United States District Court Sides with Nash and NDL Client v SSA
Posted March 10, 2015 by Tom Nash
We think that whether you are a social worker, a referring attorney, an SSA insider, a potential Nash Disability Law client, or a current or past client, you may find it instructive about how the SSA system works and how we at Nash Disability Law fight for our clients.
Consider the case of NDL client Larry Kellams (Larry gave us written permission to tell his story here.) Larry’s repeated attempts to get SSA to recognize his inability to sustain competitive employment and survive fell upon deaf SSA ears.
Larry was a longtime south suburban garbage man in his late 50s who, while he had done very physical labor for his entire life, he also struggled over many years with brutal chronic alcoholism. That disease had resulted in multiple hospitalizations and many relapses – not uncommon with chronic alcoholism. Larry’s inability to make progress with that tragic medical condition left him lying in the downtown streets of Chicago. He was turned out even by his own mother and stepfather who had no practical means to deal with the volatility associated with Larry's illness.
Separate from the chronic alcoholism, Larry had suffered a heart attack and depression which included hospitalization for suicidal ideation. People do change and Larry got sober, but was unable to work due to the residual effects of his heart attack along with ongoing depression and certain cognitive issues.
Larry applied for Social Security disability but his access to medical care was always very limited – consisting of short visits at high volume clinics hard-pressed to properly record every important detail which the SSA disability system finds important. Larry’s application for disability benefits was denied by SSA.
The decision about whether to appeal a given Administrative Law Judge’s (ALJ’s) decision or file a new application can be a tricky professional judgment. With many elements in the mix, decisions have to be made on a case by case basis. While we found fault with the ALJ's rejection of Larry's testimony and claim, after his first hearing with the SSA Orland Park “Office of Disability Adjudication and Review", we determined it was best for Larry to file a new application.
Larry, still sober, unable to work, and trying desperately to do the right thing with nowhere to live, filed the new application, but was still denied twice and headed for yet another hearing at the Orland Park hearing office in June 2012. SSA had sent an investigator to Larry’s home in an apparent attempt to check him out for fraud, but despite his request, they never supplied him a report of that visit. With a history of alcoholism and medical records from high volume clinics, Larry’s case is the kind of case that ALJs are under media and political pressure to deny.
The system seems to embrace a groupthink that when the Larrys of the world keep filing, it means there is something wrong with Larry versus something out of whack with SSA's grasp of reality. Even though he had thrown Larry out on the street in the past, Larry's stepfather testified on his behalf at the hearing along with Larry's AA sponsor. Both men offered their firsthand experiences with Larry and why he was unable to work. Nevertheless, the ALJ was dismissive of Larry, the two witnesses and both of Larry's doctors who had outlined his limits.
This time we at Nash appealed and eventually the United States District Court in the fall 2014 looked at Larry's case and our explanation of it. People who think it is too easy to get Social Security disability ought to look at what an independent judge said in Larry's case. The independent judge found the SSA judge was wrong to reject the opinions of the doctor who had tried to explain Larry's heart condition, and wrong to reject the opinion of the mental health professional explaining Larry's depression. The independent judge explained how the ALJ's suggestion that Larry had occasional relief from symptoms somehow meant that Larry was not limited by his depression "was an all too common misunderstanding of mental illness" by ALJs that the higher courts have repeatedly criticized.
Meanwhile, the Association of Administrative Law Judges (AALJ – the union that represents Administrative Law Judges who decide Social Security disability appeals) filed a lawsuit against the Social Security Administration. The SSA judges had contended they have been under too much pressure to work too hard and decide too many claims (an alleged 500 per year quota) and even suggested the impact was such that they might approve more cases than warranted, even though the statistics clearly show they have been rejecting more cases like Larry's. The AALJ was soundly rejected in its lawsuit first by the district court and then the United States Court of Appeals for the 7th Circuit. While the majority opinion in the case harshly compared the SSA judges to chicken de-boners in a poultry processing plant (!), the dissenting opinion highlighted:
Administrative law judges affect directly the lives of millions; the quality of their work deeply affects, moreover, the respect that our people have for our system of justice. The rights of Americans are not processed by our judges; they are adjudicated.
The overwhelming majority of the ALJs are hardworking public servants doing their job evaluating evidence when notions of disability qualification are oftentimes gray – not black and white. We are mindful that ALJs are under various pressures, including from Congress and the media. But at Nash, it is our view that if the SSA judges looking at Larry's situation in his first two hearings exercised the type of independence the ALJs sought to protect in their own lawsuit, they would get respect "for our system of justice." While they devoted their time and energy to complaining about their managers instead of exercising more independent judgment, Larry ended up in a nursing home at a far greater cost to the taxpayers than earlier approval of his claim would have incurred. With Larry's eventual SSI approval pending the resolution of the district court appeal matter (yet another claim we helped Larry with), the community mental health clinic, Thresholds, was able to help Larry leave the nursing home, get housing and now Thresholds periodically visits Larry to help insure he remains on the right track. If independence was exercised by the ALJs in either of the first two hearings, the state would never have needed to pay for Larry's stay in a nursing home while he awaited justice from the independent judge in the United States District Court.