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Old 12-08-2013, 11:44 AM #1
mastoidectomy mastoidectomy is offline
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Default Are these situations grounds for remand?

I have had several mastoidectomy procedures over the years (inner ear), and have been left with complications, pain, nausea, facial paralysis, infections. The infections over the years has burned a hole in my ear drum as well as dissolved inner ear bones etc... I'm 44, and the pain is just gotten really worse over the last 8 years or so. I filed in 2009, had a hearing recently 2013. The ALJ in her ruling stated that I went to a clinic several times were I received "cleanings" of debris. The clinic has no ENT'S, and provides no such services, they simply provide me with pain and anti swelling medication for said mastoidectomy complications. She stated I received "cleanings" there in an effort to show that my diagnosis of symptom of otitis media "infections" is unfounded as at these "cleanings" no infection was noted. The real reason no infection was noted is because it is beyond their medical scope to even look for it let alone detect it. She completely fabricated this idea of me getting "cleanings" there as part of her ruling, it just did not occur, and she states it happened, twice!
As I said the facility simply prescribes my meds and referrals FOR volunteer ENT services, which I get maybe once a year if lucky. The ENT states as have other ENT'S, that I must see ENT at least three times a year for debriment to prevent infection, for life, and this clinic does not do these procedures she states that I received there, she made it up, from thin air!
Is an ALJ's statement of treatment "cleanings", which did not occur grounds for a remand as it is clearly a complete fabrication by the ALJ of services rendered at the clinic in question. This ALJ has gone from 60% approval down to 30% in just the last two years, she is lying, lying, lying, and is obviously brazen about it to actually insert made up facts such as these. She is so emboldened that she does not even consider that the clinic in question might not even do the "cleanings" she said I got there, she feels she can do or say anything, can she?
Any help?
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Old 12-08-2013, 03:04 PM #2
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Originally Posted by mastoidectomy View Post
I have had several mastoidectomy procedures over the years (inner ear), and have been left with complications, pain, nausea, facial paralysis, infections. The infections over the years has burned a hole in my ear drum as well as dissolved inner ear bones etc... I'm 44, and the pain is just gotten really worse over the last 8 years or so. I filed in 2009, had a hearing recently 2013. The ALJ in her ruling stated that I went to a clinic several times were I received "cleanings" of debris. The clinic has no ENT'S, and provides no such services, they simply provide me with pain and anti swelling medication for said mastoidectomy complications. She stated I received "cleanings" there in an effort to show that my diagnosis of symptom of otitis media "infections" is unfounded as at these "cleanings" no infection was noted. The real reason no infection was noted is because it is beyond their medical scope to even look for it let alone detect it. She completely fabricated this idea of me getting "cleanings" there as part of her ruling, it just did not occur, and she states it happened, twice!
As I said the facility simply prescribes my meds and referrals FOR volunteer ENT services, which I get maybe once a year if lucky. The ENT states as have other ENT'S, that I must see ENT at least three times a year for debriment to prevent infection, for life, and this clinic does not do these procedures she states that I received there, she made it up, from thin air!
Is an ALJ's statement of treatment "cleanings", which did not occur grounds for a remand as it is clearly a complete fabrication by the ALJ of services rendered at the clinic in question. This ALJ has gone from 60% approval down to 30% in just the last two years, she is lying, lying, lying, and is obviously brazen about it to actually insert made up facts such as these. She is so emboldened that she does not even consider that the clinic in question might not even do the "cleanings" she said I got there, she feels she can do or say anything, can she?
Any help?
I have no idea, what does it matter if its remand eligible anyway? To gain a remand you must either prevail at appeals council which is all but impossible, or pursue a civil lawsuit in a real courtroom, either way requires you to appeal the alj's decision, incidentally you must proceed through the appeals council if you wish to file a federal lawsuit anyway, a process that will likely eat up nine months more of your time.

