Disability Lawyer Blog

Monday, January 14, 2013

Arthritis Patients Applying for Social Security Disability

According to the Center for Disease Control, Arthritis is one of the most common causes of disability in the United States.

Before addressing how a person with Arthritis can qualify for Social Security Disability Benefits, it is necessary to explain the nature of this condition. Arthritis is a disorder affecting the joints and is characterized by inflammation and joint pain. It is most prevalent in the thumbs, fingers, feet, hips, knees, neck, back, and shoulders. The joints are integral for many body movements, and arthritis can limit range of motion and prevent necessary movements. Arthritis is typically seen in older individuals but can affect children as well. There are three main types of arthritis: osteoarthritis, rheumatoid arthritis and psoriatic arthritis. About twice as many women are affected by arthritis than men.

Osteoarthritis (OA): also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.

Rheumatoid Arthritis (RA): An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis can also affect your whole body with fevers and fatigue. Rheumatoid arthritis is much more common in women than in men and generally occurs between the ages of 40 and 60. Treatment focuses on controlling symptoms and preventing joint damage. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. RA can lead to the formation of tissue that can harden and form a bony ankylosis which is a fusion of the joint that prevents any movement of the joint. Rheumatoid arthritis can be diagnosed by a blood test that reveals a rheumatoid factor (antibodies) in the blood. X-rays are also used to determine if there is swelling of the effected joints.

Psoriatic arthritis: is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear. Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

There are two basic ways that a person can qualify for Social Security benefits due to arthritis. An individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or show that he or she is unable to work.

The list of impairments is essentially a "Blue Book" used by the Social Security Administration to determine whether an individual meets the Social Security definition of disability. If a person’s condition “meets or equals” the listing, then that person is automatically deemed to be disabled. The listing for rhematoid arthritis and psoriatic arthritis is contained in Section 14.09 of the listing. The listing refers to these conditions as "inflamatory arthritis". In other to meet Section 14.09 of the listing, a claimant must prove that he or she has one of the following conditions:

RA or psoriatic arthritis present in a joint in the legs, causing significant difficulties in walking.

RA or psoriatic arthritis that affects joints in both arms, preventing a claimant from performing many types of tasks with the arms (involving both large muscle movements and small manipulations).

An inflammation or permanent deformity in one or more major joints, along with moderate involvement of at least two more organs or body systems, causing at least two symptoms out of these four: severe fatigue, fever, malaise, and/or involuntary weight loss.

Ankylosing spondylitis or another spondyloarthropathy, with fixation of your spine of at least 45 degrees.

Ankylosing spondylitis or another spondyloarthropathy with fixation of your spine of at least 30 degrees, along with moderate involvement of at east two or more body systems, or

Repeated flare-ups of RA or psoriatic arthritis with at least two of symptoms (such as fever, extreme fatigue, malaise, or weight loss) that cause limitations in activities of daily living, social functioning, or ability to complete tasks.

In cases of osteoarthritis, a claimant can also seek to prove that his or her condition meets Section 1.02 of the Listing, which is the Section that deals with "Major Disfunctions of the Joints". In order to meet this Section of the listing a Claimant must have:

Major dysfunction of a joint;

Characterized by gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability); and

Chronic joint pain and stiffness; with

Signs of limitation of motion or other abnormal motion of the affected joint(s); and

Findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s).

If your condition is severe but not at the same or equal level of severity as a medical condition on the list on Section 14.09 or Section 1.02, then the Social Security Administration must determine if it interferes with your ability to do the work you did previously (during the last 15 years).

If you cannot do the work you did in the past 15 years, the Social Security Administration will see if you are able to adjust to other work. The Social Security Administration will consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.

Monday, January 7, 2013

Military Service and Social Security Disability

Earnings for active duty military service or active duty training have been covered under Social Security since 1957. Social Security has covered inactive duty service in the armed forces reserves (such as weekend drills) since 1988.

If you served in the military before 1957, you did not pay Social Security taxes, but we gave you special credit for some of your service.
You can get both Social Security benefits and military retirement. Generally, there is no reduction of Social Security benefits because of your military retirement benefits. You’ll get your full Social Security benefit based on your earnings.

　
Social Security and Medicare taxes

While you are in military service, you pay Social Security taxes just as civilian employees do. In 2012, the tax rate is 5.65 percent, up to a maximum of $110,100. If you earn more, you continue to pay the Medicare portion of the tax (1.45 percent) on the rest of your earnings.

　
How your work qualifies you for Social Security
To qualify for benefits, you must have worked and paid Social Security taxes for a certain length of time. In 2012, you will receive four credits if you earn at least $4,520. The amount needed to get credit for your work goes up each year. The number of credits you need to qualify for Social Security benefits depends on your age and the type of benefit for which you are eligible. No one needs more than 10 years of work.

Extra earnings
Your Social Security benefit depends on your earnings, averaged over your working lifetime. Generally, the higher your earnings, the higher your Social Security benefit. Under certain circumstances, special earnings can be credited to your military pay record for Social Security purposes. The extra earnings are for periods of active duty or active duty for training. These extra earnings may help you qualify for Social Security or increase the amount of your Social Security benefit.

