Study Guide

Lesson Three
The Sequential Analysis Process

Notice:  At the end of each lesson, you'll find a lesson completion notice.  In order to earn your Certificate of Achievement, this notice must be submitted to our training coordinator Dr. Jeff Scott for all sixteen lessons of both the online Study and Business Guides. Do not submit a lesson notice until you have completed the lesson in both the DA Pro and online.  Make sure that you pass the basic quiz inside of the DA Pro software.  If cannot pass a lesson quiz, you're not ready to move on to the next lesson.  If you need assistance, please do not hesitate to contact us.

In this lesson, we will introduce you to the concept of Sequential Analysis and how this procedure is used in the evaluation of a Social Security disability case.  

What is Case Processing?

We have already mentioned the case assessment process earlier in this training program.  Now we will inject a little more detail into our explanation of this important process.  First, let’s review the primary purpose of a case assessment.  The purpose of a case assessment is to determine the approximate chance of winning the case before you accept it for representation. 

The first step taken by an advocate in all cases is the case assessment process.  As mentioned in previous lessons, a case assessment allows you to determine the approximate percent chance of winning the case.  Under Social Security's contingency fee rules, you are only paid for cases that result in a benefit payment to the claimant.  Therefore, the case assessment process is really a screening system designed to increase the number of cases won by the representative. The more cases won, the higher your overall income!

A case assessment is performed by weighing certain case characteristics like the client's age, education, type of impairment, etc., to determine that client's chances of winning benefits.  It can take years to develop the skills needed to perform an effective manual case assessment with any accuracy.  For this reason, we provide our basic students with a case assessment card.  This card is a simple tool that can be used as a basis for an obligatory assessment.

Those of you who have the Case Assessment Navigator software will be able to perform professional quality assessment from day one of your service.  Be sure to also read the Marketing and Services training segments inside the professional version of the Case Assessment Navigator program.  These segments will teach you how to use the software in marketing and as a means of generating an additional income.  If you're an Executive student, you can find the Navigator inside of the Office Suite. 

A Closer look at the Case Assessment Process:

At the beginning of every case you encounter, you’ll need to determine the potential viability of that case.  The determination of viability is never final until the case is won or loss.  The reason the search for viability is not final is because new issues can enter a case at anytime during the adjudicative process.  These new issues may improve or lower your chances of winning the case. 

Our years of experience have allowed Disability Associates to determine early in a case, those issues that will help the case to be successful  This does not mean that every case that looks viable at the start with be an allowance.  The entire case assessment process is nothing more than an approximation of our chances of winning.  However, the case assessment process used by Disability Associates is still extremely important to those who wish to make a living in this field.  Our approximations are far superior to the shot-in-the-dark case assessment approaches used by many attorneys and ex-SSA employees in this field.  We will teach you how to perform a case assessment later in your course.  For now, it is only essential that you recognize when and why the case assessment process is important.

As part of the case assessment process, you must perform a client interview.  In our approach to representation, the interview is usually performed by phone just prior to performing the case assessment.  The reason we perform an interview prior to the case assessment is because the interview may make the assessment unnecessary. 

In the interview, look for case finding that may destroy the case at a later time. 

Examples:

·        The claimant has never seen a doctor for his condition.

·        The claimant does not appear to have a severe impairment.

·        The claimant was incarcerated during his impairment period.

·        The claimant is suspicious or evasive.

·        The case appears weak or unbelievable. 

If any of the above is found during the interview, this may make the assessment unnecessary.  If the claimant is suffering from a progressive disorder that may worsen, take the claimant’s information and check back in a few months. We provide additional interview types later in this course and in our Client Referral Network.

Accepting a Case:

Once the viability of a case has been assessed, it's time to accept the case. Accepting a case begins by sending the client an Information Packet.  The Information Packet contains your company information, instruction sheet, Social Security forms, medical release form, fee contract, fee petition form, etc., for the client’s signature. The most important Social Security form in the information packet is the “Authority to Represent” form, also known as the SSA Form 1696.

