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Applying for Social Security Disability Insurance (SSDI)

Compiled by Linie Moore


The following is Social Security Disability information I've collected over the Internet and through friends. This is for information purposes only, not legal advice.

Table of Contents:
  • Social Security Disability Information
  • Impairment
  • Listing for adults
  • Residual function
  • Burden of proof
  • Evidence
  • SSDI Q & A
  • Do I need an attorney?
  • Factors affecting your disability claim
  • Getting Started
  • Administrative Law Judge (ALJ)
  • What will I testify about at the ALJ hearing?
  • Evaluations by "SS blue book" (Liver disease, depression & Arthritis criteria)
  • How Betty made it through the system
  • Karen's step-by-step approach
  • Providing Medical Evidence to SS: A guide for your doctor
  • Will My Benefits be Cut Off?
  • Putting together your SS packet

  • Social Security Disability Information

    What is Social Security Disability?

    Disability is the "inability to to do any substantial gainful activity" by reason of a medically determinable physical or mental impairment:
    • which can be expected to result in death; or
    • which has lasted or can be expected to last for a period of not less than twelve months.

    The claimant must have a severe impairment that makes the claimant unable to do the claimant's previous job or any other substantial gainful activity which exists in the national economy. Further, recent law has generally made a requirement of Citizenship. To determine if the claimant can do any other work, the Social Security Administration will consider the claimant's residual functional capacity, age, education and work experience. A determination by another agency that an applicant is disabled will impact a claim. If found disabled by some other non- governmental or governmental agency, the evidence toward that finding is important.

    The Social Security Administration determines disability by a five step process:

    1. The claimant must have no substantial gainful activity.
    2. The claimant must have a severe impairment. If work is not being performed, Social Security will initially look at any physical or mental impairments to determine whether one is disabled or blind.
    3. The analysis generally ends if the claimant meet or equal a listing of impairments. The listings are medically determinable criteria, for a presumptive finding of disability. If the claimant does not meet or equal a listing, the analysis goes to steps 4 and 5.
    4. The claimant's impairment must prevent the claimant from working previous employment over the past fifteen years.
    5. The impairment must be so severe that any other work which exists in the national economy cannot be performed.This analysis at steps four and five depend on the claimant's residual functional capacity
    There are several forms of Social Security disability, including Disability Insurance Benefits, Widow's Benefits, and Supplemental Social Security Income (SSI). Social Security, however, no longer grants disability based solely on drug or alcohol addiction or, generally, to non-citizens. There are also children's benefits, which have been subject to recent changes. Social Security may also be available to those disabled by Chronic Fatigue Syndrome or Fibromyalgia. The claimant needs to provide evidence to Social Security. Social Security will generally not pay for getting all the medical evidence they need to decide a case.

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    Impairment

    Any impairment must be a medical, anatomical, physiological or psychological abnormality that can be shown by a medically acceptable clinical and laboratory diagnostic technique. Physical or mental impairments must be established by medical evidence consisting of signs, symptoms and laboratory findings, not only by the claimant's symptoms. Symptoms are a description of physical or mental impairments. An individuals statement alone is not enough to establish that there is a physical or mental impairment. Signs are anatomical, physiological or psychological abnormalities which can be observed separate from a statements (symptoms). Signs must be shown by medically acceptable clinical diagnostic techniques. Psychiatric signs are medically demonstrable phenomena which indicates specific abnormalities of behavior, affect thought, memory, orientation and contact with reality. They must also be shown to be observable facts that can be medically described and evaluated. Laboratory findings are anatomical, physiological, or psychological phenomena which can be shown through the use of medically acceptable laboratory diagnostic techniques. Some of the techniques include chemical tests, electrophysiological studies, electrocardiogram, electroencephalogram and psychological tests. The kind of evidence that needs to be supplied to Social Security must show an impairment and how severe it is during the period it is said that one is disabled. Remember, the Social Security Administration will only consider the impairments that one says they have or about which they receive evidence, with a possible exception of those who suffer from Chronic Fatigue Syndrome "CFIDS" or perhaps Fibromyalgia. Social Security can help get medical evidence and reports when giving SS permission to request such from your doctors.

    In almost every case, no matter what the disease is, the answer is the same - "Maybe, it just depends upon how badly you are affected by the disease." One example might be cancer. The word "cancer" is scary to anyone, but there are many cancers which can be treated and cured very quickly, with little or no lasting effect. On the other hand, of course, there are cancers which cause great suffering and ultimately death. The question in each individual case is "How sick is this particular individual with cancer and how long is this person going to remain sick?" Skin diseases are another example. The vast majority of skin diseases, while annoying, would not be considered to be disabling. On the other hand, there are some uncommon, very severe skin problems which are clearly disabling. In extreme cases, psoriasis, which is not rare, may be disabling. Thus, almost without exception, the mere fact that an individual has a disease with a certain name does not guarantee that the individual either will or will not be found disabled. It all depends upon how sick the person is.