If you became disabled while on active military service on or after October 1, 2001 you can receive expedited processing of your Social Security disability claim.
When you apply for Social Security benefits, you will be asked for proof of your military service (DD Form 214) or information about your reserve or National Guard service.

Monday, December 31, 2012

Self-Employment and Social Security Disability Benefits

Recently, I was asked the same question by two potential Social Security Disability Claimants: one is a small business owner who suffers from Lyme's disease and the other one, is a self-employed electrician who suffers from rheumatoid arthritis. They both wanted to know whether they could continue to work on a part-time basis and be eligible for Social Security Disability Benefits.

The answer to their question is fairly complicated due to the fact that both of them are self-employed. If they had been salaried employees, the answer to their question would have been relatively straight forward. Under Social Security Disability rules a person cannot be eligible if he or she is engaging in a Substantial Gainful Activity (SGA). For salaried employees, SGA is generally work that brings in over a certain dollar amount per month. In 2012, that amount is $1,010 for non-blind disabled applicants, and $1,690 for blind applicants. If a salaried employee makes more than that amount per month, the Social Security Administration figures that the applicant must not be disabled. If a person makes more than the amount determined to be the SGA level, that person cannot be eligible for Social Security Disability regardless of how sick he or she may be.

However, in the case of persons who are self-employed, SGA is not determined solely on monthly income. A small business owner might work 40 to 50 hours a week and make very little or no profit. In order to deal with this particular issue, the Social Security Administration has an evaluation criteria which consists of three tests.

The Social Security Field Offices will consider all three tests before it can be established that the individual's work activity is not SGA. The following are just brief descriptions of each of the three tests:

1. Test One: Significant Services and Substantial Income

The individual's work activity is SGA if he or she renders services that are significant to the operation of the business, and if he or she receives from it a substantial income; or

2. Test Two: Comparability of Work Activity

The individual's work activity is SGA if, in terms of all relevant factors such as hours, skills, energy output, efficiency, duties, and responsibilities, it is comparable to that of unimpaired individuals in the same community engaged in the same or similar businesses as their means of livelihood; or

3. Test Three: Worth of Work Activity

The individual's work activity is SGA if, although not comparable to that of unimpaired individuals, it is, nevertheless, clearly worth more than the amount shown in the SGA Earnings Guidelines when considered in terms of its effect on the business, or when compared to the salary an owner would pay to an employee for such duties in that business setting.

As one can see from these requirements, those who are self-employed while applying for Social Security Disability Benefits will undergo a high level of scrutiny by the Social Security Administration. The Field Offices will make a determination on a case by case basis depending on the level of involvement and the value of the work that the applicant performs for his or her particular business enterprise.

Given these complicated circumstances, it is advised that self-employed applicants who wish to continue working while applying for Social Security Benefits should seek the assistance of a skilled Social Security Disability Lawyer.

Monday, December 24, 2012

Holiday Greetings!

The Holiday season is a perfect time to reflect on the the things that we have accomplished during the year and to take a moment to thank those who were there for us when we needed a helping hand.

Obtaining Social Security disability benefits for those who suffer from chronic conditions or physical ailments is not an easy task. Fortunately, I am very proud to say that during 2012 I was able to count on an outstanding network of medical and social service providers who were always there for my clients. I would like to mention just a few of them in this post. In the next few days, I will attempt to look back at my office records in order to find those that I have missed. Hopefully, I will have sometime to call these great friends or to send them a note expressing my gratitude.

Since the list of people that I have to thank is very long, I most instances, I am just mentioning the particular organization or group that they belong to.

Community Health Services (CHS)- with special thanks to Soraya Maldonado
Latino Community Services
Institute for the Hispanic Family
Catholic Charities
Charter Oak Clinic
The Village for Families and Children
Hartford Behavioral Health
The Malta House
The Institute of Living
The Lupus Foundation of America, Connecticut Chapter
Magda Quinones from St. Francis Hospital
Dr. Miguel Colan
Dr. Keshav Rao
Dr. Gary Belt

Finally, I would like to add that words cannot describe the emotions felt by my clients when they are able to get Social Security Disability Benefits after a prolonged struggle. Most of them wait well over a year and endure enormous hardships before they are able to receive benefits. As their lawyer, I know very well that each and everyone of my clients are also very grateful for the assistance provided by their medical and social service providers in the process of obtaining social security disability benefits.

Monday, December 17, 2012

35 More Compasionate Allowances Added by the Social Security Adminstration

Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.

Compassionate Allowances (CAL) are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

This month, the Social Security Adminstration added 35 more compassionate allowances, bringing the total number of such conditions in the expedited disability process to 200. The new conditions include: rare diseases, cancers, traumatic brain injury (TBI) and stroke, early-onset Alzheimer's disease and related dementias, schizophrenia, cardiovascular disease and multiple organ transplants and autoimmune diseases.

Note: Conditions highlighted in Red are effective December 1, 2012.

