restrictions on driving? 

A Yes, I'm not supposed to drive for long periods of time. 

Q How far do you think you drive normally when you get in a car? 

A The most I drive, typically, is four blocks. 

Q Can you use your foot to push on the pedal? 

A On the gas pedal. I use my left foot for the brake. 

Q Can you feel with your right foot? 

A Not with the toes. With the heel more. 

Q I see. Well, I asked you about housework earlier. Who does 

the housework at your house? 

A Mainly, my husband and my middle child, 1I1I1I1t 

Q So, you have lots of help around the house? 

A Umchum, yes, um-hum. 

Q How about meals? 

(PHONETIC) . 
696 

23 

A All three of my children are a full day of school, so they 

have breakfast at school, lunch at school; and my husband is off early 

in the afternoon, so he typically cooks, or we have sandwiches, or --

Q Uh-huh. 

A -- out to eat. And after surgeries, I was on the Meals on 

Wheels program to where somebody would come by and bring me food, the 

church. 

Q Very good. How about socially? Do you get out much? 

A No. 

Q You mentioned medications earlier. What kind of medications 

are you on? 

A prescription medications, Lortab, Xanax, and Ambien. 

Q And how often do you take them? Do you take them every day? 

A Yes. And Albuterol inhaler. 

Q Do you have any side effects associatea with your pain 

medication or your anxiety medication? 

A The pain medication makes me nauseous, itchy, dizzy, so I 

typicallY, after I take that, I lay down. I get real hot. 

Q Urn-hum. 

A And I also become irritable, so I typically lay down and go to 

sleep when I take that. And the anxiety medication helps to regulate 

the anxiety somewhat, but it also affects -- gives you kind of a 

numbness and nonability to be out driving, or 

Q Urn-hum. 

A operating machinery, or anything. 

Q So 
697 

24 

ALJ: Try and speak up a little louder, would you, ma'am? 

CLMT: I'm sorry. 

ALJ: That's all right. 

BY ATTORNEY: 

Q Do you have any kind of walking apparatus or -- I know 

you've -- I've seen that you've had different things throughout your 

process of healing. 

A Urn-hum. 

Q What kinds of things have you had? 

A I've had a wheelchair, crutches, a walker with wheels and a 

walker without wheels, a cane, and I have a -- not an electric 

scooter, but it's a scooter that I can put my right leg up on, and 

then, you pedal with your left leg. 

Q And is that what you came here today with? 

A Yes. 

Q I see. 

A And I still have all the other -- the doctor's instructed me 

to keep everything else. When it rains and snows, if I have to get 

out, I use the walker. 

Q I see. Do you drink alcohol or take illicit drugs? 

A I have an occasional drink of wine --

Q Urn-hum. 

A glass of wine. I don't use illicit drugs. 

ATTY: Okay. That's about all the questions I have at this time, 

Your Honor. 

ALJ: Okay. 
698 

25 

EXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q Ma'am, I you have three children, and how do you handle 

taking care of them? 

A My husband works from 5:30 in the morning until 2:30 in the 

afternoon, so about the time that they're getting out of school, he's 

off work, and their school is all within four blocks, so take, I take 

them to school, and We share picking -- the responsibility of picking 

them up. My father and his wife live two doors away from me. My mom 

lives two blocks away from me. So, I have my family, really, there to 

help. 

ALJ: Okay. Let's see if we can't -- I, I just needed to bring 

that up and just check into it. Let's, let's talk a little bit with 

our vocational expert. 

(The vocational expert, tllllllllllllllillfhaving been first duly sworn, testified as follows:) 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q Ma'am, your name is? 

A 

Q you've probably been in hearings 

with" •••• 

A I believe so, Your Honor. 

ALJ: All right. 111111111., would you have any problem with 

her 

ATTY: No objections, ·Your Honor. 

ALJ: -- testimony? 

ATTY: No objections. 

ALJ: I didn't think you would, I'm sure. Ms. Bottrough is very 
699 

26 

well-recognized and does a good job. I know that. And most of the 

attorneys tell me that, anyhow. All right. 

BY ADMINISTRATIVE LAW JUDGE: 

Q Ma'am, you've looked at the records already. I know that, and 

I'm not going to go through all that usual kind of thing. Just tell 

us, from the records, what you find that she the kind of work she's 

done, say, in the past 15 years, and give us some idea about what that 

work entails. 

A The jobs that, in my opinion, meet SGA, Your Honor, would be 

1111111111111111111111111111111111 in a bank, which is light skilled 

work; S2 , also light skilled work; sedentary 

semiskilled work; and light skilled work. 

Q Urn-hum. What kind of jobs are those from the standpoint of 

exertional requirements, ma'am? 

A The light jobs would require being up on your feet the 

majority of the workday, with lifting requirement being a maximum of 

20 pounds. The sedentary jobs are done primarily in a seated 

position, with a maximum lifting re~irement of 10 pounds. 

Q All right, then, ma'am. Let's see. Hard to kind of ask 

quest10ns that'I have in mind, here. Let's assume, ma'am, for the 

sake of a hypothetical, here, that I found that a secondl here. 

Let's assume that I was to find that she would, as a result of her 

physical injuries, would be able to lift, say, 10 pounds occasionally, 

but less than 10 pounds on any kind of a frequent basis; and let's 

just say that in an eight-hour workday with normal work breaks, now, 

that she would only be able to, to walk and/or stand approximately two 
700 

27 

hours. On the other hands, let's assume that in an eight-hour 

workday, she'd be able to do about six hours in an eight-hour workday 

with sit -- reference to sitting. Now, with those particular 

restrictions right there, would there be any work that she's done in 

the past that she could do? 

A The occupation of telemarketer. 

Q Urn-hum. 

A And in -- which is a sedentary semiskilled job. And in 

Oklahoma, there's 5,100 of those kind of jobs; and 296,000 in the 

nation: 

Q. All right. And now, ma'am, let's also make the assumption 

that we have an individual that would -- just a second, now. I'm 

going to pull something up here that I can kind of depend on. Well, 

ma'am, let me ask this. In the jobs that you just mentioned, would 

these be jobs that -- well, you would have to be able to deal with the 

public, assume, in those jobs; or would you? 

A That's correct, you would. 

ALJ: Okay. Hm. Well, to be perfectly honest about it, I'm 

having a little trouble finding the kind of -- let's let'IIIIIIIIIFFIl 

you some questions. He's real good at this sort of thing. So, go 

right ahead and ask some questions, tIIIIIIIIII 

EXAMINATION OF VOCATIONAL EXPERT BY ATTORNEY: 

ask 

Q In the first hypothetical that was described, if an individual 

suffered from anxiety, and on occasion, would feel anxious, regardless 

of rational fear or not, and had to remove herself from that 

situation, meaning she'd have to leave her station of employment, and 
701 

28 

that occurred once a week, would that eliminate any of those jobs? 

work? 

A How long would she have to remove herself from the station of 

Q Oh, let's say, three hours. 

A It would preclude competitive employment. 

Q Anywhere? 

A Anywhere. 

Q If we take out the anxiety part of the question that I just 

asked you, and I said, well, if we had an individual who was capable 

of doing the kind of work that you said; however, if she sits for 

longer than about 45 minutes, she's had an ankle injury, and that 

ankle begins to swell and become uncomfortable, and her only method of 

relief would be -- well, she. has two methods of relief: one, taking 

pain medicine, which might make her a little foggy; or she could get 

in a reclining position where her foot would have to be higher than 

her heart for a period of, say, 30 minutes, three times a day. Would 

that eliminate any of· the jobs that you've described? 

A It would eliminate all of them, and preclude competitive 

employment. 

ATTY: Okay. I, I, I. think that would cover it,. Your Honor. 

ALJ: All right, then. Let me take a reat good look at it and 

see what we've got here, and I'll, I'll look it allover and try to 

take it under advisement and try to get to it just as quick as I can, 

which should be pretty close -- pretty, pretty fast. I'm, I'm, I'm 

not real far behind, so I can handle it, I think, by looking at it, 

and I'll study ,it over. And it's good to see you again. Do you have 
702 

29 

any more cases with me today? 

ATTY: Not, not today, Your Honor, but I did have one more 

question that --

ALJ: Yeah. Go right ahead. Ask it. 

ATTY: -- related to that she 

ALJ: Sure. 

ATTY: -- she's asked me earlier about her records. 

RE-EXAMINATION OF CLAIMANT BY ATTORNEY: 

Q Are, are we missing some more recent records? 

A Yes. 

ALJ: Okay. 

BY ATTORNEY: 

Q Okay, and is it related to your ankle or your knee? 

A Yes. I had a --

Q Okay. 

A knee surgery that's not included, and I had a following 

surgery as a result of an injury from the last knee surgery being 

(INAUDIBLE) . 

ATTY: Okay. 

RE-EXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q When was that surgery on --

A The last knee surgery was I don't know the exact date. 

Q That's all right, ma'am. Just give me a --

A June of 2009. 

Q Okay. 

A And during that knee surgery, they did -- I think it's called 
703 

30 

an endotracheal anesthesia, where they put a tube, and they put a hole 

in my throat. 

Q Urn-hum. 

A And I had an upper respiratory infection, so everything 

drained in my ear, and as a result of the hole put in my throat from 

the last knee surgery, they had to put a tube in my ear August of 

2009. 

Q All right. Now, what happened after that? Did you have any 

other surgeries or anything? 

A Yes. I was having some, I had some weight gain, and hair 

growth, and not a consistent menstrual cycle; so, they ran some tests, 

and I had a nabothian cyst found in my cervix/uterus. And so, in 

December of 2009, they -- I had another surgery that burned out my 

uterine lining and removed the cyst. 

ALJ: All right, then. Let me say this: I'm going to go ahead 

and make an allowance in the case, and I will make a recommendation, 

of course, that you do follow it closely within the next, say, six 

months to a year, because she's a very young woman, and there's no 

question in my mind she'll be -- probably, if all goes well, she'll be 

all right. Time will tell. But I'm doing this on the basis, .really 

and truly, of the fact that, well, based primarily on the fact that 

she just had so many different surgeries that had come about since 

this injury that she's had, it just seems like she's always been in 

the hospital and all that. Now, it's true that some of the things 

have developed here since she was last insured. The ganglion cyst, 

for instance, that she had on the wrist, and other things. But 
704 

31 

generally speaking, I think what she has here is a problem that 

where she's had, had to have the metal removed in one instance, some 

of the metal removed in one instance, and all that. So, I'm going to 

put her, probably, in here, as meeting a listing with reference to the 

lower extremity, and also, below the sedentary level of function. And 

then, what I'll do is ,. I'll recommend that they reconsider her in the 

not too distant future, because I have a great deal of faith in the 

fact that the kind of things that she's got are things that are not 

permanently a problem, as a general rule. They're more -- well, 

they're a hindrance, there's no question about that, and she won't 

ever get over everything entirely, but she'll get to the point where 

she can go -- now, of course, a question came up, well, why couldn't 

she go back to being some of the things she's done in the past, like 

being a £ and a, and a, a Well, the main 

reason there is that she's had so much trouble with the swelling, and 

having to keep her leg up, and, and all that, and I do know she's had 

some, some problems that are mental in nature. She's showing on her 

records here that she's had some problems with -- well, they mention 

mood as one of the main things, and some anxiety that's associated 

with that. They're indicating here the somatoform type of activity, 

and then, some personality problems that have gone into it, also. And 

that's all covered under the, the medical opinions of the Ph.D. and 

some of the other doctors in here. I notice, too, that she has had a 

good deal of trouble with pain, and has had to go through the pain 

management people, and I was particularly impressed, incidentally, 

with the report that was given by Dr .. . and al though 
705 

32 

Dr. I don't see him as a treating physician, I do note in 

here that he gave a pretty good summary of the problems that she has 

had, indicating that back on February 19, 2009, that she was status 

post her fracture to the right ankle, and status post an ACL tear in 

the left knee, so we've got two of the lower extremities that are 

involved. I note here that when she was 31 years old, she fell 

through an attic onto the floor, that was on March 13, 2008, and was 

found to have a pilon fracture of the right tibia and right fibula 

with a shortening and slight displacement, and she's had numerous 

surgical procedures since then. And I note here that she, in 

March the 25th, why -- of that year, why, she -- let's see. March 25, 

2009, she had the external fixator removed, and an ORIF of the 

fracture with plate and screws. It indicates there the fusion 

actually took place on December the 11th, 2008, I guess. And then, of 

course, she fell again on February the 8th, and apparently, that was 

2009, and came up with even more. Now, has been the 

one to take care of it. And so, I'm going to go along with the 

concept that, in view of her testimony, that she's still using a 

walker, and that she's having chronic pain, stiffness, and there is 

some evidence of some decreased vision, some sinus allergies, some 

panic attacks, some asthma, some peptic ulcer disease, various joint 

pains, bruising is easy, et cetera. I'm showing her as separated with 

three children here, but that isn't true, is it, ma'am? 

CLMT: No. At the -- we had separated, but not anymore. 

ALJ: Not anymore. So, your husband is at home now, and is able 

to take care of the children after 2 o'clock in the afternoon. 
706 

33 

CLMT: Correct. 

ALJ: And that's helpful. All right, then. I think we've got 

enough here for that. The thing that I've noted in here -- and the 

reason that I let it .90 on as much as I did, is, I felt like this 

might be a closed period. But apparently, it isn't. But it's -- I 

think, probably, based on what I'm seeing here, the doctors seem to be 

somewhat optimistic about her possibilities, so -- and I am glad to 

see that, and I'm glad she's -- I'm sure she is, too. She'll have 

some problems, of course, I'm sure, in the future. There's no 

question about that. But let's hope she gets a lot better. Okay, if 

there's nothing further, then -- is there anything further, Mr. Smith? 

ATTY: No, Your Honor. 

ALJ: Okay. We'll go ahead and make the allowance on those 

reasons I just set. forth. The hearing stands as closed. 

ATTY: Thank you, Your Honor. 

ALJ: Incidentally--

(The hearing was closed at 1:09 p.m. on April 26, 2010.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcr.i~p~t~ilo~n~olf"ltlhlelltllelsltli.mOny recorded at the hearing held in the case of ~ before Administrative Law 

Judge W. Howard O'Bryan, Jr. 

n-r-----.--/· 
707 

,y SEcli 

l~'?, SOCIAL SECl/R.I-':Y ADMINISTRATION WIUSA'\\: 

\"UIIIIlj' Refer To: I "'. 7 -''''t,rr9.t-- Office of Disability Adjudication and Review 

301 Nw 6th 8t 

3rd Hoor West 

Oklahoma City, OK 73102 

Date: \APR 1 7 2000' 

NOTICE OF DECISION - FULLY FAVORABLE 

I have made the enclosed decision in your case. Please read this notice and the decision' 

carefully. 

This Decision is Fu/ly Favorable To Vou 

Another office will process the decision and send you a letter about your henefits. Your local 

Social Security office or another may first ask you for more information. If you do not hear 

anything for 60 days, contact,your local office. 

The Appeals Council May Review The Decision On Its Own 

The Appeals Council may decide to review my decision even though you do not ask it to do 

so. To do that, the Council must mail you a notice about its review within 60 days from the 

date shown above. Review at the Council's, own motion could make the decision less 

favorable or unfavorable to you. 

If You Disagree With The Decision 

Tfyou 'believe my decision is not fully favorable to you, or if you disagree with it for any 

reason, you may file an appeal with the Appeals, Council. 

How to File an Appeal 

To file an appeal you or your representative must request that the Appeals Council review the 

decision. You must make the request in"writing. You may use our Request for Review foim, 

HA-520, or write a letter. 

You may file your request at any local Social Security office Or a hearing office. You may 

also mail your request right to the Appeals Council; Office of Disabilitv Adjudication and 

Review, 5107 Leesburg Pike, Falls Churcb, VA. 22041-3255. Please put the Social Security 

number shown above on any appeal you file. 

Permanent Subcommittee on Investigations 

EXBIBIT#14 PSI-SSA·28-001732 ' 
708 

Page 2 00 

Time to File an Appeal 

To file an appeal, you must file your request for review within 60 days from the date you get 

this notice. . 

The Appeals Council assumes you got the notice 5 days after the date shown above unless 

you show you. did not get it within the 5-day period. The Council will dismiss a late request 

unless you show you had a good reason for not filing it on -time. 

Time to Subniit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider with your 

request for review. 

How an Appeal, Works 

Our regulations state the rules the Appeals Council applies to decide when and how to review 

a case. These J1!Jesappear in the Code of Federal ReguJlltions, Title 20, Chapter III, 

Part 404 (Subpart 1). 

Jfyou file an appeal, the Council will consider all of my decision, even the parts with which 

you agree. The Council may review your case for any reason. It will revieW your case if one 

of the reasons for review listed in our regulation exists. Section 404.970 of the regulation lists 

these reasons. 

Requesting review places the entire record OfYOUT case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

1 

On review, the .Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law Judge for a new decision. 

rr No Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed 

only under special rules. 

See Next Page 

PSI-SSA-28-001733 
709 

u 1 .[1_1 Page 3 oB 

If You Have Any Q~e~tions 

cc: 

If you 'have any questions, you may call, write or visit any Social Security office. If you visit 

an office, please bring this notice and decision with you. The telephone number of the lOCal. X 

office that serves your area is (405)605-3000. Its address i oeial secu:, 2~1~rom, 

Shepherd Mall, Oklahoma City, OK 73. • . _ ~- ~. 

W. Howard O'Bryan, Jr. (04 ) 

, United States of America 

Administrative Law Judge 

Fede",\ Administrative Judieiary 

PSI-SSA-28-00 1734 
710 

IN THE CASE OF 

(Wage Earner) 

SOPAL SJj:<:.-.;rru1X lMt~mSTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINIS:rRATIVE LAW JUDGE 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

lt~ (Sodai Security Number) 

I approve.the fee agreement between the claimant and his representative subject to the condition 

that the claim results in past-due benefits. My deteimination is limited to whether the .fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. I neither 

approye nor disapprove any oiher aspect Of ih¢ agreeplent. 

YOU MAY REQUEST A REVIEW OF THIS ORD.ER AS INDICATED BELOW 

'Fee Agreement ApfJrovakYou may ask us .to review the approval of the fee agreeme~t. If so, 

write us within 15 days from the day you get ·this order. Tell us that. you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the apprOv3.! of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, JID 

Regional Chief Administrative Law Judge 

S~;A. O))J,.:R Regional Ofc 

.. 

~ 

iiIliiililliiiiik ~ ... 

Dallas, 'fX 75202 

Fee Agreement Amount: You· may also ask for a review of the amo 

representative .under this approved fee agreement. If so, =le",a",sey "'7""--",,="-'-=-="'-'=--=:' 

deciding Administrative Law Judge within 15 days of the day yo 

the fee due to the representative. Your representative also has 

not agree with the fee am'ount under the approved agreemen ,. 

You should include the social security mbber(s ow on this order on any ~that you 

send us. 

<..-c.~.-----.z. oz.JS - W. Howard O'Bryan, Jr. (0453) 

Administrative Law Judge 

APR 1 7 2008 

Date 

PSI-SSA-28-001735 
711 

IN THE CASE OF 

S·OEIAL SEcURiTY ADMINISTRATION 

. Offic~ ofDlsabflitYAdJ\id{cati"OiI andR~ri~~ 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

(Wage Earner) (SQcial Security Number) 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before Ihe.unldelrsillTledon a requestfor heating dated March 27, 2008. The evidence 

of record. supports ~~;;r~~~~~:i . (20 CFR 

.404.948(a)): The:ll 

The claimant is alleging disability since June 15, 2006. 

The issue is whether the claimant is'disabled Under;~eclions 216(\) and 22J.{d) orthe SoCiai Security Act. Disability is defined as the inability to . 

engage in any substantial gainfut activilY by reason or any medically detenninable physical or menial impairment or combination of impainnents 

(hat can be expected to resull in dea!h or that has lasted or can be expected to'last for a continuous period of not less than 12 months:. 

There is an additional :issUe whether the insured status. requirements. ofsec1ions 216{i) and 223 of the Social Security AcI an: met. The claimant's 

earnings recard s.hows that the claimant has acqwred suffi~ient Cjll,arters of coverage to remain insured thit:.ugh Decrmber 31. 20t 1. Thus. the 

claima~t must establish disability on orbefore·lhstdate';n.ord.:r to be entitled to 8 period of.di!Oabilityanddj~bility insurance b~fjts. 

After careful review of the entire record. the..under$igned finM.that..the claimant has been disabled rrOln June 15, 2006 throug~ the date of this 

decision. The undersigned also finds that the insured status rc:quirmu~nlS "fthe Social Security Acll.Vere met as of the date disability is 

established. 

APPLICABLE LAW 

Under the authority of the Sociill Security Act, the Social So;wity Ad~ninistmtion has cslBblifhc:d a five-stcp seqllt1ltial evaluation p~ for 

de'lennin.ing whether an individual i!ii disabled (20 CFR A04.1 520(a» •. Th~ SlcpS arc followed in order. If it is detennined thalthe ~laimant is or is 

not dis.abled at a step of,the evaluation'process, the evaluation will riot go on to the next Step. 

