EDPNA PRACTICE EXAM

Question 1

To be disability insured for Title II Disability benefits an individual must,

Answer 1

Have worked 5 out of the last 10 years and paid into the system.

Question 2

At the fourth step of the sequential evaluation process, if a claimant has the residual functional capacity to perform his/her past relevant work, then,

Answer 2

A finding of not being disabled is made, and the analysis stops there at step four.

Yes, in the context of the Social Security disability sequential evaluation process, if at step four it is determined that a claimant has the residual functional capacity (RFC) to perform his past relevant work (PRW), then the claimant is found to be not disabled, and the analysis concludes at that step without proceeding to step five1. The sequential evaluation process is designed to stop at the step where a determination can be made. If the claimant cannot perform PRW, or if there is no past relevant work, then the evaluation proceeds to step five.

Question 3

A new client contacts you on 5/16/21 about assisting him in filing an appeal. His initial denial notice is date‐stamped 3/1/21, but he indicates that he did not receive the notice until 4/4/21. He kept the envelope in which the notice was mailed, and the postage date was 3/31/21. You:

Answer 3

c. assist him in filing an immediate appeal, requesting that the appeal be considered timely filed since he can prove he did not receive the notice within five days of its date‐stamp.

Question 4

4. An individual is applying for Title II Disability benefits with a 1/1/2013 onset date, who earned 4 quarters of coverage each year in 2008, 2009, 2010, 2011 and 2012, would have the following date last insured for benefits,

Answer 4

December 31, 2017

The Date Last Insured (DLI) is indeed the last day of the quarter in which a claimant meets the insured status for disability or blindness. However, if the individual has a consistent work history and has earned 4 quarters of coverage each year from 2008 to 2012, the DLI would extend beyond the onset date of 1/1/2013 due to the “20/40” test. This test requires 20 quarters of coverage within the last 40 quarters. Since the individual has earned coverage for each year from 2008 to 2012, they would have coverage extending beyond 2013.

The correct DLI would be the last day of the quarter in which the claimant’s insured status expires, which could be December 31, 2017, if they did not earn any more quarters of coverage after 2012. The Social Security Administration uses the individual’s work history to determine the DLI, and the “20/40” test is a common method for this calculation.

Imagine you have a big jar of cookies. To be allowed to take a cookie, you need to have put at least 20 cookies into the jar over the last 10 years. The 10 years is like the jar, and the 20 cookies are like the work you’ve done.

In the Social Security system, the “cookies” are like the work credits you earn when you work and pay Social Security taxes. The “jar” is the last 40 quarters, which is like the last 10 years. You need to have earned at least 20 work credits (cookies) within the last 40 quarters (10 years) to be eligible for disability benefits.

So, if you’ve worked enough to earn those 20 credits in the last 10 years, you can “take a cookie” – which means you can get disability benefits if you need them. If you haven’t put enough cookies in the jar, you can’t take one out, which means you wouldn’t be eligible for the benefits. It’s a way for the Social Security Administration to make sure people have worked recently enough and long enough to qualify for disability benefits

Question 5

5 full consecutive months will be served as a waiting period on Title II claims during which time you were disabled. Once you have served a 5‐month waiting period on a claim, no 5 month waiting period is required on a subsequent allowed claim as long as that subsequent claim is filed within how many years of the month you again became disabled?

Answer 5

5 years.

For a Social Security Title II claim, once you have served a 5-month waiting period on a claim, you are not required to serve another 5-month waiting period on a subsequent allowed claim as long as that subsequent claim is filed within 5 years of the month you again became disabled. This is because the Social Security Administration recognizes the initial waiting period and allows a grace period for re-filing if your disability recurs. The 5-year timeframe provides a window during which you can file a new claim without needing to wait an additional 5 months, assuming your disability continues or recurs within that period. This policy is designed to streamline the process for individuals who have recurring disabilities and need to reapply for benefits.

The rule regarding not having to serve another 5-month waiting period for Social Security Title II benefits if a subsequent claim is filed within 5 years of the month you again became disabled is found in the Social Security Administration’s rulings. Specifically, it is mentioned in SSR 82-52. This ruling explains that entitlement to benefits can begin after the 5-month waiting period in Title II claims, or with the first full month of disability in a no-waiting period case, as long as the current disability began within 5 years of a previous period of disability ceasing. This provision is designed to help those who have recurring disabilities and need to reapply for benefits.

