Monday, February 25, 2013

New Social Security Ruling on Drug Addiction and Alcoholism

Sometimes it can be difficult for a claimant that has had problems with drugs or alcohol to obtain Social Security Disability benefits. As a general rule, if a claimant’s condition would improve if he or she stops using drugs or alcohol, the SSA would deny the claim.
Over the past few years there has been considerable controversy as to how Social Security Disability cases dealing with drugs or alcohol should be evaluated. This past week, the Social Security Administration issued new ruling on how to evaluate these cases. See SSR 13-2p, on "Evaluating Cases Involving Drug Addication and Alcoholism (DAA)." 78 Fed. Reg. 11939 (Feb. 20, 2013). This SSR is effective on March 22, 2013.

SSR 13-2p will replace the 1996 EM-96-200, which has been repeatedly extended over the years. The ruling issued last week states that "This SSR obsoletes EM 96-200."; moreover, it rescinds and replaces SSR 82-60.
In my practice, I often worry that the mere occasional use of these substances by claimants could negatively affect their cases. Fortunately, the new ruling clarifies that mere occasional use is not sufficient to deny benefits and it clarifies in order for the SSA to consider the use of drugs and/or alcohol in a case, the claimant must have a "medically determinable addiction" to alcohol or drugs. Specifically, the new ruling states that "A claimant’s occasional maladaptive use or a history of occasional prior maladaptive use of alcohol or illegal drugs does not establish that the claimant has a medically determinable" addiction.
The Ruling gives a step by step analysis to determine whether a claimant is disabled if the Claimant has struggled with addiction. Below is a decisional outline explaining SSA’s DAA evaluation process:
1. Does the claimant have DAA?

a. No—No DAA materiality determination necessary.

b. Yes—Go to step 2.

2. Is the claimant disabled considering all impairments, including DAA?

a. No—Do not determine DAA materiality. (Denial.)

b. Yes—Go to step 3.

3. Is DAA the only impairment?

a. Yes—DAA material. (Denial.)

b. No—Go to step 4.

4. Is the other impairment(s) disabling by itself while the claimant is dependent upon or abusing drugs or alcohol?

a. No—DAA material. (Denial.)

b. Yes—Go to step 5.

5. Does the DAA cause or affect the claimant’s medically determinable impairment(s)?

a. No—DAA not material. (Allowance.)

b. Yes, but the other impairment(s) is irreversible or could not improve to the point of nondisability—DAA not material. (Allowance.)

c. Yes, and DAA could be material—Go to step 6.

6. Would the other impairment(s) improve to the point of nondisability in the absence of DAA?

a. Yes—DAA material. (Denial.)

b. No—DAA not material (Allowance.)

For the complete text of SSR 13-2p visit:

Monday, February 18, 2013

Fibromyalgia and Social Security Disability

Fibromyalgia is a condition characterized by widespread pain, fatigue, sleep, memory and mood issues.  Very little is know about what causes this condition and there is no known cure for it.  Many of its symptoms are subjective and extremely difficult to prove with objective tests.  For this reason, Social Security claimants with a diagnosis of fibromyalgia usually face an uphill challenge in having their benefits granted.  Nonetheless, claimants with this condition, who have well documented medical records evidencing serious physical and mental limitations, should not be discouraged from pursuing their claim for benefits.    

Social Security has a disability listing that gives approval criteria for a number of conditions raging from arthritis to multiple sclerosis.  However, no specific listing exists for fibromyalgia.  Fortunately, in July 2012, the Social Security Administration issued a ruling that gives Social Security examiners a framework on how to analyze claims dealing with this condition.   The ruling directs claims examiners and judges to rely on criteria issued by the American College of Rheumatology.  Therefore, applicants with fibromyalgia must be under the regular care of a rheumatologist in order to be able to successfully make a claim for Social Security benefits.  In making the diagnosis of fibromyalgia, the doctor must make the following findings:

·         Chronic widespread pain, including pain in the back, neck, or chest

·         Evidence that shows your doctor ruled out other diseases that could cause the same symptoms (the symptoms of fibromyalgia often overlap with those of lupus, hypothyroidism, and multiple sclerosis), such as lab tests and examination notes, and

One of the following:

·         Tender points sites in at least 11 of 18 tender point areas of the body, with tender points occurring on both sides of the body and both above and below the waist. A list of the tender points can be viewed in the SSA's recent ruling on fibromyalgia. In testing tender points, your doctor should apply the approximate amount of pressure needed to blanch his or her own thumbnail. Or,

·         Repeated manifestations of six or more fibromyalgia symptoms, signs, or conditions that often occur with FM, particularly fatigue, non-restorative sleep, cognitive or memory problems (“fibro fog”), depression, anxiety, or irritable bowel syndrome (IBS). Other possible symptoms include headache, muscle weakness, abdominal pain, Raynaud's phenomenon, seizures, and dizziness.
Moreover, the rheumatologist must issue an opinion as to the claimant’s ability to carry out work related activities.

