The Recency Element of Past Relevant Work

The Recency Element of Past Relevant Work

Social Security will deny a disability claim if they find the claimant can do “Past Relevant Work” (PRW), either as it was actually performed or as that type of work is generally performed based on the appropriate Dictionary of Occupational Titles code.[1] In order for a prior job to be PRW it must meet three elements: Substantial Gainful Activity (SGA), Duration and Recency.[2]

  1. SGA

This element is satisfied if the work met the definition of SGA under 20 CFR Sections 404.1571-404.1575 and 416.971-416.975.

  1. Duration

This element is satisfied if the job lasted long enough for the claimant to have learned the skills necessary to resume that type of work and achieve average performance without significant re-training.

  1. Recency

This element is met if the job was performed within the 15 years prior to the date of adjudication or the Date Last Insured, whichever comes first. The scope of this period may be extended if there is a continuity of skills, knowledge and processes that can be established between such work and the claimant’s more recent work. However, the scope of this period may not be shortened.

In the interest of certainty, Social Security has formulated rules for decision-makers to follow. Some rules seem “black and white” and I often tell my clients “Social Security has to draw the line somewhere.” However, in certain cases, these rules would produce an unfair result when the exact language of the rule is not matched but the underlying rational behind the rule is present. For most of these rules Social Security has created exceptions that prevent unfair results. For example, there are several exceptions to the SGA guidelines, including the subsidized work environment[3] and the unsuccessful work attempt.[4] In the context of the Grid rules, Social Security acknowledges that in some cases it would be unfair for the rules to change overnight when the claimant reaches a certain age, so the borderline age situation was developed.[5] In the context of transferrable skills, Social Security recognizes that as a claimant gets older, obtaining employment would be increasingly more difficult unless only a minimal amount of adjustment is required, such that the claimant could be expected to perform “at a high degree of proficiency with a minimal amount of job orientation.”[6]

These concepts should be applied to the PRW 15 year rule. For example, take an individual of advanced age (55-60), who worked in manual labor for the last 14 years but is now reduced to the sedentary exertional level. The Grid rules would ordinarily direct a finding of disability.[7] However, if this individual worked as a telemarketer for three months 14.5 years ago, the Grid rules would direct a denial (unless other limitations prevent the claimant from doing that work). In this case, using the rational above, vocational analysis of PRW should address whether any significant changes have occurred in telemarketing work since the claimant last performed it. This might reveal two things: First, that there are currently comparable jobs available but in fewer numbers. Second, that despite the claimant’s prior work experience, telemarketing is so different now that the knowledge from this experience is obsolete and the claimant would need to be completely retrained. In this case, the rational behind the recency element is not met, and telemarketing should not be found to be PRW.

This could be a critical issue in your Disability case. Consider a free consultation with a disability attorney who is familiar with these rules and regulations.

 

By Charles Sagert

[1] 20 CFR § 404.1560; SSR 82-62.

[2] SSR 82-62.

[3] SSR 83-33.

[4] SSR 05-02.

[5] 20 CFR § 404.1563(b); HALLEX II-5-3-2.

[6] SSR 82-41.

[7] 20 CFR Part 404, Subpart P, Appendix 2.


Social Security Disability and Self-Employment

When Social Security receives a claim for disability benefits, the first question is whether the claimant performed Substantial Gainful Activity (SGA) during the alleged period of disability. If so, the claimant is ineligible for benefits during that time. SGA is generally defined as “work that involves doing significant and productive physical or mental duties, and is done (or intended) for pay or profit.” 20 CFR § 404.1510. Each year Social Security formulates a dollar amount that is used as the benchmark for SGA. In 2016 the amount is $1,130 per month and in 2015 it was $1,090. If this amount is or was exceeded, the earnings are presumed to be SGA. Gross earnings through employment can be easily compared to these benchmarks, but earnings through self-employment require further analysis.

