Indiana Social Security Disability Attorney Blog

The numbers are in for 2010 for the percentage of cases which are allowed at the initial stage and allowed at the reconsideration level. The initial stage is when a person files a disability claim for the first time. Many of the people who are denied at the initial level believe that everyone is denied “the first time”. Actually, the numbers suggest that no quite “everyone” is denied. Rather on a national level, 35.4 % of the people who file disability are awarded benefits! Indiana is close to this number. In Indiana, 33.3% of the initial cases are allowed.

If a person is denied at the initial level, the next step is to ask that the initial denial be “reconsidered”. This stage is called the reconsideration level. At this level, there is no hearing because this is the opportunity for SSA to determine whether it made a mistake. Basically this is a paper review by physicians hired by SSA. Nationally in 2010, the allowance rate was 12.7%, Indiana’s allowance rate at the reconsideration level was 5.9%, tied the lowest in the nation with Mississippi.

The next level is the hearing level. If you have any questions about the disability process, please call our office 765-644-8410.

Physicians and psychologists must make a determination about how their mentally ill patient is functioning on a daily basis. This determination or assessment is used by mental health practitioners to: determine when treatment is needed, track the progress of treatment and select the site of service (whether treatment is to be administered in-patient or out-patient). The scale ranges from 1-100.

According to the fourth edition of the Diagnostic and Statistical Manual of the Mental Disorders published by the American Psychiatric Association (DSM-IV), a score between 1-10 is suggestive of “persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.” On the other end of the spectrum is the scale between 91-100 which describes a person who is “superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.” Somewhere in between are many who suffer from mental illness with varying degrees of severity.

It is not unusual to read in mental health records that a client with mental health issues has been assessed with a GAF score between 50-60. According to the DSM-IV, this score means that the person has “moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).” Clients with severe mental health issues commonly have scores under 50.

Narcolepsy is a chronic disorder resulting in an irresistible urge to sleep and frequent daytime “sleep attacks.” This disorder is viewed as a neurological problem rather than a mental illness or something caused by anxiety. Little is known about the exact cause of the condition. Some researchers believe that the brain producing a reduced amount of a certain protein is the likely cause. Unfortunately, there is no known cure for this condition. Treatment is geared toward either reducing or controlling the symptoms.

Narcolepsy may be accompanied by one or more of the following symptoms: periods of extreme drowsiness (every 3 to 4 hours during the day), dream like hallucinations, sleep paralysis, and cataplexy (a sudden loss of muscle tone while awake resulting in an inability to move). Sleep periods can range from a few seconds to a half an hour.

Without question, narcolepsy can form the basis of an award of Social Security Disability benefits. This particular disease is not found in the Listings of Impairments. As a consequence, it is important for a person representing a disability claimant to know how SSA looks at this disease. First, narcolepsy is not a listed impairment. SSA considers the closest listing to equate with narcolepsy to be Listing 11.03, Epilepsy-Minor motor seizures. Second, SSA examiners evaluate narcolepsy after a period of 3 months of prescribed treatment. Therefore consistent treatment records are a must. Third, as in all disability cases, it is vital to provide as much medical evidence that is available including: physician treatment notes, results of electroencephalogram (EEG), a list of the medications used and their responses, a detailed description of the narcoleptic attack along with other events that sometime accompany a narcoleptic attack (such as cataplexy, hypnagogic hallucinations or sleep paralysis).

Many claimants who file a claim for Social Security Disability benefits receive a letter from SSA entitled “Potential Private Pension Benefit Information”. This letter informs a claimant that he/she may be entitled to some private pension benefits upon retirement. Normally, the letter gives a specific pension name, plan names and address. It may also disclose an estimated amount of benefits.

How does the SSA know this information? Why is the SSA sending that information? Is this SSA disability? All private pension plans are required to report the names and social security numbers of the plan’s beneficiaries to SSA and the IRS. SSA computers are able to match a Social Security Disability claimant’s social security number to the social security numbers reported by the plan. Federal law requires that SSA notify all potential plan beneficiaries of the fact that they have been reported as a potential beneficiary under a private pension plan. Many plan beneficiaries do not know that they are potential beneficiaries of private pension plans. The government actually wants the plan beneficiaries to know of the existence of their plan. The government also encourages plan beneficiaries to make a claim for benefits if proper.

