An updated policy addressing documenting and evaluating disability in young adults was released, Social Security Ruling, SSR-11-2p, which became effective in September. The Teacher Form discussion at this blog post will help in developing your questions for teachers, counselors and anyone in a position to understand your child’s day to day level of function.
Evidence Can be Inconsistent and Must Be Resolved
It is common to present within the submitted documentation inconsistent evidence. The best person to address the inconsistencies is the person representing the young adult. The best time to resolve these inconsistencies with additional documentation is before the hearing. Evidence needed to document a young adult’s impairment-related limitations, other considerations for evaluating limitations, disability insured status, issues related to the sequential evaluation process, and resolving inconsistencies in the evidence.
CAVEAT: pay close attention to “RESOLVING INCONSISTENCIES IN THE EVIDENCE.”
First: Be aware of inconsistencies. The Global Assessment of Functioning (GAF) evaluation often contributes to inconsistencies. GAFs for children and young adults can misrepresent the claimant’s status. GAFs represent one event, one day often and are not representative of the entire ability or disability of the claimant.
Second: Be prepared to address the inconsistencies. The SSA will look through the record specifically for inconsistencies. SO SHOULD YOU.
GAF: The Global Assessment of Functioning (GAF) is a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living.
Resolving Inconsistencies in the Evidence
The Social Security Administration evaluates relevant evidence for consistency and is instructed to resolve any inconsistencies that need to be resolved. After reviewing all of the relevant evidence, the SSA determines whether there is sufficient evidence to make a finding about disability. It is your job to be certain all the evidence needed to make this finding is presented for review.
“All of the relevant evidence” means:
The relevant objective medical evidence and other relevant evidence from medical sources;
Relevant information from other sources, such as school teachers, family members, or friends;
The claimant’s statements (including statements from the young adult’s roommates or family members); and
Any other relevant evidence in the case record, including how the young adult functions over time and across settings.
If there is sufficient evidence and there are no inconsistencies in the case record, the SSA will make a determination or decision. If there are inconsistencies in the record, the decision or determination will be made based upon the majority of the evidence or the most probative evidence which outweighs the inconsistent evidence, and when additional information would not change the determination or decision.
Seek Out and Document Evidence
It is your job to understand where inconsistencies are in the record and address them. It is best to address them with other documented findings. For example if a GAF indicates a high level of concentration while employers, teachers and other persons in contact with the claimant understands there are good days and bad days, document that finding in their reports.
Be able to point out where inconsistencies are not “material.” An inconsistency is not “material” if it would not affect the outcome of the case or any of the major findings. If the SSD can make a fully favorable decision despite the inconsistent evidence, that inconsistency would be immaterial.
An inconsistency could also be immaterial in an unfavorable determination or decision when resolution of the inconsistency would not affect the outcome. This could occur, for example, if there is inconsistent evidence about a limitation in a specific work-related activity. If a person is able to climb ladders but the work of the individual does not require them to climb a ladder such as in a desk job or clerk position, the inability to climb a ladder would not reduce the number of sedentary occupations he or she could do.
Consultive Exam Inconsistencies
Sometimes an apparent inconsistency is not a true inconsistency. This often happens in consultive exams. If you find the consultive exam does not accurately reflect the young adult’s issues, ask the examiner to include within the record, that one exam does not embrace the scope of the issues for the claimant.
For example, the record for a young adult with attention-deficit/hyperactivity disorder may include good, longitudinal evidence of hyperactivity at home, in the classroom, and on work experience placements in the classroom, but show a lack of hyperactivity during a consultative examination (CE). The observations during the consultative examination may represent a “good” day, rather than the overall level of functioning or the effect of an unusual setting. In this case, there would be only a normal variation in functioning at the time of the consultative examination.
Accepting the observation of the young adult’s behavior or performance in an unusual setting, like a consultative examination, without considering the rest of the evidence could lead to an erroneous conclusion about the young adult’s overall functioning.
Clarify Inconsistencies before a Decision
The Court will request additional information where the evidence is insufficient, including when a material inconsistency exists that cannot be resolve based on an evaluation of all of the relevant evidence in the case record. However, it is much more common for a claim to be denied. It is crucial to deliver to the SSA all evidence upon which a claim can be based and to address inconsistencies prior to submission by resolving them within the record or submitting additional information to clarify the inconsistencies.