At step one, the undersigned must detennine whdher the claimant is engaging in substantial gainful activity (20 CFR 404. I 52C(bH. SubsamtiB:l 

~~~!~~~o~~~·~~;~s~~~n:~~·~r!k":a~~~n~Z~~~:i!i~.~~~t~~a~ga~o~i~~~~:e.i~;l~~~~~~ual'is not engaging in SGA, me analys.is pmceats to the second step. ' 

At step two~ the undersigned must deremtine whether the claimant has a medka!ly determinable impairment Wl is "seYen:" OT a combination or 

impaiiments that is "severe" (20 CFR 404.1 S20(c». An impairment or combination ofimpainnents is "severe" within the meaning of the 

regulations ifit significantly limits an individual's ability to perfonn basic: lNOI"k activities:. lrlhe c(ajmant does not ha ... ~ a severe lfIedically 

ddenninable impairm.ent or ~otn~jnation of impajnuCTtts. he is not disabled. If the claimant has a severe' irnpainnent or cQrJ)binslipn of 

impainnents. the a~lysis proceeds to I~e third step. 

At step three, the undersigned must determine whether the claimant's i~pajnnent or conibination of impairments. meets or medically equals the 

criteria of an impainnenlliS1ed in 20 CFR Par1404. Subpart P, Appendix I (20 CFR 404.1S20(d).404.1525, and 404,1526), Ifthcc1aimant's 

impairment or combination of impairments meetS or medically equals t~e criteria of a listing lind meets the duration requirement (20 eFR 

404.1509), the claimant i~ di.~bled. Iftl does not, the ana1ysis proceeds to the next step. 

SeeN~1 Page 

PSI-5SA-28-001736 
712 

Page 2 of13 

8efo~ considering step rour of the stqucnlial eva1uation process. me undersigned musI. fim dClennine the claimant's residual functional capacity 

(2Q-CFR·404.1-520fe»). An indiyidual's residual functional capacity is-his·ability to-do physical and-mental won:-8o[ivitics: on a sustained basis 

despite limitations from his impairments. In making Ihis finding. the undersigned must consider all of lhe claimant~s impainnenls, including 

impairments .hat are not scvcrc:(20 CFR 404.1 520(e) and 404.1545; SSR 96-8p). 

Next. the undersigned must ddermine at step four whether the claimant has the residual functional capacity to perform rhe requirements of his 

past reI""ant work (20 CFR 404.1520(1). If the claimant ha>!he rcsidlllll functional capacity to do his past rel"""ntwork, the claimant is not 

disabled. rfmc: claimant 4i unable to do any past relevant 'IIVOIk or does not have any past relevant wort.. the analysis proCeeds to the fifth and last 

step. 

At the last step of the sequential evaluation process (20 CFR 404. 1 S20(g)). the undersigned must dClennine whethcrthe claimant is able: to do any 

other worle considering his residual functional capacity, age. education. and wor\c experience, If the claimant is able to do Other work. he: is not 

disabled. trth.c claimant js not ab1e to do other work and meets the duration requiretnent. he is disabled. Although the claimant genmlly 

(I)fltinLics to have ttlc burden or proving disability at this step. a limit~ burden of going forward witb the evidence shifts to the ~ial S~urilY 

Admini5tr.ation. fn order to suppon a finding that an individual is 001 disabloo at Lhis S1q1. the Social Security Administration is responsible for 

providinc: evidence that demonstrates that other wort: exists in significant numbers in me national economy that the clai~n' can do, given the 

residual functional capacity. age, education. and wor\c c:tperience (20 CFR 404.ISI2(c:) and 404. I S6O(c). 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the· undersigned makes the following findings: 

1. The claimant's date last insured is December 31,2011. 

2. Th'e tlaimant has not engaged in substantial gainful activity since June 15,2006, the 

alleged onset date (20 CFR 404.1520(b)-and 404.1571 et seq.). Vocationallnronnation 

javasclipt:hideShowData ViewSection(%22J obsWorkedintheLast 15years%22} 

~ Jobs WorbdihtheLoSl15years 

Job Title 

1. firefighlerll!lSpeclQr 

Type of Business 

Government 

From 

May 1986 

javascript:hideShowData ViewSection(%22WorkDevelopment-lnitial Level%22) 

~ Work D~tle{op"'l!n/. tnlliDI uvd 

Claim Type:: DIB 

To 

May 2006 

8201821 Pend;ng: No 

javascript:hideShowDataViewSection(%22TicketiProgramlllfOlmatiOIl-InitiaIU:vel%2:n 

~ Ticket/Progm", lnJormQ/iolJ -l"mal Lef~l 

Panieipate tn Ticket program or another program? No 

javasc!ipt:hideShowDntaViewSection(%22TicketIProgram[llfonnatiollReconsiderationLevel%22) 

~ TiclullprogrOn. 711jtimiuflo/i - 7lec-onSlderiJtlon"uvd 

Participate in Ticket program or another proW<lom? No 

javascripthidcShowDataVicwSection(%22Ticket/Prcigramlnfonnation-HcnringLcvel%22) 

~ Tkket/Progralf1 "iformlltwn - Hegrin, uvel 

Participate in Tickc=t program or another program? No 

jllvascnpt:hideShowDataViewSection(%22AdditionalRehabilitationlnfonnation%22) 

See Next Page 

PSI-SSA-2B-001737 
713 

Page 3 of 14 

Working now? No 

Bcc:a.1JSC: of other rea50M (not my condition) The I?Bteer that l bcd. required an annual 

. physical. In March of20061 djd~not·pass·1he-_rcquim:L physical. The.particular Dr. that 

evaluated me coocliJdcd that. in his opinion. I would not be able 10 continue my present duties 

S(oppci working because: because o'r.the heart bypn$S in 1997.1 ~d the oppottUnity to volunlari!y Tetln: in May of 

2006. sn that's whall did •. with we intt?ilion of reLi~nglchangjng careers. On June l:S, 2006 J '?"8S di.a~ as needing a double bypass on my heart and arterial bypass tn both legs. I don't 

believe that l am [lOW able to work anymore. 

StOpp~ working when: 05/3112006 

Coronary artety dls~e Blocked car~liac.artc:ries! B!ock~ leg aneries, Back injur.y, 

,H}1)Othyroidism. PBirlfiJI wa!kitlg,'Ede'n1~ ill. the lower eXtm'Aities. HyPertension,. Anxiety My 

numerous moiical conditions cause combin.d1 S)'IQptoms. My back. after S sllrgeries sti!ls Allegro ImpainnenlS: =·o~a~~~~!~ ~::i~;;~~~'~~:!~S=~~:~b~~b=n:n!::;:c~. ~~ne!:~ get short of breathe easily. my lower'extrt"rilitiis Slay SwQlfen aN;l it is very.painful to walk:. t 

bave aMicr:y and. it makes it difficult to leave the bouse. 1 am told these disabilities will not 

get any bdrCT. Heart wenal bypaSsx2 1?97 and 2006: 

3. The c1aimiint ha~ the JollowiQg severe impairm_ent(s): 

Mlegation(s) 

iavascript:hideShGw9a:iaViewSection(%22Impainnenls·,LlmitationsandPain-lnitialLevel%22) 

~ fmpulrml!nts, LimilittionsaM"I'aiti -1n1ti4tLive1 

Coronary artery dis~ Blocked cardiac artc:ries. BJ~ked leg arteries. Back i~jury. 

H~th~roidism. Painful waikjn~ ~~ in the f.ower ex.t~nitjes, Hypertension. ~iety My 

n.umerons medical conditions cauSe combined:s~toms. My ~8Ck, after 5 surgeries' stills 

AUc ed hn innents' -hurts. Pailu[fccts my s!eeping .. btfl~in~'I'ftiJlg,.sian.ding and walking. l have an aggn::SSive g pa . roan of hean disease. Heart attack.. triph:-~YJ?8Ss ~ double-:bypa5.5 after.affects. tiredn~, 

get short Qfbrc.athc easily. my !ow.er extremities stay swellen and it is yery painful to walk. I 

have anxiety and ~~ ma~1$ it a~ffkult tl;! leave 1~ I!ou....e. 1 am told these disabilities will not 

get any better. Heart arterjl:ll bypa.. .... o;Jt2 19'97 and·t006. 

The anxiety and ·mo;Iictncs arid medical condilions ~use me lin mability to concen1tate or 

focus Orrinstn,lctiDos.ll1Jn v~ rQrgetf'uland catlnoc.·sil r(lr tong periods oftim.e. It is very 

limitations: painful to waOc, lift,'sit or' stand for lorig pen6ds ortime~ 'ynable to stay in an)( position fot 

ai"iy length of'limc, l h.ave to lake lots ornaps because 1 can't sleep at night because of pain 

and arixiety. . 

PainfOthcr Sympt9lTls: Y cs 

IJnpainnents First lnterfered With Ab~~r~ June 15.2006 

Height: 6' 

Weight: 250 Ibs. 

Sec 4, E ~ Farone or more of the bospi181(s) Ilisted,l had more iJ)patient stays·Sec, 6, F ~ I 

hDd Uiese tests more than once; EKG (Heart test). Treadmill (exercise test). Cardiac 

Cstherization • Hearing Test, Vision Test·: 8100d Test (~ot HM. Breatbing Test. X':R.ay. 

·Client·Retnaru ~ 3368: .. ~~ycr_s~~·{~~~-~r~=~t~~=-~~t~~i!d~~~Yi~I~\frn~ 

rttiram:lll ..... uL.lldn't beenougn fO!' me and my familY to uveon, but I was plarmingon lindint 

anOl.ller job. Then I had the lasl4 surgeries and concluded due to my c<;>nditiooS thai J would 

not be able to continu~ wo~ng. ·Jnt~et. medical form initialed on: 0210812007· 

iavascript:hideShowDataViewSection(%22EffectonWork-lnitialLeve1%22) 

~ Effed on Work ~ Jni~ir'l Le~J 

EverWorla:d: Yes 

Working Now: No 

When Stopped: 05131/2006 

Stopped Working Bec3use: Because of other rtasons (not my condition) The ca~ that ( had. required an annual 

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PSI-SSA-28-001738 
714 

Page 4 of14 

physical. In M~h of~OO6 I did not pass the: required physical. The particular Dr. that 

eVa·hiatelfme·C(f~1ndtltt~t;in tJis opinion~ I wouid nOi. be'able tQ'c;ontinut'myprcsent duties 

because ofthctleart bypass in 1997.1 had the opportunity to voluntarily retire in Mify of 

2006. so that's what I did. with the: intention of n:tiring/c:hangjng careers. On June 15.20061 

was diagnosed as needing a double b-ypass on my heart and artcriBl bypass in both legs. I don't 

bclil:Vc lhat [ am noW' able to work anymore. 

Worlc After impainnen1 First Interfered: No 

Explanation: took early retirement 

javascripthideShowDataViewSectionl%221m·painnents,LimitationsandEffec!sReconsiderntionLevel%22) 

~ Impairment5, LiRlitations and Effects ~ Re~o,uiderat~on Levt/ 

Any Changes in Condition: No 

Any New Ulnesscs Of fnjuries: No 

Any New Li~ilations: No 

How Condition Aff~ts Ab~~:,~~ Una~le to stand or w.1lk forvCf'Y long. 

How Daily Ac[illitie;. Changed; No change, No ben~. 

Client Remarks - 3441: 

Intemetusingi~'i. bli ....... R ... "'l"ln.,_om'p'eI,erAlldress: 

R<poit Cornpldcr Emalf)':difrW .. , ••• "".,-.... ;~",."""" subtiliiiedon: 12118.12007 .. .. '-..• '-. __ .•. 

Work Since Original Qaim Filed: No 

Submitting New EvidcilCe: No 

Reason Appeal Requested: I AM DISABLED 

javascript: hideShow Data ViewSecti'on(%22Impainncnts:LimitationsandEffectsHearlngLevel%22) . 

~ IlIIpairlllenls, Li",ilarions and Effms * Heating upel 

Any Changes in Condition: Yes 

Changes in Condition: ~i:~hne I can stand before I mlUt tit and rest is getting shaner because of my increasing back 

Date Occurred: F-ebruaty 2008 

Any N~ IIln~ or Jnjuri~:· y~ 

Ne'N IUnesses~ Injuri~" or Conditions: 1 ha~e now been diagnosed as a Type 11 Diabetic, 

Date Occurred: 3/12f{).8' 

Any New Limitations: No 

How Condition AtTects Ab~~~a~N~~~~ I nill care fo~ my own pCJSOnal ne:o:k. 

How Daily Activities Changed: As.l.stated be.rore.the timc I can stand is geUj,n~ sboner and shorter due 10 increasing back 

palO. J must Sit and n:slmDre often so any activIty I do takes longer. 

Worked Since Filing- For Reconsideration: Yes 

Submitting New Evidence: Yes 

!l1 •• Ill'. DISABLED DUE TO 2 HEART BYPASS SURGERIES, S Reason Appeal Requcsted: BACK SURGERI~ !fUSION), HEART DISEASE. SLEEP APNEA, HBP • . HYPOTHYROID. FATIGUE & SHORlNESS OF BREATH. 

(20 CFR404.1520(c)). 

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PSI·SSA·2B-D01739 
715 

Page 5 of 14 

Primary Disorders of back discogenic and degenerative (7240) 

Musculoskeletal (01) Essential hypertension (4010), Coronary artery disease, Blocked.cardiac 

arteries, Blocked leg arteries, Back.injury, Hypothyroidism, Painful 

Secondary walking, Edema in the lower extremities, Hypertension, Anxiety My 

Cardiovascular (04), etc., numerous medical conditions cause combined symptoms'. My back, after 5 

surgeries stills hurts. Pain affe.cts my sleeping, bending, lifting, standing 

and walking. I have an aggressive form ufheart disease. Heart attack, 

tt:iple-bypass ~nd do.\Ible-bypass after affects, tiredness, get short of breathe 

easily, my lower extremities: stay swollen and it is very painful to walk. I 

have anxiety and it makes it difficultto leave the house. I am told these 

disabilities will not gei any better. Heart arterial bypassx2 1997 imd 2006. 

The anxiety and medicines and medical con!iitions cause me an inability to 

. concentrate or focus on instructions. I am very forgetful and cannot sit for 

.long periods oftirtJe. 11 is very paintulto walk, lift, sit or stand for long 

peri~s of time. 'Unable to stay irl I!hY poSition for any lensth oftinie. I ha~e 

_to.take lo.ts of naps because I,.~tsleep at nighLbecause of pain arnd 

.anxiety related disorders (3000), obeSity and hyperalimentation (2780), etc., 

. Height: 6' 

Weight: 250 lbs. 

meets the' criteria. of section(s) l.04A, etc., of 2(fCFR Part404,.subpart P, Appendix 1 

(20 CFR 404.1520(d». The. record shows tlie.clalmant-is functional below the sedentary 

level for any sustained, continual'or regulat; activUy. 

In making this finding, the undersigned considered all symptom's and the extent to which these 

symptoms ClIn reasoiuiblY.be accepied as consistent. with the objectiVe medical evidence and 

other eVidence, based on the requirements of20'CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

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PSI·SSA·2B·001740 
716 

Page 60f13 

.", EX€RTI0IW:'I:JMIT"'TIONSo None .. tobti.n..,. (Pr<>«od .. _ 8.) 

1. Occasionally 11ft amJOI o.arry Qndudlng upward·pWIb19) 

{I'n!b.imuM) - W,han less. Urdn Otl1J-.thlrd cd lhollme (Hiss, (han 10 poonds. Oxpfaln tho amoum "lmoipolJnM) rt, nom 6. 

o /u:; ""lion lDpctJm$ 

o 10v,,,,,.d •. 

'1& 20 """"ds 

D5!>pound. 

0100 pounds or fTY.]r& 

2. rreqtJendY liIt.nd/orcany Onclll<fmg ul"""fII puling) 

(nqIx1m'l1l1) - '"""" ..,.._ IWl>!hIrlIs d1lhe lirre 01 10 •• Ilia. 10 p"'1><fS. eJqlIa .. 1IIe emoum (lilJlO!p>unds) In kem 6. 

01 ... 11>"" IGpooods 

13! 1D pcunt1. 

025p""r.d. 

o SO pP1md'S or more 

3. sjond _,on .. 11< (WlI~ ronnaI breaks) fur Blotal';l • 

o· fD~- It'lan 2 hOOrti in an S·hclII' do:Dy 

o at least 2 "ours in an a-hour WottuJay 

011 3bQIJffi hOllreln ~n l.H\Ql.lr wCtf1¢"Y 

o l1l8dlr:aI1y reqU1/gd hQnd~ri:I S'IIiI~SV\J d9Yic9 is neCGs.sary for ambulatlon 

4. Sft lvrlth nonnol_ksJ for. lolal of. 

t1 (ot.$ '!tJ.a;n- .. bOut 6 hours in an 8·how workday 

Q!2 about 6 hours in an 6..tJOUf woJkday 

o must periodically aJti'rtlate liining and standing \0 ralie..-e pair. OcT dlscomf.ort. <I! ch~kQ(j; ilxptsin in 6.) 

5. PUGh dnd/or PUll (incMtill9 oJPOraDon or hand arid/0f1001 conttOls) • 

S lJO,li~ted, other tTI&l -e5 !Shown 10r Uit aOO/Of C81ry 

o limited Ii'l up~·e1 extreml~eB {Qe~lI00 nalur.o.ilfId ~cgroo} 

o Jimltca fI'IlQWctf 9Xtr.omJdo-c (dOsc:;1bo JlD;llJtl) and Clf:g'ce} 

6. E>:piain how and ~ UIO 0YId0nc0 suppO.,:;)OOf conclusions In IJ-em 1 through 5. 

Ole Ibe spe<Hio ",ct. upOn ""'''*' your cortcIuslo!lo ere baoed. clt. hlll$ 68,~ l~t' fuo.Jo;1. )Ul'C hM ot;!Ql'QJlnry art.ry .(tfld ~er'Jpll.et'.l .rt.ery dheaoe 

\o"ien r~v"'8cUlariutLon. Haa'ner ckY. ET'1' 11-27-06 sh=;:IWSI no tache!!lia at 6.76 nets by 

report of tM C':tt:ljlQlo~ht~ »0 c..";"e$t 'Pldll nCN. DOII!.G complll1n of le9 al1d h.ip p.aln. 

IrOlE ASI of 0.8i1 riqbe a..~d Q.9'; left. JlS$ nomlil xc·a.YOl o! nip!! &rid k.."le.ea. Rad 

lumbar ft1&~on lh 2'iHH. i'1~X'C8 lu."I'lbbr 6D doSrccs now. tJo 10P8 of 50n:;.,prlon. 

rOltl-axe8-4 or mot:.or. 

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PSI-SSA-2B-D01741 
717 

Page 7 of 13 

S. POSTURALlIMrfA"iiONs 

o ~orae estaclisnad. (Proceea lO Sfi:ctlon C,) 

F""luenlly O!:<aoi<lnoDy Hen 

1. ClImbing· """WOtan .. B 0 0 ··,"cIdorl'opIII~ .. S 0 0 2. B8lendng .. iii 0 0 3. SIo9ping .. 0 a 0 4. Kneelln,j .. IS! 0 0 S. Croucltlng .. a 0 0 6. C<aWIir1g .. jg 0 0 7. Whon .... than I\'IO-thlrtl. of iIlo time lor Irequon1l}l or .... tIlan o",,·tlllrd re, oe<:8$lor\alli. 1u~1 descriIle """ 9X?iidn. Also e~Pla!A how 8fId why 11M lW'i:I~nce fiUPPOOS. )'QUf oondu$iQrlS In Iterm. 1 tmough 6. Cite 1M 

SpecrrlC facts upon Wlleh YOUf CtItn:::IIu:s.iOnS 11M b~oo. 

Soc A6 

Specify tho lislingi.) (i. ... i2.Vi "'rough 12. 1bj under .. ~ich tho item. below .re beiilg nitCd . 11,0' 

FUNCTIONAL' 

LlMriAl10H DEGREE OF LIMITATION 

NOn. Mild Moder8l_ ~ksd" ~'"'''''' .. _/It 1. f!e<trictlon of Aaivkies Evldenoe 

otDaIly living 0 IS! 0 0 0 0 

None Mild Moderale Mar\<e<l' Exlrem .. tl1SjJfllde .. 2. otHkuIll9G.ln MaintainIng £vId~hQ! 

Socia! F'unctJonIng 0 18 D 0 0 0 

NOna tlild ...-.-... MElfkfNj' ExUam.· .. th$Ufl'd<int 

l.. ·OffficulUes In ,,"""t~nlng Evid~ 

~mnion. Per!isle!1C~. D If§ 0 fJ Cl t:l or PaOQ 

IV. CONSVt.TAI'IT'S NOTES . 

~tv" claiman't: is 5-£-04 rIo malo_ He tkmi8& bein9 dsprouedr bu~ he raporta a "littlil b-it" of atlZ1Bty for ..-hieh he ta.kes .1 iii. Qf Xanax daily. At. KSS* be. dld 

not appear depresled. Ke nporc~ that he is 4:-' avid news vatcl\er, lind he ap,endl. 

qui~e ~~·bl·tl- Qt- ~ -'W()~1nq·-ln--ttlc-yard.-Hct .la_ .rc.t,..Lt.l)d_f'tCCl_hll1_'ob .•.. lila_NSf! """.til 

ee.s.enticilly unretn:'1cab1e _1th no deficits in any domaiD, wun. t.he exception .of 

'Io'orkinq lI.'te~rYI whirh.\laJI. p'oss1bly in t.he mUd1r problematic ranqe. ThEre havE.' 

DoO'n nCl -p":Y':"'l In.padcnt tt'Cl-tJt.:l!~t'lt..~ 

OX-R .... O ~neriilbed A.n%iety Oisorder 

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PSI-SSA·2B-001742 
718 

VASCULAll lABORATORY 

mTIHG DOPPLER, rnroros 

NMre: JII' __ .·iiI" -."li .. ,_-'--_ DAn;.: J0/10/07 

AGE; ~ 'SEX' _11_ ~O l"H'iS1C\AN: STl'<TE OF OIUJulOMll 

Page 8 ofl3 

DIABEtES: N. HTi<: ~ CAD: _. _Y_' HlGRCIl()UlSTeIlOL:........l...... 

Cl..AlJDlCATlON: __ 1_ I'VO: ---:!!.:.- SMO!WIG1 PAST: -.X..- PIlESl!NT: ~ 

. LgOPJ\f,Ss\il!,!il!: 

COMIiION ~()RAL 

.I'(}PLITE .... L 

1'00000RIOR 11B1AL 

DORSAL1S PBlJIS 

OOl'I'LE8 S!QW.I.S: 

COMMON FEMORAL 

'I'OPLlTE.Al 

POSTeIlIOR TIBIAL 

OORSAUS PEDIS 

RIGHT ASl ,,91 

-~-

130 i 0.89 HO ,0.9& 

...1lL 1..uz.. ..ill..- ..Q...i.L 

I. 

RIGHT ~ hUT 

l-... -

COMM£NTs: !he reBt1.nq, o!0PlOl"r "iqnd" ""9 ibllOrmal in bp,il;! 1MB. 'l'h" 

rast,in9 pressures a:rc abnonml in t:.h,e right leg and" ·bo1:daxlJ.n,e 

~~ .. -, 

------:--'----.\ ------. P~ySICl ... N SlGN"TuRE: ___ -: . ..,.. ____________________ _ 

~ ! 

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PSI-SSA-2B-001743 
719 

- Page 9 of 13 

'.~~~~--.. ' . 

PATIE~ __ OAn /0,f$!Jc><:>7 

ADDRESS AGE S'6· ·S£)(.,-I1 ....... __ _ 

__________________ HEiGHT WEIOKt __ _ 

I 

LINEAR 

TElEPHOIIIE NO., ___________ BUllD IIfrERMEDIATE ____ _ , lATERAl _______ _ 

OCcuPAnON, _________ ~ __ ---------BlOODPREasuRE-----------

DOCTORIS)~ 

!'ATIEN'!" pas. !'·WAVEs 

AURIC. RATe TWAVES 

VENT. RATE S·TSE"~ENT 

P.A ImE:RV,.\L" RHYTHM 

Q.AS IN.TERVAL El!,C. AXIS 

o..T INTEFWAL flEe. POSITION 

FlNPINOS We;- f1tt55'-n~G- p"'efL..c:,E- T{C/.fcj,vCo:; t9rz..& 

A- f3,va fZ..,'1/f'- 1-'/'(3)0-1# L...fr G-":; 

) 

REMARK8 ________________ ~7~<~~----~\----______ --__ --------

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PSI·SSA·28·001744 
720 

Page 10 of 13 

DATEJOR.: 

NAME: 

SSiCASE#: 

OllEr COMPi.AJNr: 

I.. s.:--"", hip pain. 

2. History of"""" problems. 

3, Book problem •. 

HISTORY OF PRESENT IlliIESS: 

11><: patient is 8 S6-yeer~1d CilUI:IlIim male "ith. slgni6C1111 hislol}i of cardiovascular 

~ iilc\l!ding <9rori!I!Y BrtfJ)' di~. as \I/OU .. po:riphenll wscular dis=e. The 

poLiom CIlITeG.tly .t>ICSIbalIhC, moshignifiCBOllUnJ:tionallirMalionhe has is trouble . 

..... !lcing. roovinsOt'llo!1iIi ,,":'tk..eendaiY to pain iD his hips. ,He SO)'" Iiispain 00""'1 on 

basica1lY wijh oily sortof""tivil)' IlIl!l is rl'!ievtd with ..... II i. hhalt:r11l j~",,~ It is 

~.c 1ll1li,,~g\1.~c.~ ;nr~~ .!'" js.~~",. oblelO ride. $IlUI~.bike ~. while, 

whlch ~""'tn h<Jn.lM.tP t!I'!.Jl<li!l. ~0'1!et!!!'~, He al", ""me ossoc'lIl&il 1'.1;< jialn md ba"·l\WK.~aJ.f~P!'!!>_wi\!t,"",!""!Jlinee1Cmy. os ... 11 as "nc:Ji,vel fifsi9n. He 

rq>OlU ~e GWrcol b..,kl'tUn is l\lidUIlIl, tipproilmiuely ~t U-S rlhliiCoti<m:Oif~Dtio:l. 

lti. J>Oi\ paipable. 'EX1Ciili, he ifii<;j IiaVii plilinh~t radiaic. inlo hi"lefl1ci''P''Cilically 

onthe.posWior .. poet <>fhiithjgn. .1~~patienl OUIrtDlly deni<;$eny5!!<;s!pajft.· He has 

DOt ~ MY <best pain'since his'mOst reCent CJ\BG in 2006. H. has <>61 uSe,l . 

niltogl)'Cerine and' feeto 'Iike hisl'uDoli<>no:l·limi;'lion wdioY1lSCuiarly is improVed si= 

thai operation. The poJj,:nt tuncntJy .lates Ihiu his main limiWlon ilrthe hlps. .lthaogb 

be is bCS,i8nt to do onytlifrig pbysical sccondliry [0 hi. eXI<nSive cordiovlllCUlar biSlOIY. 

PAST MEDiCAL HlST0RY: 

1. Histo>yofm~al inf~on. 

2. CormWy orlay diitASt. 

3. P'lri~'v=lIr dj$e4se. 4. llyp6i1ijroid. . 

S. Oegjinemtive di..: discosc. 

6.C8,""",ts. 

PASl: SIJR<iICAI~ HISlUR Y: 

l. ~VCSSI!ICA~.l997. 2. Twa VtosiI CABO,lOO6. 3. [.4..13 lami_y in 2004. 

4. F""ioilIA:U·2004. 

S. Lcll.I<kd otupedeetomy. 

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PSI-SSA-28-001745 
721 

/'~l~':--

6. ~QhI sidtd"stnpec!cctOlllJllllld $ub$equent redQ IICCOIlda:y to infJun. 

SOCrAL HlSTOR Y: t: Past hi>lol)' or $I1lok!ng, """ not smukEd for J ycazs. dalics mccool or drug$. The patient 

if .... t~ I lind """ attempted to wolf< .. a lnlCk.driver, but he has had 

diffi<:ulty....,Ddary 10 IIiI' pain, .. w.:U as history .,r cardim-:w:ulnr issues. 

FAMILY HlSTORY: 

l. Strong fiunily hiotory of coronary arIel}' disease. 

PHYSiCAL EXA,MIlI1A110N: 

VITAl. SIGNS: Blood pres""'" is 160190. PuI~i.sS •. Rcspi .. tiOTl9 ate 12. ' 

TempernJUreis·98.1. Vi-' ""uity: With. g1!1SSC$. 2000 right; 2O/2j) left; without ~ rigbt2llf7,O; left 2oaOO. Hoigbt: 72 112 inclIoa. Wei&In: 2.S4 p<>Unds. 

GENUA!. q;)MMll,NTS: TI)<; j'll1i1!ft1 i> very pte"""" CaucuiOJl male, <oopemtive, 

altJ!; awake IIIiII ~b:<! in 110 m::U1t disu ...... nhis tim... :. flEENli ,ijeal.l>is'alnllunalii:, n~. Pupil> <Ii>: equal, roun<I, and reacrlvelo 

lisJ!,l'§D.d..i~rno1fi!Uon, Extraocular musc~'"", inl\ld. No ... and tboaI have moUl 

lInd,piriknil:!!\li!line- Hchasgood denution .. NoMduttaatC,i.>leci inlilii~ NobnlilS 

~~ul~, .... ,.. 

CA.!WJP"'~~CU\,..\R: . RIllIUW: JII1e and rhythm .. illwut munnur. LUNGS, ·at...,. 10 aWCldtalion billllcrolly. 

AlID!'l~: Soft, and nonle!ldo'. Bowehound."," posipw. 

'ElC;rRE.M.tIIllS: No, !'lema, ql!lJosi. or clubbUm- No lower atro:!Uly .pIIlsc:s wen: 

paJpillile, ibclUJIiRg!ionodit pedis and poSl';;O, b'bial. 'The poUOnt rcPOtU he typically 

ha.t~1i'!!lllJ.'!!"'it!i~p'plor. . .. M!.I.!iC;;l:JLQ~KELllTJ1,L: No mastic spasms ON 1I0I<0. ~~Ie'~ti.lIc ..... S}'ttlDIf!!ricm;xl '~P.ri>i~. J:?ecp, "'npon reflexes oro 2+ upper end I"",'tr exlreriliti .... Range of motiOn: 

Plclk. sce~ ofmation sIloc/. The poti""l doeS liavelwited hip'lI@on U "":11 .. 

ml;lllion. The patient wu .bl. te heeliUld loe ,,-.ik eff<CliV<;)y bilatc(ally. He wos able to 

BOI up (lut ot't¥ thai; caslly IU1d 11<1 On to the •• am tablc.<.asily. Joint <Um ~ non 

spedli.;:· .Sauiilht:leg nUsctcStS were positive Oll the left Scaled ood it WIll! "",it; •• 

bil;.imiJll',wIi)!isupme:. . . 

NEUl,tOLOGlCAL: eraruol nen'eSlltlnl'ugl,Xllare iruactj)it>"Iy. No fOcalder"';tSin 

scnS8rilln Or Slriogth Werc oo\J!d. oLlier thon .he patient doeSbavc dccn:aSc in ~on 

on tJ!e·\~postmorlind Ia1cnlllSpCCl (ofllis qUe His .pine ",as nollcodq 10 palpation 1"'"' tl1e aIfOctOd areaS: Fine mOlar Itilt""'" appropriote aJ\d inlAct. H~ did IIOt appear Il> 

rul\'elltly radicular pain ar the tim. of exam. 

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Page 11 ofI3 

PSI·SSA·28·001746 
722 

I!;J~~T~--' 

MENTAl. ST A1llS: Pad .. t i .. lone. He was ,,~n kept. Moler bc:bovior was 

~aie. Speecli, fIiOilghl proces.s."d 1lioughl <onlonl wac approprillle. 8e0s0riom 

and cosnitian "'$ appiupriorc. as ...... judgment IUld insigh~ 

ASSESSMENT; . 1. Stvere bip poin .. ith f1l'!Ol;OnallimiUlli"" .. 

J. HistorY ohignilieanf c:.attIiollllOCular di ...... <mona,y ~ disease and 

poripbcl1ll':-ulu di5e .... Tho p:11ient curmtlIy denies thest poin and does !lOt 

oSe nitro, . 4. Hi~Oty of ~ve joint disease: and <lise disease. 

S. Hypolhyroid. 

6. Cafanll;ts. 

__ DATE 

Page 12 ofl3 

Various physicians, treating and non-treating, have written ·that..the ·claimant suffered from 

various medical prdblemsand ·that the c1aimll!lthassigQi-ficant work re~tr-ictions. While the 

find'ing that a person is ~disabled" under the, provisions of .the SoCi~1 Security Act is an issue 

reserved to the Commissionerl (SSR 96-5pl), opinions from any medical source on issues 

reserved to the Commissioner must never be ignored: The adjudicator is required to evaluate a\l 

evidence in the pase record that may have a bearing on the determination or decision of 

disability, inc!iJdingopinions from medicarS0litces ab:ciut isSues reserved to the Commissioner. 

If the case record contains an opinion 'from a medical source on an issue reserved to .the 

Commissioner, the adjudicator must evaluate all the evidence in the case record to determine'the 

extent to which the ~pinion is supported by the record, . 

, The fact that the claimant's treating physician, after extensive examinations and treatment, has 

forined such opinion' as to the claimant's ability to perform sustained work activity was 

precluded strongly suggests_ .a, significantly limited rl;:sidual fun~tional capacity, Further, 

considering the claimant's diagnoses and multitude of prescribed medications tried, the 

undersigned fin'ds that treating physician's opinion is well s~pport and is not inconsistent with 

the other substantial evidence in the case Tecord; thus, it is afforded controlling weight (20 CFR 

404.1527(d)(2) and SSR 96-2p), 

1 ~Hnder. 2D- CER_4Q~Uj21(e). some issues are, nQl me.dic.al JuY.~ ~~rd.i!lg. ttu: n:atYI~.~q g:v~ty. Q.f _~ in9jvigua:I's 

impainnent(s) but are administrative findings that are dispositive of a case; i.e., di.at would direct the dete:nnination or decision of 

disability. The following are"e:<:amplc:s of such issues: 

1. Whether an individual's impainnent(s) meets or is equivalent in severity to the requirements of any impairment(s) in the 

listings; 

2. What on individual's RF;C ·is; 

3, Whether an individual's RFC prevents him or her from doing past relevant work; 

4. How the vocational fact~ of age, education, rmd work experience apply; and 

5. Whether an individual is "disabled" under the Act. . 

The regulations provide that the final responsibifity for deciding issues such as these is reserved to the Commissioner. 1 J 

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PSI-SSA-28-001747 
723 

Page 13 of 13 

In maki;;g thi;f1"i~(Ii;;g, the unde[sig;;ed~~sid~~iall ~ymplOrns and the exientto which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

·other evidence, based on the requirernentsof20·CFR404.1529 and SSRs 96.4p and 96·7p. The 

undersigned has also considered opinion evidenCe in accordance with the requirements of 

20 eFR 404.1527 and SSRs 96· 2p, 96-5p, 96·6p and 06-3p. 

After considering the evidence of record, the undersigned finds that the claimant's medically 

determinable iinpairrnent(s) could reasonably be expected to produce the alleged symptoms and 

that the Claimant's statements concerning the intensity, persistence and limiting effects ofthese 

symptoms are generally credible. ' , 

The State agency medical opinions are given little weight because oltter medical opinions are 

more consi~tel1t wiih the record as a whole and evidence received at the hearing level shows that 

the claimant is more limited than determined by the State agency consultants. Furthennore, the 

State agency consultants did'nol adequately consii'lerthe claimant~s subjective complaints or the 

combinei:l effe~t ofihe claimant's impairments, 

5. ThecjaiH1ant has been under a disabiH9',an:lefinedin the,S,o~ialSecurjty Act, from 

JUne 15",2006, through the date,of.this dcCision(ZO <;FR 404.1520(d». 

DECISION 

Based on the application fora period of disability and disability insurance benefits filed on 5? 

February 8, 2007, ihe claimant has been disabled under secti 16(i) and 223 d) ofthe Social 

Security Act b'eginni'ng on Junei5, 2006: " • ". 

W. Howard O'Bryan, Jr. (04 

AdrniIlistrative Law Judge ' 

APR 17 1008 

Date 

PSI·SSA·28·001748 
724 

~SECu 1 j'I. ~ SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

301 Nw6th St 

3rd Floor West 

Oklahoma City, OK 73 I 02 

Date: IDEC 0 4 2001 

NOTICE OF DECISION -FULLY FAVORABLE 

I have made the enclosed decision in your case. Please read this notice and the decision 

carefully. 

This Decision is Fully Favorable To You 

Another office will process the decision and send you a letter about your benefits. Your local 

Social Security office or another may first ask you for more information. If you do not hear 

anything for 60 days, contact your local office. 

The Appeals Council May Review The Decision On Its Own 

The Appeals Council may decide to review my decision even though you do not ask illo do 

so. To do that, the Council must mail you a notice about its review within 60 days from the 

date shown above. Reviewal the Council's own motion could make the decision less 

favorable or unfavorable to you. 

If You Disagree With The Decision 

If you believe my decision is not fully favorable to you, or if you disagree with it for any 

reason, you may file an appeal with the Appeals Council. 

How to File an Appeal 

To file an appeal you or your representative must request that the Appeals Council review the 

decision. You must make the request in writing. You may use our Request for Review form, 

HA-520, or write a letter. 

You may file your request at any local Social Security office or a hearing office. You may 

also mail your request right to the Appeals Council. Office of Disability Adjudication and 

Review. 5107 Leesburg Pike. Falls Church. VA 22041-3255. Please put the Social Security 

number shown above on any appeal you file. 

Permanent Subcommittee on Investi ations 

EXHIBIT #15 
725 

Page 2 of3 

Time to File an Appeal 

To file an appeal, you must file your request for review witbin 60 days from the date you get 

this notice. 

The Appeals Council assumes you got the notice 5 days after the date shown above unless 

you show you did not get it within the 5-day period. The Council will dismiss a late request 

unless you show you had a good reason for not filing it on time. 

Time to Submit New Evidence 

You should submit any new evidence you wish to the Appeals Council to consider witb your 

request for review. 

How an Appeal Works 

Our regulations state the rules the Appeals Council applies to decide when and how to review 

a case. These rules appear in the Code of Federal Regulations, Title 20, Chapter 1Il, 

Part 404 (Subpart J) and Part 416 (Subpart N). 

If you file an appeal, the Council "'ill consider all of my decision, even the parts with which 

you agree. The Council may review your case for any reason. It will review your case if one 

of the reasons for review listed in our regulation exists. Section 404.970 and 

Section 416.1470 ofthe regulation list these reasons. 

Requesting review places the entire record of your case before the Council. Review can make 

any part of my decision more or less favorable or unfavorable to you. 

On review, the Council may itself consider the issues and decide your case. The Council may 

also send it back to an Administrative Law Judge for a new decision. 

If No Appeal and No Appeals Council Review 

If you do not appeal and the Council does not review my decision on its own motion, you will 

not have a right to court review. My decision will be a final decision that can be changed 

only under special rules. 

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726 

Page 300 

If You Have Any Questions 

cc: 

If you have any questions, you may call, write or visit any Social Security office. If you visit 

an office, please bring this notice and decision with you. The telephone number of the local 

office that serves your area is (405)799-0702. Its address is Social Security, 200 Ne 27, 

Moore, OK 73160. ,~ S2: ~~~~~--.--~~ ~ ~ 

W. Howard O'Bryan, Jr. (0453) 

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 
727 

IN THE CASE OF 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

ORDER OF ADMINISTRATIVE LAW JUDGE 

CLAIM FOR 

4Claimant) 1<--___ _ Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

(Wage Earner) ."~--,---- (Social Security Number) 

J approve the fee agreement between the claimant and his representative subject to the condition 

that the claim results in pa:;t-due benefits. My determination is limited to whether· the fee 

agreement meets the statutory conditions for approval and is not otherwise excepted. I neither 

approve nor disapprove any other aspect of the agreement. 

YOU MAY REQUEST A REVlEW OF THIS ORDER AS INDICATED BELOW 

Fee Agreement Approval: You may ask us to review the approval of the fee agreement. If so, 

write us within 15 days from the day you get this order. Tell us that you disagree with the 

approval of the agreement and give your reasons. Your representative also has 15 days to write 

us if he or she does not agree with the approval of the fee agreement. Send your request to this 

address: 

Joan E Parks Saunders, J. D. 

Regional Chief Administrative Law Judge 

SSA ODAR Regional Ofc 

Rm460 

1301 Young St 

Dallas, TX 75202 

Fee Agreement Amount: You may also ask for a review of the amount of the fee due to the 

representative under this approved fee agreement. If so, please write directly to me as the 

deciding Administrative Law Judge within 15 days of the day you are notified of the amount of 

the fee due to the representative. Your representative also has 15 days to write me if he/she does 

not agree with the fee amount under the approved agreement. 

~. 

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728 

You should include the social security number(s) shown ....... ~,,"""",.. W1ypaP~() send us. ~~~~---~ ~ W. Howard O'Bryan, Jr. (0453) 

United States of America 

Administrative Law Judge 

Federal Administrative Judiciary 

Date DEC 0 4 2001 
729 

IN THE CASE OF 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication aod Review 

DECISION 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits', and Supplemental Security2 

Income 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the undersigned on a request for hearing dated November 7,2007 (20 CFR 

~ 

404.929 et seq.). The evidence of record supports a fully favorable decision; therefore no 

(20 CFR 404.948(a) and 416.1448(a». The claimant is represented by 

~nattorney. 

The claimant is alleging disability since August 22, 2006. 

The issue is whether the claimant is disabled under sections 216(i), 223(d) and 1614(a)(3XA) of 

the Social Security Act. Disability is defined as the inability to engage in any substantial gainful 

activity by reason of any medically determinable physical or mental impairment or combination 

of impairments that can be expected to result in death or that has lasted or can be expected to last 

for a continuous period of not less than 12 months. 

With respect to the claim for a period of disability and disability insurance benefits, there is an 

additional issue whether the insured status requirements of sections 216(i) and 223 of the Social 

Security Act are met. The claimant's earnings record shows that the claimant has acquired 

sufficient quarters of coverage to remain insured through September 30, 2009. Thus, the 

1 Title 11 oflhe Social Security Act is administered by the SocgJ Security AdminiSlration. Title II appears in the United States Code as §§401. 

433. subchapter II. cltaprer 7, Tille 42. bttp-lIw,,'w.ssa gov/OP Home/sAAcL~ilIt02JQ200 btml1 

2 Regarding YOUT SSt _caliDn only- Eligibility fur sst payments is not dependent in any way upon insured status. With regard tocillimant's 

Title XVI application, the payment orbcnefitsmny not. be: made tor any perlodlhatpnudes the dale on which the claimant's applicaLion was filed (20C-F.R. § 416.5{}J). Therefore. for [he p.lrposesofthis decision, a determination that disability covering the period from June 11.2007 is 

considered to be a fully favorable detaminalion. 

3 10 Code or Ft'dtral RqulatioDs Ch. III (4.1"()6 edition) stdioa 404.948: Dtdding a case without an onl beariag before an 

admillistrative taw judge. (0) Decision wli"lly favorable. If the evjdence II Ihe hewing record supports a finding in fllvor of}'Ou and 81111e 

partiC's on every issue.lhe Administrative Law Judge:: may issue ahe.vmg dtc;ision without holding an oral hewing. _ .. )) 

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730 

Page 2 of30 

claimant must establish disability on or before that date in order to be entitled to a period of 

disability and disability insurance benefits. 

After careful review ofthe entire record, the undersigned finds that the claimant has been 

disabled from August 22, 2006 through the date of this decision. The undersigned also finds that 

the insured status requirements of the Social Security Act were met as of the date disability is 

established. 

APPLICABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404. 1520(a) and 416.920(a». The steps are followed in order. If it is 

determined that the claimant is or is not disabled at a step of the evaluation process, the 

evaluation will not go on to the next step. 

At step om:, the: undcI'5igned must dctcnninc whether the dainant is engaging in substantial gainful activity (20 CFR 404, I 52()(b) and 

~ 16.92O(b)). S\,bstantial gainful activity (SGA) is defined as work activity Ibal is both subslantial and gainful. Iran individual engages in SGA. 

she is not disabled regardless of how l'te\lCTe her physical or mcnlal impainnents are and regardles.'i of her age, edu::alion. and work experience, If 

the individual is not engaging in SGA, the analysis proceeds to flc second step. 

At step t\\'\\ the undersigned mus(delcrminc whether the clamant has a medkaJl)' dettmlinable inpainnent that is "severe" or a combination of 

imp:ainncnts that is. "severe" (20CFR 404.IS2()(c) and 416.920(c}}. An impa.irmentor combination of impailDlents is ··se .... ctt·' within the 

meaning of me r~gtJllllions if it significantly limits 111 individual's abilit)' topertorm basic work a.ctivities. If the claimant does not have B SEvere 

medically detcnninilbh: impainnenl or combination ofimpaimlents, she is not disabled lrthe claimant has 11 severe impairmcrt or combinalion 

of impairtm::nts, the aoalysis proceeds to !he third step. 

At step rnree, the undersigned must determine whether lhe clamant'S impairment or combination of impairments meets or medicaDy equals the 

criteria ofan impaimlent listed in 20 CFR Part 404. Subpart P, Appendix I (20 CfR 404.1 520(d). 404, 1525, 404.1526, 416.920(d), 416.915, and 

416.926). If the claim81fs impairment or combinnlion of impairments meets or medically eqllBls me criteria ora listing and meets the dural ion 

requirement (20 CFR 404.1509 and 416.909), the claimant is disabled. If it dOC's DOl the analysis proceeds to !be: nextslep. 

Before considering §ep four of the sc:quentiw evaluation proa:ss. the undersigned mllst fiI"5t determine Ih~ claimant's residual fwlctional capacity 

(20 CFR 404.1 520{e) and 416.920(e». An individual's residual fun!;lian,al ~lIpacity is her ability 10 do physic.al and mental work activities on a 

sustained basis despite limitlJl.ions from her impairments.. In making this finding. th~ undersigned must consid~J all oflhe elairren1's 

impainnenls, including impairments thai are not severe (20 CrR 404. U20(e), 404-.1545, 416.920(e), and 416.945; SSR 96~8p). 

Nex.t., the undersigned must detennine at st.ep four whether the- claimant has the residual functional capacity to perfonn the requiremenlS of her 

past relennt work (20CFR 404.1520(1) and 416.920(0). If the claimll11 has the: residual flB1Cliona1 capaciry to cb her past relevant work.lhe 

claimant is 0()1 disabled. If the claimant is unable to do;my pDSl relevant work or does nothaye any pa.q relevant work, th~ lIlalysis proceeds to 

the fifth and last step. 

At the last step of the sequential tvaJuali0n4 process (2~ CFR 404.1520(g) and 416.92O{g». the undersigned must dtkrmtnl: whether !.he 

claimant is oble to do any other work coll.~Ocring her rc.~idual functional capacity. age, cdJcatiOll. and work experience. If the claimatl is able to 

do olher work. she is nol disabled. If'he c1aimnnt is notable to do OIlier work and meets lhe duraJion requirement, she is disabled. Although the 

daimant generally continues to have the burdcn of proving disabilily at this step. a limited burden ofsoing ro ....... ard with the eYldence' SiillsS lo 

4 The law d~fjn" diJabiJity.5 th~ inability to do any sub,tlntial g.ainfuladivity by rHson OraRY medically ddtrmin.abfe pbysieal or 

mental lmpairmul which can be eJ.~dtd 10 rrJult ia death orwhkb has '.sttd or taD be Uptded to hut lor a cOlltiQUOdS period "fnot 

1~5S IbaD 11 mooth,... To Dleet this dtfinition. you must have a H"'ct"t impairment, ",'hich makts you unable to do your prcvloUJ work or 

any other substantial gainful aClivity which nists in tbe national economy. To cltlerminc whelM'" you Irc able to do any otber work. we 

consider your re5idual rUllellonal capadey and your ag!', eduCilion. lod work upeneDCe. bttp:/Iwww.ssa.govIOP_Home/dr20/404/404-

lSOS.htm 

5 5 The burdcnofproofthen stlifl~ to the CommissiCl'lerto pmYe thal the claimant is nat disabled. The Administrativc Law Judge mllStfind lhe 

claimant disabled unlcss tbe Commissioner proves by substantial evidence that the claimant is presumptively not disabled W1\Jcr lhe MedicalVocational Guidelines or rulings5; or that thcre exist a significant number of other jobs in Ihe nalional economy that the claimant can perform 

with he-r limitations.S 

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731 

Page 3 of30 

the Social Security Administration. In order to 5Upport a finding thai. an individual is not disabled aJ. this step. the SodaJ Security AdminislJalion 

is responsible for provicing evidence thut demonstmlr.$ dull othtt yo;ort ex.ists in significant numbers inlhe national economy that the cJlllimatll 

can do, given !he re5idual functional capacity, age, edulllIion. and work experience (20CFR 404.13 t2{g). 4(I4,1560(c). 416.912(g) and 

416.960(c». 

FINDlNGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant's date last insured is September 30,2009. 

2. The claimant has not engaged in substantial gainful activity since August 22, 2006, the 

alleged onset date (20 CFR 404.1520(b). 404.1571 et seq., 416.920(b) and 416.971 et seq.). 

Vocation.llnfonn.tion 

javascript:hideShowData ViewSection(%22Jobs WorkedintheLast 15 years,:"22) 

8 Jobs Worked in Ihe LosIIS yeaTS . 

Job Title Type of Business From 

I. cashier/stocker relail grocer 2001 

2. facility mainlenance--rel2air job corps 2003 

3. landscaoer landscaping business/departments 0812004 

javascript:hideShowDataViewSection(%22WorkDevelopment-lnitiaILevel%22) 

8 Work Developmenl- II.ilial Level 

Claim Type: OIB 

To 

2002 

2004 

02/15/2006 

820/821 Pending: No 

javascripl:hideShowDataViewSection(%22Ticket/Programlnformalion-InitiaILevel%22) 

8 Tickel/Program Informallon - Inil/all.evel 

?articipate in Ticket program or another No 

program? 

javascript:hideShowDalaViewSeclion(%22TicketiProgramlnformalion· 

ReconsiderationLevel%22) 

~ Ticket/Program In/ormation" Reconsideration Level 

Participate in Tickel prognun or anoth.r No 

program? 

javascript:hideShowDalaViewSeclion(%22TicketiProgramlnformalion-HearingLeve1%22) 

~ Ticket/Program In/o'lIUJlio/l - HeaTing Le,'el 

Participate in Ticket program or another No 

program? 

javascript:hideShowDataViewSection(%22AdditionaIRehabilitationlnformation%22) 

8 Addillollul Rehabilitalion Informalion 

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732 

Pag,e40f31 

Wo,/dngnow? No 

Slopped working because: Because of/he pain. 

SIOOPed working "'hen: 09115/200~ 

Alleged Impairmenls: Back pain l1Ial affects ,Ighlleg 

. 3. Tbe claimant bas the following severe impairment(s): 

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733 

Page 5 001 

I Disorders of back' discogenic and I Obesity' and bypcralimentation (2780), 

6 1.04 Dise,lkrs ofthe mint (e.g.. hunJaLed lJudeus PU/posIiS. spillal (lJadin6idi1is. spinal sttlJOJi$, o~eoarrhri1;s, dtgene,od~e disc direase, 

ftJc£t tU1hrilis. verrebraljroClUre). multing in rompfrJmise of a nen't TOOl (Including the anuJiJ equilfll) or tlJe spinal cord. With: 

A. Ellitlena of nen:e root compr~(}" cltmilaeriut/ ~v nntfD-QllillOnUc distribtJritJII ojpoin. IJmiIllliolU of MDtWn ojtlte spbte, 

Malolo/ats (lIIrOphy wilh fUSodakd ltIIlSde wtahess Of wuude ~aknUJ) IIcctnrq1Q11ied bycenlUry Of reflex 10lSO and, ifthue is 

inlroll'eJrIUIl of,he low back. pofiey Jtraight-lez fllising IDt (silting and supine); 

OR 

B. Spinal arae/llloiditis, confimwJ". Dpel11live ntJIn Of parIJohJgy rtpnrts a/tissue bio~y. Of by appropriate merlicoJly tlcceprubll! 

irrwging1 manifested hf sc,r.ere hMrnlng or paJ'tful t/ysatht!sia, ,esulling iff Ihe lUed for chango;n pcWtion or pMlure more than ollce e1-'t'ry 

two hours; 

OR 

C l,.IlMbat 5pUtai nenMis resulting in pstlldockJudirotion. esh1blished by [",dings on wropriJJte mediclJlly acceptable imaging. 

mIJnifesJed by cJlt'rJllic non- radi.cu./iU pain and w«JlinUJ, ll1Id r15ulting in inability to lU'1Ibld.~ effecn...,!ly. III d~firJl!d in 1.008 lb. 

POLICY INTERPRETATION RULING 

TITLES II AND XVI: "'j! ALUATION OF OBESI7Y 

This Rululg supersedes SSR OO-Jp, Titl .. n aM XVI: Evolu.lien ofObesity (65 FR 31039, M.y 15,2000). 

PURPOSE: To pro~idc guidance on SSA policy concemingthe enlullti>n ofobc:sity in disability claims filed WIder lltles n and XVl of the 

SodaJ Security Act (Lhe Act). 

CITATIONS: Sections 216{i), 223(d). 223(0. 1614(.). and 1614(c) oflh' Ac~ as arncndod; Regulidions No.4, subpart p, se<lions 404.1502, 

404.1508. 404.1509, 404.J;J2, 404.1520. 404.1521. 404.1523. 404.1525. 404.1526. 404.1528, 404.1529, 404.1530, 404.1545, 404.1546, 

404.1561,404.1594. lIIId append;. I: ... d Regulations No. 16. subpart I, ,",clions 416.902, 416.908, 416.909. 416.912. 416.920. 416.921. 

416.923,416.924,416.925,416.926,416.926 .. 416.928, 416.929, 416.930, 416.933, 416.945, 416.946, 416.961, 416.994. ""d 416.994 •. 

INTRODUCTiON: On August 24, 1999, we' published 8 fmaJ rule in me Federal Register deleting listing 9.09. ~ from the Listing of 

Impairrnenl<; in 20 CFR. subpan p. appendix 1 (the Jistings). The final rule was eITt:ctiye on October 25, 1999. 64 FR 46122 (1999). 

We stated in the preamble to the final rule that l'.'c: deleted listing 9.09 bel;3use our experience adjudica1ing cases. under this listing indicated tha1 

the criteria in the listing were not approprillte indical:OfS oflisting·levd severity. lh our experience, the (;riteriQ in listing 9.09 did not represenla 

degree of functional limitation that would prevent an individual ftom tngaging n any gainful BCtivity. 

However, even though we deleted listing 9.09, we made Some chalges to t~ listings to 'eM.ve that obesity is still addressed in oor listings. In the 

final rule, We added paragraphs to the prefaces ofthc musculoske1etal. respiratory, and cardiovascu1nr body system listings lhat provide guidance 

about the. potential eff~cl.s obesity has in causing or cunuifnlling tl) impairments in those body systems. Sec listings sections 1.000. 3,001, and 

4.00F. The paragraphs stale that we consider obesity to be II medically determinable impairment and remind adjudicators to consider ilS effects 

when evaluating disability. The provisions also n:mind adjudi~rs lhat the combmed effects of obesity with other inlJlairmenes. can be greater 

thW1 the elTec\s of each of the impainl1enls c(Jrlsiderec3 separately. They also instrvtl adjudicators to consider the e{fects of obesity not only under 

the Ibain.gs but also when assessing B. claim at other steps of !he sf:quentia! e\'alualion JKocess. including when 8iSessiog an individual'S residual functional eapaciry, 

When we published tbill final rule, in response to public commenlS,. we sUJled that w(: ~"Ould provide additional guiL1ance in a Social Security 

Ruling (SSRj. (64 FR at 46126) On May I~, 2000, w. published SSR 00-3p (65 FR 31039) to provide !hat .dditional guidance by discussing 

how we evaluate obesity in disability claims filed by adults and children under litlcs U and XVI of the Act. Since then. we have pmlished several 

final rules tha1 revise some of the criteria we use to evaluate disability claims undCT titlts II and XVI of the Social Security Act We are. issuing 

this SSR lo reflect the changes to the {Ules thai: we have ~bJished since we published SSR OO-]p. 

POLIC!' INTERPRETATION: 

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734 

Page 6 of31 

Wbatisobesjty'J 

Obesiry i~ a complex, chronic disease ctuuaClc:rized by excessjve accumulation of body fal. Obesity is generally the result of a combination of 

factors (e.g" gentle, ~nYironmental. and behavioral), 

In onc sense. the cause of obesity is simply that tht energy (food} taken in exceeds the energy expended by lhe individual's body. However, the 

influences on intake, Lhe influences on ex.penditure, the metabolic processes in be(\\'C'Cn. and the averaD genelic ennttols an: complex and not wei undetstood. 

Thc NaliL)naJ InSliMes of Heatth (NIH) established medical criLena [or the diagnosis of obesity in il! Clinical Guiddincs OR the Identiflcation 

Evaluation and Treatment of Overweight and Obesity in Adults (NIH Publica1ion No. 9&-4083, September 1998). These guidelines ciBSSify 

ovcn'leig.l1t and obesity in adullS according to Bod)' Mass Index (8MI), 8MI rs lhe ra1fo of an individual's weight in k:ilograms 10 the SQuare of 

his Of her height in meters (t.;gfml). For adullS, both men and women, the Clinical Guidelines describe a OM[ of 25~29.9 as "()vcrwcig.ht~ and 8 

8MI ofJO.Oor abo\'e as "obesiry." 

The Clinical Guidelines recognize three tenls ofobe.sity. level J in~udes BMls of30.0~3"'.9. Levell! includes 8M Is of3S.0~39.9. Level U1, 

teooed ~extreme" obesity and representing the greatest rist fur developing obesity-related impairments. includes BMls greater than or equal to 

40. These lewis describe Ihe extent of obesity, but they do not oonclaie with my specifIC degree offunaional10ss. 

In addition, aJlhough there is often a significan1 correlation between BMl and ex.cess body fal this is ft01 always the case. The 9ini£!l Guidelines also provide for Considering whether an individual of a given height and weiglll has excess body fat when determining whether Ile (lr 

she hilS obesity. Thus, it is possible for someone whose BMI is bdow )0 to have obesity if too 1arge III percentage of thc wcight is from fat. 

like:wise, someone with a BMl above 3D may nol hal'e obesity if a large percentage of the weight is from musdc. Howtva. in most cases. the 

BMI will show whether !he indi~idual has obesity. It also will usually be evidenllTom the information in the OlSe record whether the: indi~idual 

should not be iOl.J1d to have obesity, despite a BMI of 30.0 Of obo ... e. See 'F5tion~, below. 

The Clinical Guidelines do not pro~ide criteria for diognosu,g ob~sily in children. Howc~er, a 8MI grealerthlUl or equal 10 the 95lb percenlilt for 

a chil~'s age is generally considered sutlicient to estsblish the dimgnosis of obesity. (BMls in the9SIll percentile vary by age and se.x of the chid.) 

DMl·tor-agc>-and¥gender charts are published in medical textbooks or PrQfcsswnal journals and by lhe Naliunw Cenl.er for Health Statistics. As 

with adults, the amount of body fat is considered in milking the diagnosis of obesity in children. 

Treatment for obesity i$ orten unsuccessful. EYen iftreaunent resullS in weight loss at first, weight lost is oftefl regained, despite the etToru oflhe 

individual to maintain tile loss. See qucsti(Jn D. below, for addiional discussion of obesity (reatmed. 

2. How does obesity affect Wicsl and menial heAlth') 

Obesity is a risk factor that increa.<;es an indi~idual's chances of dt~eloping impaJrmenls in most body systems. It commonly leads to, and often 

I;omplicates. chronic diseases of the C8Idio~BScular. respiratory, and musculoskeletal bod)' s)'stems. Obesity increases Lhe risk or developing 

impainnents sue" as type JI (so-call('d adult onset) diabetes. mellitus-c:vtn in childJCn~ gall bladder diseasc~ h),pcrteMion; heart disease: 

pcriphc::rat vascular disease~ dyslipidemia (abnormal levels or fatty substances in the blood)~ stroke; osteoarthritis: and sleep apnea It is 

associalcd wiLh c.odomcu-ial. brcasl, prostate~ and colon cancers, WId other physil;al impai.nnenlS. Obesity may also cause or contribute 10 mental 

impainnents such as depression. The effectS of obesity may be subtle, sufO.h as the loss or mental clarity and slowed reactions that may result 

from obesity-related Siltcp apnea. 

TtK fact thaI obesity is II risk factor for other impaicmcnl5 docs nol meiiUl that indi~idua1s wilh obesity necessarily hll~e any of th[;sc impairments, 

It mCMS that they are at greater than average fisk fIJr developing tie othcf impairments. 

3. How do we consider obesity inCh, sequential eV1lluaripn process')} 

We will consider obes~ in delennining whether: 

The indi ... idual has a medic-ally detenninable impairtnenL See question .... 

1lle indj"idual's impainnenl(s) is se~ere. See question 6. 

The individual's impainnent{s) mCC(S or equals the requirements of a.listtd impainnent in the listings. See que~ion 7. (We use special 

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Page 7 of31 

rules for some contillling disability reviews. See quesliQ1, 1 t.) 

The individual's impainncflt(s) prevCflts him or her from doing past relevant work and other- work ttw. exists in significant numbers in the 

national coonomy. Hov.ever, these steps ~ply onty in title II and adult title XVI c.asc::s. Sec qu~tims 8: and 9. 

4. How is obesity idootilied as a medically detcnninablt impairment? 

When t.<;.tahlishing lhe existence or olrshy, We wil1 gencraDy rely on the judgment ofaphysician who has examined the claimant and reported tW 

or her appearance and build~ as. we11 as weighe and height Thus, in the absence of evidence to the conttaty in the case record, we will accept 0 

diagnosis ofobesilY given by a treating sourcc U1 by II. consull.a1il'c eXlUllincr. Ho\\'cvcr. iftllere is evidence thai indicalcs that the diagnosis is 

ql.lestionabh: Wld the evidence is inadequalc to detcnniJ1( whether or not the individual is disabled. we will rontact \he source fot: clarification. 

using we guidelines in 20 CrR 404.1512(e) and 416.911(e). 

-When tht evidence jna case does not include u. diagnosis or obesity, rut does include clinical noleS or other medical R:cords showing consi.tenlly 

high body weight Qr BMI. we may ask II medical source to clarify whetherthe individual has obesity. However, in moo such cases we will usc 

OUT .iudgme:nllo estohlish lhe I"re<>ence or obesil)' bllSed on lhe medicsl findings and other cvidence in the ca..c record. even if a uealing or 

examining source has nol indicalcd a diagoosis of oboesit},. Gencrally, we will not purcn.ase a consultative cxamina.t.ion jilsi to est8lblish the 

diagnosis of obtJ;ity. 

Whetl deciding whether an individual has obesity, we will aJso consider the iooividual's weight over time.1 We will not count minor, sholHenn 

weight loss. We will consider the irdividual to have obesity as long as his or her weight or BMI shows essentially a consislCnt pattern of obesity. 

(See question l3 for a discussion of weight loss.ll1d medical improvemenl) 

Finally, there arc a numbuormethods for measuring body fal: and. ifsuch inronnaCion is in a case record, we wiIJ eonsickr it However. we will 

not purchase such lesting. In most cases. the medical and other evidence in the case' record wifl e.Uabllsh whethet the individual has ob~sity. 

5. Can we find an individual disabled based 00 obesity alom:? 

If an individual has the medicaUy determinable impairment obesit)· that is "severe" as described in question 6, we may find that the obesity 

mcdicaJl)" equals a listing. (In the case or a child seeking btncfils under title XVI. we may also find that rt functionally equaJs the listings.) We 

may also find in a title U claim. or an adult claim under title XVI, that the obesity rc:sulb ill a finding lhat the individual is disabkd bllSCd Dn his 

or her residual functional capaci[)' (RFC). age. education. and past work experience, However. we will also consider the possibility of cOCICisting 

or r~lated conditions, especially as the leVel of obesity incn:ases. We provide an example of when we muy find obesity to medicaJ1y equaJ a 

listing in question 7. 

Sequcntial Evo!uation' 

Step 2 Se\'t'rs; Impamnent 

6. When is obeSity a "!iCvcre" jmPairmenl" 

As with any other medical condition. we will find thai. obtsity is a ~SC\lCft" impairment when. alone or in combination with another medicaUy 

detenninable physical or mental impnirmcnt{s). it ~ignltjcantly limits BJ1 individual's physical or mental ability to do basic work activities. (For 

children appl)'ing for disability Wider title XVI. we witt lind lhat obc-sity is a "severe" impairment when it ~U$C$ more than minimal functional 

limitations.) We will also consider the etfects of any symptoms (such as pain or fatigur) thal could limit ~lioning. (Sec SSR 85-28. "Titles If 

aIld XV!: Medical Impairments That Arc Not Severt" and SSR 96-Jp. "Till~ II and XVI: Considering Allegations of Pain and Other Symptoms 

In Delennining Whether a Medically Det~nninable Impairment Is Severe.") Therefore. we witl find that an impairme.nt{s) is "nO\ severe" only if 

it is a slight abnormaHty (or II tombin8lion of ~tig.ht 8bnonnaJiti~) that has no more than 8 minimal effect on the indi\'icluBl's ohility to do basie 

work activities (or, for achitd applying ullier title XVI, iF il CIllJs.es OD more tron minimal functional limitations). 

There is no spc-cific level of weight or BM[ that equates with a "scvere- Of a "not severc" impairrnenl Neither do descriptive tenns for levels of 

obesity (e.g., "severe," "extreme," or "mDrbid" obesity) establish whether obesity is or is not 8 K sevtre" impairment for disability prognun 

purposes. Rmher~ we will do an individualized assessment of the: impact of obesity on an individual's functioning when dedding whether the impainnent is severe. 

sequential E"'almtion 

Step 3 The Listings 

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Page 8001 

7_ How do we C\'niuate obesity at AAP 3 or sequential c:voluation the listings'" 

Obe~ity may be a fallor in both "meets" and "cquaJs" dctemlmalions.. 

Because there is no listing for obesity, we will fmd that an indi\'idual with obesilY "meets" the requirements of a ii$ting ifhe or she has another 

impairment that, by itself. meeu the ~qujrcmenl! o£IIJisting. We will also find that a listing is met if mere is an impairm(.JIt that. in combination 

with obesity. meets the requirements of a listing. for example. obesity may increase: the severity of coexisting or related impaim\cnlS to the 

extent tha1 the combination of impairments meets the requiremenLS of 8 IistinE. This is 6pecially true of muscutos-ioell:tai. rnpiralory. and 

cardiova5I..'Ular impairments. 1t mlly also be (rue for other coexistng ot related iJ'l'lP<li""eflts. including mental dlrorlien. 

For l!xample.,. when evaluating impairments under mental disorder listings IlOSe, 112.05D, or 112.0SF. obesity th3I. is "scoccn!," as explained in 

quesli(ln 6. satisfies the criteria in listing 12.0SC for a physical impairment imposing an additional and significant wor"·rc1a1.ed limi18tion of 

function and in listings 112.0SD and Ill.OSF for a physical impairment imposing an additional and significant Iimita1ion of function. We will 

find the requirements of listing 12.05 are: met if an individual's impairmem satisfies the diagoostic description in the inlroductory paragraph of 

listing 12.0S and anyone of the (our sets of criteria in t.he listing. In the case of.an indjvidual under age 18~ we will find that the requirement! of 

listing 112.05 are mew jfthe child's impairment satisfies the diagnostic description in the introducwry paragraph of lis.ting 112.05 and anyone of 

the $ix Stl'i ofcrileria in the listing.. (See sections 12.00A and 112.00A of the listlogs,) 

We milY also find Ihal obesity. by itself, is medically equi\'alenl to a listtd impairment (Of. in the case of a child applying Wlder title XV1. also 

functionally equivalent 10 the Iisfings). For example, if lhe obesity is of such a level mat it results in iITI inability to ambulate effectively, as 

defined in seclions 1.00.B2b or IOI.OOB2b or lJ1e listings, it may subsl.itute fOf Ihe major dysfunoioo of a joim(s} due to any cause: (lind i.ts 

associalcd criteria), with the involvrolent of one major periphernl weight-bearing joint in listi.ngs I.02A or 101.02A, 8I1d we will then make B 

finding or medical equivalence, (See question 8 for funher discussion of evalu8ting the f",ncHonai effects. of obesity, including functionaJ 

equivalcm::c determinations ror children applying for benefits under title XVL) 

We will also find equivalence if an individual has multipJe impainnents, including obesity, no one of which meets. or equals the requirements ofa 

listing. but the combin8lfon of impainnct1ts is equi ... a1ent in stverit), to a liSled impainnenl For cxllftlple. ohesity affC'C1$ the cardiovascular and 

respiratol'}' systems OOcause of the increased wortlond Ole additionsl body mass places on these: systems. Obesity makes it harder for the chest 

and lungs 10 expand. This means that the respiratory system must worl.: harder to provide needed oxygen, This in tlIm makes the hean. wor\.: 

harder to pump blood to carry oxygen 10 Ille body. Because the body is working harder u1 fest., its abilit)' to perform additional work is less than 

would otherwise be expected. TOOs, we may find that !he combination of a pulmonary or cardiovasrular impainnent and obesity has signs:, 

symptoms. and laboratory fmdings. that of equai me:dtc:sl 

signiliciIllce r.o one oflhe respif"iIIory or cardiovascular Jistine~' 

Ho,",'ever. we will not make assumptions about the scverity Of runctionHi effects of obesitj' COmbined with other impainn~nl$. Obesity ih 

combination ..... ith IITIolhc:r impainnent Mayor may nOl. increase the severity or functionallimilations of Ihe olJ1er impairment We will evaluate; 

each case based on the inrormaUon in the case record. 

S(QllrIIlial E~'q{Uatiotl' 

Stew:4 and 5 Aunsing Functioninc in Adylts 

Step 3 Assessing FUTldional Eguividence in Children 

8. How do we eyaluBIS obesity jnassessing res-idual functional C3oac1ty in adults and functional equivalence in children'" 

Obesity can cause limitation of function. The fullClions likely 10 be limited dc:perd on many factors, including when: the excess weight is carried 

An individual may have limitations in any of the cxationBi fuoelions such as sitting, standing, walking, lifting, canying.. pushing., and pulling. It 

may also affect ability to do poslural furctions... such as climbing, balllRCC, swoping. and crooching. HI(. 8bilily w manipulate may be affected by 

the presence of adipose (farty) tissue in the hands and Jing~fS. The ability to tolerate extrem: ~ humidity, or hazards may also be affected. 

The effects of obesiry may not be obvious. For exanlple, some people with obesity also have sletp apnea. This can Icad to drowsiness and lack 

or mental clarity during the: day. Obesity may also affect an individual's social functioning. 

An assessm('nt should abo be made of the dfeel ()besity has upon Ihe individual's ability to perfonn routine movement and necessary phys.ical 

actiYrir), within the work tnVironmenL fndivid.ullls with ooesily may have problems with the ability to sustain a function over lime. As explwned 

in SSR 96w 8p ("Titles II and XVI: Asgssing ResKtuai Functional Capacity in lnitial Claims"), Qur RFC asSe5$mC'nl:$ must consider an 

individual·s ~ remaining ability to do sustained work acti ... itics in an ordilUll)' worksttting on a rcgulliI' and oontinuing basis. A "regular 

and continUing basis~ means I hours a day. for 5 days a "'eck:, or lin c:quivJjenl work schedu.e In cases inyooing obesity. fatigue may all'ect the 

individoal's physical and menta! ability to sustain work acti ... ity. This may be particularly true in cases involving sletp apnea. 

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Page 9 oDI 

The combined effects of obesity with other impainnenLS may be grealcr than. might be expected without <Ibesity. For c.x.ample, someone with 

obesity and arthritis affecting a weight-bearing joint may have more pmn IUId limitation-than might be e,xpecled from the wthriu:s alone. 

For a child applying for benefits under title XVI. we may evaluate the functional consequences of obtsity (either alone or in combination with 

othJ!r impairmt'nlS) tQ decide if the child's impainnent(s) functionally e~uals the listings. For example, the functional limitaf..ions imposed by 

ohesity, hy it~f( or in comhination with another impainncnl(s:), may establish an extreme Jimitar..ion in one domain of functioning (e.g .• MO\,lng 

about and manipulating objects} or mart:cd hmit.alions in (Wo domains (e.g., MOving about nnd manipulating objects and Caring for yoursdf), 

As with any other impainnent, we will explain how we reached our condusions 00 whether obesity cw.sed any physical or mentallirriLations, 

9, How coo we consider obesity in the assessment pfRK when SSR 96=8RW'S "Age and body habitus are not factors in assessing RFC"? 

The SSR goes on (0 say that "[ilt is incorrect to filld thai. iIlI individuaJ has limiLations beyond those caused by his or her medically detenninable 

impairment!s) and anY related symptoms due to such factors as ag~ and nalural body build,. and dte activities the in.dividual was accustomed to 

doing in his or her previous. work." (Emphasis added,) We ihCluded liIe italicized sta.t.ement in the SSR to distinguish between indi\'iduals who 

have a medically detenninable impainnenl of obesity and individuals who do nOl When we identify (lbesity as a nlcdically detenniflablc 

imIJainnent (see questian 4. above). We will t:Onsider any functional Iimilalions resulting flOm the obesity in the RFC ~metll, in addition 10 

any limi1.8tions resulting from any other physical or menial impsinnems lhal we identify. 

Effect of the Rules Gange' 

Claims in Which PriQr Listinus Aooly 

and Do Not Apply 

10. How does the de!etign Qflising q 02 affect ciajmstKndinggnOctober 25 1999? 

The final rules that detcled the listing became effecli\'e on October 25, 1999, The final rules deleting listing 9.09 apply to claims tha1 wen: filed 

before October 25. 1999. and Ihal we~ awai1ing an initial detennin:u.ion or that were pending appeal 81 M)' level of the administrative review 

protess or thou had been appe:alcl.lto COurt. The change affettcd the entire claim, i",ltlding lhc period bc:foreOcto"ber 25, 1999. This is our usual 

policy with respcctlO an~ chaTtg~ in our listings. 

However, different rules apply to individuals ""'ho were alrcnd)' fo\!nd eligible to receive benefits pri<Jr to Octobcr2S. 1999, For an ex.planalion . 

of how \\.'C a.ppl)' listing 9J)9 in continuing disability reviews. see question 11. . 

11, How'do<s d!iilelion Qflinng 9.09 affect cI:Jina a1ctady allowed? 

Deletion oFlistillg 9,09 does not affect (he entitlement or eligibility of individuals receiving benefits becBllSe their impairmcnt(s) met or equaled 

that listing, W.; will nOlliro thal their dis.abilities have ..:ndcdjusl because we deleltd listing 9.09. 

We must periodically I1:vicw all claims to determine whether the indi ... idunl'$ disllbility continues. When we conduct 8 periodic continuing 

disnbility -review (CDR), we will not find thai. an jndividunl's disability has ended based on a change in a listing, for individuals receiving 

disability benefits \!nder title U and sdults receiving paymentS under tide XVI, wc apply the medical improve:mtnt review s.tandard described in 

20 CFR 404.1594 and 416,994. 

We will fir.;l evahmle whether the individuat's intpairment{s) has medically impro\'ed and, if so, whether an)' medical improvement is related to 

the ability to work. Trlhe individual's imprunncnt(s) has not medically improved, we will find thm he or she is still disabled, unless we find Ul81 

an cXI;t:ptiolllo the medical improvcmt:l1t standard applies. Even iffhe impainnc:nt(s} has medically improved, we will find thal the improvement 

is not related to lhc abilit)" to work ifdle impainncnt{s) continues to nleel or equal ttle same' listing section used to make our most recent favorable 

dedsioo. This is true e\'en if we hove since: deleted lhe listing section that we used 10 make the most recen1 favorable decision, See 20 CFR 

404.1594{c)(J)(i) and 416,994(b){2)(ivXA). We: apply a similar proY'ision when We do CDRs for individuals who have not attained age 18 and 

who :ue eligible ror tille XVI benefits basod on disability (20 CFR 416.994a(bX2»). 

Even jf 111.; indi\'il.luaJ's impainnenl{s) has medically improved and no longermects or equals prior listing 9.09. we must still detennlne whether 

he or sh~ is currently diSabled, considering all of tbt= i""airments. 

12, What amount or weight loss would rmresent "medical improyement"" 

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-

Page 1000 I 

Because an individual's weight may fluctuate: over time and minor weight c;banges DIe:: ofliUle significance to an indi\'idual's ability to fimai.on, it 

. IS not appropriate to conclude that an individual with obesity has medically improved because of 8 minor weight loss. A loss (If les..'i than 10 

percent of initial body weighlls too minor to result in a finding that !,here has betn medical improvement in the obesity. However. we will 

consider thai obesity has medically improved if an individual maintains 8 consistent loss of at least 10 percent of body weight for at least 

12 mon1hs. We will nOlcount miour. shon~lerm chWlgc:S in weight when we: decide whether 11'1 individual ~as maintained Ole loss conSistently. 

If there is a coexisting or relnlf"d condition(s) and lhe obesity has not improved, we will still consider whether me coexisting or related 

ClIndition(s) has mC'dicaily improved. 

t1' we find that there has been medical improvement in obesity or 1n any coexisting or related c01'1dition(s), we must also decide whelher the 

mediCAl improvement is related to the ability to work. Ifnecessal'Y, we witl also decide whether any exceptions to the medical impro\'ement 

review standard apply and, if appropriate, whether the individual is currently disabled. 

IJ What are !he goals iWd methods oftreatmrnl foroW;ly? 

Obesity is 0. disea'ie Ihat requires treatment, although in most people the effect of trcalmer( is limited. Howeyer, if untreBl.ed. it lends to progress. 

A c(Jmmon misconception is that Ihe goal or trealment is to reduce weigtll to a "normal N level. Actually. the goal of realistic medicallrtatment 

for obesity is only to reduce weight by a reasonable amount lhat will impro\le he-allh and quality of fife. People wilh extreme obesil)'. eVCn with 

treallllen~ will generally continue to have obesity. Despite t.on~term progress:, tnost treatments for obesity do nct. ha.\IC a high sucuss role. 

Recommended treatment for obesity depends upon the level of obesity. Alleveisj and II (BMt 30.()'39.9). tre8bnenl usually consists ofbehaviof 

modiflCalion (diet and exerti&e) with the oplion ofmediC3lion. usually either in the form of 8 fat-blocking drug or an appetite suppressant. Some 

people do not res-pond 10 medication. while others experienct negative side effects. (In making 0lU" decision, we will also consider any side 

effects ofmeditalion the indi'iiduul ex.perienteS.) Indi\liduals with coexisting. or related conditions may not be abl~ to Ulke medicatiofl becilUSc Df 

its. efTecls on their other conditions. 

Generally~ physicians recommend surgery when obesity has reached levd Il1 (BMf 40 or grtBter). However. surgery may also be an option at 

level I! (8M I 35·)9.9) if there is a serious coexisting or related ClIndilion. Obesiry surgery modifies the stomach. the intestines. or both in ord~r 

10 reduce lIle nIllounl of food that the individual can eat at one meal or Ihe lime food is available for digestion and nhsorption Surgery is 

generally a last resort \\'iLh individuals for whom other fonns of treatment have faikd. Some individuals also experience signifu:.ant neg.ative side 

efTl!Cts from surgery (e.g .. "dumping syndrome" -1ha1 is, rapid emptying of Ole slOrmch's contellfS marlted by various signs and symptoms). 

Obesity is a life·long disease. Even when lreatment has been successful. individuals wilh. obesity generally need to stay in treatment or \bey win 

gain weight again, juS1 as: individuaJs with other impainnents may need to stay in trtabnent Individuals who ha'ie had surgery should receive 

continuing foIlO\~-up care because of health risl>s related to the surgery. As with other chronic disorders, effective treatment of obesil)' requires 

regular medical fotlCM'~up. 

14. How dQ ..... e eyaluate failure 1Q follow prescribed treatment in obesity cases" 

Before railurc to follow prcscriNd tn:atmcnl for obesity tan become an issue in :I case, Vo'e must fi~t find that tI'Ie individual is disabled becall:se 

nf ohesity or a combillation of obesity and another impnirment1s). Our regulations at 20 CFR 404.1530 and 416.930 provide that. in order to get 

bcnelits. no individual muS1 follOVo' treatment prescribed by his or hcl physician if lhe tn::alment can restort the ability to work.. lIDless Ihe 

individual hns 311 aCl;cplabte reason for failing tl> follow the prescribed treatrnenL We will rarely usc "failure to follow prescribed treatment" for 

Obesity to deny or cease benefits. 

SSR 82-59, "Titles U and XVI: Failure To Foltov., Prescribed Trcalment," cxpitlins thai we wit! find failure to follow prescribed treatment only 

when all of lhe folb"'ing conditions exist: 

The individual has an impairment(s) that meets the definition of disability. including the duration requirement,. and 

A lIeating source has prescribed treatment that is clearly expected to restore the mility to engage in !IJbstantial gainful activity, and 

The ~idence shows tha the individual has failed to fuitO'lol>' prcscribc:tJ tn:a1m(nt without a [!,ood rea$OlL 

If an individual who is disabled because of obesity (alone or in combina1ion with another impainnent(s» does nl){ have B treating source who has 

prescribed lreaut1em for the obesil)'. !here ts no issue of failure to follow prescribed treaamenl. 

The treatment must be prescribed by /I treating source, as defined in our regulllllor5 til 20 CFR 404.1502 and 416.902, not simply recommended. 

A mating souru's state-ment that an individual Ushou.ld" lose weight or hns "been advised" to gel mo~ c~'Cr:cise is not prescribed treatmenL 

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Page 11 of31 

degenerative (7240), etc., etc., etc., etc., etc., etc., 

Allegation(s) 

javascripthideShowDataViewSection(%22lmpairments,LimitationsandPain-lnitiaILevel%22) 

8 Impairmentr, LlJn/tarions and Pain -Initial Level 

Alleged ImpaimlenlS: Back pain Ihat affects right leg 

I can't sit or stand for long periods of time. t can't walk thai well because of 

my right leg pain. I can't do a lot of things noW thai I could do when I was 

Limitations: healthy--like I can~ ":Ork on my truck or play ~ith my son. I ~an'l ~tand or walk more than 10 mmutes al a hme. I can't thmk when I am 10 pam--1 Just 

think about sitting down or lying down. I have a difficult time 

concentrating. 

Pain/Other Symptoms: Yes 

Impairments First Int~rfered With 0812212006 

AbIlity to Work: 

Height: 5' 9" 

Weight: 325 l'os. 

er R ks 3368' I injured myself because I fell off the lawn mower and had to maneuver it 

Icnt emar - . so iI wouldn't hit the car that was coming. 

javascript:hideShowData ViewSection(%22Effecton Work-Initia!Level%22..l 

El Effect on Work -/trit/al Lnoel 

When a trealing SOltrce l~ prescribed treatment for obesity, the treatment ml.lst clearly be cxpecttd to improve the impairment to the extent that 

thi!" penon win not be disabled. As noted in queSlton B. 1111: goals of trtalmenl. for obesity are geRtTaUy modtsL, and treatmen'l is ofien 

ineffective. rherefo~. we will not find failure to follow prescribed treatment unless there is clear evidence. that Ueatmcnl would be successful. 

The obesity must be expected to 1mprove to the point III "chich. tile indh'idua} would nOI metJ our defmit;oo of disability. consid,cring not only the 

obesity. but any other ilJ1Jsirmellt(s}. 

Finally, even ifwe'find that a treating source has prescribed treatment for obesity. that the treatm~nt is clearly expected to restore the ability to 

engage in SGA. and !.hat the individual is not following the prescribed treatment., we must stilt consider whether the individunl hlL'i a good reason 

for doing so. In milking this finding, we will follow th.e gUidance in our regulaliom and SSR 82·59. which provide that acceptable justificmioJ1s 

for failing to foll<M prescribed treaLment include, but arc nollimited to. the following: 

Thc specific mediWlI treatment is COJltrary to the teaching and tenets of the individuaJ's rciigion. 

The indivhlulli is unable to afford prescribel1lR:8.lment that he or she is willing to accept, but for whith free commWlity resources are 

un~vaillJble. 

Th~ treatment carries 8 high degree of risk because oflhe enomlity or urusual nature of the procedure, 

In this regard. most health insurance plans and Medicare do not dcfra)' the expr:nsc of !fulment for obesity, Thus. M individual who might 

benefit from behaYioral or drug therapy might nol be able to afford il Also. because not enough is known about the long-lenn effe.t;1S of 

rnc;di(;alions used to trea1.obesity, som: people rna)' be rductllnt to use them due to lhe potential risk. 

Because. ofLhe risks and potential side effects of surgery lOI obesity, \\1: will not find that all individu.al has failed 10 follow prescribed treatment 

for obesity when Ihe prescribed tn:illmcnl is surgery. ' 

EFFECT(VE DATE: This Ruring is effectivc uponpuolicatjQn irl tht FederaJ Register, 

CROSS.REFERENCES: SSR 82·52. "Titl.:s tI and XVI: DUJaIion of the Impainnent;" SSR 82~59. --ritles II and XVI: Failure To Follow 

Prescribed Trcatment;" SSR 85-28, "Titles U and XVI: Medical lmpainnents That Are Not Severe;~ SSR 96-3p, "Tilles tl and XVI: Considering 

Allegations of Pain and Osher SymptolllS In Determining Whelhtt a MedicaJiy rkterminable Impairment Is Severt;- SSR 96-6p, "TiUes II and 

XV!: Considl!raticlfI of Administrative Findings. of Fact by Stale Agenty Medical and Psychological Consllhants and Other Program Ph}'Sicians 

and PsychulogiSLS til the Administrative Ulw Judge and Appca1s Council Levels (If Adminisuative Rl:view: MeditaJ EQuivalence:" SSR 96-8p, 

"Titles II and XVI: Assessing Residua) FUf1Cliotlai Capacity in }nilia] Claims;" and PrOgI1llTl Operations Manuw System sections 

01 ])010.005 fT., Dl24110.006. 0124570.001, DI )4001.010,0134001.014, .nd 0134001.016. 

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740 

Ever Worked: Ves 

Working Now: No 

When Stopped: 09/15/2006 

Stopped Working Because: Because oflbe pain. 

Work After Impainnent First Interfered: Ves 

Change Attendance: Ves 

Page 12 of31 

£ I . I was injured 0812212006. I was off for a couple of weeks and then I went 

xp an.tlon: back: for one day and couldn't sland the pain and had to stop working .. 

javascripl:hideShowDataViewSeclion(%22Impairments,LimitationsandEflectsReconsideralionLevel%22) 

~ ImpairmenL" Limitations and Effects - Reconsideration Level 

Any Changes in Condition: Ves 

Changes in Condition: The pane in back: and right leg is getting worse. 

Date Occu"':ed: unknown 

Any New Illnesses or Injuries: Yes 

New Illnesses, Injuries, or Conditions: getting harder to do everyday things 

Date Occurred: unknown 

Any New Limitations: Ves 

New Limitations: can't walk that well. 

Date Occurred: unknown 

How Condition Affects Ability to Care It make it harder to which I can't bend over I have to get someone to help 

for Personal Needs: me and people have to be there for me most of the time 

How Daily Activities Changed: none 

Work Since Original Claim Filed: No 

Submitting New Evidence: No 

Reason Appeal Requested: I AM DISABLED 

javascript:hideShowDataViewSection(%22Impairments,LimitationsandEffectsHearingLevel%22) 

~ Impairments, LimitatlollS alld Effect., - Hearing Level 

Any Changes in Condition: Ves 

Changes in Condition: The pain is getting worse 

Date Occurred: none 

Any New Illnesses Or Injurie.: No 

Any New Limitations: No 

How Condition Affects Ability to Care It takes me a very long lime to do scuff. I have to sit down because of the 

for Personal Needs: pain. 

How Daily Activities Changed: It is getting harder to do stuff. 

Worked Since Fiiing For N 

Reconsideration: a 

Submitting New Evidence: No 

Reason Appeal Requested: NONE PROVIDED 

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741 

Page 13 of31 

(20 eFR 404.1520(c) and 416.920(c». 

4. The claimant does not have an impairment or eombination of impairments that meets 

or medically equals onc of the listed impairmcuts iu 20 CFR Part 404, Subpart P, 

Appendix 1 (20 CFR 404.1520(d)aud 416.920(d». After cardul consideration of the entire 

reeord, the undersigned finds that the claimant has the residual functional capacity to 

perform sedentary work except the record shows tbe claimant is functional8 below tbe 

sedentary level for any sustained, continual or regular activity9. In making this finding, 

tbe undersigned considered all symptoms and the extent to wbicb thcse symptoms can 

rcasonably be accepted as consistent with tbe objective medical evidence and other 

evidence, bascd on the requirements of20 CFR 404.1529 and 416.929 and SSRs 96-4p and 

96-7p. Tbe undersigned has also considered opinion evidence in accordance witb the 

requirements orlO CFR 404.1527 and 416.927 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

STATEMENT OF THE CASE: 

The claimant filed a concurrent claim alleging a date of onset of S122106; last SGA S/06, 

date of filing 7/5107, which would give a first date of entitlement for DIB benefits of 2/07 

and SS! benefits ofS/I/07. The PIA is unknown. The ACEH is unknown. The claim 

does involve a workers' compensation case with a date of onset of S/22/06, being an 

injury to the right hip, low back, with radicular pain into the right leg as well as 

situational depression. 

The claim does involve obesity, which is a material factor in the claim which will be 

discussed with particularity hereinafter. 

. The rates of compensation, by agreement of the parties, are $213.36 for temporary total 

disability as well as permanent partial disability and a total of 16 weeks has been paid 

from 1113/06 to 2/22/07. No adjudicatory orders have'been entered in the case, only a 

Form A appointing Dr, , a treating physician. 

8 Residual rliRCtional capacity is lhe !;l.aimanl'~· m.ll-'Cimwn remaining abilily tu 1.10 sU:5'LBined work adivities in an ordinary work setting on a 

regUlar and continuing basis. A "regular and continuing basis" means eight (&) hours a day, for fIVe (S) days (i,e .. forty (40) hoUfl) a wC'ek or an 

cqui ... alentwork schC'dule (Social Stcwity Ruling 96-81"). The dairruull mUS1l\a .... e bolh lite mental and physiCal abilities to perform sustained 

work iJcti .... ities. Sinc~ th~ e .... idt:l1~ supports a finding that me claimanl has had a subslantialloss of ability to meet Ihe dem8llds of basic work: 

rdated acli .... ities on 01 sustained basi~. the unskilled, sederaar), occupational bOliC is signir.cantly eroded anda fmd~ng o(disabitity is justified 

under Social Serurity Ruling 96-9p. 88 

9 Sociat Sewrity Ruling 9&-8p pro .... ides that a findiDg of disabled is i!Jppropt'iale whenevct there is an inability to persist at work.Jike t&\.:5 for 

the rull course of 81 8-hour ·workday or .5-day workw«k.. Clearly. the claimant's medically dctcnninilble sever; impainncntSllreclude the: 

claimant from engaging in substantial gainful activity on a rq.ular and continuing basis. Social Security Ruling 96-9p stipuhllcS tha1 an 

individl.lal who has the residuaJ 1Un~jonal capacity for k:ss than a full range of sedentary wale. should be: consid~red disabled iftheir restrictions 

would signilicantly erode the occlpationai base for sedentary 'Mlrk. The claimant is malkedty. funaiooally limited, Thus, a rmding of disabled is 

warranted. Mediul:--Voc:aUoo.al Rult 201.00 (h) ApPl'ndiJ 2, Subpnt P, IUgul.tions NO.4 may be used as me framework: for the decision. It 

directs a finding of disabled, Social Sfcurity Ruling 85-IS and Social Srcurity Ruling 96-9p both stipulate mat an individual must, on a 

SUStained basis. be able to mderstand, remember and carry oul simple instructions; make simple work-related dccisions~ respond appropriately to 

5upcn'isiM. coworkers, usual work Sluations and 10 delll wilh changes in a mUlmc work setting.. A substantial loss of alrility to meet anv one Clf 

Ihtsc hasic \\'ork~relaled activjties would severely limit the potential ocwpalional base for all age groups ani WarJunt a finding of disabled. 

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742 

Page 14 oDI 

PERSONAL HISTORY: 

•• S:SNi'" 

never been 

The claimant appears to have a prior application, is a United States citizen by birth, has 

no felony convictions and has no prior workers' compensation claims. 

EDUCATION: The claimant graduated high school from in 

~ttempted to go to a Junior College for only one semester and entered Job Corp, 

~e received a certi~ce." The claimant has no military 

service, does not have an._..__ as it was suspended for failure to 

have insurance. 

* The claimant appears to have a learning disability and is very slow and was a poor 

student. 

EARNINGS: (See Exbibit in tbe record) 

Duties involved lifting occasionally 50 pounds, 20 pounds, walkmg, 

standing, bending, stooping, balance, and bilateral use of the hands. The claimant states 

he was the "foreman" in that he had two other people which he supervised in his crew, he 

directed their work and had no right to hire and fire. 

c. ~1I1I1I1r----lllL=a~n~ds.sc;a~prrin~g~---r----------r~(3~m~0)~to~~------l . Seasonal Work 

Duties involved lifting occasionally 50 pounds, frequently 20 pounds, with walking, 

standing, bending, stooping, balance, and bilateral use of the hands. 

Landscaping Wages 

unknown 

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Off and on for 3 years 
743 

Page150f3l 

Duties involved lifting occasionally 50 pounds, frequently 20 pounds, with walking, 

standing, bending, stooping, balance, and bilateral use of the hands. 

PRIOR INJURIES/ACCIDENTS AND MEDICAL: 

13 years Oklahoma City Children's Hospital 

Surgery, chronic ear infections 

200 I broken ankle - two surgeries 

Splinter in eye while working in wood shop - no claim filed 

FACTS OF ACCIDENTIINJUR1ES SUSTAINED: 

On 8/22/06, the claimant was pushing a large 42 inch mower on the side of a hi 11 and twisted and " 

injured himself when he tried to brac,e himself and thereby sustained an injury to his right hip 

and back. The patient was initially Jen at_He was given medications and returned to 

work. The following day, he tried to return ~t could not due to the severe pain in his 

M

i ht hi and back. He was seen in the ER, evaluated and given medication and referred back to 

On follow up, the patient was again placed on medication and released back to 

regu ar uly. 

The patient continued to have pain in his right hip and back and noticed the pain radiating up into 

his back and became severe. 

The patient has constant pain in his right hip and has difficulty sitting, standing, going up and 

down stairs, or inclines. The patient cannot squat or kneel. He rates his pain at a 10 on a 10 

point scale. He states the pain moves up his right hip and into his leg and from his right hip into 

his lower back. He states he has pain in hip that will go down to his calf causing numbness and 

tingling into the foot. 

The Honorable Richard Blanchard entered an Order selecting Dr. as a treating 

physician in the workers' compensation case. Dr. ' examined the patient on December 

11,2006, and his repon is of record. Based upon thc claimant's signs and symptoms, Dr. 

ordered an MRl and ordered medications for pain and muscle spasms. 

Physical examination on December 11,2006, revealed: weight 326 pounds, height 5'9", BP 

132/90. Examination of the lumbar spine reveals moderate tenderness, limitation of motion, as 

well as positive straight leg raising, 

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744 

Page 160f31 

A medical summary of treatment is included herein. The claimant presently is still under 

treatlI\ent by the treating physician, M.D. 

MEDICAL SUMMARY 

.................................................... ~ .................. . DOCUMENTS 

Form 2- None 

5/22/07 AMENDED FORM 3: PSYCH OVERLAY 

Wages Records 

** •• ** •••• *.*.***.*** •• *.** •••••• ** •• ** •• **** •••••••••••••••••••••• * •••• 

11126/07 .::D~r.,--_ 

1117107 

11/5/07 

Follow-up appt w/an updated MRI Scan. Clmt has an L-4-5 right 

par median disc protrusion w/disc desiccation at L-4-5 and L-S, S-J. Clmt 

was unable to locate his lumbar myelogram and contrast CT scan, which 

reportedly show the pars defects at L-5 w/ a Grade I spondylolisthesis at 

'i> L-S, S-l. Dr. ' I has again assessed Clm!' s body habitus and his current 

weight of still being over 350 Ibs and thinks that it would be in the Clmt's 

best interest to not undergo surgery at this time due to his size. Dr. / 

advised the Clmt that ifhe could get to 300 Ibs or less then Dr. 

would reconsider. Meanwhile, Dr. r is recommending that the Clmt 

undergo a FCE for permanent restrictions. 

Dr. 

Follow-up appt. .. Dr. recommends surgery, but Clmt needs to lose 

about 50 lbs. Clmt doing same, back is still painful. Needs refill of 

Percocet. Gave Rx of Per co dent 5/325 #90 3xday, no refill; and another 

Rx for Percodan 5/325 #90 3xday. not to be filled until 12-7-07. Will see 

back after first of year for follow-up and hopefully Clmt will have lost 

some of the weight that he needs to lose before Dr.' does surgery. 

Dr.' 

Took history ofincident. .. Per Dr. I .. " surgery is an option, but 

due to Clmt's obesity, not feasible at this time. Dr. took x-rays of 

lumbar spine, but results are less than optimal due to elmt's body habitus 

and failure for the beam to penetrate the Clmt's body weight sufficiently, 

although Dr. ' could detect the presence of Grade I spondylotic 

spondylolisthesis. Dr. I noted that C1mt's MRI was done nearly a year 

ago and the myelogram and CT Scan were not at this appointment for his 

review. Dr. ' recommends an updated high resolution MRI, Clmtwill 

retrieve his myelogram and CT Scan and bring them in after the HRlMRI 

for Dr. i 's review. Feels that Clmt's problem could be treated 

See Next Page 
745 

Page 17 oDI 

surgically in normal weight people, but shares Dr. ,'5 concerns 

about proceeding to surgery in a patient this size. Dr. . will review the 

recol1unended studies and go over the Clmt's risks/potential options 

before making a final determination ... Clmt needs to avoid any repetitive 

bending, twisting or lifting greater than 10 lbs and needs to alternate 

between sitting and standing at his discretion. 

I Of8f07 ~D..:..:r.:-. _---:-_ 

Follow up herniated disc ... need his Percasits refilled ... they are current ... the 

court apparently appointed either Dr. . or Dr. ( and he has his app\. 

November 5 ... no marked distress ... blood pressure 130/86 ..• normal gate ... 

persistent tenderness in the low back ... leg raises positive on the right. 

