Sequestration Will Increase Backlog of Social Security Disability Cases

The budget cuts --known as sequestration--  that took effect last Friday will probably increase the time that SSDI and SSI applicants will have to wait to have their cases decided.  These cuts will also affect the quality of the services provided to disability applicants at Social Security Field Offices and at the agency's toll free numbers. 

 

Fortunately, sequestration will not affect the monthly payments sent to those who are already receiving SSDI or SSI.  The amount of their benefits will remain the same and payments are expected to continue to be issued on a timely basis.

 

The negative impact of these cuts will be felt by those disabled individuals who still have their cases pending at the application stage or at the hearing level.  Over the past few years, the Social Security Adminstration has struggled with a backlog of applications for SSDI and SSI.  In the past, special funds had been identified to deal with this problem and important steps had been taken by the federal government to speed up the process.  Now, it is evident that the Agency will be forced to make one giant step backward.  A news report from "The Federal Times" predicts that the "Social Security Administration’s pending disability insurance claims backlog" could nearly double. 

 

Given this sad state of affairs, individuals considering filing for Social Security Disability Benefits should consult with a Social Security Disability Lawyer before applying for disability benefits.  In my experience, many claimants delay their claims when they file incomplete applications or when they fail to mention important issues during the early stages of the Social Security Disability process.  For this reason, in my office, we always like to help claimants with their intial application.  There is no additional cost for helping prepare the application documents.  In fact, we will not charge any legal fees unless we win. 

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: www.gpo.gov/fdsys/pkg/FR-2013-02-20/.../2013-03751.pdf

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.

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.

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:

http://strokesupport-ct.org/contact-us.html

 

Congestive Heart Failure and SSDI Benefits

If you suffer from congestive heart failure, you may be eligible for Social Security Disability benefits.  Congestive heart failure, occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body.  Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests.

The Social Security Administration generally calls congestive heart failure “chronic heart failure.”  In adult disability claims, Social Security uses the  five-step sequential evaluation in deciding whether the claimant is entitled to 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  congestive heart failure: 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 listing for congestive heart failure is found in Section 4.02. Section 4.02 states that in order to meet the lisitng of impairments, the claimant must suffer from one of the following

• Systolic failure. This occurs when the heart has weakened pumping strength and can be shown by one of the following:


• the heart’s ejection fraction (the percentage of blood pumped out of the heart with each heartbeat) is 30% or less during a period of stability (not during an episode of acute heart failure), or


• the heart’s left ventricular end diastolic dimensions are larger than 6.0 cm.

OR

• Diastolic failure. This occurs when the heart is unable to fill properly, and must be shown by all of the following:


• thickness of left ventricular wall and interventricular septum 2.5 cm or larger on imaging


• an enlarged left atrium 4.5 cm or larger, and


• normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure).

In addition, the claimant must also have one of the following symptoms.

• Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to certain difficulties.


• If an exercise tolerance test would be too risky, persistent symptoms of heart failure that very seriously limit activities of daily living (ADLs) are required, or


• At least three episodes of heart failure and fluid retention within the past 12 months, requiring emergency room treatment or hospitalization for at least 12 hours.

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.

Applying for Social Security Disability with Multiple Sclerosis (MS)

 

Every competent Social Security Disability lawyers knows that applying for Social Security Benefits with Multiple Sclerosis (MS) can be a complex task due to the episodic nature of this condition.  It is well known that, in many cases involving MS, there are periods of time when the condition makes a person very sick and periods when there are little to no symptoms.  However, with the right strategy and suficient medical evidence, claimants have a good chance of being awarded Social Security Disability Benefits. 

Multiple Sclerosis is an autoimune condition that affects the central nervous system, the brain, the spine and the optic nerve.  MS affects the myelin (a the fatty substance that surrounds and protects the nerve fibers in the central nervous system), as well as the nerve fibers themselves. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.  Symptoms include: fatigue, numbness, walking (gait) balance, & coordination problems, bladder dysfunction, bowel dysfunction, vision problems, dizziness and vertigo, pain, cognitive dysfunction, emotional changes, depression and spasticity.

There are two basic ways that a person can qualify for Social Security benefits due to Multiple Sclerosis. 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.

Social Security uses the Listings of Impairments manual as their guide to determine whether a claimant meets or not the Social Security Administration's requirements for total disability.  The listing for Multiple Sclerosis is found in Section 11.09.  Section 11.09 states that in order to meet the lisitng of impairments, the claimant must suffer from one of the following:

1. Disorganization of motor function; 


2. Visual or mental impairment; or


3. Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the multiple sclerosis process.

Please note that the lisiting provides a very specific definition of each one of these symptoms.  For a more detailed definition click on the link: http://www.ssa.gov/disability/professionals/bluebook/11.00-Neurological-Adult.htm#11_09   Claimants must prove that they suffer from symptoms of the level of severity specified in the listing in order to be found to meet from one of these three characteristics. 

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 support our friends in the Connecticut chapter of the National Multiple Sclerosis Society visit: http://www.nationalmssociety.org/chapters/ctn/index.aspx

For our firends in the Massachusetts Chapter visit: http://www.nationalmssociety.org/chapters/MAM/index.aspx

Depression is common during the course of multiple sclerosis. In fact, studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions.
Learn more about Depression