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    Listings for Adults

    The listings are medically determinable criteria you generally must be very ill to meet or equal these listings. If you do not meet or equal a listing, you go to the next step. Included below are the adult listings. While these listings were updated recently, this page cannot verify that the listings are exact and to date. The listings may be looked up at 20 C.F.R. Section 404 Subpart P Appendix I:

    Part A • Sec.
    1.00 Musculoskeletal System.
    2.00 Special Senses and Speech.
    3.00 Respiratory System.
    4.00 Cardiovascular System.
    5.00 Digestive System. including liver disease 5.05 (see below)
    6.00 Genito-Urinary System.
    7.00 Hemic and Lymphatic System.
    8.00 Skin.
    9.00 Endocrine System and Obesity.
    11.00 Neurological.
    12.00 Mental Disorders. (see below)
    13.00 Neoplastic Diseases, Malignant.
    14.00 Immune System.

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    Residual Function

    Residual Function: The residual functional evaluation based on your age, education and work experience, that helps them make this determination in steps four and five, and it is defined by the limitations that your impairments have on you. The impairments may be assessed either from a physical or mental standpoint. The evaluation is made ultimately by Social Security. However, when your treating physician(s) hold an opinion on how you are functioning, particularly if the treatment is over a long period with sustained contact, Social Security will give the opinion(s) great weight.

    What a "medical functional capacity assessment" describes. This assessment describes an individual medical ability to do work-related activities such as sitting, standing, moving about, lifting, carrying, handling objects, hearing, speaking a mental impairment, the medical assessment will include your ability to reason or make occupational, personal or social adjustments. The medical evidence must be complete enough to allow the Social Security Administration to determine the nature and limiting affects of impairments for any period in question, the probable duration of individual impairments and an individual residual functional capacity to do work-related physical or mental activities. Information from other sources may help an individual to understand how an impairment affects ability to work. Some other sources that may help are: public and private social welfare agencies, observations by non-medical sources and other practitioners such as chiropractors, audiologists, etc. If a family medical doctor writes a letter that an individual is totally and permanently disabled, it will not help one receive benefits that is for Social Security to conclude. The report must contain all of the items covered under what a medical report should include (i.e, history, clinical findings, laboratory findings, diagnosis, treatment, medical assessment). It must be complete. Social Security will use the doctor's reports as evidence to make their determination, but not for its conclusion.

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    Burden of Proof

    The burden is, generally speaking, on the claimant. Attention should be brought to the Social Security administration illustrating everything that shows disability. The Social Security Administration will consider all relevant information they receive from the applicant. If the information is not present in the claimant's file (or the tape of the testimony) then it is not considered. The opinion by a claimant's frequently treating doctor, with objective tests for impairment, over a long period of time is given more evidentiary value than the opinion of consultative examiners. Specialists are given more weight than generalists on specified topics of impairments. Once the claimant shows that the impairment limits to the extent that the claimant cannot perform past relevant work, than the burden shifts to Social Security to show that the claimant cannot perform any significant and competitive work in the national economy.

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    Evidence

    The claimant should provide Social Security with information about age, education and training, work experience, daily activities both before and after the date of disability, efforts to work and any other evidence showing how impairments affect the ability to work. The Social Security Administration accepts evidence from reports from acceptable medical sources.

    The medical sources that are acceptable are: licensed physicians, osteopaths, certified psychologists, optometrists for measurement of visual acuity and visual fields (they may need a report from a physician to determine other aspects of eye disease); and individuals authorized to send them a copy or summary of the medical records of a hospital, clinic, sanitarium, medical institution, or health-care facility.

    Generally, the copy should be certified as accurate by the custodian or by any authorized employee of the Social Security Administration, Veteran's Administration or State Agency. Generally, Social Security will not return an uncertified copy or summary for certification unless there is some question about the document. These reports should contain the claimant's medical history, clinical findings such as the results of physical or mental status examinations, laboratory findings such as blood pressure, x-rays, etc., diagnosis (statement regarding disease or injury based on its signs and symptoms), treatment prescribed with response and prognosis and a medical assessment (except in statutory blindness claims, and disability claims for widowers and surviving wives).

    Remember, Social Security gives greater evidentiary weight to opinions of treating sources who have cared consistently over a long period to that of a single consultative examination. However, specialists examining a claimant in their area of expertise are given more weight than generalists. Further, objective evidence of impairment, such as a positive MRI scan, are given a greater weight to opinions based on subjective findings, eg., complaints of pain. The medical opinions are best described in terms of functioning. For instance, many hours at one time can the comfortably claimant sit, stand or walk, or in combination of these positions? How much can the claimant occasionally, frequently, or continuously lift or carry? Can the claimant use hands for grasping, pushing, pulling, or fine manipulation? Can the claimant use feet for pushing and or pulling leg controls? Can the claimant bend, squat, crawl, climb, or reach? Is the claimant restricted from activities involving unprotected heights, moving machinery, weather changes, automobiles, exposure to dust, fumes, and gases? Can the claimant understand and remember instructions? Can the claimant persistently sustain concentration? Can the claimant socially interact? Can the claimant adapt? Are the functional limitations materially related to a problem with drugs or alcohol (if so, benefits may be restricted)?