9119/07 

9/14/07 

Dr .. 

1, Weight reduction surgery most likely will need to be necessary procedure in 

order to get this gentleman back to where he can return to the work force. [n 

dealing with this type of individual you have to treat the whole person as 

opposed to just the spine and ignore the rest of the individual. 

2. If Dr. • or Dr. . feels that they are "capable of' the challenge ... I 

would not have any problems referring Mr. I to these physicians. 

3. No further surgery is perused by the patient: 

A. left CE should be done before MMI 

B. vocational evaluation should be obtained 

C. medication management for pain and limitations should occur 

D. it should be long term pain management 

4. A neuropsyc Eval is not necessary this man is currently on Effexor and is 

doing better regarding his depression 

5. This gentleman remains TID 

Or. 

Follow up medication management low back ... I am seeing him until the court 

decides what to do with regard his morbid obesity and disc herniation ... I havc 

not seen~ce March ... He ran out of medications and is seeing his PCP Dr. 

... present time pain level is 10/ I 0 ... It will go down to a 7 if he is ver 

inactive today_moves reasonably well... blood pressure 136/98 .. . 

medications ar~ed today ... Celebrex, Zanaflex. Percasits, Effexor ... for 

depression and mood ... refillable 3x follow up one month 

9/6/07 Dr. 

Response to ct. questions: 

1. I cannot state whether he should undergo a gastric bypass surgery ... ask a bar 

iatric surgeon. 

2. It is my opinion he has an aggravation of pre-existing injury: grade I LS/S I 

spondylolisthesis and bilateral pars defect. As concerns to whether or not the 

right L4/5 disc protrusion is work related 1 presume that to be so. 

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746 

Page 18001 

Unfortunately one cannot be treated without treating the other so as a result 

the su ested sur ery is most likely the result oftbe injury on 8/22/06. 

3. Unles could realize substantial weight loss ... 100+ Ibs. It would 

not be wort while to do surgery nor would I consider it because of tbe risks 

associated ... whether he had a gastric stapling or not. In addition if he were to 

loose that amount of weight, as he is only 24 years of age, he might avoid 

surgery altogether. 

~6n~5~/O~7 __ ~D~r~.~___ I r

M

ec

s

e1ved rep0;t from Dr. ... . conedc:rnilng & and a letter form 

6/04/07 

. lor the need for ongomg mica management. As you are aware the 

patient is morbidly obese and based on his morbid obesity and findings of 

milligrams, CT and MRI, Dr. did not feel surgery is warranted until 

the patient could undergo weight reduction measures which would include gastric 

bypass procedure ... I have been asked by Ms. I if I would be willing to 

revive this medication management until he has lost the weight he needs in order 

for Dr. • to proceed wI some type of surgical intervention. 

Based on these circumstances I will be able to continue medical maintenance on 

this individual if the court so desires ... however, he is such a young individual wi 

some type of resolution will need to be obtained w/in the reasonable period of 

time. 

Dr. 

apparently _is having significant problems from an emotional 

standpoint, not just from his back and leg pain ... 

X-rays: lumbar milligram and CT and MRl .. .l don't find a 

significant disc herniation that might be helped by a more simple procedure such 

as a right L4/5 diskectlimy. 

Recommendations: it is my opinion that diskectomy above the level of the 

spondylosis is usually not helpful. .. in this case wlo more over whelming findings, 

surgery would be a set up for failure ... his morbid obesity prevents him an ideal 

milligram and CT scan, but there is enough resolution combined wi the MRl to 

make what I believe is a sound medical decision. 

regard 10 his emotional health, I received a letter from attorney . 

directing him to apparently free psychiatric clinics, blc of significant 

epression. It is my opinion, this is a secondary dx related to his overall condition 

and he may benefit from neuropsychological evaluation and counseling. None the 

less, my opinion remains the same that his morbid obesity prevenls any 

reasonable successful surgery based on his diagnostic findings .... unles~is 

unable to achieve significant weight reduction he would not be a surgical 

candidate and the risk would far out weigh any benefits. 

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747 

5/11/07 

4/19/07 

4/12/07 

4/12107 

Page 19 of 31 

Therefore it is my opinion at the present time he can be released from my care 

having reached MMI from a neurosurgical standpoint. ... 

Work restrictions: permanent 100b weight limit, wllOib pushinglpulling as noted 

on my May 10,2005 form 5. 

Dr.l 

Form 5- released to modified work ... restricting lifting IOlbs, 

push/pulll Olbs ... continuing med tx yes. . 

Dr. 

flu of his low back and right hip injury ... has seen Dr. I and feels like 

he is a surgical candidate and has scheduled a myelogram Cr for him on 

4/25/07.. .. Dr. I I is going to follow up again wi him on the May 10th .... 

Today ~ state he is about the same ..... still has numbness in his leg and he 

states his medications are getting low. 

Today,lIIIn0ves about reasonably well .... still has persistent pain in his low 

back on the right and straight leg raising is still positi ve on the right.. .. 

It is my opinion at this time that the patient is in need of ongoing medical care per 

the direction of Dr. .... 1 will not give him a return appointment.. .. he 

has been advised to get his medications and refilled and they are refillable 

x2 .... we will not need to see him back unless so directed by the Court. 

Dr. 

Form 5- TID until myelogram 

Dr. 

flu ... had·pt~ ... offered some minor improvement, and the first ESI was beneficial 

but the second was not. ... cx of back and right leg pain that has remained 

persistent and severe .... he rates the pain as 10 out of 10 .... has subjective 

weakness in the right leg, as the leg will sometimes buckle and give away wi 

walking. 

Impression 

I. Right L4/S disc herniation and bilateral L4/5 pars defects wi probable 

complete defect on the left at LS .... only a minimal grade I, L5/S I 

spondylolisthesis 

2. Degenerative L4/5, LS/SI disc disease 

Recommendations 

I. He is in need of a lumbar myelogram and CT scan wi flexion and extension 

films. 

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748 

4/04/07 

4/04/07 

Page 20 001 

2. Either require a right L4/5 hemilaminectomy and diskectomy or an L4/5 

L5/S I TLIF and L4 to sacral fusion w/ instrumentation .... according to" 

his sx are severe and have not improved ... might be possible just to consider 

an L4/5 diskectomy as he has primarily back and right-leg pain .... myelogram 

and CT scan will be very beneficial, particularly in regard to the L5 segment. 

Work status: I don't think he can realistically work under his current medical 

conditions and should remain TrD untillhe lumbar myelogram and CT scan is 

performed and a flu appointment will be made afterwards. 

Dr. 

Form 5- modified work .... continue med tx ..... 

Dr.S 

PROCEDURE REPORT 

Dx 

I. Lumbar disc displacement 

Name of Procedure: lumbar ESI #2 al L4/5. 

AP and lateral x-ray showed needle placement in the L4/5 position wi contrast in 

the epidural space, not to be intravascular or intrathecal. 

Plan: flu. 

2122/07 Dr. 

2/15/07 

patient is to be seen by Dr. , ... thought he should undergo initial 

conservative management...series of ESl's and pt for 12 visits .... patient still 

having back pain that radiates in right hip and leg ... he states standing, walking, 

stooping, bending and twisting makes symptoms worse . 

Flu Dr. 

month. 

Rx: shower chair 

Dr . 

.. . continue medications T rarnadol and Flexeril ... flu one 

... COllSt~lIt aching, throbbing, burning and tingling sensation that will awaken him 

at night. ... pain is IO/IO ... aggravated wi most activities, particularly walking and 

somewhat improved wi sedentary activities .... subjective weakness of the right 

leg .... trouble wi walking blc of the right leg wants to buckle and give 

out. .. urinary frequency is associated .... pain extends down to the right foot wI 

numbness of all toes and the right foot. 

MRI 12/15/06 negative right hips. 

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749 

2/15/07 

Page 21 of31 

MRI lumbar spine- paracentral right protrusion wI subarticular protrusion at L4/5 

and central L51S I disc herniation .... appears to be a near complete pars defect at 

L5 on the left .... 

Ox 

1. right paracentral L5 disc herniation and central L5/S 1 disc herniation that 

appears to be secondary to work related injury .... 

2. bilateral pars defect wI almost a complete deficit at L5 on the left, but no 

spondylolisthesis 

3. degenerative L4/5, L5/S1 disc disease. 

Rx 

I. pt comprehends of program ... 

2. trial ESI 

3. flu 8wks .... alternative surgical solutions would be a right L4/5 diskectomy 

or an L4/5, L5/S1 PLIF infusion wI instrumentation ... hx wi these patients 

wI ruptured disc above L5/S I wI pars defect often do poorly .... diskectomy 

seems to aggravate the spondylolisthesis below and creates back pain 

postoperatively wi less than ideal recovery. That is still an option as the 

alternative at L4/5, L5/S I PLIF infusion wi instrumentation. 

4. he understands his condition .... 

Restrictions: TID by my observation of his ambulation ... .i don't think there is 

really realistic that he can do and could certainly put himself or fellow employees 

in harms way 

Dr. ,c ·FORM 5 

TID .... 

Recommend: L-ESI, and pI 12 visits .... continuing treatment 

1103/07 Dr. J 

MRI of the right hip was unrevealing .... MRl of lumbar spine was significant and 

he has a right paracentral and subarticular disc protrusion at L415 that could 

effect the transferring L5 nerve root as well as the exiting L4 nerve root in this 

area .... small disk protrusion wi associated DDD .... pars interaricularis thinning 

bilaterally wI a near complete defect at L5 on the left .... positive SLR at 60 

degrees ... 

My opinion the patient has a disk herniation at L4/5 on the right representing a 

permanent anatomical abnormality and is need of further medical care ... .i 

recommend that he be seen by neurosurgeons in Dr. • • group .... TTD 

and need of medical care .... Rx: Flexeril and Trarnadol. 

*.* •••••••••••••• * •••••••••••••••••••••••••••••••••••••••••••••••••••••• 

2006 

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750 

Page 22 of31 

12115/06 MRI I hips 

I. negative 

2. DOD at L4/5 and L5/S I 

12115/06 

12(14/06 

12!l1/06 

MRII Lumbar Spine 

I. Disc protrusion L4/5 ... mild DOD ... could be traversing L5 nerve right as 

well as exiting L4 nerve root 

2. Small central disc protrusion L5/S1 with moderate DOD 

3. Bilateral parse ... thinning with near complete defect at L5 on the left 

4. Moderate congenital spinal canal stenosis 

5. NOffila1 ... muscles bilateral 

Deposition of 

Dr. 

I. patient needs further medical care. 

2. possibly sustained a labnal injury to right hip. 

3. Rx: MRllumbar spine and right hip 

4. medications Celebrex, Zanaflex 

5. flu 

6. TID at this ,time and has been since September 5, 2006 

on August 22 .... hurt his back and he has been 

back to work yesterday and tbey said he should not 

have any problems and not he is having some problems after he 

started going back to work yesterday .... no numbness or tingling .... no 

incontinence .... pain starts in his hips and goes down all the way through his 

leg ... denies any new trauma. He is taking some medications for his leg .... but he 

does not know what they are and he is really almost out oftbem. 

Ox: 

I. on the job injury 

2. sciatica 

He was taken to the exam room and interviewed ... .! will place him on Flexeril, 

prednisone and Lortab ... f/u wI Concentra in the next 2-3 days .... stable and 

discharged .... 

go home ... should be able to rtw after released by 

Limitations 

I. slowly return to you usual activities 

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751 

Page 23 of31 

2. avoid lifting, pushing, or pulling 

3. avoid sitting for long periods 

4. do your back exercises regularly 

5. ke,ep flu appointment 

6, take meds 

right leg and hip using walk behind lawn mower and it slipped 

and I tried to brace myself. ,. patient has not been working blc be chose not to 

work" ,he feels a pattern of sx is about the same" ,he states does want to get back 

to regular duty. 

Physical exam: palpation is positive for pain at the laterally on the right. 

Dx: hip strain 

Activity status: regular activity released from care today" ,return to clinic as 

needed, Patient will reach MMI in about I wk according to tbe guideline 0% PPD. 

9/05/06 

Dx: sprain of unspecified site of hip and thigh 

~ 

9/05/06 _ 

right leg and hip .... right hip and right leg lots of pain. 9/05/06 _. 

~mployee .cx about his leg which was leg 

8/30/06 

which was injured 

Patient states: :injured right leg and hip using a walk behind lawn mower and it 

slipped and I tried to brace myself." 

Hx: has not been working blc he chose not to work;,., feels4he pattern of sx is 

about the same .... he states he does want to gel back'to regular duty, 

Assessment: hip strain 

Plan: medications .... regular activity release from my care today .. .. flu as needed.' 

Notes: patient will reach MMI in about I week. 

Concentra 

recheck hip ... patient states that is doing better. 

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752 

Page 24 oDI 

8/30f06 __ 

~eemployeeo ••••• 

8/22/06 

ho ex about his leg was injured 

Hx: patient has been working their regular duty .... feels the pattern of sx is 

improving and feels better .... patient has had pI 3 times. 

Exam: palpation is negalive for pain 

Assessment: hip strain 

Plan: medications .... regular activity not released from my care. 

=8/.='0=/0",-6 _-..:7 • 

just woke up so il is not irritated 

8f30/06 

Returning for following visit.. .. return to regular duty 8/30/06 

829106 __ 

~oday 

~ 

.... pain is 5/10 .... tendemess remains late .... 

. 

pallent states he ? right hp while pushing a mower and slipped. 

8128//06 7 • 

23 y/o male injured leg 8/22/06 .... "using walk behind lawn mower and it slipped 

and I tried to brace myself and injured right leg and hip". 

Returns for recheck ... working regular duty .... pattern of symptoms is 

worsening .... continues to have pain in his right hip that radiates down his right 

leg. 

Exam: palpation is positive for pain at the area of the greater trochanteric and 

laterally over the tensor fascia lata. 

Assessment: hip strain 

Plan: medication, pt 

Work status: regular activity 

8/24/06 __ 

- ...... ·-~~~miUGiIT HIP 

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753 

Page 25 of31 

Exam shows no fracture, dislocation or acule boney abnonnality. 

~ 

Impression: negative right hip 

23 ylo male employees of.-, 

Hx: cx of pain in his right hip that radiates down is right lateral thigh, onset 

yesterday when he fell at work ... denies any back pain, numbness or tingling .. 

X-ray: hip x-ray .... no fracture seen. 

Palpation at the hip is positive for pain at the greater trochanteric .... 

Assessment: hip strain 

Plan: patient was instructed to elevate the extremity and to apply ice intennittently 

OTe medications. :::.:; 

Activity status: regular activity not released from care. 

flu ... .it is my opinion that the above injury and/or symptoms are more likely than 

~ 

not 10 be directly related to work activities. 

patient was mowing on a slope (push mower) had to strain to keep mower from 

slipping and felt a pop in his leg .... pain in hip and thigh .... pain is up when 

'prolonged walking ... 

Assessment: patient to pl.. .. pain and tingling in his toes. 

**** ••• * •• **.**.* •••• *.**.*.* ••••••••• * •••••••••••• *.* •••••••••••••••••• 

~ 

2004 

. 

21 y/o employee of~uthis eye which was injured 12120/04. 

Patient states: "saw dust in left eye" ... 

Hx: patient states he was putting something above his head .... had saw dust on it 

which blew into his face and got into his eye .... hurt so badly gave him a 

headache. 

Assessment: 

1. conjunctival foreign body 

2. corneal abrasion 

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754 

Plan: meds, regular activity no! released from care .. .. f/u: 

CURRENT MEDICATIONS: 

Tramadol 50 mg' 

Flexeril 

Percocet 5 mg. 

Celebrex 200 mg. 

Effexor 75 mg. 

Zanallex q day to BID 

Hypertension medication 

FIVE STEP SEQUENTIAL DISABILITY EVALUATION: 

Page 26 of31 

Under the Five Step Sequential Disability Evaluation Process described in 20 C.F.R. 

Section 404.1520, the claimant has met the burden of proof as follows: 

1. That the claimant has not engaged in any "substantial gainful activity" 

(SGA) since 8/22/06. 

2. The claimant ha~ a "severe medically determinable impairment" to wit: 

Patient has a right paracentral and subarticular disc protrusion at L4-

5 and it was feIt by the radiologist that this disc protrusion could affect 

the transferring L5 nerve root as well as the exiting L4 nerve root in 

this area. He was also noted to have a small central disc protrusion at 

LS-Sl with associated degenerative disc disease. He was also found to 

have pars interarticularis thinning bilaterally with a near complete 

, defect at LS on the left. 

__ ~~M.D. 

January 3, 2007 

Obesity: Weight 350 pounds, Height 5'9" 

Hypertension 

Depression 

3. These impairments meet or equal one of more of the impairments described 

in Social Security Regulations and the Listings of Impairment, to wit: 

See Next Page 
755 

Page 27 of3l 

1.04 Disorders ollile spine (e.g. herniated nucleus pulposus, spinal 

stenosis, degenerative disk disease, resulting in compromise of a nerve 

rootwitb: 

A. Evidence of nerve root compression confirmed by MRI, pain, 

limitation of motion ofthe spine, muscle weakness accompanied by 

sensory loss with positive straight leg raising test (sitting and supine) 

4. The claimant can not do past relevant work: 

The claimant's past relevant work is grounds maintenance and landscaping, 

which required occasional lifting of 50 pounds and frequent lifting of25 

pounds, with standing, walking, lifting, stooping, bending, kneeling, 

crouching, climbing, repetitive twisting. 

Notice of Reconsideration dated October 3, 2007: 

"You said that you were unable to work because of back pain that affects the 

right leg. 

The medical evidence shows the following: Although you are experiencing 

pain in your back, you are able to sit, stand, bend, and walk well enough to do 

some ty.pes of work. Medical evidence does not show any other impairments 

which keep you from working. 

Your condition prevents you from doing your past work, but it does not 

prevent you from doing other work which is less demanding." 

THE GRIDS: 

Residual Functional Capacity: Maximum sustained work capacity is limited 

to sedentary work as a result of severe medically determinable impairments: 

201.27 Younger individual, age 24, born high school graduate 

".i'lth limited education, unskilled or none. 

The GRIDS are of no assistance in resolving this case. 

EXERTIONAL LIMITATIONS: 

The claimant weighs 350 pounds, is 5'9", has difficulty going from a sitting 

position to a standing position, has marked antalgic gait and tends to favor 

his left leg as any weight bearing on the right leg is painful. The patient has 

limitations of sitting for 30 minutes, standing for 30 minutes, with inability to 

See Next Page 
756 

Page 28 of3! 

lift anything over 25 pounds, with no bending, stooping, kneeling, crouching, 

crawling. Sit, stand, walk less than 2 hours out of an 8 hour day. 

NON-EXERTIONAL LIMIT A nONS: 

Constant pain, relieved only with narcotic medication, with the need to get ofT 

his feet and lie down due to constant pain and muscle spasms, and situational 

depression. 

5. Other work in the national economy within the limitations: 

Residual functional capacity is the claimant's maximum remaining ability to do 

sustained work activities in an ordinary work setting on a regular and continuing 

basis. A "regular and continuing basis" means 8 hours per day for 5 days a week 

or an equivalent work schedule. Social Security Ruling 96-8p. The claimant must 

have both the mental and physical abilities to perform sustained work activities. 

Because the evidence supports a finding that the claimant has had a substantial 

loss of ability to meet the demands of basic work related activities on a sustained 

basis, the unskilled sedentary occupational base is significantly eroded and a 

finding of disabled is justified under Sucial Security Ruling 96-9p. The claimant 

is disabled within the meaning of the Social Security Act and Regulations. 

Therefore, based upon the claimant's residual functional capacity, based upon the 

claimant's age, education and work experience, superimposing the limitations caused by 

the severe medially determinable impairments, there are no jobs within the national 

economy that the claimant can perform on a regular basis within the limitations imposed 

and, therefore, is entitled to a tinding by this United States Administrative Law Judge of 

"disabled. " 

Various physicians, treating and non-treating, have written that the claimant suffered from 

various medical problems and that the claimant has signiticant work restrictions. While the 

finding that a person is "disabled" under the provisions of the Social Security Act is an issue 

reserved to the Commissioner! (SSR 96-5p!), opinions from any medical source on issues 

reserved to the Commissioner must never be ignored. The adjudicator is required to evaluate all 

evidence in the case record that may have a bearing on the determination or decision of 

disability, including opinions froI)J~ca1 sources about issues reserved to the Commissioner. 

If the case record contains an :'Jpimon from a medical source on an issue reserved to the 

Commissioner, the adjudicator must evaluate all the evidence in the case record to determine the 

extent to which the opinion is supported by the record. 

The fact that the claimant's treating physician, after extensive examinations and treatment, has 

formed such opinion as to the claimant's ability to perform sustained work activity was 

precluded strongly suggests a significantly limited residual functional capacity. Further, 

considering the claimant's diagnoses and multitude of prescribed medications tried, the 

See Next Page 
757 

Page 29 of31 

undersigned finds that treating physician's opinion is well support and is not inconsistent with 

the other substantial evidence in the case record; thus, it is afforded controlling weight (20 eFR 

404.1527(d)(2) and SSR 96-2p). 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of 20 CFR 404.1529 and SSRs 96-4p and 96-7p. The 

undersigned has also considered opinion evidence in accordance with the requirements of 

20 CFR 404.1527 and SSRs 96-2p, 96-5p, 96-6p and 06-3p. 

After considering the evidence of record, the undersigned finds that the claimant's medically 

determinable impainnent(s) could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity, persistence and limiting effects of these 

symptoms are generally credible. 

The State agency medical opinions are given little weight because other medical opinions are 

more consistent with the record as a whole and evidence received at the hearing level shows that 

the claimant is more limited than determined by the State agency consultants. Furthermore, the 

State agency consultants did not adequately consider the claimant's subjective complaints or the 

combined effect of the claimant's impairments. The Administrative Law Judge affords greater 

weight 10 the opinion of the examining (nontreating) source. This opinion is well supported by 

medically acceptable clinical and laboratory findings, and is consistent with the record when 

viewed in its entirety. The State agency consultants did not consider all of the claimant's 

impairments contained in the medical evidence of the record. The State agency consultants 

failed to consider the combined effect of all of the claimanl's impairments as required by the 

regulations. The State agency did not adequately consider the entire record, including the 

stateme.nts of collateral sources. The State agency did not adequately consider the entire record, 

including the subjective complaints and other allegations of the claimant. 

5. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 

416.965). . . 

The demands of the claimant's past relevant work exceed the residual functional capacity" 

6. The claimant was a younger individual age 18-44 on the established disability onset 

date (20 CFR 404.1563 and 416.963). 

7. The claimant bas at least a bigh school education and is able to communicate in 

Englisb (20 CFR 404.1564 and 416.964). 

8. The claimant's acquired job skiDs do not transfer to other occupations within the 

residual functional capacity defined above (20 CFR 404.1568 and 416.968). 

9. Considerin"g the claimant's age, education, work experience, and residual functional 

capacity, there are no jobs that exist in significant numben in the national economy that 

the claimant can perform (20 CFR 404.1560(c). 404.1566, 416.960(c), and 416.966}. 

See Next Page 
758 

Page 30 of 31 

In determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual functional capacity, age, education, and work experience in 

conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. 

(fthe claimant can perforin all or substantially all of the exertional demands at a given level of 

exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" 

depending upon the claimant's specific vocational profile (SSR 83-11). When the claimant 

cannot perform substantially all of the exertional demands of work at a given level of exertion 

and/or has nonexertional limitations, the medical-vocational rules are used as a framework for 

decision-making unless there is a rule that directs a conclusion of "disabled" without considering 

the additional exertional and/or nonexcrtionallimitations (SSRs 83-12 and 83-14). If the 

claimant has solely nonexertionallimitations, section 204.00 in the Medical-Vocational 

Guidelines provides a framework for decision-making (SSR 85-15). 

If the claimant had the residual fUnctional capacity to pertorm the full range of sedentary work, 

considering the claimant's age, education, and work experience, a finding of "no 1 disabled" 

would be directed by Medical-Vocational Rule 201.28. However, the additional limitations so 

narrow the range of work the claimant might otherwise perform that a finding of "disabled" is 

appropriate under the frdmework of this rule. 

10. The claimant has been under a disability, as defined in the Social Security Act, from 

August 22, 2006 througb tbe date of this decision (20 CFR 404.1520(g) and 416.920(g». 

DEcrSlON 

Based on the application for a period of disability and disability insurance benefits filed on June 

12,2007, the claimant has been disabled under sections 216(i) and 223{d) of the Social Security 

Act beginning on August 22, 2006. 

Based on the application for supplemental security income filed on June 12,2007, the claimant 

has been disabled under section 1614(a)(3)(A) of the Social Security Act beginning on August 

22,2006. . 

The component of the Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments, and if eligible, the amount and the months for wIDch payment will be made. 

Medical improvement is expected with appropriate treatment. Consequently, a continuing 

disability review is recommended in 12 months. 

Workers' Compensation offset may be applicable. 

See Next Page 
759 

10 

W. Howard O'Bryan, Jr. (0453) 

United States of America 

10 Administrative Law Judge 

Federal Administrative Judiciary 

Date 'DEC 0 4 2001 

W. Uoward O'Bry'n, Jr .. (045J), UnitHi Stiles AdmiaUlnlU ... 1.. .... Jud~ Social So;uriry AdJnilliBlTlrion, OfTlce or Adjudic.lJ.ion 1114 Rtnew. YIho may pn-lide: j 

USC 5S6(b}; Powm ordl!: pJ"f:sidinj: officer: 1 USC SS6(c);Spccia! roieofthe Admini~tntivc law JudgE UI Social Sl:Cwil}': "«klerY C.mpbcU 461 u.s. 4'8, 471, lOO 5.Ct. 

1~52, 1959. I S.S.R.S. 3, IO,'CCH 1 H.S85 (198J)'WUR v Hreldsr '11 F,ld 506, SID, 16S.S.R..S. 279,113 (10Ih Cit. 1987)~ 79) F.ld 702. 704-703', 14 

S.S.R.~.III.II\l·90.CCH 1 17,071 (SlhCif. Iqsti).~ '''IJ.wi1, 6S1 F.2dSll (7\hCir. J9!lI);£wW.u".~. S27F.2d224(3rdCir.197S)( .... dminiRntl\1: llW 

JudKC mu.sl d .. ,'d0l' full rttIX,J ... hen: cI.im.", 1101 rep-oe&.Ic1I hyroll1lsrJ).: BLII 1C'e.~. 131 F.Zd 1216. oJ. S.S.R.S. 340, CCH 1 l:UU (Sib Cir. 198"),~ y. 

~ 754 t',2d214t8lhCif. !985):IQrd,nv Ucsklu 83~F.2d 1314. 20 S.s'R.S. U8,Crn, 11.808 (11ktI Cir. 198T},(AdmjaistrarivtLawludl!:elNJSldevdcprlln~d 

even if c1aimanl represmted by wunsel); Soc:NiI Secwily Kuling 11-2); Social Security Rt.,:ulations 20 Cfll U 404.944 and 0416.14-14, f,ft 1IItI,10 CFR 404.953, <l.04.9S I, 

<116.1450 and ,tI6.14'I, Sac:ill Securil)' At!, §§ 30S(b}1IIJd 1631(1;)(1, 
760 

'to/29/2008 11:18:11 AN 

VIRGINIA DEPARTMENT OF REHABI~ITATIVE SERVICES 

TEL£DICTATION 

R-__ -

CHIEF SYMPTOMS: 

MEDICAL CONSULTANT REPORT 

10/24/2008 

DATE DICTATED: 10/28/2008 

'l'YPE OF CLAIM: 

AUTH#: 

REGION: 4 

Neck pain, low back pain and shottness of bre,ath. 

HISTORY OF PRESENT ILLNESS: 

EXHlSIT NO. iF 

PAGE:IOFI 

Ttle claimant is a 53-year~ld female wltl\ a past medical history of COPD. history of 

motor vehicle accident fIVe years ago, low back pain. neck pain an~ pain In the 

knees came 10r evaluation of Disability Determination Services. 

~ per the claimant, her main symptoms are neck pain which has been present for 

the last several years, getting worse and worse. The claimant rates her pain as 

8/10, occasionally radiates to the hands. Any kind of movemEint from side to side 

exacerbates the pain. She sees r - as an outpatient, who Is a family cars 

physiCian. She has never had X.nIYS or an MRI scan or myelogram for the neck pain, 

although she had been sent to physical therapy once In the past which did not help 

her neck pain. The claimant was Mverreferred fo a specialist in the past for her 

neck pain. 

Also, the claimant complains of low back pain and hip pain at times. The pain 

becomes worse on bending, stooping, crouching, crawling and lifting weights more 

than 20 pounds. Also, she ,never had an X.nIyof MRI scan for the back to SUggest 

Permanent Subcommittee on Investigations 

EXHIBIT #16a 

, 01$ 
761 

10/29/2008 

Page 2 

EXIIIBITNO.6F 

PAGE:4OF8 

the pathology of the back pain. She has never been sent to a specialist for her back 

pain. 

The claimant describes having a motor vehiCle aCCIdent in the past, five years ago, 

wfth fracture of the left hlp. She does not use a cane, walker or crutches for 

ambulation. 

She also has shortness of breath. mostly on exertion. She has never had an MRI 

scan or Hay In the past. 

The claimant also complains of pain in her right hip jillnt and pain all over. She has 

never worked In the past 

REVIEW OF SYSTEMS; 

No fevers, chills or rlgol!!. No headaches. No Change in Vision. Negative for tinnitus 

or hearing loss. Negative for sore throat. No odynophagia. No neck mass. No for 

chest pain. Positive for shortness of breath on exertion. No palpitations. Negative 

for pain in the abdomen. No nausea, vomiting, diarrhea or constipation. Negative 

for bumlng or pain in the urine. No hematuria. No di:alness. No loss of 

consciousness. No seizures. Positive for neck pain. Positive for low back pain. No 

depression or anxiety. Positive for pain In the knees. 

PAST MEDICAL SURGICAL HISTORY: 

1. COPD. 

2. Gallbladder surgery in the past. 

3. Motor vehicle accident five years ago with left hlp fracture, status post repair. 

4. Low back pain. 

5. Neck pain. 

6. Pain In ttie knees. 

7. Hysterectomy In the past. 

AIl.ERGIES: 

No known drug allergies; 

, ... 
762 

1W2912OO811:19:43/W 

10/29/2008 

Page 3 

SOCIAL HISTORY: 

The clalmantsmokes one pack a day. No alcohol. No illicit or intravenous drug . abuse. . 

MEDICATIONS: 

1. Usinopril 

2. Hydrochlorothiazide 20/12.S mg, one table CI. dally. 

3. Advair Disk 25O/S0. one puff b.l.d. 

4. Rosuvastatin 20 mg q.d. 

5. Spiriva HandlHaler, one puff in the morning. 

6. Hydrocodone 5/500, CI.4h .• as needed. 

PHYSICALI;XAMINATlON: 

The claimant being examIned was not in any acute distress. lying consdous and 

comfortable. 

EXHIBIT NO. IF 

PAGE:IOF8 

VITAL SIGNS; Respirations are 80. Temperature 98.S. Pulse 70. Blood pressure Is 

120/70. Height S feet 4 inches. Weight 134 pounds. Vl5ion 20/20 

GENERAL: The CI.aimant was pleasant and cooperative, not In any acute distress. 

GROSS AND FINE MANIPULATIONS: The claimant can climb on the eXamination 

table with no difficulty. Grasp and shake hand strength was normal. The claimant 

ean pick up a coin from a flat surlace with no difficulty. 

VISION AND HEARING: Vision was 20/20 bilaterally. A formal hearing test was not 

done but seems grossly intact. 

EARS AND EYES: PERRLA. EOMI. 

NECK: No lymphadenopathy. No Jugular venous pulse. No thyromegaly. 

HEART: Rate is regular. No murmur. No 53. No 54. 

LUNGS: Clear to auscultation but air entry Is decreased. Expiratory phase was. 

prolonged. No rhonchi. No wheezing. 

3015 
763 

1at»2OO1 11 :iQ".2& NI. 

.10/29/2008 

Page 4 

ABDOMEN: Soft. Nontender. No organomegaly. Bowei sounds are present 

SPINE: Mobility and curvature normal. No kyphosis or scoliosis. 

EXTREMITIES: No cyanosis, dubbing or edama. Parlpharalpulses felt 

NEUROLOGIC: Alert and oriented. Cranial neIVIIS II-XII are Intact. 

MOTOR EXAMINATION: Power was 5/5. 

SENSoRy EXAMINATION: Intact. 

CEREBELlAR: No cerebeliar si~. 

EXHIBIT NO. if 

PAGe iOF8 

MENTAL STATUS: The claimant's appearance, behavior and speech were normal. 

ThoUght proeesa and content were nonnal. Concentration and attention were 

normal. Judgment and Insig/lt were normal. Attitude and degree of I:()operation 

was normal. rund of information seems adequate. 

OIAGNOSES: 

1. Neck pain. 

2. Low back pain. 

3, Chronic obstructive pulmonary disease (COPD), . 

4. Motor vehicle accident five years ago with left hip fracture, status post repair. 

5. Gallbladder surgery in the pust. 

6. Pain In the knees. 

7. Hysteraetomy. 

PROGNOSIS: 

1. The claimant's main symptoms ilie pain in the neck and low back pain. 

2. Her range of motion on physical examination was normal. although the 

claimant has mild neck tenderness. 

3. On examination, the claimant cando normal flexion/extension of the 

lumbosacral spine and her gross and fina manipulations were normal. 

4. The claimant doBS not use a cane, walker or crutches for ambulation, 

although she had a history of hlp fracture, but at this point in time her pain Is 

in the right hlp which was not Involved In the car accldent. 
764 

11li2Q12OO811:21.1)/W 

10/29/2008 

PageS 

EalTNO,6F 

PAGE: 1 on 

5. It 1& possible that the claimant has degenera~e arthritis, as per her age, but 

she does not demonstrate any significant abnormality to rastrlct her acttvlty. 

FUNCTIONAL INFORMATION: 

The claimant was cooperative and gave full effort during the examination. The 

number of hours the claimant could be exp$cte<! to sit. stand and walk will be 6-7 

hours with normal breakS. No ilmltatil;lns in bending, stooping. crouching, or 

crawling. No limitations in reaching, handing, fingering or grasping. No relevant 

visual, communicative, workplace or environmental limitations, 

MEDICAl. SOURCE STATEMENT: 

With no limitations. 

CREDIBILITY: 

Credibility of the report Is moderate, 

" \ \. 

I, "'-

This transcl'lption was made from a recording of the voice of , - by 

Superlor/1t on 10/29/2008. 
765 

DuPlEx 

Social Security Administration 

Retirement, Sun'ivors, and Disability Insurance. 

Notice of Disapproved Claim 

EXHIBIT NO.1. PAOE:1oF5 

Date: Octor 11 2008 

We are writing about your claim for Social Security disability benetits. Based on a review of your health problems you 

do not qualify for benefits on this claim. This is because you are not disabled under our rules. . 

We have enclosed information about the disability rules, 

About The Decision 

Doctors and other trained staff looked at your case and made this decision. They work for your State but llsed our rules. 

Please remember that there are many types of disability programs •. both government and private. which use different 

rules. A person may be receiving benefits mder another program and still not be entitled mder our rules. This may be 

true in your case, ' 

How W. Made The Dedsion 

."Jl ~ele\'ant reports IVere requested and the following evidence was used to decide your claim. 

r"!'onreeel Y,eu 08120/2008 

T""oOrtTec~ived 09/24/2008 

0812712008 

RESPIRATORY report received 1012 SI200S 

10129/200S 

We have determined that YOllr condition is not severe enough to keep you from working: We considered the medical 

and other information, your age. edllcation. training. and work "''Xperienee in determining how your condition affects 

ymrr ability to work 

You said that you are unable to work because of breathing problems. back problems. limited education. migraine 

headaches, vision problenis. hypertension. . 

The evidence shows that you have pain in your back, but you are still able to si~ stand. walk and move aboutwithin an 

adequate range without "-,,,istance. You have breathing problems. but a recent breathing study has shoIYn that you retain 

a sufficient ability to breathe. There are many jobs in the economy that do not require much education Migraines are 

very bothersome. but generally respond well to treatment and medication There is no evidence lliat you have signiticant 

difficulty with vision, Your hypertension has not caused you any severe complications. 

Although you have not ,.orked in the past, you should be able to do work that does not require heavy lifting or ..... pose 

you to dust or fumes. 

EXHIBIT #16b 

Permanent Subcommittee on Investigations F • 
766 

The last day of your specified 7-yeor period is 0112015. 

EXHIBIT NO.1. PAGE: 2 Of' 5 

If your condition gets worse and keeps you from \mrking, write, call or visit any Social Security office about filing 

another application 

If You Disagree With The neclsion 

If you disagree with this decision you have the right to appeal. We will review your case and consider any new facts 

you have. A person who did not make the frrst decision will decide your case. 

You have 60 days to ask!'or an appeal. 

The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it uniess 

you show us that you did not get it within the 5.Jay period. 

You must have a good reason for waiting more than 60 days to ask for an appeal. 

You have to ask for an appeal in "Titing. We will ask you to complete a form SSA-561-ill, called. "Request for 

Reconsideration". You may contact one of our offices or cnll 1-300-772-1213 to request this form. Or you may 

complete this form online at http://www.socialsecuritv.govidisabilitviappeal. Contact one of our offices if you 

want help. 

In addition you should complete a "Disability Report - Appeal" to tell us about your medical condition since you 

filed your claim. You may contact one of our offices or call 1-8oo-772-12l3 to request this form. Or, you may 

complete this report online .fter you complete the online Request for Reconsideration 

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It 

contains more information about the appeal. 

New Application 

You have the right to file a new application at'any time, but· filing a new application is not !he same as appealing this 

decision. If you disagree with this decision and you file a new application instead of appealing: 

you might lose some benefits, or not qualify for any benefits, and 

we could deny the new application using this decision, if the' facts and issues are the same. 

So, if you disagree with this decision, you should ask for an appeal within 60 days. 

¥ You Want Help With Your Appeal 

You can have a friend, lawyer, or someone else help you. Ther~ are groups that can help you find a lawyer or give you 

free legal services if you qualify. Th,!'re are also lawyers who do not charge unless you "in your appeal. Your local 

Social Security office has a list of groups that can help you "ith your appeal 

If you get someone to help you, you should let us know. If you hire someone, lVe must approve the fee before he or she 

can collect it And if you hire a lawyer, we will withhold up to 25 percent of any past due Social Security benefits to pay toward the fee. . 

Other Benefits 

Based on the appDt9tion you filed, you are not entitled to any other benefits, beside. tho.e you may already be 

getting, In the future, if you think you may be entitled to other benefits you will need to apply again, 

_., ..... 77_ ... 
767 

If You Han Any Questions 

EXtUIT NO.1. PAGB:30,S 

If you ha~e. any questions. you may call us toll·free at I·S{)()"772.1213. or call your local Social Security office at the 

nmnber sho"n below. We can answer most questions over the phone. You can also "Tile or visit any Social Securiiy 

office. The office that serves your 8Te<' is located at: 

SSA· BLUEFIELD 

3014 E CUMBERLAND RD 

BLlJEFIELD. WV 24701 

304·327· 7671 

If you do caU or visit an office. please have this letter with you. It wilfhelp us answer your questions. Also. if you plan 

to visit an office. you may call ahead to make an appointment This "ill help us serve you more quickly. 

Enclosures: 

SSAPub. No. 05·10058 

Disability Rules Factsheet 

Laurie Watkins 

Regionnl Commissioner 

& 
768 

16/1112010 1'3: 55 o TESSNEAR 

1-____ _ 

Licensed Clinical PsYcb.ologiB 

-so 

(! 

- Report of Psychological Evaluation 

CONFIDENTIAL: FOR PROFESSIONAL USE ONL V 

Date Name:~::==-. of Birth 

Date of Evaluation: 9-27-10 

ss;n." •••• 

Age: 5S 

Length of evaluation: 3 hours 

Reason for Referral: WIIS refe!Ted by her 

psychological evaluation in connection with 

~L..v PAQI: 1 OP12 

provided for review include 

OwcruugeS~~~'II""'-'. 

~ ...... ---£Ora 

benefits. Records 

:nospol!tlll, 9·17·09; . 

~_,5.7-09; 

Consultationrepon, ~ 

Identifying Information: b is a 55 year-old white woman. She is driven to t11e 

evaluation by her pastor and she asks him to be present througll the interview and he 

agrees. They drove to the area yesterday and stayed last night with his sister. She is not 

able to state the route they used and says they had 11 little trouble finding this location. 

Asked if she understands why she is here. . SIll'S that her attorney wanted her 10 

come. She completes intake £Oms without assistance, beDding low over the fonns to 

write. She says, "I can't read much.» Limits of confidentiality are discussed and she 

is told that the appoilllment tDday is for evaluation oo.ly and that it is no~ intended as 

treatment She is also told that the purpose is to dete_e the effects of any mental 

. impairmelll on her his ability to sustain gainful employment, and that thCI results could be 

favorable or unfavorable. 

Medical History: ~ says she has a history ofbreathiDgptoblems, high blood 

pressure BlId hack pain for 7 or 8 years because of a bad disc. She broke her hip in a 

motor vehicle accident 6 or 7 years ago and says she also crushed her pelvis and broke 

ribs. She was bospitalized overnight about Z weeks ago because of chest pain, and says 

this has happened before. She bas had SUlge!)' for her gall bl,adder and also had Ii 

hysterectomy. Medical records state that she also bas a history of osteoporosis, 

rheumatic fever and COPD. She had a work-up in May of 2009 because of severe 

headaches on the right side. Her SED rate was elevated and doctors tried to rule Out 

arteritis, inflammation of arteries in the brain or head. She seenlS not to know what the 

fJ.1lal diagnosis was, and it may be that studies have J1Qt yet been conducted. 

Permanent Subcommittee on Investigations 

EXHIBIT #16c 
769 

11"/11/21'116 19:55 0 TESSNEAR PAGE 04 EXHIBIT NO ... ZF 'Aoe.: lOf11 

.. L, P5)dlOlogiasl Evalnation 

She brings the wllowing Ii$( of medications from I Hospital 

DiscbargelI'ransfer Instructions, 9-13-10: Advair inhaJ", 250150 mg I puft'x2, 

Metoprolol50 mg, Prilosec 20 mg, aspirin 81 mg, Plavix 75 ms. Lortab 7.5 mg every 4 

. hrs, Ibuprofen 800 mg every 8 hrs, LisinoprillHCfZ 20112.5 mg, Paxi110 mg, 

Pre<lnisone 60 mg, Spiriva 18 mcq. She says she sometimes forgets to take her 

medication. Asked about side effects, she says, "I keep a headache allilie time," and she 

also bas a dry mouth. Sb.e says she loS! her Medicaid card in July and when her current 

supply of medicine runs out, she will not be able to get more. 

PsYChiatric lJil!tm.i a says she ha, "always been a worrier' !>ut her nerves got 

worse in 2002 Ot 03 when her husband be(:ame ill. She saw a coWlSclor, ( 

. . one time in Vansant and says she was lIot sure the counselor inteJlded her to 

return $I) she did not make anothet Bppoint:n1ent. She was also 1I0t sure that it would help. 

She has never been psychiatrically hospitalized or made a wicide attempt. .Sbe thinks she 

began using medication for her neJVeS about 2 years ago. Family psycbiatric history 

includes "Mollllny, she takes medicine fur depression." 

Asked w/lat her usual mood is, she says, "I'd liJ..""e to say a good one, pretty fair." Asked 

if she ever feels depressed, she says yes and rates her l6\tel of depression today as 4 on a 

IO-point =le. She bas not bad erying spells for a while ami says ber appetite is variable, 

She has lost weight and does not know how much but says she Can tell in ber clothes. 

She bas trouble sleeping and awakens often because.ofpain and also because oiher 

. tboughts. She says she never wakes up without Ii headache. She has lost interest in 

things she used to enjoy like worldng in her flowers and mowing the lawn. She says she 

stopped doing those things 5 or 6 years ago. She denies feelings of guilt and suicidal 

ideation ("as of light now, I don't think I would J!tver"). Sbe does not give any history of 

manic or bypomanic episodes . 

..... says she feels anxiOus when she must travel or meet new people. She does not 

like to be in crowds and says, "I don't visit Wal-M.art." She rates her anxiety today as "5, 

maybe 7" and says that this evaluation bas made ber more nervous. She wonies 

excessively and reports muscle aches and tensiolJ, dry IIlOIlth, headaches and abdominal 

distress. She is irritable and sometimes gelS restless. Concentration is reported to be 

poor and she Says she cannot focus and loses her train ofthou8ht. She says sbe cannot 

follow a 30-minute TV progrem. She also reports panic attacks in which she is sbort of 

breath, sweats, feels like she is choking and has pounding heart. She cannot say how 

often they ocrur but the last attack was a couple of weeks ago. They usually last 5 or 10 

minutes. Sbe bas gone to the hospital and says she was told til/ii her symptoms were, in 

fact, due to a problem willi her heart. Asked about phobias, sbe reportS tile common fears 

of snakes nnd height&. Sbe describes compulsive countiDg of ceiling tiles and says she 

checks the door loch, more oftetl now dlat she lives alone.' She does not hoard but notes 

that "anything people don't want, they give it to me." She uses band sanitizer but does 

not describe exeessive conccro about germs and contamination and does not report an 

exdcebssiV? need for order. Ret" {lIlH~~ater ~cedYStlthatshhe bahasS mowr 9& all h(~ Ii~e an aptize<! her 12 years ago. e ..... noli !at e gotten more nervous qUite a 

bit"). He gives her 8 ride to church and also took her husband when he WitS living. He 

2 
770 

H1/1l/21l1e 19:55 TESSNEAR E~O.'~ PAGE: 30.12 

& JiWsychologiaol Evaluation 

says that .he is DOW very llIlXious in the car and worries ire gels tBo close to the edge of 

the road. He says she is aIso nervous at the church. 

. Substance Use: _ denies ever using alcohol,lWU'ijuana, or other recreational 

substances. She says she bas never abused pain piUs or other prescription medicatiort. 

She smokes Y, pack a day arid has 5 or 6 cups of coffee, no tea and no soda. She is 

infurmed that her caJfei.ne intake may be ex.aceIba!ing ber anxiety and is urged to 

consider cutting back. 

~: • says she finished the 7th grade at y. She believes 

she was retained in the 2"d grade and maybe the 4111• School records appear to indicate 

retention in the I" and 4"', with social promotion to the 6th. Standardized test scores 

(Lorg(}-~dike) from 4

111 grade report Totsl IQ 53. She was not in special education, 

home SChooled, suspended Of expeUed. She believes she had deye\Opmentsl delays 

involving both speech and motor development. Grades were poor and she sal'S thal 

school was hard for her. She was not involved ill extmc:urricular activities but got aiOIlg 

fairly well with peers and teachers. She has never attempted to obtain 11 GED and has not 

had other training or educa1ion. 

Worle Histoty: '. ? has never ~rked for payor done volunteer work, babysitting 

or neighborhood jobs. 

P§ychosociaI HiSlQIX: _ was born and IlIised in 'Virginia Her 

mother, who is stiJlliving. was a homemaker. Her father worked lD the mines and cut 

logs. He died of cancer 7 years ago. was the 5"' of 10 children and says she is 

close to some' but not others. She was nlaJried at age 18 IUld her husband worked a strip 

nune job. She says he died 5 years ago of Al2;heiiner' s and congestive heart fiillure. 

They bad 2 daughters, now 3 I and 36, and they adopted another girl who recently turned 

18. When she moved out, • lost herfood stamps. Aslred why she has not reapplied, she says she needs to but she appears to be overwh.elmed by how to do it. She 

cunlllltlyUves alone in 8 trailer she owns and she has cat. At the end of the evaluation 

while she i~ out of the room, her pastor says, "She wouldn't teU YOIl this but," and then 

goes on to say that her home burned down fur the 3td time a few years 8g0, after being 

struck by lightning. He says her financial situation is dire and the churcll helps her as 

much as possible. and paid for her husband's funeral. 

Legal History: She denies ever being in jlliJ, arrested or charged with any offense. 

AbuseHistorv' She denies any history of mental. physical, sexual or emotional abuse. 

(Some of these questions 8{C asked after the pastor has gone, in the event that she might 

be uncomfurtable with some history, but she did nol offer any additional information at 

thattime.) 

Mili~ History:' She has never served in the military. 

Daily Activities: goes lo bed between 10:30 and 11 and gets up 3 or 4 times in 

. the night. She wakes up around 5 or 5:30 and does not nap during the day. She bathes. 
771 

18/11/2810 19; 55 TESSNEAR PAGE 86 EXHIBIT NO.12f' 

PAGI!:4Of~1 

......... ydlological EvaluailoD 

eve!)' other-day and says it is bard fur herm get in and out of the tub but she caresfo, 

. grooming and hygiene without assiatance. Her daughlerli help witJI household cbores and 

her son-in-law and daughter take care of the lawn. She cooks ~every now and then," and 

does some dishes, laundry and sweeping. S~ says site can malee nUnor household 

. repairs like changing a light bulb. She uses 'a telephone and says she has trouble with the 

directoty because ofpoor vision. She says she has cataracts in both eyes. Sbe has never 

used l'ubJio transpOnation like a bus but thinks she could. She obtained a driver's license 

after taking the test twice and says she does 1ittIe driving now. She only goes on shan 

trips and says she cannot find her way homB. She leaves her home once ~,week to go to 

church and sometimes picks up a few thing$ at the SlQre but her daughterS do some 

shopping for her. She does not read books, newspav= or magazines and says that 

reading gives her a bad headache, 'She does not garden or do other outdoors activities . 

and does not use a computer. She thinks she can write a check and says she would need 

help balancing a Checkbook. She pays bills in penon using cash. She does not watch TV 

and listens to a linIe IIIlI£ic in the vehicle. 

Socim Functioning: a says she gets along ok with most people but she is shy and 

avoidant Her pastor says that she does not like to ask fur help and she appears to have 

limited assertive skills. She says she gets into arguments with her children but does riot 

have II. history or iDteq>erwual conflict. She has a few friends from chW'Ch and only sees 

them on Sunday. She ramy visits friends or family. She never did participate in social 

activities. She says sbe used to go to church 3 times a week and aOds ,that J!er faith has 

helped her .through her difficult times. 

Tests Administered: 

Clinical interview 

Review of Records 

Mental S1atus &.amination 

Wechsler Adult InteUigel1ce Scale - 411> Edition (W AlS-IV) 

Belwvloral Observations and Ya1idity o/Findings: Rspport is established and the 

impo\1aJlce of making a gQOd effort is diseussed with E'" She is etlCOU!1lged to 

give accurnte information and is told that apparent exaggeratiOll or inaCCllIate reporting of 

symptoms will be DOted in the report of lIVlIluatioD. She indicates that site underslllnds 

and appears to inake a good effort. She approaches testing ill a tJloughtful, deliberate 

manner. When questions become more difficult, site says, "I'll try." These results are . 

thought to bean accurate and valid assessment ofher functioning. 

Test Results: 

W AIS-IV: The W AIS-IV provides ClOmposite Scores with a mean of 1 00 and a standard 

deviation of 15. vcr replaces VIQ. on the W AIS-m and PRI replaces PIQ on the W AISill. CI refers to 95% Confidence Interval. She produces tbe fullowing: 
772 

16/11/2616 19:55 TES9EAR PAGE 67 EXHJBr1"NO.1U 

PAG&:JoP12 

...... bbPP'Ycho1ogtcat Evaluation 

Scale' Coml!!lsite Soorll 

Verbal ComprehelWion Vel 66 

Perceptual Reasoning PRJ 60 

WorldngMemory WMI 71 

Processing Speed PSI 68 

Full. Scale. FSIQ 60 

(CD 

62-73 

56-68 

66-80 

63-80 

57-65 

~ 

1 

0.4 

3 

2 

0.4 

DescriPtor 

EmmlelyLow 

E>.."U"eme\y Low. 

Borderline 

Extremely Low 

Extremely Low 

These SCOre3 indicate that reliltive to other individuals in ber ege group;. • 

measured level of intellectual functioning falls within the Mild Mental Retardation range. 

These fmdings are generally consistent with her reported education and work history. 

Pair wise PiSCtejlancy Comparison finds WMl is significantly higher than PRJ. . 

Scaled scores have B mean of 10 which is considered averag~ for someone in this age 

group, with a standard deviation of 3. She obtajn~ the fullowing subtest scaled 'scores: 

Verbal Comprehension 

SimilariuCll 

Vocabulary 

Information 

Scaled score 

3 

5 

4 

Working Munory 

Digit Span 

Afithmetic . 

Scaled score 

7 

3 

Perceptual Reasoning 

Scaled SCOre 

Block Design 

Matrix Reasoning 

ViS\l31 Puzzles 

3 

2 

5 

. PrOCessllrg Speed 

~ ScaledSWe 

S~nbolS~ch 4 

Coding 4 

Relative to the overall mean of' all subtes!$, site displays a streJlg!h Oil Digit Span. No 

relative weaknesses are fuWIII. It is noted that she bas particular difficulty with Block 

Design and consistently reverses the designs. She bas problems comprehending the 

instructions and must be reminded to use all of the blocks. When she realizes that she has 

one block out of order, she leaves it and attempts to change the other 3. These behaviors 

might suggest a leamiDg disability in a younger person and in bt.r case, may reflect some 

. organicity. 

WRAT-4: The WRAT-4 is a norm-refetenced test of academic achievement tbat is used 

to assess basic skills of word reading, sentence COOlprehension, spelling and math 

cornputatiol1 For cadi subtest, standard scores are reported with a mean of 100 and a 
773 

16/11/2111a 19:55 e TESSNEAR . ~NOJlJ 

II 

PACi:IOF11 

...... lIJlsycboIOgical Evaluation 

SUIlt.ilard deviation of 15. Confidence intervals (CI), percemile ranks, and grade . 

eqwvalent SCOfCS II{I) also reponed. She produces: 

Standan!Scom 2lli.a ~ ~ 

Word Re.adillg 69 62-19 2 U 

SenteMe Comprebeosicm 71 64-80 3 4.7 

Spelling 74 66-85 4 4.4 

Math Computation 71 62-84 3 3.2 

RtadiDg Composite 08 ·63-75 2 

These scores· indicate that her ability to recognize Wld prOllOllllCe words, sp~lItbem, and 

understand their meaning in the context of a sentence is at 41\1 grade level. Ability to 

solve math problems is a little lowe(. 

Menial Statu$ .EJ:llm: 

Appearance: -.is neatly dr~ in tell cropped pants, orange polo shirt and 

SlUldal&. Het c,I(\thing is a little lightweight fur the cooleK weather today. She has long 

white bair and is tanned and wears toeuail polish. Fingernails are long and clean. She 

wears glBSSeS and make-up. She giVes her height as 5'4" and her weigbt as 117 pounds. 

She looks older than her stated age. . 

Relation to Eramimr: She is friendly and coopera1ive, and makes good eye contact 

MolorlPhysicaI: She is right-hand dominant and wears glasses. She does not use any 

device to assist bearing, movement or balal1ce. She is restless and fidgety and takes ODe 

shott break. She sits on the edge of her seat with her ant\j folded. She chews and picks 

at her nails and taps her foot 

Speech: Rate and volume of speech are within normalliroits. She speaks clearly and 

coherently, using a regionailUX:ent. No \IIII.ISWIllatencies or word fiuding problems are 

observed. 

Affect andMood: Range of affect is restricted and mood is primarily anXious. SI)Ie 

becomes defensive and soimds 1\ little angry and irritable ufter having problems with 

mental status questions. 

Oi'ienlOiio,,; She is oriented to person, place and date . 

. ITlSi!Jhi: She displays accUrate insight into the nature of her problems. She does· not 

exrernslize or blame others. 

Judgment: She is able to make reasonable decisions and ·to manage her daily actiVities; 

though, she notes that "living alone, seems like it's all hard." She is helped by her 

daughters with important decisions, and says they advise on matters like caring for the 

6 
774 

HI/11/2e10 19:~5 TESSNEAR PAGF 89 EXHiBiTlto.11F 

,AGI: 10Fn 

...... PsycholOgical E~'3luatioll 

trailer and maimainiog a vehicle. She sounds overwhelmed by 1hese tasks and says, "I 

need somebody to decide." , 

Memory: She is able to re<:al16 digits forward and one trial of 4 digits backward, which 

is a good performance relative to her overall intellectual functioning. She can recall what 

she had for supper last night ("Breen beans, chicken, potatoes") and cannot sive any 

importllll1 story recently in the news. She recalls 4/5 words immediately and is aware that 

she bas omitted one. After a 10-minute delay, she recalls 215 and again knows that me 

omitted 3. She can oame the current pmlident but not the governor ("calJ'l think ofhis 

name"). Asked to name the last 3 presidents, she says, "Clinton, .Bush. The I"st three? 

Besides Obama, I can't remember." Ability to rqmrt personal history is fair to poor, 

suggesting some impairment oflong-term memory. 

Atterdion and ConcentrQtion: AttentIon is variable and she is confused at times. She has 

much difficulty with serial 7'9 and is given a lilirt to help her get started but still dues not 

comprehend the task. She lOa}'$, "Count by 7'l From 971 92, 87." She is then asked to 

do serial 3 's and again becomes confused. She slowly begins at 45 and says, "no, 44, 38, 

36," and stops to ask that the instructions be repeated. She also bas trouble giving three 

months pfthe year in reverse order("oh, Lord, I c!on'tknow if I can do that or not"). She 

begins, "DeGembcr, Febnw:y, March, ~ and is stopped and told to begin with "December, 

November," to which she replies "Iantwy." She correct.ly spells W(JTldforward but says 

she cannot do it bacicw'll'd. (She appears to be getting very fiustrated and irritable.) 

Thought CQntent andPr=: Stream of thought is organized and logical without 

evidence ofloose associations, delusions, flight ofideas or other indicators of psychotic 

process. Asked if she thinks people talk about her, sIle says, "1' d say they probably do. 

BecauseI'm notH educated as most oftbem are." Asked if they plot against her, slle 

says, "I'd say some of'em does." She does not believe she is being followed ("not that I 

know of'). She denies suicidal or homicidal ideation. 

PerCJJption:. She denies RUditory or visual hallucinations or other \UJUSuai perceptual 

experiences. 

Social Judgment:' If sbe lost something that belonged to someone else, she says, "1 would 

hunt for it." If she saw'smoke and fire in a crowded theater, she says, "I would run, I 

guess." She asks that the question about what to do with a found letter be repeated, then ' 

says, "I guess I would jll'Obably pick it up." Sbe says a lie is "something you intend to 

do" and a mistake "is just ... " 

FUlId of K1wIvledge: She says 3 cities or towns in the'USA are Richlands, Grundy, and 

Abingdon. She knows tile number ofweelr.s in a year and incorrectly solves $1.00-

.17=.82. Site cannot identify Amelia Earhart and says, "I don't know. Who was she?" 

Abstract Reasonillg: She interprets No use Ctyillg over spilled milk by saying, "For 

instance, say if you break something, there's no .need to cry about it?" Sbe says People 

who live in glasshouses shouldll '11111'011' stones means "if you're doing something 

7 
775 

16/11/21:116 19:55 TESSNEAR PAGE 16 EXHImT NO.12f 

PAGI: '0'12 

F L Psychological Evaluation 

somebQdy else is ~iog, you shouldn't say anything about wba1 they're doing." She says 

a dOB and cat are alike because uboth are cold-blooded animals," and different because "a . 

dog barlcs, a cat meows." 

Diagnostic Impressions: 

Axis I: 300.02 Generalized Anxiety Disorder 

Panic attacks 

Axis IT: 3 t 7 Mild Mental Retardation 

Peironality traits (dependent, avoidant) Axi$ m: Deferred 

Axis IV: Living alone, poor social support, severe financial limitations 

Axis V: GAF - 48 (Note: 'Ibc Global Assessmeol of Functioning is bc<t 1Ise4 to 

monitor cl!ange ""'" time Jiom the pm;pecIive of a ~e tater. Coroporlng 

differell1 ratingi made by different observel's 81 diIlerent times iIlll)' lead to iIIaccuntte com:Iusioos.) 

SUmmary and Conclusions: .. J is a 55 year..old w~an with a 'f" grade education 

and no workhistoxy. She bas a history of medical problems that include back pain and 

chronic headaches. She bas always had some anxiety and it intensified about 8 years ago 

when her husband became ill. 

Credibility: SeIf'-report. available recordli, third party report by her pastor, interview 

presentation and psychological testing life consistent, supporting her credibility. 

Diagnostic raUonoJe. • produces IQ soores ofVCI66, PRI 60, WMl71, PSI 68 

and FSIQ 60, which fall within the Mild Mental Retardation range. Standllfdized testing 

from 4

ib grade reports lQ ofS3. Her adaptive functioning is consistent with Mild Mental 

RetardaJiOD iu that sire bas limited communication skills, relies 011 oth6CS fur roost of her 

transportation needs, and depends OIl her daughters for assistance with routine 

maintenance of her home and vehiGles. It seems likely that she bas overstated some 

actMtlt:S of daily living. She lost food stamps when her daughter ,moved out 8lld she has 

not applied because she does not know bow. Her pastor note:! tbat she does not like to 

admit to problems or ask for help. She also has a history of worrying excessively ~nd this 

got worse when her husband's medical problems became more serious around 2002. She 

reports greater nervousncs~ around other people. and says she is irritable and cannot focus 

her attl'lltion. She has headaches, IlUlscle aches, dry mouth and abdominal distress when 

anxious. This is consistent with Generalized Anxiety Disorder. She also reports pBllic 

attacks in which she feels like she is cbokfug, has chest pain, her heart pounds and she 

breaks out in a sweat. Panic Disorder is not given because she is unable to say how 

frequently these attacks occur, but they are often en6ugh to add to heJ- distress. She also 

has personality traits that impact her functioning. She is socially avoidant and has relied 

on her family to assist with many routine activities and decision-making. Now, though, 

her husband is gone and her youngest daughter has left home so she is alone for the first 

time and is having even more difficulty /Unaioning. 

8 
776 

16/11/2816 19; 55 TESSNEAR ~.M ,.0:10111 

rstn la,l'sycbOlo81cal Ev.lluation 

Progn())i~ I • Intelleauailimitations are lifelong IIll.d not expected to change. 

Her anxiety has also been present ~ childhood but only at tile cum:nt level since 

afOund 2002 or 2003. More aggressive treatment may be helpful in reducing some orher 

symptoms but significant change is not likely. Her anxiety, is expected to contillUe, 

especially if she lives alone. 

Capability to manage j/nIIk may be able to manage funds that might be 

awarded to her if she bas SOme initial assi:ltllIIce (perhaps from her daughters) in setting 

up aD account. However, she bas no QJl:perience with this and has paid bills ill cuh so it 

is likely that she would have trouble ntanaBiJlg finances independ"JItJy. 

Functional in!onnation: is able to understand and fullow simple instructions 

but requires repetition even fur these. She is fl!1her self-conscious about errors and 

becomes defensive, irritable and ftustnned when she does not understand. She is 

expected to have collllklenible difficulty learning Dew skills and will require 

demonstration and supeIVision for many tasks until she catches OD. Concenlmtion is poor 

and once it is disrupted, she bas great diffi~ty regaining focus. She is VeJY nervous 

around people wd cannot work with the public. She is also quite navous in a vehicle, 

whether she is the driver or passenger. She has trouble making decisions on her OM! and 

docs nol iniriote activities. 

Treatment recommendations: 'ould benefit from learning stralegies for 

ml\ll8ging anxiety. She may also n~ assistance witb some living skills, espeCially those 

that involve finances and ways to uliliz.e colDIDunity resources. However, her previous 

attempt at counseling was only mildly successful and she may not have understood the 

illlentiollll of her counselor. She will need specific guidance about how counseling 

wor~ what she is expected to do, how to set goals; and so on, if she is to benefit. 

-

Licelllled Clinica.l P$)'chologist 

9 
777 

, 1.3 

DATE: 09-25-2009 

CHIEF COMPLAINT: Lab work results and flu shot.' 

HISTORY.oF PRESENT ILLNESS: This is a 54 year old. white female who comes in 

today initially for a flu shot and then wanting \0 talk to me because of her blood work, 

She stated that she wanted to know her lab results and my nurse suggested that she 

may want to talk to me about it directly because of some of results went up instead of 

down, This is primarily a discussion viSit. ' 

I did. review patient's labs. I did explain to her that after one month of being on the 

Crestor and just under that, that she would maintain good __ changes as 

far as increases. Her cholesterol did go up a couple points, in her bad cholesterol. But 

her triglycerides and her good choleslerp! went down. I asked patient to give it another 3 

months before maklng determination. Her liver functions were normal and will continue 

to check that in the next 3 months as well. 

We also reviewed side effects of flu shot and how she can potentially experience 

influenza like symptoms despite getting the shot. Also described she needs to get her 

influenza vaccination as well as pneumonia shot. All the patient's questions were 

answered to her satisfaction. Patient verbalized understanding all instructions and 

agrees with current plan. . 

_ :;:;;;;;;;;;;;;;::~::::~ ,(' J"'~·/r;Ji!/V,~..'l~ 

L",_·,_,V· - MLG:bjp 

0: 09·28-2009 T; 10-13-2009 

Permanent Subcommittee on Investil!ations 

EXHIBIT #16d 
778 

HISTORY OF PRESENT ILLNESS: Patient is a 53 year old female who comes in for 

a couple of complaints today. Firsi being allergic rhinitis type symptoms with runny nose, 

nasal congestion. Patient states that she has used a nasal steroid in the past and had 

good results with this. Patient denies any fevers or chills and states she has just been 

getting persistent post nasal drainage and cough. 

Patient also states she was being evaluated for her soelal security and 'as a result she 

was sent to have pulmonary function, test done and was told that she had abnormal 

pulmonary function test and that her primary care physician should get this report, but I 

,have not yet seen this report. She was told at that evaluation that she should consider 

getting a nebulizer machine for her COPO. 

Finally patient states that her famify has been waking J:ler up, sometimes telling her that 

she Is making a lot of noise when she sleeps. Question whether this is actually apnea 

with some sonorous breathing because of her chronic I.ungdisease. 

Another thing patient complained about was with her increasing allergic rhinitis type 

, symptoms and coughing states she now has some right rib pain: 

REVIEW OF SYSTEMS: As stated above. All other systems negative. 

PHYSICAL EXAMINATION: . Weight 140. Height 5'4". Blood pressure 130/90. Heart rate 

is 95. Temp 97. Respiratory rate is 18. 02 sat is 98%. GENERAL: Patient alert and 

oriented, no acute distress. HEENT: Pupils equal; round and reactive to light. TM's 

intact. Nasal mucos.a is moist. Lips, teeth and gums normal. NECK: Supple. No JVO. No 

thyromegaly. No bruits appreci~ted, HEART: Regular rate and. rhythm with no murmur, 

rub or gallop. LUNGS: Decreased significantly bilaterally. ABDOMEN: Soft. non tender, 

non distended. EXTREMITIES: No edema, dubbing, or cyanosis. 

MUSCULOSKELETAL: Patient hes some increased paraspina! muscle spasm noted 

mid thoracic area with pain to palpation around her right 10lh rib. OSTEOPATHIC: 

Reveals a posteriorly subluxed right 10'" rib arid T6 rotated right. 

ASSESSMENT AND PLAN: 

1. Allergic rhinitis. Patient was instructed to use saline sinus rinse on a dally basis to help alleviate sonie of herrcllergic rhinitis. She was also given prescription for 

Flonase to use 2 puffs each nostril daily. If her symptoms do not improve, patient 

was instructed io follow up with our office again in the near future. 

Permanent Subcommittee on Investigations 

EXHIBIT #16e 
779 

Office Note 

---

PAGE 2 

2. COPD. Patient was told recently that she had significant COPD on evaluation for 

social security. Will obtain that record that was apparently 9rdered by social 

security board, but I am not sure exactly how this was done. But will get this 

report and evaluate it. In the meantime, will give patient a nebulizer machine and 

start her on some Albutetol and Atrovent to take prn in this machine. 

3. Questionable obstructive sleep apnea. Given patient's description of what her 

family members were telling her she was doing with sonorous breathing and 

making loud gasping noises, I suspect she does have a component of apnea. 

Therefore will do an "Are You Sleeping?" evaluation at her home through 

Lovejoy. . 

4. Somatic dysfunction of T spine and ribs: Patient was treated with soft tissue 

technique and high velocity low amplitude treatment and had resolution of her 

symptom.: ~rior to leaving the office today . 

• 

CEG:bjp 

0: 11-10-2008 T: 11·12·2008 
780 

DISABILITY REPORT - ADULT - Form SSA-336S 

(3368) Section 1 - Infonnation About the Disabled Person 

A Nam.S ___ .CI 

B. Social Security Numbe4e 5 ••••• 1

£XHI8IT""'2I 

PA~:10F8 

C. Daytime Telephone Number (If you do not have a number where we can reach you, give us a 

daytime number where we can leave a message.): 

[). Give the name of a friend or a relative that we can contact (other than your doctors) who knows 

ahout illnesses, or conditions and can with claim. 

:E. What is your height without shoes? 5' 4" 

F. What is your weight without shoes? 1371bs. 

, (3. Do you have a medical assistance card? Yes 

If "YES·, show the number h: ••••••• 

R Can you speak and understand English? Yes 

If ''NO'', what is your preferred language? 

NOTE: If you cartnot speak and understand English, we will provide an interpreter, free of charge. 

Hyou cannot speak and understand English, is there someone we may contact who speaks and 

understands English and win give you messages? 

(If'~YES", is this the same personas in "D" above? Ifit is, show "SAME" below, ifnot complete ' 

, below.) 

1 Can you read and understand English? Yes 

J. Can you write more than your name ,in English? Yes 

Permanent Subcommittee on Investigations 

EXHmIT#16f 
781 

EXHIBtI' NO. 2E PAQI:ZOFI 

(3368) Section 2 -Your Illnesses, Injuries, or Conditions and How They Affect You 

A What are the illnesses, injuries, or conditions that limit your ability to work? 

Breathing and back problems with limited education, migraine headaches, problems seeing, 

and bigh blood pressure. . 

B. How do yoUr illnesses, injuries, or conditions limit your ability to work? 

I cannot breathe real good and have to use lnbaIers all the time. My back hurts too bad to·lift, 

stand or sit for any length of time. I keep migraine headaches all the tbne. My blood pressure is 

not under control so I stay dizzy. I can't see very wen either. 

C. Do your illnesses, injuries, or conditions caUse you pain or other symptoms? Yes 

D. When did your illnesses, injuries, or conditions first interfere with your ability to work? 2004 

E. When did you· become unable to work because of your illnesses, injuries, or conditions? 

02/01/2008 

F. Have you ever worked? No 

G. Did you work at any time after the date your illnesses, injuries, Or conditions first interfered with 

your ability to work? 

H. If "Yes, .. did your illnesses, injuries, or conditions cause you to: 

work fewer hours? 

change your job duties? 

make. any job-related changes such as your attendance, help needed, or employers? 

Explain: 

I. Are you working now? 

If"NO," when did you stop Working? . 

J. Why did you stop working? 

(3368) Section 3 -Infonnation About Your Work 

A List all the jobs that you had in the 15 years before you became unable to work because of your 

illnesses, injuries, or conditions. 

* = Longest Job Held 
782 

IN THE CASE OF 

(Claimant) 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office ofDlsabillty Adjudication and Review 

DECISION 

CLAIM FOR 

Widow's Insurance Benefits (Disability) and 

Supplemental Security Income 

JURISDICTION AND PROCEDURAL mSTORY 

This case is before the undersigned on a request for hearing dated March 9, 2009 (20 CFR 

404.929 ee seq. and 416.1429 et seq.). The claimant is alleging disability since February 1,2008. 

On June 16,2010, the undersigned held a video hearing (20 CFR 404.936(c) and416.1436(c)). 

The claimant appeared in Bluefield, WV, and the undersigned presided over the hearing from 

Roanoke, VA. P - , an impartial vocational expert, also appeared at the hearing. 

The claimant is represented by 1 _ ""~ an attorney. The record was left open to 

allow time for the undersigned to obtain a consultative psychological evaluation of the claimant 

The report of the claimant's psychological evaluation was received and reviewed by the 

undersigned (Exhibit 12F). 

The issue i"s whether the claimant is disabled under sections 216(i), 223(d), 202(e), and 

1614(aX3XA) of the Social Security Act. Disability is defmed as the inability to engage in any 

substantial gainful activity by reason of any medically detenninable physical or mental 

impairment or combination of impairments that can be expected to result in death or that has 

lasted or can be expected to last for a continuous period of not less than 12 months. 

Other issues are whether the claimant is the widow ofthe deceased worker, has attained the age 

of 50, is unmarried (unless one of the exceptions in 20 CFR 404.335(e) apply), and has a 

disability that began before the end of the prescribed period The prescribed period ends with the 

month before the month in which the claimant attains age 60, or, if earlier, either 7 years after the 

worker's death or 7 years after the widow was last entitled to survivor's benefits, whichever is 

later. 

In this case, the claimant's prescribed period began on September 14,2005, the diLte the wage 

earner died Therefore, the claimant must establish that her disability began on or before 

September 30,2012 in order to be entitled to a disabled widow's benefits. 
783 

2 • Page 2 of4 

After careful review of the entire record; the undersigned finds that the claimant has been 

disabled from February 1,2008, through the date of this decision. The undersigned also fmds 

'that disability was established during the prescribed period for entitlement to disabled widow's 

benefits. ' 

APPLICABLE LAW 

Under the autJiority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404. 1520(a) and 416.920(a». The steps are followed in order. Ifit is 

,determined that the claimant is or is not disabled at a step of the evaluation process, the 

evaluation will not go on to the next step. ' 

At step one, the undersigned must'determine whether the claimant is engaging in substantial 

gainful activity (2OCFR 404. 1 520(b) and 416.920(b». Substantial gainful activity (SGA) is 

dermed as work. activity that is both substantial and gainful. If an individual engages in SG A, 

she is not disabled regardless of how severe her physical or mental impairments are and 

regardless of her age, education, or work experience. If the individual is not engaging in SGA, 

the analysis proceeds to the second step. 

At step two, the undersigned must determine whether the claimant has a medically determinable 

impairment that is "severe" or a combination of impairments that is "severe" (20 CFR 

404. 1520(c) and 416,920(c». An impairment or combination of impairments is "severe" within 

the meaning of the regulations if it significantly limits an individual's ability to perform basic 

work activities. If the claimant does not have a severe medically determinable impairment or 

combination Qfimpairments, she is not disabled. If the claimant has a severe impairment or 

combination of impairments, the analysis proceeds to the third step. 

At step three, the undersigned muSt determine whether the claimant's impairment or combination 

of impairments meets or medically equals the criteria of an impairment listed in 20 CFR Part 

404, Subpart P, Appendix I (20 CFR 404. I 520(d), 404.1525, 404.1526, 416.920(d), 416.925, 

and 416.926). If the c1aimant's,impairment or combination of impairments meets or medically 

equals the criteria.of a listing and meets the duration requirement (20 CFR 404.1509 and 

416.909), the claimant is disabled. If it does not, the analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the undersigned must first 

determine the claimailt's residual functional capacity (20 CFR 404.1520(e) and 416.920(e». An 

individual's residual functional capacity is her libility to do physical and mental work. activities 

on a sustained basis despite limitations from her impairments. In making this fmding, the 

undersigned must consider aU of the claimant's impainnents, including impairments that are not 

severe (20 CFR 404. 1520(e), 404.1545, 416.920(e), and 416.945; SSR 96-8p). 

Next, the undersigned must detennine at step four whether the claimant has the residual 

functional capacity to perform the requirements of her past relevant work. (20 CFR404.l520(f) 

and 416.920(f). If the claimant has the residual functional capacity to do her past relevant work, 

See Next Page 
784 

Page 3 of4 

the claimant is not disabled. If the claimant is unable to do any past relevant work or does not 

have any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step of the sequential evaluation proce~s (20 CFR 404. 1520(g) and 4 i6.920(g»), the 

undersigned must determine whether the claimant is able to do any other work considering her 

residual functional capacity, age, education, and work experience. If the claimant is able to do . 

other work, she is not disabled. If the claimant is not able to do other work and meets the 

duration requirement, she i~ disabled. Although the claimant generally continues to have the 

burden of proving disability at this step, a limited burden of going forward with the evidence 

shifts to the Social Security Administration. In order to support a finding that an individual is 

not disabled at this step, the Social Security Administration "is responsible for providin,g evidence 

that demonstrates that other work exists in significant numbeis in the national economy that the 

claimant can do, given the residual functional capacity, age, education, and work experience (20 

CPR 404. 1512(g), 404. 1 S60(c), 416.912(g) and 416.960(c)). 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following fmdings: 

1. The claimant is the unmarried widow of the deceased insured worker and has attained 

the age of 50. The claimant met the non-disability requirements for disabled widow's 

benefits set forth in section :202(e) of the Social Security Act. 

2. The preseribed period ends on September 30, 2012. 

3. The claimant has not engaged in substantial gainful activity since February 1, 2008, the 

alleged onset date (20 CFR404.1520(b), 404.1571 el seq., 416.920(b) and 416.971 el seq.). 

4. The claimant has the following severe impainnents: menW retardation ap,d anxiety 

(20 CFR 404.1520(c) and 416.920(c». 

On September 27, 20 I 0, : . '., performed a consultative psychological 

evaluation of the claimant (Exhibit 12F). On this administration of the WAIS-IV, the claimant 

attained a Full Scale IQ of 60. During standardized testing in the 4th grade, the claimant was 

assessed with a Total IQ of 53 (Exhibit 12F-3). - iiagnosed the claimant with' 

anxiety disorder, mild mental retardation, and a global assessment of functioning (GAF) score of 

48. 

5. The severity ofthe claimant's impairments meets the criteria of section 12.0se of 20 

CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 416.920(d) and 

416.925). . 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective medical evidence and 

other evidence, based on the requirements of20 CFR404.1529 and 416.929 and SSRs 96-4p and 

See Next Page 
785 

.. -- Page40f4 

96-7p. The undersigned has also considered opinion evidence in accordance with the 

requirements of20 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p. 

The claimant's impainnents meet listing 12.05C. The "paragraph e" criteria of this listing are 

met because the claimant has mental retardation initially manifested before age 22 with a valid 

verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment 

imposing an additional and significant work-related limitation of function. 

After considering the evidence of record, the undersigned fmds that the claimant's medically 

determinable impainnents could reasonably be expected to produce the alleged symptoms, and 

that the claimant's statements concerning the intensity. persistence and limiting effects ofthese 

symptoms are generally credible. 

The record does not contain an assessment of the claimant's mental limitations' from a state 

agency psychological consultant 

6. The claimant has been under a disability as defined in the Social Security Act since 

February I, 2008, the alleged onset date of disability (20 CFR 404.1520(d) and 416.920(d». 

DECISION 

Based on the application for disabled widow's benefits protectively filed on June 11, 2008, the 

claimant has been disabled under sections 202(e) and 223(d) of the Social Security Act since 

February 1, 2008. 

Based on the application for supplemental security income. protectively filed on June 11, 2008, 

the claimant has been disabled under section 1614(aX3)(A) of the Social Security Act since 

February 1,2008. 

The component ofthe Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments and, if the claimant is eligible, the amount and the months for which payment will be 

made. 

William B. Russell 

Administrative Law Judge 

January 28, 2011 . 

Date 
786 

(The following is a transcript in the hearing held before 

William B. Russell, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on June 16, 

2010, at Roanoke, Virginia, in the case of , " Social 

Security Number The Claimant appeared in person and was 

repr@"p"ted by r _ Attorney. Also present were iu .. 

""'-~_~_"' __ =-" Medical Expert and Vocational Expert.) 

(The hearing commenced at 3:04 p.m. on June 16, 2010.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: You are •••••• " is that correct? 

CLMT: Yes. 

ALJ: ............ I'm'Judge Russell. I'm the Administrative Law 

Judge assigned to hear your case. I'd like you to know I have no 

connection to the prior agency that has denied your claim for benefits 

and I will be issuing you a totally new and independent decision. 

-----------•• (PHONETIC)is here,to assist me. He's a medical doctor. 

~_. (PHONETIC) is a Vocational Expert. I've had a pre-hearing 

conference with ___ ._------- so we will -- may have an abbreviated 

hearing. 

If anyone asks you a question, if you don't understand the 

question or don't know the answer, please stop and tell us you don',t 

know or you don't understand. Fair enough? 

CLMT: Yes. 

ALJ: All right. you have one, requested the right 

to send ••••• out for a -- your own consult, psychological. Is 

that correct? 

ATTY: That's correct, Your Honor. I've discussed it with her. 

She's agreed to go'. I would like permission to send any imposed here. 

ALJ: All right. I'll give you 60 days on that. 60 days CE,by 

Permanent Subcommittee on Investigations 

EXHmIT#16h 
787 

2 

attorney. All right, you have also pointed out that based on your 

claimants education, lack of a work history and age, that age 60 and 

age 55, based on Exhibit 7F which limited her to medium work, she 

would grid and you. - as I understood, your pre-hearing motion or 

request to me was that you be' allowed the psychological; if the 

psychological did not justify disability before her 55th birthday that 

you were going to amend to her 55 th birthday, where she will 

automatically grid. Is that correct? 

ATTY: That's fully correct, Your Honor. 

ALJ: All right, I will grant that too. I do have to take some 

testimony from the claimant. Did you have any objections to the 

evidence of record as it stands now? 

ATTY: No, Your Honor. 

ALJ: I will admit the evidence founds in sections A through F 

into the record. 

(Exhibits A through F, previously identified, were received into 

evidence and made a part of the record thereof) . 

ALJ: All right, ••• ,o.r •• ", I have to get some information from 

you and I have to take testimony under oath. Do you have any 

objection to giving me sworn statement? 

CLMT: No. 

ALJ: Would you raise your right hand along with my experts? 

(The Claimant ' .......... ;, having been first duly sworn, test1 'f' 1e d as 'f 0 11' ows: J' 

EXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE: 

Q address? 

A It's 
788 

3 

Q All right, and your home phone number? 

A -7 bQ All right. You're alleging disability from February 1, 2008, 

~s that sound correct? 

A I think so. 

Q Oh, okay. Had you worked since that day, or have you ever had 

a job in your life? 

A No, I've never had a job. 

Q All right, How far did you go in school? 

A Seven. 

Q All right. Did you ever get aGED? 

A No. 

Q How tall are you? 

A 5'4". 

Q Do you know your current weight? 

A I think, 115, I believe. 

Q What was your weight in 2008? Do you 

A Probably 130, I'm, I'm not for sure. 

Q You've lost a little weight then? 

A- Yes. 

Q Okay. Do you have a driver's license? 

A Yes. 

give your best guess. 

Q All right. How well do you read and write? 

A Not very well. 

Q How did you pass the driving test? 

A I took it -- it was like a written test, whenever --
789 

4 

Q Right. 

A -- I took it, and I think I just barely did pass it. 

Q All right, but you could read over it. Did they read it to 

you or did you have to read it yourself? 

A I bet I had some help with it. 

Q Okay, now, -------____ I'm going to ask you questions, and if 

it turns this happened, it's okay. I know, know from past experience 

now that some of the rural counties in Virginia, when you're trying to 

get your drivers exams sometimes they come up and kind of tap on the 

paper and give you hints. Did that happen in your case? 

A I think so. 

Q Okay, all right. 

(The vocational Expert, ~~ .. ------. testified as follows:) 

having been first duly sworn, 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q 4l, any indication of a work history. 

A No work history. 

Q All right. 

ALJ: , unless you have something to add, I will wait 

on l - (PHONETIC) report and in t~e alternative to the 

report she will grid out at age 55 anyway. Otherwise, I would like to 

as} F ml&.· one,' one or two more questions. 

REXAMINATION OF CLAIMANT BY ADMINISTRATIVE LAW JUDGE. 

Q T j[ • ' you are the widow 0 •••••••• (PHONETIC') . 

Is that correct? 

A Yes. 

Q Had you remarried? 
790 

5 

A No. 

Q Okay. That's all I have for you. ~1I1I1I~i thank you for 

coming in. ________ -----._~, will talk to you about what's happening 

after the hearing. There will be nothing further. The hearing will 

close at 

HA: 3:10 p.m. 

(The hearing closed at 3:10 p.-m. on June 16, 2010.) 

C E R T I FIe A T ION 

I have read the foregoing and hereby certify that it is a true· 

and complete transcription of the testimony recorded at the hearing 

held in the case of ; before Administrative Law Judge, 

William B. Russell. 
791 

DISABILITY REPORT - ADULT - Form SSA-3368 

(3368) Section 1 • Information About the Disa.bled Person 

A Name:"" •••••• 

B. Social Security Number:,,_._. 

EXHrarrNO. :IE P'AGE:10F' 

C. Daytime Telephone Number (If you do not have a number. where we can reach you; give us a 

daytime number where we can leave a message.): 

••••• ~our number 

D. Give the name of a friend or a relative that we can contact (other thail your doctors) who knows 

about your illnesses, injuries, or conditions and can with your claim. 

Phone: 

E. What is your height without shoes? 5' 1 " 

F. What is your weight without shoes? 170 lbs. 

G. Do you have a medical assiStance card? Yes 

If"YES", show the number here: ? 

H. Can you speak and understand English? Yes 

If "NO", what is your preferred language? 

NOTE: If you cannot speak and understand English, we will provide an interpreter, free of charge. 

lfyou cannot speak and understand English, is there someone we may contact who speaks and 

understands English and will give you messages? . 

(If "YES", is this the same person as in "D" above? If it is, show "SAME" below, if not complete 

below.) 

1. Can you read and understand English? Yes 

J. Can you write more than your name in English? Yes 

Permanent Subcommittee on Investi ations 

EXHmIT#17a 
792 

EXHIBfT NO, 'Ii PAGE:10P 9 

(3368) Section 2 - Your Illnesses, Injuries, or Conditions and How They Affect You 

A What are the illnesSes, injuries, or conditions that limit your ability to work? 

diabetes, heart, high blood pressure, cholesterol, depression, degenerative disc disease, left 

elbow pain, and limited use ofleft hand 

B. How do your illnesses, injuries, or conditions limit your ability to work? 

The diabetes Is not controlled by the medications. I can't see well out or my right eye and get 