Monday, December 10, 2012

Religious Leaders go to Washington to Defend SSDI

Last week, Former Connecticut Governor John Rowland used a section of his daily radio talk show on WTIC News 1080 to criticize the Social Security Disability Program. I didn't have a chance to listen to the show but I was told that he blasted SSDI and criticized it for allegedly being plagued with widespread misuse of public funds. Readers of this blog who don't reside in Connecticut might not be aware that John Rowland was a Republican Governor who, in 2004, resigned from office during a corruption investigation. He later plead guilty in federal court and served ten months in prison, followed by four months of house arrest.

While John Rowland was using disability claimants as scapegoats for the financial havoc that corrupt politicians like him have caused, a group of well respected religious leaders were in Washington defending SSDI. On December 4th, The Jewish Council for Public Affairs and the Interfaith Disability Advocacy Coalition gathered on Capitol Hill to speak out in support of the Social Security Disability Insurance (SSDI) benefits program. SSDI is an important lifeline for Americans unable to work due to illness or injury. The two groups provided compelling testimony dispelling the myths about the program being widely abused and wasteful. Their visit to Congress was a persuasive push to ensure that SSDI is not a victim of fiscal cliff negotiations.

The briefing featured presentations from two former SSDI recipients who were able to return to full-time employment after suffering tragic accidents that rendered them unable to work. The first, Donna Eshghi, a full-time nurse from Wichita, KS, contracted Hepatitis C after an unexpected needle-prick at work. A single mother, she was able to use SSDI benefits to support her family until she was able to return to work. And Deborah Krotenberg, an attorney from Atlanta, used SSDI benefits to keep herself afloat until she was able to return to work full-time after she was paralyzed in a serious car accident.

Kathy Ruffing, a Senior Fellow, Center on Budget and Policy Priorities,discussed her recent report: Social Security Disability Insurance is Vital to Workers With Severe Impairments. Additionally, Curtis Ramsey-Lucas, of the American Baptist Home Mission Societies, closed the event with an interfaith prayer.

"As a nation, we need to be committed to ensuring that when Americans become unable to work due to illness or accident, there is a safety net," said Rabbi Steve Gutow, President and CEO of JCPA. "SSDI is literally a lifeline for millions of Americans. People who collect disability insurance have paid into the system and therefore it is critical that the benefits they have earned are available in their time of need. Recent political attacks on SSDI are misguided at best. And now, as Congress and the President find ways to negotiate away from the fiscal cliff, we hope they will remember that SSDI is a critical program that must be protected."

Some key facts about SSDI:

According to the most recent government statistics, in October of 2012, there were 8.8 million Americans collecting SSDI.
There are record numbers of SSDI recipients now not because the government has made it easier to collect disability benefits, but rather because Baby Boomers are getting older and more prone to illness or injury, as well as a record number of women in the workplace. In fact, Steve Goss, the Chief Actuary of the Social Security Administration recently testified about these trends before the United States Congress.
By cutting funding to the Social Security Disability Insurance program, states and local communities will feel the brunt of the burden.
Denying or delaying benefits to disabled Americans leads to additional human suffering. They might have to file for bankruptcy or apply for welfare; some may end up in home foreclosure or be unable to get medical treatment without their SSDI benefits.
It’s not easy to qualify for SSDI benefits. The qualifying standards have been raised and there are many diseases which no longer solely qualify claimants for benefits, like alcoholism, diabetes, drug abuse and obesity.

Monday, December 3, 2012

Do I Automatically Get Medicare with SSDI?

...this is definitely one of the questions most often asked by my clients... Clients also ask me a lot about whether they will get Medicaid. I will address these questions separately below:

MEDICARE:

You will receive Medicare after you receive Social Security Disability Benefits for 24 months. When you become eligible for disability benefits, the Social Security Administration will automatically enroll you in Medicare.

It is important to note that Social Security starts counting the 24 months from the month you were entitled to receive disability, not the month when you received your first check. This two year period starts five months after your disability began. (This is due to the fact that there is a five month waiting period to receive SSDI.)

However, special rules apply to:

End-stage renal disease (permanent kidney failure). People with permanent kidney failure get Medicare beginning:

The third month after the month a regular course of renal dialysis begins; or
The month of kidney transplantation.

Lou Gehrig's Disease (amyotrophic lateral sclerosis). People with amyotrophic lateral sclerosis get Medicare beginning with the month they become entitled to disability benefits.
Medicare has four parts:

Hospital insurance (Part A) helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free.
Medical insurance (Part B) helps pay doctors' bills and other services. There is a monthly premium you must pay for Medicare Part B and you have the option to refuse this coverage.
Medicare Advantage (Part C) plans generally cover many of the same benefits a Medigap policy would cover, such as extra days in the hospital after you have used the number of days Medicare covers. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organization under Part C. There might be additional premiums required for some plans; and
Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment. Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary and you pay an additional monthly premium for the coverage.

MEDICAID:

In Connecticut and Massachusetts, if you are an SSI beneficiary, you may be automatically eligible for Medicaid; an SSI application is also an application for Medicaid. Typically, SSDI recipients get Medicare and SSI recipients get Medicaid. SSI recepients do not have to wait a 24 month period to receive Medicaid benefits.