Bill was one of my Social Security Disability clients. Bill had been a truck driver until he injured his back. He had herniated discs and muscle spasms. His injury had stolen his livelihood and his dignity. Bill’s wife left him, he lost his insurance, and eventually his home. He began living in his truck. His chiropractor allowed him to park his truck in his office’s parking lot.
I got a call from Bill’s chiropractor on a cold morning in February, 2004. His chiropractor found him dead in his truck that morning. Bill committed suicide in his truck that doubled as his home. I’ll never forget Bill.
The only treatment Bill was getting for his back was from his chiropractor. Bill’s chiropractor was the only person willing to treat Bill free of charge. Bill had been waiting 4 years for a decision in his Social Security Disability case when his final denial came in. (All of his mail was sent to his chiropractor’s office). He killed himself later that day.
Social Security denied his initial application, which is very common. Most people are denied after initially applying. Then, he filed his request for Reconsideration. Again, he was denied. It’s also very common to be denied at this stage. He requested a hearing before an Administrative Law Judge and waited over a year to get his hearing. The judge denied his claim. He appealed to the Appeals Council and waited almost 2 years before he got the Appeals Council denial. The day he got the denial is the day that his heart stopped beating, but his life ended years earlier.
Bill had a hard time sitting, walking, and standing. He even found it difficult to lie down comfortably. His pickup truck didn’t provide any sort of level of comfort. Bill found some relief with chiropractic treatment, but his relief never lasted long. He was in constant pain. Bill was also severely depressed but couldn’t afford treatment and there were no free resources in his area. His chiropractor filled out every form I sent in support of his disability case and wanted to help Bill more than anything; he saw Bill’s suffering first hand and would call me and tell me about it.
Bill’s claim was denied because the only evidence that Bill had that he was disabled was from his chiropractor. Chiropractors are not considered “acceptable medical sources” by the Social Security Administration. Unless records from chiropractors are accompanied by records from an “acceptable medical source,” like an M.D. or D.O., they are about as good as your neighbor writing a letter saying that you are in pain.
Usually, a claimant is sent for an examination by a doctor who is paid by Social Security. These exams are called Consultative Examinations. The doctor that Social Security sent Bill to see for his Consultative Examination didn’t find him limited at all. The doctor didn’t do X-rays or MRIs and, although Bill walked slowly because of the pain, he could walk; although the pain made him nauseous at times, he could use his hands and he could sit. The doctor concluded that Bill could lift and carry 20 pounds occasionally and 10 pounds frequently. Bill hadn’t lifted that much in years — in fact, he hadn’t lifted more than a few pounds since he hurt his back. The doctor never put Bill through any sort of testing to see if he could actually lift those amounts.
At Bill’s hearing, the judge only considered the Social Security doctor’s report and found that Bill was not disabled. Bill appealed and the Appeals Council affirmed that decision. Bill’s next step would have been to file in Federal Court. Bill was out of money, out of hope, and out of time. The system failed Bill, and I know that he’s not the only one.
The current law only considers the following types of practitioners to be “Acceptable Medical Sources”:
• Licensed physicians (M.D. or O.D.).
- Licensed or certified psychologists at the independent practice level.
- School psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, are AMSs for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only.
- Licensed optometrists for impairments of visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices.
- Licensed podiatrists for impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle.
- Qualified speech-language pathologists (SLPs) for speech or language impairments only. For this source, “qualified” means that the SLP must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State that he or she practices, or hold a Certificate of Clinical Competence in Speech-Language-Pathology from the American Speech-Language Hearing Association.
- For cases filed on or after March 27, 2017, licensed physician assistants for impairments within the licensed scope of practice only.
- For cases filed on or after March 27, 2017, licensed audiologists for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only.
- For cases filed on or after March 27, 2017, licensed Advanced Practice Registered Nurses (APRN), also known in some States as Advanced Practice Nurse (APN), and Advanced Registered Nurse Practitioner (ARNP) for impairments within his or her licensed scope of practice.
There are four types of APRNs with a handful of State variations:
- Certified Nurse Midwife (CNM);
- Nurse Practitioner (NP);
- Certified Registered Nurse Anesthetist (CRNA); and
4. Clinical Nurse Specialist (CNS).
That’s a long list, but it’s important to note who is NOT on the list: Marriage Family Therapists (or other therapists), Licensed Social Workers, Naturopaths, Registered Nurses, and, of course, Chiropractors.
Since Bill’s suicide, the list of acceptable medical sources is longer than it was in 2004. Even today, though, Bill would still have been out of luck because chiropractors are still not considered acceptable medical sources.
The Consultative Exam that Bill went to where the doctor concluded that Bill wasn’t significantly limited after a 15-minute consultation was simply inaccurate. Bill was hobbled over and gritted his teeth when he talked because he was in so much pain. Bill was 50 but his pain had aged him — he looked more like he was 70 years old.
Most of these doctors perform very short consultations and almost never conclude that the individual is significantly limited. Their conclusions are more speculative than anything because claimants are never put through actual performance tests where they are required to sit, stand, and carry as they would in a job situation. Judges regularly rely on these reports to deny Social Security Disability benefits for claimants like Bill.
Social Security should recognize all treatment providers as acceptable medical sources. Bill’s chiropractor had documented Bill’s pain and limitations repeatedly. Bill’s chiropractor had done countless exams and had a longitudinal relationship with Bill. He knew the extent of the damage to Bill’s back and saw the daily struggle that Bill had just to survive the day.
Next, Social Security should not rely so heavily on Consultative Examinations. Doctors who perform these exams for Social Security routinely find that claimants are able to lift, carry, stand, walk, and sit in excess of what the claimant is actually able to physically perform. If Social Security is going to rely on these reports, they should be based on actual physical testing and simulated work situations, not mere speculation on the part of these doctors.
For Bill, life was unbearable. Bill needed medical treatment that he would be able to get after receiving his Social Security Disability benefits.
Disability benefits that Bill paid into when he was working.
Disability benefits that were supposed to be there when Bill found himself unable to work.
The disability benefits that never happened.
The system failed Bill and so many like him.