headaches and dizziness. I have numbness in my feet and they give out from under me. I have 

d1f1iculty walking, shortness of breath, ell!iily fatigued, sleep a lot, blurred vision, thirstiness, 

uncontrollable infections, cuts don't heal propery, numbness In fingers and toes. I have been 

ralling and am afraid to go anywhere with out anyone. I am tired all the time and my lnunune 

system is very bad now. 

C. Do your illnesses, injuries, or conditions cause you pain or other symptoms? Yes 

D. When did your illnesses, injuri~ or conditions first interfere with your ability to work? 11/06107' 

E. When did you become unable to work because of your illnesses, injuries, or conditions? 

11/06/2007 

F. Have you ever worked? Yes ,~ 

G. Did you' work at any time after'the date your illnesses, injuries, or conditions first interfered with 

your ability to work? No 

, ~ 

H. lfnyes," did your illnesses, injuries, or conditions cause you to: 

woCk fewer hours? 

change your job duties? 

make any job-related changes such as your attendance, help needed, or employers? 

Explain: 

1. Are you working now? No 

lfnNO," when did you stop working? 07/0712007 

J. Why did you stop working? 

I got laid ofIthen had a heart attack in November,2007 and health went downhill and could no 

longer work. 

(3368) Section 3 -Information About Your Work 
793 

&XHlBTT NO. 3E 

PAO&:3 OF. 

A List all the jobs that you had in the 15 years before you became unable to work because of your 

illnesses, injuries, or conditions. 

• = Longest Job Held 

* 

B. Whichjob did you do the longest? 

scheduler. 

12007 

Hours Per 

Day 

8 

yIPer 

C. Describe this job. What did you do all day? (If you need more spape, write in the "Remarks" 

section.): 

answer phone caDs from distributor, take the info about what product they wanted, office work 

and pack up one a month and move boxes upstairs 

D. It1 this job, did you: 

Use machines, tools, or equipment? Yes 

Use technical knowledge or skills? No 

Do any writing, complete reports, or perform duties like this? YH 

E. In this job, how many total hours each day did you: . 

Walk? 1 

Stand? 1 

Sit? 8 

Climb? 0 

Stoop? (Bend down & forward at waist.): 1 

Kneel? (Bend legs to rest on knees.): 0 

Crouch? (Bend leg.<; & back down & forward.): 0 

CraWl? (Move on hands & knees.): 0 

. Handle, grab or gnlsp big objects? 1 

Reach? 2 

Write, type or handle small objects? 8 

F. Lifting and Carrying (Explain what you lifted, how far you carried it, and how often you did this.): 

lifted boxes of orders once a month and carried them upstairs in the beginning and in the end 

others did it for me . 

G. Heaviest weight lifted: Less than 10 Ibs. 

H. Weight you frequently lifted (By frequently, we mean from 1/3 to 2/3 of the workday:): 

Less than 10 Ibs. 
794 

1. Did you supervise other people in this job? No 

How many people did you supervise? 

What part of your time was spent supervising people? 

Did you hire and fIre employees? 

1. Were you a lead worker? No 

(3368) Section 4 ·Infonnation About Your Medical Records 

A Have you been seen by a doctorlhospitallclinic or anyone else for the illnesses, injuries, or 

conditions that limit your ability to work? 

Yes 

EXHIBIT NO.3. 

PAGlE:"OF I 

B. Have you been seen by a doctorlhospitaJlclinic or anyone else for eIl).otionaJ or mental problems that 

limit your ability to work? 

Yes 

C. List other names you have used on your medical records: 

Tell us who may have medi~aJ records or other infonnation about your illnesses, injuries, or 

conditions. 

D. List each DoctorfHMOfTherapist. Include your next appointment; 

First Visit: 

Last Visit: 
795 

Address: 

Phone: 

Reasons for 

neurologist 

What treatment was received? 

tests 

Name: 

Address: 

Phone: 

Reasons for Visits: 

congestive heart failure 

What treatment was received? 

First Visit: 

Last Visit: 

First Visit: 

Last Visit: 

consultation while in Russell County Medical Center in'Lebanon VA 

E, List each Hospital/Clinic. Include 

Date In 1: 

Date In 2: 

Date In 3: 

HOirtp,ltielt11 Date First Visit: 

none 

for Visits: 

treatment did you receive? 

doctors do you see at this hospitallclinic on a regular basis? 

EXHIBIT NO. 3& PAGE: 50FII 
796 

-- ---- - -- -

none 

doctors do you see at this hospital!clinic on a regular basis? 

ftOutp'ati,ent Date First Visit: 

IIErnergeJlcy Room Dates of Visits: 

Appointment: none 

HospitaL'Clinic Number: 

doctors do you see at this hospital/clinic on a regular basis? 

EXHlarT NO. 3E PAGE: eOF. 
797 

DuPlEx 

Supplemental Seciuity Income 

Notice of Reconsideration - Disability 

From: SocialSecUlity AdnUnistration 

EXHIBI'TNO.la 

"AGE: 1 01=' 7 

Date: April 15, 2009 

Claim Nmnber:~."II'. Reconsideration Filed: 1O,20i2008 

Upon receipt of your request for reconsideration we hBd your claim independently reviewed by a physician and 

disability examiner in the State agency which works with us in making disability determinations. The evidence in your 

casehas been thoroughly evaluated; this includes the medical evidence and the additional information received since 

the original decision. We fmd that the previous determination denying your claim was proper tmder the law. 

It you believe that the reconsideration deternlination is not correc~ you may request a hearing before an administrative 

law judge of the Office of Disability Adjudication and Review. It you want a hearing YOll must request it not later than 

60 days from the date you receive this notice. You may make your.request through any Social Security office or on the 

Internet at http://,,~vw.SQcinlsecllrity.gov/disability!~pi'e.l. As part of the appeal process, you also need to tell us about 

your current medical condition. We provide a form for doing tha~ the Disability Report - Appeal. You may contact one 

of our offices or call 1-800-772-1213 to request this form. Or, you may complete the report online after you complete 

the online Request for Hearing by Administrative Law Judge, R""d the enclosed leaflet and the full explanation of your 

right to appeal on the second page of this notice. 

How w. Made The Decision 

The following evidence was considered in evaluating your claim r addition to the medical reports already in file . 

• _«lOrt lreceived 01113/2009 

We have determined that your condition is not severe enough to keep you from working, We considered the medical 

and other information. YOllr age, education, training, and work experience in determining how your condition affects 

your ability to work. 

You said that you are unable to work because of diabetes,dizziness, numbness in hands and feet; heart disease, prior 

congestive heart failure, hbp and cholesterol', depressiorr, degenerative disc disease, problems with left elbow and hand; 

vision problems; shortness of breath; sleep apnea; headaches', caIJlal tunnel; frequent bladder infections. 

The evidence shows that Diabetes and hypertension have not caused damage to any vital organs. Your records indicate 

that you may have discomfort in your back, hands, or various other joints or muscles, however, you remain able to 

Permanent Subcommittee on Investigations 

EXHIBIT #17b 
798 

EX\ofIlIrT NO. iB 

stand, walk and x:nove about adequately without assistance. You are able to use your hands and arms to perform Po~tb~ 7 

tasks, You may e:-.:perience fluctuations in vision at times, but evidence shows that your vision is corrected \vith 

prescription lenses. You have a history of heart disease with stent placement, but your records reveal that your heart is 

functioning satisfactorily at this time. Upon examination, your heart has a regular rate and rhythm, your lungs are clear 

and you have adequate breathing ability. You have normal refle."es w:>d good muscle strength. l\>/igraine headaches with 

some associated nunibness or dizziness at times are treatable and shOUld not prevent you from working on a regular 

basis. You may feel depressed at times, but this does not prevent you from performing ordinary activities such as caring 

for your peISOllSI needs, doing light household chores, managing your finances and socializing. Werealize you may 

continue to have difficulties, but your condition is not so severe as to be disabling. 

Based on the description of the job you performed as a scheduler in the past for several years, we have concluded that 

you have the ability to do this job. 

HYou W.ntHelp With Your Appeal 

You can have a friend, l."yer, or someone else help you. There are groups that can help you find a la"yer or give you 

free legal services if you qualify. There are also lawyers who do not charge W1less you win your appeal. Your local 

S1al Security office has a liit of groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she 

can collect it 

New Application 

You have the right to file a new application at any time, but filing a new application is not the same as appealing this 

decision. If you disagree with this decision and you flIe a new application instead of appealing you might lose some 

benefit., or not qualify for any benefits. So, if you disagree with this decision. you should file an appeal "ithin 60 days. 

You may want to contact your local public assistance office to find out if you qualify for payments from them. 

The application you filed with US is not an application for medical assistance (Medicaid). If you need medical 

assistance or have any questions about your eligibility for Medicaid, you should get in touch with your local 

welfare/social service office. < 

Please get in touch with Social Security if you believe this decision is "TOng or you have any questions or need more 

information. Most questions can be handled by phoning or writing any Social Security office. If you visit a Social 

Security office, please bring this notice with you. If the decision in your case is based on incorrect information. we will" 

be happy to make whatever change is necessary. 

Y ~ur Right To Appeal 

If you still are not satisfied with the decision, you may request a hearing of this decision by the Office of Hearings and 

Appeals. WUMUST REQlJEST THE HEARING IN WRITING WITHIN 60 DAYS FROM THE DATE YOU RECEIVE TIDS NOTICE, If you cannot send us a "uitten request for 8 hearing within 60 dilYS, be sure to contact us by 

phone, If you wait longer than 60 days, "'e \\-ill not conduct a hearing review of our decision unless you have a good 

reason fot the del. y. 

If you request a hearing, your case will be assigoedto an administrative law judge of the Office of Hearing and 

Appeals. The administrative law judge will let you know when and where your case will be heard. 

The hearing proceedings are informal. The administrative law judge will summarize the facts in your case, e'''plain the 

law, and state what must be decided. Then you will have an opportunity to explain why you disagree with the decision 

made in your case, to present additional evidence and to have a witnesses testify for you. You can also request the 

.dministrative law judge to subpoena unwilling witnesses to appear for cross",xamination and to bring with them any 

information about your case. You have the right to request the administrative law judge to issue a decision based on the 

"Titten record without you personally appearing before hiullher. If you decide not to appear at the hearing, you still 

have the right to submit additional evidence. The administrative law judge "ill base the decision on the evidence in 

your tile plus any new evidence submitted 

In having your case heard, you can represent yourself or be represented by a lawyer, a friend, or any other person. 

Contllct your Social Security office for names of organizations that can help you. 
799 

Enclostrre: < 

SSAPl.lb. No. 70-I02Si 

SSA-L1130 . 

SiMpLeX 

cc: 

Laurie \\1'atkins 

Regional Commissioner 

EXHrBIT NO. is PAGE: 3 OF 1 
800 

NUMBERHOLDER (IF CDB CL.-\!lI.{): 

DDD o fi'~NTHS AFTER ONSET: 

Diabetes Mellitus 

lITN, Sleep Apnea, Carpal Tunnel, CAD, 

Migraine headaches 

used in rnllkil'lQ II dacI!>ign on 

Adminisl1ldionlOlII'1Cl1hfilrp$!'5Ol'1Ql' 

Securttyff'dcther!l{l9neil!ll< 

The PAPERWORK REOUC'TlON ACT of 1995 reqUrv5 U!! to notifvYGU Ihotlhislnformmjon coUediot1 is In ~ 1'1'1111 tI'!e ~ nrq..irom&nl5 of stldloit :3501 of II1a PQp!YWIlr1< Reduetion 

Ac:I:oI1995. We may not r:onm.d. or sponsor. and \IOU lIIBooll<IQJirsdlll, 8CC\k1ct1on of inf=bonImlBss ildl:;pJftYS elldd OJteeordrol n..nJb6l"; 

TIME rTTAAES TO COMP1..ETE THIS FORM: Weaslill"ltltell1!llllwmtBke )'CUsboIJ:20 mlnutas to eomplel9 II'\lsflmn. Tt1s.Inc:l!:.dnlhe time i\wiHhlkll to road h!nsIl\JellOl"lS, QBlhertlle 

I"lIIC1IS!I8rY tsets.!I"Id n_O\A \he form. llyouf1eoie eornmants or suggeillol"lS on trttesHm:&ta.l'Ifite ScielI!I5eetJity Admh1is:ra~onATTN; Reports al!t6Tlll"lC$ Officer. 1-A-21 OparlltiOnsBu16ng, 

BaltimQfll. MD 21235--0001. S.nd "'"tv «lIIm.nt. ,.Iatlngto our "'tIIJIe. tUN" .1IfI ..... to the oI'II~ "1ft!! 'bo~ All Aoqu,lft tor SOcmt SlKutIt}I em,1Ind other (:1I.1m.-r~~ 

WOIlNItIon llhau!d be •• '" to)'<lUl" 1o~1 Sod,." SetUl1ty oMc., Who .. iIddr ... 110 1I"~ under aD~hll Se-*y Adrnlnl.tr.t1"'" Intbe u.s. GoVIWTllntI"ll MCtlon of VOU!"teilptlor.. dIr.dory. . 

I. LIl\HTATIONS: 

For Each Section A • F 

:::::::> Base your conclusions on 8J~'e'1den(e in fiJe (clinical and laboratory ftndingS. 'symptoms', observations',lay evidence', 

reports of daily activities~ etc.). 

==> Check the blocks which reflect your reasoned judgment. 

:::::::> Describe how the n'idenee substanUatH your con~htsiom. (Cite specific clinical and laborato~ fmdings, 

observations. lay evidence. etc.). 

==> Ensure that you have requested: 

• Appropriate treating and examining source statements regmlmg individ\1~I's capacities (D! 22505.0001'( and DI 

22510.0oofO and that you have given appropriate ","eight to treating source- condQSi.oru. (see section ill) 

• Considered and responded to any alleged limitations imposed by symptoms {pain. fatigue, etc.) attributable, in 

your judgrnent, to be medically determinable impairment Discuss your assessment of symptom~related limitations 

in the explanation for your cOnclusions in A-F below. (See also section IT) 

• Responded to aU allegations of phJ~icallimitations or factors which can cause phJ~icallimitations. 

:::::::> Frequently means occurring one.-third to two-thirds of an 8-hour wcrl::day (c~mulative. not continuous). 

OccasionaUy means occurring from very little up to one-third, of an 8-hour work day (cumulative. not continuous). 

fFORMl<RLY S:SA~I7""U!i "'RPJHOREDmONS} CONTINUED oN PAGE 2 

Permanent Subcommittee on Investigations 

EXHIBIT#17c 
801 

A. EXERTIONAL LIMITATIONS 

DNone established. (Proceed to section B.) 

1. (kcasionaUy lift andlor carry (including upward pulling) 

EXH1Brr NO.1:1F PAGlE.!20F7 

(ma..'-:ill).um) -- when less than one-third of the time or less than ten pounds, elo.-plain the amount 

(time/pounds) in item 6. . 

o less than 10 pounds 

o 10 pounds 

~ 20 pounds 

o 50 pounds 

o 100 pounds ormbre 

2. Frequently lift andlor carry (including upward pulling) 

(maximum) -- when less than two-thirds of the time or less than ten pounds, explain the amount 

(time/pounds) in item 6. 

o less than 10 pounds 

IRl 10 pounds 

025 pounds 

.0 50 pounds or more 

3. Stand and/or walk (with normal breaks) for a total of--

o less than 2 hours in an 8-hour workday 

o at least 2 hours in an 8-hour workday 

IRl about 6 hours in an 8-hour workday 

o medically required hand-held assistive device is necessary for ambulation 

4. Sit (with normal breaks) for a total of--

o less than about 6 hours in an B-hour workday 

~ about 6 hours in an 8-hour workday 

o must periodically alternate sitting and standing to relieve pain and discomfort. (If checked, 

. elo.-plain in 6.) 

5. Push and/or pull (including operation ofhandlfoot controls) --

IRl unlimited, other than shown for lift andlor carry . 

o limited in uppel' elo.1remities (describe nature and degree) 

o linlited in lowel' extremities (describe nature and degree) 

6. Explain how and why the evidence supports your conclusions in items 1 through 5. 

Cite the specific facts upon which your conclusions are based .. 

See Attached 
802 

B. POSTURAL LIMIT ATIONS 

D None established. (Proceed to section C.) 

EXHlBrr NO.17F PAG~:l0F7 

Should avoid all ladders, ropes Frequentlv Occasionally .Never 

1. Climbing - ramp/stairs and scaffolds. D' ill D • ladder/rope/scaffolds 

2. Balaocmg ill D D 

3. Stooping ill D D 

4. Kneeling ill D D 

5. Crouching m D D 

6. Crawling m D D 

7. " ... hen less than two-thirds of the time for frequently or less thao one-third of the time for 

occasionally, fully describe and e~'Plain. Also e~l'lain how aod why evidence supports your 

conclusions in items 1 through 6. Cite the specific facts upon which your conclusions are based. 

See Attached 

C. MANIPULATIVE LIMITATIONS. 

mNone established. (Proceed'to section D.) 

LIMITED UNLIl\UTED 

1. Reaclringall di~ections (including overhead) D D 

2. Haodling (gross manipulation) , D D 

3. Fingering (fine manipulation) D D 

4. Feelin-g (skin receptors) D . D 

5. Describe how the activities checked "limited" are impaired. Also, e~'Plain how and why the 

. evidence supports your conclusions in item 1 through 4. Cite specific facts upon wlrich your 

conclu si on is based. 

See Attached ' 

D. VISUAL LIMITATIONS 

m None established. (proceed to section E.) 

LThUTED UNLIl\UTED 

L Near acuity 

2. Far acuity 

3. Depth perception 

4. Accommodation 

D D 

D D 

D D 

D D 

5. Color vision D D 

6. Field of vision D D 

7. Describe how faculties checked "limited" are impaired. Also explain how and why evidence 

supports your conclusions in item 1 through 6. Cite specific facts upon which your conclusions are 

based. 

See Attached 
803 

E. COl\fl\RTNICATIVE LIMITATIONS 

IX] None established. (Proceed to section F.) 

EXHIBIT NO. 17' PAGE: 40Fl 

LThDTED UNLThIITED 

I. Hearing D D 

2. Speaking D D 

3. Describe how the faculties checked in "limited" are impaired. Also, e)"l'lain how and why the 

evidence supports your conclusions in items I and 2. Cite the specific facts upon which your 

conclusions are based. 

See Atta ched 

F. ENVIRONMENTAL LThIITATIONS 

D None established. (Proceed to section II.) 

AVOID AVOID EVEN 

CONCENTRUED MODERATE 

UNLThfITED EXPOSURE LXPOSURE 

I. 

2. 

3. 

4. 

5. 

6. 

E)"ireme cold 

E"ireme heat 

Wetoess 

Humidity 

Noise 

Vibration 

7. Fumes. odors, dusts. 

IX] D 

IX] D 

IX] D 

IX] D 

IX] D 

IX] D 

gases, poor ventilation, etc. IX] D 

8. Hazards (machinery, 

D 

D 

D 

D 

D 

D 

D 

AVOID ALL 

EXPOSURE 

D 

D 

D 

D 

D 

D 

D 

heights, etc.) D m D D 

9. Describe how these environmental factors iinpair activities and identify hazards to be a voided. Also, 

explain how and why evidence supports your conclusions in items I through 8. Cite the specific 

facts upon which your conclusions are based. 

See Attached 
804 

II. SYMPTOMS 

EXHlBrT NO.17F PAOE: $OF7 

For symptoms alleged by the claimant to produce physical limitations, and for which the follo,,1ng have 

not previously been addressed in section I, discuss whether: 

A. The symptom(s) is attributable. in your judgment, to a medically determinable impairment 

B. The severity or duration of the syrnptom(s), is iii your judgment, is disproportionate to the e"-peeted 

severity or e"-pected duration on the basis of the claimant's medically determinable impairment(s). 

C. The severity of the symptom(s) and it's alleged effect on function is consistent, in your judgment, 

mth the total.medical anel non-medical evidence, including statements by the claimant and others, 

observations regarding activities of daily living, and alterations of usual behavior or habits .. 

See Attached 

III. TREATING OR E.XAMINING SOURCE STATEMENT(S) 

A. Is treating or examining source statement(s) regarding the claimant's physical capacities in file? 

~Yes o No (includes situations which there was no source or wh~n the 

source(s) did not provide a statement regarding the claimant's 

physical capacities.) 

B. If yes, are there treating/examining source conclusions about the claimant's limitations or restrictions 

which are significantly different from your fmdings? . 

til Yes ONo 

C, If yes, e"-plain why those conclusions are' not supported by the evidence ftle, (Cite the source's 

narne and the statement date) 

See Attached 

MEDICAL CO!:,SULT ANT'S SIGNATURE MEDICAL CONSULT ANT'S CODE DATE 

12 4'9/(9 
805 

RFC Continuation 

Sections Being Modified 

SSA-4734-UA - Phv.ical RFC 

[] Section I. • Limitations 

[] Section II.. Symptom., 

~ Section III. Medical Source S(.1tements 

SSA-4734-BK-Sup- Mental RFC 

D Section III. Functional Capacity Assessment 

SSA-538-F6 - Childhood Disabilitv Evaluation Fonn 

D Section III. E~'Planation ;f Findings 

SSA-2506-BK - PRTF 

D Psychiatric Review Technique Form 

These findings complete the medical portion of the disability detennination. 

48 year-old female alleges "diabetes, heart, 'hypertension, cholesterol, depression, degenerative disc disease, left 

elbow pain,limited use ofleft hand, headaches, dizziness, numbness in feet, fatigue, shortness of breath, blurred 

,ision". Diagnosis: (I) Chronic lower back pain and pain and numbness nl the lower extremities muscutoskeletal nl 

natllre from chronic degenerative hunbar disk disease, as weUas small fiber generalized neuropathy from diabetea 

mellitus, (2) Chronic pain and numbness in the upper extremities from moderate bilateral carpal tumlel syndrome; '(3) 

Recurrent l11igranleitension headaches; (4) Chronic polyarthralgia; (5) AlL'ciety disorder with insolIUua, (6) ObstIllctive 

sleep apnea. Medications: ElaviL Plavix, GemfibroziL Pravostatin, MetfonMl, Atenolol, Lexapro, Lisinopril, Glipizide, 

Aspirin, and Lantus insulin. 

Alleged ollset date: 11/0612007 

Educational yea .. : 12iM11ecial education 

Vocational backgrolUld: 

Occupational yea .. : 15 ate: 13! 2 

Visual impairment 

Concurrent 

611lf08 Physical exa,M,.tion is lUlremarkable for significant abtlormality. 

6124i08 MRI scon of the bran!: Small area of nlcreased signal nllensity nl the ",rute matter on U,e left. wluch may 

represent CIU-OIUC ischemic change. There is only one area involved, and there is no enhancement. 

7HOi08 chest x-ray: uuremarkable for significant abnonuality. 

7/li08 EKG: Negative EKG component, but positive S)'nptoms 

7/11/08 Echocardiogram: Trivial,nitral regurgitation; otherwise ber1ign echocardiogram with nonualleft velltricular 

cavity siZe and llonualleft ventricular systolic function. 

7/11/08 Stress myocardial perfusion ituaging scan: lIegative, nonnal stress myocardial perfusion nnaging; also negative, 

nonnal gated SECT imaging. 

7118/08 Polysonography revealed obstructive sleep apnea-b)'Popnea S)ndrome with significant response to CPAP therapy. 

7130;08 Physical exalnination: Blood pressure 122/68; she is awake, alert and oriellted to pernO1\, place, and time. Her 

speech and cognition are 1I0nnai. Cranial nerves 2 to 12 are intact No nystagmus noted. She has nom,.! muscle strength 

in all four extremities. No sensory deficit elicited. DTRs are 2+12+ bilaterally symmetrical. Her coordnlOtion and gait 

arenonna1. 
806 

EXHIBrT NO. 1n 

Activities of daily living reveal the c1aimallt manages pernonal care indepelldently. She prepares co,nplete":;:~Js~' 7 

COllcerning house hold chores, she dusts, vacuuming, and does ti,e lalUldry. She drives a car. She shops for groceries, 

clothes, and medicine. She mallages her personal finances. She socializes regolarly. She call walk lip to olle-halfmile. 

She ambulates wiU, a calle. She call follow inatmctions with some repetition. She gets along with authority figures. 

Records reveal DO significant damage to ~ital organs due to hypertension, diabetes mellitus, or cholesterol levels. 

There is no significant abnormality related to headaches, dizziness, numbness, fatigue, shortness of breath, and 

blurred vision. She has adequate range of motion and muscle strength throughout. 

In assessillg tile credibility ofU,e claimant's statements regarding symptoms alld tlJeir effects on function, her medical 

history was considered. 

Of greatest significance in detenniIriug U,e credibility of U,e claintant's statements regarding symptoms and their effects 

on her functioning was her medical·itistory. The description ofU,e symptoms and limitations provided by Ute claimanl 

throughout the record bas been inc~llsistent and is 1101 persuasive. Based on the evidence ofrecord~ the claimant's 

statements are fOlUld to be partially credible. 

RECONSIDERATION ADDENDUM 

The claimant alleges diabetes,dizziness, numbness in hands and feet; heart disease, prior congestive heart failure,hbp and 

cholesterol; depression; degenerative disc cisease, problems with left elbow and hand; vision problems; shortness of breath; sleep 

apnea; headaches; carpal tunnel; frequent bladder infections. and that her condition has WJrsened. The evidence establishes the 

impainments of DOD, Diabetes Mellitus, CAD (sip acute coronary syndrome and placement of 2 stents), HTN, Obstructive Sleep 

Apnea, and bilateral Carpal Tunnel Syndrome. 

Claimant had outpatient PT in September 2008 to help strengthen her legs. She reported on 10102108 that she was doing well, and her 

physical therapist noted that she tolerated all exercises well. A neurology follow up on 11,\)5/08 reports she has recurrent migraine 

headaches, chronic pain and numbness in all extremities, and bilateral CTS. She was encourajJed to consider carpal tunnel release. 

A visual exam on 12105/08 revealed VA corrected was 00 20f25; OS 20125 and OU 20120-2. There were no signs of <labetic 

retinopathy. Her diagnosis is Myopic astigmatic presbyope. An' exam on 12109/08 revealed the claimant has gained over 50# in the 

past year. Current medications are Mertormin, Gemfibrozil, Lantus insulin, Humalin, Lyrica, Furosemide, Plavix, Usinopril, Atenlol, 

pravastatin,lexapro, CPAP. She was alert, cooperative, pleasant and NAD. Lungs were clear, heart was RRR, normal bowel sounds: 

no cyanosis, clubbing or edema of extremities. She was neurologically intact. Sensory and motor were intact. These records also 

note the claimant has a history of CAD and is sip acute coronary syndrome with two slents implanted in November 2007. A cervical 

MRI on 1113/09 revealed DOD throughout the C-spine. 

The opinion of .hat claimant was temporarily disabled from 3111/08 to 6/11/08, is an Issue Reserved to the 

Commissioner, however, this opinion has been considered in this evaluation. 

The claimant's statements are considered to be partiany credible. Although she has bilateral carpal tunnel syndrome, she remains able 

to use her hands and anms for ordinary activities. She has diabetes without evidence of end organ damage. She has normal strength 

and ROM of her extrem~ies. Her heart and lungs are functioning satisfactorily. She has degenerative changes of the spine but is able 

to stand and walk without assistance. She uses a cane at times, but the evidence does not indicate that this is a medical necessity. 

The claimant should be able to perform work at the level described herein: - 434 Spec. CAd.: l~ 

4f91W 

Signature 
807 

NH __ 

May 4, 2009., 11: 26 

PAGE 1 

UNIT: DVTDVT 

REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE 

On May 1, 2009, we talked with you and c~mpleted your REQUEST FOR HEARING for 

SOCIAL SECURITY BENEFITS. We stored your REQUEST FOR HEARING information 

electronically in our records and attached a summary of your statements. 

What You Need To Do 

o Review your REQUEST FOR HEARING to ensure we recorded your statements 

correctly. 

o If you agree with all your statements, you may retain the REQUEST FOR 

HEARING for your records. 

o If you disagree with any of your statements, you should contact us within 

10 days after the date of this notice to let us know. 

MY NAME IS •••••••••• 

MY SOCIAL SECURITY NUMBER IS ••••• ., 

I REQUEST A HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE. I DISAGREE WITH THE 

DETERMINATION MADE ON MY CLAIM FOR SSI DISABILITY/TITLE II BENEFITS BECAUSE I 

AM DISABLED 

AM SUBMITTING ADDITIONAL EVIDENCE WITH THIS REQUEST. 

I WISH TO APPEAR AT A HEARING. I UNDERSTAND THAT AN ADMINISTRATIVE LAW JUDGE OF 

THE OFFICE OF DISABILITY ADJUDICATION AND REVIEW WILL BE APPOINTED TO CONDUCT 

THE HEARING OR OTHER PROCEEDINGS IN MY CASE. I ALSO UNDERSTAND THAT THE 

ADMINISTRATIVE LAW JUDGE WILL SEND ME NOTICE OF THE TIME AND PLACE OF A HEARING 

AT LEAST 20 DAYS BEFORE THE DATE SET FOR A HEARING. 

IT COULD BE ESPECIALLY USEFUL IN MY CASE SINCE THE ADMINISTRATIVE LAW JUDGE 

WOULD HAVE AN OPPORTUNITY TO HEAR AN EXPLANATION AS TO HOW MY IMPAIRMENTS 

PREVENT. ME FROM WORKING AND RESTRICT MY ACTIVITIES. 

Permanent Subcommittee on Investigations 

EXHIDIT#17d 
808 

May 4, 2009, 11:26 

NH __ PAGE 2 

I AM REPRESENTED BY WHO IS AN ATTORNEY. 

MY PHONE NUMBER IS ••••• 191 DATE May 1, 2009. 
809 
810 
811 

(The following is a transcript in the hearing held before 

Karen B. Peters, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on Max 19, 

2010, at Bristol, Virgioia. in the case of I I 

Social Security Number .1 I he Claimant appeared in person 

and was represented by~ ~ Attorney. Also present was ---___ ~-_ Vocational Expert.) 

(The hearing commenced at 11:24 a.m. on May 19, 2010.) 

OPENING STATEMENT BY ADMINISTRATIVE LAW JUDGE: 

ALJ: Well, good morning I'm Karen Peters, I'm 

the Administrative Law Judge. Counselor, do I need to go over the 

definition of disability in any preliminary matter? 

ATTY: You don't, Your Honor. I waive reading of those. 

ALJ: All right. Now, according to my notes, this lady applied 

July 11th of 2008. Her date last insured is 12/31/2012, so she's well 

within her insurance status. Let's look at our e-file index; we have 

thr~ugh 4A, l2B, 5D, 13E and then the F section, 21F. The last notes 

being (PHONETIC) of April 2010. Any objection to 

admitting the record, sir? 

ATTY: I do not, Your Honor. 

(Exhibits lA through 21F , previously identified, were received 

into evidence and made a part of the record thereof). 

ALJ: Let me state for the record that just before we went on 

record, we had a brief discussion -- or I had a brief discussion with 

counsel about the possibility of amending the onset in this case to 

this lady's 49-and-a-half birthday which is how far we can take a grid 

backwards. You would be 50 as of.....,of this year? 

CLMT: Yes. 

ALJ: So you just 49, E S " Okay, so if you move that six 

months, September, October, November, December, January --. so we"re 

Permanent Subcommittee on Investigations 

EXHmIT#17f 
812 

2 

talking about March 19th of this year, that isn't going to give her 

much of a lump sum. 

ATTY: Right. 

ALJ: But, at least that gets us lined up with where the medical 

record is, I think. And the reason I'm trying to reach an agreement 

on this ma'am, is that we have a physical assessment, 17F, by a 

physician. A physician actually reviewed your record Apri1>9th of 

2010. He put you at a light exertional level. It seems to me that 

over time you've actually been getting worse so that -- you wouldn't 

disagree with that. And so it seems to me that some point in time, 

you along the way, probably have actually reached the sedentary 

exertional level. And the, the furthest back I can stretch it and 

meet the grid rules would be age 49-and-a-half, and that simplifies 

things for us and allows me to reach a decision more quickly and 

conclusively using that grid rule. But you are giving up a little bit 

of -- not a little bit -- you're givin.9 up your onset date of July of 

'08 -- excuse me, your onset of November of '07 and moving it forward 

to March of '09. Are you satisfied with that result? Do you 

understand why we're trying to --

CLM:r': Yes. 

ALJ: -- to settle it that way? 

CLMT: Yes. 

ALJ: Okay. If you're satisfied with that ma'am, then I will 

find in your favor that you are at a sedentary exertional level, and 

that you could not return to your past work at a sedentary exertional 

level with some other limitations that you might have, and that 
813 

3 

therefore you would fit that grid rule. Okay? Anything ~1se sir? 

ATTY: I think that's' everything, Your Honor. 

ALJ: All right. Thank you all so much, we appreciate your 

coming and we'll get a decision out to you as quickly as we can ma'am. 

CLMT: Thank you. 

ALJ: All right, thank you. 

(The hearing closed at 11:28 a.m. on May 19, 2010.) 

C E R T I F I CAT ION 

I have read the foregoing and hereby certify that it is a true 

and complete transcr._· tion 0 'mony recorded at the hearing 

held in the case of , before Administrative Law 

Judge Karen B. Peters. 

C~steiman, Proofreader 

Free State Reporting, Inc. 
814 

IN THE CASE OF 

(Wage Earner) 

SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability, Disability Insurance 

Benefits, and Supplemental Security Income 

JURISDICTION AND PROCEDURAL HISTORY 

This case is before the undersigned on a request for hearing dated May 1, 2009 (20 CFR 404.929 

et seq. and 416.1429 et seq.). On May 19, 2010, the undersigned held a video hearing (20 CFR 

404.936(c)and 416.1436(c». The claimant appeared in Bristol, VA, and the undersigned 

presided over the hearing from Bristol, VA. • .-. an impartial vocational expert, also 

appeared at the hearing. The claimant is represented by - an attorney. 

At the hearing, the claimant and her representative amended the alleged onset date of disability 

from November 6, 2007 to March 19,2010, which is within 6 months of the claimant s 50th 

birthday. 

The issue is whether the claimant is disabled wider sections 216(i), 223(d) and 1614(a)(3)(A) of 

the Social Security Act. Disability is defined as the inability to engage in any substantial gainful 

activity by reason of any medically determinable physical or mental impairment or combination 

of impairments that can be expected to result in death or that has lasted or can be expected to last 

for a continuous period of not less than 12 months. 

With respect to the claim for a period of disability and disability insurance benefits, there is an . 

additional issue whether the insured status requirements of sections 216(i) and 223 of the Social 

Security Act are met. The claimant s earnings record shows that the claimant has acquired 

sufficient quarters of coverage to remain insured through December 31,2012. Thus, the 

claimant must establish disability on or before that date in order to be entitled to a period of 

disability and disability insurance benefits. 

After careful review of the entire record, the undersigned finds that the claimant has been 

disabled from March 19,2010, through the date of this decision. The undersigned also finds that 

the insured status requirements of the Social Security Act were met as ofthe date disability is 

established. . 

EXHffiIT#17 
815 

Page 2 of5 

APPLICABLE LAW 

Under the authority of the Social Security Act, the Social Security Administration has 

established a five-step sequential evaluation process for determining whether an individual is 

disabled (20 CFR 404.1 520(a) and 416.920(a». The steps are followed in order. If it is . 

determined that the claimant is or is not disabled at a step of the evaluation process, the. 

evaluation will not go on to the next step. 

At step one, the undersigned must determine whether the claimant is engaging in substantial 

gainful activity (20CFR 404.1 520(b ) and 416.920(b». Substantial gainful activity (SGA) is 

defined as work activity that is both substantial and gainful. If an individual engages in SGA, 

she is not disabledtegardless of how severe her physical or mental impairments are and 

regardless of her age, education, or work experience. If the individual is not engaging in SGA, 

the analysis proceeds to the second step. 

At step two, the undersigned must determine whether the claimant has a medically determinable 

impairment that is severe or a combination of impairments that is severe (20 CFR 

404. 1520( c) and 416.920( c». An impairment or combination of impairments is severe within 

the meaning of the regulations if it significantly limits an individual's ability to perform basic 

work activities. Ifthe claimant does not have a severe medically determinable impairment or 

combination of impairments, she is not disabled. If the claimant has a severe impairment or 

combination of impairments, the analysis proceeds to the third step. 

At step three, the undersigned must determine whether the claimant s impairment or combination 

of impairments meets or medically equals the criteria of an impairment listed in 20 CFR Part 

404, Subpart P, Appendix 1 (20 CFR 404.1 520(d), 404.1525, 404.1526, 416.920(d), 416.925, 

and 416.926). If the claimant s impairment or combination of impairments meets or medically 

equals the criteria of a listing and meets the duration requirement (20 CFR 404.1509 and 

416.909), the claimant is disabled. If it does not, the analysis proceeds to the next step. 

Before considering step four of the sequential evaluation process, the undersigned must first 

determine the claimant s residual functional capacity (20 CFR 404.1520(e) and 416.920(e». An 

individual s residual functional capacity is her ability to do physical and mental work activities 

on a sustained basis despite limitations from her impairments. In making this finding, the 

undersigned must consider all of the claimant s impairments, including impairments that are not 

severe (20 CFR 404. 1520(e), 404.1545, 416.920(e), and 416.945; SSR 96-8p). 

Next, the undersigned must determine at step four whether the claimant has the residual 

functional capacity to perform the requirements of her past relevant work (20 CFR 404.1 520(f) 

and 416.920(f)}. If the claimant has the residual functional capacity to do her past relevant work, 

the claimant is not disabled. If the claimant is unable to do any past relevant work or does not 

have any past relevant work, the analysis proceeds to the fifth and last step. 

At the last step ofthe sequential evaluation process (20 CFR 404. 1520(g) and 416.920(g», the 

undersigned must determine whether the claimant is able to do any other work considering her 

See Next Page 
816 

Page 3 of5 

residual functional capacitY, age, education, and work experience. If the daimant is able to do 

other work, she is not disabled. If the claimant is not able to do other work and meets the 

duration requirement, she is disabled. Although the claimant generally continues to have the 

burden of proving disability at this step, a limited burden of going forward with the evidence 

shifts to the Social Security Administration. In order to support a finding that an individual is 

not disabled at this step, the Social Security Administration is responsible for providiI\g evidence 

that demonstrates that other work exists in significant numbers in the national economy that the 

claimant can do, given the residual functional capacity, age, education, and work experience (20 

CFR 404.l512(g), 404. 1 560(c), 416.912(g) and 416.960(c». 

FINDINGS OF FACT AND CONCLUSIONS OF LAW 

After careful consideration of the entire record, the undersigned makes the following findings: 

1. The claimant s date last insured is December 31, 2012. 

2. The claimant has not engaged in substantial gainful activity since March 19, 2010, the 

amended alleged onset date (20 CFR 404.1520(h), 404.1571 et seq., 416.920(h) and 416.971 

et seq.). 

3. The claimant has the following severe impairments: morbid obesity, diabetes mellitus, 

diabetic neuropathy, cervical degenerative disc disease, status post bilateral carpal tunnel 

release surgery, status post myocardial infarction, gastroesophageal reflux' disease (GERD), 

and depress 

On April 9, 2009, ,_"":- ,reviewed the claimant s evidence in file and assessed 

her as able to perform light work (Exhibit 17F), ' t the claimant had been 

diagnosed with chronic lower back pain, chronic numbness an pain of her lower extremities, 

which W'!S due to diabetic neuropathy and degenerative disc. disease, chronic pain and numbness 

in the upper extremities due to caIpal tunnel syndrome, chronic polyarthralghis, and obstructive 

sleep apnea. 

On March 15,2010,. ...... . .Jerformed a checkup on the claimant for an episode of 

syncope (Exhibit 27F-8). -:.... . '\ the claimant s past medical history included coronary 

artery disease, status post stent placement in November 2007, hyperlipidemia, hypertension, 

myocardial infarction x 2, sleep apnea, renal stones, diabetes mellitus type II, and caIpal tunnel 

syndrome, On physical examination, the claimant was 61 inches tall and weighed 230 pounds. 

4. The claimant does not have an impairment or combination of impairments that meets 

or medically equals one ofthe listed impairments in 20 CFR Part 404, Subpart P, Appendix 

1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926). 

5. After careful consideration ofthe entire record, the undersigned finds that the 

claimant has the residual functional capacity to perform the full range of sedentary work 

as defined in 20 CFR 404.1567(a) and 416.967(a). 

See Next Page 
817 

Page 4 of5 

In making this finding, the undersigned considered all symptoms and the extent to which these 

symptoms can reasonably be accepted as consistent with the objective mediCal evidence and 

other evidence, based on the requirements of20 CFR 404.1529 and 416.929 and SSRs 96-4p and 

96-7p. The undersigned has also considered opinion evidence in accordaDce with the 

requirements of 20 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p. 

After considering the evidence of record, the undersigned finds that the claimant·s medically 

determinable impairments could reasonably be expected to produce the alleged symptoms, and 

that the claimant s statements concerning the intensity, persistence and lirniting effects of these 

symptoms are generally credible. 

The State agency medical consultants physical assessments are given little weight because 

evidence received at the hearing level shows that the claimant is more limited than determined 

by the State agency consultl!nts. 

6; The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 

416.965). 

The demands of the claimant s past relevant work exceed the residual functional capacity. 

7. Applying the age categories non-mechanically, and considering the additional 

vocational adversities in this case, the claimant was an individual closely approaching 

advanced age on the.established disability onset date (20 eFR 404.1563 and 416.963). 

8. The claimant has at least a high school education and is able to communicate in 

English (20 eFR 404.1564 and 416.964). 

9. The claimant s acquired job skills do not transfer to other occupations within the 

residual functional capacity defined above (20 CFR 404.1568 and 416.968). 

10. Considering the claimant's age, education, work experience, and residual functional 

capacity, there are no jobs that exist in significant numbers in the national economy that 

the claimant can perform (20 eFR 404.1560(c), 404~1566, 416.960(c), and 416.966}. 

In determining whether a successful adjustment to other work can be made, the undersigned 

must consider the claimant's residual functional capacity, age, education, and work experience in 

conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. 

If the claimant can perform all or substantially all of the exertional demands at a given level of 

exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" 

depending upon the claimant's specific vocational profile (SSR 83-11) . 

. Based on a residual functional capacity for the full range of sedentary work, consideripg the 

claimant s age, education, and work experience, a finding of disabled is directed by MedicalVocational Rule20U4. 

See Next Page 
818 

Page S ofS 

11. The claimant has been under a disability as defined in the Social Security Act since 

March 19, 2010, the amended aUeged onset date of disability (20 CFR 404.1520(g) and 

416.920(g)). 

DECISION 

Based on the application for a period of disability and disability insurance benefits protectively 

. filed on July 8, 2008, the claimant has been disabled under sections 216(i) and 223(d) of the 

Social Security Act since March 19,2010. 

Based on the application for supplemental security mcome protectively filed on July 8, 2008, the 

claimant has been disabled under section 1614(a)(3)(A) of the Social Security Act since March 

19,2010. 

The component of the Social Security Administration responsible for authorizing supplemental 

security income will advise the claimant regarding the nondisability requirements for these 

payments and, if the claimant is eligible, the amount and the months for which payment will be 

made. 

/s/ ~ .B. PdM..t 

Karen B. Peters . 

Administrative Law Judge 

May 28, 2010 

Date 
819 

DuPlEx 

Social Security Administration 

Retirement, Sun1vors, and Disability Insurance 

Notice of Disapproved Claim 

Date:A~ 

CloimNumbe~ 

We are writing abeut your claim for S()CiaJ Security disability benetits, Based on a review of your health problems you 

do not qualify for benefits on this cloim, This is because you sre not dis.bled under our rules, 

w. have enclosed information about the disability rules, 

About The ~dslon 

Doctors and otiler trained staff looked at your case and made this decision, They work for your State but used our niles, 

Please romember that U,ere sre many types of disability programs, beth government and private, which use different , 

rut",., A person may be receiving benefits under another program and still not be entitled under our rules, This mny be 

true in your case. 

How We Mnde The Decision 

All relevant reports were requestea and the following evidence "'lIS used to deCide your claim, 

and 06/22/2006 

rep"rt recei,vea 06/22/2006 

We have determined that your condition is not severe enough to keep you from working, We considered the medical 

and other information, your age, eaucation, training, nnd work eXjJ!'rience in determining how your condition affects 

your ability to work 

You said thaI you are UMble to work because of severe back and leg pain, nerve problems, numbness, insomnia due to 

pain, and bulging disc, 

The evidence shows that your condit,ions have cau<;ed you some limitations in your nbility to nmctklO, However, 

evidence shows that despite having back and leg pain and mmlbness, you are able to slMd, walk, move abou~ and use 

your arms alld hands within an adequate range, Wlri1e your insomnia may be bothersome, this condition is not so severe 

as 10 be considered totally disabling, Although you may occasionaUy feel n_rvou, and depressed, yotl are able to 

understand, remember, cooperate with others, and perform your normal daily tasks, 

We realize that your condition keeps you from doing ille t}pe of work that you have'done in the pas~ but it does not 

keep you from doing less demanding worl 

Permanent Subcommittee on Investigations 

EXHIBIT #18a 
820 

If your condition gets worse and keeps you from working. write, call or visit any Social Security office nbout filing 

another application. 

H You Disagree 'With The Decision 

If you disagree with this decision, you have the right to appeal. We will review your case and <:onsider any new facts 

you have. A person who did not make the first decision will decide your case. 

You have 60 days to ask for an appeal. 

The 60 days start the day after you get this letter. We assume you got this leLter 5 days after the dale on it unless 

you show us that you did not get it within the 5-day period. 

• You must have a good reason for waiting more than 60 days to ask for an appeal. 

You have to ask for an appeal in writing. We "ill ask you to sign a form SSA-561-tr2, called URequest for. 

Reconsideration." You may request this fonu online at: httv:/i\\~vw.socialsecurity.g(",ioliljnei"" .. -561.pdf. Contact 

one of our offices if you want help. 

In addition, you have to complete a "Reconsideration Disability Report" to tell us about your 

medica! condition since you filed your claim. You may cont>lct one of our offices or call J -800-772-1213 to 

request this fom!. Or. you may complete .this report online at http://mvw.socialsecurity.g<lv!disabilitv!recolL 

Please read the enclosoo pamphle~ "Your Right to Question the Decision Made on Your Social Security Claim." It 

contains more information about the appeal. 

New Application 

You have the right to file a new application at any time, but filing a new application is not the &1me as appealing this 

decision. If you disagree with this decision and you file a new application instead of appealing: 

you might lose some benetits, or not qualify for any benefits, and 

we could deny the new application using this decision, if the facts and issues are the same. 

So, if you disagree with this decision, you should ask for an appeal within 60 days. 

H You Want Help With Your Appeal 

You can have a friend, lawyer, Of someone else help you. There are groups that can help you tind a lawyer or give you 

free legal services if you qualify. There are also lawyers who do not charge \mles~ you win your appeal Your [ocal 

Social Security office has a list of groups that can help you with your appeal. 

If you get someone to help you, you should let us know. If you hir. someone. we must approve the fee before he or she 

can collect it And if you hire a bwyer, we will withhold up to 25 percent of any past due Social Security benefits to 

pay toward the fee. 

Other Benefits 

Based on the applkation you filed. you .... not entitl.d to ahY other benefits, besides tho.e you may al ... ady be 

getting, In the futu .... if you think you may be entitled to other benefits you will need to apply again.· 
821 

If You Have Any Questions 

If you have any questions, you may callus toll-free at 1·80o. 772-1213, or call your local Social Security office at the 

number shown below. We can answer most questions over the phone. You can also write or visit any Social Security 

office. The office that serves your area is located at: 

SSA- BLUEFrELD 

3014 E C1JMBERL.".NO RD 

BLUEFIELD, WV2470! 

304 327-7671 

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan 

to visit an office, you may call ahead to make an appointment. This will help us serve )"C'u more quickly. 

Enclosures: 

SSAPub. No. 05·10058 

Disability Rules Factsheet 

cc: 

7 

Laurie Watkins 

Regional Commissioner 
822 

DuPlEx 

Social Security 

Notice of Reconsideration . From: Social Security Administration 

Dat_e: .. Ap.ri.1 4., .200.7 

Claim Numb<jr 

Upon receipt of your request for reconsideration we had your claim independently reviewed by a physiciM and 

disability examiner in th. Stat. agency which works with us in making disability determinations. The evidence in your 

case has been thoroughly evaluated; this includes the medical evidence and the additional information received since the 

original decision We find that the previous determination denying.your claim was proper under the law. The last page 

of this notice identifies the legal requirements for your type of claim. 

The determination on your claim was made by an agency of the State. It was not made by your own doctor or by other 

people or ngenci~s 'niting reports about you. However. any evidence they gave us wns ,used il1 making this 

determination. Doctors and other people in the Sl1te agency who are trained in disability evaluation reviewed the 

evidence and made the determination based on Social Security law and regulations. 

It' YOII believe that the reconsideration determination is not correct, you may request a hearing before an administrative 

law judge of the Office of Hearings and Appeals. If you want a hearing, you must request it not later than 60 days from 

the date you receive this notice. You may make y"t1r TOqUest through any Social So<''Urity office. As part of the appeal 

process, you also need to teU us about your current medical condition We provide a form for doing that, the Disability 

Report - Appeal. You may contact one of our offices or call 1-800-772-1213 to request this form. Or, you may 

complete the report online at http/fwww.sQgialsecllrity.gOl·jdisobilitvlhearing. Read the enclosed leatlet for a full 

explanation of your right to appeal. If you do not request a hearing of your CAse within the prescribec time period, you 

still have the right to tile another application at any time. 

How w. Made the Decision 

The following evidence was cOllsidered in evaluating your claim in addition to the medical reports already in file. 

. 

, . 

.... ·f 

07 

03/0912007 

. report received 03/20/2007 

12007 

007 

'2007 

We have determined that your condition is not severe enough to keep you from working We considered the medical 

and other information, your age, ecucation, training, and work experience in determining how your c"ndition affects 

yom ability to work. 

You said that you are unable to work because of severe back ,Uld leg pain"numbness. insomnia due to pain, bulging 

disc; nerves. depression, problems with memory and concentration. 

The evidence shows that while you experience some restrictions as a result of your back and leg pain and numbness, 

you are able to perform some limited standing and walking should be able to perform work activities that do not require 

an excessive amOlUlt of these acthTities. Although you report difficulties with your nerves resulting in in&.lrnnia, 

'-.. 96-- Permanent Subcommittee on Investigations 

EXHIBIT #18b 
823 

problems with your memory and concenlrJting, evidence shO\vs that you continue to be .ble to .ct, think and 

commtmicnre in your O\\TI interest 

We realize that your condition keeps you from doing the type of work that you have drute in the past, but it does not 

keep you from doing less demanding work. 

HYou Want Help With You~ Appeal 

You can have a friend, lawyer, or someMe else help you. There are groups that can help you find a lawyer or give you 

free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local 

Social Se<.,\lTity office has a list of groups that can help you with your appeal. 

If you get someone to help you, you should let us know, If y"u hire someone, ,\'. must approve the fee befdre he or she 

can collect it. And if you hire a lawyer, we will withhold up to 25 percent of any past due Social Security benetits to 

pay toward the fee. 

New Application 

You have the right to lile a new application at any time, but ftling a new application is not the same as appealing this 

decision. If you disagree with this decision and you file a new application instead of appealing: . 

.. you might lose some benefits, or not qualify for any benefits, and 

we cOuld deny the new application using this decision, if the facts and issues are the same. 

So, if you disagree ~'ith this decision, you should ask for an appeal within 60 days. 

This decision refers only to your claim for berietll' ilDder the Social Security Disability Insurance Program, If you 

applied for other benetlls, you will receive. separate notice when. decision i, nlade on that claim(s). 

If you have questions about your claim. you should get in touch with any Social Security office .. Most questions can be 

handled by telephone or mail. If you visit an office, hewel'er, please take this leUer with YOll, 
824 

Summarized below are legal requirements for the various Iypes of disability chims: 

DisabUity Insurance Claim 

To be considered disabled, a person must be [mabie to do any subslantial gainful worl: due to a medical condition which 

has lasted or is expected to last for at least 12 months in a row. The condition must be severe enough to keep a person 

from working not only in his or her usual job, but in MY other substantial gainful work. We look at the person's age, 

education, training and work experience when we decide whether he or she can work. . . 

Disabled \Vldow (Widower) Claim 

A widow, widower, or surviving divorced wife (age 50-60) must meet the disability requirement of the·law within a 

specified 7-year period .. A person may'be c-Onsidered disabled only if he or she has a physical or menial inlpairment that 

is so severe as to ordinarily prevent a person from working The disabiliiy must have lasted or be expected to last for a 

continuous period of at least 12 months. 

Child Disability Benefits . 

Childhood disability benefits may be paid to a person age 18 or older if the person has a disability which began before 

age 22 or within 84 months of the end 'of an earlier period of childhood disability. The condition, whether physical or 

menta!, must be severe enough to keep the person from doing any substantial gainful work. We look at the person's 

age, education and pr .. ,ious training when we dec.ide whether he or she can work. In addition, the condition must hove 

lasted or be expected to·last for at IOl'st 12 months in a row. 

Enclosure: 

SSAPub. N,1. 70-1028f 

S8;\-L928 

SiMpLeX 

Laurie Watkins 

Regional Commissioner 
825 

Mar. 30. 2007 2:29PM No. 9950 P. 2 

P~icaJ TheIaPy • OccupatioMI Therapy 

PATIENT: 

DATE: 

IIRN: 

COB: 

EMPLOYER: 

JOBTm.E: 

PHYSICIAN: 

DlAGNOSJS: 

CASE MANAGER: 

FUNCTIONAL CAPACITY EVAWAnON 

SAPUNG GROVE RBfABILITATION SERVICES 

Lumbar ..... atiM dlIc dIuaM and Jwnhar spondylosis 

willi mrelopdty 

QlHWL IHfORMADON 

35 year-old whits mala was refelNd to 

FuncllDnai Cspacjty EvalUation by -

at work on 08125105 when he wa. lifting 

a miI1ir19 jade. He states he felt a pop in bedt with immediate onset of pain, which 

~ 

became more I8V8I8 over the next 2-3 dayS. He has undergone epidural steroid 

JC2 wiIhout impnwemenI as well 88 facet joint injections X3 without 

Improvement He h8$ been offworil sinoe 08l26I05. 

SUBJECTNEi The patient CUITtntIy nItes his pain at T of 10. He describes the pain 88 

constant In the lower back bilaterally radiating InIo the hIpI willi c:anstant pain in tho left 

Iowar exlremity to the knee. He I8POIta occ:aalonal tingling In Ih8 filet bIIaferaIly, left 

~ 

greater than right • MIl • DQCatiorIIII pain in tile right loWer extremity \MIich he 

iI not. MVIIIV • thO left. It should W 0Q(ed tt.t he! ~ approximately 1 % 

houl'l to the clinic thIS morning and last took hiI pU) medIGatIon at approximately 8:00 

a.m. Start of the evaluation was 10:00 a.m. 

PAST MEDICAL HISTORY: ll18 patient c:IetWe6 any other medical problems. He denies 

any significant prior Il1Iury to his CUInIIIt complain!$. 

JQB Tt1LE; ___ The patient stataa that his job required freq~ lifting, 

pushing, pulling. ~ng, and reaehlng of varfOUI weights oc:caaionalIy heavy. 

He .... he has beCl/1 off worK sInQe" day aftIIrthe injury on 08126105. 
826 

Mar. 30. 2007 2:29PM No. 9950 P. 3 

. Page2 

Func:tior1aI capac:;ty Evaluation Nam~& •.... 

Dale: 09I28l2OO6 

MYISU!.9MFLIITAb MSmMa 

INmA!-VITAL SIGNS; 

Haight 5'11" •. WeIght 217 pounds. 

BloOd pressure: 140/80. 

Heart rate: 84 bpm •. 

Pain Rating: W1D. 

TRUNK RANGE OF MOTlON! UeIng goni~ technique, the patient demonstrates 

the following range of motion: 

Flexion .w 

Extension to neutral Right_~ 15" 

Left aide ~ 20° 

He reports pain primarily with flexion, but also bae pain with all other movemenl8. 

CfflVICAL RANGE! OF MgNi Using getuOll'lBlriC tedlnlque, the patient 

demonttratea actNe range of motiOn as foIIowI: 

FIeldon 45" 

Exfansion 30" 

RotatIon right 65" 

Rolation left 55" 

No epecific c:anplainll of pain with movement. 

UPPER EXTREIIITY RANGE Of MOp: UsIng gonIomeIrie tadlnlque. the patient 

dernorI8fr8tes ective range or motion of bOIh upper exIIemiIies gr088Iy wtthln normaJ 

Umits willi the $XC8I)tion of shoulder fieldon and abduction, which was limited to 

approximately 120° clue to tow back pain.. 

!.Q.W.§R g'!'@MflY BANGE Of MqDOH; Using gonIometric technique. the patient 

dernonaIratos active tangII 01 motion of boIh JoMr 8ldnIn1itie8 groeeIy within oonnal 

IImiII witt the ~ of biIatsralIy hlp fieldon whiCh was limited to SOO in the sitting 

position due to loW back pain. 

MANUAL MUSCLE TEl1JNQ; In ilia upper txIIVmIIIeI, the paIient cIernonstratM gross . 515 8ItengIh wtth myaI:omIt tasting althOUgh lie daes complain of pain with resi8Ied 

shoulder flexion and abdudIon. Lower elCfniImily 8Irength me&8I./IliI6l .. foIIo\w: 

Right /lip flexion 4+15 with loW back pain 

Left hlp flexion 315 wIIh low back pain 

Right knee flexion 5IS 

Left knee fIaxion' 4+15 

Knee extension 515 bilaterallY 

Left dotII/Ieldon 4-15 

Bilateral planlarflolUon 3/5 (the patientwu unable to perfOmI bilate1'91 heel ,.i$e) 
827 

Ma r. 30. 2007 2: 29PM No. 9950 P. 4 

Page 3 

Functional Capacily Evaluation 

tleuR~ Reflexes are 2+ in bilateraUy Iowar exnmitles at 1he knees 8I1d the 

anklea. The paIient dDaa report • eIIght deaease In aensatIon In the left toot along the 

bottom; hlllMMJr. no specific dermatOme. 

iA!Ii The patient arnbuIatea with a stoopecI8O/IIeWh8t tIexed posture at the waiat and 

the hips with a limp on the left. However, he does net uIiIiz/I an 88$I5tiVe deVIce. 

GENERAL OBSERVAl1ONS: The patient appeal1l to be In acute dialr888 frequentJy 

shifting his poa(tIon.lItiIO and standing frequently. rubbing his leg. When aiHIng. he sitS 

on either hlp not aymmetricaIIy as well as Iaana on his upper eldremitlel. 

NLPADOHi The patient Is moderaleIy lender in bilatnllumbar pal'll8pinals as well as along the PSIS. Moderate tendeI'I\e8$ WiIh palpation d the Q8ntraI &pine along L5-S1 area. 

ClBJIiCM fUNCTIONAL W§H'EW 

HMDGRfP S1'J!EHS!TH TEST: The patIenl's sialic handgrIp atrangIh was asaessed 

1I81ng the handheld dynamomeIer in pcJIIition 3 for tine trIaIi with reeuItII as foIIowt; 

l!!fJmI .BfJI!!l!.!fl 

t 41 pounds. 20 pounds 

2 22 pounda 44 pounds 

3 25 pounds 44 poLll'lda 

SQ!III!!IfTSi TIle patient 1& right hand dominant Tbe values demonfiIl'ated a coefticIent of vatiaIIon gn:ater than the acceptable 15% leVel suggeating an invalid test 

IICCRI tmd poor or InconIiitent effoIt on the patienl's part. 

1lUL1J.fPSl!ION HANPGRJP STBENGllf TEST; . The p!lti6nt'e ebIIic handgrlp 

e1rength was aaseeeed using the handheld dyI'I8InQII!eCe at fiye potltion& With re&\III8 • foIJDW!I: 

Sllttlno 

1 

2 

3 

.. 

5 

.!!!md 

30 pounds 

32pounda 

5OpoLnIs 

37pounda 

2Spounds 
828 

Ma r. 30. 2007 2: 30PM No. 9950 P. 5 

coMMENJ'8i TIle values demonstrated form the expected Bell shaped. curve when 

these are plotted on a gmph suggesting a vaIIcI eIfort 

RAPID EXCHANGE GRIP TeST; The paUent was tested In position :3 on a handheld 

dynamometer fOr IIoIh hands to .... what he c:ouId muimalIy petfonn and compare it 

to his one time maximum stJantJIh value from aboVe. He perfOrmed 8 repetitions to each 

hand while the evaluator rapidly rnovae! the dynarnorneIer to each hand. He 

demOnS1rated a maximum value en ilia right hand of 47 pounds and 40 pounds on the 

left hand. This would dernonstraIe • correlation between statiC grip aIrangttl testing and 

rapid exdIange grip. 

MATERIAL HAN[!UNG A£tMDES: 

(Ib) 

lifting - Floor 10 knuc:Ida pnlfened 

Root to knudda ie91itt 

12111. To knudcIe back lift 

Knudde to tIhOufder 

ShouJderto overhead 

CIJITYing (SO feet) 

PuM1n9 (25 feet) 

Pulling (25 filet) 

RIght Unilateral lift 

RIght UniJa1erll Lilt 

Occasional Frequent Constant 

Unable to perform. 

Unable to pedarm. 

Unable to perfonn. 

7.51bs. 3.751ba. 1.9 lba. 

7.51bs. 3.75 Ibs. . 1.9 Ibs. 

Unable to pedomI. 

50 IbI. 261b5. 12.51bs 

Unable to /*fOIm. The patient we. un.ote 

to walk bac:kwalds reporting lnaeaslng 

numbness in the left lower ex!l9mity, Test 

WIll dileOnIlnUed. 

Unable to pedorm. 

Unable to peIfonn. 

COMMENTS: WIth the lifting test, the patient was unable to perform a squat or foIward 

bend a11he trunIt enough to reach the box With the exoeption of 12 Inches to 1InucIde. at 

whidI pOInt he 111M able tD readllhe box, but unable to flft the minImUm WeIght Which 

waa 1.5 poundt d\le to pain. The patlent rated his pain level sa a 7 of 10 at the 

beginning rA malIIriaI handling ac:IIviIie8 getting 88 high 88 10 of 10 toward the end of 

matarIaI handling. He did req\lllll ,. bteIaka II1d indicated that he needed to ait dawn 

feeling IighIhNcIed following tho lower Ie¥eI • The patient did make an effort to 

8II8mpt the IIIIa; however, was not able to pedorm. 

The datil suggeeW that the patient Is capable of peifonning the abOve frfting capac:ities. 

However. he COIlId have perhaps lifted Il1Ol8 than the values listed aboVe, but due to 

IncraaaIng cornplai-da of '*'" dIange In tymptoms. and a/IenId body mechanlca. _ did 

not prtICeed further than the partk:uIer vall.MiI\I noted abOve. 

Projec:ted vaIueI regarding the pallent'l ability to pedorm Ih8 abOva rnanfioned tasks an 

a frequent or c:onstII'It ba&i$ In caletAllted by takin{J the approJdrnate 50% at the values 

in the ptCJIIiout c:oIurM. 
829 

Ma r. 30.2007 2:30PM No. 9950 P. 6 

PageS 

Funclfonal Capacity Evaluation 

Name: , $ 

Date: 0IIJ2W2006 

NONMATERIAL HANDYNG AC1M1JESi 

Never OccasIonal Frequent Constant 

Reaching: X 

Sitting: X 

StandIng: (up to 2 hounI at a time) X 

Walking: (uP to 2 hours at a time) X 

FIngeI1ng: X 

RepetiIIw Bending: X 

KneeUng: X 

Static SquatICroucIr. X 

RepeIItlveSquat X ~8 Aim and Leg Movements: X 

Crawling: X 

StaIr Climbing: ;iC . 

COMMENTS; It should be noted the patient attempted aU actiYitIea; hoWever. when 

petfo/'mitIg kneeling and squatting tile pdent was able to get Into the posiIIon, but 

requinMt P$iItance to get out d the potIiIIon. SIttIng was obaeMd to be 15 minutes or leu before changing posiIion& or requesting to 1Iand. standing was again 15 to 20 

mirIutea befoIa requesting to IIil With walking. the patient ambUlated very slowly with II 

limp on the 18ft. With stair climbing,' the patient took 2 minutes and 20 eeconds to 

ascend and dafKlend 12 steps v.1tictI normally fBkIIs Iesa than 30 sec:oncIe for !he 

average indMcIuaL WiItt climbing !he IIeps, he perfonnad a etep.to paUem IeadIno with 

tile left w.r extremity and I1IQWing Ii9n1licant upper extremity support. 

P.AlNlFUNC119N QUESTJQNHA!RES: In conjunction oMth the Functional Capacity Ev8IuaIion. the patient comp/eIIIId a __ of peinIfuncIIon questlonnaitas aIao for the 

putpO$8 at 8I88SIIing the presence and degIee of inapJIn:IpIiate IIIneI8 behavior. Tha 

patient IIOIWd posltive In 12 out of 14 CIIfegoriee. which suggests a high level at 

Inappropriate 0If\eM behIwior from a aubjecllve atandpCint. 

1. TlIe vaIuu given appear to be valid and objectiVely dkt not present with symptom 

magnification or inapplOPllate Illness behavior, however, test queslioonai'e 

Indicated high IaWI8 01 inappropriaIa illnills behaVior. 

2. The patient', IetIvitIN qualify him for a sedentiIIy phyIIcal demand level of wortc 

based on the U.S. Department d Labor Standardi as outlined in the QjCtionary of 

t'lrg!l!!flooe! Tilles· . 3. Refer the patient bac:!c to .¥IIh the findinga of tIlll Functional Capacity 

EvaluaUon In order to tIIIabIisIl hls'Ml/tt QlJllbiIitie, and reaIIIotiona therein. 
830 

Mar. 30. 2007 2:31PM No. 9950 P. 7 

PageS 

Functional C8paciIy Evaruatlon Date: 

4. Based on the objective findlnga ~ tile Func:tIonaI Capacity evaluation It would 

appear that the patient could not return 10 work at this time. With obseIved 

damonsIration of the inability 10 8ft greater than 15 mInuIea or stand greater than 

15 m~. the patient would be tnerrectlva In an oIIiG8 situation. Howaver, this 

deCillIon as alwayS .. 18ft 10 the discraIIon and judgment of the refeIring physidan 

based on his 8III8SIII'II8nt and !he data from tfIe patient'l .FunctionaI Capadty Evaluation. ' . 

This evaluator can· only IIapa that the fincfinga of thi$ evaluation Win he/J) aid the 

physIdan, the patient, the employer, and the case MarltlgGr in the IWOMIon of this 

caae. or at least provide InfonnaIiDn to help aid this individual In oIher employment 

opportunities for this Individual. 

If I can be of fuJther lI8Siatance. please do not hesitate 10 contact me. Thank you wry 

much,-forthe I'8ferraI oIlhis nU;e genIIeman. 

Sincerely, 

---------- NYHialb 

cc: .... ----.... ". 
831 

03/0612007 WE 17:40 FAX •••••••• 

ENCOUNTERS~RY 

New Work Comp 

NAME:. 

CHART: 

DATil; 02-07-07 

Dare: 

Doctor .rRccord: 

Examiner: 

The oariM' M"!iIIUes to have back and left leg relmed p.in. The patient was m:Jnaged ;.._ 

~. j _____ 1 COtJtemplared a fusion and I concur that this- was a .reasonableoption. The patient doclined surgery and conIinues II) dc<lioe surgery as of thiN day's date. 

He has olready undergone a FeE. He is ther.rOT!! by definition at MMI. He con return to 

work tomorrow with restrictions .as outlined per FeE. His Lurccl prcsc:rlption is coDvened to 

\..Qrtab 7.5 mg ti.d.II9O. one p.o. ci.d. p.r ••• with six moom refill. Thol;c can be renewed 

through this office or [ would prefer through Southwtern Pain Management. I do DOl see 

an)' reason what so ever to ~lDEe or incr~ hilt nllfcoLic reqlliremeat and do believe that 

be shoul<i be reCOlTOd [0 • pain =gement group SQ they""" wean him from Lortllb 1<. 

anti .. inn:tmmaloricN H\1L't'·I.he-COunl.er alooe. 

Jfis physical examination demo",= a positive ,!(aight leg rai,e On the left. He does bave 

the sug.,"OSriQn ot' anterior column !'ailure 0' !lie right. He bas no DlOlar or ."",,,.ty deticits. H. 

bas no coif atrophy. H. does hove some incn:a.'iCd hamslring tonicity. No .p .. ", is identified 

although some tenderness is subjectively reponed to palpation at caudal U·S 1 level. 

DIAGNOSIS: nz,S2. 

Return visit hele is 10 bep.r.n. Per Virginia Worli: Olmp ,tJmdardand reviewol liMA 

Guides II) the Evaluation ofPenruwenllmpainnent. 5th FA;'on. the palien' would have 0% 

impaimu:::nL 

Dictated but not edited by: ) --... -------......... 

"'~3Ii:. MPu.j.j 

DO; 00-07-07 D'l': 02-Q9..{)7 

00/0612007 S;J8:53PM Pagel 

Permanent Subcommittee on Investigations 

EXHIBIT #18d 

~013/028 
832 

Fono Appt'Ovul 

Ol\ffi No. 096O-l).413 

PSYCHIATRIC 

A. As.ws!;ment is from: 8125105 to Present 

B. Medical Dbpositi.on(s}: f 

o No Medically Determinable Impairment 

2. IS.J Imp.irment(s) Not Severe 

3. 0 Impairment(.) Severe But Not E,(pected to Last 12 Months 

4. 0 Meets Listing (Cite Listing) 

5. 0 Equals Listing (Cite Listing) 

6. 0 RFG Ass",,,,ment Neeessa!}' 

7. 0 Coexisting Norunental Impairment(s) that Requires Refeml to Another Medical Specialty 

8. 0 Insufficient Evidence 

C. Category(ies) Upon Which the Medic.1 Disposition i. Baud: 

1. 0 12.02 OrgallicMentalDisorders 

2. 0 12.03 Schizophrenic. Paranoid and Other Psychotic Disorders 

3. !Xl 12.04 Affective DisordeJl! 

4. 0 12.05 Mental Rec1rdation 

), 0 12.06 Amciety-Related Disorders 

6. 0 12 07 Sornatoform Disorders 

7. 0 12.03 Personality Disordern 

3. 0 12.09 Substance Addiction Disordm 

9. 0 12.10 Autism and Other Pervasive Developmental Visordm 

!Xl These findings complete the medic.1 portion of the di"ability delenninDtion. 

Permanent Subcommittee on Investiaations 

EXHIBIT #18e 
833 

II. DOClTl\ffiNTATlON OF FACTORS THAT EVIDENCE THE DISORDER 

A. 12.02 O"ganic Mental Disol'de.'S 

D Psychological or behaviornJ abnormalities .",oci.ted with. dysfunction of the brain .. as e\~denced by at lenst one 

of the following: 

j. D Disorientation to time and plaoe 

2. D MemoJ}' impajm~~nt 

3. D Perceptual or thinking disnlTbances 

4. 0 Change in persoll3lity 

5. 0 Disturbance in mood 

6. 0 Emotion.IIability and impairment in impulse control 

7. 0 Loss 01 measured intellectual ability of at least 15 IQ points from premorbid levels or overoll imp.irm""t 

index clearly within the s(:verely impaired range on neuropsychologic.:,1 testing. e.g., the Luria·Nebraskn, 

Holstead-Reitan, etc. 

o A medically determill3ble Impairment is present that does not precisely satisfy the diagnostic criteria above. 

Disorder 

PertillOnt symptoms, signs, and l,boratOlY tindings that substantiate the presence of the impairment: 

o Insufficient evidence to substantiate the presence 01 the disorder (e" .. plain in Part IV: Consultant's Notes). 

Form SSA-Z506-BK (9-2000) (2) 
834 

B. ] 2.03 Schizophrenic, Paranoid and Other Psychotic DisOl-del"S 

o Psychotic features and deterioration that are persistent (continuous or intennittent), as evidenced by at Jeast one of 

the following: 

I. 0 Delusions or hallucinations 

2. 0 Catatonic or other grossly disorganized behavior 

3. 0 Incoherence, loosening of assoei,tions. illogical thinking. or poverty of content of speech if associated 

\vith one of the following.: 

n. 0 Bltmt affect, or 

b. 0 Flat affect, or 

c. 0 Inappropriate affect 

4. 0 Emotional withdrawal and!or isolatiM 

o A medically determinable impairment is present that does not precisely satisfy th~ diagnostic criteria above, 

Disorder 

Pertinent symptoms, signs. and laboratory findings th.t substantiate the preset!';' of this impairment. 

o Insufficient evidence to substantiate the presence of the disorder (expl.in in Part IV. Consul~mt's Notes). 

Form SSA-l~06_BK (9.!OOO) (3) 
835 

C. 12.04 Affective Disorders 

o Dlsturbtmce of mood, accompanied by a fuJI or partial manic or depressive sYTldrome. as evidenced by at least one 

of the following: . 

l. 0 Depressive s}ndromo chameterized by ot least four of the following' 

3. D Anhedonia or pen'asive loss of interest in almost aU acti\'ities, or 

b. 0 Appetite disturbance wiu, change in weight, or 

c. 0 Sleep di.,turbonce, or 

d. 0 Psychomotor agitation or retardation, or 

e. 0 Decreased energy, or 

o F eclings of guilt or wotthlessness. or 

g. 0 Difficulty eoncelltmting or thinking, or 

h. 0 Thought, of suicide; or 

i. 0 Hallucinotion" delusions or pamnoid thinking 

2. 0 Manic S}ndrorne characterized by at least three of the following: 

a. 0 Hyperactivity, OT 

b. 0 Pressures of speech, or 

c. 0 Flight of ideas. or 

d. 0 !nIlated self-esteem, or 

e. 0 Decreased need for sleep, or 

DEasy distmctibility, or 

g. 0 Involvement in ~ctivitieS ~th.ve a high probability of painful consequences which are not 

recognized. or 

h. 0 Hallucinations, delusions or pamnoid thinking 

3. 0 Bipolar syndrome "ith 0 history of episodic periods manifested by the full symptomatic picture of both 

manic and depre...'\Sive s}ndromes (and currently charac·terited by either or both S)Tldromes) 

IS] A medically determinable impairment is pres,ent that does not precisely satistY the diagnostic criteria above 

Disorder TP trtmnt for depresison 

Pertinent symptoms, signs, and lab<lratory findings that substantiate the presence of this impairment (;:.""I<1;n in 

Part IV, Consultant's Notes, if nocessary); 

o Insufficient evidmce to substantiate the presence of the disorder (e""lnin in Part IV, Consultant's Noles). 

Fmll5SA~1~06-8K (9·1000) 
836 

D. 12.05 Mental Retardation 

o Significantly subaverage genernl intellectual functioning with delicits in adaptive functioning initially manifested 

during the developmental period; i.e., the evidence del1l<lllStrntes or supports onset of the impairment before 

age 22, with one of the following: . 

L 0 Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileling. ""ling, 

dressing, or b.thing) and inability to follow instructions such that the use of stancJardized measures of 

intellectual timctioning is precluded-

•. 0 A valid verbal, performMce. or full scale lQ of 59 or less* 

3. 0 A valid verbal, performance, or full scale IQ of 60 through 70 and a physical (If other mental impairment 

imposing an additional and significant work-rel.ted Iimitotion of ftmction' 

4. 0 A valid verbal, performance, or full """Ie IQ of 60 through 70· 

o A medically determinable impairment is present UUlt does not precisely satisfy the diagnostic criteria above. 

Disorder 

Pertinent symptoms, signs, and l.bomtmy findings that substantiate the presence of this impairment 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV. Consultant' s Notes) 

·NOTE: ficms 1. 2. ~. mId .. corr~olld tOo (jstin~ 11.lY.'A.12.05B. 12.05C. and n.05D. re.-,-pecti\'eIy. 

FOOl) SSA·2506-BK (9.:!OOO) ($) 
837 

E. 12.06' An:tiet)'-Related Disol'ders 

o An.xiety as. the predominant distwbance or anxiety e:\.}lerif"JlCed in the altempt to master syroptC!ms, as evidenced by 

at least one of me following: 

I. 0 GeneIll!ized persistent Rmciely accompanied by three of the following: 

•. 0 Motor tension. or 

b. 0 Autom)mic hypeIllctivity, or 

c. 0 Apprehensive expectation. or 

d. 0 Vigilance and scanning 

2, 0 A persistent irrational fear of a specific object1 9Ctivity or situation which resull'i in a cornpeUing desire to 

aVClid the dreaded object, activity, of situation 

:\. 0 Recurrent severe panic alUlck.s manifested· by a sudden unpredictable onset of intense apprehension. fear, 

terror, and sense"of impending doom occurring on the average of at least once a week. 

4. 0 ReClDTent obsessions or compulsions which are iii source of rnarl:.ed distress 

5. 0 Recurrent and inllU.o;cive recollections of a tn:mmatic txperienc..c:. which are a source of marked distress 

IX] A mooi""Uy determinable impairment is present that does nbt precisely satistj; the diagnostic criteria above, 

Disorder TP trtmt for anxiety 

Pertin~nt symptoms. signs. and laboratory findings that substantiate the presence of this impairment: 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV. C',()nsu!tant's Notes). 

Fonn SSA-1506-BK (9w],OOO) (6) 
838 

F. 12.07 Somatofonn Disordel'$ 

o Ph,ysic.aJ symptDms for which there are ltD demonstrable organic findings or known phySiological mechanisms, as 

evidenced by at lea.t one of the following: 

I. 0 AhistolY of mlrltiple physionl symptoms of severnl years duration beginning before oge 30, that Mve 

caused Ule individual to take medicine frequently, see a ph~~ician often and alter life patterns significantly 

2, 0 Persistent nOOOIgaruc disturbance of one of the following; 

a. 0 Vision. or 

b. 0 Spaech. or 

c. 0 Henring or 

d. 0 Use (If. limb, or 

e.' 0 Movement and ils control (e.g., coordination disturbances, l"ychogcnic seizur~, akin""i., 

~y.sk:inesia), or 

f. 0 Sensation (e.g.. diminished or heightened) 

}, 0 Unrealistic in,terpretation of physical signs or sensstions associated 't,'ith the preoccupntion or belief that 

one has a ,serious dise3$~ or injwy 

o A medic~dly de.terminable impairment is present that does not precisely satis.ty Ule diagnostic criteria aoove, 

DisorderPertinent symptoms, signs, and laboratory lindings that substantiate the presence of this impairment: 

o Insufficient evidence to s"bstanti.te the presence of the disorder (explain in Part IV, COll.<Il1tant' s Notes). 

FOllu S.<L-\-1506·BK (9·2000) (1) 
839 

G. 12.08 Pel .. onality DIsOI"del .. 

o InflexibJe and mnladaptive personality traits whicli cause either significant impairment in social or occupational 

functioning or subjective distre....s, as evidenced by at leest one of the foUowing: 

o Seclusiveness or autistic thinJdng 

2. 0 P.thologi""lly inappropriate slI'Piciolisness or hostility 

3. 0 Oddities of thought. perceptiO!\ speech and behavior 

4. 0 Persistent disturoanc.es of mood or afloct 

5. 0 Pathological dependence, passivity, or aggressivity 

6. 0 Intense and unsrobl. interperson.l rel.tionwps and impulsive and damaging behavior 

o A medically determinable impairment is present that does not precisely satistY the diagnostic criteria above. 

Disorder 

Pertinent symptoms. sigriS, and l.boratory frndings that substantiate the presence of this impairment 

o Insufficient evidence to substantiate the presence of the disorder (explain in Part IV, Consultnnt's Notes). 
840 

H. 12.09 Substance Addiction Disorders 

o Behavioml changes CIt physical changes aSSCIciated with the regular llse of substances that affect the central 

nervous sy-stem. 

If present, evaluate under one or more of the most closely applicablo listings: 

I. 0 Listing 12.01---0rganic mental disorde",-

2. 0 Listing 12.04-Affective disorders' 

3. 0 Listing 12.06-.<\n,xiety-reloted disord",," 

4. 0 Listing 12.0S-Personality disorders" 

5- 0 Listing I L I4--Periphernl neuropalhies' 

6. 0 Listing 5.05--Lil.ter damage'" 

7. 0 Listing 5.04-CTRstritiS· 

S. 0 Listing 5. DS-Pancreatitis' 

9. 0 Listing 11. 02 or I L D:1-Seizures* 

o A medically determinable impairment is present that does not precisely satisfy the diagnostic cliteria above. 

Dis('Irder 

Pertinent symptoms, signs, and laboratory fIndings that substantiate the presence of this impairment: 

o Insufficient evidence to substantia;e the presence of the disorder (explain in Part N. Consultant's Notes). 

"NOTE: It~n}S: L 2. 3 ... :1. 5, 6. 7. S.nnd 9 ,orre;;:pondtolistio~ U09.-\.. U..09B.12.09C. J2.09D.ll.09E.ll.09F. U09G. ],;t0911 nod }'2.09L 

respectivef't'. JfJtC:IllS 1. 2. 3.or4 afe d)ed::ed. onrythe t'lInbertdj~ms instlb:Sedions UA. nc.1IE. or DGOftJlt fonn need be dlCd;:c;d. TIle flfSt block ulKh tbt! diso'fder he.'1dinp: iu those subs~ions should not be chected unless ~ ,vidence substanti"trs the pre;!OlCe of the (~sorck:r sepru1lte from-the :rubstNlCt ,,(klidion disorckr. 

(9) 
841 

I. 12.10 Autistic Disol-der and Other Pel-vasive Developm"ntai DisOl-d<'l'1' 

o Qualitative deficits in the de'relopment ofreciprocaJ social intemction, in the development of ver-hal and nonverbal 

communication skills. and in imaginative activity. Often there is 0: markedly restricted repertoire of acth'ities and 

intere$ts. which frequently ace stereot)ped and repetitive. 

J. 0 Autistic disorder, with medically d"""mented find~ of all of the following: 

a. 0 QuaJitathre deficits in reciprocal social interaction 

h. 0 QuaHlative delicits in verbal and nonv~.al conlmunication and in imaginative acti1rity . 

c. 0 Markedly restricted repertoire of activities and interests 

2. 0 Other pervasive developmental disorders, with medicslly documented fmdings of both of the following: 

3. 0 Qualitative deticits in reciprocal social inteIilction 

b. 0 QuIlHtative deficits in verbal and nonverbal corunnmication and in 1nlaginative Dctivlty 

o A medicnUy determinable impairment is present that does not precisely satisfy· the diagnostic criteria above. 

Disorder 

Pertinent symptoms, signs. and JaboratoJ)" findings th~t substantiate the presence of this impairment: 

o Insllffioient evidence to substantiate the presence of the disorder (""1"ain in Part IV. Consultant's Nota,). 

(10) 
842 

IlL R>\TlNG OF FUNCTIONAL LIMITATIONS 

A. "B" Clitelia of the Listings 

b1<licate to what degree the following fumtionallimitations (which are found in porngraph B ofiistings 12.02.12.04. 

12.06-12.0S and 12.10 and parngraph D of 12.(5) exist as a result of the individual's mental disorder(s). 

N01E: Item 4 below is more than a measure of frequency and duration. See 12. 00C:4 and also .. ad carefully the 

instructions for this section 

Specify the listing(s) (i.e .• 12.Q2 throush 12. 10) under which the items below are being ra';d 12.04, 12.06 

FUNCfIONAL 

LIMITATION DEGREE OF LIMITATION 

Insufficient 

l. Re.''itriction of Activities None Mild Moderate . M",ked* Extreme*- Evidence 

of Dail~ LiYing 0 ISJ 0 0 0 0 

Insufficient 

2. Difficulties in Maintaining None Mild Moderate Mnrked* Extreme* Evidence 

Social Functioning f:{] 0 0 0 0 0 

Insufficient 

3. Difficulties in Maintaining None Mild Moderate Marked' Extreme- Evidence 

Concentration, Persistence, 0 f:{] 0 0 0 0 or Pnce 

One Four* 

or or. b1.."llfficient 

4. Repeated Episodes of None Two 1bree* More E"'idence 

Decompensation, Each of ~ 0 0 0 0 Extended Duration 

iIoD~ oflnJ.lifl'lt1onth."tsatisfi~ tht: fimctlon,'II cri1c:"(l11. 

FOim SSA-2506-BK (9-::WOD) (11) 
843 

B. "C" Critnia of the Listings 

l. Complete Ihis s«tion if 12.02 (Organic Mental), 12.03 (Schizophrenic, etc.), or l2.04 (Affective) applies IUld the 

requirements in paragraph B of the appropriate listing are not satisfied, 

NOTE: Item I below is more than a measure of frequency and dt~atioll See 12.0OC4 and also read carefully the 

instructions for this section. 

o Medically dOCtlmented histmy of a chronic OfgroriC mental (12.02). ~chizophrenic, etc. (12.Q3), or affective (12.04) 

disorder of at Jt:aSt 2 yerus' duration that has cau'ied more than a minimal limitation afability to do any basic work 

activity. with symptoms or signs currenUy attenuated by medication or psychosocial support, and one of the 

follmving: 

l. 0 Repeated episodes of decompensation, each of .. ,tended durntion 

2, 0 :.:\. residual disease process that has resulted in such marginal adjustment that even a minimal increase in 

menlal'dernands or clmnge in the environme;nt would be predicted to enuse the individual to deoompen..<I.3te 

3. 0 Current histmy of I or more years' inability to fimction outside a highly supportive living arrangement 

WitJ1 an indication (If continued need for such an arrnngement 

/Xl Evidence does not establish the presence of the "C" criteria 

o Insufficient evidence to establish the presence of the "C" criteria (e~1'I.in in Part IV, Consultant's Notes), 

2. Cmnplete Ihis sec~on if 12.06 (An.'<iety-Related) applies ltIId the requirements in paragrnph B of listing 12.06 are 

not satisfied, 

o C;orupJete innbility to function independently outside the area of one's home 

IX] Evidcmce does not establish the presence of the 4·C'· criteria 

o Insufficient evidence t6 establish the presence of the "C" criterion ("'Plain in Part IV. Consull'Utt's Notes). 

Fonn SSA-l~8K (9~2000} (12) 
844 

IV. CONSULTANT'S NOTES 

35 YOM ALlEGES nerve problems. 

9/27/05 reports somewhat anxious and depressed due to no improvement of his 

back symptoms. DX: anxiety. TX: start Jdonopin 

3/9/06 reports he is continued on Klonopin. Notes full orientation, NAD 

5/4/06 reports he does not be in any acute physiologic distress and is not 

overtly depressed. 

ADLs: performs personal care with assistance, wife does household chores and 

cooking, does not drive due to his medications, handles finances, enjoys 

talking to family. he reports problems with concentration. reports using a 

cane for ambulation. 

No evidenc.e of formal mental health treatment IP psych admissions. 

Suggest the claimant has a non"severe mental impairment. 

Based on the evidence of record, the claimant's statements are found to be partially 

credible. 

RECON INFO: 

Worsening condition: Insomnia worse, anxiety problems. 

New conditions: Trouble concentrating, remembering and focusing. 

PRTF: 7/06: Easily responsive to stimulation. Oriented X 4. Well groomed, cooperative 

and has a normal ability to communicate. 12/06: Does not appear to be depressed. Noted 

to be taking Klonopin. 

ADL: Reports no significant changes in pain questionnaire answers and ADL's from 

previous decision. 

Section 223 and section 163:\ of tho Social S""urily Act authorize the information requested on this form. The 

information provided will be used in making a d~cision on this claim, C',ompletion of this l'0rm is mandatory in 

disnbility claims involving Dlenbl impairments. Failure ttl conlplete this foml may result in B delay in processing the 

claim. Information furnished on this form may be disclosed.by the Social Security Arlm.lnistrntion to another person or 

governmental agency only \~'ith respect to Social Se.;urityprograms and to comply with federal laws requiring the 

exchange of information between Social Security and another agenc).·. 

We may also use the inforrn~tion YOli give llS when we match records by computer. Matchingprogmms compare our 

records with those of other Federal. State, or local government agencies. tvIany agencies may lL~ nlatchingprog:rnms 

to fmd or prove that a person quaHfies for benefits paid by the Federal government The law allows us to do this evro 

if )'0\1 do not agree t\,1 it, 

Explanations about these and other reasons why information about you may be u..~d or given out are available in Social 

Security offices. U you want to learn more about this, contact any Social Security office. 

PAPERWORK REDUCTION ACT STATEMENT: The Paperwork Reduction Ad of 1995 requires us to notify you 

that this information collection is ill accord8!1ce with the c1earnnce requirements of section 3507 of the Paperwork 

Reduction A.ctoi 1995. \Ve may not conduct or sponsor, and you are not required to respond to, a collection of 

information unJess it dispia)'s a valid OMB control number. \Ve estimate that it will take you about J 5 minutes to 

complete this form. This includes the time it will take to read the instnlGtiollS, gather tho neces$!lT}' faclS and till out the 

!\1rm. 

(13) 
845 

Suggest no changes to original decision. 

Section 223 and section 1633 of the Social Security Act authorize the information requested on this fonn, The 

information provided wiH be used in making a decision on this claim. Completion of this form is mandatory in 

disability claims inv(llving mentnl impairments, Failure to complete this form mny result in a deJay in processing the 

claim. Information .fumi~he<f on this t'onn may be disclosed by the Social Security Administration to another person or 

governmental agency only with respect to Social Security progrnms £llld to comply with federal laws requiring the 

exchange of information between Social Security and another agency. 

\l/e may also use the infonnl'ltion you give 1J:I> when we match records by computer. lvintching programs compare our 

rec<Yrds with those of other Federal, State, or local government agencies. l\1any agencies may \lse matching programs 

to tind or prove that a person qualifies for benefits paid by the Federal government The law nUows us to do thi-; even 

if you do not agree to it 

R~lanations about these nnd other reasons why information nbout you roilY be used or given out are avaiJable in Socia! 

Security offices. If you want to Jearn more about this, contact any Social ~ecurity office. 

PAPERWORK REDUCTION ACT STATEMENT: The Paperwork Reduction Act or 1995 requires us to notify you 

that this information collection is in accordrulce with the clearance re"luirements of section 3507 of the Papenvork 

Reduction Act of J 995. W'e may not conduct or sponsor, and you nre not required to respond to, a coIl~tion of 

information lmie.'is it displays a valid 01.f8 control number. \Ve estimate that it will take you about 15 rninutes to 

complete this form. This mcludes the time it wiiJ take to read the instructions, gather the necessary fa cts and fin out the form. -. . 

(1l) 
846 

PSYC~OLOGY 

From: 

Examiner Name 

Reviewer Name 

Claimant Name ISex 

I aM 

Type ofCf8lm f8I DIB DDAC DDWB 

Case History o INtTIAL 181 RECON 0 ALJ 

o 'COngressional or Controlled Inquiry 

o Reopening of Prior Decision 

o Prior ALJ, ACt Court Decision 

o Prior Disability Established' _______ _ to 

Date Last insured or Prescribed Period 

Please Review the Medical Evidence and Respond to the following: 

Examiner Telephone Number 

Reviewer Telephone Number 

Birth Date (mo, da, yr) I Application Date (mo. da, yr) 

OF , a . 05/02/2006 

o SSI ADULT 0 SSI CHILD 0 BLINDNESS 

DDHO OTERI 

o CDR Involved 

CPO Date 

Cess. Date 

o Age 18 Redetermination 

DOU,.r 

Alleged Onset 

09/25/2005 

II Please provide an assessment of the individual's current residual functional capacities. 

D SSI Childhood - Piease prepare SSA-538 

o Physical I&l Mental 

o Please provide an assessment of whether there has been medical improvement (M!) in the inividual's impairment(s) since CPO. 

IfM! has occurred, a decision is needed as to whether MI is related to the individual's ability to work. 

o CPD was based on meeting/equaling listing __________ _ 

o RFC Comparison Needed. 

o Speci~c problems or questions: 

Please see form in shared drive. suggest no changes to original decision. 