Question 6

All of the following information is used in determining the claimant’s alleged onset of disability for the purposes of their disability claim:

Answer 6

a. The date they last worked due to their medical condition.
b. The date their disability prevented them from earning SGA.
c. The date their medical records reflect a severe impairment which interferes with their ability to earn SGA.
d. The date which begins a 30‐day break from earning above SGA after which claimant either had UWA(s) or earnings below SGA.

“UWA(s)” stands for Unsuccessful Work Attempts. In the context of Social Security, a UWA is when someone tries to work but has to stop or reduce their work to below Substantial Gainful Activity (SGA) level within 6 months because of their disability or because special conditions that allowed them to work are removed. Basically, it’s like giving work a try but not being able to keep it up because of a disability. This doesn’t stop someone from being considered disabled for Social Security benefits. If someone has a UWA, it means they tried to work but couldn’t keep it up, and it helps Social Security decide when their disability started.

Question 7

A homeless 30‐year‐old claimant moves in with his mother and then files an application for SSI disability benefits. His mother, who receives a $4,000.00 per month pension, is allowing him to live with her for free, and paying for his food. The claimant will:

Answer 7

A homeless 30‐year‐old claimant moves in with his mother and then files an application for SSI disability benefits. His mother, who receives a $4,000.00 per month pension, is allowing him to live with her for free, and paying for his food. The claimant will:
a. have his benefit reduced by one‐third, as he receives in‐kind support.

a. have his benefit reduced by one‐third, as he receives in‐kind support.

In the scenario described, the claimant will have his Supplemental Security Income (SSI) benefit reduced by one-third because he is receiving in-kind support from his mother. This is because the Social Security Administration (SSA) considers in-kind support and maintenance as income when determining SSI benefit amounts. In-kind support includes food and shelter that someone else provides for you. Since the claimant’s mother is providing both food and shelter, this is counted as in-kind support.

The section of the law that supports this is found in the SSA’s official explanation of how living arrangements affect SSI benefits. Specifically, the SSA’s policy states that if you live in another person’s house and pay less than your fair share of food or housing costs, your SSI benefits may be reduced. This is known as the one-third reduction rule. The SSA uses this rule to ensure that the SSI benefit amount reflects the claimant’s actual need for assistance, taking into account the support they receive from others.

Question 8

A claimant with severe mental impairments is awarded disability benefits but is deemed incapable of managing his own funds. His sister is appointed as his representative payee, and Social Security has requested that she provide documentation of how she is spending the claimant’s money on his behalf. The sister has failed to respond, and another relative has anonymously advised Social Security that she has a “drinking problem.” SSA will likely:

d. require the sister to come into the local Social Security office to receive the
claimant’s monthly benefit check, so that a determination of her accounting and fitness to continue as the claimant’s representative payee can be made.

Answer 8

require the sister to come into the local Social Security office to receive the
claimant’s monthly benefit check, so that a determination of her accounting and fitness to continue as the claimant’s representative payee can be made.

Question 9

Into which education category does a person who obtained a 7th grade through 11th grade level of formal education generally fall?

Answer 9

Limited Education.

A person who has obtained a 7th grade through 11th grade level of formal education generally falls into the Limited Education category in the context of Social Security Disability eligibility evaluation. This means they have basic reasoning, arithmetic, and language skills, but not enough to perform most of the more complex job duties needed in semi-skilled or skilled jobs.

The law and regulation section that supports this classification is found in 20 CFR 416.964, which outlines the four categories of education used to evaluate an individual’s education level during the disability determination process. This categorization helps in assessing the vocational factors at step 5 of the sequential evaluation process when determining disability.

Question 10

A client comes to you asking for representation for their Title II claim for benefits due to chronic heart failure. In reviewing the claimant’s medical records, you see that recent medical evidence shows your client has diastolic failure with left ventricular posterior wall plus septal thickness of 2.7 cm and an enlarged left atrium of 4.3 cm with normal elevated ejection fraction during periods of stability. The record also shows that your client has experienced three episodes of acute congestive heart failure within the last year. Does your client’s chronic heart failure meet a Listing?

No, because their impairment does not meet or medically equal the requirements for both subsections A and B of the appropriate Listing.

Answer 10

No, because their impairment does not meet or medically equal the requirements for both subsections A and B of the appropriate Listing.