Once these forms are signed by the applicant and returned, you forward some of these materials to the applicant’s local Social Security District Office. These materials notify Social Security of your representative status and start the representational process. These materials also afford you the opportunity to make a request or inform Social Security of issues later on in the case.

If you’re using a fee contract, and you should, send a copy of your signed contract with the SSA Form 1696.  Social Security will add these two vital documents to the claimant’s folder.  If at a later date you need to interact with Social Security on behalf of your claimant, these two documents will verify your authority to do so.  Once you’ve established yourself as the claimant’s authorized representative, you’re ready to begin case processing.


Case Development:

Case development is the process of requesting and gathering all available medical and vocational information relevant to the applicant’s case.  In order for you to evaluate the client's case and create an argument, you must have evidence that supports your argument.  This supportive evidence is gleaned from the claimant's medical and vocational records.

How much case development you need to do depend on the case level.  If you enter a case at the initial level before the client has applied, you would want to acquire as much of the claimant's evidence as possible in order to formulate a case strategy prior to approaching Social Security.

If you enter a case on the reconsideration level, the claimant has already applied and been denied.  Social Security will already have copies of all evidence used in the prior decision.  Therefore, in this situation, you can request copies of the claimant's medical and vocational evidence directly from Social Security.  The same is true if you entered a case on the Administrative Law Judge level. 

In most cases, you’ll end up requesting evidence from everybody.  Therefore, we recommend that you always start with the claimant.  Try to get the claimant to supply you with copies of his evidence.  You can then directly request anything else you need from Social Security or from the claimant's medical sources.

The Case Evaluation Process:

A case evaluation is the process of reviewing a claimant's medical and vocational records for the purpose of creating an argument on behalf of the client.  As a representative, you have both the power and responsibility to disagree with Social Security's opinion that would result in a denial of benefits.  You disagree with Social Security by pointing out bits and pieces of medically supportable signs, symptoms or allegations that would further reduce your client’s ability to perform work. Your findings are then presented to Social Security for their consideration prior to a decision in the case.

If for example, Social Security feels that your client, who is suffering from heart disease, can still perform less demanding work that requires sitting. You could then point out that Social Security forgot to address the client's back condition.  You discuss his back condition pointing out its affect on his ability to sit. 

Example:  As a result of severe back pain, the claimant is unable to sit for more than fifteen minutes without experiencing increased pain, stiffness and numbness of the lower extremities.  These findings, which in our example were ignored by Social Security, would further reduce the claimant's ability to adapt to work that requires sitting.

Having received your argument, Social Security must decide if the claimant can in reality perform less demanding work that requires the ability to sit. What I have just described is often called the case evaluation game!  The object of the game is for the representative to find subtle but important medically supportable findings (signs and symptoms), that further reduce the claimant's perceived ability to perform work.

Creating an Argument:

Once you have completed your evaluation of the claimant’s medical and vocational evidence, you would list those factors within the evidence that support the claimant’s alleged limitations.  Using the findings within the claimant’s medical documentation, the advocate establishes the existence of the alleged impairment, describes the impairment severity, explain how the impairment limits work and request that Social Security allow benefits. We will discuss the process of writing an argument later in your training. We also have available the MemoWrite program.  The MemoWrite is a mini-course in argument creation that includes an argument template. 

If you're an Executive student, you already have access to the MemoWrite course.  This would be a good time to enter the memowrite and begin reading.  You access this program by visiting our website at www.ssahelp.com.  Click on the Member login link and then click MemoWrite.  Enter your ID and Executive password to access. 

Submitting an Argument:

After evaluating the client’s medical evidence and creating an argument, the representative submits the argument to Social Security.  This action forces Social Security to consider the advocate’s argument before making a final decision in the case.  It is this act of reconsideration by Social Security that will enhances your client's chances of receiving benefits.

Wait for Decision:

Once Social Security has gathered and reviewed all known evidence, including your argument, they will make a decision.  At this stage there is not much you can do except wait.  However, sometimes Social Security will contact the representative during this stage and request additional information.  You should cooperate and be honest with the SSA office at all times.  Having said this, you are not obligated to perform actions that would hurt your client's case.