o Continued on Attached Sheet 

Form SSA-44&: {5·2004} ef (11).2004) Destroy F Permanent Subcommittee on Investigations 

EXHmlT#18f 
847 

DDD 

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dIr.Rory. 

I. LIl\1ITATIONS: 

For Eacb Section A - F 

==> Base your c·onclusions on aU t"\idence in file (cliniC!l1 and ISliarBtOIY flDdings~ Sj'mptoms', observations:. Jay evidence; 

reports Clf daily activities; etc.). 

==> Check the blocks \\'hich reflect your reasontd judgment. 

==> Describe oow the el"idence substantiates your condwiom. (Cite specific clinical and laboratory findings, 

observations, lay e\·jde-nce. etc.). 

==> Ensure that you have reqt~ted: 

• Appropriate treating nnd examining Source statements regarding individual's' capacities (DI 22505.oooff and D1 

22510,OQOff.) and ibat y<ltl have given appropriate ,,'eight to treating source conclusions. (see section !II) 

• Considered and responded to any alleged UmitatioDS imposed by symptoms (pain, fatigue, etc,) attributable. in 

your judgment. to ~ nledicaHy determinable impairment. Discuss your ~ment of symptom-related iimit.:'1tions 

In the e:\.--planation for your conclusions in A~F below. (See also section II) 

• Responded to aU allegations of phy-sicailirnitations or factors \vruch can cause physk:aI limitations. 

==> Fre-quently means occurring one-third t('l hVOMthirds of an 8Mh(lut workday (cumulative, not continuous). 

Occasionally means ocC\uring from \'uy little 'Up to Me·third of an 8Mho'Ur work day (c'Umuh:ttive, not oontinuous), 

USE PRIOR IDmONS) CONTINUED ON PAGE 1 

PAGE 1 
848 

A. EXERTIONAL LIMITATIONS 

ON one established. (Proceed to section B.) 

1. Occasionally lift andlor carry (including upward pulling) 

(maximum) -- when less than one-third of the time or less than ten pounds. e:l.l'lain the amount 

(time/pounds) in item 6. 

o less than 10 pounds 

o IOpounds . 

tIl 20 pounds 

o 50pounds 

o 100 pounds or more 

2. Frequently lift andlor carry (including upward pulling) 

(maximum) -- when less than two-thirds of the time or less than ten pounds, explain the amount 

(time/pounds) in item 6. 

o less than 10 pounds 

tIl 10 pounds 

o 25 pounds 

o 50 pounds or more 

3. St:md andlor walk (with normal breaks) for a total 01'--

o less than 2 hours in an 8-hour workday 

tIl at Ie-,st 2 hours in an B-hour workday 2 - 3 hours 

o about 6 hours in an g-hour workcLw' 

o medically required hand-held assistive device is necessary for ambulation 

4. Sit (with normal breaks) for a total of _. 

o less than about 6 hours in an 8-hour workday 

m about 6 hours in an B-hollr workday 

o must periodically alternate sitting and st.mding to relieve pain al~d discomfort. (If checked. 

e:l.1,I3in m 6.) 

5. Push andlor pull (including operation ofhandlfoot controls)-· 

m unlirrrited, other than shown for lift andlor carry 

o limited in upper e:l.iremities (describe nature and degree) 

o limited in lowel' e:l.iremities (describe nature and degree) 

6. Explain how and why the evidence supports your conclusions in items 1 through 5. 

Cite the specific facts upon which your conclusions are based. 

See Attached 
849 

B. POSTURAL LIl\flTATIONS 

o None established. (Proceed to section C) 

The claimant is a.ble to frequently use rnmps and' Frequently Occasionally Nevel' 

I. Climbing - ramp/stairs climb stair... The claimant 

- ladder/rope/scaffolds should never climb ladders. o .0 

2. Balancing ropes or scaffolds. 0 . 0 

3. Stooping 0 0 

4. Kneeling 0 0 

5. Crouching 0 0 

6. Cra,,1ing 0 0 

7. \\-'hen less than I,vo-thirds of the lime for frequently or less than one-third of the time for 

occasionally, fully describe and explain. Also explain how and why evidence supports your 

. conclusions in items llhrough 6. Cite the specifIc f..cts upon which your conclusions are based. 

See Attached 

C. MANIPULATIVE LIMITATIONS 

o None established. (Proceed to section D.) 

LIMITED UNLIMITED 

1. Reaching all directions (including overhead) 0 0 

2. Handling (gross manipulation) 0 0 

3. Fingering (fine manipUlation) 0 0 

4. Feeling (skin receptors) 0 0 

5. Describe how the activities checked "limited" are impaired. Also, explain how and why the 

evidence supports your conclusions in item I through 4. Cite specitic f3ct~ upon which your 

conclusilm is based. 

See Attached 

D. VISUAL LIl\flTATIONS 

ts'lNone established. (Proceed to section E.) 

LThflTED UNLThflTED 

o 0 

o 0 

o 0 

o 0 

r. Near acuity 

2. Far acuity 

3. Depth perception 

4. Ac<oommodation 

5. Color vision 0 0 

6. Field of vision 0 0 

o 

o 

o 

o 

o 

o 

7. Describe how faculties checked "limited" are impaired. Also explain how and why evidence 

supports your c{)nclusions in item I through 6. Cite specific facls upon which your conclusions are 

ba,ed. . . 

See Attached 
850 

E. COMMUNICATIVE LIMITATIONS 

IKI None established. (Proceed to section F.) 

LIMITED UNLIMITED 

L Hearing D D 2~~q D D 

3. Describe how the faculties checked in "limited" are impaired. Also. explain how and why the 

evidence supports your conclusions in items I and 2. Cite the specific faots upon which your 

conclusions are based. 

See Atl.1ched 

F. ENVIRONMENTAL LIMITATIONS 

D None.established. (Proceed to section II.) 

AVOID AVOID EVEN 

CONCENTR~TED ~fODERATE 

UNLIMITED EXPOStlRE EXPOSURE 

AVOID ALL 

EXPOSllRE 

1. E:-."treme cold ill D D D 

2. El.ireme heat ill D D D 

3. Wetness 0 D D D 

4. Humidity ill D D D 

5. Noise ill D D D 6. Vibration ill D D D 

7. Fumes. odors. dusts, 

gases, poor ventilation, etc. ill D D D 

8. Hazards (machinery, 

heights. etc.) D D D m 

9. Describe how these environmental factors impair activities and identify hazards to be avoided. Also, 

explain how and why evidence support. your conclusions in items 1 through 8. Cite the specitlc 

facts upon which your conclusions are based. 

See Attached 
851 

U. SYMPTOMS 

. For symptoms alleged by the claimant to produce physical limitations, and for which the following have 

not previously been addressed in section I. discuss Whether: 

A. The syrnptom(s) is attributable, in your judgment, to a medically determinable impairment 

B. The severity or duration' of the symptom(s), is in your .iudgmen~ is disproportionate to the expected 

severity or e';pected duration on the basis of the claimant's medically deterolinable impairment(s). 

C. The severity of the syrnptom(s) and it's alleged effect on function is consistent, in your judgment. 

with the total medical and non-medical e"dence, including st;,tements by the claimant and others, 

observations regarding activities of daily Jjying. and alterations of usual behavior or habits. 

See Alta ched 

III. TREATING OR £,XAMINING SOURCE STATEl\JENT(S) 

A. Is treating or examining source statement(s) regarding the claimant's physical capacities in file? 

mYes o No (includes situations which there was no source or when tbe 

source(s) did not provide a statement regarding the claimant's 

pbysical capacities.) 

B. If yes, are there treating/examining source conclusions about the clainl.1nt's linritations or restrictions 

which are significantly different from your findings? 

mYe. DNo 

C. If yes, explain why those conclusions are not supported by tbe evidence file. (Cite the source's 

name and the statement date) 

See Attached 

MEDICAL WNSTJLTANT'S SlGNATURE MEDICAL CONSULTANT'S CODE DATE 

.. 32 41YOi 
852 

RFC Continuation 

Sections Being Modified 

SSA-4734-UA - Physicai RFC 

El Section I. . Limitations 

El Section II.. Symptoms 

El Section III. Medical Source Statements 

--

SSA-4734-BK-Sup - Mental RFC . SSA-2506-BK - PRTF 

o Section Ill. Functional Capacity Assessment o Psychiatric Review Technique Form 

SSA-538-F6 - Childhood DIsability Evaluation Form 

o Section Ill. E~l'lanation o[Findings • 

These findings complete the medical portion of the disability detennmation. 

The daimant alleges disability due to se\'ere back and leg pain. nerve problems, numbness, insomnia du.; to 

pain, and bulging disc. He reports his condition. He alleges that these symptoms result in limit.,tions in 

standing, w.lking, lifting, carrying and performing at a consistent pace. The medical evidence establishes a 

medically determinable impairment ofDDD. 

09119/05: MRI showed right posterolateral L4-5 disk bulge wfo herniation or 

mass effect; asymmetric lumbosacroili.c articulation; minimallevoscoliosis. 

12/14/05: TP noted claimant clo continued bilateral LE pain to his thighs 

despite ESI on 11/17/05. 2nd ESI administered. 

02/02/06: CT showed minimal DDD at L4-5 and L5-S1 wfo evidence ofnerye root 

compression. Normal bone scan study. 

03/14/06: lumbar discogram showed abnormal p.in and left-sided leg p.1in at 

L51S1: right-sided facet arthrogram produced back pain and bilatealleg pain; 

positive concordant back pain at S I/S2 with a posterior te.t within the disc. 

TP asse.$sed that the caudallurubosacral disc junction was the majoc problem. 

03/27/06: TP noted no acute physiological distress, back pain with walking and 

getting up, 217#, positive SLR on the left at 70 degrees. TPnoted probable 

construct and dynamic stabilization of the symptonlatic disc, fusion oflbe 

symptomatic disc with a rudiment.1f)' disc. and a f.cet joint fusion. 

5/4/06 f'u - elmt wishes to proceed with pain mgmt before having surgery. PE: 

2171bs, positi"e SLR on left, mo,'es about with an ant.11gic gait. DX: 

multi-level DDD, accelerated by his work iIljury. 

ADLs: pertorms persoR.11 care with assistance, wife does household chores and 

cooking, does not drive due to his medications, handles fmances, enjoys 

talking to lamil y. he reports problems with concentration. reports using a 

cane for anlbulatioll. 
853 

In assessing the credibility of the clainlant's statements regarding symptoms and their etfects on function, his 

medical history, his acti"ities of daily living, the type of treatment he received, his response to treatment, 

observations and the consi~1ency of the evidence IVere considered. 

The claimant has desl'fibed daily activities that are signiticantly limited. This is consistent with the limitations 

indicated by other evidence in this case. He requires an assistive device to ambul"te. 

Based on the e\~dence of record, the claimant's statements are found to be partially credible. 

The medical source opinion of the treating source, '__ in the report dated 5/4/06, indicates that the 

claimant is unable to work Tbis is an issue reserved to the Commissioner. However, consideration "'l1S given 

to this opinion. 

pea. Code: 32 4.')'07 

RECONINFO: 

Worsening: back & leg, insomnia and anxiety. . 

New conditions: trouble concentrating. focusing & remembering. 

7/06: Gait·normal. Sitting on R buttock with L leg in e:\.1ension. L-Spine with tenderness off midline bilaterally 

in a symmetrical distribution diffusely se,'ere. Muscle spasm bilaterally in a symmetrical distribution. 

Active ROM. Flexion restricted LBP present bilaierally- severe. E,,1ellsion restricted to I degrees LBP present 

bilaterally- severe. Passive ROM. Flexion restricted, e:\.lension restricted. Neuromuscular exam normal. 

Saeral spine with moderate tendemess in midline. Legs with normal inspection. ROM, muscle strength. tone 

and stability. CN I-IZ int.,ct & symmetric .. l. Motor & sensory exams WNL. DTR's 2+ throughout. 8/06: 

Underwent irljections for back pain. 9/06: FCE: Noted to ambulate with a stooped somewhat flexed posture at 

the waist and the hips with a limp on the L. Does not need an assisti"e device. Reflexes 2+ in bilaterally LE. 

Slight decrease in sensation in the L foot along the bottom however no specific demlatome, FCE limits 

claimant to sedentary physical demand level of work, but is unable to sit greater than 15 minutes or st.,nd 

greater than 15 nunutes. The P. T rep further notes that the claimant would be ineffective in an office situation. 

10/06: Positive SLR on L. Decreased sensation in L leg below the knee. Othenvise has 5/S strength in LE's. 

Gait is markedly ant"lgic and ambulates very slowly. Sits willi all weIght on R hip with L leg e"iended out 

in front. 12/06: Antalgic gait tavoring L leg. Appears to ha,'e good srrength in the LE but this is compromised 

because ofL knee pain & back pain. OX: Multilevel lumbar DOD with deterioratiOlL 'Several abnomlal discs 

which would probably benefit from an interbody fusion as well as Dynesys instrument.,tion. 2/07: ClO back & 

L leg pain. Recommended a fusion. Patient declines surgery. Already undergone an FCE and therefore by 

defmitioll is at MM!. Exam: Positive SLR on L. Suggestion of anterior column failure on R No motor or 

sensory deficits. No calf atrophy. Some increased hamstring tonicity. No spasm identified although some 

tenderness is subjectively reported to palpation at caudal L5-SlleveJ. 

Per ... ~ ..... ~ ... , .... I in the report dated 217107 indicates that the claimant is able to return to work mth 

restrictions .. This is an issue resen.ed to the Commission and is given appropriate weight and considered. 

Per . ';""" .. ...1 in the r"port dated 1217106 indicates that the claimant is unable to work. This is an 

issue reseryed to the Commissioner and is given appropriate weight and considered. 
854 

ADL: Reports no significant ch:lnges in pain questiOlmaire answers and ADL's from previous decision. 

Suggest no changes to original decision. 
855 

IN THE CASE OF 

(Claimant) 

. (Wage.Earner) 

. SOCIAL SECURITY ADMINISTRATION 

Office of Disability Adjudication and Review 

DECISION 

CLAIM FOR 

Period of Disability and Disability Insurance 

Benefits 

INTRODUCTION 

The claimant filed a Title If application for Disability Insurance Benefits on May 2, 2()06 

(protective filing date), alleging disability since August 25, 2005. After initial. and 

reconsideration denials; he requested a hearing. The hearing was held on JanUary 25, 2008 in 

Bluefield, West Virginia, with the undersigned Administrative Law Judge presiding by 

videoteleconference. The claimant appeared and testified, represented by _ Q 

Anorney at Law. Also testifying was : - vocational expert, 

The general issue is whether the claimant is entitled to a period of disability and Disability 

Insurance Benefits under· sections 2160) and 223 of the Social Security Act. The specific issue 

is whether he is under a disability, which is defined as the inability to engage in any substantial 

gainful activity by reason of any medically determinable physical or mental impairment that can 

be expected to result in death Or that has lasted or can be expected to last for a continuous period 

of not less than 12 months. . . 

EVALUATION OF THE EVIDENCE 

The record reflects that the claimant met ·the disability insured status requirements of the Social 

Security Act on the alleged onset date, and will continue to do so at least through December 31, . 

2010 (Exhibit 3D). 

Permanent Subcommittee on Investigations 

EXHIBIT #18g 
856 

- Page 2 of4 

At the hearing, the claimant testified that he has a general equivalency diploma and past relevant 

work as a welder. He said he has not perfonned any gainful activity since August 2005, and 

claimed disability due to back pain that precludes sining or standing more thBll 15 minutes at a 

time. ClaimBllt testified that pain has persisted despite epidural steroid injectiens, use of a back 

brace and TENS unit, BIld treatment at a pain clinic, and reported tluit he does ve;x little during 

~rse _a of the day. The vocational expert testified that claimant's past relevant work. as a 

'skilled job performed at the heavy level of exertion. provides no skills that are 

transferable to sedentary work. . 

The medical evidence reveals that the claimant saw . for orthopedic evaluation on 

September 6, 2005 and related lower back pain that had persisted sinCe an injury at work on 

August 25, 2005. MRI of the lumbosacral spine on September 19, 2005 showed right. 

posterolateral disc bulge at U-S (Exhibit 1 F). Claimant had a series of epidural steroid 

injections (Exhibit 3F), but records from the treating physician indicate that symptomatology 

persisted (Exhibit 4F). Claimant was advised to consider surgical intervention, but he elected to 

pursue treatment from a pain management center (Exhibit l6F). Results of Functional Capacity 

Evaluation on September 26,2006, which showed claimant to be incapable of sitting or standing 

more than 15 minutes at a time, indicate that he is incapable of even sedentary work activity 

(Exhibits IIF and 12F). Subsequent records from : _ document radiculopatliy in the 

lower extremities with positiv~ straight leg raising bilaterally, anC _ as indicated that )Ie 

concurs with recommendation for spinal fusion (Exhibits 19F, 22F, and 27F). 

The record reflects that· the claimant was' years old on the alleged onset date and has a general 

equivalency diploma. There is no evidence to suggest that he has perfonned any gainful activity 

since August 25,2005. The claimant has a back disorder, which is "severe" as that term is defined 

in the Regulations. Though severe, it does not meet or medically equal the requirements of any 

impainnent listed in 20 CFR Part 404, Appendix I to Subpart P. 

The claimant's description of his limitations is' consistent with the medical evidence of record, and 

his testimony is ciedible. After consideration of all evidence of record, the undersigned concludes 

that back disorder can reasonably be expected to produce chronic pain and physical limitations that 

would preclude performance of even sedentary work on a regular and continuing basis. In 

reaching this conclusion, the undersigned has reviewed the opinions of the state medical 

consultants pursuant to 20 CFR 404.1527 and Social Security Ruling 96-6p. Claimant was denied 

initially and upon reconsideration based on a finding that he is able to perform work at the 

sedentary level of exertion that does not involve exposure to hazards (Exhibits 8F· and 17F). 

Because these opinions were rendered by non-examining physicians and are not supported by the 

objective medical evidence of record, they are entitled to very little weight With due consideration 

of Social Security Ruling 96-9p, the undersigned concludes that the occupational base is eroded to 

the point that there do not exist a significant number of jobs which the claimant is capable of 

perfonning. Accordingly, the claimant is under a "disability" as defined by the Social Security Act 

and Regulations. 

See Next Page 
857 

- Page 3 of4 

FINDINGS 

'After careful consideration of the entire record, the Administrative Law Judge makes the 

following findings: 

I. The claimant met the disability ins~ status requirements of the Social Security Act on the 

alleg,ed onset date, and will continue to do so at least through December 31, 2010. 

2. The claimant has not performed subStantial gainful activity since August 25, 2005. 

3. The claimant has a back disorder, which is "severe" as that term is defined in the 

Regul~ions. 

4. The claimant's impairment does not meet or medically equal the requirements of any 

impairment listed in 20 CFR Part 404, Appendix I 'to Subpart P. 

5. The claimant!s assertions concerning his ability to work are credible. 

6. Limitations imposed by back disorder preclude performance of even sedentary work on a 

regular and continuing basis. ' 

7. The claimant is unable to perform past relevant work as a welder. 

8. The claimant was 'years old on the alleged onset date, and accordingly is a yo~ger individual. ' 

9. The claimant has a general equivalency diploma. 

10. The claimant has not acquired any skills from past relevant work that are transferable to 

other jobs at the sedentary level of exertion. 

. 11. Considering the claimant's limitations, he cannot make an adjustment to any work that 

exists il! significant nwribers in the national economy; a finding of "disabled" is therefore 

_ reached in accordance with the provisions of Social Security Ruling 96-9p. 

12. The claimant has been under a disability, as defined in the Social Security Act and 

Regulations, since August 25~ 2005. 

DECISION 

It is the decision of the Administrative Law Judge that, based on the application protectively 

filed on May 2, 2006, the claimant is entitled to a period of disability commencing August'25, 

2005, and to Disability-Insurance Benefits lDlder sections 216(i) and 223, respectively, of the 

Social Security ~ct. 

See Next Page 
858 

$ a Page 4of4 

Any benefits to which claimant may be entitled are subject to offset to reflect receipt of Workers' 

Compensatioo payments. 

Administrative Law Jodge 

Date 
859 

(The following is a transcript in the video-hearing held before 

Richard L. Swartz, Administrative Law Judge, Office of Disability 

Adjudication and Review, Social Security Administration, on _. - .- $ 

I'uery 25, 2008, at Bluefield, W_es.t 1l.iJ#nia, in the case of 

Social Security Number J TT The Claimant appeared in 

person and was represented by --- Attorney. Also present was . Vocational Expert.) 

(The h-earing commenced at 2: 16 p.m. on January 25, 2008.) 

OPENING STATEMENT BY ADMINISTRATIVE-LAW JUDGE: 

ALJ: We're ready to proceed with the hearing in the case of 

Claimant. Is your name .............. t 

CLMT: Yes, sir. 

ALJ:IIIIIIIIZSII' I have your Social Security Number as 111111111111' 

CLMT: Yes, sir. 

ALJ: Is your mailing address,III •••• II ••••• ,',n •••• 

CLMT: Yes, sir. 

ALJ: This is a claim for Disability Benefits. I'm Judge Richard 

L. Swartz with the Office of Disability. You're being represented 

today by your attorney, 

CLMT: Yes, sir. 

--------(Phonetic)? 

ALJ: Counsel, we have an exhibit file in this gentleman's claim 

with the materials you submitted most recently that have been added to 

the file, and the last exhibit now is number 28, Section F. Have you 

had an opportunity to review that file? 

ATTY: Yes, sir. 

ALJ: Do you have any_ Obj~ctions to including any of those 

materials? 

ATTY: No, sir. 

ALJ: We show the exhibit file that is dated today part of 

Permanent Subcommittee on Investigations 

EXHmIT#18h 
860 

2 

today's record. I also, have,IIIIIIIIII"", who is present here in the 

room with me, although he is not on the screen right now, but he is 

here to testify as a Vocational Expert. Have you discussed that with 

• 

ATTY: Yes, sir. 

ALJ: , including you, that makes two of you here to' 

testify. Counsel, would you like to proceed? 

(The Claimant"~IIIIIIII"illP, having been first duly sworn, 

testified as follows:) 

EXAMINATION OF CLAIMANT BY ATTORNEY: 

,~jllllll"II'one of the things I wanted to ask you about is your 

last job that you had. Where were you working at? Who was you working 

for? 

A __ 

Q Okay. What was you doing for them? 

A I was a 

Q Okay. It looks like the record shows you had an accident while 

you was working for them. Is that right? 

A Yes, sir. 

Q If you would, briefly explain to the judge what happened to 

you. What, what were you doing and how were you hurt? 

A Me and another colleague was lifting a miner jack out of the 

wash tank, and I just felt something snap in my back and --

.Q How much does this jack weigh approximately? 

A I, it, it was maybe 150 pounds. Something like that it was. 

Q Okay. All right. 

A Who'd you go first to get treatment with over this problem? 
861 

3 

A I went to -- first to 

Q Was that ,------.- (Phonetic) or --

A It was the emergency ~ __________ (Phonetic), it was. 

Q Oh, okay, okay. 

A I had to see him at the emergency room, and then he told me to 

see my family doctor the next day, and then --

Q Which was who? 

A 

Q Okay. I figured we'd get to him. Okay. Now a good part of the, 

your medical records covers, looks like it was (Phonetic) 

and i_--- (Phonetic). What kind of doctor is ------'! 

A" He's a neurosurgeon. 

Q Okay. Back specialist? 

A Yes, sir. 

Q Okay. What, what brought y,ou, what brought you to 

~ 

Did were you referred there by one of your other doctors? 

A Yes. 

Q Okay. 

A I seen him -- ______ referred me to and L.r. 

"" _____ =, he was a orthopedic doctor, I guess, so he referred me to a 

neurosurgeon, which was ~~~------

Q Okay. What did -- what did Dr. -- w~ll, are you still treating 

with him? 

A ---- .. 

Q Right. 

A No, he left, and .~_J was his partner, so 114 - took 
862 

4 

over his patients. 

Q Okay. We'll go back to for just a minut,. What did 

he do for you? What kind of treatment did he give, give you? 

A Well, he give me epidural shots, Facet injection shots 

Q Did he run any tests on you? 

A MRI, also FeE test or --

Q Right. 

A I had to have that and --

Q One of the things I wanted to mention to you, it looks like 

back in February of '06, February 9th of '06, he was speaking about 

installing some hardware in your lower spine and also doing fusion 

surgery as well. Did he discuss that with you? 

A Yes, sir, he did. 

Q Okay. What was the conversation? I mean, did, did, did he say 

that was the only alternative you had -- that he was looking at or --

how did that 

A Well, it was, you know, he said, you know, either that or just 

learn to live with it, you know? That was basically, basically all he 

could do, you know, but --

Q Now you'd mentioned the FeE. Did you make it through the FeE 

okay? 

A Well, I had a lot of trouble out of it, but, you know, they, 

you know, determined, you know, I couldn't stand, you know, over 15 

minutes, whatever, couldn't sit, you know --

Q Well, one of the things they put in there was sit for around 

15 minutes is, it's kind of painful for you. 
863 

5 

A Yeah. 

Q Are those limitations, and this was, I believe, September of 

'06, September 26, '06. Are those limitations still accurate? Or are 

they or are they not accurate as we sit here today? 

A Yeah, yeah, they're accurate. 

Q Okay. 

A Yeah, they're still the same. I can't hardly sit or stand. 

Q Well, as far -- and you mentioned going to next. 

What if anything has --------'~, been able to do for you? 

A Basically, he, he tried to, you know, he give me some of the 

epidural blocks, you know, and of course they didn't, they didn't faze 

it none. That's you know, other than medications, that's all. That's 

all of it. 

Q And he, .. ~ _______ , had mentioned in July 18th of last year 

2007, that, that you've been wearing a back brace. Do you use the back 

brace now? 

A Yes, sir, yes. Yeah, he prescribed me a back brace. Yes, sir. 

Q Okay. 

A And a TENS unit, too, also. 

Q A TENS unit as well. 

A The pain clinic is the one that prescribed me the TENS unit. 

Q Okay. 

A So. 

Q What type of -- well, who's the doctor you see at the pain 

clinic now? 

A Well, - "_ (Phonetic). 
864 

6 

Q 

A Yes, sir. 

Q Okay. What have they been doing for you down at the pain 

clinic? 

A They, the TENS unit, you know. Basically, just -- see, now 

they tried to, they give me some of those epidural blocks, too. 

Q Epidural? 

A Yes. They was like maybe. cortisone, or somethi'ng. But I had, 

the last one I had, the cortisone, t --------- (Phonetic) said it you 

know, interacted with the nerve roots where they were irritated so 

bad. 

Q Right. 

A And I had a lot of trouble of it, so wouldn't give me no more 

of them. 

Q Okay. 

A So that's basically it, other than medication and TENS unit; 

that's basically all what they're doing now. 

Q Okay. What, it looks like you're being treated some with _ 

~,Phonetic). Is she a counselor? 

A Yes, sir. 

Q what, what are some of the things she's been treating you for? 

A Well, depression, anxiety, you know --

Q Is this stuff due to the, due to the, the, the accident? I 

mean, were you doing okay beforehand? Before this accident? 

A Well, yeah. I mean, I just was getting really depressed, you 

know, where I can't do nothing. 
865 

7 

Q Okay. 

A Yes, sir. 

Q One of the things' -- well; actually, some of the things she 

had mentioned. in one of her notes that I -- that you're nowadays 

easily aggravated, irritated. What, explain that for us. 

A I just,' seems like, you know, everything bothers me, you know. 

Anything loud, you know, TV, anything like that, or even my young-un, 

you know? 

Q How old is your 

A He's eight. 

Q Okay, so --

A Sometimes, you know, he, like, he runs through the house, 

a-hollering, it just goes allover me. 

Q Okay. Are you living in any way as far as interacting with 

your son? 

A Well, I, you know, I can't do none of the things I used to do 

with him, you know. I, I still spend time with him,' you know, doing 

what I can with him, but it's not like I, you know, do very much with 

him. 

Q Okay. How, you know, overall, generally speaking, with the 

difficulties you've been having, explain for the judge if you would, 

how you function throughout the day, after, you know, starting when 

you get up in the morning. I guess first place would be how do you, do 

you sleep okay at night? 

A No, sir, I don't. Sometimes you know I wake up during the 

night. You know, I hadn't been asleep, maybe, two hours or so, and 
866 

8 

Q Do you take medications -before you go to bed? 

A Yes, sir, and sometimes, you know, when it wears off, like, a 

couple hours, you know, I have to get up because of my back's real 

stiff and hurting my legs and stuff, and I have to get up, move 

around, take-more medicine before I, you know, get anymore relief 

again. 

Q Are you sleeping in a regular bed? 

A No, sir. Most time I sleep on a sectional couch. 

Q Okay. 

A So regular bed, it seem like it, almost soft or something, I 

don't know what it is. Seem like I'm cut in two from my waist down 

when I try to sleep in a bed. I sleep on a hard couch. 

Q When you do get up and start moving around, what do you do 

throughout the day? 

A Well, you know, different days bring along different things, 

you know. According to howl feel, you know, sometimes I, you know, I 

might, if it's pretty out, I might get out and walk around the, you 

know, the place -- or enjoy that or, you know, usually I, I end up 

having to go on back into the house. 

Q During the summertime, do you do any outside working, around 

the home, for example, mowing the grass? 

A No. 

Q Who does that? 

A I, usually, my brother-in-law or my nephew will. 

Q Okay. How about house work? For example, doing some dishes or 

vacuum cleaning, things like that, dusting? Do you help with 
867 

9 

housework? 

A Well, my back, if I, if I feel all right, some days I do, you 

know. I mean, just do what I can, you know. I, if I start hurting I, 

you know, I have to sit down and quit, or -- but yes. 

Q Are you married? 

A Yeah. 

Q Does your wife work outside the home? 

A No, not now she don't. 

Q Okay. Okay. And I thought I'd mention, too, Judge,~""7J~ is 

presently receiving Workers' Compo benefits. 

ALJ: Okay. 

Q How is your energy level during the day? 

A Well, I just, I don't, I don't have a lot of energy, it don't 

seem like, you know. But, you know, it seem like I have good days and 

bad days, you know? 

Q Sure. 

A It just, you know, fluctuates, you know? 

Q Sure. Are there any days during the week that you need to lay 

down and rest? 

A Oh, yeah. Yeah, I, some days, you know, I might take a nap for 

a hour or something, you know, it, you know, I do that if, like if I 

don't sleep good at the night or something, it hits me during the day. 

If I can get comfortable, I'll take a nap, you know? 

Q How many days out of the week, approximately, would that be? 

A Well, now, most of the time, at least four or better, you 

know. Some, you know, it's just different weeks, you know? 
868 

10 

Q Okay. How about -- do you have a driver's license? 

A Yes, sir. 

Q Okay. Do you drive now? 

A No more than I have to. I mean, I might take my son to the bus 

stop or 

Q How far is that away from yo~ home? 

A The bus stop ain't -- it might be a quarter of a mile. 

Q Okay. 

A Or I might go to a convenience store, you know, which is three 

or four miles down the road, you know. 

Q Okay. How far was it from your home up to here? How long did 

it take you to get to this hearing office? 

A Let's see, it took us about a hour, twenty minutes, I guess. 

Q Okay. Who's us? 

A Me and my wife. 

Q Okay. Did you drive, or did she drive? 

A She drove. 

Q Okay. Does it hurt you to drive a distance like this? 

A Oh, lord, yes. Yeah, I have, it hurts me to ride, yeah. 

Q Okay. How long did you work for the, for the4 ... i.· lliill.,,---ii·. 

where you hurt, hurt? 

A Let's see, I just worked for them right around two years. Best 

to my recollect. 

Q Okay. Who was you with, if anyone, before them? 

A I, before them, i was working in Bristol, Tennessee, fo~~ .. · .... 

.... 
869 

11 

Q Okay, what was you doing? 

A Let's see, welded, fabricated big trucks. 

Q Okay. How long was you working with them . 

. A I worked for him for two-and-a-half years. 

Q Ok~y. Where was you at before that? 

A Before that I was wit~I"IIII""""""ltin Glade Springs. 

Q What did you do there? 

A I .................... . stuff, yeah. 

Q Approximately how long did you work with them? 

A I worked with them about 12, 13 years. 

Q Okay. Okay. Enjoyed your work? 

A Oh, yeah, yeah. I was good at my work. 

Q Okay. Judge, I think that's all I have for right now. 

ALJ: Okay. 

BY THE ADMINISTRATIVE LAW JUDGE: 

Q There's one of your doctors in the file said you were -- they 

were going to send you to a .- Did you ever see ---------------

A Yes, sir. He's at the pain clinic where -'----------

Q Oh, okay. 

A Sometimes I see ---------=, sometimes 

Q Are you on any pain medicine now? 

A Yes, sir. 

Q What, what do they give you? 

- yeah. 

sat.,. 

A Lortab, Lortab 10, or I think that's what they're called. 

Q How often do you take them? 

A Every four to six hours, as needed. 
870 

12 

Q You actually do that? I mean, how often do you actually take 

them? 

A Well, if it needs, you know -- I usually try not to take over 

four a day at least, you know? In a 24-hour period," you know? 

Q Okay. 

A But sometimes, now, if I, I may have to, you know. Just 

different days, if I don't need them, I don't, I try not to take them, 

but 

Q 

A 

Q 

A 

Q 

Do you have any dependents? Other than your wife? 

I have a eight-year-old son, yeah. 

Is your son healthy? 

Basically. 

Okay. He's not, you know, severely handicapped or anything 

like that? 

A Oh, no. Uh-uh. No. 

ATTY: Didn't he "have some issues early on? 

A He was born with, he was born with problems, but, you know, 

he's, he's doing good now. 

Q How about your wife? Is she healthy? 

A Yeah, she's, she's preity healthy. Yep. I also, on the 

medication, I take Klonopin for depression and anxiety. 

ALJ: Yeah. Okay. That's all the questions I have. Counsel, do 

you have anything else? 

ATTY: No, sir. 

BY THE ADMINISTRATIVE LAW JUDGE: 

Q """1.,'3 the record indicates you have a GED education. Is 
871 

13 

that right? 

done. 

A Yes, sir. 

Q Did you get, have any kind of training since then? 

A Since the GED? 

Q Yeah. 

ATTY: Like any kind of technical training, things like that. 

A No, no, I've just, I~ve just worked, you know. That's all I've 

Q How about the '~[IIIIIIIII Did you go to a school for that or you 

just learn on the job? 

A The what? 

ATTY: The what, Judge? 

Q The 'is ••• 

A Oh. 

Q Did you learn that on the job or did you go to a school? 

A ,No, I basically learned it on the job, you know. 

Q Okay. 

(The Vocational Expert, 41111111111111", having been first duly 

sworn, testified as follows:) 

EXAMINATION OF VOCATIONAL EXPERT BY ADMINISTRATIVE LAW JUDGE: 

Q .. 111111111'1"1: would you state your name and address please? 

A 

Q Counselor, do you have any questions about or objections to 

1I111111111111111111"qualifications? 

ATTY: No, sir. 

Q have you been present for the entire course of 

the hearing? 
872 

14 

A Yes, Your Honor. 

Q Did you review the vocational materials in this file? 

A Yes. 

Q Do you need any further information from 111111111-'. 

A No, Your Honor. 

Q Would you give us your assessment of his past relevant work 

experience? 

A Yes, sir. The work he did as a is SVP: 5, 

which is skilled, and it's classified as heavy exertional level. 

Q That basically covers it all? 

A Yes, it does. He's ju~t a, he's a skilled .. 1I1I1I1I 

Q Okay. Are there any& I jobs at a sedentary, light level 

so he could transfer these skills to such a thing? 

A No, most of the .llIlIljobs are between medium and heavy. 

ATTY: You can stand up long as you need to. 

Q ISIIIIIIIIII"" if the claimant is about 36 or 37 years old, in 

that neighborhood. If, with his education level and this past work 

experience, if he were limited to do the sedentary or light work where 

he would need some sort of an occupation where he could change 

positions throughout the workday, more than, more than most standard 

breaks and lunch, in order to relieve discomfort, can you suggest any 

jobs at either one of those exertional levels? 

A As long as he's able to sit, and stand and walk six hours in 

an eight-hour day, and be productive, there's some unskilled, light 

exertional level jobs (INAUDIBLE). We have, there's a, a storage 

rental clerks, storage facility rental clerk. Do you need a DOT 
873 

15 

numbers on these? 

Q No. 

A On the DOT number, you don't need -- 80,500 nationally; 6,400 

in the Mid-Atlantic. We have unskilled sales clerk" which' is at the 

light level. There's l64,600'nationally; there's 5,800 in the MidAtlantic. We have assembler small parts, there's a -- and that's under 

skilled, light. There's 30,500 nationally, and 4,700 in the MidAtlantic region. Do you need more than that, Your Honor! 

Q No. How about at the sedentary level? Are there any there for 

you where you would have the opportunity to change positions 

occasionally if you wanted to? 

A Yes. 

Q Other than the regular breaks, and so forth. 

A Yes, Your Honor.' Again you'd have to be able to set six hours 

out of an eight-hour day and be productive. There's a charge account 

clerk. There's 380,000 nationally, and there's 34,000 in the 

Mid-Atlantic region. There's an order clerk, 587,000 nationally; 

27,400 in the Mid-Atlantic. There"s a office clerk with addresser, 

there's 343,000 nationally, and 17,500 in the Mid-Atlantic. Would you 

need more than that, sir? 

Q No, I guess that would do. Are there any hazards involved in 

these jobs so if a person had some sort of problem (INAUDIBLE) they 

were required to avoid hazardous situations. Would that be a 

difficulty in any of these? 

A No, Your Honor. 

Q How about if,they were limited to only occasional stooping and 
874 

16 

crouching? Could they do that, with all of these, with these jobs, 

would that, would that be a problem? 

A No, Your Honor. 

Q If your discomfort limited you to, to the extent that you were 

required to change positions from sitting to standing, or standing to 

sitting, at least briefly in order to relieve discomfort for about 

every 15 minutes, could you still perform any of these jobs? 

A It would be, I mean, you, you've got to be productive in an 

eight-hour work day. I guess it goes with the, the frequency and 

duration. If he's able to sit and stand every 15 minutes and still be 

productive, then that would work but if, if he baSically having 

problems staying on task then that would take those jobs away. 

Q Okay. He's described to us frequently why he has to just, has 

to sleep during the day. Could he do that on any of these jobs?, 

A No, Your Honor. The you get a 15 minute break in the 

morning, a lunch break, and 15 minute break in the afternoon, and if 

he's having to take more than that, then it would probably result in 

being discharged. 

Q He's also testified so some ongoing depression or anxiety that 

has developed since the time of his accident. If this affects on his 

ability to perform all of the different parts of employment or at 

least (INAUDIBLE), would it compromise any of these jobs? 

A Not these jobs, Your Honor. These are unskilled jobs, but 

probably unskilled jobs or jobs (INAUDIBLE) 30 days (INAUDIBLE). 

Q Would he have to be able to work eight hours a day in order to 

do these jobs, with at least some position or other. 
875 

17 

A He would have to work eight hours a day. 

ALJ: That's all the questions I have. Counsel, do you have any? 

ATTY: I don't think so, Judge. We would just ask Your Honor, to, 

if you would, to take into account the results of the FCE and the 

opinions rendered by the, the FCE examiner at Exhibit 12F, and the 

opinions in combination of the neurosurgeons, well, 

actually, first He's at Exhibit SF. He, he did say that, 

that he had reviewed the FCE results and did not believe that, that 

could perform any work right now. And we would also ask Your 

Honor to consider, if you would, that either meets or equals 

listing 1.048 for spine disorders as well, and I think that--

ALJ: Okay. 

ATTY: I think that's all I have, Your Honor. 
876 

18 

ALJ: ........ 'we're finished. You can leave, okay? Good luck to 

you. 

CLMT: Thank you, sir. 

ATTY: Thank you. 

ALJ: 'You're welcome. Goqd luck. 

CLMT: Thank you. 

(The hearing closed at 2:43 p.m. on January 25, 2008.) 

C E R T I F I CAT ION 

I hav~ read the foregoing and hereby certify that it is a true 

and complete transcription of the.-testimony recorded at the hearing 

held in the case of ' .,,'" '. "·1 1 ' before Administrative Law Judge 

Richard L. Swartz. 
877 

September 14,2011 

W. Howard O'Bryan. Jr. 

Administrative Law Judge 

SOCIAL SECURITY 

Office of Disability Adjudication and Review 

}O I NW 6

1h Street 

Room }OO 

Oklahoma City, OK 73102 

Dear Judge O'Bryan: 

I havc noticed that your decisions include duplicate copies of medical evidence already 

contained in claimants' files. Additionally, you reference unnecessary legal and medical 

authority in lengthy fOOTnotes in the decisions. This conduct is inconsistent with agency policies 

and rC!,JUlations. Accordingly, I direct you to modify your decisions, as described in detail 

below. 

A review of 168 decisions issued by you in Fiscal Year 2011 shows that. in 153 of those 

decisions, you included significant amounts of superfluous information, including unnecessary 

and lengthy citations to legal and medical authority. In addition, you inserted images of the 

claimant's medical records in your findings of fact and conclusions of law. instead of analyzing, 

the information. Furthermore, instead of making specific findings, you simply state, "ctc. etc. 

etc." at some points of the decision. Attachment A contains several decisions highlighting the 

inappropriate language and information. 

As a Social Security Administration (SSA) Administrative Law Judge (ALI), you are responsible 

for conducting hearings and issuing legally sufficient and defensible decisions. See HALLEX 

J-2-0-S.B. A legally sufficient and defensible decision requires that you comply with SSA's 

laws, regulations. rulings, and policies. In order for SSA to continue to meet its obligations to 

the public, it is essential that AUs discharge their duties in a timely manner that reflL'Cts a high 

degree of responsibility, professionalism and integrity. You are expected to provide hearings 

and decisions to claimant~ in a timely and judicious manner. Satisfying these responsibilities 

requires an ALl to follow both the letter and spirit of the policies he is bound to follow. 

To ensure that you provide claimants with legalJy sufficient and judicious decisions. ! am 

directing you to comply with all agency regulations and policies. 

Specifically, pursuant to HALLEX I-2-8-25.C. Writing fhe Decision, ContenJ and Format, the 

decision must state why the case is before the ALI for a decision: provide the rationale for the 

AW's findings on the relevant issues and the ultimate decision; list the ALT's findings on the 

Permanent Subcommittee on Investi ations 

EXHIBIT #19 
878 

relevant issues: and state the AL.l's ultimate decision in a decisional paragraph which includes 

the relevant dates. (emphasis added) 

The second part of the decision should proyide the rationale for the ALl's findings on the 

relevant issues and the ultimate conclusion. by including the' following as applicable: 

(a) an explanation of the findings on each issue leading to the ultimate conclusion. 

(b) appropriate rcrerence to the applicable statutes, regulations, and SSA rulings. 

(c) a discussion of the weight assigned to the various pieces of eyidcncc in rcsoh'illg 

conflicts in the overall body of evidence. 

(d) resolution of all subjective allegations, especially those regarding symptoms, :1I1U an 

assessmcnt of the credibility orthe evidence. 

The fourth part of the decision should provide the ALl's ultimate conclusion in the case. '1 he 

decisional paragraph should he ViTitten in language which is hrief and to the point 

Section D, LanRuaRe (llld Style. sets forth that the ALl must write the decision so that the 

claimant can understand it. Further. the ALJ must avoid using non-prescribed standardized 

language, i.e. boilerplate, in the rationale. (emphasis added) 

In addition to the direeti\'e to adhere to the acceptable rormat for preparing decisions ,md to 

Teli'ain from using unncccssnry language in your decisions. I am directing you to refrain from the 

following: 

1. Inserting any portion of a claimants' medical evidence into the decisi(}n.Jll~,AL.LJll,lJ.Sl 

anal v:,.;, .. the evidence of rICcord. \Vhilc such analysis mav necc:js,,!rilYJl:ilujrc tll~ 

i!Qiudicator to ,ummarize som'! or the evidence. it is unnecessary to insec1j!l1~g~~_o[thc' 

actual evidence into the decision. The claimant has access to all evidence_ in the .record. 

and inserting ima£~JL.Qf..J,re e\'idencc into the decision is unncc\:ssurj}v duplicatTyc. In 

addition. such a practice makes the decision more dimcult to unders1Dnd, 

2. Including pOl1ions of medical or legal authorilv in rootnotes, or in the bod\' of the 

decision. Notably, HALLEX 1-2-8-25.0, Language and Sly/e, scts forth that an AU 

must not cite medical texts and medical publications as the authority for resolving any 

isslie. If it is necessary to refer to a medical text or medical publication. the ALI must 

submit the material to the claimant or the rcpTesentatj\'e for review and comment. and 

make the material a part of the record. 

3. Summarizin!! claimants' impairments using the abbreviation "etc." or anv uerivatiolLi~r 

this tcrm. 

2 
879 

In Dt'cember 2008, Re!,>ional Chief Administrative Law Judge Joan Parks Saunders orally 

counseled you regarding the content of your decisions. In 2010, I orally counseled you !"ice 

about this issue. Despite these discussions, you continue to engage in conduct that directly 

atTcets the agency's mission to sen'e the public ef1iciently and cffecti\ely. This conduct is 

inconsistent with agency policies and regulations. Although this dircctiw docs not constitute 

disciplinary action. please he advised that failure to follow this management directive may lead 

to disciplinary action, 

You should consider the Employee Assistance Program (EAP) as a possible resource for 

assistance in resolving any personal problems tbat may be adversely affecting you. I be toll-free 

number for the EAr is 1-800-222·0364. 

J urge you to accept this letter in the spirit in which it is given. as notice that your compliance 

with agency law. regulations. rulings. and policies is essential to providing due process for the 

public we save. I sincerely hope that this letter has reinforced agency expectations and results 

in your improwd conduct. I am available to discuss how \"e might further assi,! YOL!o 

Respectfully. 

'cf Administrative Law Judge 

J acknowledge receipt of this management directive. My signature below does not signify 

agreement. merely acknowledgement of receipt. f 

Dated: 

3 
880 

OFFICE OF APPELLATE OPERATIONS 

execUTIVE DIRECTOR'S BROADCAST Volume 2, Issue 16 

Executive Director: Judge Patricia A. Jonas 

Deputy Executive Director: Judge Gerald Ray 

Executive Officer: Vanessa G. Butler 

In this issue {CHck on links below to go to}: 

• RemandS of OIsmlssafs DeclIne 

• Progress Towards Fiscal Year 2011 Goals 

.. OAO Staff Profile 

• Technology Tip ~ Graphics 

• ODAR LDP Brings Management Experience 

to Appeals Officer 

• Endocrine Disorders Remain Impairments 

Remands of Dismissals Decline 

August 19, 2011 ) 

THE FOUR PILLAR:S OF 

DISABIUTY ADJUDICATION ANI) REVIEW 

.. Due Process of Law 

.. FaciuS1AcclI!1IIcy 

• Policy Compliance 

• Timely Service 

_~I!~~,t , 

I , " 

Trends in dismissal remands demonstrate how CAO's data 

collection and analysis mission can contribute to improved 

performance of the disabilITY adjudication process (see 

OAO newsletter 1 Cl18,'1 C). OAO staff noticed that in FY 

iOO9.Appeais-{;"c;uri'Cilfemands of requests for review (RR) L ___ :....-____ :....-_____ -==-. ___ -i 

of administrative law judge (AU) dismissals had reached 

22.2% of all remands, according to data gathered through 

the Appeals Review Processing System (ARPS). 

After several educational efforts, that percentage dropped 

to 19% in FY 2010 and is on track to a projected deciine to 

17.6% ofRR remands by the end of FY 2011. These 

reductions became even more Significant when compared 

with a projected 38% increase in RR from FY 2009 

through FY 2011. 

... 

Analysis of mare detailed ARPS data revealed 

that the three biggest of 18 measured reasons 

:;.. for dismissal remands are: 

ARPS data show that the first two measures are projected 

to drop 12% and 40%, respectively, by the close of FY 

2011, and the third would increase only 15%. 

What brought about the decline in dismissal remands? 

OAO prepared desk ::Gides for ALJs summarizing proce~ 

dures for handling dismissals due to failure to appear, when 

hearing requests aren't timely filed, and dismissals at the 

claimant's request. Appeals Council members presented 

the dismissal guides and refresher sessions to ALJs attend~ 

ing the 2010 and 2011 Annual National judicial Educational 

Program in Falls Church/Alexandria (OA.o 

p.3). 

Appeals Council members also held discussions with small 

groups of ALJs an reasons for remands. in addition, the 

Office of the Chief Administrative Law Judge circulated a 

memo on Sept 29, 2010, to regional chief ALJs reiterating 

dismissal rules as spelled out in several HALLEX sections. 

30000 

25000 

20000 

15000 

10000 

5000 

FY 2009 FY 2010 FY201i 

projected 

• Dismissal Remands $: RR Total Remands 

In our n&t i$5ue: 

[To be published on September 9. 2011) 

.. Baltimore Offices Help Power DAD Public Service Mission 

.. Plus much more, 

Permanent Subcommittee on Investi ations 

EXHIDIT#20 PSI-SSA-126-<l00003 
881 

DAD Executive Director's Broadcast 

Progress Towards FY 2011 Goals 

(4'" Quarter. FY 2011) 

Progress In Reducing RR Cases That Are Now or 

Will Be 650 Days or Older by Ihe End of FY 2011 

We-beganFiscaJ Year2011 With 34,275 cases that wouldbecome 650 days 

Old ifoot proc&ssedby the end of the fiscal year. In other wonts, DAD /lad 

34,275 cases that had been pending for more than 285 days at the starl of 

the fiscal year, Ourmonthfy progress is shown below. By 08/12/2011, there 

I¥e(e 1,235 cases actvalfy 650 days Dr older. 

As of "::"',)9 5 we dosed 

650+ day aged closed by month ~::~~:;, ~~:~rot~~~~'Ie 

7,000 5:81'9 411650' aay--.aged cases 

~ i l'i I<i l' i·:~~·;:; ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 

d''.: ~o~# ~ecJ ')~~ «# .. 'b": t:/i2<''' +"'~ ')..:,ct ')~ 

RR FY 2011-lo.oale AVerage Processing Time 

Request for review average processing time (AP7J per week peaked in tile 

middle of the fiscal year as we addresser! l/le cases projected to be 650 days 

or older by end of the fiscal year. Our goal for RR APT is 370 days. 

ODAR LDP Brings Management 

Experience to Appeals Officer With a long track record of production-oriented work, 

Appeals Officer Klara Huesers wanted to explore her interest 

in experiencing responsibilities at the man~ement !eveL 

Her opportunity came with acceptance into the 2010~2011 

ODAR Leadership Development Program (LOP). which was 

open to attorneys hired on an "excepted selVice~ basis. 

H uesers had long familiarity with disability adjudication at 

the case level since she joined the Minnesota Disability 

Determination SelVice as a disability examiner. After a dozen 

years there, she acc~pted a position with SSA in August 2006 

as a Federal reviewing official and most recently served as an 

AO in Branch 13 in Falls Church. Under her ODAR LOP, 

she's pelformed three assignments, all of which provided a 

broader perspectlve of ODAR and OAO's functions and a 

different work environment. Her three assignments were: 

• Office of 1he Chief AdmlnistrallVe Judge (OCALJ) as 

acting exeOlUII2 aSSIstant to then"Deputy C)-llef 

';dnl;r;!strstive Law Judge Anderson and where 

Hu€sers gained vaiuable experience worklng in a trom offlce 

envtronment ~It was totally different" from the insular nature 

of production, she says. For example, she experienced 

receiving large volumes of e-mail, leading her to learn 

strategies for organizing and filing it and managing 

responses. "It was a sink or swim environment," she says. 

• An assignmel~t witt; ODAR's Dallas offlce 

deputy regional n-ianagement officer exposed Huesers 

fle!d of labor-management reiatlQns. She supelVised a !egal 

team that responded to grievances and other issues in the 

region and helped develop methods for addressing griev430 

41. 

390 

370 

350 

330 

31. 

290 

27. 

~---------375 ance and pelformance issues on a continuing basis and 

monitoring their status. 

• He~ las! assianme'it returned Huesers to Faits Church 

where she served as acting deputy director of the DIviSIOn 

of Finance and Budget AnalySiS supervising three branch 

chiefs She learned budget terminology, provided a fresh 

set of eyes for review of budget and other reports, assigned 

work, helped troubleshoot staffing issues, and pursued 

employee development opportunities for staff. 

The ODAR LOP has been ~a wondelful opportunity to try out 

things you think you might be interested in or find things you 

never thought you'd be interested in,n she said. It also 

enhanced her sklU set and understanding of ODAR's varied 

responsibilities. 

haVe 10 g81 or front office 

Huesers to hel OAO 

T})6 earlier 'n your ::;areer you do n. the better 

learn SQme of tne baSICS of 

0; 

ofODAR 01 

Page 2 

PS!-SSA~126.{)OO0D4 
882 

OAQ Executive Director's Broadcast 

Endocrine Disorders Remain 

Impairments After Listing Update 

Citing significant advances in diagnosis and treatment of 

endocrine disorders over the past 26 years, SSA adopted a 

major revision in the medical evaluation criteria for the 

disorders, which cause hormonal imbalances that can lead 

to a wide range of medical problems. After June 7, 2011, 

all endocrine disorders - including diabetes mellitus (OM) 

and thyroid, pituitary and adrenal gland disorders no 

longer can serve as the sole ground for a disability finding 

for adults and children, except for children under 6 who 

require dally insulin, according to the l;Doated listl~:J 

reguia!ior" (There's also a vlde~ on der.<and prepared by 

the Office of Medical Listings Improvement.) 

For OAO analysts and Appeals Council adjLldicators, the 

most frequent application of the endocrine listing 

(9 00;10S 00) occurs in reviewing ALJ findings for steps 4 

and 5 of the~evaluation process. Even though most 

endocrine disorders were, in effect, delisted, they remain 

potential medically determinable impairments and their 

complications can contribute to exertional, postural, 

environmental, visual, manipulative and even mental 

limitations associated with a variety of other body systems 

such as cardiovascular, renal, mental, neurological and 

visual, points out Division I Chief AAJ Gabriel DePass. 

Anatysts and adjudicators should review the ALJ's residual 

functional capacity (RFC) finding to ensure it reflects these 

limits when they're supported by the medical evidence of 

record (MER). 

For example, a thyroid disorder may cause blood pressure 

and heart rate changes resulting in arrhythmia (abnormal 

heart beat) and eXertlonallimitations because the claimant 

cannot handle the stress of lifting heavy objects, A pituitary 

gland disorder may result in an electrolyte imbalance (and 

eventual diabetes), leading to muscular fatigue and balance 

problems, preventing claimants from working on a ladder. 

With diabetes, an individual who has hypoglycemia 

(abnormally low blood sugar level) may have seizures or 

cognitive deficits, inhibiting operation of machinery. 

As Judge DePass notes, endocrine disorders also can 

affect cognitive funcUoning. ~MentaJ conditions are 

interesting because a Jot of us don't think about them,~ he 

says. ~When you have a hormone imbalance or imbalance 

in electrolytes, in particular, it can affect a person's mood. 

A person may get grumpy and irritable, causing socia! 

limitations, or suffer short-term loss of memory. n 

When evidence of endocrine disorders appears in the MER, 

analysts and adjudicators should scrutinize the ALJ's 

evaluation of a claimant's credibility and subjective statements relating to his or her general feeling. ~The claimant 

may say his whole metabolism is off and that he's fatigued, 

depressed or sleepy,~ Judge DePass says. Those 

complaints, if supported by the record, should be reflected 

in RFC limitations and the claimant's ability to perform past 

relevant work or other work. For example, a claimant 

suffering from fatigue would not qualify for a job driving a 

bus. 

AU9ust 19, 2011 ) 

All hearing office actions (favorable decisions, denials and 

dismissals) dated on or after June 7 should evaluate 

endocrine disorders under the new rules. The endocrine 

listing change also could factor into analysis of a request for 

review of an ALJ action based on the legal principal of res 

judicata {see OAO neWsletter 7,'22:11}. 

Employee Benefits Information System (EBIS) 

You mav be Interested in an c·nline re!lre.,lent semmar that 

IS now a'vaiiable througl-: tr.e Emp!oyee Beneftt Information 

System (E8IS, Acco,omg to Bob Genlken of the Falls 

Cnurcn offIce of the CenTer for Personr,e' Pohcy a"nc 

Staffing ~he EBIS al: permanert SSA employees 

ac::ess to benef:! as well as information 

regardln9 the:f awn ~en,;Ms A Personal Statemenl of 

Benefits provides p~ojected ret:rement benefits :nformatlon 

regarc!n;l disability ~et!ter:1em early-out retirement aeat!"l1~·SErvice SUf\!tV:Jr benefits heaim and life insurance 

anu eave oalances 4:-: annL!lty calculator IS 

w~ere .,tou ;,lav ente: variOUS retJrernent dates and 

th~ee averaqe sa!a;les to aid in tlnancla: planning In 

E61S p~ovides Informat:or· on the effects of the 

VVH1:Jfal' EhlTllPatlDn PrOViSion If applicable. Finally the 

system has the ab!llly to %tHr.atE future Thnft Savmgs Plan 

balances rates of return ana annuIty payments based on 

your personal TSP informatior' and allocations You can 

access EBIS Via the Intranet at wor'1< from the QUick Tools 

Chart on the OPE Portal. 1n addition you may access the 

EBIS eve! tr,e I".tranet from vc-,ur home computer at t,"IIS lmk. 

For firsH!rf\e EB!S users :t l~ 'SLggested that you enter ~ 

the OPE Portal as tieipful rWllS a:--,o I',strucfions are 

p!ovlded w"len i0991"9 01"' fror~ t!lIS locatIOn 

Analyst Tip Prototype States; As tne Appeals Council 

works morE cases across jurisdictions, analysts need to know 

the differences between and non~prototype states 

When claHTants move in or any of the 10" prototype" 

states - AiabaTi2 Alasl<.a. California (LA West and North 

Branches). Colorad:), LCluisiana , Michigan. Missouri. New 

HamDshlre, New York and Pennsylvania - their prototype or 

non-prototype status With tbem In prototype states, the 

clairrant receives aT"! determlnal!on. skips the reconSideration level and car request a hearing as the next level of 

appeal. In staies. the claimant is entitled to a 

reconSideration afte:" an Initial determination. 

<3fld must rave a 'econSlderat,or. determlnallon before re~ 

questing an ALJ hearing ThiS poilcy (!eft over from 1990s 

era disability design tes:) piays ar important role when you 

analyze a request for reVIEW of an AU dismissal of a heanng 

request. For example. an AU should d!smlss a ,",eanng 

reQuest from a ciaimant who moves to Michigan from Indiana 

after a denial at the Inl!ia! level because the claimant has yet gone to tt"Je reconSideration level as reqUired 

In Indiana The claimanfs relocation to Michigan doesn t 

anow the claimant to forego the recor;slderatlon level even 

Stnce tlie onglnating status stays 

For a handy table showing when claimants 

~ are entitled to a hearing, see HALLEX 1-2-4-99. 

Page 3 

PS!-SSA-126-000005 
883 

OFFICE OF APPELLATE OPERATIONS 

EXECUTIVE DIRECTOR'S BROADCAST Volume 3, Special Edition - Quality Review 

Executive Director: Judge Patricia A. Jonas 

Deputy Executive Director: Judge Gerald Ray 

Executive Officer: Vanessa G. Butler 

DAO staff may submit suggestions for consideration to: 

IIIODAR OAO Admin Services. 

In this Special Edition (Click on links below to go to): 

.. Division of Quality Brings New Data, 

Insight to Disability Process 

• "Focused Quality Reviews" Enhance DQ's Mission 

.. What the Data Reveals So Far 

.. DQ Plans ALJ Participation 

.. DQ Dives Deep into Quality Data 

.. DQ Sampling Method Seeks Objectivity 

.. Top 10 Reasons for Remand of 

Unappealed Hearing Decisions 

• RR/DQ Differences: Favorable Decision Brevity 

Puts More Focus on Record 

• DQ Own Motion Review Timeline 

• Absence of Substantial Evidence 

Triggers Own Motion Review 

• "How MI Doing?" Gives ALJs Easy Access 

to Remand Data 

• Q&A on Disability Adjudication Consistency 

Division of Quality Brings New Data, 

Insight to Disability Process In its first full fiscal year of operation (FY 2011). OAO's 

Division of Quality (DO) Appeals Council members 

exercised own motion reView of 22% of the 3,692 favorable 

hearing decisions they reviewed while allowing the 

remainder to proceed to effectuation. Of own motion cases 

closed at the end of FY 2011. the Council issued 550 

remands and 73 favorable, 57 partially favorable and 5 

unfavorable decisions, with 128 cases pending responses 

from claimants (see charts, page 2). These results, 

however, represent only one dimension of DO's quality 

review mission (see Focused Reviews, p. 1). 

As Division Chief MJ Robert Johnson describes DO's role: 

"We define quality broader than whether the hearing 

decision is right or wrong." DO !everages OAO's national 

perspective and position at the end of the administrative 

review process to generate and analyze data never before 

available to SSA on unappealed hearing decisions, 

These data and analyses will help SSA ldentify patterns of 

decisional shortcomings and suggest topics for training 

programs and the possible need for policy clarifications or 

procedural adjustments. They also will lend insight into 

state disability determination service (DDS) versus hearing 

level decision-making that could lead to granting disability 

benefits at the DDS level, thereby reducing claimant wait 

times and appeals. 

January 13, 2012 

THE FOUR PILLARS OF 

DISABILITY ADJUDICATION AND REVIEW 

• Due Process of Law 

• FactualAccuracy 

• Policy Compliance 

• TImelyServlce 

() 

As DQ staff review unappealed decisions by administrative 

law judges (ALJs) and hearing office senior attorney adjudicators (SMs), they enter extensive information into the 

Appeals Review Processing System (ARPS), providing SSA 

with a fresh data perspective of its disability process. These 

data detail everything from the most recent DDS decision 

and procedural, evidentiary and residual functional capacity 

(RFC) issues to how the hearing level adjudicators used 

medical and vocational experts. (For details on DO's data 

sampling methodology, see story on p. 3.) 

(See Division of Quality .. on p. 2) 

AU Courtesy Copy As a courtesy to agency administrative law judges, we 

provide a copy of this special issue of the DAD Executive 

Director's Broadcast. It describes the operation of the DAD 

Division of Quality, which conducts pre--effectuation reviews 

of thousands of favorable ALJ decisions a year. 

To provide feedback, ALJs may address an e-mail to 

IIIDDAR DAD Admin Services, 

"Focused Quality Reviews" 

Enhance DQ's Mission In addition to its sampling of pre-effectuation reviews, the 

Division of Ouality (~O) conducts focused, post-effectuation 

reviews in certain circumstances, with several goals in mind, 

These goals include: identifying recurrent decisional issues 

for incorporation into future focused training; identifying 

where changes may be needed in policy articulation or in 

hearing office procedures; and helping ALJs and hearing 

offices to provide service to the public in the form of quality 

adjudication and decisional articulation. 

These goals are accomplished not only by identifying 

general pattems but also by taking a closer look at what 

underlies outlier statistics. ODAR can use information 

gleaned from these "focused quality reviews" (FORs) to 

develop training programs, materials, tools, or software to 

support ALJs and hearing offices in overcoming problems 

that are identified and in providing public service at the 

consistent, policy-compliant level that adjudicators and 

managers across ODAR seek to maintain. 

(See Focused Review ... on p. 4) 

The DDAR Office of Appellate Operations publishes the Executive 

Director's Broadcast generally every other week. To see past issues. 

go to the DAD newsletter searchable archive on the SSA Intranet. 

Permanent Subcommittee on Investi ations 

EXHIBIT #21 
884 

What the Data Reveals So Far 

FY 2011 Division of Quality 

Own Motion Review Rate 

below). FDfcases where the AC declined own motion review, 

effectuaUon proceeded to pay benerrts to claimants. 

Motion 

Review 

22% 

FY 2011 Dispositions by Division of Quality 

of AC actions taken 

Corrective decisions 

Action 

Pending 

15.7% 

Division of Quality ... from p. 1 One example: DQ staff collect data on cases where an AU 

or SAA approved a disability claim based on the same evidence that the DDS used to deny it "We look to see 

whether the decision issued at the hearing level could have 

been issued earlier,» says Judge Johnson. "Quality 

involves a timeliness factor, too - not just giving the right 

decision but giving it as soon as possible. Could that 

decision have been issued earlier? If so, why wasn't It? 

Was it evidence that came in, was it just a difference based 

on the same evidence? That's what we're starting to 

coUecLM 

Trends in Step 3 versus Step 5 decisions provide another 

example of DO's contribution to understanding dJsabHlty 

policies' effect on adjudicator actions. Of the decisions DQ 

reviewed in FY 2011, hearing offices decided cases at Step 

5 (ability to perform other jobs) versus Step 3 (medica! 

impairment deemed disabling) at about a 4-1 ratio, a 

disparity that surprised Judge Johnson. "In days gone by, 

there were more Step 3 decisions. I think Step 3 grew 

harder to use as a basis for a favorable decision as we 

added functionality and evaluation of credibHity" (see OAQ 

newsletter 2/18/11, p. 3). DO collected information on 657 

Step 3 and 2,833 Step 5 decisions. As a new source of 

data and insight on this issue, DO staff are participating in a 

recentry formed SSA workgroup examining what factors 

result in Step 5 allowances. 

As with ALJ decisions reviewed by OAO disabH1ty program 

branches, evidentiary support of the RFC constitutes the 

biggest portion of problems in favorable decisions for which 

DQ invokes own moHon review. "One ofthe reasons is the 

frequent use of inability to sustain working eight hours a 

day," says DO Division Director Carmine Borrelli. ~That's 

become a catch-aU for a lot of adjudicators in these cases. 

They often don't point to any evidence indicating the 

claimant has these Ijmitations.~ Use of this finding also 

avoids the need for a vocation a! expert. "What we envision 

is giving feedback to the agency saying this is an issue that 

needs to be clarified. It's not being applied properly and 

consistently." 

DQ Broadens Goals for FY 2012 

Based in OAO's Crystal City, Va., offices, DO consists of 

four support staff members, five managers, 46 attorneyadviser analysts, five appea!s officers and seven 

administrative appeals judges. DO recently added 12 new 

attorney advisers and plans to expand the number of cases 

it reviews, Borrelli says. In addition to reviewing 

unappealed favorable decisions in FY 2012, DO may 

extend its efforts by reviewing unappea!ed dismissals, the 

effectiveness and clarity of AC remand orders, and 

compliance with those orders. 

DQ Plans AU Participation The Division of Quality plans to include ALJs in its 

review process during FY 2012. Two AUs Would 

help review and adjudicate cases during a series 

of 120-day details. Division Chief AAJ Robert 

Johnson says he and other OAO staff remember 

the positive experiences they had working with 

AUs on the now-terminated Decision Review 

Board (see OAO newslett~JJj§l11). "You learn 

from each other," Judge Johnson explaflls. 

"AUs have a perspective that we don't always 

know or appreciate." Incorporating ALJs into 

DQ's peer review also offers an external benefit. 

"If you have an AU and AAJ that did the case 

review together and determined that own motion 

was necessary, that gives you an additional 

measure of credibility," he says, "ALJs also can 

see in the course of four months a substantia! 

number of decisions written by other ALJs and 

share what they learned with their hearing offices. 

It's a win~win all around." 

Page 2 
885 

OAO Executive Director's Broadcast 

DQ Dives Deep into Quality Data The type of data the Division of Quality collects shows 

how its mission extends beyond review of individual 

cases. In fact, the July 2011 ARPS update boosted the 

number of fields in the OQ case analysis too! to about 100 

so DQ could collect even more data. DAD will share 

analysis of these data with other SSA components to help 

shed light on possible areas of improvement of the 

disability adjudication process. 

In addition to numbers of effectuations allowed, remands 

and Appeals Council decisions, other examples of data 

DO collects and analyzes include: 

• Variances between the 10 regions in the rate of 

effectuations, remands and AC decisions. By sampling 

at least 3,500 decisions, DO obtains data that are 

statistically valid to the regional leveL It began sampling 

Boston region favorable decisions after the June 13, 2011, 

tennination of the Decision Review Board. 

• How much time DQ review adds to the effectuation 

process. Review of a favorable ALJ or SM decision 

delays its effectuation to give DO staff time for analysis 

and deciding whether to invoke own motion review. In FY 

2011, DO review added only 23 days on average to cases 

where it decided to allow effectuation to proceed without 

own motion review. 

• Decisions by hearing office SAAs as well as ALJs. 

In FY 2011, DO took a higher percentage of own motion 

reviews for SM decisions - by 5 percentage pOints - than 

for ALJ decisions. Since SMs make only on-thewrecord 

decisions, the lack of a hearing to help resolve issues such 

as earnings contributed to higher review rates, DO found. 

Other factors included not addressing onset dates that 

invaded the period of a prior claim, and basing a deCISion 

on the Medical-Vocational Guidelines but not considering 

transferability of skills when claimants had held skilled or 

semi-skilled jobs. As with ALJs, the most prevalent issue 

with SM decisions was lack of medical evidence in 

support of RFC findings. 

• Whether decisions involving certain impairments 

are more prone to error. 00 tracks primary and 

secondary impairments that pose the greatest problems 

to ALJs and SAAs for reaching legally sufficient 

decisions. 

• The impact that use of a medical expert (ME) has 

on legal sUfficiency of step 3 decisions and use of the 

vocational expert (VE) has on step 5 decisions. This 

data collection effort may indicate whether the rate of DO 

effectuations, remands and decisions varies by whether 

an ALJ took testimony from an ME or VE. 

• How often hearing decisions do not properly 

address work activity after onset. DO found 191 

instances of this problem in FY 2011. Often during own 

motion review, representatives submitted evidence of 

earnings that helped DO adjudicate the case, sometimes 

in the claimant's favor. 

January 13, 201i ( J 

DQ Sampling Method 

Seeks Objectivity In selecting a sample of favorable hearing decisions for 

review, the Division of Quality takes a simple, straightforward approach. It accesses the hearing level's Case 

Processing and Management System and usually selects 

every tenth favorable decision in each region at a rate of 

four a day and about 70 a month. The quality review 

work group, DAD Executive Director's Office staff and 

the Office of Systems developed this system to ensure 

that DQ obtains an objective sample, without 

identification of individual ALJs, hearing offices or 

allowance rates. 

Review of favorable ALJ decisions became a subject of 

contention after Congress approved the 1980 "Bellmon 

Amendment" to the Social Security Act, which resulted in 

a review program that initially targeted high allowance 

ALJs. In 1984, Congress Bmended the Act to terminate 

the Bellm on review because of concerns about its effect 

on ALJ decisional independence. Unlike Article 3 Judges, 

the judicia! independence of ALJs is constrained by 

agency policies that are binding on the ALJs. 

DQ adjusts the rate of cases produced by its sampling 

approach when it needs to manage the size of its incoming case workload. DQ staff work under a tight 

deadline that requires them to determine within 60 days 

whether to invoke own motion review. "We have parameters that we set that control the flow of cases so that we 

are n01 inundated and cannot get to them all," explains 

Division Director Carmine Borrelli. "If we need cases 

qUicker, we can increase the number per day. If we are 

getting overloaded, we can decrease that number." 

Top 10 Reasons for Remand 

of Unappea/ed Hearing Decisions The list below shows the top 10 reasons in descending 

order for Appeals Council remands in FY 2011 of 

favorable hearing leve! decisions. At the end of FY 2011, 

Council members serving with the DAD Division of 

Ouality had issued 550 remands. There are 170 reasons 

for remand; any remand can have up to three reasons 

associated with it. 

• RFC eXertionallimitatlons inadequately evaluated 

• RFC - mental limitations inadequately evaluated 

• Claimant credibility - failed to discuss appropnate 

credibi!ity factors 

• RFC - other (articulation issues) 

• Drug or Alcohol Abuse - msufficient articulation of 

DAA rationale 

• RFC - non-mental non-exertional limitations 

madequately evaluated 

• Incomplete/inaccurate record - record inadequately 

developed 

• Onset date/closed period/CDR 

• RFC effect of combmation of impairments 

inadequately evaluated 

• Treating source - recontact necessary 

Page 3 
886 

( OAO Executive Director's Broadcast 

Focused Review . .. from p. 1 When DO finds, based on its sampling of pre-effectuation 

cases, that there is a much higher-than-average rate of own 

motion review for an ALJ or hearing office, then it may conduct FORs to evaluate what may be a problematic pattem in 

the adjudication of disability cases. OAO also selects subjects for FORs based on analyses of other agency data. 

OAO is working with the ODAR Division of Management 

Information and Analysis, as well as the SSA Office of 

Ouality Performance, to develop algorithms to improve the 

selection process for additional FORs. 

After completing the FOR, DO reports its data and findings 

(but no recommendations) to the Office of Chief Administrative Law Judge and ODAR executives for whatever 

educational or other executive action they deem appropriate. 

Since DO began performing FORs in the spring of 2011, it 

has completed about 16 for ALJs and SAAs and about three 

for hearing offices. "Our focused reviews don't involve our 

DO adjudicators," notes Division Director Carmine Borrelli. 

"We don't want them involved because it is post-effectuation. 

We're not taking own motion review, we're just trying to see 

if we can identify any trends or issues that might be problematic or require a reminder or training for a judge or hearing 

office." 

The Appeals Council's own motion review authority (fQ 

CFR 404.969 and 416.1469) prohibits sampling cases 

based on "the identity of the decision maker Of the identity of 

the office issuing the decision," so the Council does not 

take adjudicative actions regarding specific cases reviewed 

under the post-effectuation focused review of cases. 

Teams of DO managers and attorney-adviser analysts 

perform the focused quality reviews, which take about four 

to five days each. Once a team selects an FOR subject, it 

screens a sample of 60 to 80 cases for a random period 

against several criteria. collecting data and information that 

might reveal issues of concern or patterns that may conflict 

with agency policies or regulations. Some criteria that may 

be included are how many decisions are on the record, how 

many are bench decisions, how long the hearing lasted, 

whether claimants submitted additional evidence after the 

state agency determination, and whether the file includes 

opinion evidence from treating, examining or non-examining 

sources, DO staff then conduct a more in-depth review of 

about 25% of screened cases and report on those findings. 

Focused quality reviews, for example, have identified 

several judges that rely solely on opinion evidence received 

at the hearing !evel. "The ALJ doesn't evaluate it or evaluate whether it is consistent with the other evidence, which is 

required before the opinion evidence can be given controlling weight, and finds that claimant is disabled. In many of 

these cases, the opinion evidence was not supported and 

was inconsistent with the other evidence of record," Borrelli 

says, As for hearing offices, an FOR found that one office 

used the same two medica! experts in about 80% of cases 

instead of selecting them on a rotational basis. "In that 

case, we did a referral to the Chief ALJ's office to let them 

know we've found this pattern," In other studies, DO found 

that hearing offices did not follow other agency policies and 

procedures in the assignment of cases. 

January 13, 2012 () 

DO staff begin each FOR with an open mind "not expecting 

to find anything," Borrelli adds. ''What we find, we find. 

Then we report it. We don't have any agenda behind what 

we're dOing. We're just trying to make sure that the agency 

issues consistent dedsions and follows proper procedures, 

regulations and the law so that the people who should be 

found disabled are and the people shouldn't be aren't 

That's our goaL" 

RRiDO Differences: Favorable Decision 

Brevity Puts More Focus on Record 

Reviewing favorable ALJ or SAA dedsions makes for a differ~ 

ent experience than reviewing requests for review (RR), OAO 

analysts and adjUdicators have learned. DO Division Chief 

MJ Robert Johnson, who has more than a dozen years experience adjudicating RRs, spelled out the differences he's seen: 

• Favorable decisions are shorter, with about two to 

three pages or less of rationale compared with two or three 

times that amount in ALJ denial decisions. Shorter decisions 

tend to mean briefer descriptions and evaluation of the medical evidence, including medical source opinions, and less 

rationale explaining the nexus between the medical evidence 

and the RFC. "Sometimes you have to reconstruct the rest 

of the decision to figure out the basis for the AU's finding of 

the RFC before you can ask whether it is supported by 

substantial evidence." 

• DQ staff can find themselves taking benefits away from 

claimants because the record doesn't support a favorable 

decision and doesn't even require a remand, "You have to 

prepare for a different mindset," Judge Johnson says. In 

(See RRJOQ Differences. . on p. 5) 

DO Own Motion Review Timeline 

During various periods in its history, the Appeals Council has 

conducted own motion review of favorable hearing decisions. 

Launched at the end of FY 2010 (see OAO newsletter. 9/17/10, 

p. 3) after 10 months of planning, the Division of Ouality made 

history as the first OAO component dedicated solely to own 

motion review, which it performs under 20 CFR 404.969 and 

416.1469. Since DO's work deals with decisions where 

claimants already have received a favorable disability decision, 

regulations specify a unique timeline for Appeals Council action: 

• 60 days after the hearing decision: The Council must 

decide whether to review the decision on its own motion. DO 

attaches an alert to the electronic case file notifying other SSA 

components not to effectuate payment until the Council acts. 

• When it opts for own motion review, the Council sends 

claimants and aU affected parties a notice explaining the 

reasons and setting a 2S-day deadline for submission of 

additional evidence or written statements. 

• 110 days after the hearing decision: The agency begins 

paying interim (but not retroactive) benefits if the Council hasn't 

released the case for effectuation. issued a corrective decision, 

or remanded the case to the hearing office and it has not issued 

a new decision. If the Council issues an unfavorable decision 

or the AU does so on remand, the agency wi!! not regard 

interim benefits as overpayments. 

To assist field offices and payment centers in understanding 

how it operates, DO added a frequently asked questions page to 

the OAO Intranet website. 

Page 4 
887 

( OAO Executive Director's Broadcast 

RRlDQ Differences . .. from page 4 FY 2011, that happened in only five cases, however. 

Actually, he was surprised by the number of more-favorable, 

corrective decisions that DO judges issued by approving an 

earlier onset date when supported by the medical evidence. 

Often in these cases, DQ analysts and adjudicators 

discovered that the hearing level found a claimant disabled 

during a period covered by a prior determination but didn't 

reopen it to address its earlier onset date. 

• DO analysts and adjudicators see fewer briefs or 

contentions to help identify issues, including errors of law, 

since the decisions they review are favorable. Representatives sometimes submit statements in response to own 

motion notices but the number has been smaller than expected. 

• Every case has a deadline of 60 days from the ALJ's 

or SM's decision (or ALJ dismissal of a hearing request 

when an SAA issues a favorable decision) for the Appeals 

Council to decide whether to conduct further review and 

decision-making on its own motion or allow effectuation to 

proceed. 

• Analysts produce more detailed remand orders that 

draw content from own motion notices. These labor-intensive notices explain to claimants at length why the Appeals 

Council will assume jurisdiction over their case for further 

review and hoW it may affect them. 

"In response to our own motion notices, sometimes 

claimant representatives submit medical evidence and we 

will issue a favorable decision based on their submission," 

Judge Johnson says. "A number of cases have gone back 

to ALJs who have held a hearing and gotten additional 

development, which supported a favorable decision. So I'd 

caution people about looking at own motion review as an 

indication that the decision was wrong." 

Absence of Substantial Evidence 

Triggers Own Motion Review What prompts DAD's Division of Quality Appeals 

Council members to take own motion review of an 

unappealed hearing decision under 20 CFR 404.969 

or 416.14697 They use this criterion: Whether the 

case record shows the decision is supported by 

substantial evidence (HALLEX 1-3·3-4). It two AAJs 

agree there's a lack of substantia! evidence, then the 

case undergoes further review and a possible remand 

or corrective decision (see DO Own Motion Review 

Timeline, page 4). 

This approach often means that Council members 

allow effectuation of a favorable AU or SAA decision 

even though it may not sufficiently discuss the 

evidence or articulate the reasons for a finding of 

disabled. If the adjudicators' review nonetheless finds 

sufficient evidence in the record that supports the 

finding, the Appeals Council won't invoke own motion 

review. For example, an AU could make an error of 

law by not properly discussing evidence of a claimant's 

drug or alcohol abuse (DAA), but itthe record supports 

a disability finding regardless of the OM, then the 

Council would not take own motion review. 

January 13, 2012 ( ) 

"How MI Doing?" Gives ALJs 

Easy Access to Remand Data As one of its key missions, DAD shares disability 

adjudication data it collects with other SSA components 

for uses they deem appropriate for their missions. A case 

in point: ODAR has launched a web-based system called 

"How MI Doing?" (HMID) that gives every AU a quick 

look at several types of data including Appeals Council 

remands issued under the Council's own motion and 

requests for review authorities. Called "How MI DoingT 

(HMID), the system allows AUs to compare their 

personal workloads and productivity against the average 

of all AUs in their hearing office, their region and 

nationally, updated daily. 

The remand data that AUs see come from information 

that DAD staff enter into the Appeals Review Processing 

System (ARPS). These data now appear as HMID bar 

chart displays showing AUs all 10 remand categories, 

top 10 remand reasons in each category and the top 20 

reasons across all remand categories. ALJs can see 

data for Appeals Council remands, court remands or a 

sum of them for their hearing office, region and nationally. 

While ALJs conceivably could have accessed remand 

data previously, it would have taken a lot of time and 

effort, says Jeffrey Uu, Ph.D., senior advisor, ODAR 

Office of Electronic Services and Strategic Information. 

Since the rollout on Aug. 9, 2011, following seven months 

of testing and fine-tuning, ALJs nationwide can simply 

click the appropriate MI menu items on their desktop to 

display HMIO data and rankings. They cannot yet see 

their personal remand data and rankings for several 

reasons, including the need to build a data history and 

track and adjust for ALJ relocations between hearing 

offices. 

Personal data that ALJs do see include their pending, 

dispositions, average processing time - for the week, 

month and fiscal year to date - and hearings scheduled 

for the coming three full months. ALJs do not see 

comparisons to individual ALJs in their hearing office, but 

see themselves compared to averages for all the office's 

AUs (including themselves). The system tallows the 

same principle for comparisons to each ALJ's region and 

in the nation. HMID also delivers productivity data to 

hearing office decision writers (OWs). It similarly provides 

a graphical display that compares and ranks the number 

of decisions they drafted against the average for all DWs 

in their hearing office, and against regional and national 

averages. ~Management wants people to know - this is 

where you are," Liu says, 

See the next page for a Q&A discussion 

with Deputy Executive Director Gerald Ray 

on disability adjudication consistency. 

Page 5 
888 

( OAO Executive Director's Broadcast January 13, 2012 ( 

Judge Gerald Ray Addresses Disability Adjudication Consistency 

The Office of Appellate Operations is the home of the Appeals Council and serves as the final administrative 

step in the SSA disability adjudication process. reviewing more than 130,000 hearing level decisions across 

the country. SSA now has added pre-effectuation review of favorable hearing decisions to OAO's 

responsibilities. Gerald Ray, OAO deputy executive director and an administrative appeals judge, offered the 

following answers to OAO newsletter staff questions about the reasons behind OAO's newest mission. 

Q Did recent press articles and the July 2011 TRAC study on inconsistencies in disability adjudication 

prompt SSA to establish the new program to review favorable hearing~/evel decisions? 

A No. We stood up the Division of Quality (~O) more than seven months before these articles and the study 

were published - not in response to them. The articles and the TRAC study point to wide disparities in ALJ 

decisional patterns. In fact, the TRAC study contended that obtaining a favorable Social Security disability 

hearing decision depended more on the judge than the facts of the case. SSA created DQ because there was no 

pre~effectuatjon review of favorable decisions. which constitute the bulk of hearing decisions (about 60% in FY 

2011). The agency is obligated to administer the disability program in an even-handed manner. Any unfairness in 

adjudication undermines public confidence in the agency, and undermines the credibility of the program and the 

people who administer it. 

Q How is it possible to achieve even~handedness in hearing decisions when claimants and their 

circumstances differ so much? 

A Social Security law and regulations provide the framework for ensuring that applicants for disability receive the 

benefits of due process of !aw, correct identification of the issues and adequate consideration of relevant 

evidence, all resulting in appropriate decisions. 

Q Administrative law judges and senior attorney adjudicators each adjudicate hundreds of cases a year. 

People often use heuristics to deal with complex issues, so couldn't they help reach a decision in a 

disability case? 

A People frequently use heuristics, or rules of thumb, to form a mental framework to simplify consideration of 

issues, often based on their experience in dealing with similar problems. Properly crafted heuristics can 

effectively speed up the process of correctly dealing with complex issues. However, use of inartfu!ly crafted 

heuristics to view a problem in a customary or traditional manner may result in framing issues too narrowly, over~ 

reliance on incomplete information, and limiting consideration of options only to those that have worked in the past, 

or interpreting information only in a manner consistent with the preconception connected with the heuristic. Thus, 

heuristics may interfere with appropriate decisjon~making. 

Q What has DQ found in its reviews of favorable hearing level decisions? 

Analysis suggests that most ALJs, SAAs and other agency adjudicators increased dispositional output in A accordance with agency production goals; however, both random and focused reviews of favorable hearing 

decisions strongly suggest that some decision-makers rely on heuristics that are not compliant with the current 

law, regulations and policies of the agency. Thus, we see that some decisions are not supported by substantial 

evidence. 

Q What is the goal of focused quality reviews? 

I believe that nearly all ALJs are conscientious in deciding cases and want to do a good job. Our ALJs have A quasHudicial independence, which prohibits the agency from telling ALJs whether to find a claimant disabled 

or not disabled. Our ALJs are professionals, ready to take self-corrective action when they receive appropriate 

feedback and consistent messaging regarding quality. We believe the information obtained through DO analyses 

will provide valuable insights in development of analytical tools and training the agency can provide to improve 

disability adjudication and ensure that its adjudicators fairly admin!sterthe disability program. 

Page 6 
889 

Permanent Subcommittee on Investi ations 

EXHIBIT #22 
890 

Overview of all Final Actions 

The Division of Quality closed a total of 3692 cases initiated in fiscal year 2011. Of those cases, 

3564 became final by the end of fiscal year 2012, and 128 closed in fiscal year 2012. The 

Council effectuated 2,880 cases (no action taken), remanded 665 cases, and issued a decision 

on 147 cases. 

1# Cases 

Overall Proportion 

EFF 

2880 

78% 

Own Motion 

REM 

665 

18% 

DEC 

147 

4% 

OM Total 

Total 

812 

22% 

Cases 

3692 

Breakout of Disposition Type 

Division of Quality FY 2011 Final Action Report 

February 8, lOll, Page Z of 11 

147, 

4% 

III EFF !III REM DEC 

PSI-SSA-12S-000014 
891 

Decisions By Sequential Evaluation Step 

A total of 3616 cases (98% of the 3692 decisions reviewed) were decided at either step 3 or 

step 5 of the sequential evaluation process. The Council effectuated 78% of the cases at both 

steps. 

Step 3 

% total Step 3 

Step 5 

% total Step 5 

Decisions Made at Step 3 

by AC Outcome 

DEC, 33, 

5% 

Division of Quality FY 2011 'Final Action Report 

February 8,2012, Page 3 of 11 

EFF 

535 

78% 

2287 

78% 

III EFF 

lIiREM 

DEC 

Own Motion 

REM 

114 

17% 

538 

18% 

DEC Total 

33 682 

5% 100% 

109 2934 

4% 100% 

Decisions Made at Step 5 

by AC Outcome 

DEC, 109, 

4% 

III EFF 

III REM 

DEC 

PSI·SSA·126-000015 
892 

Decisions By Type (OTR vs. Bench) 

A total of 592 decisions (16% of the 3692 decisions reviewed) were either decided on the 

record (6%) or issued as a bench decision (10%). The Council took own motion on 27% of the 

decisions issued on the record and on 23% of the bench decisions. 

EFF 

OTR 166 

%OTR 13% 

Bench 281 

% Bench 71% 

On the Record Decisions 

by AC Outcome 

DEC, 18, 

8% 

Division OfQI,J;3Bty FY 2011 ~inal Action Report 

February 8, 2012, Page 4 of 1l 

III EFF 

III REM 

DEC 

Own Motion 

REM 

43 

19% 

71 

19% 

DEC Total 

18 227 

8% 100% 

13 365 

4% 100% 

Bench Decisions 

by AC Outcome 

DEC, 13, 

4% 

III EFF 

III! REM 

DEC 

PSI·SSA·126-000016 
893 

Child 55I Decisions 

The Council reviewed a total of 181 (5% of the 3692 decisions reviewed) child supplemental 

security income decisions and took own motion on 36 (20%) of them. 

Child 551 

% Child 551 

Division of Quality FY 2011 Final Action Report 

February B, 2012, Page 5 of 11 

Own Motion 

EFF 

145 

80% 

REM 

31 

17% 

Child 5S1 Decisions 

by AC Outcome 

DEC, 5, 

3% 

DEC 

5 

3% 

IIIEFF 

III REM 

DEC 

Total 

181 

100% 

PS/-SSA-126-000017 
894 

Own Motion Rate by Region 

As stated above, the Council took own motion on 22% of the 3692 decisions reviewed. The 

regional own motion rate ranged from 15.5% (Region 8) to 26.2% (Region 6), with an average 

rate of 22% and an overall rate of 22%. 

Own Motion 

Region EFF REM DEC OM Rate Total Cases 

1 160 34 8 20.8% 202 

2 259 75 10 24.7% 344 

3 279 72 15 23.8% 366 

4 278 72 12 23.2% 362 

5 305 57 11 18.2% 373 

6 256 77 14 26.2% 347 

7 259 61 17 23.1% 337 

8 273 39 11 15.5% 323 

9 272 60 20 22.7% 352 

10 269 53 11 19.2% 333 

NHC 270 65 18 23.5% 353 

Total 2880 665 147 22.0% 3692 

Total Cases and Own Motion Rate by Region 

400 

350 

24.7% 23.8 300 

-20.8% 

250 

200 

t 

3 

150 

100 

50 

a 

2 3 

Division'of Quality FY 2:011 final Action Report 

February 8, 2012, Page 6 of 11 

26.1%' 

23.1% 

18.2% 

3 7 

4 5 6 7 

III Total Cases - OM Rate 

8 

15.5% 

3 

22.7% 

9 

30.0% 

25.0% 

23.5% 

19.2% 20.0% 

15.0% 

3 

10.0% 

5.0% 

0.0% 

10 NHC 

PSI-SSA-126-00001B 
895 

Regional Own Motion Rate by Adjudicator 

Of the 3692 decisions reviewed by the Council, 3164 (86%) were issued by an Administrative 

law Judge (AU) and 528 (14%) were issued by an attorney advisor (AA). The own motion rate 

for AA decisions was 24.6% versus 21.6% for AU decisions. The own motion rate for AU 

decisions varied from 14.3% (Region 8) to 25.8% (Region 6). The own motion rate for AA 

decisions varied from 15.5% (Region 3) to 30.8% (Region 5). 

AU Decisions by Region and AC Action AA Decisions by Region and AC Action 

OM OM 

OM Total 

Region EFF REM DEC Rate Cases Region EFf REM DEC 

1 140 28 7 20.0% 175 1 20 6 

2 221 66 10 25.6% 297 2 38 9 0 

3 230 63 15 25.3% 308 3 49 9 0 

4 243 64 12 23.8% 319 4 35 8 0 

5 260 38 10 15.6% 308 5 45 19 1 

6 219 63 13 25.8% 295 6 37 14 1 

7 223 50 14 22.3% 287 7 36 11 3 

8 234 30 9 14.3% 273 8 39 9 2 

9 234 48 18 22.0% 300 9 38 12 2 

10 208 31 10 16.5% 249 10 61 22 1 

NHC 270 65 18 23.5% 353 Total 398 119 11 

Total 2482 546 136 21.6% 3164 

AU vs. AA Own Motion Rates by Region 

35.0% 

30.0% 

25.0% 

20.0% 

15.0% 

10.0% 

5.0% 

0.0% 

Division of Quality ~ 2011 Final Action Rep.ort 

February 8, 2012, Page 7 of 11 

III AU OM Rate AAOMRate 

OM Total 

Rate Cases 

25.9% 27 

19.1% 47 

15.5% 58 

18.6% 43 

30.8% 65 

28.8% 52 

28.0% 50 

22.0% 50 

26.9% 52 

27.4% 84 

24.6% 528 
896 

Nature of Decisions Issued by the AC 

As stated above, the Council issued a decision on 147 (4%) of the 3692 cases reviewed by the 

Council. The Council issued a less favorable decision in 28% ofthe decisions. In 22% ofthe 

decisions, the Council changed the basis of the disability finding, but not the overall outcome. 

The Council reopened a prior determination or decision in 21% of the decisions. 

Type of Decision 

Reopened prior determination or decision (onset date invaded prior period) 

Changed the basis, but not the outcome, of the decision 

Found an earlier onset date 

Other favorable decisions 

Upheld determination or decision after receipt of further information (SGA) 

Corrected errors in onset and application dates 

Issued less favorable decision 

Issued fully unfavorable decision 

Division of Quality FY 2011 Final Action Report 

February 8, 2012. Page 8 of 11 

Total: 

/I % 

31 21% 

32 22% 

14' 10% 

10 7% 

7 5% 

7 5% 

41 28% 

5 3% 

147 

PSI-SSA-126-000020 
897 

Reasons Cited for QRB Remands, FY2012 

Cited Remand Reason 

Employee - Income Calculation 

Employee - Unsuccessful Work Attempt 

Employee - Other 

Income - Further Del.elopment 

Issues I Period Properly Before AIj Were Not Decided 

Self-Employed - Income Calculation 

Sel~Employed - Other 

Se~Employed - Unsuccessful Work Attempt 

SGA Consideration Of Entitlement To Twp I Epe 

SGA - Consideration Of Uwa And I Or Irwe, Etc. 

SGA EIo9luation Of Employee Criteria 

Cardiolo9scular Impairment Not Adequately Considered 

Combination Of Impairments Not Considered 

Endocrine System Impairment Not Adequately Considered 

Genrtourinary Impairment Not Adequately Considered 

Impairment Improperly Found "Not Se"",re" 

Mental Disorder Not Adequately Considered 

Multiple Body Systems Impairment Not Adequately Considered 

Musculoskeletal Impairment Not Adequately Considered 

Neurological Impairment Not Adequately Considered 

Obesity Impairment Not Adequately Considered 

Other 

Special Senses And 

Listing 1.00 - Not Adequately Addressed Or Evaluated 

Listing 11.00 - Not Adequately Addressed Or EIo9luated 

Listing 12..00 -Insufficient Articulation Of"B" Or"C" Criteria 

Listing 12..00 - Not Adequately Addressed Or EIo9luated 

Listing 14.00 - Not Adequately Addressed Or EIo9luated 

Listing 2.00 - Not Adequately Addressed Or EIo9luated 

Listing 3,00 - Not Adequately Addressed Or EIo9luated 

Listing 4,00 - Not AdequatelY Addressed Or Evaluated 

Listing 9.00 - Not Adequately Addressed Or EIo9luated 

other Adult Issue 

Division of Quality fY 2011 Hna! Action Report 

February 8, 2012, Page 9 of 11 

PSI-SSA-126-0DO021 
898 

Reasons Cited for QRB Ren1ands (coned) 

Cited Remand Reason 

listing 100,00 Not Adequately Addressed Or E\aluated 

Other Child Listings Issue 

Claimant Credibility Failed To Discuss Appropriate Credibility Factors 

Claimant Credibility - Other Issue 

Consultati.e Examiner - Opinion Not Identified Or Discussed 

Consultative Examiner - Opinion Rejected Without Adequate Articulation 

Consultati.e Examiner - Recontact Necessary 

Consultati.e Examiner Weight Accorded Opinion Not Specified 

Non-Examining Sounce Opinion Not Identified Or Discussed 

Non-Examining Source Opinion Rejected Without Adequate Articulation 

Non-Examining Source - Weight Accorded Opinion Not Specified 

Non,-Medical Source - Opinion Not Identified Or Discussed 

Non-Medical Source - Opinion On Issue Reser.ed To Agency 

Rfc Effects Of Combination Of Impairments Inadequately E\aluated 

Rfc Exertionai Limitations Inadequately E\aluated 

Ric - Mental limitations Inadequately EI.I3luated 

Ric - Non-Mental Non-Exertionsl limitations Inadequately Evaluated 

Ric Other 

Treating Source - Opinion Not Identified Or Discussed 

Treating Source - Opinion On Issue Reser.ed To Agency 

Treating'Source Opinion Rejected Without Adequate Articulation 

Function By Function Analysis Not Adequately Articulated 

Other 

Division of Quality FY 2011 Final Action Report 

Febru<lry 8, 2012, PaS8 10 of 11 

12 0.7'% 

PSI-SSM 26-000022 
899 

Reasons Cited for QRB Remands (cont' d) 

Cited Remand Reason 

Misapplied Framework - Improperty Considered Non-Exertional Limitations 

Misapplied Framework - 1m property Considered SkiJI Le;el/ Transferability 

Misapplied Framework - Other 

Misapplied Framework - Reliance On Ssr Was Incorrect Or Incomplete 

Misapplied Grid Rule' 1m property Considered Age Category 

Misapplied Grid Rule Improperty Considered Education / Literacy 

Misapplied Grid Rule, Improperly Considered Non,Exertional limitations 

Misapplied Grid Rule - Improperiy Considered Skill Leloel/ Transferability 

Misapplied Grid Rule - Other 

Miscellaneous - Decision Mischaracterizes Hypo Or VE Response To Hypo 

Miscellaneous - Other 

Miscellaneous - VE And DOT Not Reconciled 

Miscellaneous - VE Evidence Not Addressed In Hearing Decision 

VE Hypo - Other 

VE Hypo Did Not Encompass Allimpairrnent 

VE Hypo Inconsistent With Exertional RFC Established 

VE Hypo Inconsistent With Menial RFC Established 

VE Not Obtained', Manipulation Limitations Warrant VE Elidence 

VE Not Obtained, Mental limITations Warrant VE Evidence 

VE Not Obtained - Other 

VE Not Obtained 

Other 

Res JUdicata Dismissal 

Acquiescence Ruling Improperty Or Not Applied 

AU Misconduct / Unfair Hearing 

Drug Or Alcohol Abuse - Da! A As Material Factor To Disability 

Drug Or Alcohol Abuse, Insufficient Articulation Of Da! A Rationale 

Drug Or Alcohol Abuse, No Finding Of Disability 

Incomplete /Inaccurate Record, Lost/Inaudible Recording 

Incomplete I Inaccurate Record Lost Recond I E\idence 

Incomplete I Inaccurate Record, Record Inadequately De\eloped 

New Evidence Presented Upon Administrati"" Appeal! Reliew 

Non-Disability Issues 

Onset Date! Closed Period f CDR 

Other 

Division of Quaht)' FY 2011 Final Action Report 

February 8, 2012, Page 11 of 11 

PSI-SSA-126-000023 
900 

Enclosure - Page 1 Questions from Subcommittee Staff 

Questions from Subcommittee Staff Regarding Issues Raised 

At the September 13, 2012 Hearing 

On Improving the Quality of Disability Benefit Award Decisions 

1) Please explain why the agency no longer allows DDSs or ALJs to procure a Minnesota 

Multiphasic Personality Inventory ("MMPI") exam and provide any related directives 

or documentation. If the agency prohibits the procurement of any other symptom 

validity tests, please include the policy and reasoning behind that decision as well. 

We no longer purchase symptom validity tests such as the MMPI because there is no test that, 

when passed or failed, conclusively establishes a claimant's credibility. While a definitive 

statement regarding credibility would make an adjudicator's job easier, the MMPI cannot 

provide it; therefore, using it may cause the adjudicator to ignore the totality of evidence, as 

required, and issue an incorrect decision. 

Additionally, tests such as the MMPI have weaknesses in their psychometric properties that limit 

their consistent applicability in our program. For example, the MMPI is generally inappropriate 

for use with persons who have English as a second language, who cannot read at the eighthgrade level, or who have a low IQ. 

While we no longer purchase validity tests, claimants or their representatives continue to submit 

them in support of a claim. We plan to seek external expertise to evaluate our policy and provide 

additional guidance to help our adjudicators determine how to best handle these tests if they are 

in the medical record. 

2) Please also provide the following annual information for the past five years: 

o Number oftimes a DDS decision-maker or ALJ requested an MMPI or other 

symptom validity test; and 

o Annual amount spent by the agency on these exams. 

We do not track the incidence of requests for symptom validity tests or the costs specifically 

associated with their purchase. 

3) Please provide information regarding the data the agency plans to capture regarding 

outlying ALJs, as well as an explanation as to how it plans to use that data for future 

reviews. 

In recent years, we've made progress in capturing structured data at all adjudication levels so that 

we can identify areas for improvement and make changes based on objective data instead of 

anecdotal information. Regarding recent improvements in hearing level data, the Office of 

Appellate Operations (OAO) created and uses the Appeals Review Processing System (ARPS), a 

case processing system that captures structured data on AU decisions. ARPS data, which helped 

Permanent Subcommittee on Investigations 

EXHmIT#23 
901 

Enclosure - Page 2 - Questions from Subcommittee Staff 

identify 170 reasons for remand, serve as the foundation to determine whether ALls are correctly 

applying the applicable decisional framework. 

Although ARPS captured structured data on claimant-requested appeals of unfavorable or 

partially favorable ALl decisions beginning in 2008, OAO started examining deficiencies in 

fully favorable ALJ decisions in 2010 when OAO's Division of Quality (DQ) was reinstituted to 

take own-motion reviews in fully favorable ALJ decisions. With the combination of data from 

ARPS on different case outcomes, as well as more traditionally captured data from the Office of 

the Chief Administrative Law Judge like the number of dispositions, allowance rates, and the 

length of time cases spend awaiting ALl decisions, we now have access to information that helps 

identify policy non-compliance. As we gain experience with these data, we will reevaluate what 

more we need. When we identify anomalies, we take a closer look to determine the appropriate 

course of action to address the issue. 

In 2011, we instituted focused post-effectuation reviews performed by specially-trained DQ staff 

to help provide insight into identified anomalies. When DQ staff receives a topic for a focused 

review, they analyze a minimum of 60 decisions and perform in-depth reviews on 25 percent of 

the analyzed cases to determine if the ALl correctly applied the law, our regulations, and our 

internal business processes. DQ staff reports data on each ofthe decisions they review and 

provides their findings to ODAR executives. Based on the findings, ODAR executives can 

determine the appropriate course of action, including training, counseling, or reminders about 

relevant law, agency policy, or guidance. 

While we continue to perform additional focused reviews, we are also providing more 

individualized feedback, enhanced training, and additional electronic resources to our ALls. The 

combination of each ofthese approaches is improving the quality of ALl decisions. 

For many years, concerns and misunderstanding about the scope of ALJs qualified decisional 

independence made the agency hesitant to take action on issues related to quality. That is no 

longer the case. Our improved training and comprehensive quality reviews are improving 

compliance with policies and procedures. The vast majority of our ALJs strive to make the right 

decisions and to treat the public fairly. The tools we have recently implemented provide them 

better training and feedback so that they can achieve these goals, and we believe that we have 

made significant progress towards improving our decision-making. However, if after counseling 

and training, an ALl is not following our policies and procedures, such as not appropriately 

managing his or her docket, then we pursue appropriate disciplinary action with the Merit 

Systems Protection Board (MSPB). Recently, the MSPB issued a decision finding that there was 

"good cause" to remove an ALJ from his position because of his failure to acceptably manage his 

cases by not scheduling a sufficient number of hearings and issuing an acceptable number of 

decisions when compared to his peers in the hearing offIce and other hearing offices in the 

region. 

4) Please provide an explanation as to the varying error rates among the different regions. 

The Appeals Council's (AC) remand rates are not the same as case "error" rates-a remand 

means the AC identified a legal deficiency but does not always mean that the AC necessarily 

2 
902 

Enclosure - Page 3 - Questions from Subcommittee Staff 

disagrees with the ALl's ultimate decision to deny or allow the case. Also, some issues can be 

outside of the ALl's control, such as the submission oflate evidence. 

There are a number of factors that contribute to the variances in the remand rates between the 

regions. For example, remand rates may be affected by differences in development of the record 

at the DDS level, diversity in regional economies (i.e., rural and urban), disparity in the type of 

work available in different regions, the frequency and occurrence of certain types of impairments 

in regions, the number of non-English speaking claimants in regions, and the size of regions. 

Some of the variances in regional remand rates may be due to how AU s apply the decisional 

framework or if they stay current with the decisional framework. We are working to ensure 

AU s issue quality decisions. 

In an effort to ensure ALI s issue quality decisions, we continue to improve training programs 

and create better individual feedback tools, such as "How MI Doing?" This resource gives ALJs 

extensive information about their remands as well as information on performance in relation to 

other AUs in the office, region, and Nation. Currently, we are developing training modules 

related to each of 170 identified reasons for remands that we will link to the "How MI Doing?" 

tool. Further efforts to promote quality decisions include a test pilot of the Electronic Bench 

Book (eBB) for our AUs. The eBB is a web-based tool that aids in documenting, analyzing, and 

adjudicating a disability case in accordance with our regulations. We designed the tool to 

improve accuracy and consistency in the disability evaluation process. 

As previously noted, the DQ oversees quality by performing focused post-effectuation reviews 

of hearing offices, AUs, representatives, doctors, and other subjects. We identify potential 

subjects for focused reviews based on data collected through agency systems, findings from preeffectuation reviews, and internal and external referrals from various sources regarding potential 

non-compliance with agency regulations and policies. 

Through improved training, development of new electronic tools, and quality assurance efforts, 

we are improving AU compliance with the controlling decisional framework, which should 

reduce regional variances that are within our control. 

5) Please explain why the Department of Labor's O*NET database is not sufficient to use 

for disability claims, as well as any documentation of tbis decision. 

Currently, O'NET does not measure strength and physical requirements in a way that our 

disability rules require. Our regulations and program policies contain specific definitions of the 

physical exertion requirements of work in the national economy, and classify jobs as sedentary, 

light, medium, heavy, and very heavy. O'NET does not measure work using these definitions. 

Additionally, regulations provide specific definitions of skill requirements that we use to assess 

whether a disability claimant can adjust to other work that exists in the national economy. For 

example, the regulations define unskilled work as a job a person can usually learn to do in 30 

days. O'NET does not contain data at this level of detail. 

We believe that there are aspects of O·NET that we can use. We are currently working with the 

Department of Labor's Bureau of Labor Statistics (BLS) to determine if they can meet our data 

needs. 

3 
903 

Enclosure - Page 4 - Questions from Subcommittee Staff 

Using the names, descriptions, and tasks of occupations in the O'NET system as a starting point, 

we are working with BLS to test the feasibility of using the BLS National Compensation Survey 

platform to collect additional information on strength, specific vocational preparation, and nonexertional requirements necessary for our disability programs. 

Chapter 8 of the National Academy of Sciences report on O*NET 

(hnp:!!www.nap.edu!catalog.php?record id=12814) extensively discusses our past research and 

views over the last decade or more. 

In addition, our Occupational Information Development Advisory Panel issued a review of the 

National Academy of Sciences report on O'NET (see attached document titled, "Complete -

Findings Report OIDAP 062810") and included questions and answers with National Academy 

of Science staff on issues about O*NET. 

[SEE ATTACHMENT] 

6) Please provide an explanation and detailed cost justification of the estimated 

$108 million the agency plants to spend to create a new database to be used by SSA in 

determining disability claims. 

We previously estimated the cost of developing our own database for a new Occupational 

Information System at $108 million over five years; however, several months ago we modified 

our approach. 

In FY 2012, we signed an interagency agreement with BLS for approximately $400,000, which 

funded research planning activities to test the collection of data on strength, specific vocational 

preparation, and non-exertional requirements using the specific definitions and measurements 

required by our regulations for a broad set of occupations. In FY 2013, we negotiated a separate 

agreement for about $11 million to fund the test. 

7) Please provide for each ODAR hearing office the rate at which the Office of Appellate 

Operations Division of Quality exercised "own motion" review. This should include, 

but is not limited to, the following hearing offices: Oklahoma City, Oklahoma; 

Roanoke, Virginia; and Montgomery, Alabama. 

The Appeals Council collects this information on a regional basis but not for individual hearing 

offices because its analysis would not be statistically significant at that level. In FY 2011, the 

Appeals Council reviewed 3,692 cases for possible own-motion review. Given the review of a 

relatively small random selection of favorable decisions nationwide, the regional level is the 

smallest denominator at which we could assess findings that are statistically significant. As 

noted in the Subcommittee's minority report, the regional own-motion rates for the identified 

hearing offices were: 

4 
904 

Enclosure - Page 5 - Questions from Subcommittee Staff 

• Dallas Region, 26.2%; 

• Philadelphia Region, 23.8%; and 

• Atlanta Region, 23.2%; 

8) Finally, the Senators requested the agency provide a response to each ofthe 

recommendations in the Report. 

We will provide this information as an insert to the hearing transcript, as requested by the 

Subcommittee. 

5 
905 

Occupational Information Development 

Advisory Panel 

Findings Report: 

A Review of the National Academy of Sciences Report 

A Database for a Changing Economy: 

Review of the Occupational Information Network (O*NET) 

June 28, 2010 

Report to the Commissioner of Social Security 
906 

OCCUPATIONAL INFORMA nON DEVELOPMENT ADVISORY PANEL 

REVIEW OF 

THE NATIONAL ACADEMY OF SCIENCES 2010 REPORT 

A DA TABASE FOR A CHANGING ECONOMY: REVIEW OF THE OCCUPA TlONAL 

INFORMA TlON NETWORK (OWET) 

Executive Summary 

Based on a January 2010 request from the Social Security Administration (SSA), the 

Occupational Information Development Advisory Panel (OIDAP or Panel) reviewed 

the National Academy of Sciences (NAS) report, A Database for a Changing 

Economy: Review of the Occupationallnfonnation Network (0 'NET), 1 for relevance 

and lessons learned useful to SSA's development of an occupational information 

system (OIS) to replace the aging Dictionary of Occupational Titles (DOT) in the 

disability adjudication process. The OIDAP describes the background of the 

request, the OIDAP methodology for reviewing the O'NET Report, its findings and 

lessons learned, and offers SSA areas for consideration. 

Common Ground: NAS Panel and OIDAP Areas of Agreement 

1. The NAS panel's review of the use of the O"NET in disability 

adjudication reached the same conclusion as that of other national 

governmental bodies, the OIDAP, and SSA in that the O"NET in its 

current form is not suitable for disability adjudication.2 (See pp. 7-8 of 

this report) 

2. The NAS and OIDAP reports reached the common conclusion that 

significant changes would need to be made to the O"NET in order for it 

be suitable for disability adjudication. For example, changes to the 

O"NET content model, the Behaviorally Anchored Rating Scales (BARS), and 

the level and unit of analysis would all be required. These changes would 

involve a costly revalidation of the entire O'NET system and have the 

potential of negatively impacting the ability of the O'NET to serve the 

purposes for which it was designed. (See p. 8 of this report) 

3. The O"NET Report included a variety of important conclusions 

regarding occupational database maintenance that were similarly 

reached by the OIDAP for the OIS's development including: 

1 Given how past and current studies of occupational databases are referred to by the audiences who may read this report, the 

OIDA? has chosen to refer to the O*NET review as being conducted by the NAS not by the National Research Council as it is 

also sometimes referenced. 

2 p. 161, National Academy of Sciences (NAS) report, A Oatabase for a Changing Economy: Review of the Occupational 

Information Network (O·NET). 

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• focusing on collecting, maintaining, and publishing high-quality 

data; 

• considering input from the scientific and user communities on the 

research and usability processes; 

• developing plans and procedures for refreshing the occupational 

database; 

• using technology for communication or for the delivery platforms 

to users; and, 

• exploring the use of Internet-based methods for developing an 

online user community. (See p. 9 of this report) 

4. The NAS staff deferred to the expertise of the OIDA P for SSA's 

occupational data needs. The NAS panel did not contain a subject matter 

expert in SSA disability adjudication, in private sector disability adjudication 

needs, or in the use of occupational information in disability applications in 

general. (See pp. 9-10 of this report) 

Going Forth: OIDAP Areas of Future Exploration 

5. The application of O·NET in SSA's disability adjudication process would 

require SSA to change its definition of "skills" as well as the way skills 

are assessed in SSA's disability programs. The manner in which O"NET 

defines skills and conceptualizes skills transference conflicts with SSA's 

disability program requirements, its regulatory definition of skills, and the 

regulatory rules by which skills are considered in disability claims. (See pp. 

10-11 of this report) 

6. The O"NET is a general purpose database addressing the needs of the 

primary users (e.g., workforce development, economic development, 

career development, academic and policy research) for which it was 

designed. The disability adjudication data needs and purposes are very 

different and not a subset of the general purpose database. (See pp. 11-

16 of this report) 

Jcoe 22 20~ 0 
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7. The O*NET Report did not articulate the evaluation criteria that the NAS 

panel may have used for its evaluation of the O*NET. (See p. 16 of this 

report) 

8. The forensic defensibility of using O*NET data for disability adjudication 

was not addressed by the NAS panel. (See pp. 16-17 of this report) 

Considerations3 

Based on these findings, and our review of the O*NET Report in general, the OIDAP 

upholds its September 30, 2009 recommendations to SSA. The OIDAP further 

advises that SSA should consider: 

Internal Expertise Unit 

1. Cautious progress on the R&D agenda for the OIS until the scientific 

expertise unit recommended by the OIDAP in its September report has 

been established. As noted in the O'NET Report, developing a research 

agenda and its priorities would be advisable. 

Information Sharing with Other Government Agencies 

2. Continued and expanded SSA and DOL cooperation on mutually 

beneficial areas, such as sampling and/or data collection. This 

cooperation may include examining how DOL has historically developed 

and used occupational data for its own labor-related adjudicative needs. 

3. Collaboration with other Federal agencies, such as the Department of 

Defense, Office of Personnel Management, Rehabilitation Services 

Administration, and the Census Bureau, regarding work analysis 

methods or other studies, surveys, or information of value to the 

development of the OIS. 

~ See pp. 17-18 of this report for discussjon. 

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Ethical and Legal Concerns Regarding O'NET and DOT 

4. Consideration of potential ethical and legal concerns that might arise 

from repurposing O'NET or by pursuing an update to the aging 

Dictionary of Occupational Titles framework for use in the disability 

adjudication process. 

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Introduction 

At the OIDAP's inaugural meeting, Commissioner Astrue requested that the Panel 

provide the SSA with its content model and classification recommendations by the 

end of FY 2009. The Panel delivered the Content Model and Classification 

Recommendations for the Social Security Administration Occupational Information 

System report to Commissioner Astrue on September 30, 2009. 4 

As the OIS project transitioned into the research and development (R&D) phase, a 

January 19, 2010 letter from Commissioner Astrue requested further advice and 

recommendations from the OIDAP regarding the: 

1. development of sampling and data collection plans for R&D; 

2. creation of a process for recruiting job analysts, including methods for 

certification criteria and training; 

3. assistance in establishing associations between human function and the 

requirements of work; and, 

4. review of relevant documents or reports SSA identifies that may affect or 

inform its work on the OIS. 

This report addresses a request made by SSA at the January 2010 quarterly 

meeting that the OIDAP review the NAS report, A Database for a Changing 

Economy: Review of the Occupational Information Network (O*NET) 5 (herein 

referred to as the "O*NET Report"). The purpose of the review was to examine data 

quality, sampling, and other issues that might be useful to the development of SSA's 

OIS. 

The O*NET Report also contains topics that may be helpful to future OIS R&D 

activities. Thus, these technical topics will be addressed in subsequent OIDAP 

reports as appropriate, such as in the areas of measurement, sampling, data 

collection, and evaluation metrics. 

" Because of the OIDAP's Federal Advisory Commfttee Act status, subcommittees do not recommend directly to SSA, but to 

the OIDAP. These recommendations are deliberated and voted upon by the entire Panel. The subcommittee reports 

contained in the OIDAP's report appendices were finaliz-ed on September 1, 2009 for Panel deliberations and voting on 

September 16~17, 2009. Therefore, the recommendations by the OIDAP to Commissioner Astrue on September 30,2009 are 

in the Final Report and Recommendations section, or the first 68 pages of the report, not in the appendices. The 

recommendations for the content model data elements were meant as a starting point for further development and refinement 

by SSA through the R&D process. The OIDAP report can be retrieved from http:ltwww.ssa.gov/oidap/paneLdocuments.htm 

'O"NET Report, Retrieved from http://www.nap.edu/catalog.php?recor<Ud=12814 

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Background 

A decade after the release of the O'NET, the Employment and Training 

Administration of the US Department of Labor (DOL) commissioned a review of the 

database by the NAS. This was the first time in three decades that an independent 

body reviewed a civilian occupational information database. in the United States 

since the NAS conducted a similar review of the DOT in 1980. 6 

The OIDAP applauds the DOL for opening the O'NET to user, stakeholder, and 

public review and critique. The process can only serve to strengthen the database 

for the workforce development and similar purposes for which it was primarily 

developed? 

OIDAP Methodology for Review of the O'NET Report 

The Prepublication Copy/Uncorrected Proofs of the O'NET Report were released by 

the NAS to the public on December 4, 2009. On January 8, 2010, in their 

professional roles outside of the OIDAP, two Panel members (Mary Barros-Bailey, 

PhD and Mark Wilson, PhD) met with the NAS O'NET study staff to clarify factual 

inaccuracies in the O'NET Report. In addition, two Social Security Administration 

staff (Associate Commissioner Richard Balkus and Occupational Information 

Development Project Director Sylvia Karman) met with the NAS staff on January 12, 

2010 to provide information regarding the disability adjudication process that was 

inaccurately reflected in the O'NET Report. At both meetings, the NAS staff 

indicated that only factual inaccuracies could be corrected because the O'NET 

review panel had already disbanded. 

At the January 22, 2010 OIDAP quarterly meeting, the Panel discussed inviting NAS 

staff to present their findings at the next OIDAP meeting based upon SSA's request 

to the OIDAP to review the O'NET Report. Between quarterly meetings, the OIDAP 

Chair requested that the Panel review the O'NET Report in its entirety in preparation 

for a presentation by NAS staff at the next March quarterly meeting. 

On March 25, 2010, Ms. Margaret Hilton, Study Director, and Mr. Tom Plewes, 

Associate Study Director at the NAS for the O"NET panel, presented to the OIDAP. 

6 This report is often called the ~MiI!er Study." Retrieved from http://WYM'.nap.edu/openbook.,php?recordjd=92&page=R1 

7 pp. 12, 24. 25. 36, and 37, Appendix B. 
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INFORMATION NETWORK (0 'NET) 

See Appendices A and B for the NAS presentation materials and transcript. The 

final O'NET Report became available to the public and to the OIDAP on May 11, 

2010. The preliminary report drafted by the OIDAP Chair was reviewed by the 

Executive Subcommittee on June 9, 2010 and deliberated upon by the full Panel on 

June 10,2010. 

A Word about Timing 

An important insight arising out of the March 2010 presentation by Ms. Hilton and 

Mr. Plewes centered on the timing of the O*NET panel's deliberations and 

recommendations that were completed by the end of April 2009,8 or five months 

before the OIDAP September 30, 2009 report was available. 9 Indeed, the NAS 

panel had disbanded by August 2009 - when their report entered NAS's internal 

review process. The O'NET Report was not released in the prepublication format 

until nearly three months after the dissemination of the OIDAP report. The timing of 

both panel processes and reports could lead to the mistaken impression that the 

NAS panel took OIDAP's findings and recommendations into account when it 

actually did not. 10 

The NAS staff referenced the OIDAP report and recommendations as an attempt to 

be complete in the literature citing; 11 however, the technical working papers and 

other research considered by the OIDAP, as well as the OIDAP report and 

recommendations, were never read or considered by the O·NET panel in its 

deliberations or when arriving at its recommendations. The NAS staff clarified the 

timing and referencing of the OIDAP report when presenting in March 2010 and via 

a footnote 12 in the final copy of the O'NET Report. Ms. Hilton indicated that, should 

the NAS panel have considered OIDAP's findings, these would presumably have 

affected their conclusions. 13 For a timeline of each panel's process, see Appendix 

C . 

• p. 61, Appendix B. 

9 pp. 60,129, and 130. Appendix B. 

"pp.16, 130-131, and 146, Appendix B. 11 p. 61, Appendix B. 

"p. 161, O'NET Report. 

13 p. 62, Appendix 8. 

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OIDAP Findings 

Review of the O'NET Report by the OIDAP resulted in eight general findings that 

are detailed in this section. 

Common Ground: NAS Panel and OIDAP Areas of Agreement 

FINDING #1: The NAS panel's review of the use of the OWET in disability 

adjudication reached the same conclusion as that of other national 

governmental bodies, the OIDAP, and SSA in that the OWET in its current 

form is not suitable for disability adjudication. 

Pages 11 and 12 of the OIDAP report identify the occupational data requirements of 

SSA's disability programs including the need to: 

1. reflect national existence and incidence of work; 

2. reflect work requirements; 

3. be legally defensible; and, 

4. meet the following technical, legal, and data requirements: 

a) occupations aggregated at a level to support individualized disability 

assessment; 

b) a cross-walk to the Standard Occupational Classification; 

c) precise occupationally-specific data; 

d) core work activities; 

e) minimum levels of requirements needed to perform work; 

f) observable and deconstructed measures; 

g) a manageable number of data elements; 

h) sampling methodology capturing the full range of work; 

i) inter-rater agreement justifying data inference; 

j) data collection of high quality data; 

k) valid, accurate, and reproducible data; 

I) whether core work activities could be performed in alternative ways; and, 

m) terminology that is consistent with medical practice and human function. 14 

14 See SSA working papers Developing an initial Classification System and Social Security Administration's Legal, Program, 

and Technical/Data Occupational Information Requirements. Retrieved from http://wvm.ssa.gov/oidap/paneLdocuments.htm 

and also see p. 50, Appendix.8. 

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The NAS panel did not consider these occupational data needs for SSA's programs, 

as confirmed in their staffs presentation to the OIDAP in March 2010. 15 Like SSA 

and many other independent and government bodies that have previously arrived at 

the same conclusion (General Accounting Office, 2002a, 2002b; Institute of 

Medicine, 1998, 2002; OIDAP, 2009; Social Security Advisory Board, 2001), the 

O·NET Report16 agrees that "". disability determination was an important use of the 

DOT and because O·NET was created to replace the DOT, it seems fair to conclude 

that O*NET has failed to replace the DOT in this particular usage." (p. 161, O·NET 

Report) 

The NAS staff added that, "". we didn't look in-depth at this whole disability 

question. We took a quick look, and we thought it needed further study.,,17 

FINDING #2: The NAS and OIDAP reports reached the common conclusion 

that significant changes would need to be made to the O*NET in order for it be 

suitable for disability adjudication. 

Both the O-NET Report and the OIDAP conclude that a variety of measurement and 

scaling issues of descriptors in O-NET would be highly problematic for disability 

adjudication. The NAS staff and the OIDAP specifically focused on the application 

of BARS within the O-NET during the March 2010 NAS presentation. 18 

The O·NET Report correctly identifies the problematic issues (e.g., dichotomous 

definitions, complex terminology, confounded difficulty levels, no clear continuum, 

etc.) 19 associated with BARS in general, and specific to disability adjudication. 20 

However, the staff could not identify a way in which these BARS could be changed 

with disability adjudication occupational information needs in mind without 

revalidating the entire O·NET database that cost $75M over the last dozen years, 

not including the cost of its development. 21 Neither could we. Future costs 

associated with the disruption this redesign would have upon the primary users 

identified by the O·NETs mission is incalculable. To the extent that SSA would 

:: ~. ~1 ~~~~~~~port " p. 78. Appendix B. 

"pp. 30. 67-76. and 110, Appendix B. 

"pp. 63, 74, 75. 76. 87, 166, 177, 196, O·NETReport. 

'" p. 30, Appendix B. 21 pp. 69, 71, and 110, Appendix B. Note that on p. 71, Mr. Plewes indicated, U! don't believe you can fundamentally change 

the anchors and retain the system as rt is. But the panel didn't look at that.~ The discussion on p. 110 indicates how changing 

the problematic BARS would mean having to revalidate the ratings across the entire O*NET system. 

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consider the use of BARS, it would need to ensure when and how BARS would be 

suitable for an OIS developed for disability adjudication. 

FINDING #3: The O"NET Report included a variety of important conclusions 

regarding occupational database maintenance that were also similarly reached 

by OIDAP for the OIS's development including: 

focusing on collecting, maintaining, and publishing high-quality data; 

considering input from the scientific and user communities on the 

research and usability processes; 

developing plans and procedures for refreshing the occupational 

database; 

• using technology for communication or for the delivery platforms to 

users; and, 

exploring the use of Internet-based methods for developing an online 

user community. 

FINDING #4: The NAS staff deferred to the expertise of the OIDAP for SSA's 

occupational data needs. 

The NAS panel did not include a subject matter expert with a specialty in disability 

adjudication in the private or public sectors,22 or in particular to SSA's disability 

program needs. On March 26, 2009, Ms. Sylvia E. Karman, the Director of the 

Occupational Information Development Project, presented to the NAS panel about 

the need for occupational information in SSA's disability programs. 23 Beyond the 

one-hour presentation, the NAS panel did not review or consider other currentlyavailable working papers or reports specific to the occupational information needs 

for disability adjudication; therefore, during the March 2010 presentation to the 

Panel, the NAS study staff deferred to the OIDAP for expertise in the use of 

occupational information as pertinent to the disability adjudication process. 24 

The O*NET Report's first recommendation in Chapter 8 caited for the development 

of an interagency task force whose first order of business would be to study SSA's 

occupational information needs. According to Mr. Plewes, this recommendation has 

22 p. 16, Appendix B. 

"P. 160, O'NET Report. 

;!4 pp. 33, 55, and 59, Appendix B. 

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already been performed by the OIDAP's review. 25 Based on the review of SSA's 

needs, the OIDAP voted unanimously in 2009 that a new OIS was needed to replace 

the DOT in disability adjudication. O'NET was not recommended as that 

replacement. 

Going Forth: OIDAP Areas of Future Exploration 

FINDING #5: The application of o 'NET in SSA's disability adjudication process 

would require SSA to change its definition of "skills" as well as the way skills 

are assessed in SSA disability programs. 

The NAS panel cited various conflicting and confounding definitions of skills within 

the O'NET content model. 26 Broad conclusions regarding transferability of skill may 

make sense for the primary users of O'NET data, such vocational rehabilitation 

counselors who may need to consider broad brushstrokes of occupational 

information as a starting point in the vocational exploration process to which they 

may add other information (e.g., results of psychometric assessments or employer 

contacts) when developing a rehabilitation or retum-to-work plan that may include 

educational or other vocational interventions to develop a client's or evaluee's 

vocational potential. However, the same conclusions are contraindicated for 

disability adjudication. For example, the O'NET Academy27 describes a 

transferability of skill tool called TORQ that was used in Indiana to assist laid off 

workers in exploring skills transference to other work. The pod cast describes a case 

of a recreational vehicle team assembler and finds transferability of skill to the work 

of a dental hygienist. This conclusion of transferability of skill is highly problematic 

for SSA as its process does not allow for considering retraining, accommodations, or 

other vocational rehabilitation interventions in disability adjudication. 28 The NAS 

panel did not consider transferability of skill within the disability adjudication process 

or how the design of the O'NET could results in data that could be highly 

problematic for work experience and transferable skills analyses at Steps 4 and 5 in 

the sequential evaluation process. 29 

25 p. 33, Appendix B. 

" p. 32, O'NET Report. 

27 O*NET Academy is accessible at http://YMW.onetacademy.comlfaq/contentpartner.cfm 

"pp.116-117, and 120, Appendix B. 

29 p. 117, Appendix B. 

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The treatment of skills and skills transferability with the use of a general purpose 

database such as the O'NET could potentially result in inaccurate decisions and 

increased denials in the sequential evaluation process. Again, the O'NET was not 

designed to meet disability adjudication needs. Changing the O'NET for disability 

adjudication needs would make it problematic as a tool for the purposes for which it 

was created and where this kind of transferability of skills method may be helpful. 

With respect to the issue of skills and skills transference in its September 2009 

report, the OIDAP recommended data elements to include in the content model and 

data collection effort that best fit with the disability adjudication process. Specifically, 

by its recommendations, the OIDAP attempted: 

to distinguish the essential components of the definition of what a skill is and 

how a skills analysis or work experience analysis is performed and [to] 

separate them into those elements or processes for which occupational data 

could be gathered. By doing so, we are able to study the resulting data 

collected vis-a-vis current paradigms of how skills transfer or could transfer, 

as well as to provide the opportunity to potentially explore other methods that 

might result in greater face and predictive validity that are based on empirical 

data. We note that SSA uses the "transferability of skills analysis" at Step 5 in 

very limited circumstances. We mean to include the consideration of an 

individual's ability to do past work or other work as currently conceived by 

SSA (unskilled, semi-skilled, or skilled)30 (p. 48, OIDAP Report) 

FINDING #6: The O*NET is a general purpose database addressing the needs 

of the primary users (e.g., workforce development, economic development, 

career development, academic and policy research) for which it was designed. 

The disability adjudication data needs and purposes are very different and not 

a subset of the general purpose database. 

Different Missions. Different Users 

The assumption that the creation on an OIS would be parallel, duplicative, or 

redundant31 to the existence of the O'NET is incorrect and does not consider the 

"20 CFR 404.1S66(d) and 416.966(d) for SSA definnion of skills and transferability of skills. 

"p.161,O·NETReport. 

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differing missions, user needs, purposes, or other design considerations of each 

occupational database. The NAS panel inferred the O*NETs mission as DOL 

needing to "[m]eet the competitive labor demands of the worldwide economy by 

enhancing the effectiveness and efficiency of the workforce development and 

regulatory systems that assist workers and employers in meeting the challenges of 

global competition." (p. 6, O'NET Report). On the other hand, the mission of SSA's 

OIS is to provide specific physical and mental job demands and measures that are 

directly related to SSA's evaluation of limitations resulting from disability claimants' 

impairments. 

Consequently, unlike the OIS that is being developed by the SSA specific to one 

purpose - the disability adjudication process and the users specific to that system -

the first paragraph of the O'NET Report states that the O'NET was developed by 

the DOL not only for use within some of its programs, but also for many users in the 

national economy identified as: 

• workforce development 

• economic development 

• career development 

• academic and policy research 

• human resource management32 

Because of the many users for which the O'NET content model was designed, its 

development of its design took considerably longer than is anticipated for the OIS's 

development. O'NET users utilize the general purpose33 data as the starting point 

within their processes upon which further research and information may be required 

whereas the OIS needs to provide very specific information to assist decisionmaking at the n=1 level. 

Different Purposes and Needs: Econometric v. Ergometric System Designs 

Understanding the occupational data needs of specific users is important to 

concluding whether the O'NET fits that need well. For example, a RAND 

32 The Q*NET Report states, ~a primary goal of Q*NET is to help state workforce development offices carry out their dual 

mission of assisting individuals in gaining challenging, rewarding work (and any required education and training) and assisting 

employers in recruiting, hiring, and developing skilled workers." p. S. Also see pp. 12, 24, 25, 36, and 37, Appendix 8. 

"pp. 23. 25. 27, 29, 70, and 61, Appendix B. 

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Corporation study (Hansen, Campbell, Pearlman, Petho, Plewes, & Spenner, 2008) 

assessing the development of a common framework for the various military 

occupational information systems34 concluded that: 

... no single existing system is likely to be fully appropriate for DoD's needs 

.... All of the existing systems ... , including the O*NET, provide information 

that is too general and abstract. If 000 wishes to develop a uniform 

[occupational analysis) system applicable across the services, their 

components, and the civilian workforce, the need to build the system in-house 

seems inescapable. This is the only way it could be substantively meaningful 

to users and stakeholders. 35 (p. 20, Rand Report) 

The O*NET Report and the 2008 report by the RAND Corporation both indicated 

that the design of an OIS is specific to its purpose. The RAND report best describes 

this initial and crucial decision in the development of any occupational database 

when it states: 

A major requirement for choosing among occupational analysis system 

options is understanding, in fairly specific terms, the objectives or purposes to 

be served by the system. Indeed, this understanding is needed before any 

truly meaningful discussion of key underlying systems concepts and issues 

can occur.36 (p. xiii, Rand Report) 

Further, the RAND panel posited: 

When considering alternative [occupational analysis) systems ... there are no 

unequivocally "right" or "wrong," or "better" or "worse," choices in the absence 

of specification of the system's intended purposes and applications. Each 

type of process, job descriptor category, and level of analysis has utility for 

different purposes and is therefore relatively more or less suitable for different 

applications. Specification of such purposes is in turn a function of the 

particular needs of potential users. Consequently, such needs must also be 

3-4 According to the RAND study, ~The Army, Navy. Air Force and Marine Corps have separate occupational systems forthelr 

officers and enlisted workforces while the clvilian workforces follow the patterns of the federal workforce and use that 

occupational system. As a result, 000 uses over 15 different occupational systems with over 6,000 occupational definitions. ~ 

lr 32) 

,,::~g ~:~~~: Retrieved from hHp:/lwww.rand.org/pubsltechnicaUeportsl200S/RAND_TR610.pdf 

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specified in some detail, or an [occupational analysis] system may not meet 

the needs for which it was developed. 37 (p. 14, Rand Report) 

We agree. Thus, the purpose, program, data, technical, and legal requirements for 

the use of occupational information in SSA's disability adjudication process38 were 

considered by the OIDAP in arriving at its conclusions and recommendations, but 

could not have been considered by the NAS panel because their members did not 

have access to that information at the time of their deliberation to consider such 

design questions as: 

1. Descriptor coverage: work- and worker-oriented attributes; 

2. Descriptor level of analysis: breadth or narrowness of descriptor definition;39 

3. Descriptor application: work, workers, both; 

4. Descriptor specificity: across all jobs and/or job specific; 

5. Descriptor common framework needs; and, 

6. Descriptor metrics or scales. 

When considering how DOL and SSA need to answer these design questions based 

upon their distinct purposes and data needs, the OIDAP found the answers were 

fundamentally different40 The polarity in the design and data needs between the 

O'NET and an OIS for disability adjudication is important to comprehend. Without 

recognizing the needs of each primary user or user group, broad associations of 

descriptors - or the data collected with these - are meaningless. For instance, the 

O'NET Report states that there is: 

... almost perfect equivalence between the O'NET descriptors of near vision, 

far vision, visual color discrimination, and depth perception and the RFC41 

assessment (descriptors of near acuity, far acuity, color vision, and depth 

perception). The scales and definition of scale points, however, are still quite 

different between the two scales. (p. 165, O'NET Report) 

37 RAND report. 

" p. 33, Appendix B. 

39 The unit of analysis for each occupational analysis purpose is distinctly different. For the Q"'NET, this unit of analysis is the 

occupation level. For SSA, 10 meet its burden of proof at Step 5 of the sequential evaluation process, the unit of analysis is at 

the job level. This essential design decision is critical to understand in understanding whether a system is designed 

econometrically or ergo metrically. 

4ll p. 66, Appendix B. 

41 p. 56, Appendix 8 indicates that the O"'NET panel did not consider the MRFC in their review of the O*NETs use in disability 

adjudication. 

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For the casual observer who might not understand human function vis-a-vis sensory 

criteria, near vision may seem almost perfectly equivalent to near acuity and far 

vision may also seem almost perfectly equivalent to far acuity, when in reality they 

are functionally different. If these data elements are included in an occupational 

analysis system, their measurement with respect to work activity may not be 

adequately captured if the differences are not recognized by those designing the 

system. 42 The difference is not a matter of nuance; rather, it is a matter of 

understanding occupational data vis-a-vis its application in the disability context that 

involves the appropriate measurement of human function. 

Understanding human function and disability is important to correctly determine 

appropriate occupational analysis design for database used in disability adjudication 

and to make decisions regarding the proper unit of analysis. The O'NET does not 

use job level data collection that is essential to the disability adjudication process. 

The general purpose design of the O'NET was appropriate for the needs of its 

primary constituents, 43 but not as part of a forensic decision-making process 

requiring greater specificity and certainty in the person-job match that is central to 

the individualized assessment. 

These essential differences in database designs are best illustrated by 

understanding econometric and ergometric occupational database system designs 

and which results in the data needed by users. See Appendix D for a model and 

table indicating the differences between econometric and ergometric designs in 

occupational analysis systems. 

The O'NETs main constituency, workforce development users, identified a need for 

a higher level of aggregation than exists in the present O'NET.44 The broad and 

more abstract data needs of workforce development users led to higher aggregation 

in O'NET, a result of an econometric design approach. These broader occupational 

categories are mostly aligned with the SOC and, thus, can be linked with other data 

collected at that level. However, this level of aggregation is counter to the needs of 

an OIS for disability adjudication. 45 This design feature of the O'NET is appropriate 

42 p. 31, Appendix B. 

43 p. 23, Appendix B. 

44 p. 37, Appendix B. 

45 pp. 55 and 108, Appendix B. 

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for workforce development, but not for disability adjudication that needs an 

ergometric design for data generalizability to a single individual - the claimant - not 

to the American workforce. 46 

Regarding the overall OIS framework, the OIDAP opined in its 2009 report that the 

creation of an OIS for disability adjudication did not mean starting from scratch, but 

building upon the best features of the DOT, the O'NET, and other occupational 

information systems to meet the purpose and needs for which the occupational data 

is required 47 Insofar as the O'NET is tied to the Standard Occupational 

Classification (SOC) and the OIS should crosswalk to that classification as was 

recommended by the OIDAP, the SOC could serve as a shared bridge to anyone 

wishing to connect to the O'NET-SOC descriptor framework. 48 In its 2009 

recommendation to SSA regarding an initial work taxonomy framework, the OIDAP 

Taxonomy and Classification Subcommittee utilized the dimensions associated with 

the O'NET and SOC work activities as part of its framework development. These 

dimensions constituted approximately 30% of the recommended taxonomy. 

FINDING #7: The O'NET Report did not articulate the evaluation criteria that 

the NAS panel may have used for its evaluation of the O·NET. 

Although the O'NET Report identifies how the NAS panel went about its charge,49 it 

is unclear what evaluation criteria was used by the panel in its review of the O'NET. 

This might have been beneficial to the reader as it was with the 1980 NAS report 

reviewing the DOT. 5o 

FINDING #8: The forensic defensibility of using O'NET data for disability 

adjudication was not addressed by the NAS panel. 51 

For human resources management applications discussed in' Chapter 7 of the 

O'NET Report requiring the need to meet legal criteria, the O'NET was found not to 

be legally defensible for the same reasons it would not be defensible in disability 

adjudication. The O'NET was never designed to be forensically applied, nor does it 

.. pp. 37, 38,103, and 109, Appendix B. 

" p. 17, OIDAP report . 

.. p. 90, Appendix B. 

"pp. 16·17, O"NET Report. 

50 See Miller, et a1. 

51 pp. 57 and 88, Appendix B. 

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need to be for the purposes for which it was created. Furthermore, the NAS staff 

concluded that the various sources " ... mayor may not be the best representation of 

work that is performed ... ,,52 although, as noted earlier, an important consideration 

for SSA's occupational data needs for legal defensibility is that it reflect national 

existence and incidence of work. 53 

Chapter 8 in the O'NET Report refers to a 2000 study by one of the O'NET 

developers, the American Institute of Research (Gustafson & Rose, 2003), that was 

commissioned by the SSA to review O'NET's suitability for use in disability 

adjudication. The article concludes that "a version of O'NET [could be]lega/ly 

defensible and acceptable to decision-makers and claimants alike" (p. 15). It is 

unclear what premises were considered to arrive at this conclusion or if the need for 

ergometrically-derived data was evaluated vis-a-vis its application at the n=1 

individualized assessment level. For instance, the article posits Static Strength as 

an example of a suitable descriptor among the 54 O'NET descriptors evaluated 

when SSA has routinely cited this descriptor as an example of a descriptor that is 

too holistic and abstract for disability adjudication purposes. 

52 p. 39, Appendix B. 

"pp.11-12. OIDAP report. 

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Additional Lessons Learned: Considerations for SSA 

Of particular interest to the OIDAP was the timeline for the development of the 

O'NET. Because of the massive nature of the O'NET content model, the Advisory 

Panel for the Dictionary of Occupational Titles (APDOT) took three years to arrive at 

its recommendations to DOL. Eight years elapsed from the time of the APDOTs 

creation until DOL released its first prototype of the content model and data 

collection began. 54 By comparison, an OIS for SSA needs a simpler ergometricallydesigned occupational analysis system with a content model inclusive of discrete 

descriptors, that will not require the massive undertaking of O'NETs development or 

the prolonged timeline. It does call, however, for a system that is designed to 

produce high quality, forensically-defensible data, which is a scientifically-based and 

designed product. General Recommendation Four in OIDAP's September 2009 

report called for internal and external expertise for the development and 

maintenance of the OIS. As Ms. Hilton indicated, the vision for the development of 

the O'NET was also" ... to have some permanent professional people within the 

Department of Labor who could oversee the development of a better and improved 

database for the future.',55 This type of unit was likewise recommended in 1980 with 

the NAS review of the DOT. 56 Such a unit has not historically existed within SSA. 

Because of the forensic nature of the SSA OIS, the OIDAP advises that SSA 

establish a steady but cautious research timeline. It further counsels against undue 

acceleration of the R&D agenda until the scientific expertise unit proposed in the 

September 2009 report has been created and the development of a plan and priority 

schedule for research is established. 

The OIDAP understands SSA has been meeting with or briefing DOL about the OIS 

since before the OIDAP's inaugural meeting, including meeting with the Employment 

and Training Administration and more recently also the Bureau of Labor Statistics. 

Although it is clear that the purpose and needs of each occupational database are 

due to very different econometric v. ergometric design features, nonetheless, the 

OIDAP finds value in the O'NET Report's recommendation calling for increased 

cooperation between SSA and DOL possibly involving areas of sampling and/or data 

" p. 45, Appendix B. 

55 p. 18, Appendix B. 

"pp. 218-219 of the Miller. et al. study on the DOT recommended that "A permanent, professional research unit of high quality 

should be established to conduct technical studies designed to improve the quality of the DOT as well as basic research ... " 

and goes on to further describe the composition of the unit to include PhD-level Scientists (e.g., SOciologists, psychologists, 

statisticians, etc.), BA- or MA-Ievel research assistants, and support staff. 

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collection that may be mutually beneficial to each agency. SSA may also wish to 

explore with DOL how that agency has historically developed, maintained, and 

applied the occupational data it collects for its own forensic and adjudicative needs 

(e.g., US Department of Labor, Office of Administrative Law Judges for labor-related 

immigration cases). SSA may consider the development of ethical standards, data 

protection, or other systems to safeguard the integrity of the occupational data it 

collects for its disability programs. SSA may also benefit from collaboration with 

other Federal agencies, such as the Department of Defense, Office of Personnel 

Management, Rehabilitation Services Administration, and the Census Bureau, 

regarding work analysis methods and other information of value to the development 

of the OIS. 

Lastly, the OIDAP raises concerns regarding potential research and assessment 

ethics57 and legal considerations in repurposing the O·NET. The same concerns 

hold true in applying the aging Dictionary of Occupational Titles to the disability 

adjudication process without regard to updated and current research, psychometric, 

and technology opportunities to meet the specific occupational data needs implied 

by the individualized assessment process. Until an occupational information system 

is developed that can meet individualized assessment purposes, and despite the 

DOT's flaws, today it still remains, " ... the most comprehensive set of occupational 

characteristics currently available.',58 (p. 195, Miller Study) 

57 See the research and assessment standards in the codes of ethics for the American Counseling Association, American 

Psychological Association, and the Commission on Rehabilitation Counselor Certification. 

S8See pp. 173 and 195, Miller, et a!. 

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Acknowledgements 

We appreciate the fortunate timing a review of the O'NET presents to the OIDAP 

when we are at the genesis of providing SSA with our advice and recommendations 

regarding the OIS's R&D. We are grateful for DOL's willingness to make the 

database available for professional and public review and critique. 

The contents of this report are not meant as a criticism of the use of the O"N ET for 

the primary purpose for which it was created and should not be interpreted as such. 

Based on our study and review of SSA's occupational information needs, the 

purpose of this report was to review lessons learned through the O*NET's database 

study by the NAS that might be helpful to our advice and recomrnendations to SSA. 

Emerging needs in the OIS's R&D process rnay warrant further review of the O*NET 

Report to inforrn OIDAP future discussion and deliberations on technical matters. 

We especially appreciate the NAS panel's acknowledgement of the unique needs of 

SSA for occupational data that are not met with the econometric design of the 

O"NET. Despite having completed their recomrnendations and disbanding as a 

panel before they had the opportunity to review SSA working papers or OIDAP's 

recommendations, the NAS panel elevated the issue of occupational data specific to 

disability adjudication to a national level that has served to ultimately clarify the need 

for the development of an ergometrically-based OIS for SSA's disability adjudication 

process. We thank the NAS study staff for their graciousness and willingness to 

present to the OIDAP, and particularly for their inclusion of footnotes in the final 

report to settle potential misunderstandings conveyed by the timing of their process 

and the publication of their uncorrected proofs and final reports. 

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Conclusions 

Understanding the differences in occupational systems designs is inherently a 

technical subject. Casual observers who do not have intimate knowledge and 

understanding of work analysis as applied to the residual functional capacity of an 

individual may not grasp the nuances in system design and data quality, or how this 

may affect generalizability to the claimant in SSA's individualized assessment. We 

suspect that this chasm in knowledge will continue to occasionally bring those who 

do not understand,why the O'NET and OIS designs are very different, almost 

complementarily so based on the needs of their primary users, to ask "Why not a 

"tweaked" O'NET for disability adjudication?" 

As noted in our September report, "Undoubtedly, there are some aspects of the DOT 

and the O'NET occupational information systems that are helpful to the 

development of the OIS tailored to SSA's disability adjudication needs," (p, 19, 

OIDAP Report), Our recommendations in that report included some features of both 

systems that met SSA's legal, program, technical, and data needs and already 

considered 100% of the O"NET and SOC work activities in its recommended work 

taxonomy framework, or constituting about 30% of that recommended starting 

taxonomic framework. The recommendations went further by introducing features for 

the new OIS to allow it to function within the context of its forensic intent and 

application, What we learned from the O"NET Report serves to uphold our 2009 

general recommendations and to provide additional insights to further assist with our 

mission as identified in our charter. 

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Bibliography 

20 CFR 404. 1568(d) and 416.968(d): Skill requirements. 

American Counseling Association. (2005). ACA code of ethics. 

http://www.counseling.org 

American Psychological Association. (2010). Ethical principles of psychologists and 

code of conduct with 2010 amendments. Retrieved from 

http://www.apa.org/ethics/codelindex.aspx 

Commission on Rehabilitation Counselor Certification. (2010). Code of professional 

ethics for rehabilitation counselors. http://www.crccertification.com 

General Accounting Office. (2002a). SSA and VA disability programs reexamination 

of disability criteria needed to help ensure program integrity. Washington, 

DC: Author. Retrieved from http://www.gao.gov/new.items/d02597.pdf 

General Accounting Office. (2002b). SSA disability programs fully updating disability 

criteria has implications for program design. Washington, DC: Author. 

Retrieved from http://www.gao.gov/new.items/d02919t.pdf 

Gustafson, S. B., & Rose, A. M. (2003). Investigating O'NET's suitability for the 

Social Security Administration's disability determination process. Journal of 

Forensic Vocational Analysis, 6,3-16. 

Hanser, L. M., Campbell, J., Pearlman, K., Petho, F., Plewes, T., & Spenner, K. 

(2008). Final report of the panel on the Department of Defense human capital 

strategy. Santa Monica, CA: RAND National Defense Research Institute. 

Retrieved from 

http://www.rand.org/pubs/technicaUeports/2008/RAND_ TR61 O.pdf 

Institute of Medicine. (1998). SSA's disability decision process: A framework for 

research. Washington, DC: The National Academies Press. Retrieved from 

http://books.nap.edu/openbook.php?record _id=6194&page= R7 

Institute of Medicine. (2002). The dynamics of disability: Measuring and monitoring 

disability. Washington, DC: The National Academies Press. Retrieved from 

http://www.nap.edu/openbook.php?record_id=10411 

Miller, A. R., Treiman, D. J., Cain, P. S., & Roos, P. A. (Eds.) (1980). Work, jobs, 

and occupations: A critical review of the Dictionary of Occupational Titles. 

Washington, DC: The National Academies Press. Retrieved from 

http://www.nap.edu/openbook.php?recordJd=92&page=R1 

Occupational Information Development Advisory Panel (OIDAP). (2009). Content 

model and classification recommendations for the Social Security 

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Administration occupational information system. Retrieved from 

www.ssa.gov/oidap 

Occupational Information Network (O·NET). (2010). Retrieved from 

http://online.onetcenter.org/ 

Social Security Advisory Board Report. (2001). Chariing the future of Social 

Security's disability programs: The need for fundamental change. 

Washington, DC: Author. Retrieved from 

http://www.ssab.gov/Publications/Disability/disabilitywhitepap.pdf 

Social Security Administration, Office of Program Development and Research. 

(2009). Working paper: Developing an initial classification. Baltimore, MD: 

Author. Retrieved from http://www.ssa.gov/oidap/paneLdocuments.htm 

Social Security Administration, Office of Program Development and Research. 

(2009). Working paper: SSA legal, program, and technical occupational 

information requirements. Baltimore, MD: Author. Retrieved from 

http://www.ssa.gov/oidap/paneLdocuments.htm 

Tippins, N. T., & Hilton, M. L. (2010). A database for a changing economy: Review of 

the Occupational Information Network (O·NET). Washington, DC: The 

National Academies Press. Retrieved from 

http://www.nap.edu/catalog.php?recordJd=12814 

United States Department of Labor, Employment and Training Administration. 

(1991). Dictionary of Occupational Titles. Washington, DC: Author. 

24 
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APPENDIX 

Appendix A: NAS Presentation Slides to the OIDAP 

Appendix B: Transcript from the Occupational Information Development Advisory 

Panel Quarterly Meeting, March 25, 2010-Presentation of Margaret Hilton, Study 

Director and Senior Program Officer Center for Education, The National Academies 

and Mr. Thomas J. Plewes, Associate Study Director and Senior Program Officer, 

Committee on National Statistics, The National Academies 

Appendix C: Timeline of NAS and OIDAP Processes 

Appendix D: Econometric v. Ergometric Occupational Analysis Designs 

June 22 2010 25 
931 

TAB A 
932 
Study Charge from DOL 

• Document and evaluate current and 

potential uses of O*NETin: 

workforce development 

- HRM 

- research 

• Explore linkage to SOC and other data 

sets 
Study Charge 

• Identify improvements, especially in: 

- currency - efficiency 

- cost-effectiveness - use of new technology 
Panel Selection 

• Consulted NRC standing committees 

and others to identify experts 

• Balance of expertise, views of O*NET 

• NAS President approved provisional slate 

• Provisional slate posted for public comment 

• Confidential bias and conflict discussion at first 

meeting 

• Final approval of panel members 
Panel Members 

• Nancy Tippins (Chair), Valtera Corporation 

• David Autor, M.I.T. 

• John Campbell, University of Minnesota 

• Keith Ewald, Ohio Job & Family Services 

• Richard Froeschle, Texas Workforce Commission 

• Les Janis, Georgia State University 

• Virginia Lesser, Oregon State University 

• Kerry Levin, Westat 

• Kenneth Pearlman, Independent Consultant 

• Ann Marie Ryan, Michigan State University 

• Juan Sanchez, Florida International University 

• William Shobe, University of Virginia 
Study Process 

• Literature Review 

• Workshops in March and April 

• Deliberation in closed sessions 

• Draft enters NRC review process in August 

• Response to Review approved in November 

• Transmittal to DOL in November 

• Public release of prepublication draft in December: 

http://books.nap.edu/catalog.php?record_id=12814 

• Editing/technical corrections • Final report in April or May 
Prior NRC Studies 

Review of DOT (1980) 

• Criticized uneven coverage and many other aspects 

of DOT (pp. 9-11) 

• Recommended fundamental changes, including: 

Continuous updating (p. 13) Creation of permanent, professional cadre (p. 14) 

Outside technical advisory committee (p. 14) 

Emphasis on cross occupational linkages (p. 15) 

Alignment with federal job classification systems 

(p. 15) 

• Led to creation of APDOT and O*NET 

Source: NRC, Work, Jobs, and Occupations: A Critical Review of the 

Dictionary of Occupational Titles, 1980 
Prior NRC Studies 

Preliminary review of the SSA research plan for 

redesign of the disability determination 

process (1998) 

• Concern that O*NET, as being developed, 

would not meet SSA's needs (p. 24) 

• SSA and DOL should enter into an 

interagency arrangement to create a version 

of O*NET with information on minimum, as 

well as average, 

job requirements (p. 24) 

Source: NRC, The Social Security Administration's Disability Determination 

Process: A Framework for Research, Second Interim Report, 1998 
Prior NRC Studies 

Review of the SSA research plan for redesign 

of the disability decision process (2002) 

• DOL is no longer updating the DOT (p. 9) 

• O*NET will not meet SSA's need to define 

functional capacity to work without major 

reconstruction (p. 9) 

• Barring some resolution, SSA will be left with 

no objective basis for justifying decisions (p. 

9) 

Source: 10M, The Dynamics of Disability: Measuring and Monitoring 

Disability for Social Security Programs, 2002 
Prior NRC Studies 

Study of changes in work and occupational analysis 

(1999) 

Concluded that O*NET: 

Brings together most comprehensive 

analytical systems (p. 6) 

Is theoretically informed (p. 6) Is fully accessible (p. 6) 

Offers significant improvement over DOT (p. 7) 

Maps to other systems (p. 7). 

Source: NRC, The Changing Nature of Work: Implications for 

Occupational Analysis, 1999 
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Who Uses O*NET? 

1. Online Career Guidance Systems-

-37 million users in 2009 

2. State workforce development 

experts-for job counseling 

3. Human resource managers 

4. Researchers 

5. Vocational rehabilitation counselors 
Chapter 8 

• SSA uses DOT for disability 

adjudication 

• O*NET is the successor to DOT 

• Could O*NET be used by SSA? 

• Compare SSA RFC approach with 

O*NET descriptors 
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RFC/O*NET Comparison 

Physical Abilities 

• RFC: Perform specific physical 

tasks, e.g., lift 20 pounds with the 

hands and arms 

• O*NET Abilities: Less specific 

measures 
O*NET Abilities: Static Strength 

32. Static Strength The ability to exert maximum muscle force to lift, push, pull, or carry object!;. 

A. How important is STATIC STRENGTH to the performance of your current job? 

Not Scnr=iJal Very Extre=:ly 

Importl11t* !:n:pJrtant lrqJortant Important lrqJortant 

(j) GJ ® @ @ 

• If you marked Not Important, skip LEVEL below and go on to the next activity. 

B. What level of STATIC STRENGTH is needed to perform your current job? 

Push an empty Pull a 4O-pound sack Lift 75-poLUld bagl 

shopping cart of fertilizer across the la'Ml of cetrenl onto a huck 

l 

W @ ® @ 

Highe<.t level 
RFC/O*NET Comparison 

• RFC: Lifting, standing, sitting, 

pushing; postural limitations on 

balancing, crouching, crawling 

• O*NET Work Context: Time spent 

sitting, standing, climbing, walking, 

etc. 

• Anchors differ: RFC specific time 

ranges vs. O*NET relative time 
O*NET Work Context Descriptors 

34. How much time in your current job do you spend sitting? 

Never 

Less than half 

the time 

About half 

the time 

More than half 

the time 

Continually or 

almost continually 

.... 

- ---(2)-----------<3)------- ... GI)-------.-.-@ 

35.How much time in your current job do you spend standing? 

Never 

Less than half 

the time 

About half 

the time 

More than half 

the time 

Continually or 

almost continually 

36.How much time in your current job do you spend climbing 

ladders, scaffolds, poles, etc.? 

Never 

Less than half 

tre time 

About half 

the time 

More tl,an half 

the time 

Continually or 

almost contiwally 

.. ----.--.-.-.. @ 
O*NET Work Context Descriptors 

37. How much time in your current job do you spend walking or running? 

Less than half About half 

Never the time the time 

More than half 

the time 

Continually or 

almost continually 

38. How much time in your current job do you spend kneeling. crouching. 

stooping. or crawling? 

Less OlaD half About half 

Never tre time the time 

More than half 

the time 

Corrtiruallyor 

almost contiooally 

® 

39. How much time in your current job do you spend keeping or regaining 

your balance? 

Newr 

Le" than half 

ttetime 

About half 

the time 

(J)-------"---.. 

More Ihan half 

the time 

Contirruallyor 

almost continually 

---
RFC/O*NET Comparison 

Environmental Conditions 

• RFC: Ability to withstand 

environmental hazards such as heat, 

cold, wetness, vibration, etc. 

• O*NET Work Context: Exposure to 

heat, cold, contaminants, vibration 

• Anchors differ: RFC "unlimited" to 

"avoid all exposure" vs. O*NET "never" 

to "every day." 
O*NET Work Context Descriptors: 

23. In your current job, how often are you exposed to very hot 

(above 90° F) or very cold (under 32° F) temperatures? 

Ooce a year or more Once a month or moce Once a week cr more 

Never but rot e very month but not every ""ek but not every day Every day 

w w @ ® 

25. In your current job, how often are you exposed to 

contaminants (such as pollutants, gases, dust, or odors)? 

Once a yearor more Once a month ormore Once aweek ot more 

Never but not every month but not every week but not every day Every day 

® ® ® 

27. In your current job, how often are you exposed to whole 

body vibration (like operating a jackhammer or earth moving 

equipment)? 

Once a year or more Once a month Of more Once a week or more 

Never but not every month but not every week but not every day Every day 

w ® ® 
RFC/O*NET Comparison 

Sensory/Perceptual Abilities 

• RFC • Near acuity • Far acuity • Color vision • Depth perception 

• O*NET Abilities • Near vision • Far vision • Visual color 

discrimination 

• Depth perception 
Recommendation 

• SSA and DOL should create an 

interagency task force to study the 

viability of potential modifications of 

O*NET to accommodate SSA needs 

• Analyze SSA occupational information 

needs 

• Analyze interagency cost-benefit and 

cost-sharing 
Aggregation Issues 

• O*N ET now includes 1,102 occupations, collects 

data 

on 965 

• SOC 2010 includes 840 occupations 

• Since 2006, O*NET has added 153 new 

occupations-- "breakouts" of SOC occupations 

and green occupations 

• Some O*NET users need these disaggregated 

data and would welcome further disaggregation 

• Other users need aggregated occupational 

categories aligned with the SOC 

• The panel did not agree about the appropriate 

level of aggregation 
Aggregation Issues 

• Recommendation: Assess benefits 

and costs of changing the occupational 

classification system 

I ncluding research into whether and to 

what extent O*NET occupations represent 

excessively heterogeneous clusters of jobs 

for the purpose of disability determination 
Data Collection Issues 

Conclusion: The O*NET Center uses a 

multimethod sampling approach, 

collecting data from different types of 

respondents who mayor may not 

represent the work performed in that 

occupation. The impact on 

measurement error is unclear 
Data Collection Issues 

• Conclusion: The construct validity of 

the taxonomies of descriptors varies 

across the content model domains 
Improving Database Quality 

• Conclusion: Over the past decade, DOL 

has achieved its goal of populating O*NET 

with updated information, but short-term 

policy agendas have sometimes reduced 

focus on core database activities. 

• Recommendation: Focus resources on 

core database activities, leaving 

development of most new applications 

and tools to others. 
Improving Database Quality 

• Recommendation: Establish and 

support a technical advisory board to: 

- prioritize research suggestions - develop RFPs for high priority research 

- review and rank proposals 
Enhancing Service to Users 

• Conclusion: A lack of effective, 

ongoing communication between the 

O*NET center and current and potential 

users hinders full use of O*NET 

• Recommendation: Establish and staff 

an ongoing, external user advisory 

board 
O*NET Lessons Learned 

• Developing and maintaining a highquality database requires expertise 

and funding 

-Development cost ??? 

-Data collection costs: $6 m/year 

to update 100 occupations/year 
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o 

--........ 

en 

Q) 

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UNITED STATES OF AMERICA 

SOCIAL SECURITY ADMINISTRATION 

+ + + + + 

OCCUPATIONAL INFORMATION DEVELOPMENT 

ADVISORY PANEL 

+ + + + + 

QUARTERLY MEETING 

DAY 2 

+ + + + + 

Thursday 

March 25, 2010 

+ + + + + 

St. Louis, Missouri 

+ + + + + 

1 

The Quarterly Meeting of the 

Occupational Information Development Advisory 

Panel convened at 8:30 a.m., pursuant to 

notice, in the Colonnade Ballroom, 13th Floor, 

Sheraton St. Louis City Center, 400 South 14th 

Street, St. Louis, Missouri, Mary BarrosBailey, Chair, presiding. 

PANEL MEMBERS PRESENT: 

MARY BARROS-BAILEY, Chair, Ph.D. 

ROBERT T. FRASER, Ph.D. 

SHANAN GWALTNEY GIBSON, Ph.D. 

THOMAS A. HARDY, J.D. 

H. ALLAN HUNT, Ph.D. 

SYLVIA E. KARMAN 

DEBORAH E. LECHNER 

DAVID J. SCHRETLEN, Ph.D. 

NANCY G. SHOR, J.D. 

MARK A. WILSON, Ph.D. 

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ALSO PRESENT: 

DEBRA TIDWELL-PETERS, Designated Federal 

Official 

MARGARET HILTON, The National Academy of 

Sciences 

THOMAS J. PLEWES, The National Academy of 

Sciences 

DEBBIE HARKIN, Staff 

MICHAEL DUNN, Staff 

ELIZABETH KENNEDY, Staff 

SHIRLEEN ROTH, Staff 

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TABLE OF CONTENTS 

Call to Order 

Overview of Today's Agenda 

Public Comment 

Presentation: Overview of The 

National Academies' Review of O*NET 

Margaret Hilton 

Thomas J. Plewes 

Panel Discussion and Deliberation 

Administrative Meeting 

Adjourn 

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1 P-R-O-C-E-E-D-I-N-G-S 

2 (8:39 a.m.) 

3 MS. TIDWELL-PETERS: Good morning, 

4 everyone. If you could please take your 

5 seats, we are about to begin. 

6 I am Debra Tidwell-Peters, the 

7 Designated Federal Officer for the 

8 Occupational Information Development Advisory 

9 Panel, and we welcome you this morning to our 

10 second meeting of 2010. 

11 I am going to now turn the meeting 

12 over to the Panel Chair, Dr. Mary Barros13 Bailey. Mary? 

14 CHAIR BARROS-BAILEY: Thank you, 

15 Debra. 

16 Good morning. I want to welcome 

17 back those who were in attendance with us 

18 yesterday at the start of our second quarterly 

19 meeting in 2010, and also welcome those who 

20 are with us for the first time this morning, 

21 whether it be in person or telephonically. 

22 This is just a reminder that this 

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1 meeting is being recorded. 

2 For those listening in remotely, to 

3 follow our agenda please go to our website, 

4 www.ssa.gov/oidap for a copy of the agenda. 

5 As I indicated yesterday, for those 

6 attending our meeting for the first time who 

7 might be interested in the activities and 

8 deliberations of past meetings, if you go to 

9 the meeting page on our website you can click 

10 on any agenda, and associated with that agenda 

11 are the PowerPoints that were delivered for 

12 or to the OIDAP since our inaugural meeting in 

13 February of 2009. 

14 On our website you will find a 

15 variety of materials, including technical 

16 papers and the first report issued by the 

17 panel in September of 2009 called "The Content 

18 Model and Classification Recommendations for 

19 the Social security Administration, 

20 occupational Information System. " The 

21 occupational Information System is also what 

22 we call the OIS. 

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1 It outlines our advice to SSA 

2 regarding the data elements we felt essential 

3 to include in the content model specific to 

4 disability adjudication. 

5 As we indicate at the start of each 

6 meeting, the charter of the Occupational 

7 Information Development Advisory Panel, OIDAP, 

8 is to provide social security with independent 

9 advice and recommendations as to the 

10 development of an OIS to replace the 

11 Dictionary of Occupational Titles in the 

12 disability determination process. 

13 To reiterate something I said 

14 yesterday, our task is not to develop the OIS. 

15 As our name implies, we are advisory in our 

16 capacity. 

17 Yesterday during her report to the 

18 User Needs and Relations Subcommittee, Nancy 

19 Shor encouraged public feedback and comment 

20 upon the september report. I want to 

21 emphasize what she said that we welcome 

22 input from stakeholders and the public at any 

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1 point along this process. 

2 To help streamline input into the 

3 September report, we are strongly encouraging 

4 feedback through May 21st of this year. 

5 Besides having the report available at our 

6 website, disseminating it for feedback through 

7 notices along with our meetings in the Federal 

8 Register since November, notifying individuals 

9 subscribed through our electronic mailing list 

10 about it, and the public feedback request, and 

11 speaking about it at four conferences, with 

12 presentations slated at eight more conferences 

13 between now and May 21st, we are attempting to 

14 get the word out about the report, as well as 

15 potentially including it in other means, such 

16 as the Open Government website and/or 

17 independently through the Federal Register. 

18 What stakeholders say matters, and 

19 we want you to know that what you have to say 

20 we want to hear. 

21 Following our review of our 

22 September report, Commissioner Astrue further 

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1 requested our assistance in providing SSA with 

2 recommendations, and we reviewed those 

3 yesterday. I will reiterate them this morning 

4 for those who weren I t in attendance with us 

5 yesterday. 

6 In January, he asked us to provide 

7 SSA with advice in four areas -- in developing 

8 a sampling and data collection plan for the 

9 research and development process. Number two, 

10 for helping with advice and recommendations 

11 for the creation of a process for recruiting 

12 field job analysts, including methods for 

13 certification criteria and training. Three, 

14 establishing associations between human 

15 functions and the requirements of work that 

16 would serve the disability evaluation process. 

17 And, four, reviewing relevant documents or 

18 reports SSA identifies that may affect or 

19 inform SSA's work on the OIS. 

20 In our agenda for today, we 

21 specifically address the fourth request by 

22 Commissioner Astrue. 

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1 As identified in the September 

2 report, the data elements recommended to SSA 

3 were the starting point of our process, not 

4 the finish line for the OIDAP. While many 