The client’s chronic heart failure does not meet a Listing because their impairment does not meet or medically equal the requirements for both subsections A and B of the appropriate Listing. According to Social Security’s Listing 4.02 for chronic heart failure, to meet the listing, an individual must satisfy both part A and part B despite receiving prescribed treatment.

Part A typically requires documented evidence of severe limitation of activities due to symptoms such as angina, syncope, or congestive heart failure. Part B usually requires specific findings on medical tests, such as imaging or exercise testing, that show the heart’s inability to pump enough blood to meet the body’s needs.

In this case, while the client has experienced episodes of acute congestive heart failure and has certain measurements indicating heart issues (like the enlarged left atrium and septal thickness), there is no indication that these findings meet the specific criteria outlined in both subsections A and B of Listing 4.02. Therefore, the client’s condition does not meet the requirements for a Listing based on chronic heart failure.

Question 11

What is NOT true about the basic definition of disability?

Answer 11

What is NOT true about the basic definition of disability?

a. Has the ability to do any substantial gainful activity.

Note: The claimant must not have the ability to do any substantial gainful activitiy.

Question 12

What is true about unskilled work?

Answer 12

a. The work needs little or no judgment to do simple duties.
b. The work can be learned on the job in a short period of time.
c. A person does not gain work skills by doing unskilled jobs.
d. All of the above.

Unskilled work refers to jobs that require little or no judgment to perform simple duties, and these tasks can typically be learned on the job in a short period of time. Additionally, while performing unskilled work, a person does not gain the work skills that are usually associated with semi-skilled or skilled jobs. Therefore, the correct answer is d. All of the above. Unskilled work is characterized by its simplicity and lack of requirements for advanced training or specialized skills

Question 13

Which statement is true about disabled widows’ benefits?

Answer 13

a. The deceased must have been fully insured at the time of their death. (404.335 (a))

Question 14

13. The following would be a situation that requires the use of a fee petition to obtain
    representative fee,

Answer 14

d. The representative told the claimant that their fee was pro bono but changed their mind and decided after the case was approved to charge a fee for services.

Question 15

Under Vocational Considerations, if we find that you can no longer do the kind of work you have done in the past, consideration will then be given to your residual functional capacity, age, education and work experience to determine whether you can do other work. By other work we mean:

Answer 15

Jobs that exist in significant numbers in the national economy.

Question 16

Res Judicata would apply if,

Answer 16

The claimant misses the appeal deadline and files a new claim with the same onset date as the prior claim with all the same issues and facts being considered.

Res Judicata is a legal principle that prevents a claim from being re-evaluated if it has already been judged on the same issues and facts. In the context of Social Security claims, Res Judicata would apply in the situation described in option b. If a claimant misses the appeal deadline and files a new claim with the same onset date and all the same issues and facts as the prior claim, the Social Security Administration (SSA) can deny the new claim on the basis of Res Judicata. This is because there are no new facts or evidence to warrant a different decision, and the SSA aims to avoid redundant evaluations of the same claim.

The SSA’s Program Operations Manual System (POMS) outlines the application of Res Judicata in GN 03101.160, stating that if a new application is filed with the same issue by the same party and no new facts or evidence, the application may be denied on this basis1. This policy helps maintain the efficiency of the claims process by preventing repetitive reviews of identical claims.

Question 17

RFC is,

Answer 17

A claimant’s maximum remaining ability after considering all of their limitations and symptoms caused by a medically determinable impairment.

Question 18

At Step 4 of the Sequential Evaluation, RFC is used to,

Answer 18

Assess their ability to perform past relevant work‐related activities.

Question 19

Which statement is accurate about prescribed treatment?

Answer 19

The SSA with good cause will determine if you have acceptable reason(s) for failure to follow prescribed treatment.

the Social Security Administration (SSA) will determine if there is good cause for a claimant’s failure to follow prescribed treatment. Good cause may include reasons such as the claimant’s inability to afford the treatment, severe side effects, intense fear of surgery, religious prohibitions, or medical disagreement among the claimant’s own medical sources. The SSA recognizes that there may be legitimate reasons why a claimant cannot adhere to prescribed treatment and will consider these when evaluating disability claims. If a claimant fails to follow prescribed treatment without good cause, it could affect their eligibility for disability benefits.