The Social Security's Decision:

Depending upon Social Security's decision, the representative will either prepare an appeal of the denial decision or begin the billing process.  We will discuss both of these processes later in the course.
 

Social Security's Internal Application Process

An individual disability application usually begins at the Social Security District Office (DO).  The DO is responsible for determining the applicant's non-medical eligibility to apply for benefits.  The District Office staff may also initiate a request for copies of the applicant’s medical evidence.  Once this is done, the case is transferred to the State or Federal Disability Determination Section.  This process usually takes about two or three weeks before the case is transferred to the Disability Determination Section.

When a case first arrives at the Disability Determination Section (DDS), a disability examiner is assigned to the case. The examiner begins the case development process by requesting the claimant's medical and vocational records that have not arrived as a result of the District Office request. These records are used to prove the severity of the claimant's impairment.

When the DDS examiner reviews the claimant's medical documentation, he applies a special internal process called Sequential Analysis (SA).  The Sequential Analysis process is performed by asking a series of questions that are answered within the claimant's medical evidence.  SA is a useful tool in determining a case outcome because it removes much of the emotional element experienced by some when reviewing a claimant’s medical documentation.

Let's repeat the previous DA Pro lesson three information by again reviewing the steps within the sequential analysis process.  Understanding the SA process is very important to your future effectiveness as a disability advocate.

Question or Step One of SA:  

Does the claimant have a medically determinable impairment?  

If the answer is no, the examiner will write a denial decision based on the reasoning that there is no significant impairment that reduces the claimant's ability to perform work.  This would result in a denial of benefits.  If the answer to the first question is yes, the evidence does support the existence of a medically determinable impairment, then you and the examiner move to the second question within the SA process. 

As a disability advocate, you must be aware of the sequential analysis process and follow this sequence in the same way that the Social Security examiner does.  This will allow you to effectively counter the examiner's opinion by using a more favorable interpretation of the same facts. You can also add other supportive evidence that may not have been considered by the examiner.

Sequential analysis is a flow chart procedure that enables you to determine at what point in the evaluation process the denial or allowance decision was made.  (View Sequential Analysis Chart)

Sequential analysis tells us the reason why or the exact issue used by the examiner in making his denial decision.  It is a lot easier to develop an argument for a reversal of a denial decision when you understand specifically why the case was denied in the first place. 

Step Two of SA: 

Is the Impairment severe?

If the answer is no, the case is considered by Social Security to be non-severe.  This will result in a denial of the case.  If the answer is yes, you may then move to step or question three of the sequential analysis process.

Step Three of SA: 

Will the impairment last for twelve continuous months?

If the answer is no, the case is denied based on the duration.  Social Security’s definition of a total disability requires that the claimant’s impairment last or be expected to last for twelve continuous months.  If the answer is yes, you move to step four.
 

Step Four of SA: 

Does the impairment meet or equal the listing?

The medical listing is a book used by Social Security to determine the severity of an applicant’s impairment.   If a claimant’s condition meets or equals this listing, the case will merit an immediate allowance.  If the impairment severity is does not meet or equal the listing, you move to step five of the sequential analysis process. 
 

Step Five of SA:  

Can claimant still do his past work?

If the answer to this SA question is yes, then the case is denied.  The case is denied based on the claimant’s ability to return to his past work.  If the answer is no, then you move on to the sixth and final step of the sequential analysis process.

Step Six of SA:  

Can the claimant perform other less demanding work?

If the answer is yes, the case will be denied.  If the answer is no, the case will be allowed based on the claimant’s inability to perform even less demanding types of work.  The majority of adult disability cases are both allowed and denied based on step six of the sequential analysis process.

Determining the Reason for a Denial:

The sequential analysis process makes it fairly easy to determine why a case was denied.  However, there are other methods of making this same determination.  Let's assume for a moment that your client has just received word from the Social Security office that his initial application has been denied.  The claimant has come to you for help with his case. The claimant is currently eligible for a reconsideration appeal of the denial decision. You're entering the case at the reconsideration level and you're wondering why the case was denied on the initial level.