    Who pays for getting all the medical evidence Social Security needs to decide a case? Generally, individuals are responsible for submitting evidence to support claims for disability. However, Social Security will help by asking sources questions on one's behalf. The Social Security Administration will generally not pay for this information. There are rare situations when Social Security will pay for this information. The situations when Social Security will pay for medical evidence. If the evidence in the file shows that there may be a disability but it does not contain the medical findings to make a disability determination and Social Security must have this additional information. If, Social Security finds one or more of your medical sources has the information but they will not give Social Security the information until they are paid for it, Social Security may pay for the report. Generally, Social Security may pay when a hospital or clinic charges a small fee to cover its copying and mailing costs and the only way to get the information would be to have an individual take a special examination at Social Services expense. The evidence may be submitted to any Social Security Office to the office of any State Social agency, or to one of Social Security's employees authorized to accept evidence at another place such as an Administrative Law Judge. If your doctors do not provide Social Security with the medical and other evidence they need and request, Social Security will make its decision about your case based on the information provided in your file. A religious or personal reason not to take a medical examination, test or treatment requested by Social Security may be a valid excuse not to have it. However, if medical sources cannot give social Security sufficient medical evidence about impairment to determine a disability, they may ask that a physical or mental examination be taken. These examinations are called consultative examinations. Social Security pays for the consultative examinations. They may also pay for transportation to the place of the requested examination.

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    Social Security Questions and Answers

    Q: I understand that to get Social Security disability benefits, your disability must be expected to last at least a year. Does this mean that you must wait a year after being disabled before you can get benefits?

    A: You do not have to wait a year after the onset of the disability before you can get benefits. You should file as soon as you can after becoming disabled and benefits begin after a 5-month waiting period. The waiting period begins with the month Social Security decides your disability began.

    Q: I have been receiving Social Security disability benefits for the past four years and my condition has not improved. Is there a time limit on Social Security disability benefits?

    A: No. You will continue to receive a disability benefit as long as your condition keeps you from working. But, your case will be reviewed periodically to see if there has been any improvement in your condition and whether you are still eligible for benefits. If you are still eligible when you reach 65, your disability benefit will be automatically converted to retirement benefits.

    Q: I had a serious back injury four years ago and received disability benefits for about 18 months until I could return to work. Unfortunately, my back problems have recurred and I don't know how much longer I will be able to continue working. When I initially applied for benefits, I waited several months before I received my first check. If I reapply for benefits, will my wait be as long as it was the first time?

    A: Maybe not. It depends on what the new medical reports say and whether additional evidence is required. A worker who becomes disabled a second time within five years after benefits stop can have his or her checks start again, beginning with the first full month of disability if the new claim is approved.

    Q: My brother had an accident at work last year and is now receiving Social Security disability benefits for himself, his wife, and daughter. Before his accident, he helped support another daughter by a woman to whom he has never been married. Is the second child entitled to some benefits as well?

    A: Yes, even though your brother wasn't married to the second child's mother, Social Security pays benefits to all of his children, even if they were born out of wedlock. Each child is entitled to equal benefits.

    Q: What are Medicaid and Medicare?

    A: If you qualify for disability insurance benefits you will be eligible for Medicare after two years and five months. If you qualify for SSI you will be eligible for Medicaid. Even if you have not yet been approved for SSI you may qualify for Medicaid through the state. Medicaid is an assistance program under which money from Federal, State and local taxes pays medical bills for certain eligible needy and low-income people. For more information you may contact the Social Security Administration.

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    Do I need an attorney?

    You have the right to have an attorney represent you in your Social Security case. Although attorney representation may not be absolutely essential in all cases, statistics have shown that people represented by an attorney have been more successful than people without attorney representation. Whether you hire an attorney is entirely up to you; but you should consider the advantages by examining what an attorney can do for you in your Social Security case.

    By law, an attorney can only charge you 1/4 of the past benefits if you win the case, up to a maximum of $4,000. Every case is different. Your attorney's role depends on the particular facts of your case. However, a few things your attorney may do are:

  • Gather medical and other evidence.
  • Analyze your case under Social Security Regulations.
  • Contact your doctor and explain Social Security Regulations to obtain a report consistent with those regulations.
  • Refer you to additional doctors for further medical reports to support your claim.
  • Send you to a vocational expert for a report on your ability to work.
  • Suggest that the Social Security Administration send you to a doctor for a consultative examination.
  • Obtain documents from your Social Security file.
  • Review actions taken by the Social Security Administration.
  • Ask that a prior application for benefits be reopened.
  • Seek waiver of a time limit.
  • Request subpoenas to insure the presence of crucial witnesses or documents at your hearing.
  • Advise you how best to prepare yourself to testify at your hearing.
  • Protect your right to a fair hearing by objecting to improper evidence and procedures.
  • Cross-examine adverse witnesses at your hearing.
  • Present a closing statement at your hearing arguing that you are entitled to benefits under Social Security Regulations.
  • Submit a written summary of the evidence and argument to the Administrative Law Judge.
  • If you win, make sure that the Social Security Administration correctly calculates benefits. If you lose, request review of the Hearing Decision by the SSA Appeals Council. If necessary, represent you in a federal court review of your case.

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    Factors affecting a your disability claim

    No one can say with absolute certainty whether or not a social security disability claim will be allowed. There are certain factors that can be predicted, with reasonable certainty, to increase the likelihood of a favorable decision and the actual payment of disability benefits. It is to those factors that the body of this chapter is addressed. As previously mentioned, disability for purposes of receiving social security benefits is determined by whether or not the claimant's disability and other factors fit neatly into the scheme of one of the GRID TABLES". The overwhelming majority of disability claims that are approved, are based on one of the Grid Tables. The following factors directly impact on which table's standards the claimant's disability will be determined.

    A. Age of Claimant
    The age of the claimant is the single most important determining factor in whether or not the claim for disability benefits will or will not be approved. Theories: Claimants age 50 or over that due to education and skills are unsuited for sedentary work, often win for that reason. Those who have a history of sedentary work and are below age 50 have a far more difficult time in obtaining a favorable ruling unless they can show that they are unable to sit due to the weight placed on the hip. The hip is the largest joint in the body and hip pain can be disabling if it is severe.

    Appearance: Claimants suffering from severe hip impairments will display a seriously altered and or labored gait. Administrative Law Judges will observe the claimant's walk, limp and any devices such as canes, walkers etc. necessary to walk or stand.

    B. Education Of The Claimant
    Education has very little to do with whether or not a claimant is allowed disability benefits unless the claimant is functionally illiterate ie: unable to read and write well enough to function in a modern society at the same level as the majority of the citizens. This is possibly the greatest injustice done to those applying for social security disability. There are countless hard working people in the construction or other labor intensive areas that are not illiterate, but do not have a high school education and are unable to compete and qualify for jobs with those who do have a high school education.

    C. Work Experience
    The claimant's prior work history has a major impact on the determination of the their disability. You are only required to prove that you are unable to perform the same type of work that you have done in the past fifteen (15) years. This can have a dramatic impact on your chances of winning your disability claim. It is essential that the evidence show that you cannot perform the same type of work you have done in the past. Putting together the necessary information to ensure that your evidence will show to the Administrative Law Judge that you are unable to perform the same type of work you have previously done is one of the many things that you can do to increase your chances of winning your disability case. (more will be said later about how to gather the necessary evidence)

    D. Physical Limitations
    It is not the disease or injury that makes a person disabled as it applies to social security disability. It is rather the physical limits the disease or injury causes in the claimant that determines disability. A claimant may have a disease such as cancer that has a horrible name and sends shivers up your spine, but it is not the fact that the claimant has cancer that qualifies them for disability benefits. Disability is determined based on how the cancer has placed physical limitations on the claimant. Many people have cancer. Not all people with cancer are disabled.

    E. Mental Illness
    By the date of the hearing before an Administrative Law Judge there are probably very few social security claimants that stick with the process through the hearing before an Administrative Law Judge that do not have some degree of psychiatric problems. You will have endured months if not years of physical pain, financial devastation, and the day to day difficulties that are part and parcel of having a serious condition that disables you and no doubt has turned your life upside down. It is virtually inconceivable that anyone could survive the process up to the hearing level without at least having some degree of depression as a reaction to their circumstances. In cases where the Administrative Law Judge could go either way in his decision, reactive depression brought on by your circumstances may well be the extra disabling factor that convinces the Administrative Law Judge to rule in your favor.

    History Of The Case
    The theory of the case is the reason or logic that supports your claim for disability. For each theory that supports the claimant's disability, there is also probably a theory that will deny them their disability determination. It is important to recognize those theories that would be against your case and be prepared to show how they do not apply in your case.

    The Effects of Being Disabled
    Drugs * Anxiety * Bladder Problems * Lack of Concentration * Colostomys and Illeostomys * Confusion * Depression * Diarrhea * Dizziness * •Drowsiness * Eye-Hand Coordination * Fatigue * Grasping * Headaches * Memory Loss * Numbness * Pain * Poor Stress Tolerance * Skin Conditions

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    Getting Started

    The first step in trying to be placed on Social Security disability is to see your Doctor. Ask the Doctor if in his or her medical opinion you are disabled from being gainfully employed or disabled from your present job. If the Doctor states that you are disabled, the next step is to go to your local Social Security office and get the disability forms. At this time you can also request a phone interview instead of going into the SS office for the interview.

    You will need the proper documentation:

  • Your Social Security card (or a record of your number);
  • Your certified birth certificate;
  • Children's birth certificates (if they are applying);
  • Marriage certificate (if signing up on a spouse's record)
  • Your most recent W-2 form, or your tax return if you're self- employed;
  • Your military discharge papers if you had military service.
  • Try to collect all your own medical records. This is very important, because most of the time ALL your medical records are not sent to SS.
  • Always keep a copy of any of the applications or letters you write to SS. You may need these later.

    In most circumstances, the initial SSD request will be denied. You will be notified by mail of the result. If you receive a letter informing you of your rights and you disagree with the decision rendered in your case, you can appeal the decision. Careful attention must be given to the appeal process. Any mistakes can render the appeal invalid. If that happens, you may have to start from the very beginning by filling out an application, and again submit it and wait for the determination. If the claimant receives 2 SS denials, an appeal can be filed within 60 days and the next step is the Law Judge hearing.

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    Administrative Law Judge (ALJ)

    If an appeal is taken, a hearing will be scheduled for your case. At this stage, having an attorney represent you can be helpful. Testimony will be given by the applicant. Testimony will also have to be submitted by the way of medical documentation and deposition transcripts of the treating Doctors. Additionally, friends, family, and acquaintances can testify as to the disability of the applicant. A vocational expert can also be used to show that the applicant's pain would affect job performance and therefore render the applicant unemployable.

    Once the applicant is before a Administrative Law Judge who will hear the applicants testimony, the Administrative Law Judge only will decide if the applicant is disabled. Even when a doctor testifies before the Administrative Law Judge, the finding the applicant to be disabled is a conclusion that only the Administrative Judge can render. The testimony presented to the Administrative Law Judge must be evaluated by that judge to determine the credibility of the witnesses, including medical testimony. If the Administrative Law Judge finds the testimony credible, he or she will issue a decision stating something to the affect, "in consideration of all the probative evidence including testimony of the witnesses and treating doctors to the claimants pain and on the observations of the claimant themselves, I find the claimant's allegations to be disabled to be credible." It is a this point that one will start to receive disability benefits.

    If the Administrative Law judge finds that the allegations are not credible, then the claimant and/or applicant loses. At this point another appeal can be taken to get another hearing. At this next hearing, new evidence may be presented as to the applicants disability. Finally, an appeal may be taken to the appeals Council. The observations of the Administrative law judge weighs heavily with the Appeals Council. The Appeals Council will not hear testimony. They will only review the record and not get a chance to see the applicant.

    The overall procedure can be lengthy. Numerous hearings can be held by an administrative judge that can last for years. Besides the applicants presentation of the case, the government, the other side in these cases, can present it's own testimony showing that the applicant is not disabled and should not be entitled to disability benefits.

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    What will I testify about at the ALJ hearing?

    1. Medical Condition
    2. Medical History
    3. Physical Abilities
    4. Mental Abilities
    5. Education and Training
    6. Work Experience
    7. Daily Activities

    1. Medical Condition The judge will ask how your medical condition makes you feel. You should tell the judge about the symptoms you experience such as pain, dizziness, numbness, nausea or paralysis as well as you can. Before the hearing, you should make notes to yourself about what conditions you have and how they affect you. Don't leave anything out. For example, if your case involves pain, you might be asked:

  • Is the pain burning, stabbing, crushing, sharp, throbbing, radiating or aching?
  • Do your activities affect the pain?
  • What do you do to relieve pain?
  • What medicine do you take for pain?
  • How well does the medication work?
  • Are there any side effects from the pain medication?
  • 2. Medical History The judge may ask you how often you see your doctor, what sort of treatment your doctor provides, what medication you are presently taking, how often you take each medication and whether there are any side effects.

    You may also be asked to describe the symptoms and treatment of your medical condition since it began. You may be asked what your doctor has told you about your problem, but the judge won't ask you medical questions about your disability.

    3. Physical Abilities If you have a physical disability, the judge will ask you a lot of questions about what you are able to do. For example:

  • How far you can walk before resting
  • How long you can sit and stand at one time during an eight-hour day
  • How much you can lift.
  • 4. Mental Abilities The judge will ask about your ability to understand, carry out and remember instructions, to use good judgment, to respond appropriately to supervision, co-workers, usual work situations, and changes in your work setting.

    5. Education and Training The judge will ask you how far you went in school, if you have had any training in the military, if you can read and write, and if you have had any job training.

    6. Work Experience The judge will ask you about the jobs you have had during the past 15 years. If your condition caused you to miss a lot of work or caused you to stop working, you should explain this.

    7. Daily Activities The judge will ask you a lot of questions to find out how your disability affects you. For example:

  • How do you spend your time during the whole day;
  • How well you usually sleep;
  • If you take naps during the day;
  • What things you do around the house, such as cooking, housework, or gardening;
  • If you go shopping;
  • If you drive a car;
  • What hobbies and activities you have now.
  • You may also be asked how your daily routine has changed since you became disabled. For example, what kinds of activities did you do before you became disabled that you can't do now?
    1. The nature, location, onset, duration frequency, radiation, and intensity of any pain;
    2. Precipitating and aggravating factors (e.g., movement, activity, environment conditions);
    3. Type, dosage, effectiveness, and adverse side-effects of any pain medication;
    4. Treatment, other than medication, for relief of pain;
    5. Functional restrictions; and
    6. The claimant's daily activities.

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    Evaluations by "SS blue book"
    (Liver disease, depression & arthritis SS criteria)

    "The Blue book", does not accurately assess "severity of impairments". Much of the info is outdated, and many illnesses are not discussed. Yet, SSA only evaluates the medical evidence against the severity of the listed impairment. No gray area, just a either/ or for approval. True, SSDI is a total disability program. But how many public or private employers will cope with a disabled worker whose impairment will interfere with the performance, conduct or attendance standards of the position. Even if it is a sedimentary job?

    SSA law judges apply the actual law in arriving at disability determinations. The claimant must demonstrate a severe impairment as shown by the medical evidence.

    The "Blue Book" is actually a reprinting of a small portion of Social Security's regulations on disability. Probably less than half of people who get on Social Security disability benefits do so as a result of "meeting a listing" which is what the "Blue Book" contains. Actually, both state agencies and the ALJs are supposed to be applying the same law. The reasons for the differences in approval rates are complex, but to my mind the biggest reason is that state agency allowances are subject to "Quality Assurance" (QA) reviews. As a result of these reviews the state agencies cannot allow someone unless they are in terrible shape. The ALJs are not subject to these QA reviews.

