Articles Posted in Social Security Disability

According to the National Institutes of Health, 20,000-30,000 adults are afflicted with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease (named after its most famous sufferer). The disease is described as “rapidly progressive, invariably fatal neurological disease.” Usually sufferers of the disease will succumb within 3 to 5 years of diagnosis, though 10% of those afflicted have survived up to ten years. Most diagnoses occur in patients between the ages of 40 and 60, and men tend to suffer from the disease more than women.

For people with a properly functional nervous system, voluntary movements are caused by the motor neurons of the brain relaying signals to the motor neurons of the spinal cord, which in turn relay the signals to the muscles. In sufferers of ALS, these motor neurons rapidly degenerate and die, essentially cutting off the part of the brain that controls voluntary movement from the rest of the body. If a person’s muscles do not receive the signals to move or perform other actions from the brain, they degenerate, or atrophy, from lack of use. Typically, the earliest symptoms of ALS include twitching or stiffness of muscles, random muscle weakness in the arms and legs, and slurred speech.

Eventually, those afflicted with the disease lose all strength in their muscles, therefore losing the ability to voluntarily move their extremities. Once the neurons connecting the brain to the diaphragm (the muscle beneath the lungs that controls breathing) degenerate, the sufferer will be required to go on a ventilator. Most deaths from ALS occur due to respiratory failure.

Section 4.00 lists several cardiovascular ailments that could potentially qualify a person for disability. There are number of tests used to make such a determination. One such test that the Social Security Administration explains thoroughly is the exercise test.

Exercise tests are for the most part exactly what they sound like. They involve using machines commonly found in the local gym, such as treadmills and exercise bicycles, to measure how the cardiovascular system responds to physical activity. Such tests can tell doctors about both the severity of preexisting cardiovascular disease or allow these same doctors to measure recovery after a cardiac event such as a myocardial infarction (heart attack). The SSA requires that all exercise tests that it purchases follow acceptable protocols.

One type of exercise test is the exercise tolerance test (ETT), which is used to determine whether a claimant qualifies for disability by virtue of having ischemic heart disease or chronic heart failure. Ischemic heart disease is when normal blood flow to the heart is inhibited due to one or more coronary arteries becoming constricted. When heart muscle tissue dies due to this impaired blood flow, the result is a heart attack. Chronic heart failure is when the heart is unable to provide the other body tissues with a sufficient amount of oxygenated blood. The SSA requires that all exercise tolerance tests have specifically documented parameters and be paced to the patient’s capabilities.

The Social Security Administration (SSA) has a broad category of mental impairments called “Organic Mental Disorders.” What makes “organic” mental disorders different from the Affective Disorders and Anxiety Disorders that have been discussed earlier on this blog?

“Organic Medical Disorders” as described in Listing 12.02 are “psychological or behavioral abnormalities associated with a dysfunction in the brain.” Specifically, they are mental ailments that can be traced to something amiss in the brain, detectable in laboratory tests such as MRIs. This is in contrast with “psychiatric disorders” which are diagnosed behaviorally. While the term “organic mental disorder” and its various permutations are virtually obsolete in the practice of psychiatry (including being removed from the DSM-IV), the SSA still uses the term when describing the category.

To prove that that one’s organic medical disorder is severe enough to merit disability, an applicant must demonstrate that certain requirements are present. List A the many ways the loss of “specific cognitive abilities” or “affective changes” characteristic of an organic mental disorder can manifest. They are:

Section 14 of the Social Security Disability listings describe diseases of the immune system. The SSA organizes Immune System Disorders into three categories: autoimmune disorders, immune deficiency disorders that are not HIV, and HIV. An autoimmune disorder occurs when the body literally starts attacking itself. The immune system mistakes healthy tissues for hostile, rendering multiple body systems impaired. One of the most common autoimmune disorders is systemic lupus erythematosus (SLE), also known as “lupus.”

SLE primarily strikes people between the ages of ten and fifty. Women are ten times more likely to be affected than men. African Americans and Asians are afflicted more often than those of other races.

SLE can affect any organ or body system. It is a chronic inflammatory disease that’s accompanied by constitutional symptoms such as severe fatigue, fever, malaise, and involuntary weight loss. Some sufferers of lupus develop severe chronic arthritis and extreme photosensitivity. Other complications resulting from SLE potentially include blood clots, anemia, fluid around the heart or lungs, and fluctuating cognition a.k.a. the “lupus fog.” The American College of Rheumatology lists eleven criteria—symptoms that commonly manifest in those with SLE. Having at least four of the eleven problems with no other explanation will often lead to a diagnosis of SLE. The SSA specifically cites the College’s criteria as a guide to proper diagnosis and documentation of SLE.

It’s estimated that three million Americans suffer from anemia. That number is expected to increase as the population continues to age—almost 10% of people over sixty-five have some form of the disease.

Red blood cells are rich in a substance called hemoglobin, a protein that carries oxygen molecules to all other cells. In adults, hemoglobin-rich red blood cells comprise 35%-52% of a person’s blood; this percentage is known as the hematocrit level. Normal variations in the hematocrit level depend largely on factors such as gender and physical fitness. Anemia occurs when a person’s hematocrit levels drop too low, indicating that the red blood cells are not properly transporting oxygen to other parts of the body.

The American Society of Hematology traces anemia to two basic causes: anemia resulting from a too low amount of red blood cells and anemia resulting from red blood cells that do not function properly. Social Security has a section (Hematological Disorders, Section 7.00) that addresses both forms.

Many people do not know that obesity is not a listed impairment under the Social Security Regulations. At one time, weight and height were considered in combination to be a reason for disability. However, on August 24, 1999, obesity was deleted from listing 9.09.

Now, SSR02-1p sets out how obesity must still be addressed within the listings. SSA recognizes that obesity has potential affects in causing or contributing to impairments in the respiratory system.

Even though obesity was deleted from the listings, SSA recognizes that obesity is a medically determinable impairment that is often associated with disturbance of the respiratory system, and disturbance of this system can be a major cause of disability in individuals with obesity. The combined effects of obesity with respiratory impairments can be greater than the effects of each of the impairments considered separately. Therefore, those deciding whether disability should be granted must consider any additional and cumulative effects of obesity.

The Social Security Administration recently announced that monthly Social Security and Supplemental Security Income (SSI) benefits for more than 60 million Americans will increase 3.6 percent in 2012.

The 3.6 percent cost-of-living adjustment (COLA) will begin with benefits that nearly 55 million Social Security beneficiaries receive in January 2012. Increased payments to more than 8 million SSI beneficiaries will begin on December 30, 2011.

This increase is based on a cost of living adjustment or COLA. The specific formula for a COLA adjustment is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers. The last COLA to effect Social Security benefits was in 2008.

With regard to migraine headaches, SSA indicated in Q&A 09-036 that migraines cannot be considered a “medically determinable impairment” solely on a diagnosis in the evidence or on a claimant’s reported symptoms. SSA requires that there must be clinical signs or laboratory findings to support a finding of migraine headaches.

Consequently, a diagnosis of migraine headaches requires a detailed description from the physician of a typical headache event (intense headache with more than moderate pain and with associated migraine characteristics and phenomena) that includes a description of all associated phenomena; for example, premonitory symptoms, aura, duration, intensity, accompanied symptoms, and effects of treatment. SSA cautions that the diagnosis should be made only after the claimant’s history and neurological and any other appropriate examinations rule out other possible disorders that could be causing the symptoms. Clinically accepted indicators of the diagnosis for migraines include: a headache event that lasts from 4 to 72 hours if untreated or unsuccessfully treated; along with two of the following: unilateral, pulsating (throbbing in parentheses quality; moderate (inhibits but does not wholly prevent usual activity in the premises or severe (prevents all activity) pain intensity, worsened by routine physical activity (or causing avoidance of activity). At least one of the following must occur during a headache: nausea, vomiting, photophobia or phonophobia.

While reflex sympathetic dystrophy is not a listed impairment under the Listings of Impairments, SSA recognizes that it could be a condition that may result in disability. Social Security Ruling 03-02p suggests that reflex sympathetic dystrophy is a chronic pain syndrome most often resulting from trauma to a single extremity. It can also result from diseases, surgery, or injury affecting other parts of the body. Even a minor injury can trigger RSD. According to SSA, the most common acute clinical manifestations include complaints of intense pain and findings indicative of autonomic dysfunction at the site of the precipitating trauma. Later, spontaneously occurring pain may be associated with abnormalities in the affected region involving the skin, subcutaneous tissue, and bone. It is characteristic of this syndrome that the degree of pain reported is out of proportion to the severity of the injury sustained by the individual. When left untreated, the signs and symptoms of the disorder may worsen over time
Obviously, RDS must be diagnosed by a qualified treating physician. After a diagnosis has been made, it is important to establish what limitations result from this condition. If the limitations are serious, pervasive and long lasting, this condition can serve as a basis for disability.

Effective July 28, 2011, the Social Security Administration changed its policy regarding the filing of subsequent applications for disability benefits. In 1999, SSA had in place a procedure which allowed for the filing of a new application for Social Security Disability benefits even though a prior application was on file. Under this procedure, the new application was processed by the disability determination service. SSA noted that it has “seen an increase in the number of subsequent disability claims in recent years”. As a consequence, SSA believes that some decisions have been inconsistent. SSA also believes that this duplicate filing has caused increased administrative costs and higher workloads.

The new procedure does not allow for the filing of two claims for the same type of benefits pending at the same time. If the claimant wishes to file a new disability claim for the same matter and that same matter is pending at any level within the Social Security administrative system, then the claimant must either withdraw the prior claim in order to file a new one or not file a new claim and simply stand on the prior claim. This policy does not change SSA’s policy where an appeal in pending in federal court. In those cases, the claimant may file a new application while the court case is pending.