The notice does not insure that a person will actually receive private pension benefits. Instead it is meant only as a notice that the matter should be followed up with by the person receiving the letter. The notification letter has nothing to do with the disability claim itself.

As many of you known, if there is no agreement on the federal budget by midnight tonight, there will be a partial government shutdown. This shutdown will last until there is a budget agreement. As of today, SSA has issued plans for how it will operate during any shutdown. Here are some of the highlights:

Will Disability Payments Continue? Yes. SSA has recognized that disability payments under Title II and Title XVI are funded indefinitely through trust funds. As a consequence, those payments will continue.

Will the Local SSA Offices Be Open? Yes, the SSA offices in Indianapolis, Anderson and throughout the nation will be open but on reduced hours and for only critical functions. For example, disability applications and adjudications will continue but the issuance of new and replacement SS cards will not occur.

What is the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)? IBS describes a set of symptoms which include abdominal pain. To be sure, it can cause, in some cases severe pain and result in disability. However, IBD is considered by the medical profession to be the far more serious disease. Generally, IBS is relatively common, occurring in one in five persons while IBD occurs only in about 1 in 200 persons.

IBD usually includes either Crohn’s disease [painful ulcers in their small and large intestines and sometimes inflammation in the rectum] or ulcerative colitis [which is a disease that results in ulcers in the rectum and large intestine]. IBD is normally diagnosed by endoscopy, biopsy, appropriate medically acceptable imaging, or operative findings. On the other hand, IBS is a “rule out” diagnoses. That means that a physician has decided that his/her patient has IBS after all other tests have ruled out other diseases.

SSA has a listing [5.06] for IBD. That means if the disabled person has IBD based upon the criteria set out by SSA, then a finding of disability will be made. Unfortunately, SSA does not have a listing for IBS. Which means that it is much more difficult, although by no means impossible, to be awarded disability for IBS.

Treatments which are used to attempt to relieve pain are important facts to be considered by the Administrative Law Judge in accessing claims for Social Security Disability based on pain. Some treatments are effective and some are not effective. Most pain relieving treatments do not totally “do away” with the pain. Treatments may include: the use of heat; massage; whirlpool; traction; prescribed exercise; bed rest; a TENS unit; biofeedback; trigger point injections; nerve blocks; acupuncture; chiropractic treatments; cranial sacral therapy; behavior modification; counseling/psychotherapy; herbs, vitamins, etc; and attendance at a pain clinic or enrollment in a pain program.

Pain medication is in a class by itself as a factor for the consideration of the extent to which pain is debilitating. The use of pain medication has advanced in recent years to a specialty in the medical profession. The use or non-use of pain medication alone will not determine the outcome of a claim for disability based on pain. However, is is a factor which the federal regulations require an Administrative Law Judge consider. Often times pain medications causes side effects which impairs the ability to function [drowsiness; dizziness etc.] Side effects are also facts which must be considered in accessing whether the person can perform sustained work functions.

Obviously, no one but you can know the extent of your pain, how it feels or how long it lasts. There is no definitive medical test which can conclusively measure pain.

SSA allows pain to serve as a basis for disability. According to 20 CFR § 404.1529(b)(c) and SSR 96-7P, the ALJ must first evaluate whether a medically determinable both impairment exists which could reasonably be expected to produce pain, and then assess the credibility of the claimant’s allegations about the intensity and persistence of her pain. Aidinovski v. Apfel¸27 F.Supp2d 1097, 1103 (N.D. Ill. 1998). The factors which the ALJ must consider include: (1) objective medical evidence; (2) prior work record; (3) daily activities; (4) location, duration, frequency and intensity of pain; (5) precipitating and aggravating factors; (6) use of medication; (7) other treatments and measures used to relieve pain; (8) observation of testimonial evidence by the claimant; and (9) the consistency of the claimant’s statements.

So even if the medical record does not substantiate your complaints of pain the factors set out above will be considered to determine whether you are disabled because of pain.