    From the SS blue book:

    5.05 Chronic Liver Disease(e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With:

    A. Esophageal Varices (demonstrated by X-ray or endoscopy) with a documented history of massive hemorrhage attributable to these varices. Consider under disability for 3 years following the last massive hemorrhage; thereafter evaluate the residual impairment; or

    B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter evaluate the residual impairment; or

    C. Serum bilirubin of 2.5 mg. per deciliter (100ml.) or greater persisting on repeated examinations for at least 5 months; or

    D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

    E. Hepatic encephalopathy. Evaluate under the criteria in 12.02; or

    F. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following;

    1. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

    2. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations for at least 3 months; or

    3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.

    Please note Prothrombin time (PT) in Primary biliary cirrhosis

    Primary biliary cirrhosis is a cholestatic, not a hepatotoxic disease, so the PT does not increase much in PBC. The PBC hepatocytes (the pinkstaining liver cells which make up most of the organ) are undamaged until very late stage. Instead, the little bile ducts that drain the liver are destroyed and fibrous tissue occludes the blood vessels to the liver.

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    12.04. Affective Disorders:

    Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation.

    The required level of severity for these disorders is met when the requirements in both A and B are satisfied.

    A. Medically documented persistence, either continuous or intermittent of one of the following;

    1. Depressive syndrome characterized by at least four of the following:
    a. Anhedonia or pervasive loss of interest in almost all activities; or
    b. Appetite disturbance with change in weight; or
    c. Sleep disturbance;. Or
    d. Psychomotor agitation or retardation; or
    e. Decreased energy; or
    f. Feelings of guilt or worthlessness; or
    g. Difficulty concentrating or thinking; or
    h. Thoughts of suicide; or
    i. Hallucinations, delusions or paranoid thinking; or
    2. Manic syndrome characterized by at least three of the following:
    a. Hyperactivity; or
    b. Pressure of speech; or
    c. Flight of ideas; or
    d. Inflated self-esteem; or
    e. Decreased need for sleep; or
    f. Easy distractibility; or
    g. Involvement in activities that have a high probability of painful consequences which are not recognized; or
    h. Hallucinations, delusions or paranoid thinking;
    OR A. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes); AND B. Resulting in at least two of the following:
    1. Marked restriction in activities of daily living; or
    2. Marked difficulties in maintaining social functioning; or
    3. Deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or
    4. Repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behaviors).

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    1.02. Active Rheumatoid Arthritis and Other Inflammatory Arthritis.
    With both A and B:

    A. History of persistent joint pain, swelling and tenderness involving multiple major joints (see 1.00D) AND with signs of joint inflammation (swelling and tenderness) on current physical examination despite prescribed therapy for at least 3 months, resulting in significant restriction of function of the affected joints, and clinical activity expected to last at least 12 months; and

    B. Corroboration of diagnosis at some point in time by either:

    1. Positive serologic test for rheumatoid factor; or
    2. Antinuclear antibodies; or
    3. Elevated sedimentation rate; or
    4. Characteristic histologic changes in biopsy of synovial membrane or subcutaneous nodule (obtained independent of Social Security disability evaluation).
    1.03. Arthritis of a Major Weight-Bearing Joint (due to any cause): With history of persistent joint pain and stiffness with signs of marked limitation of motion or abnormal motion of the affected joint on current physical examination. With:

    A. Gross anatomical deformity of hip or knee (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) supported by x-ray evidence of either significant joint space narrowing or significant bony destruction and markedly limiting ability to walk and stand; or

    B. Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint and return to full weight-bearing status did not occur, or is not expected to occur, within 12 months of onset.

    1.04. Arthritis of One Major Joint in Each of the Upper Extremities (due to any cause): With history of persistent joint pain and stiffness, signs of marked limitation of motion of the affected joints on current physical examination, and X-ray evidence of either significant joint space narrowing or significant bony destruction. With:

    A. Abduction and forward flexion (elevation) of both arms at the shoulders, including scapular motion, restricted to less than 90 degrees; or

    B. Gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability, ulnar deviation) and enlargement or effusion of the affected joints.

    1.05. Disorders of the Spine:

    A. Arthritis manifested by ankylosis or fixation of the cervical or dorsolumbar spine at 30 degrees or more of flexion measured from the neutral position, with X-ray evidence or;

    1. Calcification of the anterior and lateral ligaments; or
    2. Bilateral ankylosis of the sacroiliac joints with abnormal apophyseal articulations; or
    B.Osteoporosis, generalized (established by X-ray) manifested by pain and limitation of back motion and paravertebral muscle spasm with X-ray evidence of either:
    1. Compression fracture of a vertebral body with loss of at least 50 percent of the estimated height of the vertebral body prior to the compression fracture, with no intervening direct traumatic episode; or
    2. Multiple fractures of vertebrae with no intervening direct traumatic episode; or
    C. Other vertebrogenic disorders (e.g., herniated nucleus pulposus, spinal stenosis) with the following persisting for at least 3 months despite prescribed therapy and expected to last 12 months. with both 1 and 2:
    1. Pain, muscle spasm, and significant limitation of motion in the spine; and
    2. Appropriate radicular distribution of significant motor loss with muscle weakness and sensory and reflex loss.
    1.08. Osteomyelitis or Septic Arthritis (established by X-ray);