If it is found that due to fibromyalgia the claimant cannot do the work performed in the past 15 years, the Social Security Administration will see if he or she is able to adjust to other work. The Social Security Administration will consider the persons' medical conditions as well as his or her age, education, past work experience and any transferable skills that the claimant may have.  If the claimant cannot adjust to other work, the claim will be approved.  If the claimant can adjust to other work, the claim will be denied.

Monday, February 11, 2013

Mental Illness and Social Security Disability

If you have a mental health disability and cannot work, you might qualify for Social Security benefits. To qualify, Social Security must decide that you cannot do work that you did before you became ill and you cannot adjust to other work because of your medical condition(s).   Mental Health conditions that might entitle you to Social Security Disability benefits include:

·         schizophrenia

·         mental retardation

·         autistic disorders

·         anxiety

·         depression

·         schizoaffective disorder

·         personality disorder

·         bipolar disorder

·         substance abuse disorders

Your disability must also last or be expected to last for at least one year. Social Security pays benefits only for total and long-term disability. To qualify for Social Security Disability (SSDI), you must be covered by Social Security Insurance by having paid Social Security taxes.  If you have limited income, you may also qualify for the Supplemental Social Security Income Program (SSI).

In determining whether you qualify for benefits, Social Security will consider such factors as your ability to function independently, appropriately and effectively; the amount of supervision or assistance you require; the settings in which you are able to function and your ability to function on a sustained basis.

Your functional limitation will be rated within four areas: activities of daily living, social functioning, concentration, persistence, or pace, and episodes of increased symptoms. If your mental impairment(s) is severe (resulting in at least two of these restrictions), evaluators will determine if it's severe enough to be a listed mental disorder.

For a free consultation with a Connecticut Social Security Lawyer or a Massachusetts Social Security Lawyer, you can complete the form on the right side of the page or call toll free (855) WIN-RAMOS.  Our office represents Social Security claimants throughout both states and has offices in Hartford, CT and Springfield, MA.

Monday, February 4, 2013

Stroke and Social Security Disability

If you have suffered a stroke, you may be eligible for Social Security Disability benefits. A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage.  As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

In adult disability claims, Social Security uses the five-step sequential evaluation in deciding whether the claimant is entitled to disability benefits. Under the first two steps, the SSA will determine whether the claimant is working, and whether his or her impairment is considered “severe.”

Once the first two steps are decided in the claimant's favor, there are two basic ways that a person can qualify for Social Security benefits due to  stroke: 1. the individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or, 2. show that he or she is unable to work.
Social Security uses the Listings of Impairments manual as their guide to determine whether a claimant meets or does not meet the Social Security Administration's requirements for total disability. 
The Social Security Administration generally calls stroke a “Vascular Accident".  This listing can be found under the part that deals with neurological impairments. More specifically, the Social Security Disability listing for stroke is found in Section 11.04. (Note that Social Security will not evaluate the claim of a claimant who has suffered a stroke until at least three months after the stroke.) To be able to obtain Social Security Disability benefits under this listing, the claimant must be unable to:

  • speak or write effectively due to either sensory aphasia (fluent, nonsensical speech and inability to understand, also called receptive aphasia) or expressive aphasia (difficulty forming words, also called motor aphasia), OR

  • control the movement of two extremities (either an arm and a leg or two arms or two legs), causing serious problems walking and balancing or using your hands to grasp and manipulate objects. 

If a claimant's condition is severe but not at the same or equal level of severity as a medical condition on the list, then the Social Security Administration must go to step 4 and 5 of the disability process and determine if the condition interferes with the person's ability to do the work that he or she did previously (during the last 15 years). 
If the claimant cannot do the work performed in the past 15 years, the Social Security Administration will see if he or she is able to adjust to other work. The Social Security Administration will consider the persons' medical conditions as well as his or her age, education, past work experience and any transferable skills that the claimant may have. If the claimant cannot adjust to other work, the claim will be approved. If the claimant can adjust to other work, the claim will be denied.
To contact a local Connecticut support organization that assists survisors of strokes visit: