ANOTHER FEDERAL COURT RECOMMENDS ANOTHER REVERSAL OF SSA JUDGE'S DENIAL OF DISABILITY BENEFITS

I am pleased, once again, to bring news of another US Federal Court recommending that the decision of a Social Security Administrative Law Judge (ALJ) denying disability benefits be thrown out.

In this case, the client had filed for social security disability more than 4 years ago.  He claimed he was unable to work at any job due to severe degenerative disc disease, a torn left shoulder, and a long-term injury to his left foot.  The ALJ denied his claim for disability benefits.  The ALJ found that the client could still do other jobs such as a polisher, telephone quotation clerk and table worker.

We appealed the claim to the US Federal Court.  On appeal, I argued that the SSA Judge was wrong to deny the claim by merely stating that the client could work at this other jobs.  I argued that under federal rules the SSA Judge was required to specifically identify these other jobs by their US DOT Code number and describe how those jobs could be performed with the client's impairments; none of which the SSA judge provided or did in his decision.

The US Federal Court agreed.  The Federal Court Judge reported that the SSA judge did not bother to identify these jobs by their DOT code numbers and fully explain any discrepancies in the job descriptions.  The Federal Court also reported that the SSA judge failed to explain how the client could perform these other jobs in light of his physical impairments; such as being unable to raise his left arm.

Notably the Federal Court also made comment on the fact that the tape-recorded transcript of the SSA disability hearing was inaudible in more than one section.  The incompetence of the SSA in providing an audible hearing transcript was noted by the US Federal Court as a "critical point" that "frustrates judicial review" and thus affected the ability of the SSA Judge to meet his burden of proof in his decision denying benefits. 

The Federal Court has recommended that the ALJ's denial of benefits be overruled and the case be sent back to the SSA for another hearing.

Social Security disability claimants should take note that at certain points in a social security case it is the burden of the SSA to prove the claimant is not disabled.  Claimants should be aware of when this point occurs and how to enforce that burden upon the SSA Judge.  Claimant should also note that when the SSA provides an inaudible transcript to the federal court on appeal, that failure to provide a clear recording and transcript could be the basis of argument of appeal in itself.

Veterans who wish to file a claim for disability compensation must file some sort of notice with the VA. The notice itself can be very informal.  VA regulations state that "any statement in a communication showing intent to file a claim for disability or for death benefits" may be accepted as a claim.

Thus according to the VA, a veteran may file literally any statement to start his claim, just as long as the statement shows an "intent to file" a claim for disability.

This is important as if the veteran does not file a claim for disability within one year of injury, then the effective date of any disability award will be the date on which his "claim" for VA benefits was received by the VA.  A veteran can literally lose decades of disability compensation by not filing early.

In the case of Mansfield v. Peake, (not from this office) decided today by the US Court of Appeals for the Federal Circuit, Mansfield; a veteran, was injured at a VA medical center during surgery in 1989.  In 1991, he submitted Form 95 putting the VA on notice of his medical negligence lawsuit against the VA.  The VA accepted Mansfield's Form 95 and the VA awarded him compensation for medical negligence in 1993.

Seven years later, in 2000, Mansfield then filed a Section 1511 claim for disability compensation with the VA.  He claimed disability dating from the 1989 surgery.  Veterans who are disabled as result of negligent treatment at VA medical facilities are compensated the same as if their injuries are service connected.  These are known as section 1511 claims.  (38 U.S.C. § 1151(a) (2000))

The VA awarded the disability compensation, but only from 2000 forward; the date the VA said it received his claim.  Mansfield argued that he should be awarded disability benefits from 1991; when he filed his Form 95 notice of injury with the VA on his medical negligence lawsuit.

The VA said "no"; it argued that the Form 95 did not show "intent" to apply for VA disability benefits.  Rather the Form 95 showed intent to file a medical negligence lawsuit.

The Federal Circuit Court agreed with the VA.  Even though Mansfield's medical negligence claim against the VA and his disability compensation claim against the VA both arose out of the same 1989 botched surgery; according to the Court the two processes and remedies are different.  The Form 95 is simply a notice to the VA that a claimant is seeking damages for negligence.  According to the Court, the Form 95 does not provide any notice or statement that the veteran is also intending to file for disability compensation benefits.  Mansfield's claim for disability compensation back to 1991 was denied.

Veteran's should take note that although there is no timeline on when they must file for disability compensation; their benefits will only start when they have provided a notice of "intent"  to claim disability compensation benefits and that is received by the VA.  The notice can be informal, but must contain evidence of the veteran's "intent" to file for disability compensation benefits.