The applicable rules are located in sections 404.1080 through 404.1096 and Social Security Ruling 83-34. The ruling should be consulted first for a general overview. Social Security may find that self-employment constitutes SGA under one of three tests:

  1. Under the Significant Services and Substantial Income test, both elements must be met. The significant services element is met if the claimant is a sole proprietor or, if not, performing more than half of the duties of the business or more than 45 hours per month of work. For a farm landlord, the question is whether he or she “materially participates,” not through an agent. The substantial income element is met if the claimant’s average monthly net income (countable earnings) reaches the benchmark amount; if the claimant’s livelihood derived from the business is the same as before he or she became disabled, or; if the claimant’s income is comparable to that of unimpaired individuals in a same or similar business in that community. If this test is not met, Social Security proceeds to the next two tests.
  2. Under the Comparability of Work test, the work is SGA if it is comparable in all relevant factors to that of unimpaired individuals in a same or similar business in the same community. Relevant factors include hours, skills, energy output, efficiency, duties and responsibilities.
  3. Under the Worth of Work test, the work is SGA, even if it is not comparable, if it is clearly worth more than the SGA benchmark amount when considered in terms of its value to the business or when compared to the salary an owner would pay to an employee for such duties in that business setting.

 

This is a general overview and the authorities cited above should be consulted for each individual situation. There are several additional details and nuances further explained in these sources. If your claim for Social Security Disability involves self-employment earnings, consider enlisting the help of a good attorney to interpret these rules and persuade social security that they operate in your favor.

Written by Hoglund Law

The attorneys of Hoglund law are licensed in Minnesota, Wisconsin and Ohio. Hoglund, Chwialkowski & Mrozik, PLLC is based in Roseville, Minnesota. In addition to handling cases involving bankruptcy & social security, Hoglund, Chwialkowski & Mrozik, PLLC handles faulty drugs and toxic exposure.

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Failure to Follow Perscribed Treatment

From time to time the issue of whether the claimant failed to follow prescribed treatment becomes the focal point. 20 CFR 404.1530 states “an individual who would otherwise be found to be under a disability, but who fails without justifiable causes to follow treatment prescribed by a treating source which the Social Security Administration determines can be expected to restore the individual’s ability to work, cannot by virtue of such ‘failure’ be found to be under a disability.” SSR 82-59 further expands on this definition declaring that the SSA may make a determination that an individual has failed to follow prescribed treatment only where all of the following conditions exist:

1. The evidence establishes that the individual’s impairment precludes engaging in any substantial gainful activity (SGA) or, in the case of a disabled widow(er) that the impairment meets or equals the Listing of Impairments in Appendix 1 of Regulations No. 4, Subpart P; and

2. The impairment has lasted or is expected to last for 12 continuous months from onset of disability or is expected to result in death; and

3. Treatment which is clearly expected to restore capacity to engage in any SGA (or gainful activity, as appropriate) has been prescribed by a treating source; and

4. The evidence of record discloses that there has been refusal to follow prescribed treatment.

A few things here are important to note. First off, the treatment must be prescribed by the treating source. The treating source must be a medical professional who attends to the claimant’s medical needs on a regular basis. Thus, a doctor the SSA sends the claimant to for a consultative examination cannot determine a claimant to be denied for failure to follow prescribed treatment. In addition, the prescribed treatment must be expected to restore the ability to work. In a recent case I had, I got the doctor to testify that even if the claimant gave up smoking, her heart and lung condition would not improve enough to restore her ability to work.

If the SSA determines the treatment was prescribed by a treating source and it would be expected to restore the ability to work, it must then give the claimant the chance to offer an explanation as to why they did not follow the prescribed treatment. The SSA’s then determines whether the given explanation was “justifiable”. SSR 82-59 provides a list of possible justifiable explanations. A few, but not all, examples include: If treatment is contrary to religious belief (with documentation of membership to the religious affiliation along with statements from the church authorities), the inability to afford prescribed treatment and there are no community resources available (all possible resources should be explored and documented by the claimant), another treating source advises against the treatment prescribed by another source, the treatment involves a high degree of risk or amputation. These are but a few examples.