    A. Located in the pelvis, vertebra, femur, tibia, or a major joint of an upper or lower extremity, with persistent activity or occurrence of at least two episodes of acute activity within a 5-month period prior to adjudication, manifested by local inflammatory, and systemic signs and laboratory findings (e.g., heat, redness, swelling, leucocytosis, or increased sedimentation rate) and expected to last at least 12 months despite prescribed therapy; or

    B. Multiple localizations and systemic manifestations as in 1.08 A above.

    1.09. Amputation or Anatomical Deformity of (i.e., loss of major function due to degenerative changes associated with vascular or neurological deficits, traumatic loss of muscle mass or tendons and X-ray evidence of bony ankylosis at an unfavorable angle, joint subluxation or instability):

    A. Both hands; or
    B. Both feet; or
    C. One hand and one foot.

    1.10. Amputation of One Lower Extremity (at or above the tarsal region):

    A. Hemipelvectomy or hip disarticulation; or

    B. Amputation at or above the tarsal region due to peripheral vascular disease or diabetes mellitus; or

    C. Inability to use a prosthesis effectively, without obligatory assistive devices, due to one of the following;

    1. Vascular disease; or
    2. Neurological complications (e.g., loss of position sense); or
    3. Stump to short or stump complications persistent, or are expected to persist, for at least 12 months from onset; or
    4. Disorder of contralateral lower extremity which markedly limits ability to walk and stand.
    1.11. Fracture of the Femur, Tibia, Tarsal Bone, or Pelvis: With solid union not evident on X-ray and not clinically solid, when such determination is feasible, and return to full weight-bearing status did not occur or is not expected to occur within 12 months of onset.

    1.12. Fractures of an Upper Extremity: With nonunion of a fracture of the shaft of the humerus, radius, or ulna under continuing surgical management directed toward restoration of functional use of the extremity and such function was not restored or expected to be restored within 12 months after onset.

    1.13. Soft Tissue injuries of an Upper or Lower Extremity: Requiring a series of staged surgical procedures within 12 months after onset for salvage and/or restoration of major function of the extremity, and such major function was not restored or expected to be restored within 12 months after onset.

    The article entitled "Traditional Management of Liver Disorders" by M. Messner and P. Brissot. They work in the Liver Unit, Pontchaillou Hospital, Rennes, France. 1990 In the article they quote, "Bed rest is an important component of the management of acute and chronic liver disorders, together with the avoidance of fatique." Another place, "Bed rest reduces functional demands on the liver and is thus advisable in acute liver disorders." If fatigue is one of your major symptoms, it should be stated in your application for SSD, and need for bed rest. Make sure you have your doctor document everything..........all your symptoms and any new problems.

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    How Betty made it through the system

    I applied for SSD and was approved on the first try and received one year retroactive payments in 6 weeks. HOW???? The key is in the documentation by your doctor. It is not sufficient to send office records to SS. You must accompany them by a letter or a report with the key information that they are looking for. This key information should clearly outline the following:

    1. ALL DIAGNOSIS: The first listed should be the one most responsible for your disability and then in descending order according to the degree of responsibility for your disability.

    2. DURATION OF ILLNESS FOR EACH DIAGNOSIS

    3. WHY YOU ARE UNABLE TO WORK. THIS MUST BE SPECIFIC.
    Examples: "This patient cannot do any work which requires decision making or number figuring due to his/her cognitive dysfunction causing poor judgment and severely impaired organizational skills."

    Example 2: "This patient is unable to do any work requiring the use of his/her hands due to severely impaired fine and gross motor skills due to swelling and pain in digital joint." Etc.

    REMEMBER THE ACTUAL SYMPTOM THAT AFFECTS THE PERFORMANCE AND THE TYPE OF PERFORMANCE YOU ARE UNABLE TO PERFORM IN SPECIFICS IS IMPORTANT.

    4. ACTIVITIES OF DAILY LIVING THAT ARE IMPAIRED.
    Example:" This patient at times is incapable of caring for his/her children without assistance because of the safety hazard due to short term memory loss, inability to concentrate on more than one task at a time and distractibility. "

    Example 2:"Cooking proposes a safety hazard for this patient because of his/her frequent involvement of his/her hands and the fact that he/she has several times dropped hot pans while attempting this task.

    AGAIN BE SPECIFIC ABOUT THE TASKS THAT YOU ARE UNABLE TO PERFORM. DO NOT BE AFRAID TO DOCUMENT EVERY ACTIVITY THAT HAS BEEN JEOPARDIZED DUE TO YOUR IMPAIRMENT.

    STATEMENT REGARDING TIME FRAME OF DISABILITY. Example:"Due to the frequent severe exacerbationa of this patients condition, it is unreasonable at this time to expect that he/she will be able to return to work anytime in the near future. Attempts to control his/her flare ups have been unsuccessful and at this time I believe that his/her condition is chronic. It is my opinion that this patient would be a liability to any employer, and would have a very difficult time at best maintaining gainful employment due to his/her incapabilities.

    NOW YOU ASK?????HOW DO I GET MY DOCTOR TO WRITE SUCH A LETTER? Ask him. You have to remember that your doctor can only document what you tell him. Forget your "I can do it" attitude if you really can't. Tell your doctor all the things that you cannot do and why. Ask him to write this letter and document your complaints and restrictions. He can only pass on the information he has. Also be sure he attaches any documentation he may have to support your claim.
    Example: neuro-psych testing results, occupational therapy evaluation, blood work etc.