Question 20

To be found disabled between age 45 and 49 an individual must…

Answer 20

a. Be illiterate and unable to communicate in English, have no past work or past work which is unskilled and be limited to sedentary work.
b. Have an RFC of less than sedentary.
c. Meet a listing within the Adult Listing of Impairments.
d. All of the above

Question 21

When does SSA NOT consider your age, education, and work experience?

Answer 21

When your impairments meet or equal a listing.

Question 22

What is the punishment for a representative who violates the Rules of Conduct and Standards of Responsibility?

Answer 22

Violation of any section of the Rules of Conduct and Standards of Responsibility results in criminal or civil monetary penalties.

Question 23

Which is true about a medical opinion if a claim was filed after March 27, 2017?

Answer 23

Supportability, consistency, relationship with the claimant, specialization.

For medical opinions in Social Security claims filed after March 27, 2017, the most important factors considered are supportability and consistency. These factors are crucial in determining how persuasive a medical source’s opinions are:

Supportability: This refers to the extent to which a medical opinion is supported by relevant objective medical evidence and the explanations provided by the medical source. The more relevant the objective medical evidence and supporting explanations are, the more persuasive the medical opinions will be.

Consistency: This involves the extent to which a medical opinion is consistent with the evidence from other medical and nonmedical sources, including internal conflicts within the evidence from the same source.

The relationship with the claimant and the specialization of the medical source are also considered, but they are not as critical as supportability and consistency. The new rules emphasize the importance of an opinion being well-supported by medical evidence and consistent with other information in the case record.

Question 24

In the sequential evaluation process, the SSA does NOT consider the presence and severity of a symptom(s) when determining:

Answer 24

If you are engaging in substantial gainful activity.

In the Social Security Administration’s sequential evaluation process, the presence and severity of symptoms are not considered when determining if an individual is engaging in Substantial Gainful Activity (SGA). SGA refers to work activity that is both substantial and gainful:

Substantial: Work activity that involves doing significant physical or mental activities.
Gainful: Work activity that is the kind of work usually done for pay or profit, whether or not a profit is realized.
Determining SGA is based on earnings and the nature of the work, not on the individual’s symptoms. If a person is earning more than a certain monthly amount (set by SSA), they are generally considered to be engaging in SGA and are not eligible for disability benefits, regardless of their symptoms. This is because SGA is viewed as an indicator of the ability to work and earn, which is separate from the medical evaluation of disability.

Question 25

Delma Anderson has an initial application pending at the Social Security Administration. She was sent forms that have a 15‐day deadline to complete and return. It is now the 20th day, what will likely happen?

Answer 25

The SSA may decide she is not eligible for benefits.

If Delma Anderson has missed the 15-day deadline to complete and return the forms for her initial application at the Social Security Administration, and it is now the 20th day, her application may be delayed or, in some cases, denied due to non-compliance with the deadline. However, if she has a good reason for missing the deadline, such as not receiving the forms in time or facing circumstances beyond her control, she may be able to request an extension or have her application processed late. It’s important for her to contact the SSA as soon as possible to explain the situation and seek guidance on how to proceed. The SSA generally allows for good cause exceptions in cases where the claimant can justify the delay.

Question 26

Alicia Garcia filed her application for disability insurance benefits and supplemental security income in January 2022. She stopped working. She is insured through December 30, 2027, for disability insurance benefits. She has a checking account with $15,000.00 in it but is using the money to live off. In May 2022 when she filed her reconsideration, she had $7,000.00 in her checking account. She was still not eligible for supplemental security income. She filed her request for a hearing in October 2022 and had $1,500.00 in her checking account making her eligible to apply for supplemental security income. The application for supplemental security income was processed. What will happen next?

Answer 26

The ALJ will hold a consolidated hearing and decide on both claims.

Here’s why:

Consolidated Hearing: When Alicia Garcia filed her request for a hearing in October 2022, she had $1,500.00 in her checking account, which made her eligible to apply for Supplemental Security Income (SSI). Since her application for SSI was processed and she also has a pending application for disability insurance benefits, the Administrative Law Judge (ALJ) will likely hold a single hearing to consider both claims together.

Efficiency and Practicality: Holding a consolidated hearing is more efficient and practical because it allows all issues related to Alicia’s eligibility for both types of benefits to be addressed at once. This avoids the need for separate hearings, which can be time-consuming and redundant.

Decision on Both Claims: During the consolidated hearing, the ALJ will review all the evidence presented for both the disability insurance benefits and the SSI claim. The ALJ will then make a decision on both claims based on the evidence and the applicable law.