Often as in both of my appeals council appeals, the council will just sit on your appeal for a year, then notify you that they will not review the decision no matter what, which is so outrageous it defies all rational response....

Bottom line, to garner a remand, you must proceed on through the system, a process that easily could tack on an additional 4-5 years of anguish and despair...
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Old 12-08-2013, 04:56 PM #3
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You, or someone on your behalf, needs to file an appeal. If you are not thoroughly comfortable with the legal process, you should probably hire an attorney or a non-attorney rep (like someone from Allsup) to do it for you.

The ALJ may or may not have written the decision, btw. A staff member could have written the decision and made the error.

An error about the medical evidence could be enough for a remand, but there are other possibly additional judicial errors that you're missing.
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Old 12-08-2013, 05:02 PM #4
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I have no idea, what does it matter if its remand eligible anyway? To gain a remand you must either prevail at appeals council which is all but impossible, or pursue a civil lawsuit in a real courtroom, either way requires you to appeal the alj's decision, incidentally you must proceed through the appeals council if you wish to file a federal lawsuit anyway, a process that will likely eat up nine months more of your time.

Often as in both of my appeals council appeals, the council will just sit on your appeal for a year, then notify you that they will not review the decision no matter what, which is so outrageous it defies all rational response....

Bottom line, to garner a remand, you must proceed on through the system, a process that easily could tack on an additional 4-5 years of anguish and despair...
It is possible to have decisions fast tracked with a "dire need" letter.

There is also the option to start a new application.

When the Appeal's Council denies a request for review, this doesn't mean they didn't read your appeal and make a decision on it. It means they read the appeal, denied you, and will not review the entire case. http://www.ssa.gov/pubs/EN-05-10041.pdf

Last edited by LIT LOVE; 12-08-2013 at 05:34 PM.
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Old 12-08-2013, 09:49 PM #5
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When the Appeal's Council denies a request for review, this doesn't mean they didn't read your appeal and make a decision on it. It means they read the appeal, denied you, and will not review the entire case. http://www.ssa.gov/pubs/EN-05-10041.pdf

Not according to my attorneys, they clearly stated that AC routinely refuses to even read the ALJ decision, which in my case they did twice!

Again, to be perfectly clear, the AC often simply refuses to even review the ALJ's decision, Daley Disability Law says its not at all uncommon...
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Old 12-09-2013, 01:14 AM #6
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Not according to my attorneys, they clearly stated that AC routinely refuses to even read the ALJ decision, which in my case they did twice!

Again, to be perfectly clear, the AC often simply refuses to even review the ALJ's decision, Daley Disability Law says its not at all uncommon...
I think you're confusing my point. I stated the AC read your appeal--which they decided was without merit, and as a result you received a denial. I didn't state that they read every ALJ decision--in some cases it might not be necessary.

Over half of the applicants that file appeals will eventually be awarded benefits, so statistically it is not a waste of time for applicants to follow through.
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Old 12-09-2013, 11:05 AM #7
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I think you're confusing my point. I stated the AC read your appeal--which they decided was without merit, and as a result you received a denial. I didn't state that they read every ALJ decision--in some cases it might not be necessary.

Over half of the applicants that file appeals will eventually be awarded benefits, so statistically it is not a waste of time for applicants to follow through.
Thats just the point intended for the op, how is it possible to decide your appeal is without merit if they have not even read the decision? You are confusing him I think, its profoundly necessary that the OP understand just what they are up against here. Its both figuratively and literally impossible for AC to reject an appeal based on such outrageousness....Yet they do just that thousands of times each year.

The only chance the op has is in a federal courtroom, tacking on an easy extra 3-5 yrs to the process, that or he can file a new claim and hope for a different outcome. These people need to understand the truth, and that is that most of them are going to lose, and lose badly!
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Old 12-09-2013, 12:09 PM #8
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Thats just the point intended for the op, how is it possible to decide your appeal is without merit if they have not even read the decision? You are confusing him I think, its profoundly necessary that the OP understand just what they are up against here. Its both figuratively and literally impossible for AC to reject an appeal based on such outrageousness....Yet they do just that thousands of times each year.

