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Progressive Diseases - How Far Back in Time Should an ALJ Review Medical Records in a Social Security Disability Claim?

Dallas, TX |

If one has a progressive disease, and the pathology of that disease contains medical records spanning years before an alleged onset date and/or the date of application, how far back in time should an ALJ be required to review the medical evidence and allow that evidence to become part of the record? For my claim, the ALJ only gave a medical expert access to the previous 3 years of my medical records, yet my onset date and date last insured were beyond those three years. My current rep doesn't seem to grasp the critical nature of this issue, so he did not bother to argue this matter during a recent ALJ hearing. How can a claimant expect to receive a fair hearing if the ALJ isn't reviewing the proper evidence and worse, isn't allowing the proper access to a ME who was the decider in my claim

By definition of a progressive disease (and SSR 83-20), it appears the rules and regulations of the admissibility of medical records is a little more lenient in regard to how far back in time the medical record should accept evidence. I have read somewhere that the ALJ usually reviews medical records up to 12 months prior to either the application date or the alleged onset date (can't remember right now), but that doesn't seem proper to me. Since a progressive disease is hard to pin point a starting date when it became disabling, shouldn't the ALJ consider ALL medical records pertaining to the pathology of that disease?

Attorney Answers 4

  1. You really need to work this out with your attorney. If you're not happy with your attorney then you need to get a new one. But you should resist the urge to use this forum as a way to second-guess your attorney.

  2. Though I understand your concerns about adequately presenting your case, There is regrettably no way that you could sufficiently provide this forum with the information needed to make even an educated guess. Sa suggested, speak to your attorney. If you do not like the response, talk to another but do not sit on your hands.

    The above is not intended as legal advice. The response does not constitute the creation of an attorney client relationship as this forum does not provide for a confidential communication.

  3. You mention that you have a rep but not necessarily if the rep was an attorney. If you have already been denied after your hearing and you are not satisfied with your representation you may switch representatives. Your next step would be the appeals council. This gives you another bite at the apple. You may wish to address your dissatisfaction with your rep to see if the problem can be corrected. If you lose in the appeals council, then the next step is federal court. Here you must have an attorney represent you and not a layperson rep.

  4. Medical records that pertain to your alleged disability and pre-date a Date Last Insured (DLI) are critical records in a social security disability hearing. It is not clear to me from your post whether your attorney secured those records. Your statement that the ALJ restricted the ME's "access" to medical records does not make sense; if medical records are in the SSA file the ME is expected to address them, and your attorney should do so if the ALJ does not. It is not clear to me whether your attorney didn't do a good job, or whether you are just grousing because you got the sense that the claim was going to be denied. You need to have a frank conversation with your attorney and resolve your concerns.

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