This approach ensures that Alicia’s eligibility for both types of benefits is evaluated fairly and thoroughly, taking into account her financial situation and medical condition as of the dates relevant to each application.

Question 27

Exertional capacity addresses an individual’s limitations and restrictions of physical strength and defines the individual’s remaining ability to perform each of seven strength demands:

Answer 27

Sitting, standing, walking, lifting, carrying, pushing and pulling

Question 28

An individual can be found disabled under the arduous work rule if they meet the following criteria,

Answer 28

History of performance of unskilled arduous physical labor for at least 35 years with marginal education and an inability to perform that work due to a severe limitation caused by a medical condition.

The arduous work rule applies to individuals who have a long history of physically demanding labor and are now unable to continue that work due to a medical condition. Here’s a breakdown of the rule:

Unskilled Arduous Physical Labor: This refers to work that requires significant physical effort and is not skilled, meaning it doesn’t require specialized training or significant work experience.

35 Years or Longer: The individual must have performed this type of labor for at least 35 years.

Marginal Education: The person has limited formal education, which restricts their ability to transition to less physically demanding work.

Severe Limitation: A medical condition must significantly limit the person’s ability to perform the kind of work they have done in the past.

If someone meets these criteria, they may be considered disabled under Social Security rules because their limited education and work experience, combined with their severe medical condition, make it difficult for them to find and perform less demanding work.

Question 29

Mr. Smith is a non‐attorney who is authorized to receive direct payment from the Social Security Administration. He is representing John Mills who recently received an initial determination denying his claim for Disability Insurance Benefits and Supplemental Security Income and requires a response within 60 days. Mr. Mills contacted the Social Security Administration and asked for the “Request for Reconsideration,” appeal forms. The Social Security Administration mailed the forms to Mr. Mills who completed the forms and took them to his representative. Mr. Smith must take what action:

Answer 29

Complete the internet disability report appeal.

Question 30

Claimant John James is a 55‐year‐old male who worked his entire life as a brick layer with a high school diploma. According to the claimant’s consultative examination, the Doctor stated that the claimant could lift no more than 10 pounds frequently and 20 pounds occasionally. The claimant could walk up to 6 hours in an 8‐hour day and sit up to unlimited in an 8‐hour day. What rule would be used to determine that the claimant was disabled or not disabled according to the regulations of the Social Security Administration?

Answer 30

The claimant would be found disabled using the Medical Vocational Guidelines for light with a high school education, where his previous work is skilled, but not transferable.

The claimant would be found disabled using the Medical Vocational Guidelines for light with a high school education, where his previous work is skilled, but not transferable. Here’s why:

Medical Vocational Guidelines: These guidelines consider a person’s physical capacity, age, education, and work experience to determine disability.
Light Work: The doctor’s assessment indicates the claimant can perform light work, which involves lifting no more than 20 pounds occasionally and 10 pounds frequently.
High School Education: The claimant has a high school diploma, which is considered when evaluating the ability to transition to other work.
Non-transferable Skills: As a bricklayer, the claimant’s skills are likely specialized and may not transfer to lighter work that he could physically handle.
Given these factors, the claimant’s inability to perform past relevant work, combined with his age, education, and work experience, would likely lead to a finding of disability under the Medical Vocational Guidelines.

Question 31

The definition of disability does not include which of the following elements:

Answer 31

The claimant must meet the insured status requirements.

Question 32

An individual who can meet the exertional demands of medium work with no limitation of fine dexterity or ability to sit for long periods of time can also meet the exertional demands of:

Answer 32

both sedentary and light work

An individual capable of meeting the exertional demands of medium work can also meet the demands of both sedentary and light work. Here’s why:

Medium Work: Involves lifting no more than 50 pounds at a time, with frequent lifting or carrying of objects weighing up to 25 pounds.

Sedentary Work: Involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools.

Light Work: Involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds.

Since medium work is more strenuous than both sedentary and light work, a person who can do medium work is generally also able to do sedentary and light work, unless there are additional non-exertional limitations that would prevent them from doing so.

Question 33

You are currently insured if during the 13‐quarter period ending with the quarter in which you either (1) die, (2) most recently became entitled to disability insurance benefits, or (3) became entitled to old‐age insurance benefits, you have at least the following number of quarters of coverage:

Answer 33

6 quarters.