You have just received your claimant's medical and vocational reports from various sources including the Social Security office.  You must now ask yourself this question:  On what basis was the client denied?   Or put another way, what was the issue (reason) used by Social Security that resulted in the claimant’s ineligibility for benefits at the initial case level?   The answer to this question can be determined in two very simple ways.

Method One: The Personalized Denial Notice

The first method used to determine why Social Security denied a case is by reviewing the claimant’s Personalized Denial Notice (PDN).  When a claimant receives his Personalized Denial Notice letter from his initial application, he is told on what basis his case was denied.  You need only to read the personalized denial notice to learn the reason for the denial. As the claimant's representative, you need to request a copy of the Personalized Denial Notice at the time you take on the case.  You can acquire a copy of a PDN via the claimant or by requesting it directly from Social Security.

Method Two:  The Technical Rationale

A Technical Rationale is nothing more than a formal version of a Personalized Denial Notice (PDN) used internally by Social Security.  The only difference between a PDN and a technical rationale is that a PDN uses informal language and a technical rational uses technical language.  The technical rational also provides a more detailed explanation of the decision. 

Our simple technical rational below contains most of the relevant information you’ll need to determine why the claimant was denied benefits. Once you have determined at what point in the sequential analysis process the case was denied, you're ready to begin your argument from that point.  Let's take a look at a technical rational and determine what information can be extracted.

Sample Technical Rationale:

Review of above Rationale:

Now, let's identify some of the valuable information found in the above technical rationale.  Remember, the above rationale is only an example of a typical rationale as used by SSA.  From the above, rationale we now know that:

1. The claimant is 34 years old.

2. He has alleged a back disorder as the reason why he can no longer perform work.

3. He has a significant impairment.  Significant simply means that his impairment is serious enough to cause a physical restriction, although not serious enough to be considered totally disabling.

4. His condition does not meet or equal the listings.  If a person meets or equals the listings, he is immediately found disabled.  The medical listing is applicable in about 10-15% of all disability claims.

5.  The claimant also has a Residual Functional Capacity (RFC) rating.  A RFC is simply an opinion of the claimant's remaining capabilities with consideration of the limiting impact of the claimant's impairment.   You can assume that any claimant with a RFC created by SSA has a severe impairment.  The presences of a Residual Functional Capacity level is an indication that the claimant's is suffering from a severe impairment that is causing physical limitations.

The SA Chart Tells All:

It's also possible to determine why a case was denied without the PDN or Technical Rationale.  How?  You let the client tell you the reason for his denial. The client will usually say something like, "SSA told me that I’m still able to do my past work.” You would then look at the sequential analysis chart.  If you compare the information given by the clamant with the sequential analysis flow chart, you’ll be able to generally determine the reason for the denial decision.  In this case, the reason was step five of SA.  Step five of SA indicates that the claimant can still perform his past work with consideration of the limiting affects of his impairment.

Residual Functional Capacity:

Residual Functional Capacity (RFC) is defined as the level of activity a person is capable of performing after the restrictions caused by his impairment have been fully considered.  A RFC is a subjective opinion made by Social Security based on the medical evidence.  As the claimant's representative, you have the right to disagree with Social Security's RFC and present a more restrictive RFC that would result in an allowance. 

If your position on the RFC issue is supported by the claimant's medical evidence, Social Security may accept your argument.  If Social Security’s RFC results in a denial, you’ll argue for a lower or more restrictive RFC that would result in an allowance.  By presenting your position in the form of a lower RFC supported by the evidence, you're in affect increasing the claimant's chances of being awarded benefits.

To Your Client's Advantage:

Because the sequential analysis process must be rigidly followed by Social Security's adjudicative staff, you’ll always know exactly what SSA was thinking in formulating their denial decisions.  This gives the advocate a tremendous advantage in arguing a case.  By following the sequential analysis process, you know in advance exactly where to focus your argument against the denial.

