Mentally ill Claimant had a severe physical impairment, but her abuse of antidepressants (drug/alcohol abuse) endangered her eligibility.

HCFS representation included the presentation of our proprietary Medical Source Statement for Mental Impairments. Since this HCFS form is filled out by the Claimant's treating physicians, it is given priority over the SSA's consulting doctors, and is instrumental in proving that a DAA is not a contributing factor. We find it is the single most important component of winning a mental illness SSI claim.

The HCFS Representative is responsible for obtaining this supporting material. Obtaining it early in the application process very often wins a case prior to the ALJ level, thereby helping the hospital to be paid sooner.

By obtaining these statements, and through careful questioning by the Claimant's representative at the ALJ hearing, HCFS obtained SSI eligibility for the Claimant due to her inability to perform other gainful activity.

Key:

1. Prove Claimant meets Listing 12.04 by compiling her medical and psychiatric records and sending these by verifiable means to the SSA.
2. Have as many as possible of Claimant's treating physicians fill out the HCFS Medical Source Statement for Mental Impairments. This form is given priority over the SSA's consulting doctors as long as there is medical evidence to support the Medical Source Statement. It requires the ALJ and the SSA's witnesses to show (by references to the hearing record) why the Claimant's treating physician opinion should be ignored.
3. As mental disabilities "remove" this Claimant from the mandatory Grid regulations, the disability Listings must be met or equaled to win.
4. Even though the Claimant met a listing, the SSA attempted to deny benefits by saying the Claimant's drug use was a contributing factor material to her Depression. The Claimant's Representative had to make the SSA prove its case (that the DAA is a contributing factor material to the determination of disability). At the ALJ hearing, the HCFS representative forced the SSA to prove the DAA by use of the following questions to the ALJ's medical expert:
   • Would you still find the individual disabled if he/she stopped using drugs or alcohol?
   • Which of the current physical and mental limitations, upon which you based the current disability determination, would remain if the individual stopped using drugs or alcohol for 30 days?
   • Would any or all of these remaining limitations be disabling?

Result:
Claimant determined to be disabled. The SSA cannot overcome the Claimant's treating physician's statements and through questioning by the Claimant's representative at the ALJ hearing, the SSA cannot prove that the Claimant's drug use was a material factor contributing to her depression. The claimant therefore may be found disabled as long as the SSA's vocational expert cannot show the Claimant can perform other gainful activity given her medical condition. The Claimant's inability to perform other gainful activity is proved through the use of the Medical Source Statement.