To be considered currently insured for Social Security benefits, you need to have earned a certain number of quarters of coverage within a specific timeframe. This timeframe is the 13-quarter period ending with the quarter in which you either die, become entitled to disability insurance benefits, or become entitled to old-age insurance benefits.

During this 13-quarter period, you must have at least six quarters of coverage to be currently insured. A quarter of coverage is earned by working and paying Social Security taxes; however, you can earn no more than four quarters of coverage per year. The number of quarters required can vary depending on your age and other factors, but the minimum is six quarters for current insurance status.

Question 34

In the absence of evidence to the contrary, a 7th - 11th grade level of formal education is considered a “limited education.”

Answer 34

The correct answer is 7th ‐ 11th. A “limited education” refers to a formal education level that typically does not exceed the 11th grade. This level of education is considered limited because it provides basic reasoning, math, and language skills, but may not be sufficient for performing more complex tasks required for skilled and semi-skilled jobs. Therefore, individuals with a 7th to 11th grade level of education are generally expected to perform unskilled work.

Question 35

Under Section 404.335 of the CFR (Who is Entitled to Widow’s or Widower’s Benefits), in order to receive benefits as the widow or widower of a person who was fully insured when he or she died, what is the minimum amount of time the relationship must have lasted between the insured and the insured’s widow/widower?

Answer 35

9 months.

To be eligible for widow’s or widower’s benefits under Section 404.335 of the Code of Federal Regulations (CFR), the relationship between the insured and the widow or widower must have lasted for a minimum of 9 months. This requirement ensures that the marriage was established for a reasonable duration before the insured’s death, providing a basis for the survivor’s claim to benefits. The 9-month duration rule is intended to prevent abuse of the system by excluding claims from very brief marriages that might not reflect a genuine long-term dependency on the deceased’s earnings. However, there are exceptions to this rule, such as if the death was accidental or occurred in the line of duty as a uniformed service member, in which case the 9-month requirement may be waived. CFR404.335
outlines these provisions to protect the integrity of the Social Security program while providing support to those who have lost a spouse.

Question 36

The re-entitlement period of eligibility is applicable to a claim if,

Answer 36

The claimant previously received disability benefits under Title II of the Social Security Act and who completes a nine‐month trial work period and continues to have a disabling impairment resulting in SSA providing the claimant with a 36‐ month re‐entitlement period.

The re-entitlement period of eligibility applies to a claim if the claimant previously received disability benefits under Title II of the Social Security Act and completes a nine-month trial work period while continuing to have a disabling impairment. This results in the Social Security Administration (SSA) providing the claimant with a 36-month re-entitlement period. During this period, the claimant can be re-entitled to benefits if their work activity falls below the substantial gainful activity (SGA) level. The extended period of eligibility (EPE) starts the month after the trial work period ends and can continue indefinitely depending on the claimant’s work activity. The first 36 months after the trial work period is the re-entitlement period.

Question 37

A claimant files a Title XVI application on 2/13/18, alleging disability since October of 2017 due to a stroke, she has not regained the ability to use her right arm and leg effectively, with her arm hanging flaccidly at her side, and her leg dragging behind her. SSA finds her disabled as of her AOD. Benefits will begin:

Answer 37

3/1/18, the first of the month following the month the application was filed.

The benefits for the claimant who filed a Title XVI application due to disability from a stroke will begin on 3/1/18, which is the first of the month following the month the application was filed. This is because, for Supplemental Security Income (SSI) under Title XVI, there is no waiting period like there is for Social Security Disability Insurance (SSDI). Therefore, the benefits start from the beginning of the month after the application is filed, provided the Social Security Administration (SSA) finds the claimant disabled as of their alleged onset date (AOD). In this case, since the application was filed on 2/13/18 and the claimant was found disabled as of their AOD, the benefits will commence from the next month, which is March 2018.

