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Appeals Council Grants Fully Favorable

Empire Justice Center January 28, 2019

The Appeals Council allows only one percent of the claims it reviews.  And Doris Cortes of the Rochester office of the Empire Justice Center recently moved into that rarified category.  Doris’s client has a long history of attention deficit hyperactivity disorder and schizoaffective disorder.  Yet, as Doris pointed out to the Appeals Council, the ALJ failed to consider the listings relevant to those disorders, listings 12.03 and 12.11. Instead, the ALJ reviewed listings 12.04 (affective disorders) and 12.06 (anxiety).  Although the ALJ had focused on the claimant’s alleged difficulty with medication compliance, Doris reminded the Appeals Council that her client was given injections of Invega Sustenna due to the seriousness of his symptoms.

The Appeals Council listened.  It sent the claim to a medical consultant, who agreed the claimant meets listing 12.03 and 12.11.  The Appeals Council specifically noted the history of injections as evidence of the severity of the claimant’s pathology.  It gave significant weight to the medical consultant’s opinion, finding the claimant’s allegations consistent with his longitudinal history and portrayal of symptoms.

 

To make Doris’s victory even sweeter, this claim involved an age-18 review.  Her client, who had been on SSI benefits as a child since 2006, was found eligible for continued benefits as an adult.  Congratulations, Doris!