5 panels are assembled to study a topic for a 

6 designated time, and that culminates with a 

7 report, after which time the panel is 

8 disbanded, our panel is different in that we 

9 have been asked for further independent advice 

10 and recommendations into the research and 

11 development process of the OIS development. 

12 The 2009 National Academies of 

13 Science report on the O*NET is the first time 

14 that an independent group has reviewed an 

15 occupational information system in 30 years, 

16 since a review of the Dictionary of 

17 Occupational Titles was conducted by the 

18 National Research Council in 1980, and what is 

19 often referred to as the Miller Study. 

20 We commend the U. S. Department of 

21 Labor for commissioning the National Academies 

22 of Science Panel to independently review the 

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1 O*NET upon the O*NET's tenth anniversary. 

2 This is an important process. 

3 It is timely that the National 

4 Academies of Science reviewed an existing 

5 civilian occupational information system while 

6 we are providing advice and recommendations to 

7 the Social security Administration on the 

8 development of an OIS. The existence of the 

9 National Academies of Science panel in its 

10 report provides us with the opportuni ty to 

11 explore areas that exist in the development of 

12 any occupational information system, and learn 

13 from that process to better advice and 

14 recommendations to the Social Security 

15 Administration. 

16 The National Academy of Science 

17 report provides us as a panel with a great 

18 chance for learning. That is the goal for 

19 this morning. 

20 We thank Margaret Hilton, the Study 

21 Director and Senior Program Officer, and Tom 

22 Plewes, Associate Study Director and Senior 

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1 Program Officer with the National Academies .of 

2 Science for accepting our invitation this 

3 morning to come and speak to us. 

4 Behind Tab 3 in our three-ring 

5 binders we will find the biographical sketches 

6 for Margaret and Tom, and we will also find 

7 copies of their PowerPoint presentations. 

8 Margaret and Tom have qui te a bit 

9 of information to present to us this morning. 

10 I will ask the panel to withhold questions 

11 until after they are completed with their 

12 presentation. 

13 Welcome. 

14 MS. HILTON: Thank you. That's it. 

15 The name of our study, which is available 

16 right now on our the National Academy Press 

17 website is called "A Database for a 

18 Changing Economy: Review of the O*NET." 

19 The Department of Labor asked us to 

20 do this study. As Mary mentioned, it seemed 

21 like a good time to study O*NET, because it 

22 was about a decade old. And they especially 

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1 wanted us to document how O*NET is used, but 

2 they also wanted us to evaluate those uses. 

3 And they are especially interested in use in 

4 workforce development, because O*NET was 

5 originally created for that purpose by state 

6 and local employment offices. 

7 They were interested in human 

8 resource management uses of O*NET, and 

9 especially in business and in job matching 

10 systems. And they were interested in how 

11 O*NET links to other occupational 

12 classification systems, in particular the 

13 Federal Government's standard occupational 

14 classification· system. 

15 The linkages are important, because 

16 it is a database. It is an electronic 

17 database, and it is sometimes used going back 

18 to the HRM and HRM information systems, HRM/rS 

19 systems. 

20 They wanted us not only to document 

21 how O*NET is used and evaluate it, but also to 

22 identify how O*NET could be improved, and they 

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1 were especially interested in the areas you 

2 see listed on the slide. Currency, how up to 

3 date is this information? Efficiency, are 

4 there better ways to collect the data? Cost 

5 effectiveness, is there any way to do it less 

6 expensively? And they wondered about using 

7 new technologies to collect the data. 

8 We just had breakfast with Mary and 

9 Sylvia and Mark. We were talking a little bit 

10 about the panel selection, and you will see a 

11 gold brochure at your place that talks in 

12 greater depth about our whole National Academy 

13 study process. 

14 Basically, Tom did most of the 

15 recruiting, and I think he did a great job. 

16 Tom talked to the members of the Committee on 

17 National Statistics. That's a standing 

18 committee of the National Academies. And he 

19 also just talked to people in the field. 

20 And when we talk to people, they 

21 identify other people, so it's a complex kind 

22 of a snowball sampling process we go through, 

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1 and we talked to many people and we have 

2 finally come up with a slate of nominees. 

3 They are only nominated. Our proposed slate 

4 of staff people goes all the way up to the 

5 President of the National Academy of Sciences. 

6 Only Ralph Cicerone, the President, 

7 can approve their membership, and yet even his 

8 approve is provisional, because those names, 

9 those nominees' names are then posted for 

10 public comment for 20 days. And at the first 

11 committee meeting we always hold a closed bias 

12 and conflict discussion, and based on that 

13 discussion some members may decide to 

14 voluntarily drop off or there may be other 

15 problems. 

16 After the bias and conflict 

17 discussion, we write a memo that goes to our 

18 lawyers, and then, finally, when the lawyers 

19 say it is okay, then they become the final 

20 committee members. So it's a complex process, 

21 but we try to -- we do it that way to try to 

22 make sure we get the best panel members. 

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1 We also are trying to balance areas 

2 of expertise, and on our panel we have - we 

3 had quite a few 10 psychologists, people in 

4 the field of work analysis, but we also wanted 

5 users of O*NET. We also tried to get a mix of 

6 views of O*NET, so that we weren't having only 

7 the people that were involved in the original 

8 development or the people that are known to be 

9 its biggest proponents, but we also tried to 

10 include people who had more questions about 

11 the system. 

12 So these are the panel members we 

13 ended up with. 1 am not going to read through 

14 all their names, but obviously they are people 

15 known in the field of 10 psychology and users 

16 and statisticians. 

17 Our study process is that we were 

18 reviewing the literature throughout the study 

19 process and, of course, our panel members 

20 helped us, because some of them know the 

21 literature quite extensively. We did hold 

22 public workshops in both March and April, and 

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1 Sylvia Karman spoke at our March workshop. 

2 The National Academy has a special 

3 exemption from the Federal Advisory Committee 

4 Act that allows us to hold some of our 

5 deliberations in closed session, and we did 

6 hold such deliberations. We created a review 

7 draft, based on all of the information we had 

8 received that entered our review process in 

9 August. 

10 Then, we did what's called a 

11 response to review, where we talk about every 

12 comment we received from the outside 

13 reviewers, how we plan to address that 

14 comment, and, if we don't plan to address it, 

15 we have to have a very good reason not to make 

16 the change. 

17 Our response to review was accepted 

18 in November. One thing I should mention is 

19 that all of our panel members and all of the 

20 outside reviewers are volunteers, so I was 

21 

22 

just going to mention the 

volunteer review coordinator. 

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1 Schmitt from Michigan State University. He 

2 approved our response to the review comments 

3 in November, and we transmi t ted our report to 

4 DOL in November, in pre-publication form. 

5 And if you are interested in 

6 reading the whole report, you can see the web 

7 address right there. It is still published 

8 right now in pre-publication form. Right now 

9 there is final editing going on to the second 

10 page proofs, and on April 22nd we expect to 

11 actually receive the books, the published 

12 books, from the National Academy Press. 

13 At the time that we get the final 

14 copies of the book, the website version will 

15 also change and reflect the changes that are 

16 in the final printed report. 

17 We have done other studies that are 

18 related to our recent O*NET study, and Mary 

19 mentioned our important study in 1980 when we 

20 reviewed the Dictionary of Occupational 

21 Titles. And that committee found a lot of 

22 flaws in DOT 

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1 lot more job titles listed in the DOT from 

2 manufacturing than existed in the economy, 

3 because even in 1980 the economy was already 

4 beginning its shift, which continues away from 

5 manufacturing towards services. 

6 That panel recommended a lot of 

7 very fundamental changes in the Dictionary of 

8 Occupational Titles. One that is actually not 

9 listed on my slide was the idea of going to an 

10 electronic database, because it is just going 

11 to inherently be out of date if you are going 

12 to create a big paper dictionary, and then 

13 have to update it and print it. 

14 So the vision was to have much more 

15 continuous updating and to have some permanent 

16 professional people within the Department of 

17 Labor who could oversee the development of a 

18 better and improved database for the future. 

19 The panel also recommended an 

20 outside Technical Advisory Committee, and the 

21 only reason I mentioned that recommendation 

22 from a study way back in 1980 is that our 

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1 panel that met just last year makes the same 

2 recommendation to the Labor Department, that 

3 they should have an outside Technical Advisory 

4 Commi ttee. 

5 1980 was a time when a lot of jobs 

6 were being lost, manufacturing was shrinking, 

7 people were being laid off, and so that 

8 committee recommended looking at jobs, 

9 defining them broadly and looking at what can 

10 be what kinds of skills, abilities, and 

11 other characteristics can transfer from one 

12 job to another? 

13 So they talked about cross14 occupational linkages. That panel recommended 

15 that the new system be more in line with other 

16 federal occupational classification systems, 

17 and that study was important, because it led 

18 the Labor Department to create the Advisory 

19 Panel on the Dictionary of Occupational 

20 Titles. And that panel led to the creation of 

21 O*NET. 

22 Another earlier study that relates 

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1 more directly to your charge was a preliminary 

2 review of a research plan to redesign 

3 disability determination. That study 

4 expressed a concern that O*NET, as it was 

5 being developed at that time, was not going to 

6 meet SSA' s needs. That panel suggested that 

7 SSA and DOL enter into an interagency 

8 agreement to create a version of O*NET with 

9 information on minimum as well as average job 

10 requirements. 

11 Another study, which Tom brought a 

12 copy of, so I can show it to you, is called 

13 "The Dynamics of Disability." And this one 

14 came out in 2002. It is related to the study 

15 I just mentioned to you, in that it is a more 

16 final study of the same SSA research plan. 

17 Basically, they observed, which we 

18 all know, is that the Labor Department was no 

19 longer updating the DOT, that the O*NET would 

20 not meet the SSA's needs to define residual 

21 functional capacity to work, without major 

22 reconstruction. And that if there wasn't any 

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1 resolution to this problem that SSA would be 

2 left with no objective basis for justifying 

3 the decisions. 

4 Now, another study that is -- we 

5 are getting a little more a little more 

6 recent, still 10 years old, the time flies. 

7 This book is called "The Changing Nature of 

B Work: Implications for occupational 

9 Analysis." This study was actually done for 

10 the Department of Defense, which was looking 

11 at a lot of different occupational information 

12 classification systems. 

13 This panel concluded that O*NET 

14 brings together the most comprehensive 

15 analytical systems. It is theoretically 

16 informed. It is fully accessible and offers 

17 significant improvements over the DOT, and it 

IB maps well with other systems. So this panel 

19 was basically encouraging DoD to consider 

20 O*NET as a framework as it tries to bring its 

21 occupational systems closer together. 

22 And now I'm going to turn it over 

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1 to Tom to tell you more about O*NET. 

2 MR. PLEWES: Thank you. And let me 

3 just say that more recently there was a Rand 

4 panel that took a look at the DOT -- that took 

5 a look at the possible use of the O*NET and 

6 other classification systems for DoD purposes, 

7 and recommended that DoD take a look at O*NET. 

8 So that work keeps on going on. I know about 

9 that, because I happened to be lucky enough to 

10 serve on that panel. 

11 Let's see here. Here we go, okay. 

12 So what is O*NET? I really don't have to 

13 tell this group that, but let me just start 

14 out with some very basics here. It is a very 

15 large database. It is probably not as big as 

16 some people would like, but it is a lot bigger 

17 than a lot of users would like to see when 

18 they open up those files. 

19 It is accessible online or by 

20 download, and it uses this thing called a 

21 content model to describe work. Pretty basic 

22 stuff, but I just want to kind of start out 

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1 this way, because I think it's important that 

2 we understand that. 

3 There is a rigor to what O*NET --

4 how O*NET approaches it. The folks who 

5 developed O*NET took a look at all of the 

6 literature at that time, and came up with, if 

7 you will, this quadrant, taking a look at not 

8 only work-oriented but job-oriented kind of 

9 characteristics of work that wanted they 

10 wanted to have incorporated. 

11 We will get into the evaluation in 

12 just a minute here. 

13 The important thing I think that we 

14 need to understand is that O*NET is a general 

15 purpose kind of a classification system. It 

16 has a wide variety of users and uses, and we 

17 drilled into some of these in the report that 

18 we published. Some of the data that we were 

19 able to assemble, that really wasn't well20 known before, was quite astounding as a matter 

21 of fact. 

22 

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1 individual users did some access to an online 

2 career guidance system, which is in turn 

3 driven by O*NET in 2009. That was a very 

4 large number, and it caused some people to 

5 think, gee whiz, maybe if we just owned O*NET 

6 we would really be rich. 

7 But the fact of the matter is is 

8 that there are a lot of folks out there who 

9 use it for career guidance and have built it 

10 into these career guidance systems state 

11 workforce development, for job counseling and 

12 the more traditional roles that O*NET and the 

13 DOT and O*NET itself were originally designed 

14 for. 

15 They had two experts, as you know, 

16 from state labor market information 

17 organizations that helped provide this 

18 information to those folks who are trying to 

19 match workers with jobs out in the field, 

20 human resource managers, researchers, and 

21 then, importantly, vocational rehabilitation 

22 counselors, who are of course represented by 

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1 your Chair and other members of this panel. 

2 Those are the folks who use O*NET. 

3 In fact, I think that if someone asked me 

4 that question, who uses O*NET, I would say 

5 you. You may not know it, but in some way 

6 this structure called O*NET fits into many of 

7 the things that you do on a daily basis, and 

8 in a wide variety of areas. 

9 The important thing is is that --

10 to understand is that it is designed to meet a 

11 wide variety of uses, but in each case there 

12 probably is a better system that could be 

13 developed for that particular use. But it is 

14 a general purpose system, and it does not try 

15 to fulfill all of the needs of all of the 

16 users, but it tries to, if you will, provide a 

17 basis for all users to understand and to view 

18 an occupational information system. 

19 So what did we say here? First of 

20 all, why did we get into this SSA business? 

21 People have asked that question. Why did the 

22 panel choose to look at this? If you look at 

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1 the original charge that the panel came up 

2 with, it does not specifically say, "Now, you 

3 take a look at whether or not O*NET meets the 

4 disability you know, the requirements of 

5 SSA for the disability adjudication work that 

6 they do. " It just wasn't there. 

7 But as the panel began to look at 

8 the major uses and the previous studies that 

9 were done by the National Research Council and 

10 the Institute of Medicine, it became very 

11 obvious that a maj or interface between O*NET 

12 and a user system was represented by the need 

13 that you are looking at now, the Social 

14 Security Administration's need. 

15 They didn't feel that they could 

16 that they could put out a report without at 

17 least addressing that interface, and so you 

18 saw Chapter 8 in our report. 

19 We did not have on the panel a 

20 person who was an expert in Social Security 

21 Administration disability adjudication, and we 

22 did not look at all of the issues that your 

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1 panel is looking at, nor in the depth of 

2 hands-on experience that you are taking. 

3 So Chapter 8 has to be looked at in 

4 a slightly different view than the work that 

5 you are doing, it seems to us. And that view 

6 is, if you are developing a general purpose 

7 occupational information network system, here 

8 is a maj or user, and are there opportunities 

9 to serve the needs of this particular user, 

10 given what we understand to be the needs of 

11 the user and the functionality that O*NET 

12 provides. So we need to make that very clear. 

13 Now, the panel was not you, and it 

14 did not bring the same expertise to bear on 

15 the issue. But I was pleased to note from the 

16 report that you put out in January that they 

17 faced and they approached the issues in many 

18 of the same ways that you have approached the 

19 issues -- by taking a look, if you will, at 

20 the ability of O*NET to fulfill some of those 

21 particular functions. 

22 

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1 O*NET be used by the Social Security 

2 Administration for this? Well, what you need 

3 to do, if you are going to make that kind of 

4 decision, is that you need to take a look at 

5 your residual functional capacity approach, 

6 and you need to take a look at the O*NET 

7 descriptors, and so let's do that 

8 systematically. 

9 You've done a lot of that work here 

10 in your report, and I will not spend a lot of 

11 time at it. But I do want. to let you know 

12 what the panel came up with. 

13 First of all, here are the O*NET 

14 descriptors. They are a mix of the cognitive, 

15 psychomotor, physical abilities, sensory 

16 abilities, a mix of the traditional, if you 

17 will, occupational classification, with some 

18 of the work in fact taken directly from 

19 Fleishman's work on the physical ability side. 

20 But it covers a wide range of 

21 domains, and it doesn't focus on the 

22 domains of absolute most interest to you. 

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1 Okay? It is, again, a general purpose. And 

2 there is, of course, the work context domain, 

3 which we won't spend too much time on. 

4 So we took a look at comparing, as 

5 best the panel could, the residual functional 

6 capacity with O*NET comparisons. And the 

7 first thing they looked at was physical 

8 abilities. We took as a given the residual 

9 functional capacity requirements that have 

10 come up with that the Social Security 

11 Administration has come up with. 

12 And it was very obvious that when 

13 taking a look at physical abilities that O*NET 

14 has much less specific -- specificity in the 

15 measures. There is not the kind of 

16 specificity that is necessary to meet the 

17 current RFCs for physical disabilities. And, 

18 interestingly enough, that is exactly what 

19 your report found as well. 

20 And this is just an example. The 

21 same example is in your report. I won't dwell 

22 on this. It's in our presentation. 

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1 In terms of comparing the RFCs for 

2 lifting, standing, sitting, pushing, you can 

3 read all those. Again, there are specific 

4 time ranges versus a relative time used in 

5 O*NET. The anchors are very different, and it 

6 causes,if you will, a not direct 

7 transferability of the O*NET work context to 

8 meet. It is the RFCs of Social Security, and 

9 here are some of the examples in O*NET, and 

10 you can see that. We'll just go through this 

11 very quickly. 

12 In terms of environmental 

13 conditions, the RFCs are quite specific in 

14 terms of ability to withstand environmental 

15 hazards. There is -- the O*NET work context 

16 has exposure to heat, contaminants, vibration, 

17 and so forth. 

18 I would call this you may not 

19 agree with me I would call some of these 

20 differences between O*NET and the RFCs used by 

21 Social Security to be marginal. They aren't 

22 critical to say O*NET will never ever meet 

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1 that, but it is a matter of your judgment. 

2 And I think you should -- you need to take a 

3 look at that, and here are the O*NET anchors 

4 there. 

5 In terms of sensory perception and 

6 abilities, we have just gone through again 

7 near acuity, near vision, far acuity, far 

8 vision. Is that nuance, or is that terribly 

9 important? If you are sitting in the field 

10 and you've got to make a judgment, perhaps it 

11 is terribly important, and you need to have 

12 something much more specific or different than 

13 O*NET is offering you. 

14 And so what did we come up with? 

15 What did the panel come up with? I think that 

16 there was there is a general concurrence on 

17 the panel with the findings of the previous 

18 National Research Council reports that O*NET, 

19 in and of itself, cannot be used in the way it 

20 is for the purpose that you need to use it. 

21 It just it is not it is not fully 

22 capable of serving that purpose. 

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1 However, there are those good 

2 things we talked about in terms of O*NET --

3 its tie-in with other classification systems, 

4 particularly with the standard occupational 

5 classification structure, the rigor that is 

6 used in building O*NET. 

7 Some of that rigor is based on 

8 surveys of workers in establishments that may 

9 have some issues with response rates, and so 

10 forth, and we looked at that also. And, yes, 

11 we recommended some revisions in the way that 

12 those surveys are done. 

13 Some of that has to do with the way 

14 in which experts, job analysts, provide their 

15 input to this. And, again, there has to be a 

16 reconsideration of some of -- the way in which 

17 that particular business is done, and we 

18 the panel made recommendations in that as 

19 well. 

20 But I think that they saw enough 

21 goodness in O*NET that they recommended that 

22 the Social Security Administration and the DOL 

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1 create an interagency task force to study the 

2 viability of modifications of O*NET to 

3 accommodate the needs of the Social Security 

4 Administration. 

5 It didn't say, "Social Security 

6 Administration, change the way you do business 

7 to meet O*NET." There are some things that 

8 could be changed within O*NET, for example, 

9 that would help make that system much more 

10 reflective of -- or much more consistent with 

II where the Social Security Administration wants 

12 to go with disability adjudication. 

13 It asks that there be an assessment 

14 of SSA occupational information needs. 

15 Whoops, we didn't recommend your panel, but 

16 that's certainly a contribution that we 

17 believe that you are making. And then, 

18 analyze interagency cost-benefit and cost19 sharing. 

20 These things don't come without 

21 cost, both to DOL in terms of the kind of work 

22 that must be done to make O*NET somewhat more 

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1 friendly to this particular use, nor certainly 

2 to the Social security Administration as it 

3 would try to work with Department of Labor to 

4 make O*NET much more friendly to the 

5 disability adjudication and the disability 

6 adjudication system -- information system much 

7 more friendly to O*NET. 

8 So there is a cost-benefit that has 

9 to be made. We did not make that cost10 benefit. The panel did not -- didn't have the 

11 time, the input, but we recognized the 

12 panel recognized that you don't make these 

13 decisions based on what is nice to have. You 

14 make the decisions based on what is practical, 

15 what is affordable, and what is consistent 

16 with the ultimate need of the user. And I 

17 think that was the recommendation. 

18 So a lot of the work that was 

19 suggested by the panel has been handed back to 

20 the Department of Labor, and not just to 

21 Social Security Administration. So, and we 

22 are still waiting to hear what Department of 

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1 Labor's response to that particular 

2 recommendation is. 

3 MS. HILTON: Thanks, Tom. That was 

4 a very good explanation of where the panel is 

5 and what we' recommended. 

6 When Debra Tidwell-Peters invited 

7 us to speak, she mentioned some specific 

8 issues that she would like us to address, 

9 because our report is very broad, so I just 

10 wanted to try to address some of the specific 

11 questions she asked about. 

12 One is the aggregation issue, which 

13 I know you all are very familiar with. I 

14 mean, obviously, DOT had 14,000 jobs. Right 

15 now, O*NET has 1,100 occupations, so that's --

16 it's a huge difference. 

17 The O*NET is aligned with soc. It 

18 does have a coding system wi th digi ts, so that 

19 you can relate any O*NET job to an soc job. 

20 Nevertheless, it is not perfectly aligned. 

21 The SOC has just revised. 

22 Obviously, O*NET has over 1,000. 

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1 Since 2006, O*NET has added 153 new 

2 occupations. These are what they call 

3 breakouts of SOC occupations. In other words, 

4 it is becoming more disaggregated. Part of 

5 the breakouts are related to the search for 

6 green occupations. 

7 What our panel observed is that for 

8 some of the users of O*NET they really want 

9 this disaggregated data. People in career 

10 guidance want to be able to direct young 

11 people towards a more specific job, not 

12 towards such a broad occupation. 

13 Obviously, your users would like 

14 more disaggregated data. On the other hand, 

15 there are either users, and specifically in 

16 workforce development. And that is the core 

17 constituency that is why, first, DOT was 

18 created, and then O*NET was created. 

19 It was to serve state workforce 

20 development people who are trying to place 

21 

22 

people in jobs. And they I ike the broader 

occupations; 

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1 aligned with SOC occupational codes and they 

2 can then link this occupation with a lot of 

3 data collected by the Bureau of Labor 

4 Statistics and state and local agencies, and 

5 that is all collected at the SOC level. 

6 So the panel observed these -- some 

7 people want more disaggregation, some people 

8 want less disaggregation, and the panel didn't 

9 agree. I think that shows that our panel was 

10 well balanced. I mean, you could say it I S a 

11 problem that they can't agree, but it just may 

12 reflect the reality. 

13 The panel although the panel 

14 didn't agree what the level of aggregation 

15 should be, again, just as in the case that Tom 

16 just mentioned, our panel met for a certain 

17 amount of time and then it quit -- that was 

18 the end of our time, money, and effort, and so 

19 the panel felt very, very strongly that this 

20 aggregation issue was critical for the future 

21 of O*NET and for the usefulness of O*NET. 

22 

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And so they recommended that the 

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1 Labor Department either conduct or commission 

2 research to look at the costs and benefits of 

3 changing it, of either making it bigger or 

4 making it smaller, and, you know, what would 

5 be the result of making it bigger, what are 

6 the pros and cons, what are the results of 

7 staying smaller, closer to SOC, what are the 

8 pros and cons. 

9 One element of our recommendation 

10 on this aggregation issue, and it's a long 

11 recommendation we had many long 

12 recommendations. So one element was 

13 specifically calling for some research into 

14 whether O*NET is too disaggregated for the 

15 purposes of disability determination, and to 

16 what extent. 

17 There is the recommendation. Sorry 

18 I didn't put it up there, but it seems -- I 

19 know you have this all right in front of you 

20 anyway, so -- okay. 

21 Data collection now that was 

22 another issue, and Tom just started to mention 

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1 it briefly. Right now, O*NET is using 

2 co+lecting data using a lot of different 

3 methods and a lot of different sources. It is 

4 collecting data from many different types of 

5 respondents, including job incumbents. 

6 Then, there are people they call 

7 occupational experts, people who may have 

8 worked in the occupation at one time, but now 

9 they might be trainers or doing something else 

10 related. That is another group. And then, 

11 the third group are the occupational analysts. 

12 Our conclusion was that these 

13 all these different sources mayor may not be 

14 the best representative of the work that is 

15 performed, and that the impact on measurement 

16 error is unclear, because with every method 

17 you introduce new error. 

18 Specifically on the issue of the 

19 use of occupational analysts, here again this 

20 was an issue where our panel did not entirely 

21 agree, and all you have to do is read Chapter 

22 2. You can tell it. But you can especially 

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1 tell it because there is a dissent at the end 

2 of our report, where two of our panel members 

3 dissented on about a few issues, but they were 

4 one of the issues was this use of 

5 occupational analysts where they felt that 

6 gi ving paper descriptions of an occupation to 

7 a trained occupational analyst would not 

8 result in an accurate rating. 

9 Another data collection issue that 

10 we identified was that the construct validity 

11 of the taxonomies of descriptors varies across 

12 the different domains of the content model. 

13 Tom showed you a picture of the content model. 

14 It is very, very big. There are many 

15 domains. wi thin the domains, there are many 

16 specific descriptors. And some of those 

17 descriptors have a strong research base. 

18 Tom mentioned the abilities 

19 descriptors. They are drawn from Fleishman. 

20 They are widely accepted as some of the best 

21 descriptors of abilities, with the strongest 

22 research base. 

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1 skills, and knowledges there is less support 

2 in the research. 

3 So to the database quality, another 

4 conclusion was that DOL has achieved its goal 

5 of populating the O*NET with updated 

6 information over about a decade. We did see a 

7 problem that there were some short-term policy 

8 agendas that were sometimes reducing the focus 

9 on the core database activities. 

10 And to mention some specific 

11 concerns there, the Labor Department and the 

12 O*NET center, trying to make it more user13 friendly, put a lot of things onto O*NET 

14 Online, which some of the users in the field 

15 don't entirely agree with, especially trying 

16 to define an in-demand occupation, define it 

17 nationally, and yet we had state people 

18 speaking at some of our workshops saying they 

19 did not like it that O*NET Online puts little 

20 flags and highlights certain occupations to 

21 suggest that, you know, these are growth 

22 areas, this is where you can place people in 

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1 jobs, and so forth, and especially now with 

2 the recession. 

3 So basically that is an example of 

4 a short-term policy agenda, and certainly the 

5 current focus on the green jobs, where they 

6 are adding a lot of green jobs, but how 

7 representative are those jobs of the whole 

8 economy. 

9 So our recommendation here was that 

10 DOL should be focusing its resources on the 

11 core database activities, and not getting so 

12 involved in developing the applications and 

13 tools and trying to become more user-friendly. 

14 Related to that, as Tom mentioned, 

15 many people just take the whole O*NET database 

16 and they make it more user-friendly anyway, 

17 especially these online career guidance 

18 systems. So Labor Department doesn't need to 

19 spend its own time and money creating these 

20 applications. 

21 Our most important recommendation 

22 for improving the quality of 

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1 database was that we strongly believe that the 

2 Labor Department should establish and support 

3 a Technical Advisory Board. That advisory 

4 board we think should be prioritizing research 

5 suggestions that come from the field or from 

6 within DOL. They should develop RFPs for the 

7 high priority research items, and then they 

8 should review and rank proposals from outside 

9 researchers to conduct that research. 

10 As I mentioned, we have many 

11 recommendations in our report. We have a lot 

12 of long recommendations. But since many of 

13 our recommendations relate to research, this 

14 is our top priority. 

15 If you are interested in how we see 

16 the priority of all of our many 

17 recommendations, I would recommend that you 

18 read Chapter 10. In Chapter 10 of our report 

19 we rank all of the research and development 

20 recommendations. 

21 We also noticed there were problems 

22 in terms of the users and the communication 

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1 back and forth between the database developers 

2 and the users. We didn't think there was 

3 enough ongoing communication. The 

4 example I just gave to you of the O*NET center 

5 identify nationally in-demand occupations when 

6 people at the state level don't even think 

7 those are in demand is an example of a lack of 

8 communication. So here we recommended that 

9 they establish and staff an ongoing External 

10 User Advisory Board. 

11 When we met not long ago with the 

12 SSA Subcommittee of House Ways and Means, they 

13 wondered, are there any lessons learned from 

14 the development of O*NET that could be 

15 applicable as you start to create your own 

16 

17 

18 

19 

20 

21 

22 

occupational information system? Our main 

conclusion would be that developing and 

maintaining a high quality occupational 

database takes a lot of expertise, and it 

requires 

estimate 

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We were not able 

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1 content model, but that was a very, very 

2 extensive research project that went on for 

3 five years developing it, developing the 

4 constructs, the taxonomies and then going 

5 to the field and pilot testing it. 

6 We do know that the data collection 

7 costs right now are about $6 million a year, 

8 and that updates 100 occupations a year. So 

9 that gives you some idea. 

10 And one other thing I'll mention 

11 related to data collection costs is that 

12 whenever O*NET adds more occupations, whenever 

13 it becomes less aggregated, more 

14 disaggregated, as it. has done, that is always 

15 going to increase your data collection costs, 

16 because you have more occupations to go after, 

17 and that means that same money that could have 

18 been used to refresh your existing occupations 

19 more frequently is going to chase more 

20 occupations. So there is always a tradeoff in 

21 any kind of database like this. 

22 

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1 take your questions. 

2 CHAIR BARROS-BAILEY: Thank you, 

3 Margaret and Tom, for your words and your 

4 presentation. I think this is very useful to 

5 us this morning. 

6 Before I open up questions to the 

7 panel, I have some questions I would like to 

8 ask. And I know that we have mentioned that 

9 Mark and I met with you independently outside 

10 of the OIDAP, and Mark outside of his 

11 university, me outside of my previous IOTF 

12 representation, and we also understand that 

13 SSA has met with you as well. 

14 So in terms of the version of your 

15 report that is online, on the website, in 

16 terms of the pre-publication copy, and you 

17 mentioned in your slides that you are going to 

18 have the final report available in April or 

19 May, what are the changes that are in the 

20 final copy of the report? 

21 MS. HILTON: I can't -- I mean, I 

22 just can't give you that answer. 

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1 changes throughout well, we made some 

2 changes to almost every chapter, as a result 

3 of the feedback we got both from DOL, from the 

4 O*NET center, and from you. 

5 But, you know, without having a 

6 copy in front of me, because every change 

7 as I mentioned to you at breakfast, there was 

8 a lot of internal discussion, because our 

9 policy is that we don't change major 

10 conclusions or recommendations. So that I can 

11 say, that the major conclusions and 

12 recommendations, including the recommendation 

13 that Tom shared with you about an interagency 

14 task force, have not changed. 

15 CHAIR BARROS-BAILEY: How about for 

16 Chapter 8? What were the specific input that 

17 you received that might have changed anything 

18 in Chapter 8? 

19 MS. HILTON: We did make some small 

20 changes to Chapter 8 in response to our 

21 meeting with you and with SSA. 

22 

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CHAIR BARROS-BAILEY: 

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1 those? 

2 MS. HILTON: Like I said, I can't 

3 without having the, you know, copy in front 

4 of me where I see the redline strikeout, I 

5 can't say. 

6 CHAIR BARROS-BAILEY: So were they 

7 editorial in nature? 

8 MS. HILTON: I would say they are 

9 more editorial in nature. 

10 CHAIR BARROS-BAILEY: Okay. 

11 MS. HILTON: As I mentioned, our 

12 policy is not to change major conclusions or 

13 recommendations. 

14 CHAIR BARROS-BAILEY: Okay. Thank 

15 you. And then, in terms of how I came at the 

16 report, and as a panel member, what guided my 

17 evaluation of the report was our own 

18 evaluation of the occupational information 

19 needs of SSA. And I know that Tom has a copy 

20 of the report, and I know that's outlined in 

21 pages 11 and 12 of the report. 

22 And so for anybody who is listening 

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1 in and wants to access a copy, I mentioned at 

2 the beginning of the meeting that you can go 

3 to our website, the home page, and access the 

4 report. 

5 The occupational information needs 

6 that are outlined in pages 11 and 12 of our 

7 report include four categories of what an 

8 occupational information system must contain 

9 to meet SSA's needs. I would like to ask some 

10 questions specific to the recommendation that 

11 the National Academies of Science panel has in 

12 terms of occupational information needs for 

13 SSA in Chapter 8 for disability determination 

14 as they relate to these four areas. 

15 One of the things -- the very .first 

16 thing that is the bullet says reflect 

17 national existence of incidence of work. It 

18 says a new occupational resource must show 

19 that work exists and that work exists in 

20 numbers sufficient to indicate that it is not 

21 obscure. 

22 

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1 things that you just mentioned was the 

2 inclusion of green jobs and whether, you know, 

3 that overemphasis is really reflective of work 

4 as it exists in the national economy. 

5 So how did the NAS panel consider 

6 this occupational information need for SSA in 

7 terms of the disability determination process 

8 in its recommendations for Chapter 8? 

9 MS. HILTON: We didn't specifically 

10 address, you know, the specific need of the 

11 work identified in numbers, or specific -- we 

12 did not identify that question specifically 

13 within the context of the need for disability 

14 determination, and we didn't even make a 

15 specific conclusion or recommendation. 

16 But I think it's fair to say that 

17 our panel believes that the current 

18 occupations that are in O*NET are pretty well 

19 representative of the occupations in the 

20 national economy. I think it's fair to say 

21 also that some -- well, I don't -- we didn't 

22 really reach consensus, as I mentioned, about 

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1 the recent growth and the new occupations that 

2 are added, with some panel members feeling 

3 like these are being added for political 

4 reasons, if they are green jobs, and other 

5 panel members saying that it is very important 

6 that any occupational system remain up to 

7 date. And if jobs are changing, and if new 

8 jobs are being created, they should be 

9 reflected. 

10 So 11m sorry that is not an exact 

11 answer to your question. 

12 MR. PLEWES: Without directly 

13 addressing this point that you make here in 

14 terms of reflecting national existence and 

15 incidence of work, I think the panel did talk 

16 to that, and consider that, in terms of 

17 reaffirming the need for the linkage to the 

18 standard occupational classification 

19 structure. 

20 The standard occupational 

21 classification structure is that structure 

22 which allows you to link to those databases 

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1 which tell you about the trends in the 

2 occupations out in the field, the new and 

3 emerging occupations, and so forth. The 

4 standard occupational classification structure 

5 is updated on a recurring cycle, a regular 

6 cycle, so there is a built-in updating 

7 mechanism there. 

8 So those two aspects of O*NET I 

9 think are commend themselves to being able 

10 to reflect the national existence and 

11 incidence of work. Whether they do or not in 

12 practical aspect as they are applied, as the 

13 O*NET information flows into -- 1 1m sorry, as 

14 SOC information based information flows 

15 into O*NET, is not something that the panel 

16 looked at. 

17 CHAIR BARROS-BAILEY: Thank you. 

18 And in your presentations I noted that you use 

19 the word "occupation" in terms of reflecting 

20 the O*NET, and I know that in terms of a 

21 decision point that DOL had to make in the 

22 development of the O*NET was what was the unit 

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1 of analysis. And in your report you indicate 

2 that to be the unit of analysis at the 

3 occupation level. 

4 Was there ever a consideration of 

5 the unit of analysis or a user need where the 

6 unit analysis was at the job level? 

7 MS. HILTON: Well, as I mentioned, 

8 when the Advisory Panel on the DOT met, one of 

9 their concerns was that it was just not 

10 practical, not affordable, to continue trying 

11 to collect data on 14,000 job titles. I think 

12 it is important to remember that even the DOT, 

13 even with 14,000, that those job titles were 

14 representing more.different, unique jobs. 

15 If you are going to create a 

16 national database, it is not ever going to be 

17 possible to define every job, because 

18 organizations have their own job titles and. it 

19 just gets very, very large. 

20 I remember Rich Froshel telling me 

21 something about when the state of Texas talked 

22 to their employers and said, "What job titles 

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1 do you use here in Texas? 11 And they got 

2 something like 80,000 different job titles 

3 back. 

4 So I believe that it -- that the 

5 reason one reason O*NET uses the broad 

6 occupations it does is that it was trying to 

7 follow the recommendations of that earlier 

8 advisory panel, which recommended looking at 

9 fewer, broader occupations, partly because, as 

10 I mentioned, their concern of identifying the 

11 transferable skills and knowledges, and so 

12 forth, that people might be able to use to 

13 move from job to job. 

14 CHAIR BARROS-BAILEY: Thank you. 

15 The second area in terms of SSA! s needs for 

16 occupation information was reflecting work 

17 requirements, that it must enable SSA to 

18 evaluate an individual's ability to perform 

19 work rather than to obtain work. As such, it 

20 says any new resource must reflect 

21 occupational information that is aggregated, 

22 defined, and measured, in a way that allows 

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1 SSA to compare work requirements to an 

2 individual's RFC and to determine the ability 

3 to work despite a severe impairment. 

4 So the question is: how did the 

5 National Academies of science panel consider 

6 this occupational information need for SSA's 

7 disability determination process in its 

8 recommendations? 

9 MR. PLEWES: Again, I think that if 

10 you look at Chapter 8, the panel did not go 

11 into the level of detail that you are -- have 

12 and will go into. Let's say that right up 

13 front. 

14 So its comparisons that I discussed 

15 with you between the RFC and the O*NET are at 

16 a fairly high level of aggregation. That 

17 said, when you go into the various 

18 descriptors, you can see that in some cases 

19 O*NET does a pretty good job, and in some 

20 cases it falls way short of the mark as to 

21 meeting this particular requirement in terms 

22 of reflecting work requirements, as you have 

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1 defined them as necessary to conduct -- to, if 

2 you will to clearly understand the RFCs. So 

3 it varies. 

4 CHAIR BARROS-BAILEY: Thank you. 

5 And you mentioned in the chapter the RFC, 

6 which is the physical. I didn't see a mention 

7 of the MRFC, which is the mental/cognitive. 

8 Was that something that the National Academies 

9 of Science panel considered in its 

10 recommendations for Chapter 8? 

11 MR. PLEWES: Not in any depth, no. 

12 MS. HILTON: No. 

13 MR. PLEWES: There was a mention, 

14 and that1s it. No. 

15 CHAIR BARROS-BAILEY: Okay. And I 

16 know you have read our report. That1s a 

17 really big area of research that needs to be 

18 done. It's one of the fastest-growing areas 

19 in terms of claims, and a really big issue in 

20 terms of disability determination. 

21 One of the questions and I know 

22 when I met with you I talked about and you 

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1 mentioned in your presentation that I'm a 

2 rehab counselor, and I talked of my role as a 

3 vocational rehab counselor and also a forensic 

4 expert. 

5 And I noted in your PowerPoint 

6 presentation that you talked about voc rehab, 

7 but I didn't see that you had anybody present 

8 to you who came from the forensic community, 

9 somebody with a legal background, somebody who 

10 does expert witness testimony. And I just 

11 wanted did you have any testimony, any 

12 information in terms of the forensic 

13 application? 

14 MS. HILTON: No, we didn't. 

15 CHAIR BARROS-BAILEY: Okay. And so 

16 that goes to my question in terms of the third 

17 bullet, that the database, the occupational 

18 information system must meet a burden of proof 

19 that the individual is actually not 

20 theoretically capable of doing some kind of 

21 work. 

22 

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1 National Academies of Science or how did 

2 the National Academies of Science panel 

3 consider this very important threshold in 

4 terms of occupational information for the 

5 disability determination process? 

6 MS. HILTON: Right. well, again, 

7 we didn I t consider that. I think one reason 

8 that what our recommendation here would be 

9 to create an interagency panel to look at this 

10 in greater detail, is that we recognize that 

11 we did not I mean, it is not only with 

12 disability determination, but many other 

13 areas, we began the process of looking into 

14 the database in greater depth. 

15 We identified areas that we thought 

16 were problematic with our quick look, and we 

17 think further study is needed. 

18 CHAIR BARROS-BAILEY: Okay. So 

19 insofar as further study has occurred since 

20 these recommendations, I know that you noted 

21 that one of the recommendations was basically 

22 for something such as our panel, then that 

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1 would be addi ti ve to' the recommendations that 

2 the National Academies of Science panel has in 

3 Chapter 8, is that what you mean by that? 

4 MS. HILTON: Well, I think as Tom 

5 mentioned. it would you know, one of the 

6 things we recommended that this interagency 

7 group do would be to look at SSA's needs, and 

8 obviously, you know, you have done that. 

9 CHAIR BARROS-BAILEY: Okay. 

10 MS. HILTON: So--

11 CHAIR BARROS-BAILEY: So in the 

12 fourth bullet -- and I just want to bring this 

13 one up, I'm not going to go through each of 

14 these individually, because it's my 

15 understanding that you didn't look at the 

16 specific needs, is that correct, in terms of 

17 apy of the occupational information needs as 

18 outlined in our report, that that was not 

19 considered by the National Academies of 

20 Science panel? 

21 MS. HILTON: Well, this report came 

22 out -- our report came out before your report, 

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1 so, you know, we couldn't addres s 

2 CHAIR BARROS-BAILEY: Our report 

3 came out in September. 

4 MS. HILTON: Oh, that's true, but 

5 our committee had done its work. Our report 

6 was in review at that point, so we were not 

7 going to be making changes except in response 

8 to review. So there was you know, it 

9 wouldn't have been possible for us to look at 

10 all of these things. 

11 I mean, I would say in terms of 

12 these three bullet points here, the reflect 

13 work requirements, as Tom just mentioned, that 

14 the analysis in Chapter 8, we did try to look 

15 at what we thought what some RFC needs 

16 were, specifically physical, and compare those 

17 with some O*NET descriptors. 

18 CHAIR BARROS-BAILEY: okay. And I 

19 know that Chapter 8 does mention our report, 

20 and it also mentions our recommendations, 

21 outlined 

22 

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MS. HILTON: Yes. 

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1 CHAIR BARROS-BAILEY: in the 

2 report, so there was some cursory review of 

3 our report, but not a consideration of our 

4 report within the recommendations? 

5 MS. HILTON: Right. Right. It was 

6 - - you know, in edi ting some some of the 

7 final editing of the report after it had been 

8 through review, just to update it, was to 

9 mention that your report had come out and try 

10 to briefly capture some of the things that 

11 were said. But the panel, no, did not 

12 deliberate on your report's findings. the 

13 panel finished its deliberations in late 

14 April, with a final teleconference. 

15 CHAIR BARROS-BAILEY: So if the 

16 recommendations had been made before our 

17 report was out, might that have impacted some 

18 of the recommendations? 

19 MS. HILTON: Certainly. I would 

20 think we would have taken that into account. 

21 CHAIR BARROS-BAILEY: Okay. Okay. 

22 I'm going to open it up to the panel to see 

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1 if there are other questions for members of 

2 the panel. Sylvia? 

3 MEMBER KARMAN: Hello. Thank you 

4 very much, Tom and Margaret, for coming out 

5 today. I do have one question well, 

6 actually, I've got a couple, but one that just 

7 occurred to me. You mentioned that it, you 

8 know, wouldn't be practical to gather data at 

9 a more disaggregated level, and the level that 

10 we've been really looking at. 

11 I notice on page 7-10 of your 

12 report that the second bullet under O*NET 

13 content refers to occupational information is 

14 not customized for jobs in a particular 

15 organization. This inability to describe a 

16 specific job in detail can limit O*NET's 

17 utility for legal defensibility, and this is 

18 for personnel selection. We face the same 

19 issue --

20 MS. HILTON: Right. 

21 MEMBER KARMAN : wi th regard to 

22 any occupational information system that we 

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1 would need in order to meet our burden at.step 

2 5. 

3 MS. HILTON: Yes. 

4 MEMBER KARMAN: And so, therefore, 

5 that is why that is so, you know, incredibly 

6 important to us.' 

7 MS. HILTON: Yes. 

8 MEMBER KARMAN: Among the questions 

9 that I have is also page 2-2 of your report 

10 provides five different questions that you all 

11 felt were important in assessing an 

12 occupational information system. 

13 And they each one starts out 

14 with, how general or specific will the 

15 descriptors of occupational requirements be? 

16 Second one is, given a particular level of 

17 generality! specificity, should the set of 

18 descriptors of a particular occupational 

19 requirement be a representative sample of all 

20 possible descriptors of that requirement? Or 

21 should it represent the entire universe of 

22 descriptors? 

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1 Third one is, should each 

2 descriptor of occupational requirements be 

3 applicable to every occupation or unit of 

4 analysis? Fourth is, is the taxonomy to 

5 include genuine taxons, such as those that 

6 exist in biology? This gets at the issue of 

7 skills that you mention there. Certainly, 

8 skills cannot necessarily meet the definition 

9 of a taxon. 

10 Five, can the taxonomy be designed 

11 to serve a wide range of purposes among 

12 diverse users? I I m wondering how the panel 

13 answered those questions for O*NET, or did you 

14 feel that the Department of Labor answered 

15 those questions for O*NET? And then, also, 

16 how did you all assess those questions in 

17 terms of our - - the needs that were outlined 

18 in Chapter 8? 

19 MS. HILTON: I think that these 

20 questions are raised as a way to introduce 

21 this whole chapter, which is about the history 

22 of the development of O*NET. 

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1 basically, near the end it said that the 

2 developers of O*NET have addressed all of 

3 these questions. 

4 So basically they are kind of 

5 rhetorical questions, if you know what I mean, 

6 saying how general or specific should this be? 

7 And then, if you read the rest of the 

8 chapter, you know, you will see that they 

9 ended up with something they called OUs,' 

10 occupational units, and I think there were 

11 about a thousand of them. 

12 So I don't think these questions 

13 are introduced, you know, with the idea that 

14 then our panel is going to answer these 

15 questions. As I say, it's a vehicle to get 

16 you to read on and find out, you know, what 

17 how the developers address these questions. 

18 And as for our panel's view on the 

19 for the first question, how general or 

20 specific, as I mentioned, our panel did not 

21 agree on how general or specific it should be 

22 and recommended that it was important to study 

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1 the pros and cons of being more and less 

2 specific. 

3 MEMBER KARMAN: Okay. I just want 

4 to mention that when we our panel went 

5 through the assessment of what basically SSA 

6 gave the panel, its occupational information 

7 needs, and a lot of what we did as a panel was 

8 really address these kinds of issues. 

9 And so what we're noticing is that 

10 almost at every stage or at every question we 

11 would have selected a direction that is 

12 decidedly differently --

13 MS. HILTON: Different from what 

14 O*NET took, yes. 

15 MEMBER KARMAN: from what the 

16 Department of Labor did, because their mission 

17 is decidedly different. 

18 

19 

20 

21 

22 

MS. HILTON: Right, right. 

MEMBER KARMAN: Thank you. 

CHAIR BARROS-BAILEY: Dave? 

MEMBER SCHRETLEN: Good morning, 

and thank you very much. I have a question 

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1 that concerns sort of the first recommendation 

2 in Chapter 8, and that is the recommendation 

3 that SSA and the Department of Labor create an 

4 interagency task force to study the viability 

5 of potential modifications of O*NET to 

6 accommodate SSA needs. 

7 And my question concerns a point 

8 that you make in Chapter 8 about the 

9 behavioral anchors for the rating scales. I 

10 think it's on pages 8 - 6 and 7 of Chapter 8. 

11 And you give an example of behavioral anchors 

12 for arm I think arm stability, and the 

13 example includes lighting a candle at a point 

14 of two on the abi I i ty scale. This is hand 

15 steadiness. And threading a needle at point 

16 four. 

17 And you make the point you 

18 acknowledge in this report that there are 

19 problems with these behaviors. 

20 MS. HILTON: With those bars, yes. 

21 MEMBER SCHRETLEN: And there are a 

22 couple of them, and you cite a couple that are 

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1 very clear, and I think that you did an 

2 excellent job of articulating some of the 

3 probfems. 

4 I do think that there are others as 

5 well that are not articulated there, but I 

6 think that the bars' anchors are intuitively 

7 appealing, but had a lot of scaling problems. 

8 And you mentioned the lack of specificity. 

9 In fact! that's sort of a theme that runs 

10 through! you know! Tom, your presentation as 

11 well, that the 52 abilities may lack some 

12 sufficient specificity for SSA's needs. 

13 But with regard to this behavioral 

14 anchors! and the problems, those behavioral 

15 anchors and the 52 abilities that they have 

16 been used to assess, have been applied to the 

17 1,102 occupational units in O*NET. And my 

18 question is this: if those behavioral anchors 

19 lack enough specificity for SSA's use, and 

20 have other scaling problems, how could it be 

21 modified, how could the existing database be 

22 modified for SSA's use? 

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1 It seems to me that the only 

2 modification would be to essentially start 

3 from scratch, because you can't simply go back 

4 and reapply new behavioral anchors to the 

5 existing database. The existing database was 

6 developed using these behavioral anchors, and 

7 so the my question is: can you envision a 

8 way of modifying O*NET that does not include 

9 replacing O*NET? 

10 MS. HILTON: I think that it 

11 deserves further study. That is what we 

12 recommended, that it needs to be stUdied. But 

13 one thing I would mention is, you know, in 

14 terms of the analysis in Chapter 8, that the 

15 whole focus - - it does not focus only on the 

16 abilities domain. You know, it also talks 

17 about the work context domain, and some of the 

18 other domains. 

19 

20 

21 

22 

I mean, that is the thing about 

O*NET. As Tom mentioned, it is a general 

purpose. It is very big. It has 239 

descriptors. It is like please all, please 

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1 none, you know. It was designed for many 

2 purposes, and it doesn't serve anyone user 

3 exactly the way that user would like it to be. 

4 MEMBER SCHRETLEN: In fact, one of 

5 the things you said is that the panel could 

6 not agree on the appropriate level of 

7 aggregation. 

8 MS. HILTON: Yes. 

9 MEMBER SCHRETLEN: And that some 

10 people might think of that as a problem of the 

11 panel, but it strikes me that it's really not 

12 a problem of the panel at all, but the fact 

13 that O*NET that Department of Labor has 

14 attempted to make a sort of all-purpose 

15 occupational information system. 

16 And there are -- different purposes 

17 have different requirements, of course. So 

18 for some reason, as you pointed out very 

19 appropriately, some users might want a more 

20 aggregated, more disaggregated system. 

21 But my question about this bars issue is 

22 really not one that I think further study 

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1 could address, because it's illogical. My 

2 question is: is there a logical way -- is 

3 there a way that it could be modified without 

4 replacing it? And I don't think that that's a 

5 question that really that further study 

6 will answer. I think it's a question that --

7 is it that a logical analysis of the existing 

8 system leads to an answer? 

9 MR. PLEWES: I agree with you. I 

10 don't believe that you can fundamentally 

11 change the anchors and retain the system as it 

12 is. But the panel didn't look at that. 

13 That's just my sitting here thinking about it. 

14 Now, how about tweaking? 

15 MEMBER SCHRETLEN: That's what I'm 

16 asking. 

17 MR. PLEWES: I think it would be 

18 possible, with proper research, to tweak. If 

19 indeed the result of the 'tweaking brought it 

20 closer to the Social Security Administration's 

21 RFCs than the current system, 

22 fundamentally changing the result. 

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1 MEMBER SCHRETLEN: Okay. So that 

2 is -- so that is wonderful. Then, how - - can 

3 you imagine even one way that it could be 

4 tweaked? That's what I'm trying to get at. 

5 I'm trying to understand how this could be 

6 done wi thout fundamentally recreating the 

7 database, because, you know, either the bars 

8 

9 MR. PLEWES: I don't give you an 

10 answer. In a research approach, I would think 

11 -- I would compare results of current with the 

12 tweaked, and then to see what the differences 

13 are. But I don't know. 

14 MEMBER SCHRETLEN: So you are 

15 suggesting like starting with new behavioral 

16 anchors. 

17 MR. PLEWES: Yes. 

18 MEMBER SCHRETLEN: On some of the 

19 existing occupational units. 

20 MR. PLEWES: On those of most 

21 interest, where the deviation between the 

22 descriptors, the anchors current anchors 

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1 for the descriptors and the RFCs are -- have 

2 the greatest differences that are very, very 

3 important to the Social Security 

4 Administration processes. Bu t that's me. I 

5 the panel didn't look at that, I have to 

6 tell you. 

7 MEMBER SCHRETLEN: Right. I guess 

B the question is, if you were to find a 

9 correspondence between revised behavioral 

10 anchors and existing behavioral anchors, that 

11 still wouldn't answer the question of what to 

12 do about levels of ability that fall between 

13 those points on the scale. 

14 MR. PLEWES: No. 

15 MS. HILTON: I mean, we definitely 

16 thought there needed to be research on the 

17 behavioral anchors, but all of our research 

18 recommendations don't necessarily mean that we 

19 think that O*NET has to be rebuilt from the 

20 bottom up. 

21 There are always costs and benefits 

22 to making any change to a big system like 

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1 this, and this is why we thought they needed 

2 an outside ongoing expert technical advisory 

3 committee, one of the reasons being to 

4 prioritize what research is most important, 

5 and, secondly, what are the potential costs 

6 and benefits. 

7 You know, some people are very, 

8 very critical of the behavioral anchors in 

9 O*NET. Our dissent, if you read the dissent 

10 to our report, the two dissenters say, "Just 

11 get rid of get rid of the behavioral 

12 anchors on the level scale ( " . because they are 

13 so problematic. The rest of the committee did 

14 not agree with that. 

15 Nevertheless, even the dissenters 

16 do not say we should scrap O*NET, that we need 

17 to start over. So as Tom mentioned, there are 

18 a lot of tweaks. You can make modifications. 

19 And then, there are costs and benefits to 

20 doing that. 

21 CHAIR BARROS-BAILEY: 

22 "tweaks," what do you mean? 

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1 MS. HILTON: For example, the two 

2 people that dissent to say that we should get 

3 rid of the level scales in the abilities and 

4 skills domains, and only use the importance 

5 scale, and that they also suggest maybe we 

6 should be looking at other scales, such as 

7 frequency or duration. 

8 I think that relates a little bit 

9 to the Chapter 8, the comparison of how much 

10 time do you spend sitting, kneeling, 

11 crouching, and it is like half the time, all 

12 the time, whereas for RFC purposes you need 

13 actually number of hours. So things like 

14 that. 

15 CHAIR BARROS-BAILEY: And you 

16 mentioned the work context, you are referring 

17 to 38 in your slide that talks about how much 

18 time in your current job do you spend 

19 kneeling, crouching, stooping, and crawling. 

20 

21 

22 disability 

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MS. HILTON: Right. 

CHAIR BARROS-BAILEY: 

determination, we 

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1 somebody who has a shoulder injury who can do 

2 kneeling, crouching, and stooping, but they 

3 can't do crawling, because that involves the 

4 upper extremity. So are you talking about not 

5 just changing the anchors but also changing 

6 the descriptors? 

7 MS. HILTON: Definitely. I mean, 

8 we called for research into the descriptors. 

9 We said that the content -- what was the exact 

10 language? The content validity of the domains 

11 and the descriptors is uneven. We think that 

12 in some domains, like abilities, the 

13 descriptors are stronger, they have a stronger 

14 research base. In some of the other domains, 

15 like knowledges and skills, there is not such 

16 a strong research base. 

17 So here again, I mean, I think some 

18 people would say that our report is radical, 

19 because how could you go back and look at the 

20 

21 

22 

content model. The content model is perfect, 

it's you know, it was studied. It was 

studied a long time ago. We think it is time 

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1 for a fresh look at this. 

2 CHAIR BARROS-BAILEY: Sylvia, and 

3 then Shanan. 

4 MEMBER KARMAN: Okay. I guess it 

5 seems like the panel must have had some 

6 things, though, in mind, you know, just sort 

7 of piggybacking on what David has asked, and 

8 Mary has brought up, because, you know, on 

9 page 8-3 the panel the National Academies 

10 of Science report, its panel stated that the 

11 panel is not advocating the adoption of O*NET 

12 by SSA, or the development of a hybrid O*NET 

13 disability system in the disability 

14 determination process. 

15 However, we conclude that a 

16 considerably modified or expanded O*NET would 

17 be capable of informing the disability 

18 determination process. 

19 So for one -- one question I have 

20 is that this seems contradictory, but, you 

21 know, then the other question I have is, given 

22 the discussion that we've just had for the 

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1 last few moments, it seems as if you all may 

2 have had something in mind, what would that 

3 modification look like that would not, as 

4 David pointed out, or as Mary brought up, 

5 really require extensive change to the point 

6 where it would be impractical and not a cost 

7 savings in terms of, you know, not requiring 

8 two different systems. 

9 MS. HILTON: And I have to say I 

10 really can't answer this question, because, I 

11 mean, this is really what the panel thought, 

12 what we have here in the report. The panel is 

13 not meeting anymore. As Tom mentioned, you 

14 know, we didn't look in-depth at this whole 

15 disabili ty question. We took a quick look, 

16 and we thought it needed further study. And 

17 since it was important to both agencies, 

18 that's why we suggested that the two agencies 

19 study it together. 

20 CHAIR BARROS-BAILEY: Shanan? 

21 MEMBER GIBSON: My question will 

22 likely be a simple followup to that, then, or 

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1 actually I have a couple of questions. The 

2 first was, I noted that the chapters did not 

3 identify the primary authors for each chapter. 

4 Is it possible to find out who the primary 

5 chapter author was for Chapter 8, so that, for 

6 example, in this case we could ask them, what 

7 were their thoughts perhaps related to those 

8 comments, so that we understand better, so we 

9 have the information going forth. 

10 MS. HILTON: No, I don't think so. 

11 You know, it is a committee consensus report. 

12 If one panel member did take a lead on a 

13 chapter, that chapter did not go forward for 

14 inclusion unless the rest of the committee 

15 agreed to it. So we really try to talk about 

16 these as committee reports, not they are 

17 not like edited chapters by individual 

18 authors. It's a consensus. 

19 MEMBER GIBSON: It just seems that 

20 there is very great distinctions among how the 

21 different chapters are written, so, for 

22 example, Chapter 7 does a very good job of 

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1 identifying specific issues related to 

2 psychometrics, which might impact the use of 

3 the O*NET. And then, we see nothing similar 

4 to it in other chapters, I ike ours, so I'm 

5 thinking one person probably wrote this 

6 chapter, and so their styles are very 

7 distinctly different, which is what leads me 

8 to that conclusion. 

9 My other -- my second question --

10 so I guess I have three now -- is in the very 

11 beginning of your discussion you talked about 

12 how you recei ved a review of the report and 

13 created a response to the reviews. Are those 

14 part of open documentation, so that we could 

15 look at them as well? 

16 MS. HILTON: No, they're not. 

17 MEMBER GIBSON: Okay. And thent my 

18 final question is simply to try to make 

19 certain I understand kind of your overall 

20 theme here. Is it a -- am I understanding 

21 correctly when I say that it appears the 

22 overarching decision of the panel was that the 

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1 O*NET is a general purpose instrument, which 

2 means it will meet the needs of some but not 

3 the needs of others, it will meet the needs of 

4 individuals and groups to differing degrees, 

5 and, therefore, other systems might be 

6 necessary or appropriate to meet the needs of 

7 different organizations. 

8 MS. HILTON: I don 1 t know that we 

9 commented on whether other systems were 

10 necessary, but certainly what you said about 

11 how it's an all-purpose and it meets some 

12 needs but not other needs, that's correct. 

13 MEMBER GIBSON: So the logical 

14 conclusion of it doesn 1 t meet the need, 

15 something else must 

16 MS. HILTON: It could be. I mean, 

17 we have to we are representing what 1 shere 

18 in our report, so we can 1 t 

19 

20 

21 panel said. 

22 

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MEMBER GIBSON: And that's 

MS. HILTON: -- go beyond what our 

MEMBER GIBSON; Okay. Thank you. 

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1 CHAIR BARROS-BAILEY: Tom? 

2 MEMBER HARDY: Good morning. It is 

3 a real pleasure having you here, and I - - I 

4 would imagine all of us would like to spend 

5 two hours talking with you, because we all 

6 have volumes of questions. And so I'm not 

7 going to take a lot of time, I just have two 

8 because in my role here - - I'm a vocational 

9 counselor, but I'm also an attorney. 

10 So I've got two different 

11 interests, and they are each and my 

12 question is that I actually rather more 

13 have a discussion than a question, if you want 

14 to know the truth. One is more for you, Ms. 

15 Hilton. Because of my vocational background, 

16 I am very interested in skills, and in 

17 transferability of skills. 

18 And we are working right now on 

19 coming up with a definition, and I noted in 

20 the report you spoke several times about the 

21 fact that O*NET doesn't truly define "skills," 

22 and that it is kind of difficult in some ways 

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l to track skills using their raters for skills. 

2 In doing that -- in reading that, I 

3 also read went out and read a little further, 

4 and I found your report on future skill 

5 demands. 

6 MS. HILTON: Okay. 

7 MEMBER HARDY: Which I read, and I 

8 thought it was fascinating. I really loved 

9 reading this. 

lO MS. HILTON: I'm glad you liked it. 

II MEMBER HARDY: You did a great job. 

l2 MS. HILTON: Thanks. 

l3 MEMBER HARDY: And it really made 

l4 me think about a lot of things. But what 

l5 really stuck with me -- and I go back to what 

l6 you said about we are very concerned about SSA 

l7 and what those needs are, but there is broader 

l8 context, and I get -- and that report really 

19 broadened my context of how skills can be 

20 used, and for workforce development, workforce 

2l planning, 

22 things. 

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education, and huge numbers of 

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1 But what struck me was all the way 

2 through here everybody kept commenting on how 

3 O*NET was not going to be useful, for the most 

4 part, in answering the workforce development 

5 questions. Is that a good reading on this, or 

6 am I kind of skewing it because of something 

7 else? 

8 MS. HILTON: Well, actually, I am 

9 not sure that you are talking about the 

10 workshop report on future skill demand. 

11 MEMBER HARDY: Future skills, yes. 

12 MS. HILTON: The people were 

13 critical of O*NET in terms of its ability to 

14 identify changes over time in the national 

15 different skill demands of work. 

16 MEMBER HARDY: Yes. 

17 MS. HILTON: I think that someone 

18 at the workshop did make that point. I do 

19 think there are some questions, you know, if 

20 you are looking at it strictly from a research 

21 point of view, whether the data in O*NET could 

22 be used, if you could track it for 20 years, 

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1 which it hasn't even existed for 20 years --

2 MEMBER HARDY: Yes. 

3 MS. HILTON: and compare 

4 versions of the database every five years, and 

5 look at what levels of the skills were 

6 reported in 1995, 2000, 2005. I mean, I do 

7 think it's theoretically possible that you 

8 could use O*NET for that purpose. 

9 But with regard to that question 

10 that you are talking about, I think that the 

11 discussion in Chapter 7 of our current report 

12 does a pretty good job of talking about how 

13 very useful O*NET is for this kind of labor 

14 market research as things change and as 

15 economists try to understand what is growing 

16 not only what is growing and shrinking, 

17 but, you know, within jobs, within a given job 

18 title, what the demands are. 

19 MEMBER HARDY: And I get that, and 

20 I guess what -- this is more of a discussion, 

21 truly. I am wondering, if we go ahead with 

22 what we're doing, and get skills defined down 

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1 to a job level, and are able to really anchor 

2 that and not use some of these O*NET 

3 descriptors, which Dr. Spenner from Duke was 

4 talking about the O*NET descriptors of skills 

5 as being 

6 MS. HILTON: Ken Spenner from Duke, 

7 yes. 

B MEMBER HARDY: Yes, being we'll 

9 just say unwieldy. If we were able to get to 

10 a better definition of "skill," take it to a 

11 job level, and then actually track that, 

12 wouldn't that be more useful than using O*NET 

l3 for those purposes, that this the other 

14 paper was talking about? 

15 MS. HILTON: I don't know. Like I 

16 say, I mean, it is your question is very, 

17 very theoretical. I mean, we are talking 

IB about creating a whole new database, and the 

19 first what you're talking about is the 

20 first step. Then, is that database going to 

21 be representative, you know, broadly 

22 representative of the jobs in the national 

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1 economy? That's the second question. 

2 The third question, you know, if it 

3 had a better -- if it had better descriptors 

4 of skill, yes, I think that could be useful. 

5 MEMBER HARDY: Okay. My other 

6 question is more of a legal question, because, 

7 again, I'm an attorney, and I have to worry 

B about these things. And this is more for you, 

9 Mr. Plewes. You were talking about doing some 

10 tweaking or nuancing, and trying to find ways 

11 where the marginal differences could be 

12 brought down. 

13 In constructing your report, did 

14 you guys talk to any attorneys about legal 

15 defensibility issue? 

16 MR. PLEWES: We recognized that 

17 there were those, but we no, we did not 

1B talk to - - if I had known that we were going 

19 to be here today, we probably would have gone 

20 

21 

22 

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(Laughter. ) 

to an attorney as one of our 

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1 presenters, I can tell you that, and a 

2 vocational rehabilitation person, thank you 

3 very much. But no, we did not. 

4 MEMBER HARDY: Okay. My concern is 

5 that, you know, everybody on the panel looks 

6 at me and goes, "Oh, you're the lawyer. Make 

7 sure we've got it right. 11 And one of the 

8 things I always say back is, "If and when we 

9 develop or when we develop this system, 

10 every piece of it must be legally defensible, 

11 because if one piece fails the test, the 

12 entire system fails the test." 

13 And in a broad sense, I kind of 

14 come back to you and say if we're looking at 

15 O*.NET and I see in your report you speak 

16 multiple times about areas that are flawed, 

17 how can we -- how can we work around that if 

18 there is a legal defensibility issue, in your 

19 opinion? 

20 MS. HILTON: Well, I'm not sure if 

21 it's exactly the same thing, but I know that 

22 some of the panel members that work in the 

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1 field of selection and development of 

2 selection tests, which are very often subj ect 

3 to legal challenges, mentioned that they find 

4 O*NET information very, very useful, but they 

5 use it as a starting point. 

6 Like if they are trying to create a 

7 selection test, they start with an O*NET 

8 occupational description, and that gives them 

9 the basic foundation of information. But 

10 then, they add a lot more specific 

11 information, specific to that organization, 

12 that more narrowly defined job title, and so 

13 forth. 

14 MEMBER HARDY: Okay. I guess just 

15 so you understand, when we go to court, 

16 whether it's in Social Security or many of 

17 those cases then end up in federal court, 

18 which is subject to federal rules of evidence 

19 as well. 

20 If you build something on any 

21 platform, that platform still must be 

22 defensible under the same rules of evidence. 

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1 And that is an issue that I have. 

2 MR. PLEWES: And I think the 

3 question for your panel is to is to think 

4 about O*NET in that case as a framework. And 

5 I think it I S fairly clear that O*NET is a 

6 framework. It would probably be preferable to 

7 the DOT as a framework in terms of some of the 

8 things that it offers in terms of its tying to 

9 the SOC and its updating, and so forth. 

10 But that,as Margaret suggests from 

11 other areas, that there probably needs to be 

12 wi thin that framework a lot of adjustment to 

13 meet the requirements that you have. 

14 MEMBER HARDY: So . you would still 

15 advocate O*NET over DOT as a basis. 

16 MR. PLEWES: I think that was done 

17 some time ago. 

18 MEMBER HARDY: Okay. 

19 MR. PLEWES: That decision was made 

20 in terms of a framework for looking at the 

21 issues. 

22 

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1 MEMBER HARDY: I could talk to you 

2 for hours. 

3 CHAIR BARROS-BAILEY: Okay. I have 

4 a quick question about that. In the days of 

5 PDP, it I S very easy to search a report in 

6 terms of key word, so I did search the report 

7 in terms of "legal" and saw that there were 

8 only two references to it. One that Margaret 

9 just mentioned, page 7-3, in terms of a 

10 starting point, and the other one that Sylvia 

11 had mentioned. 

12 And in both of those instances it 

13 it indicates that the O*NET is not 

14 defensible, and so those were the only 

15 mentions that I was able to find in the report 

16 in terms of the defensibility. And so I think 

17 Tom I s question is, if when you look at pages 

18 11 and 12 of our report in terms of the must 

19 needs of an occupational information system, 

20 and the third one being legal defensibility, 

21 it becomes a really big issue, if, you know, 

22 there are aspects of the O*NET that are not 

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1 legally defensible. 

2 Mark, you had a question? 

3 MEMBER WILSON: Yes. Welcome. 

4 It's good to see you again. It's a real honor 

5 to be here today speaking wi th you about very 

6 important issues. And, as you see, I have to, 

7 as the 10 psychologist along with Shanan, deal 

8 with very diverse sets of issues in terms of 

9 making recommendations about occupational 

10 information for this purpose. 

11 And as you know, we exchanged some 

12 correspondence, and so I and I know you 

13 might not because Mary and others were 

14 asking you some specifics about changes, but I 

15 just wanted to check to see in a couple cases 

16 if some of the things that we discussed might 

17 have gotten changed. 

18 The first one was early on in the 

19 report it and we discussed this as a 

20 potential typo -- refers to O*NET as a system 

21 providing information about jobs when, in 

22 fact, it is really an information system about 

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1 occupations. Do you remember if that got 

2 changed to occupations instead of jobs? 

3 MS. HILTON: I know we went through 

4 the report before and after review, because we 

5 got comments about that also in review. And I 

6 think that in many places we changed the word 

7 "job" to "occupation." But I don't believe we 

8 changed it in every single place, and that was 

9 partly for purposes of readability by someone 

10 who doesn't know anything about occupations, 

11 occupational analysis, or anything. 

12 The term "occupation" had not yet 

13 been introduced, so that you might still see 

14 in some of the early pages of the report 

15 references to "job." 

16 MEMBER WILSON: Yes. And I think, 

1 7 you know, the reason we discussed that was 

18 because it is sort of -- O*NET clearly doesn't 

19 provide, you know -- and it gets some of these 

20 others, but, you know, I certainly understand 

21 that. 

22 The second question I had that we 

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1 discussed - - and this was kind of more of a 

2 wish, I don't know -- and you talked about and 

3 had a slide about the advisory panel, and in 

4 your report you refer to it as external, and 

5 we discussed .the idea that we need to define 

6 the term "external." This is not contractors. 

7 Were you able to make any changes 

8 there in your report to specify what you meant 

9 by "external," so that when the agency got 

10 this they would understand what that meant in 

11 terms of your intent, or 

12 MS. HILTON: I am not sure what we 

13 did there. 

14 MEMBER WILSON: Sure. I completely 

15 understand. The other two things in terms of 

16 wishes -- and these I suspect you weren't able 

17 to do a whole lot about, but I thought I would 

18 ask. As other people have indicated, you 

19 know 1 we don't get someone the National 

20 Academies of Science prestige in work analysis 

21 very often to look at these issues and make 

22 these kinds of reports. 

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1 And so I was - - was as sort of my 

2 wish list saying that I wish you would have 

3 addressed evaluation issues and work analysis 

4 in terms of specifying what some of the 

5 criteria were that the external panel might 

6 look at. Did you make any changes there to 

7 say, you .know, we want you to look at X, Y, 

8 and Z? Or, you know, these are the --

9 MS. HILTON: Well 

10 MEMBER WILSON: fundamental 

11 evaluation criteria that should be considered? 

12 MS. HILTON: Right. As I 

13 mentioned, our policy is not to make changes 

14 to any maj or conclusions or recommendations. 

15 So, I mean, that would involve making a change 

16 to a recommendation with more detail, so --

17 MEMBER WILSON: Sure. No, I 

18 understand. And the other thing we discussed 

19 and some places you talked a little bit 

20 about panel formation, things of that sort. 

21 But it wasn't always clear what the 

22 methodology was in terms of how the panel went 

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1 about -- you know, Tom mentioned that there 

2 were experts that were aware of the literature 

3 and did lit reviews and things of that sort. 

4 But was there anything added more? 

5 And I think this gets some to Shanan's 

6 question. We really want to understand what 

7 the mind of the panel was with regard to 

8 several of these specific issues, because we 

9 are struggling with them. If there is some 

10 methodological issue that we need to address, 

11 we want to know that. 

12 Were there any expansion of, you 

13 know, here's how we went about coming to this 

14 particular conclusion in any cases? Do you 

15 MS. HILTON: Well, we did try to 

16 base our conclusions on all of the input we 

1 7 received in our two workshops. 

18 MEMBER WILSON: Right. 

19 MS. HILTON: And also, the panel 

20 members' own expertise and knowledge. We 

21 talked in closed sessions about what exactly 

22 we thought our major conclusions would be. We 

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1 basically went through several rounds of 

2 deliberation about our conclusions and 

3 recommendations, where we were talking about 

4 them in person, we talked about them in 

5 teleconference, and then we would send them 

6 out to the whole committee 

7 MEMBER WILSON: Yes. 

8 MS. HILTON: trying to reach 

9 consensus. And, you know, we did not reach 

10 consensus on some issues, as you know. 

11 MEMBER WILSON: Right. Absolutely. 

12 And especially with regard to the disability 

13 issue, you know, you mentioned that it was a 

14 much more general panel, and this wasn't 

15 MS. HILTON: Right. 

16 MEMBER WILSON: necessarily an 

17 area where you acquired experts. Were any 

18 disability experts, as part of the methodology 

19 you describe, which is sort of trying to gain 

20 consensus -- did you -- did they bring anybody 

21 with expertise in for any of those 

22 deliberations other than the panel meetings 

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1 and --

2 MS. HILTON: No. 

3 MEMBER WILSON: The next issue, 

4 which you had in your slides and I wanted to 

5 ask your thoughts on, is that the effective 

6 measurement error is unclear. And as you 

7 know, in the second panel meeting, Dr. Harvey 

8 made a presentation where, among other things, 

9 he looked at calculation of reliability 

10 coefficients in O*NET data. 

11 MS. HILTON: Yes. 

12 MEMBER WILSON: And he made the 

13 point that -- which is unique to generic work 

14 analysis, that there are lots of "does not 

15 apply" responses in any sort of occupational 

16 level profile that would be generated. so in 

17 any individual case, a large part of the O*NET 

18 descriptors in whatever domain are not going 

19 to be relevant to describing that particular 

20 occupation. 

21 And so when you calculate 

22 reliabilities on the entire profile, you get 

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1 numbers that look pretty respectable, but he 

2 presented data that seem to when you 

3 calculate the reliability on just those things 

4 that are relevant, there are dramatic, 

5 breathtaking, shocking declines in terms of 

6 the stability of these data. 

7 So I guess my question is: was 

8 there something unpersuasive about that data? 

9 Or why is it that the panel seemed to come to 

10 the conclusion that there were unclear 

11 measurement effects? 

12 MS. HILTON: Do you mean, how did 

13 we come to the conclusion that the effects on 

14 measurement error are unclear, because every 

15 new method adds to the uncertainty? 

16 MEMBER WILSON: Well, I just meant 

17 that that data was pretty persuasive to me, 

18 and it$ impact in terms of the following panel 

19 discussions, you know, I mean, it just seemed 

20 like that presentation sucked a lot of air out 

21 of the room in terms of, you know, I mean, 

22 there were people that seemed shocked when 

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1 they saw the reliability coefficients that 

2 were calculated on some of these data that 

3 people are using that appear to be almost 

4 noise. 

5 I guess that f s what I'm saying is 

6 is that why my question is: was there 

7 something about that presentation that was 

8 unpersuasive with regard to measurement error? 

9 Or why was there the conclusion that 

10 measurement error effects were unclear? Is it 

11 just because of the multi-method, is that what 

12 you're saying? 

13 MS. HILTON: Right. That 

14 conclusion is really focusing on the whole 

15 multi-method issue. 

16 MEMBER WILSON: Yes. 

17 MS. HILTON: It relates to the 

18 whole issue of using job incumbents, but also 

19 occupational analysts. 

20 MEMBER WILSON: Right. 

21 MS. HILTON: The fact that job 

22 incumbents have strengths and weaknesses as a 