Failure to follow prescribed treatment can be a devastating reason for a denial. The SSA has determined the claimant cannot work yet they get denied benefits and insurance. It is very helpful to have an experienced attorney during the lengthy process in order to advise the claimant about the proper actions to take when a doctor offers treatment as well as possible community resources available to the claimant so they can follow the prescribed treatment. At the hearing, or in a brief, it is again helpful to have an experienced attorney who has an understanding of the federal regulations in order to rebut the SSA’s denial or contemplation of denying a person for failure to follow prescribed treatment. With proper counsel and advocacy from an experienced attorney, a claimant can avoid being denied due to failure to follow prescribed treatment.

Written by Hoglund Law

The attorneys of Hoglund law are licensed in Minnesota, Wisconsin and Ohio. Hoglund, Chwialkowski & Mrozik, PLLC is based in Roseville, Minnesota. In addition to handling cases involving bankruptcy & social security, Hoglund, Chwialkowski & Mrozik, PLLC handles faulty drugs and toxic exposure.

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Planning for Disability: When to Apply for Social Security Benefits

Hoglund Lawyer Andrew Kinney

I am Andrew Kinney, an attorney practicing exclusively Social Security disability law at Hoglund Law Offices.  I do about 400 or more hearings per year.  I am licensed in Minnesota, Wisconsin, Ohio, and New York.  Our team of Hoglund Lawyers travels across the country handling Social Security disability claims, and we currently have offices in Minnesota, Wisconsin, and Ohio.

Of the tens of thousands of calls to Hoglund Law Offices just last year, some calls about Social Security disability benefits came from people who were still working, but had serious medical problems that were going to cost them their jobs.

Losing your ability to work is frightening.  It is enough not to feel well.  Disability understandably takes a toll.  For some, being unable to work can feel demeaning.  I wish it didn’t.  Other than getting the right help from doctors, there is not much you can do.  For all, planning for disability is a difficult journey in need of a clear path.  As a lawyer practicing in the area of Social Security disability benefits law, what do I tell them?  If you or someone you know is facing disability, I hope the discussion below can help.

(I’ve formatted this “planning for disability” blog just like a phone conversation.  Here is a typical first call for help.)

“Andrew, new client call on line 704.”

“OK”.  I put my headset on.

Line 704:  “This is attorney Andrew Kinney.  Can I help you with questions about getting Social Security disability benefits?”

A hesitant female voice comes on the line.  “Yes.  My name is ________.  I’ve been diagnosed with _________.  I’ve started having more problems, so I’ve reduced my hours.  I don’t think I’ll be able to keep this job much longer.  I have some questions about Social Security benefits.”

“Sure.  This is a difficult situation.  What hours are you working per week now?”

“About 25 hours per week, but I’ve just used up my family medical leave.”

“Are you making over $1,000 gross before taxes a month?”

Pause.  “Yes.  I’m about at $1,200.  But my supervisor just told me that I’ll need to go to 20 hours per week.  I might be fired.  We’re talking about it this Friday.”

“At 20 hours per week, would you make under $1,000 per month once you are at 20 hours per week?”

“Yes.”  her voice is pained.  “Or it might be zero soon.  I don’t know what I’m going to do.  I’m also going to lose my insurance.”

“That’s why Social Security set up these benefits.  You have been paying for this federal disability insurance out of your paychecks.  Now, the reason I’m asking about your monthly income is that Social Security has income limits for people that apply.  In 2011 and last year, you are allowed to make up to $1,000 per month.  If you have been making more for 3 months in a row, Social Security decides that you are working.  People can apply for Social Security benefits if they are making less than this amount per month because of medical problems, and they expect they won’t get better for a year or more.”

“So when can I apply for Social Security benefits?”

I answer her question:  “When your monthly earnings go down below the level I mentioned.”

“Well, I’ll know soon enough.  I just can’t keep this job up.  I’m making mistakes at work.  My friends who know what’s going on are trying to cover for me.  It is getting too hard.”  She is exasperated.