The only chance the op has is in a federal courtroom, tacking on an easy extra 3-5 yrs to the process, that or he can file a new claim and hope for a different outcome. These people need to understand the truth, and that is that most of them are going to lose, and lose badly!
Only 4% of the cases are given an outright approval at the Federal Court level. Most are either denied (40%) or simply remanded (47%) back to an ALJ.

http://www.ultimatedisabilityguide.c...ial_rates.html

I don't know how you came to the decision that Federal Court would give you, or anyone, a better opportunity for approval, but it just isn't true. It can give you another opportunity to keep your case alive and not lose backpay, so that new evidence can be presented to an ALJ--but that's generally what one is trying to accomplish with the AC as well.
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Old 12-09-2013, 01:36 PM #9
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Only 4% of the cases are given an outright approval at the Federal Court level. Most are either denied (40%) or simply remanded (47%) back to an ALJ.

http://www.ultimatedisabilityguide.c...ial_rates.html

I don't know how you came to the decision that Federal Court would give you, or anyone, a better opportunity for approval, but it just isn't true. It can give you another opportunity to keep your case alive and not lose backpay, so that new evidence can be presented to an ALJ--but that's generally what one is trying to accomplish with the AC as well.
The thing is that the federal court is a "real" court, while AC is just another sham barrier erected by SSA. Far more people are remanded at the federal court than at AC, I seem to recall just 2% of AC appeals experience any success.. Also, as the years rack up, date of last insured becomes the issue, as was the case with myself, then you have no other option, and don't you doubt it for a minute that AC knowing this, rubber stamps hundreds and hundreds of corrupt ALJ decisions as a consequence! The vast majority just cave in to them at that stage, the vast majority will not be getting a fair shot at AC, and every attorney knows this, it shows up in how they write the appeals, or in how they don't write them, they expend almost zero effort at this stage, they know the game....

Thats why we have the federal option, that court knows just how despicable most of these decisions really are, if you have a genuine disability, and you've been screwed royally by SSA, if you have a case, the federal court will almost always intervene, unfortunately it takes several years for them to weigh in on the matter!
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Old 12-09-2013, 04:45 PM #10
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The thing is that the federal court is a "real" court, while AC is just another sham barrier erected by SSA. Far more people are remanded at the federal court than at AC, I seem to recall just 2% of AC appeals experience any success.. Also, as the years rack up, date of last insured becomes the issue, as was the case with myself, then you have no other option, and don't you doubt it for a minute that AC knowing this, rubber stamps hundreds and hundreds of corrupt ALJ decisions as a consequence! The vast majority just cave in to them at that stage, the vast majority will not be getting a fair shot at AC, and every attorney knows this, it shows up in how they write the appeals, or in how they don't write them, they expend almost zero effort at this stage, they know the game....

Thats why we have the federal option, that court knows just how despicable most of these decisions really are, if you have a genuine disability, and you've been screwed royally by SSA, if you have a case, the federal court will almost always intervene, unfortunately it takes several years for them to weigh in on the matter!
While the AC approves 2% of the case, the FC only approves 4%. Not such a huge difference IMO, and when you factor in only about 10% of those denied or dismissed by the AC proceed to FC, than you have to assume those ambitious enough to proceed (or find an attorney that will represent them) likely have the strongest cases.

Last year (approx.) 7400 people were remanded from FC to ALJ, and 600 were approved by the FC. Whereas (approx.) 36,500 people were remanded from the AC back to an ALJ, and 3300 were approved AC.

More people are being helped at the AC level and faster than at the FC level. Most applicants will start a new application, even if it must be an SSI application, before going to FC. So, while I would agree it is important that they submit a well prepared appeal, preferably by a highly qualified attorney, I don't see the point of focusing on FC when they are at the stage the OP is.
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