GRID RULES AND SOCIAL SECURITY DISABILITY

Sometimes, an individual can be quickly approved for disability benefits by use of the "grid rules."  What are grid rules and how are they helpful?

The so-called rules are officially the "medical-vocational guidelines" published in 20 CFR 404, Subpart P, Appendix 2.

The grids look at several factors in addition to your medical impairment to see if a finding of disability is directed by the published guidelines.  

The information is laid out in a table with 5 columns in a grid (hence the name, GRID RULES).

These rules can only be used for physical impairments.  If you have psychological impairments or non-exertional impairments, the rules don't apply. 

Also, these rules only apply to claimants who are at least 50 years old.  (Young individuals can get benefits, but not by using grids).

The following 5 things are considered by the grids:

• your age
• your education level
• the skill level of the work you did in the past 15 years
• whether you have learned any skills that can be used in a different job, and
• your residual functional capacity (RFC) – what you can do despite your impairments.

Here's an illustration of how we would apply the grid rules:

In column 1, John's residual functional capacity is limited to sedentary work.  In column 2, he is 55 years old, hence a person of "advanced age."  In column 3, John has a 9th grade education, considered a limited education.  In column 4, past work experience has been in an unskilled job, so there are no transferable skills.  Based on all of these factors, column 5 directs a decision of disability, based on Grid Rule 201.01.

CAUTION:  At the application level, decision makers tend to deny most applications.  Therefore, I suspect that John's claim would be denied at the first level of review.  He will probably still get a letter stating something like this:  "You are not eligible for disability benefits.  This is because you are not disabled according to our rules."

Why would they deny this claim?  Because the decision maker will not concede the fact that John is limited to sedentary work.  They will say he can perform light or medium work.  Since they set his Residual Functional Capacity too high, he won't meet a grid rule and a denial results.  About one-half of the applications that I see denied encounter this error.

John will need to appeal this denial within 60 days.  The appeal, if filed in time, will take his claim before an administrative law judge (ALJ) who will reevaluate his medical evidence and, hopefully, recognize his RFC as limited to sedentary work.  When this happens, John will meet the grid rule (201.01) and be awarded his benefits.

The chore for John's attorney will be to prove that his client is limited to sedentary exertion level, using medical evidence from John's doctors.  The attorney will quickly analyze the denial and see right away what the problem is.  He or she will also know immediately must happen to get the denial overturned at the hearing.

So, John's attorney will go into the hearing focused on the main problem.  The goal will be to use evidence to demonstrate that Grid Rule 201.01 will determine that John is disabled under Social Security's own rules and that he should be paid.

This is so much different than what would happen if the claimant just went to the hearing unrepresented and hoped for the best. Being unaware of Grid Rule 201.01, John would probably tell the judge the truth about his impairments--but fail to direct the case to its proper focal point--Rule 201.01, where his age, education, lack of skilled work and proper residual functional capacity would direct approval of benefits.

REPRESENTED BY COMPETENT COUNSEL:  John could be found disabled on his alleged onset date of 2/18/15.*  He will receive $37,604 in past due benefits and will get a check for $1,687 per month for as long as he is disabled.  He will also get Medicare insurance to pay for medical treatment.  He will pay his attorney-advocate a $6,000 fee, taking home $31,604 in past due benefits and all of his monthly award.

UNREPRESENTED:  John may be denied again.  If so, he will receive $0 back pay and $0 per month in benefits.  He would get no Medicare insurance.  Did he just save a $6,000 attorney's fee?  Well, that's not the way I would look at it!

You don't have to understand Social Security's complicated rules.  Just be sure you hire someone who does!
_____________
THE FORSYTHE FIRM
Social Security Disability Representation
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

FORSYTHE FIRM: SOCIAL SECURITY JUSTICE 


*All names used in this post are fictional so that no claimant's identity is compromised.  Numbers are reasonable representations of benefits that might apply, not actual numbers.  Having a representative does not guarantee that you will win your case because, obviously, some represented claimants also are denied.  But having adequate representation gives you a better chance for approval, especially at appeal.  This post is used for general information and not for legal advice on any particular situation.  Consult an attorney or Social Security representative about your case.