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1 data source. 

2 MEMBER WILSON: Right. 

3 MS. HILTON: They have the 

4 strength, they obviously, they work in the 

5 job, so they know something about it. But as 

6 you very well know, there is a tendency for 

7 job incumbents to inflate 

8 MEMBER WILSON: Absolutely. 

9 MS. HILTON: you know, the 

10 abilities and skills of a job. Similarly, 

11 within occupational analysts, again, you have 

12 strengths and weaknesses, strengths that you 

13 are dealing with someone who is very well 

14 trained to do this kind of ranking --

15 MEMBER WILSON: Absolutely. 

16 MS. HILTON: a weakness that 

17 they are not as familiar with the job, with 

18 the occupation, and depending on the quality 

19 of information you provide to them, or whether 

20 they would get a chance to actually go to the 

21 

22 

field, which in O*NET case they do not 

actually go. 

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So that I 5 what that conclusion 

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1 is really based on. 

2 MEMBER WILSON: Those are all 

3 excellent points, especially that issue of 

4 inability to observe. In fact, what I would 

5 suggest is that that may be the reason why 

6 some of these data were presented -- are what 

7 they are, that these people aren't necessarily 

8 providing data based on direct observations of 

9 what actually occurred. 

10 MS. HILTON: Yes. 

11 MEMBER WILSON: And then, my 

12 it's not so much a question. It is taking me 

13 a while, but I'm trying to learn from Tom and 

14 Nancy. It seems like the sort of crux of the 

15 discussion here, which your panel dealt with 

16 and ours dealt with, and that I described to 

17 you as sort of a fundamental distinction or a 

18 di fferent way of thinking, I suspect I know 

19 who on the panel was more concerned about 

20 disaggregation, because 10 psychologists have 

21 to deal with things at the organizational 

22 level, at the job level. And I described it 

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1 there as a distinction between the econometric 

2 and the ergometric approaches to doing work 

3 analysis. 

4 And I'm just wondering about your 

5 thoughts. I understand the efficiency 

6 argument, and I very much understand the 

7 currency argument. Shanan and I made some 

8 presentations where there is good 

9 interreliability here between what you are 

10 recommending and what we said with you 

11 know, you can have the greatest data system in 

12 the world, and if it's not current, that is a 

13 problem. 

14 And you're right, as the number of 

15 descriptors and the number of disaggregation 

16 increases, there is definitely more data cost. 

17 But I'm just wondering, is it possible that 

18 the sort of top-down econometric, more 

19 rational, big picture is very different than 

20 the sort of bottom-up, here is work as it 

21 actually exists in the economy. 

22 you have any thoughts on that? 

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1 Is that potentially an area where 

2 we can sort of find that there really maybe 

3 are two fundamental different approaches that 

4 can't be very easily reconciled, and that 

5 trying to reconcile them is always going to be 

6 a sort of lever between either making the 

7 econometric approach unhappy, because there is 

8 too much detail, or, you know, perhaps moving 

9 in the other direction now where there is 

10 simply not enough detail from a defensibility 

11 -- any thoughts at all on that or --

12 MS. HILTON: Do you have any 

13 thoughts about that? 

14 MR. PLEWES: Just hearing you, when 

15 we had our meeting, and again now, we 

16 certainly wish we had invited you to give a 

17 presentation before the panel, because I think 

18 some of these thoughts probably would have 

19 been very valuable to them, and they would 

20 have been willing to address them. 

21 In their saying that they -- that 

22 they like the idea, I'm putting words in 

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1 there, but the recommendation is that if we 

2 don't change at least the linkage between the 

3 SOC and the O*NET, that kind of they say that 

4 the top-down approach that is, that the 

5 importance of the linkage to the national 

6 databases is very, very important. 

7 Now, what they didn't do is take a 

8 look at what you are suggesting, and that is 

9 that there may be another way of looking at 

10 this. I didn't see evidence that they had 

11 given that full thought. 

12 MEMBER WILSON: Well, I certainly 

13 agree, and I think that the sort of -- there 

14 are a couple of questions here. One is the --

15 how do you describe the work? And, you know, 

16 am I going to be able to defend whatever the 

17 analysis is when Tom halls me into court? You 

18 know, all those kinds of issues. 

19 But I think you make an excellent 

20 point that linkage back to what Social 

21 Security is not going to be able to do is have 

22 their own Bureau of Labor statistics and make 

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1 projections about where you know, so I 

2 think that linkage -- and, in fact, we made 

3 significant recommendations in that area to 

4 link back to those systems. I think we are 

5 very aware of the value of the econometric 

6 approach and that from a sampling 

7 standpoint. 

8 In conclusion, I just -- welcome to 

9 my world. I know that this is sort of a 

10 departure from how you normally conduct 

11 business and things of that sort. I very much 

12 appreciate you being here. I mean it when I 

13 say it you know, it has been an hour to 

14 interact with you on these issues, and I 

15 appreciate the expertise that you bring to 

16 this topic. 

17 So thank you. 

18 MS. HILTON: Thank you. Thank you 

19 for giving us an opportunity to share the 

20 panel's work with you all. 

21 

22 

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CHAIR BARROS-BAILEY: Thank you. 

Bob, do you have a question? 

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1 MEMBER FRASER: No, it's really 

2 more of a comment. I'm a vocational 

3 rehabilitation coun<selor and rehab 

4 psychologist also, and I and the folks the 

5 counselors in my unit, we do use O*NET for 

6 purposes of vocational exploration and career 

7 guidance. 

8 But in respondirig to a company 

9 relative to the legal defensibility whether a 

10 person can do a job, we simply can't use it, 

11 because it's functionally and skill-related, 

12 etcetera, it's simply not discrete enough. 

13 It's relative. So relative doesn't work, you 

14 know, for us, and that's part of our charge 

15 here in SSA. 

16 And kind of going back to Dave's 

17 comment, you know, or the issue is, can we 

18 tweak these scales? Well, you know, we have 

19 that problem with aggregation, you know, so 

20 say we have 18 truck drivers in that 

21 occupation. So we have anybody from an access 

22 van driver to an interstate trucker, you know, 

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1 a wide variance in terms of the demands of 

2 that kind of - for those different types of 

3 jobs. 

4 So I just don't see how, in an 

5 interagency effort, how we could work on this 

6 tweaking with this core problem of aggregation 

7 being an occupation versus the range of jobs 

8 being represented. 

9 MEMBER SCHRETLEN: In fact, as I 

10 was thinking further about it, I thought maybe 

11 I was not very clear in my question. But just 

12 sort of following up on that, I think the idea 

13 of what a modified O*NET system might look 

14 like, I'm trying to envision that. 

15 And it seems as though, based on 

16 the things that you have said in your report, 

17 the limitations of O*NET that you have 

18 acknowledged or recognized, that at minimum a 

19 modified system would need to not merely add 

20 more specific jobs, but actually replace a lot 

21 of the occupations, because they are so 

22 broadly aggregated, or occupational units, 

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1 because Social Security simply cannot compare 

2 an applicant to an occupational unit. They 

3 have to compare them to jobs, specific jobs, 

4 or, you know, clusters of jobs. 

5 So it would at least require a very 

6 broad supplementation, if not a complete 

7 replacement, of those occupations, that the 

8 abilities that are rated, the job 

9 characteristics that are rated would have to 

10 be more specific. And if they're more 

11 specific, you can't -- you would have to go 

12 back either to previously evaluated ones and 

13 add those, or start from scratch with new 

14 ones, and evaluate those new dimensions of job 

15 characteristics. 

16 And in any case, you would have to 

17 go back, because the bars are problematic. 

18 And in a sense, you would have to revalidate 

19 all of the ratings across the entire system, 

20 and that's why I'm saying I just don't -- it's 

21 hard for me to imagine how -- I mean, we can 

22 use the word "modification," but it's a -- it 

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1 would be a radically different system. That's 

2 the only thing that I can imagine. I mean, 

3 can you imagine can you help me imagine 

4 some way that it's not that? 

5 MS. HILTON: I have a very weak 

6 imagination. 

7 (Laughter.) 

8 But I guess what I wanted to 

9 mention is that this whole issue of, you know, 

10 once you've created something, and O*NET is 

II very big, do you want to change it? Can you 

12 change it? If you change it, will it disrupt, 

13 you know, what we have in place? 

14 And I guess I would just say that 

15 our panel felt that it was worth causing some 

16 disruption if it would result to 10nger-teI1Tl 

17 improvements in the quality of the data. So I 

18 think that's true of any database. If you go 

19 ahead and create your own, I mean, that's 

20 something that you will always have to be 

21 thinking about, because it's not like you just 

22 create an occupational database at one point 

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1 in time and just leave it. So2 CHAIR BARROS-BAILEY: Nancy? 

3 MEMBER SHOR: Thank you. I want to 

4 thank you very much for coming. This has 

5 really been fascinating. I am interested in 

6 what sort of response you have received 

7 formally, informally, that you expect to 

8 recei ve from the Department of Labor, that we 

9 -- we are kind of asking you questions about 

10 how O*NET could be modified, how O*NET could 

11 be changed, and I think in many ways those 

12 questions really are best directed to them. 

13 But, you know, your process is 

14 extremely familiar to you, but not to me. Is 

15 there a role, has there been a role, do you 

16 anticipate a reaction from them? 

17 MS. HILTON: Well, we had a 

18 briefing with them in late November, and they 

19 seemed really interested in a whole report. 

20 They are very surprised by some thing 1 like 

21 when we mentioned that green jobs might not --

22 might be a distraction from the core database 

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1 they all like were shocked, because they are 

2 very focused on green jobs these days. 

3 Since that initial briefing, we 

4 haven't really heard from them. As Tom was 

5 mentioning at breakfast, we think that when 

6 the printed report comes out that they will 

7 pay more attention once again. I can say with 

8 specific regard to that recommendation for a 

9 joint interagency task force that they were 

10 very interested. They thought -- they seemed 

11 to think that that would be a great idea, that 

12 they would love to coordinate more closely 

13 with SSA. 

14 CHAIR BARROS-BAILEY: And when I 

15 started the meeting, I talked about what the 

16 Commissioner has asked us to do in terms of 

17 the four points. And one of them was the 

18 recruitment, training, and certification of 

19 field job analysts. So I was looking for a 

20 lot of that information in your report to see 

21 how the panel came at that. 

22 

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And the sense I get is that it 

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1 wasn't really even a question addressed. And 

2 my question, because I'm a little intrigued by 

3 that, my question is, especially in light of a 

4 whole chapter on technology, when the APDOT 

5 was looking at data collection methods, and 

6 ruled out the use of field job analysts, the 

7 technology was very different then. There has 

8 been a lot that technology has done in the 

9 last 20 years. 

10 So was there -- I'm just wondering 

11 why there has -- there wasn't even a question 

12 of the use of field job analysts and data 

13 collection with O*NET, in light of the fact 

14 that it had been almost 20 years since the 

15 APDOT started their work that led to a lot of 

16 the decision-making and design. 

17 MS. HILTON: I guess I would just 

18 say that the -- that issue appears slightly in 

19 Chapter 2 in the whole discuss yon of the data 

20 collection and the fact that the occupational 

21 analysts in O*NET don't go to the field and 

22 don't 

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you know, they only receive paper 

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1 descriptions. 

2 But it wasn't something that our 

3 panel really looked at, because we were trying 

4 to look at O*NETas it is now. Actually, I 

5 don't know whether it's still relevant, but if 

6 you are interested in this whole question 

7 about field job analysts you might want to go 

8 back and look at the 1980 report, because they 

9 found a lot of problems where those field job 

10 analysts were not following the protocols that 

11 had been developed nationally, and also they 

12 weren't even finding enough there were 

13 supposed to be at least three analysts I 

14 believe rating every job title, and in a lot 

15 of cases there was only one or two. 

16 So it is a very complicated issue, 

17 and there might still be something in that 

18 older report that would be relevant, as you 

19 think about that now. 

20 CHAIR BARROS-BAILEY: Thank you. 

21 Dave? 

22 

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MEMBER SCHRETLEN: 

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1 question about the recommendation to focus 

2 resources on core database activities, leaving 

3 development of most new applications and tools 

4 to others. 

5 If Department of Labor asked you, 

6 would you regard expanding the use of the 

7 O*NET to make it suitable for disability 

8 determination a core part of the database 

9 activities, or is that one that you would 

10 advise them to farm out to others? 

11 MS. HILTON: Well, that's one 

12 reason we suggested a user advisory panel to 

13 try to deal with some of those issues. But, 

14 you know, we definitely recognize that 

15 different users have different needs, and this 

16 whole area of application -- yes, it's -- you 

17 raise a very good question. That's all I can 

18 say. I don't have the answer to it, but it's 

19 an important point. 

20 

21 

22 

CHAIR BARROS-BAILEY: Tom asked 

some questions about skills. And I noticed 

there was not a discussion about the 

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1 application or the importance of skills and 

2 skills transfer within Chapter 8 1 but there 

3 was in other areas of the report a lot of 

4 discussion about skills. 

5 As a matter of fact 1 Chapter 10 1 

6 the number one priority in tenus of all of 

7 your recommendations is conducting research on 

8 the content model 1 beginning with skills and 

9 knowledge demands. 

10 MS. HILTON: Right. 

11 CHAIR BARROS -BAILEY: And I know 

12 your report talks about that there were even 

13 problems of how to define skilll and I think 

14 there were like four or five different 

15 definitions 1 and then the one that was arrived 

16 at was -- which was sociotechnical skills, it 

17 indicates that there was a view that this was 

18 the most prominent. There was no underlying 

19 researcher data to bolster that decision. So 

20 what is currently being used as a theoretical 

21 framework for skills does not have a body of 

22 research. 

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1 Are you aware of how skills domain 

2 within the content model for the O*NET is 

3 applied, or can be applied in disability, or 

4 any transferable skills assessment? 

5 MS. HILTON: Not specifically with 

6 regard to disability, but in Chapter I 

7 think it's Chapter 6 in the workforce 

8 development chapter, we talk about a number of 

9 electronically created databases that link the 

10 various domains in O*NET -- skills, abilities, 

11 knowledges -- and compare that with what an 

12 individual has, what they think their level of 

13 it is, and then it can be linked to other 

14 jobs. So there is some progress being made in 

15 that area. 

16 CHAIR BARROS-BAILEY: And I think 

17 one that I saw on the O*NET Academy was one 

18 called TORQ. 

19 MS. HILTON: Yes. 

20 CHAIR BARROS-BAILEY: And that 

21 talks about an RV team assembler in northern 

22 Indiana, 

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where, through that system, the 

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1 transferable skill that is derived is a dental 

2 hygienist. 

3 MS. HILTON: Oh, right. 

4 CHAIR BARROS-BAILEY: But in 

5 disability determination, retraining cannot be 

6 considered when looking at transferable 

7 skills. We I re looking at residual, not rehab 

8 potential. 

9 MS. HILTON: I see. 

10 CHAIR BARROS-BAILEY: So in that 

11 instance, I haven't found a way to be able to 

12 use any of the O*NET data for transferable 

13 skills assessment, where we are looking at 

14 residual issues instead of rehab potential. 

15 Have you seen that application whatsoever? 

16 MS. HILTON: I guess I -- I am not 

17 that familiar, but what is just popping to 

18 mind -- and I don't know that this is really 

19 ever done. I am more familiar with the 

20 applications that I mentioned to you, like 

21 TORQ. 

22 

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It seems that, in theory at least, 

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1 that a person could use O*NET, or a counselor 

2 working with a person could use O*NET, and 

3 whatever jobs, occupations they had had in the 

4 past, jobs could be linked to O*NET 

5 occupations, and then the level of the 

6 different skills, knowledges, and so forth, 

7 required in those previous occupations could 

8 be identified. 

9 Then, it would be possible to 

10 identify other occupations that use those same 

11 levels of skills and identify a new 

12 occupation, without requiring any training in 

13 between, if you see what I mean. 

14 CHAIR BARROS -BAILEY: Yes. And I 

15 think I think when we look at the 

16 occupational unit that is representative of 

17 the team assembler and the dental hygienist, 

18 and we look at the DOTs the aggregated 

19 initially under those OUs, they were pretty 

20 heterogeneous as opposed to homogeneous, and a 

21 lot of other --

22 

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MS. HILTON: Yes. 

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1 CHAIR BARROS-BAILEY: And so it was 

2 still -- it would be very difficult for me as 

3 a vocational expert to have Nancy or Tom 

4 cross-examine me and say, "How did I go from a 

5 team assembler to a dental hygienist?" in 

6 terms of transferability. 

7 MS. HILTON: I see. 

8 CHAIR BARROS-BAILEY: Particularly 

9 if I can't consider retraining. 

10 MS. HILTON: And proving that they 

11 really were capable of becoming the dental 

12 hygienist without any retraining, is that what 

13 you're saying? 

14 

15 

16 

17 licensing 

18 

19 

20 the states. 

21 

22 

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CHAIR BARROS-BAILEY: COrrect. 

MS. HILTON: Yes. 

CHAIR BARROS-BAILEY: Or 

MS. HILTON: Yes, right. 

CHAIR BARROS-BAILEY: in many of 

MS. HILTON: Right, right. 

CHAIR BARROS-BAILEY: 

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1 other questions? Deb? 

2 MEMBER LECHNER: I get the 

3 underlying current from your report that one 

4 concern about maintaining two separate 

5 databases is the cost effectiveness issue of 

6 Social Security Administration maintaining a 

7 separate database from Department of Labor. 

B But I didn't see anything in the 

9 report that spoke to the cost effectiveness of 

10 the data collection methodology used by 

11 Department of Labor at the present time. And, 

12 you know, when you look at 100 occupations a 

13 year, and $6 million a year to maintain an 

14 updated database, that sort of rounds out to 

15 $60,000 per occupation, so -- which I find is 

16 really an astounding number. 

17 So I just wondered if there was any 

1B consideration to the current cost 

19 effectiveness of the process. 

20 MS. HILTON: I guess the we 

21 didn't really reach a conclusion here, but we 

22 did talk at least -- I think in two places in 

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1 the report we talk about the whole tradeoff 

2 question. There was certainly an idea that if 

3 some research was conducted on some of these 

4 domains and descriptors that perhaps not all 

5 of those descriptors were necessary, because 

6 there are 239, which is a very lot. Maybe 

7 that's why it costs $60,000. 

8 So if research would find that 

9 there would not need to be quite so many 

10 knowledges or skills or problem-solving, which 

11 appears in four different places, so that what 

12 -- it's called pruning, the idea of pruning it 

13 down a little bit, that would definitely 

14 improve the cost effectiveness of it. 

15 But we didn't go specifically into 

16 the costs of, you know, doing surveying job 

17 incumbents versus using occupational analysts, 

18 and so forth. We didn't have the data to do 

19 that for one thing. 

20 CHAIR BARROS-BAILEY: 

21 questions? 

22 (No response.) 

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1 Okay. I have one last question. 

2 And you just heard from Deb Lechner. Deb is 

3 the person that I mentioned when I met with 

4 you, that she and Joe had done the study that 

5 is mentioned in Chapter 8 in reference to the 

6 IOTF. And that reference in Chapter 8 makes 

7 it seem like the concept of the O*NET D was 

8 being tested by that study, and in reality 

9 that was a study of field job analysts. 

10 And I is that an area of the 

11 report that has been corrected in terms of a 

12 clarification of what how that study is 

13 represented? 

14 MS. HILTON: Yes, we did make that 

15 change. 

16 CHAIR BARROS-BAILEY: Thank you. 

17 Thank you. 

18 Any other questions from the panel? 

19 (No response.) 

20 Thank you. It has been a great 

21 pleasure to have you here. I think our 

22 discussions are really important. There are a 

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1 lot of things that I learned in terms of your 

2 process, in terms of where the report was 

3 issued along that process. There were some 

4 conclusions that I was coming to in terms of 

5 what your report meant within that context 

6 that I think were clarified today. 

7 And I do want to point out to 

8 everybody that there was a section of your 

9 report on page 1-11 that I thought was really 

10 important in terms of the distinction between 

11 what we're doing here and the fact that we are 

12 a panel that keeps on going, and that your 

13 panel was really time-limited. And so I think 

14 that's important to understand reports and 

15 context. 

16 And in page 1-11 , it says in some 

17 cases the evidence that could be assembled and 

18 considered with the available resources and 

19 within the timeframe of study was 

20 insufficient, leaving the panel with 

21 unanswered questions. And so I think that's 

22 really important for us to acknowledge, that 

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1 what you said at the very beginning of your 

2 presentation, that there were some areas that 

3 you just didn't have an opportuni ty to 

4 address. 

5 And so I know some of our questions 

6 are way more detailed than you had the 

7 opportunity to cover. And so I thank you for 

8 the time that you have spent with us today, 

9 for answering our questions, and for the 

10 opportunity to speak with you. 

11 It looked like Mark wanted to say 

12 something. Did you want to say something? 

13 Okay. 

14 MEMBER WILSON: Just more of a 

15 comment in terms of this, because I think it's 

16 a very relevant issue, this sort of cost17 benefit analysis, and the resources required 

18 to keep things current and up to date. 

19 And if you look at it from a sort 

20 of classical occupational analysis standpoint, 

21 and you're the Department of Labor, where this 

22 is a relatively small, you know, potentially 

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1 in some bureaucrats' minds, insignificant part 

2 of what the Department of Labor is all about, 

3 the resources that one might devote to that, 

4 and the justification for those resources is 

5 very different than, you know, I perhaps I 

6 should have, but it wasn't until fairly far 

7 into the process that I understood the scale 

8 of the operation on which Social Security 

9 operates, the underlying industries, in terms 

10 of private insurance. 

11 So the costs in terms of 

12 litigation, the costs in terms of getting this 

13 right, are enormous. And so if you look at it 

14 as a percentage of DOL's budget, in terms of 

15 what might be devoted to this issue, you might 

16 come to a very different cost-benefit analysis 

17 than if you look at it in terms of the $140 

18 billion, plus perhaps another $140 billion in 

19 private benefits in terms of justifying the 

20 effort to do a more bottom-up, job-oriented, 

21 more detailed set of descriptors. 

22 thought. 

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1 CHAIR BARROS-BAILEY: Thanks, Mark. 

2 And that was something we talked about when 

3 we met with you in January, the $140 billion a 

4 year that is used -- spent by Social Security 

5 on disability for beneficiaries and their 

6 dependents, $128 billion of that for 

7 beneficiaries. 

8 And if we would take that 

9 equivalent amount of money and apply it to the 

10 federal budget, in terms of the discretionary 

11 spending, that it would equate to about 14 

12 budgets of federal agencies including NASA, 

13 including the federal courts, including the 

14 executive office, including Congress. When we 

15 started adding all of those up, it was pretty 

16 huge to see the impact of disability. And 

17 that was jus t he federal impact; it didn't 

18 include private insurance. 

19 And so you could see that we are 

20 very passionate as a panel in terms of what we 

21 are doing, because this has huge implications 

22 to people we see on a daily basis. 

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1 So I want to thank you again. We 

2 recognize that disability determination, and 

3 its application in terms of the O*NET, was but 

4 one of the many parts of the O*NET that your 

5 panel evaluated. And there were time and 

6 resource issues that you could not control 

7 that caused limitations and delimitations to 

8 the scope of your work. 

9 We want to thank you for your time 

10 to come here to St. Louis and be with us here 

11 to present in terms of the panel's findings. 

12 We recognize your hard work over there. We 

13 recognize it. And you worked for over a year 

14 on it, and I know that you continue to work. 

15 One of the things we talked about 

16 over breakfast was how long after a panel 

17 finishes its work do you present, and you said 

18 it could be years that you might be presenting 

19 on this. So we know that it continues for 

20 you, although the panel has been disbanded. 

21 

22 insights. 

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So we want to thank you for: your 

They have been 

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1 helpful, and that you have provided to us as 

2 we report back to Commissioner Astrue in terms 

3 of our findings. 

4 Thank you. 

5 MS. HILTON: Thank you for inviting 

6 us. 

7 CHAIR BARROS-BAILEY: Okay. We 

8 will take a IS-minute break and resume our 

9 meeting. 

10 (Whereupon, the proceedings in the foregoing 

11 matter went off the record at 10:46 

12 a.m. and went back on the record at 

13 11:12 a.m.) 

14 CHAIR BARROS-BAILEY: Okay. Let's 

IS come back on the record, please. 

16 I think that the meeting this 

17 morning was incredibly valuable. I learned a 

18 lot from the process. One of the things that 

19 most stood out for me was that although our 

20 report is referenced in Chapter 8, when I 

21 talked to Margaret about that and its 

22 reference in the very first page, the National 

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1 Academies of Science panel did not deliberate 

2 on our report. 

3 As a matter of fact, they got it 

4 after the panel was disbanded. And so their 

5 recommendations at the end of the chapter have 

6 nothing to do with the content of our report. 

7 In fact, there is no contradiction between 

8 their conclusions and our report. There is no 

9 contradiction in terms of what they say in 

10 recommendation number one in terms of looking 

11 and analyzing the user needs for SSA, and the 

12 fact that that had already been done in our 

13 report. 

14 So it was a timing issue, but the 

15 way it 1 S reflected in Chapter 8 is it almost 

16 seems like our report having been referenced 

17 or cited in the first page, that it became a 

18 filter for the rest of the chapter when it was 

19 not the case. It was something they added 

20 later on to try to make it as complete as 

21 possible. 

22 And so when I talked to Margaret 

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1 about the potential of making a clarification 

2 in Chapter 8 about that, as she was willing to 

3 make a clarification about Deb's research back 

4 when she was with IOTF and the fact that it 

5 wasn't testing the O*NET D concept, it never 

6 got that far way back then, they are so far 

7 along in their process with the National 

8 Academies of Science in terms of the 

9 publication of the final report that they 

10 cannot make that clarification. 

11 And so I indicated to her that that 

12 would probably be a clarification that would 

13 be included in our report back to the 

14 Commissioner, because I think it's a very 

15 important one. Particularly, we are very 

16 sensitive in this panel to how people read 

17 flat documents in context of time with what we 

18 experienced in January, some people going to 

19 subcommittee reports that don't reflect the 

20 final recommendations that appeared in our 

21 final report to the Commissioner. 

22 So I wanted to -- I think we got a 

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1 lot of information that we potentially have 

2 the need -- more than just the few minutes we 

3 have allocated for this meeting before we end 

4 or adjourn for the day to really discuss. And 

5 so 1 wanted to see if maybe we could talk 

6 about the implications of what we learned for 

7 a couple of things that we've talked about 

8 over the last day and a half and the agenda. 

9 National Academy of Science 

10 roundtable, the 01S-1 study, but 1 think it 

11 merits a lot more discussion than we have time 

12 for. And so 1 would propose that we consider 

13 doing a teleconference at some point in the 

14 next few weeks to address the broader issue in 

15 terms of the takeaways and how this might 

16 affect our advice and recommendations back to 

17 SSA. 

18 So let me open it up in terms of 

19 the implications to the couple of things that 

20 we have been talking about the last couple of 

21 days. First, the National Academy of Science 

22 roundtable, meaning not just dealing with the 

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1 O*NET issues, but we had discussed yesterday 

2 about the DOT issues, you know, the 

3 implications of this report overall, not just 

4 Chapter 8, and the implications of the Miller 

5 study from 1980 in terms of the overall design 

6 and recommendation issues. 

7 Any thoughts about any changes, of 

8 whether we need to have that, how we need to 

9 have it? 

10 MEMBER WILSON: Just a point of --

II are we still in a public meeting? I notice 

12 our name tags are gone. 

13 (Laughter.) 

14 CHAIR BARROS-BAILEY: I think the 

15 staff is just being a lot more efficient, but 

16 I think I know who you are. So, yes, we are 

17 in the public meeting. 

18 Okay. Let me -- Sylvia, go ahead. 

19 MEMBER KARMAN: Well, one thing is 

20 is that it as we are anticipating the 

21 National Academies of Science I s final report 

22 at the end of April, depending on when that 

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1 report -- final report comes out, we may want 

2 to adjust the timing that we were thinking 

3 about for the National Academies of Science 

4 subject matter, at least roundtable. 

5 So that may -- that just might be 

6 something that we may want to tackle, because 

7 we did talk about that yesterday in terms of 

8 possibly having that in June. All things 

9 being equal, that might be a good idea, but 

10 then again, on the other hand, if we don't 

11 receive the report until, you know, the end of 

12 April, possibly even May, we certainly want to 

13 have enough time for all of the people we 

14 would invite to that panel, as well as 

15 ourselves, to have time to read it and really 

16 reflect on it. 

17 So, I don't know, I am just putting 

18 that out there. That's one thing. 

19 MEMBER WILSON: I agree. I think 

20 there is no rush. I am not opposed to having 

21 some sort of teleconference on to sort of 

22 process some of the things that we heard here 

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1 today, but I think it's important to have the 

2 report in hand, the final report, have read it 

3 and digested it. You know, I saw a lot of 

4 people taking lots of notes and stuff, so, you 

5 know, I doubt that we will forget any of that. 

6 So 

7 CHAIR BARROS-BAILEY: Okay. Thank 

8 you. And Allan? 

9 MEMBER HUNT: I was just going to 

10 point out that the final report is not going 

11 to be materially different from what we've 

12 seen, because obviously their process 

13 prohibits that. So--

14 CHAIR BARROS-BAILEY: Okay. So 

15 what I'm hearing and seeing around the table 

16 is that the roundtable concept is on the 

17 table, very much so, moving forward. And 

18 there might be some variation in terms of what 

19 we had put the timeline to be within the road 

20 map that we discussed yesterday. 

21 Shanan? 

22 MEMBER GIBSON: I was going to say 

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1 one thing we might consider, though, is based 

2 on the responses here, and our understanding 

3 of how the panel operates, I think we should 

4 probably, as part of this teleconference, 

5 discuss our expectations for what we will 

6 . achieve through this roundtable. 

7 CHAIR BARROS-BAILEY: The Four 

8 Square Document, excellent. Thank you. 

9 MEMBER SCHRETLEN: Yes, that's -- I 

10 was just going to say that it calls into 

11 question in my mind, what is the purpose of 

12 the roundtable? Do we need to visit that and 

13 ask ourselves as a panel what -- what we --

14 what our goals what we want to accomplish. 

15 CHAIR BARROS-BAILEY: Okay. 

16 MEMBER KARMAN: I guess we should 

17 definitely consider that over the next few 

18 weeks. And then, when we meet again, we 

19 should, you know, talk discuss it and just, 

20 like you said, revisit the purpose, given the 

21 responses we had. 

22 I do know that we have many more 

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1 questions, but you're right, I mean, it may 

2 not -- it may not 

3 MEMBER SCHRETLEN: It raises in my 

4 mind the question of might our time be better 

5 served doing other things than a roundtable, 

6 like spending time talking about how to 

7 respond to this, or how this panel might 

8 advise SSA to respond. 

9 MEMBER GIBSON: I would concur with 

10 that, and I would just say, though, I do want 

11 to -- that we mentioned the fact that the NAS 

12 roundtable will also be taking a secondary 

13 look at the original report, not just this 

14 report. So there does still leave that one 

15 particular issue on the table. 

16 CHAIR BARROS -BAILEY: And I think 

17 there were a lot of questions that were more 

18 technically oriented, where there were members 

19 of the National Academies of Science, O*NET, 

20 and DOT roundtables that addressed more 

21 technical aspects beyond obviously Chapter 8, 

22 that might be beneficial in terms of the 

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1 research process. 

2 You know, when we look at some of 

3 the things that have been we have been 

4 asked to provide advice and recommendations 

5 on, in terms of data collection and field job 

6 analysts, what they found with DOT and, you 

7 know, 30 years ago why it was addressed or not 

B addressed, some of those scientists might have 

9 some thoughts about that in this report, you 

10 know, other methods for data collection, same 

11 thing with sampling, some of the linkage 

12 issues that might be helpful. 

l3 MEMBER SCHRETLEN: If they would 

14 attend. 

15 CHAIR BARROS-BAILEY: If they would 

16 attend, absolutely. 

17 Mark? 

18 MEMBER WILSON: Yes. I think 

19 that I s the issue, and it I S an excellent point. 

20 In terms of what the roundtable would be, my 

21 plans were always to recommend that it be very 

22 similar in format to the one I attended that 

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1 Dave had organized, where we as a panel, 

2 certainly those interested would formulate a 

3 set of questions that the technical experts 

4 would be asked to address. And that wouldn't 

5 be the only thing, but that would be the start 

6 of the discussion. 

7 And I think the area that remains 

8 unexplored, in terms of looking at various 

9 recommendations in the NAS report, were some 

10 of the issues that Shanan and I were -- you 

11 know, can you tell us about the reviews? Can 

12 you tell us who wrote this? There aren't that 

13 many experts, and so, assuming that they would 

14 come, the 10 psychology panel members of NAS 

15 and some people who were involved in the 

16 original DOT report, are the obvious invites 

17 to this. 

18 But if they were not if 

19 significant or all numbers -- or all of them 

20 were not able to attend, then I think it would 

21 potentially be something that we would have to 

22 reexamine as to whether or not it was 

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1 valuable. 

2 CHAIR BARROS-BAILEY: And maybe, 

3 you know, beyond the panel members, I remember 

4 reading Handel and his comment in terms of job 

5 complexity. There might be other aspects of 

6 other people who presented that might 'not 

7 necessarily have been on the panel who might 

8 be helpful to have as part of that process. 

9 But so what I'm hearing is that we 

10 want to keep the NAS roundtable concept on the 

11 table, be a lot more specific in terms of what 

12 the Four Square Document would include, what's 

l3 the purpose, and what we would learn from it 

14 in terms of cost-benefit, time analysis, and 

15 also timing. 

16 Okay. Mark. 

17 MEMBER WILSON: well, and maybe one 

18 way to get at the issue that David raised, and 

19 also your initial comments about, you know, do 

20 we need a teleconference to discuss the 

21 process, you know, I .would be very interested 

22 and would invite, as we did in terms of the 

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1 Research Committee and reading the NAS report, 

2 what questions the various panel members have 

3 and, you know, that is kind of a moot point 

4 now, but I would certainly be interested in, 

5 well, were we able to assemble an august body 

6 of work analysis experts who are expert, what 

7 questions would you want to ask them? What 

8 issues should they address that were similar 

9 to the kinds of questions that, you know, 

10 David was asking his people? 

11 MEMBER KARMAN: I appreciate that, 

12 because I am thinking that as we formulate the 

13 questions or purpose around what we might want 

14 to do in terms of a roundtable, and then ask 

15 ourselves, gee, you know, is there perhaps a 

16 better way for us to attain these answers to 

17 these questions than doing that? You know, 

18 perhaps there is some other method or 

19 approach. 

20 Because, you know, to the extent 

21 that we would be asking additional questions 

22 and maybe -- specifically, with regard to that 

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1 particular report, in its final form or pre2 publication, is for us as a panel to be able 

3 to reconcile for Social Security the 

4 recommendation that, well, there is this 

5 modification notion on the table with regard 

6 to O*NET, and its use possible use for 

7 Social Security, which Social Security has 

8 looked at. 

9 And also, the recommendations in 

10 the report itself that really get at the data 

11 quality issues, and how can we deal with that 

12 as a panel moving forward and making 

13 recommendations to Social Security about the 

14 development of its occupational information 

15 systems. 

16 And it may be, as David pointed 

17 out, and, Mark, you also seconded it,· that 

18 maybe there are better ways of getting at 

19 that. 

20 MEMBER SCHRETLEN: And I just think 

21 it might be very useful for all of us to think 

22 about what we might do, in a sense kind of 

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1 preemptively, or prospectively, and do we want 

2 to wait until the Department of Labor reaches 

3 out and makes some overture, or do we want to 

4 anticipate that with something and say, in 

5 case you are thinking about reaching out and 

6 making some overture --

7 (Laughter. ) 

8 here are some preliminary 

9 thoughts, before you decide whether or not you 

10 might want to form some kind of interagency. 

11 Just to make it clear what their -- how steep 

12 the mountain is. 

l3 MEMBER KARMAN: In fact, I am kind 

14 of glad you mentioned that, because one of the 

15 things that has come to mind is that in the 

16 discussion that we had earlier, David, when 

17 you had raised the issue of the bars, for 

18 example, the behaviorally-anchored ratings, 

19 and Tom Plewes had suggested that, well, you 

20 know, these are things that could be studied, 

21 you know, perhaps a comparison of the current 

22 anchors with things that mayor 

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1 useful to Social security, or measures that 

2 may be more useful. 

3 I am thinking that that may be 

4 something that could be readily integrated, 

5 that kind of a study may be a point that may 

6 be readily integrated into the OIS design 

7 study, may give us some traction on that issue 

8 early on, at least to take a look at that, and 

9 be in a position to say to the Department of 

10 Labor, or whomever, "Well, you know, we 

11 actually did take a look at that and here is 

12 what we found." 

13 MEMBER SCHRETLEN: So we could 

14 conceivably respond to that, both rationally 

15 and empirically. 

16 MEMBER KARMAN: Yes, sir. 

17 CHAIR BARROS-BAILEY: With 

18 something that is happening right now. So, I 

19 mean, what kind of became evident from the 

20 discussion this morning is that we are 

21 

22 

delivering on what 

chronologically is beyond 

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1 beyond what the recommendations imply. I 

2 mean, they implied something that is static in 

3 time for them in August of last year. 

4 And we are - - we are, what, about 

5 seven months beyond that, and so, you know, 

6 they even mentioned in their -- I think it was 

7 Tom who said,' "We anticipated you." And "you" 

8 meaning the recommendations that we had and 

9 the information that we had in our report. So 

10 I think it's kind of a timing issue. 

11 Okay. So we've talked about the 

12 roundtable. We have talked about the 

13 implications for study. We have talked about 

14 a teleconference. I am going to ask Debra 

15 Tidwell-Peters to scan for dates for a 

16 teleconference for us to maybe process this 

17 particular topic further. 

18 Anything else in terms of specific 

19 to this topic that we need to discuss at this 

20 point? 

21 (No response.) 

22 

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1 through the rest of the agenda, so we can 

2 finish on a timely basis today. 

3 Okay. We have a couple of things 

4 to include on the agenda, approval of minutes. 

5 Elena e-mailed us all, and we got copies of 

6 the minutes earlier this week. I would 

7 entertain a motion to approve the minutes. 

8 MEMBER GIBSON: So moved. 

9 CHAIR BARROS-BAILEY: Shanan moved. 

10 Do I have a second? 

11 MEMBER WILSON: Second. 

12 CHAIR BARROS-BAILEY: Mark seconded 

13 the approval of the minutes. Is there any 

14 discussion? 

15 MEMBER HARDY: Yesterday I gave 

16 some corrections to Debra Tidwell-Peters. 

17 They were purely spelling and editing things, 

18 and I believe that these minutes would be with 

19 those corrections. I just wanted to put that 

20 on the record. 

21 CHAIR BARROS-BAILEY: 

22 there were 

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1 corrections. And I'm assuming what will go up 

2 on the website will be the corrected minutes. 

3 Any other discussion? 

4 (No response.) 

5 All those in favor? 

6 (Chorus of ayes.) 

7 Okay. Opposed? 

8 (No response.) 

9 That was unanimous. The minutes 

10 have been approved. 

11 Let's open up very quickly the 

12 discussion for the agenda for June. If we 

13 looked at our road map, there is probably a 

14 lot that is going to be going on. I know that 

15 there is going to be a lot going on between 

16 now and June in terms of the public feedback 

17 period from many different ways, probably the 

18 electronic collection of the information, the 

19 review of that information. 

20 A lot of us are going to be on the 

21 road quite a bit over the next few months, and 

22 so we -- that is probably going to be a big 

(202) 234-4433 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISlAND AVE., NW. 

WASHINGTON, D.C. 20005-3701 WNW.nealllJross.com 
1113 

148 

1 area that we are going to be reviewing in 

2 terms of the public feedback. We are going to 

3 be having probably a lot of organizations 

4 providing us feedback in terms of the report, 

5 so I anticipate that is going to be a big 

6 area. 

7 I think there are going to be a 

8 couple of technical reports that may be 

9 offered at that time, so we will probably have 

10 presentations around those. I'm assuming 

11 research in terms of maybe some of what we're 

12 going to be talking about with the NAS at the 

13 teleconference we may need to include in 

14 there. 

15 Any other thoughts? Allan? 

16 MEMBER HUNT: Labor market. 

17 CHAIR BARROS-BAILEY: Labor market, 

18 yes, absolutely, the roundtable. That is 

19 going to be a big one that we will need to 

20 talk about in terms of consideration for the 

21 agenda. 

22 Deborah? 

(202) 234-4433 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE" NoW. 

WASHINGTON, D.C. 20005-3701 WWN.nealrgross.com 
1114 

149 

1 MEMBER LECHNER: I think we 

2 probably would have a report some sort of 

3 report on the recommendations for the job 

4 training and certification of job analysts 

5 CHAIR BARROS-BAILEY: Yes. 

6 MEMBER LECHNER: -- at that point. 

7 CHAIR BARROS-BAILEY: There is 

8 probably going to be quite a bit happening in 

9 the next few months on that as well, yes. 

10 Tom? 

11 MEMBER HARDY: You are looking at 

12 possibly having a draft content model by May 

13 from the workgroup? Are we going to be 

14 looking at that, do you think, or will that 

15 still not be quite ready? 

16 MEMBER KARMAN: Well, it certainly 

17 is on track for us to be working with the 

18 workgroup to finish our considerations around 

19 the person-side elements for the content 

20 model. So I am not sure whether or not we 

21 will have something to share with the entire 

22 panel in June, but that I s where we I re headed, 

(202) 2344433 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., NW. 

WASHINGTON, D,C. 20005-3701 www.nealrgross.com 
1115 

150 

1 anyway, as far as drafts are concerned. 

2 CHAIR BARROS-BAILEY; I think from 

3 an administrative standpoint I got a lot out 

4 of the training, the professional development, 

5 and I want to thank you again for doing that, 

6 Mark and Shanan. And so we will be looking at 

7 and might also kind of scan for other areas 

8 that people would really want to see 

9 additional training about. 

10 I know we talked about the legal 

11 issues, in terms of defensibility, and, you 

12 know, is June a good timing t is there a lot 

13 going on in June, might we do it another time. 

14 So we will probably scan for that as well in 

15 terms of professional development. 

16 Okay. Any other considerations for 

17 the agenda for June? 

18 (No response.) 

19 Hearing none, I would entertain a 

20 motion to adjourn our second annual quarterly 

21 meeting for the OIDAP. 

22 

(202) 234-4433 

MEMBER HARDY: I make a motion to 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISlAND AVE., NW. 

WASHINGTON, D.C. 20005-3701 www.nealrgross.com 
1116 

151 

1 adjourn. 

2 CHAIR BARROS - BAILEY: So moved by 

3 Tom. Seconded by Allan? 

4 MEMBER HUNT: Yes, I second the 

5 motion. 

6 CHAIR BARROS-BAILEY: All those in 

7 favor? 

8 (Chorus of ayes.) 

9 I'll note that was unanimous, and 

10 we are adjourned. 

11 Thank you. 

12 (Whereupon, at 11: 34 a.m., the proceedings in 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

(202l234-4433 

the foregoing 

adj ourned. ) 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISlAND AVE., NW, 

WASHINGTON, D,C, 20005-3701 

matter were 

\\WW,nealrgross,com 
1117 

TABC 
First Public 

Workshop: SSA 

presents on the 

use of the 

OwNET In 

disability 

adjudication 

Appendix C: Timeline of NAS O'NET Panel and OIDAP Activities 

(February 2009 through May 2010) 

NAS O'NET Panel Activities 

Panel 

Deliberations 

& Final 

ommendations 

Panel Disbands & 

Report Enters RelJiew 

Process 

publication 

Copy of 

O'NET 

Report 

March 26 April 17 April August November December 4 March 25 

I 

_____________ 

I 

____________________ 1..___________ ! t 

Quarterly meetings, subcommittee research and discussions, roundtables, and 

development of subcommittee recommendations reports 

September 1 

9/1: Final Subcommittee Reports Due 

919: DRAFT report to Panel 

Deliberations & Final 

Recommendations to SSA 

9/30: Final 

Recommendations Report 

to Commissioner Astrue 

OIDAP Activities 

Panel Continues throughout 

Research & Development Phase 
1119 

TABD 
1120 

ECONOMETRIC V. ERGOMETRIC WORK ANALYSIS DESIGNS 

© Mark A. Wilson, Ph.D. 

Data Needs! Holistic 

Generalizability: n=OO {American Workforce} 

... 

\ 

Kernel: Rational (Top Down) 

.. 

....... \ 

\ 

I 

I 

I 

I 

I 

I 

OCCUPATIONAL DATA 

Data Needs: Decomposed 

Generalizability: n = 1 (Claimant) 

Kernel: Empirical {Bottom Up) 

ProKimal: Work as it is performed, 

dose associations and inference 

t 

I 
1121 

Running head: BRlEF RESEARCH PROPOSAL 

Table I 

Comparison of Ergometric and Econometric Approaches to Work Analysis 

Element 

Definition 

Primary Scales of Measurement 

Measurement Approach 

Measurement Precision 

Unit of Analysis 

Primary Purpose/Application 

Organizational Level 

Primary Threats to Validity 

Level of Legal Scrutiny 

Sample Systems 

Primary Discipline 

Ergometric 

Measurement of work as 

performed by the worker 

Ordinal, Interval & Ratio 

Decomposed 

Moderate to High 

Position & Job 

Human Resources 

The Enterprise 

Internal & SCV 

Moderate to High 

Task Inventory & PAQ 

Psychology 

Econometric 

Measurement of work as a 

labor market category 

Nominal 

Holistic 

Low 

Large Aggregations of Jobs 

Policy Development 

The Economy 

External & Construct 

Low 

O*NET&SOC 

Economics 

Note. SCV ~ statistical conclusion validity; PAQ ~ position analysis questionnaire; O*NET ~ 

Occupational Network; SOC ~ Standard Occupational Classification 

6 
1122 

Panel Contact Information 

Occupational Information Development Advisory Panel 

Social Security Administration 

6401 Security Blvd 

3-E-26 Operations Building 

Woodlawn, MD 21235 

Fax at (410)-597-0825 

Email to: oidap@ssa.gov 

Website: http://www.ssa.gov/oidap/ 

Anyone requiring materials in alternative formats or further information regarding 

this document or the Occupational Information Development Advisory Panel 

should contact the Panel staff. Records are maintained of all Panel proceedings 

in accordance with the Federal Advisory Committee Act and are available for 

public inspection at the Panel office, by appointment. 

Occupational Information Development Advisory Panel 

http://w"Ww.socialsecuritv.gov/oidap/ 
1123 

SSA RESPONSE TO RECOMMENDATIONS 

Social Security Disability Programs: 

Improving the Quality of Benefit Award Decisions 

Minority Staff Report 

Permanent Subcommittee on Investigations 

United States Senate 

September 13, 2012 

(1) Recommendation: Require Government Representative at ALJ Hearings. To ensure 

key evidence and issues are properly presented, reduce instances in which SSA ALls 

overlook evidence indicating a claimant is not disabled, and increase consistency and 

accountability in ALJ decision-making, a representative of the agency should participate in 

all ALl disability hearings and decisions. Including a government representative at the ALl 

Level has long been a recommendation of both the Association of Administrative Law 

Judges and the Social Security Advisory Board. Congress should specifically designate 

funds for such a program. 

Response: During the 1980s, we tried to pilot an agency representative position at select 

hearing offices. In August 1982, we published regulations establishing the Social Security 

Administration Representation Project following extensive consultation with Congress. See 

47 Fed. Reg. 36, 117 (August 19, 1982). The regulations called for an agency 

representative to review disability cases before a hearing in select offices, and, if necessary, 

initiate development of further evidence. The regulations also called for the agency 

representative to present the agency's view at disability hearings if the claimant had 

representation. The purpose of the pilot was to: 1) help improve the overall disability 

adjudicatory process; 2) reduce delays in conducting hearings and issuing hearing decisions; 

3) improve the quality of hearing decisions; 4) increase the productivity of ALls; 5) achieve 

more uniformity and consistency in hearing decisions; and 6) reduce hearing costs. While 

Congress originally supported the project, we received significant congressional opposition 

once the pilot began. Additionally, a United States District Court enjoined the pilot, holding 

that the pilot violated the SociiLl Security Act, intruded on ALl independence, was contrary 

to congressional intent that the process be "fundamentally fair," and failed the constitutional 

requirements of due process. Salling v. Bowen, 641 F. Supp. 1046 (W.D. Va. 1986). Due 

to congressional opposition, general fiscal constraints, and the District Court injunction, we 

discontinued the pilot. 

While different in role and scope from a government representative, we have a number of 

new and expanded initiatives that are focused on improving the accuracy, speed, and 

fairness of ALl decisions such as holding more video hearings, implementing business 

process improvements such as the Electronic Business Process, piloting IT improvements 

such as the Electronic Bench Book and the Availability and Scheduling Application, and 

establishing ALl productivity expectations. 

We rethought our regulations to expand the Senior Attorney Adjudicator program, which 

allows our most experienced hearing office attorneys to make on-the-record decisions in 

disability cases where enough evidence exists to issue a fully favorable decision without 

the need for a hearing. 

Permanent Subcommittee on Investigations 

EXHIBIT #24 
1124 

To help our most backlogged offices, in 2007, we opened five National Hearing Centers 

(NHC) around the country. We designed the NHCs to utilize electronic hearing files and 

conduct only video hearings. The ALls in the NHCshear cases from offices throughout 

the country with the heaviest workloads. We expanded this concept in 2010 with the 

creation of a National Case Assistance Center, which is staffed by decision-writers and 

support staff who assist the most overburdened hearing offices in preparing cases for 

hearings and writing decisions for ALls. 

We implemented several IT improvements that have helped increase both our efficiency 

and the accuracy of our decisions. First, we increased usage of the Findings Integrated 

Templates (FIT), a formatting tool that improves the legal sufficiency of hearing 

decisions, conserves resources, and reduces average processing time. We introduced a 

standard electronic Hearing Office process to promote consistency in case processing 

across all hearing offices. We also built the "How MI Doing" tool that allows ALls and 

support staff to view a graphical presentation of their individual productivity as compared 

to others in their office, their region, and the Nation. We are also developing training 

modules on recurring issues that eventually will be linked to this tool, allowing ALls to 

access to training on targeted topics. 

We are developing another automated tool, the electronic bench book (eBB) that aids in 

documenting, analyzing, and adjudicating disability cases in accordance with our 

regulations. The eBB will allow ALls to review and decide cases, or provide instructions 

to decision-writers, in a fully electronic environment. 

An important step in improving the accuracy and fairness of our decisions was the recent 

creation of the Division of Quality (DQ) in our Office of Appellate Operations. The DQ 

conducts post- effectuation reviews on specific hearing offices, ALJs, representatives, 

doctors, and disability issues. The DQ also samples ALl decisions prior to effectuation. 

These reviews allow us to better understand how our disability policies are being 

implemented throughout the hearings level. We use these reviews to identify common 

errors in ALJ decisions, allowing us to focus resources and training on those areas. Using 

the data we collected, we recently provided mandatory training to all ALls on residual 

functional capacity and evaluation of medical source opinions. 

(2) Recommendation: Strengthen Quality Review Process. The new ALl review process 

initiated by the Quality Division of the Office of Appellate Operations should be expanded 

and strengthened by conducting more reviews during the year and developing metrics to 

measure the quality of disability decisions. Such information should be made available to 

Congress. 

Response: We agree. For many years, the Appeals Council was not adequately funded to 

perform its oversight responsibilities. In 2007, when we committed to reducing the hearings 

backlog, I did not want to sacrifice quality in the process. Therefore, we provided resources 

for the Appeals Council to implement quality assurance initiatives and improve ALl 

training. Our first step was to collect meaningful data that are the foundation of our reviews. 

We then created the Division of Quality in the Appeals Council that began quality reviews 

in September 2010. We continue to increase the number of quality reviews we conduct. In 

2 
1125 

fiscal year (FY) 2012, we reviewed a random sample of about 7,000 hearing decisions, 

which is up from nearly 3,700 reviews in FY 2011. 

The Administrative Conference of the United States is currently studying the Appeals 

Council's case review role. This study will consider issues such as expansion ofthe 

Appeals Council's existing authority to conduct reviews of AU decisions. We expect its 

recommendations by the end of the calendar year, and look forward to discussing possible 

initiatives at that time. 

(3) Recommendation: Close the Evidentiary Record. To eliminate the confusion, 

inefficiencies, and abuses associated with the current practice of allowing medical evidence 

to be submitted at any point in a disability case, the evidentiary record should close one 

week prior to an AL] hearing, with exceptions allowed only for significant new evidence for 

which exclusion would be contrary to the public interest. 

Response: A closed record would provide the AL] with all the necessary information to 

fully consider the claim prior to the hearing, and the AL] would have the necessary 

information to adequately question the claimant or witnesses at the hearing. Furthermore, a 

significant number of AU decisions are remanded because new and material evidence (i.e., 

relevant to the time adjudicated by the AL], not previously considered, and may change the 

outcome) available at the time of the AL] decision is submitted after the AL] issues a 

decision. Some have argued that closing the record at the time of the ALJ's decision would 

encourage claimants to develop and present such evidence in time for the hearing (where 

possible), leading to a timelier and lower-cost resolution of the claim. 

The main reason to leave the record open at the hearing level is procedural. Should a 

claimant's condition worsen or a new condition arise, there are fewer administrative steps if 

the AL] record remains open. For example, the claimant would not have to file a new 

application if a new condition arose the day after the hearing but before the decision was 

issued, assuming the AL] became aware of the condition. 

The same protections afforded under the current process can be incorporated into a closed 

record provision, like the provision our Boston Region hearing offices use. In the Boston 

Region (as noted in 20 CFR 405.331), absent certain criteria, evidence must be submitted no 

later than five business days before the date of the scheduled hearing. However, to protect 

claimants, the rules do allow for the acceptance of evidence after this time period if our 

action misled the claimant, the person had a limitation that prevented submission of the 

evidence earlier, or some other unusual, unexpected, or unavoidable circumstance beyond 

the claimant's control prevented submission of the evidence. This provision encourages the 

timely submission of evidence while still allowing for the late receipt of evidence in 

appropriate circumstances. We are continuing to evaluate use of these procedures in the 

Boston Region. 

(4) Recommendation: Strengthen Use of Medical Listings. SSA should provide additional 

training to AUs on the use of SSA Medical Listings, and direct AU decisions to identify 

how a claimant meets each required element of a listing, citing objective medical evidence 

and not just conc1usory statements by an expert. 
1126 

Response: We agree, and believe that we have been making significant progress in this area 

in the years after the dates of the cases that the Committee reviewed. One of the common 

errors found in our post-effectuation reviews of ALJ decisions is lack of supporting 

rationale. We used this information to provide feedback on policy guidance and litigation 

issues specifically related to medical evidence. We also used this information to develop 

and implement AU training to address the application of the medical Listings, including 

when a finding of disability can be made at the Listing level. Our improved automation 

tools guide adjudicators through each step of the sequential evaluation, including the 

Listings. When findings are made at the Listing level, these tools prompt adjudicators to 

articulate the required elements ofthe Listing and to cite to the relevant objective medical 

evidence. 

(5) Recommendation: Expedite Updated Job List. SSA should move more quickly to ensure 

the Occupational Information System can serve as a usable replacement for the Dictionary 

of Occupational Titles to identiJY jobs that claimants with limited disabilities can perform in 

the national economy. 

Response: We recently began a new phase in the development of an Occupational 

Information System (OIS), which we expect to be significantly less expensive than our 

original estimate. While the Department of Labor's (DOL) replacement for the Dictionary 

of Occupational Titles (DOT), O*NET, lacks the vocational information we need to make 

disability determinations, we are working with DOL to collect new data for occupations at 

the detailed occupational level. In July 2012, we signed an interagency agreement with the 

Bureau of Labor Statistics (BLS) to collect information about occupations that would add 

details to the OIS and address our needs. In FY 2013, BLS will test the feasibility of using 

the National Compensation Survey platform as a means to gather the occupational data we 

need. We hope to have initial results ofthe testing by the end ofFY 2013. 

(6) Recommendation: Focused Training for ALJs. The Office of Appellate Operations, 

Quality Division, should provide training to all ALJs regarding adequate articulation in 

opinions of determinations that involve both obesity and drug and alcohol abuse. This 

training should emphasize the proper way to analyze and address these issues as required by 

law, regulation and agency guidance. 

Response: We agree. We conduct post-effectuation reviews to idcntiJY common errors in 

AU decisions. The results of these reviews show common errors include the failure to 

adequately develop the record, lack of supporting rationale, and improper evaluation of 

opinion evidence. We use this information to develop and implement focused mandatory 

training for our AUs and to provide feedback on policy guidance and litigation issues 

relating to obesity and drug and alcohol abuse. 

(7) Recommendation: Strengthen Consultative Examinations. Because many disability 

claimants do not have sufficient funds to obtain detailed medical evidence of their 

conditions, SSA should determine, with input from ALJ s, how to improve the usefulness of 

agency-funded Consultative Examinations (CEs), including by requiring an explanation of 

any significant disparity between the CE's analysis and other evidence in the case file. 

4 
1127 

Response: We agree that proper CEs are an important element in disability evaluation, and 

we have detailed rules and procedures that govern our CE process. We work closely with 

our State disability determination services to ensure the quality of the CE providers and their 

reports. In September 2012, we updated the Adult CE Report Content Guidelines and the 

Pediatric CE Report Content Guidelines, which are located on our website at, 

http://v.w\v.socialsecuritv.gov/disability/professionals/grccnbooklindex.htm. CE providers 

can use this website to help ensure their reports meet our guidelines. 

We are completing an analysis of 300 initial and ALl cases that will help us assess the 

usefulness of CEs. This exploratory study will look at whether CEs are being requested and 

conducted in compliance with our regulations and will also assess the factors that contribute 

to quality. Given the small sample size, the report will provide us with a rough assessment 

ofCE quality. This study will help us determine if we need to further examine specific 

issues. The final report will be available by the end of the year. 

(8) Recommendation: Reform the Medical-Vocational Guidelines. The medical-vocational 

guidelines should be reviewed to determine if reforms are needed. Additional study should 

be conducted to evaluate whether the current guidelines utilize the proper factors and if they 

appropriately reflect a person's ability to work. 

Response: The medical-vocational rules found in our regulations are rooted in the statutory 

definition of disability and its requirement that we consider age, education, and work 

experience in conjunction with residual functional capacity. 

The medical-vocational rules have been criticized for being incomplete or not reflective of a 

person's ability to adjust to other work, and we continue to evaluate research and data that 

could inform discussions of potential changes to the medical-vocational rules. For example 

we have asked the Disability Research Consortium to evaluate how age, education, and 

previous work history affect a person's ability to work, independent of the effects of 

deteriorating health and impairment caused by medical conditions. We are interested in the 

correlation between specific age ranges, education categories, and work skills and success in 

adapting to new work at the sedentary, light, medium, and heavy work levels. 
1128 

'!lnito1 ~tatcs ~rnlltt COMMITTEE ON M~An I" AIXl(NotlfR \llUT' mfl'H::'f:(l$\ 

1>I~'.'l<(,!!ASA.I'(j~" /MmI'Ifl''f P!\~FhfRF\...",nR HOMELAND SECURITY AND GOVERNMENTAL AffAIRS 

WASHINGTON~ DC ,(.OSl~·6250 

October 31, 2012 

VIA U.S. MAlL &. EMAIL fSuzanneJ'aync€jlSSA,gov) 

JUOOE PATRICIA A. JONAS 

Appellate Operations Executive Director 

Deputy Chait, Appeals Council 

JUDGE DEBRA BICE 

Chief Administrative Law Judge 

OffICe of Disability Adjudication and Review 

SQCial Security Administration 

Skyline Towers 

5107 Leesburg Pike, Room 140Q 

Falls Church, VA 22041 

Dear Judge Jonas and Judge Bice: 

NOTE: As of August 20]3 when this hearing record 

went to press, responses to the Supplemental Questions 

to the Record submitted to the Social Security 

Administration were still pending. Responses will be 

made a part of the Subcommittee hearing exhibit files 

when they are received and will available for review at 

the Subcommittee offices. 

The Permanent Subcommittee on Investigntions would like to thank you for appearing 

bcfore the Subcommittee at the hearing, Social Security Disability Programs: Improving the 

Quality a/Benefit Award Decisions, Fraud: Case Studies in Fetkral Employees and 

Commercial Drivers Licenses. I appreciated your hearing testimony. 

Attached are follow-up questions which, along with your responses, may be included in 

the hearing record. The responses should be submitted to the Subcommittee by Monday, 

November 26, 2012. Please email responses to Mary Robertson, Chief Clerk, Pennanent 

Subcommittee on Investigations, at mary _ robertson@hsgac.senate.gov, 

Thank you for your assistance in this matter. The Subcommittee will be sending yOU" 

copy of the final hearing record when it becomes available. lfyou or your staffhave any 

questions or would like additional information, please contact Andrew Dockham at 

2021224-2224. 

Attachment 

Tom Coburn, M.D. 

Ranking Minority Member 

Pennanent Subcommittee on Investigations 

Permanent Subcommittee on Investi ations 

EXHIBlT#25 
1129 

SUPPLEMENTAL QUESTIONS FOR THE RECORD 

FROM 

SENATOR TOM A. COBURN, M.D. 

Ranking Member 

Permanent Snbcommittee on Investigations 

to 

JUDGE PATRICIA A. JONAS 

Executive Director of Appellate Operations 

Deputy Chair, Appeals Council 

Office of Disability Adjudication and Review 

Social Security Administration 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

HEARING ON 

Social Security Disability Programs: 

Improving the Quality of Benefit Award Decisions 

September 13, 2012 

Please provide answers to the following questions by November 26, 2012: 

1. Please describe the recent review by the Office of Appellate Operations, Division of 

Quality of un appealed favorable decisions made by Administrative Law Judges, including, 

but not limited to, the circumstances that led to the review. 

2. The review found that hearing offices decided cases at Step 5 versus Step 3 at about a 4 to 

I rate. Please explain why ALJs are finding such a higher number of claimants disabled 

based their ability to perform any job in the national economy, including any 

documentation of internal reviews by the agency regarding ALJ decisions made at Step 5. 

3. You stated the Social Security Appeals Council (SSAC) is providing educational training 

on certain issues that appear problematic to ALJs based on its review. Please describe 

those trainings and provide any materials used during those training. If the trainings were 

recorded, please provide those recordings. 

4. Please explain how the agency believes conflicting medical evidence should be addressed 

by DDS decision-makers and ALJs. Include in your response any documented guidance 

the agency has provided to decision-makers at DDS and ALJs regarding the consideration 

of conflicting medical evidence, including, but not limited to training materials, general 

directives, or any study or review of the consideration of medical evidence by DDS 

decision-makers or ALJs. 
1130 

2 

5. Please provide the number of decisions by Judge Howard O'Bryan the SSAC remanded 

each year for the past 10 years. Please also include any documentation of the reason for the 

remand. 

6. Please provide the number of decisions by the ALJs or Senior Attorney Adjudicator in the 

following offices the SSAC remanded each year for the past 10 years: Oklahoma City, 

Oklahoma; Roanoke, Virginia; and Montgomery, Alabama. Please also include any 

explanation of the reason for the remand. 

7. Please provide any agency analysis regarding updating or replacing the Dictionary of 

Occupational Titles, including, but not limited to development of the Occupational 

Information System (OIS), any report or analysis performed by the Occupational 

Information Development Advisory Panel (OIDAP), and documents related to the 

agreement between SSA and the Bureau of Labor and Statistics (BLS). 

8. Please explain and provide any supporting documentation as to why the Department of 

Labor's Occupational Information Network (O*NET) cannot be used by SSA for purposes 

of disability claims, ifnot permanently, then temporarily until OIS is ready. 

9. For the past five years, please provide the annual number of claims appealed to the SSAC 

where the claimant, or the claimant's representative, submitted new evidence to be 

considered by the SSAC on appeal. 

10. For the past five years, please provide the number of cases remanded to ALJs based on new 

evidence submitted to the SSAC. 

II. SSA currently has a backlog of Continuing Disability Reviews (CDRs), which determine if 

a beneficiary has experienced medical improvement and no longer qualifies for disability 

benefits. Please explain how the agency determines if an individual has medically 

improved when the disabling condition is unclear when approved for benefits. 

Specifically, explain how the agency determines medical improvement for the following 

Oklahoma cases: III; 134; 144; and 146. IfCDRs were performed on these claimants, 

please provide information regarding the CDR, including, but not limited to whether it was 

a medical or work-related CDR. If the CDR was related to the claimant's medical 

condition, provide whether the CDR was a mailer or a full medical CDR. 

12. Please provide any documentation of agency analysis, reviews, or other documentation 

regarding agency decisions on the decision to allocate resources to CDRs. 

13. Innovators in the Oklahoma Department of Rehabilitation Services, such as Program 

Manager Jason Price, are helping ssm beneficiaries reach their potential in the workforce, 

despite their disabilities. Through innovative state efforts, Oklahoma helped 92 severely 

disabled clients find work and leave the ssm program last year. As a result, these 

individuals which SSA has determined to be unable to engage in substantial gainful 

activity - are better able to realize their full potential in life and, as an added benefit, the 

state recouped nearly $1.7 million in reimbursements last year. 
1131 

3 

a. What changes to Ticket-to-Work or other back to work programs are the agency 

currently considering? 

b. For cases DENIED at an ALJ hearing where vocational experts are utilized, are denials 

referred to the state vocational rehabilitation system or other similar entities that can 

provide appropriate employment and work support to these individuals? 

c. Prior to 1999, denied disability claimants were referred to state vocational rehabilitation 

as were all applicants to the DI program. Please explain why the agency changed this 

policy and provide any documented analysis or review of this policy change. 

d. Please explain whether policy either prohibits or discourages referrals to state 

vocational rehabilitation programs. If so, please provide the Subcommittee with a copy 

of such guidance. 

e. When rendering a determination in a case, are vocational experts and/or ALJs required 

to take into account the availability of Assistive Technology that can help an individual 

with a disability enter and persist in the workforce? If no, why not and does SSA 

support a change to this policy? 

f. The Social Security Act and regulations require that a person comply with any 

"treatment" prescribed by his or her treating physician if such treatment would result in 

the person being able to work. Is assistive technology considered by SSA to be a 

"treatment"? 

### 
1132 

SUPPLEMENTAL QUESTIONS FOR THE RECORD 

FROM 

SENATOR TOM A. COBURN, M.D. 

Ranking Member 

Permanent Subcommittee on Investigations 

to 

JUDGE DEBRA BICE 

Chief Administrative Law Judge 

Office of Disability Adjudication and Review 

Social Security Administration 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

HEARING ON 

Social Security Disability Programs: 

Improving the Quality of Benefit Award Decisions 

September 13,2012 

Please provide answers to the following questions by November 26,2012: 

I. Hearing Office Chief Administrative Law Judge for Oklahoma City Doug Stults told the 

Subcommittee that when the agency moved to electronic case files, the agency encouraged 

ALJs to electronically paste portions ofa claimant's medical records into disability 

opinions. Please explain whether the agency encouraged this practice and provide any 

training materials, general guidance, or internal studies or reviews regarding ALJs 

electronically pasting medical evidence directly into opinions. 

2. In more recent opinions issued by Judge O'Bryan reviewed by the Subcommittee, Judge 

O'Bryan continued to electronically paste portions of the medical records into his decisions 

and used "etc., etc., etc." to describe a claimant's medical condition. Please explain the 

steps taken to correct these actions by Judge O'Bryan and include any documentation of 

such actions. 

3. Judge Howard O'Bryan told the Subcommittee in an interview he was asked by the agency 

to review and potentially decide hundreds of disability cases from around the country from 

2007-2009. Please explain why Judge O'Bryan was asked to review and decide so many 

cases and provide any agency documentation regarding the decision to send Judge O'Bryan 

cases from outside the Oklahoma City jurisdiction. 

4. From 2007 to the present, please provide the number of cases sent to Judge O'Bryan from 

outside the Oklahoma City Hearing Office jurisdiction, the number of opinions issued by 

Judge O'Bryan, and summary statistics of the outcomes for each year, including, but not 

limited to, the number of favorable, partially favorable, denied, and on-the-record decisions 

and the state the claimant was located. 
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5. The Subcommittee investigation found that a number of DDS decision-makers and AUs 

would amend a claimant's disability onset date to the claimant's 50th or 55th birthday and 

approve then award disability benefits based on the medical-vocational guidelines. Please 

provide any agency guidance, general directives, or internal studies or reviews of this 

practice. 

6. Please explain whether the agency supports closing the record as to evidence for disability 

claims at any point in the appellate process and specifically, prior to a hearing before an 

AU. Please provide any internal studies, reviews, or analyses the agency has generated 

regarding closing the record for disability claims at any point during the appellate process. 

7. Please provide any agency studies, reviews, or analyses regarding disability claimants or 

claimant's representatives withholding or failing to submit evidence in support of a 

disability claim, including, but not limited to the failure to submit unfavorable evidence. 

8. Hearing Office Chief Administrative Law Judge for Roanoke, Virginia Thomas Erwin told 

the Subcommittee in an interview that he was certain that some claimant representatives 

were withholding unfavorable portions of a claimant's medical records. Please describe 

what the agency is doing to prevent claimants and their representatives from withholding 

such evidence. Please include any training materials, agency guidance, or general 

directives distributed to AUs on claimants or representatives withholding medical 

evidence. 

9. During the Subcommittee investigation, agency officials repeatedly asserted that AUs have 

qualified judicial independence, making it difficult to hold them accountable. Does the 

agency believe this independence contributed to the lack of quality in AU opinions 

identified by the Division of Quality Report finding 22 percent of AU cases contained 

errors? Aside from remands, please explain how the agency deters AUs from abusing 

their independence. 

10. You stated at the Subcommittee hearing that AUs "should not abdicate their role as a 

judge." Further, in an interview with Subcommittee staff, you stated that you did not 

consider a hearing that lasted less than 10 minutes to be adequate. You also stated that a 

hearing where the claimant is not asked a single question is inadequate. Please further 

explain what you mean by telling judges they should not abdicate their role, as well as the 

types of actions by AUs that indicate the AU may be abdicating their role as AU. 

11. Recently, the agency made the decision to stop allowing ALJs to send claimants for a 

MMPI test, which would assist in determining if the claimant was malingering or had 

credibility issues. Please explain why the agency made this decision, and provide any 

analysis or report developed when making this decision. Please also explain how the 

agency determined it could prevent ALJ s from requesting this examination when the AU s 

have "qualified judicial independence." 

12. In the absence of sending a claimant for MMPI, please explain what tools exist for an AU 

to examine a claimant's credibility. Please include any training materials, agency 
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guidance, and general directives provided to ALls regarding assessing a claimant's 

credibility. 

13. The agency recently advised ALls they are not allowed to consider social media, such as 

Facebook, when analyzing a claimant's credibility. The agency asserts doing so 

potentially compromises the claimant's personally identifiable information (PII). Please 

explain how this is the case when the information is already in the public domain. Please 

also explain how the agency determined it could prevent ALJs from accessing this 

information when the ALJs have "qualified judicial independence." 

14. In a number of decision reviewed by the Subcommittee, the ALl awarded benefits by 

giving little to no explanation or weight to the decision made at the state DDS. Many times 

the ALl would only state the following boilerplate language: 

The State agency medical opinions are given little weight because evidence 

received at the hearing level shows the claimant is more limited than determined by 

the State agency consultants. Furthermore, the State agency consultants did not 

adequately consider the claimant's sUbjective complaints or the combined effect of 

the claimant's impairments. 

Please explain if discounting the DDS decision with little to no explanation is adequate. If 

the agency has provided any materials to ALls regarding to address the DDS decision, 

please include that information in your response. 

15. In certain cases, ALJs held hearings lasting less than five minutes in which the claimant 

was not even asked a question regarding their condition. Please provide any documented 

guidance the agency has distributed or made available to ALls with regard to how to 

conduct hearings. This should include, but is not limited, training materials, general 

directives, and any agency studies or reviews of ALJ hearing practices. 

16. Many ALJs noted the pressure by the agency to decide a high number of cases. If an ALl 

decided the minimum recommended 500 cases a year that is still more than one decision a 

day. At times, a case file, by the time it reaehes the ALJ can exceed 500 pages of medical 

evidence. Please explain how the agency expects an ALJ to properly consider 500 pages of 

medical evidence in such a short period of time, as well as produce legally defensible 

opinions. Please provide any training materials, guidance, or general directives. Plea~e 

also provide the documentation by the agency that communicated to the ALlS that each 

judge should decide between 500-700 cases per year. 

17. In Alabama Case 64, Exhibit Ibis a consultative exam in which the claimant stated she 

"last worked in 1996 ... they let me go. I didn't look for work after that. I could've worked 

but I didn't." Please explain how an ALl should consider a claimant that voluntarily stops 

working. Please include any training materials, agency guidance, or general directives 

distributed to DDS employees or ALls. 
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18. In Alabama Case 64, the physician noted, in Exhibit 1 b, the claimant "had a tendency to be 

evasive, contradictory, and to exaggerate. She did not appear to be a credible historian." 

The examining doctor also questioned the claimant's need for a cane, which she brought 

with her to the exam, but did not use. Please explain how an ALJ should deal with this 

particular information, as well as credibility or malingering issues in general. Please 

include any training materials, agency guidance, or general directives distributed to DDS 

employees or ALJs. 

19. Oklahoma Case 109 also contained strong evidence of malingering, in that a claimant 

complained to an examining physician of right shoulder pain, but then appeared to have no 

problem with her shoulder outside the office in the parking lot. The same physician 

determined the claimant was "not permanently and totally disabled or in need of vocational 

rehabilitation" and "she may return to employment." The ALJ failed to address this 

evidence in the decision rendered. Please explain how the ALJ should have dealt with this 

information. 

20. In Alabama Case 65, evidence existed the claimant was non-compliant with prescribed 

treatment, specifically a pharmacy print-out of medications indicated the claimant never 

filled certain prescriptions. Yet, the ALJ awarded benefits. Please explain the agency's 

rules or regulations regarding non-compliance, including whether a claimant should be 

awarded benefits when they fail to comply with prescribed treatment. Please also provide 

an explanation of whether the claimant's non-compliance in Alabama Case 65 would 

prevent a claimant from being awarded benefits, as it did when DDS reviewed the claim. 

21. The ALJ held a hearing that lasted three minutes in which no question was asked of the 

claimant in Oklahoma Case 102. Do you consider this an adequate hearing? Please 

provide any training materials, agency guidance, or general directives distributed to ALJs 

regarding what constitutes an adequate hearing. 

22. In certain cases reviewed by the Subcommittee, hearing transcripts indicated that ALJs 

were having substantive off-the-record conversations with claimants and their 

representatives. Please explain whether ALJs should have substantive conversations about 

a claimant's disability claim off-the-record, including any training materials, guidance, or 

general directives distributed to ALJs. 

23. In Oklahoma Case 114, the Senior Attorney Adjudicator (SAA) electronically pasted a 

paragraph describing the claimant's condition written by the claimant's representative into 

the favorable opinion. See Exhibit 8g. The paragraph described a review done by the 

claimant's "treating rheumatologist." Yet, the case file indicated the claimant had only 

seen this physician one time. Please describe the evidentiary weight given to an opinion 

written by the claimant's treating physician, including whether a physician that a claimant 

has seen only once can be considered a treating physician. 
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24. Judge Peter Keltch appeared to coach a claimant about ways to maximize the benefit 

payment received each month from the agency in Oklahoma Case 151 and stated 

I'll tell you a little secret about that. If you go in, if you're approved and they say 

now where've you been living and if you say I've been having a free apartment, 

they say oh well we'll deduct a third off of your benefits because you didn't have 

any rent to pay. But if you go in and say I've been living with a friend and I'm 

going to pay him back, then they give you the full check. I mean it's between you 

and him to pay him back ifhe's been paying the rent and bills. 

See Exhibit 10. Please explain whether this was an appropriate statement for an ALl to 

make to a claimant at a hearing. Please include any training materials, agency guidance, or 

general directives relating to ALls discussing program rules with claimants at a hearing. 

25. The Subcommittee reviewed cases where a claimant would apply for disability benefits 

based on a physical disability. When the claimant was denied by the DDS and retained a 

representative for their appeal to an ALl, the claimant - at times - changed the basis of 

their claim to a mental disability. The ALl then awarded benefits based solely on the 

mental disability allegations. Please explain how you believe an ALl should deal with such 

a change in disability allegations. Please include any training materials, agency guidance, 

or general directives distributed to ALls on this issue. 

26. Please explain whether you believe the agency should increase the ages considered 

"approaching advanced age" and "advanced age" associated with the medical-vocational 

guidelines. Please also include an explanation as to why the agency attempted to increase 

the ages in the vocational grids in 2005, but later withdrew the proposed increase. See Age 

as a Factor in Evaluating Disability, 70 Fed. Reg. 67101 (Nov. 4, 2005) compared to Age 

as a Factor in Evaluating Disability, 74 Fed. Reg. 21563 (May 8, 2009). 

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