Question 38

Joe Bob Smith represents Dorothy James, a 56‐year‐old former paralegal, who is unable to work due to lumbar radiculopathy. Joe Bob filed a request for hearing by mail on 2/26/18 and they received a notice of hearing on 6/20/18 that the hearing would be held on 8/8/18. In preparation for the hearing, Joe Bob had a difficult time getting records. He requested
records from Dorothy’s pain management doctor, however despite three written requests and two phone calls, the office reported that they would not be able to provide the records due to her outstanding balance. Joe Bob also requested records from Dorothy’s chiropractor, along with a medical source statement. The chiropractor returned records and a completed medical source statement that was not supportive of disability and indicated malingering. Joe Bob submitted the chiropractor records on 8/4/18 but did not submit the completed statement since it was not supportive. In the interest of time, Joe Bob did not request Dorothy’s primary care records. At the hearing, the judge was very vocal about the missing pain management records and primary care records and did not admit the chiropractor
records into evidence. The ALJ issued a denial on 10/12/18. Joe Bob chose not to appeal the denial and sent Ms. James an invoice for $2400 for 20 hours that he spent on her claim, which she paid before finding an NADR member to appeal the claim for her.

Which of the following is true given the above scenario?

Answer 38

Joe Bob Smith waived the required 75‐day notice for hearing scheduling.

The correct answer is a. Joe Bob Smith waived the required 75‐day notice for hearing scheduling. This is evident because the notice of hearing was received on 6/20/18 for a hearing scheduled on 8/8/18, which is less than the 75-day notice period typically required. Joe Bob Smith must have waived this requirement to expedite the hearing process.

It’s important to ensure all relevant medical records and supportive documents are submitted in a disability claim to avoid such issues.

The 75-day notice rule for disability hearings is outlined in the Social Security Administration’s (SSA) Hearings, Appeals and Litigation Law (HALLEX) manual, specifically in section I-2-3-15. This rule requires the Office of Hearings Operations (OHO) to send a notice of the hearing to the claimant and the claimant’s representative at least 75 days before the date set for a hearing, unless the claimant waives the right to advance notice in writing.

For an amended notice of hearing or notice of supplemental hearing, the notice must be sent at least 20 days before the date of the hearing. The date indicated in an amended notice will be at least 75 days from when the claimant first received a notice of hearing, again, unless the claimant waives the right to advance notice.

This rule ensures that claimants have sufficient time to prepare for their hearing, including gathering all necessary medical records and evidence to support their disability claim. Waiving this notice period can expedite the hearing process, but it also means that the claimant and their representative have less time to prepare.

Question 39

What should Joe Bob have done regarding the Pain Management records?

Answer 39

Notified the judge in writing at least 5 business days before the hearing of the outstanding records.

Question 40

Claimant is age 50 and has no work history. He has always lived with his mother, who died in 2015 and left him her estate. In February 2016 he is diagnosed with lupus while on vacation in the U.S. Virgin Islands. He was detained by Customs Officials for four hours during his return
flight and finally arrived home in March 2016, whereupon he contacts you to ask about potential Supplemental Security Income eligibility. The estate he inherited remains his only assets, and he has no income. He spent most of the cash his mother left him on his Caribbean trip. As of 2/29/2016 the claimant’s remaining assets were:

2011 Audi Sedan valued at $20,000.
5 bedrooms, 3 bath house (where he lives) on 43 acres, with
standing timber. The property is valued at $500,000. This is
the estate he inherited.
$1900 in checking account

Based on this information, you advise the claimant that:

d. He is potentially eligible for SSI because the home, land and car are excluded from resources.

Answer 40

d. He is potentially eligible for SSI because the home, land and car are excluded from resources.

According to the Social Security Administration, the home you live in and the land it is on are not counted as resources for SSI. Similarly, one vehicle may also be excluded if it is used for transportation for the claimant or a member of their household.

Question 41

A 53‐year‐old male with a 6th grade education has the ability to read and
write on the 5th grade level. His past work is as a construction laborer and truck loader. Due to a severe impairment related to cervical disc surgery and fusion, DDS finds that he is limited to lifting no more than 10 pounds occasionally, sitting 6 hours and standing 2 hours in an 8‐hour day. He cannot climb ropes, ladders or scaffolds, but can perform other postural activities occasionally. Which of the following listings apply?

Answer 41

a. 201.09.

According to the Social Security Administration’s Medical-Vocational Guidelines, also known as the “Grid Rules,” Rule 201.09 applies to individuals who are closely approaching advanced age (50-54), have a limited or less education, and have no past skilled or semi-skilled work experience that they can transfer to other work.

Given the claimant’s age (53), education (6th grade), and past unskilled work (construction laborer and truck loader), along with his physical limitations post-surgery, Rule 201.09 would direct a finding of disabled. This rule considers the claimant’s inability to perform a significant number of jobs in the national economy due to his age, education, work experience, and residual functional capacity for work.