“Well, it’s good you called.  This way you can know what to do next.  What I tell people is that they should work as long as they can within their doctor’s limits.  When you reasonably can’t work much more, you’ll know.  Your doctor will also know that you are trying to keep working.  A judge’ll ask why you stopped working anyway, so trying your best is good.  As for the legal standard of what a disability is, Social Security allows benefits if you can prove with medical treatment that your medical problems will keep you from working full-time for a year or more.”

She responds:  “My doctor told me that he doesn’t know how I’ve been able to work at all.”  She laughs a little.  “He said that he normally doesn’t believe in Social Security disability benefits, but he knows what is going on with me.  He said he would help me.”

“That’s good.  Tell me about your medical issues.”  She explains her situation, including a recent surgery.  I then explain the appeal process and how our law offices can help.  I get her address and other information.

Evauating her situation, I tell her, “OK.  I think we can help you.  First, though, keep in mind that your application needs to wait until you are in a new month when you are not making too much.  Second, remember that we help people apply.  So, keep our number handy.  Also, when are you next seeing your doctor?”

She pauses.  “I have an appointment in about 3 weeks.”

“Good.  If your hours go down like we discussed or you are let go, let your doctor know at that appointment that you might need a letter from him soon that helps explain your diagnoses and limitations.  These are called narrative letters, and this will outline what’s wrong.  Letters from treating doctors can be your best chance of approval at the application stage.  We expect, however, to go to a hearing.”

“I think he’ll write a letter.”  I explain the logistics of this letter.  “What about insurance?  If I’m fired, how will I keep going to my doctors?”

“You need to keep treating for your medical problems, especially if you start a disability benefits claim.  Here are some things to do.  You should write these things down:  First, you might look into getting insurance through your husband.  Second, as you stop working, find out from your employer how to extend your current insurance through COBRA coverage.  You may be able to extend this longer than others due to disability.  Third, ask about private disability benefits, either short or long-term.  Some employers have them.  Fourth, make sure you have copies of your employer’s benefits plans.  Finally, you should look into health coverage options through your county.  A call to your county can help you understand how that works.”

“Thanks.  I’ll do these things.”

“Well, this should cover things for now.  Also, remember that some people living off savings can have early withdrawal penalties from their 401k.  Ask the IRS about having this penalty waived due to disability.  If this issue comes up, contact a local IRS office about the process.”

“Thanks.”  She sounds a little relieved.

“Thank you for calling.  As I said, keep our number handy.  Let’s hope that you can keep working, but you’ve got a plan.”

*     *     *

Hopefully, the dialogue above — which happens a lot in our practice — helps you.  Planning for Social Security disability is possible.

One last thought.  At times, our legal judgment plays into the timing of a Social Security benefits application.  Once in a great while, my clients haven’t been treating as they stopped working.  In these cases, I may have a client delay his or her application a little while until they can get to see their doctors.  I’ve seen applications denied for lack of medical evidence, which is a shame for real medical problems.  Note that delaying applications, however, can also cause a loss of possible benefits.

Legal advice about this process is important.  So if you want legal advice, you need to call a law firm — not an “advocacy” group or corporation of “representatives” that processes claims.  Whoever you call, ask if they are a law firm up front.  Otherwise, you will not get legal advice.  You have a right to choose an experienced lawyer.  Get one.  At Hoglund Law Offices, we charge only a quarter of back-pay if you win.  You pay no money up front.  Ever.

My normal disclaimer:  You should get legal advice based on your unique situation, so make sure to call Hoglund Law Offices at 1-800-850-7867 or visit HoglundLaw.com if you have questions like this.  Please don’t rely on this one example.  If you call us, you can plan for disability.  Good luck.

Andrew W. Kinney, Esq.

Written by Hoglund Law

The attorneys of Hoglund law are licensed in Minnesota, Wisconsin and Ohio. Hoglund, Chwialkowski & Mrozik, PLLC is based in Roseville, Minnesota. In addition to handling cases involving bankruptcy & social security, Hoglund, Chwialkowski & Mrozik, PLLC handles faulty drugs and toxic exposure.

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