Consider the case that came to my office last week. A 42-year old female suffering from what she describes as panic attacks, chronic respiratory problems (possibly COPD), and severe low back pain. She says she can stand 10 to 15 minutes at a time due to pain and is able to sit about 30 minutes at a time. She cannot lift a gallon of milk due the back pain and cannot bend, stoop, kneel or reach overhead. When walking, she must stop and rest about every 50 yards. She suffers shortness of breath with minimal exertion.
The problem? This unfortunate lady has no health insurance, no source of income, no public assistance except food stamps and she hasn't been examined by a doctor in over five years. That examination was by an out of state doctor who has since retired and the records cannot be found. In short, there are no available medical records to support a disability claim. What can be done?
Frankly, some representatives would turn this claimant away, explaining that you just can't win SSI cases without medical records, which is true enough. However, I look at these type cases as opportunities, not so much as "a lot of work for no pay" scenarios.
I completed a disability report on this claimant and called Social Security to schedule an appointment for her while she was in my office. (SSI applications require the claimant to appear in person at the Social Security office or to have a telephone conference with Social Security).
My goal is to get Social Security to arrange and pay for one or two consultative examinations, which should provide some medical evidence for her claim. Examiners at the state Disability Determination Service, the contracted agency which makes the initial decision on disabiilty and SSI claims, are obligated to do a certain amount of "medical development" on new cases. If there is little or no recent medical evidence, some consultative exams are almost a certainty. And since the claimant has no money to pay for medical evaluations, it's often the only way to approach a claim. I've actually had some cases approved this way.
The other option that I try is to find a free community clinic that will provide medical intervention without a fee or at a greatly reduced fee. The upside to a clinic is that they will provide actual treatment for the claimant - not just an evaluation. The downside to a free or reduced cost clinic is that it often takes a long time to get the claimant scheduled to see a doctor.
If everything goes as planned, this lady will receive reasonably prompt evaluations from the Social Security consults - and have a chance at getting her benefits started within a few months. If the community medical clinic works out, she can get regular medical treatment as well as further documentation in case her claim goes to an appeal.
I realize that this almost puts the Social Security claimant representative in dual roles--that of a Social Security advocate and a Social Worker. I don't find fault with those representatives who don't want to take on both roles. Fortunately, not all of my clients need all of these services. But the ones who do are the most needy of all.
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