The quality of your arguments will almost always rest on your ability to demonstrate to SSA that limitations suffered by the claimant are documented proof of an inability to perform any type of work. You must always attempt to clearly demonstrate in your argument that SSA did not consider all of the claimant's physical or mental limitations or that a severe impairment has been overlooked in making the prior denial decision. 

If an impairment is overlooked, you must list the claimant's present the new or additional impairment and describe the limitations caused by that impairment.  You must also explain how this new or ignored impairment limits the claimant and prevents him from performing any type of work.  This approach is the foundation for winning any Social Security disability case.


An Informed Client:

Your client should be made aware that he/she may loss the case at the initial or reconsideration levels.  This action will reduce the claimant’s anxiety level if the case is denied.  It is also a good idea to inform the claimant about the appeal process and what to expect form each appeal level.

There is also something you need to understand about the appeal process.  That is, the ALJ appeal is your best chance to win most cases.  I say this because unlike an examiner, an ALJ can take into consideration certain medical findings and physical restrictions that could not be considered by a disability examiner.  As a result, case at the ALJ appeal level are often more favorable to the claimant.  Having said this, it is still important that all impairments, physical or mental, which are causing restrictions in the claimant's ability to perform work, be brought to the attention of the examiner and the Adjudicative Law Judge.

Whole Body Issue:

The term Whole Body refers to a little known policy within the Social Security rules.  The policy essentially states that Social Security must consider the affects of all severe impairments suffered by a claimant in determining that claimant’s final Residual Functional Capacity.  The final RFC will determine if the case is won or loss.  Social Security will not consider all impairments unless those impairments are brought to their attention.

The main reason why so many of our advocates are so successful has a lot to do with our exploitation of the whole body issue.  As a disability advocate, this whole body issue enables you to present any and all severe impairments in your argument.

When all of the claimant’s limitations are added together, the result is a more limited individual.  The more limited the individual, the less likely he/she will be capable of performing work.  Therefore, using the whole body approach to every case enables you the advocate to create more limiting Residual Functional Capacities (RFC) when compared to those created by Social Security. 

When reviewing the claimant’s medical evidence, try to identify all severe impairments. Then consider each condition individually and identify all limitations caused by that impairment.  Then, add all the limitations together to formulate your RFC and your formal argument.  The majority of cases you argue will be allowed or denied based on what is known as Medical -Vocational factors.  A decision using an RFC is always based these Medical-Vocational factors.

What is meant by Medical-Vocational basis?

Any case that is decided pro or con using the issue of past or other work as shown in the sequential analysis process is said to be based on medical-vocational factors.  This simply means that in view of the findings identified in the claimant's medical and work history, Social Security feels the claimant can or cannot do his past work.  This same rationale is then used to determine if the claimant can do other less demanding work.  If the claimant appears incapable of doing other less demanding work, the case is allowed based on medical vocational factors.

The vocational analysis process is cumbersome and time consuming process.  We addressed this vocational bottleneck in two unique ways.  We created a process called common-sense vocational analysis that enables you to bypass some of the laborious research required to complete this process.  We also created a software program that does much of the analysis for you.  If you're an Executive member, you can access our Vocational RFC Analyzer software inside the Office Suite. 

It's the job of a disability examiner to logically argue that a claimant is not disabled based on an ability to do past or other less demanding work.  It is your job as the claimant's representative to logically argue that given closer analysis of the claimant's evidence, the claimant cannot perform any type of work.  We will cover the vocational analysis process in greater detail in lesson five of the Study Guide.

The secret to winning a disability case lies in your ability to convincingly argue, via the medical evidence, that a claimant is not capable of performing any type of work.  In future lessons we will show you how to use medical and vocational evidence as your primary weapon for winning a disability claim.

Summation

Lesson Four Preview:

In lesson four, you’ll be shown how to effectively use medical evidence in the evaluation of a Social Security disability claim. Be sure to review the expanded version of this lesson located in the Student Web. 

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