    If your doctor refuses to do this then get what is called an "Independent Medical Evaluation." It is an opinion by an uninvolved doctor. You will meet with this doctor and relate to him all the information regarding your disability. He will review your medical records and then make a decision on whether he can substantiate your claim. The key phrases above will help to clearly define your need for disability. Bob has a lot of experience with patients he has examined for disability and firmly believes that cases are approved or denied based on the way the information is documented.

    Remember, stress, including financial stress just makes conditions flare. If you have been denied ask for a hearing this letter so they have the information needed to approve your claim.

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    Karen's step-by-step approach

    Karen's disease was Marfan, but the process is basicly the same for any disease.

    The response we got from the Social Security article in the last issue of Connective Issues was overwhelming. We'll continue to keep you up-to-date on Social Security information as we receive it.

    To further assist you in your attempts to obtain Social Security benefits, here are tips provided by Karen. She applied for Social Security for her husband on March 30, 1994, and received her first check on October 3, 1994.

    "Determination and over-preparation helped me a lot, despite the fact that most people I came in contact with only told me about the red tape and horror stories of dealing with Social Security," says Karen. "Encouragement is something that is in short supply going through this process, but it can be done successfully."

    Here is Karen's step-by-step approach to obtaining Social Security benefits.

    1. Make a timetable that gives yourself some flexibility and try to follow it.

    2. Call Social Security to make an appointment; schedule it for at least two weeks away.

    3. Compile an up-to-date medical file; it is essential. Ask your specialists for copies of all records pertaining to disability validity, x-rays, labs, etc. (Some doctors' offices do not release x- rays; they have to come from the hospital.) If you are seeing another specialist for another problem, get those records as well. Give the doctor's office a deadline for providing you with the materials you need (at least three days before your meeting with Social Security is scheduled).

    4. In addition to your medical records, ask your doctor to write a letter for you that includes your prognosis (the length of time you will be disabled) and the restrictions that prohibit you from gainful employment.

    5. Make four copies of everything, including your records and the doctor's letter.

    6. Go to Social Security with your entire package, as well as the other information that Social Security needs. Make sure you get the name and phone number of the representative handling your case.

    7. Follow up with your representative by phone to make sure she has all the information she needs. Volunteer to provide her with additional information on Marfan syndrome. Maintain a positive attitude; you have done your homework. If it is an election year, go meet your senators and congressmen or their aides in person in their local district office. Don't be discouraged; you have a legitimate right to try to get disability benefits. Because you have provided Social Security with all the information they need, they should be able to reach a decision more quickly. However, if they don't, here's what you can do. 8. Make an appointment with a specialist, preferably at a hospital with a Marfan clinic or at a teaching hospital, and have the physician write another letter about your condition.

    9. Refer to the Federal Guidelines for Disability which relate to Marfan syndrome and are used by the Social Security Administration

    10. Network with any politicians you can.

    If you are denied by Social Security:

    1. Call your senators and congressmen to make an appointment to meet with them. Send them all of your medical records, letters and a booklet about Marfan (or other disease) and follow up with them by phone. On the phone, you can offer additional information about your ??? disease.

    2. Bring in your newest doctor letter, any recent medical records, the letter from the NMF, and any additional information you have.

    3. If all else fails, your congressmen can tell you which lawyers in your area have good track records in disability cases. "This approach is not about overloading your local social security office and congressmen with a pile of paperwork. The emphasis should be on good, solid documentation for your case," says Karen. "In my experience, the doctors have always been cooperative, and the congressmen show interest (because you are their constituent). By becoming well-informed and educated about Marfan syndrome and the social security system, you can really help your cause."

    If you'd like to speak with Karen about her approach to obtaining social security benefits, send us an email with ATT:Karen in the subject line.

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    Providing Medical Evidence to Social Security
    A Guide for Health Professionals

    (You may want to print this out and give it to your doctor. This is what your doctor needs to know when filling out statements & records for SS. The following was WRITTEN FOR doctors and other medical professionals.)

    When an individual applies for Social Security disability benefits, we must decide whether he or she is disabled under the law. We base our decision on information you provide and other evidence, including information provided by the individual. The following guidelines will help you understand the kind of information we need to evaluate claims filed

    DEFINITION OF DISABILITY Under Social Security law, an individual is considered disabled if he or she is:
    -- unable to do any substantial gainful work activity because of a medical condition (or conditions), that has lasted, or can be expected to last, for at least 12 months, or that is expected to result in death;
    -- or, in the case of an individual under the age of 18, if he or she suffers from any medically determinable physical or mental impairment of comparable severity.

    The medical condition(s) must be shown to exist by means of medically acceptable clinical and laboratory findings. Under the law, symptoms alone cannot be the basis for a finding of disability, although the effects of symptoms may be an important factor in our decision whether a person is disabled.

    If the medical evidence alone shows that a person is clearly disabled or not disabled, we decide the case on that information. Otherwise, we go on to consider other factors, such as functional capacity in light of the person's impairment(s), age, education, and work background. For a child under age 18, we generally consider the child's ability to function independently, appropriately, and effectively in an age-appropriate manner.

    WHAT WE NEED FROM THE MEDICAL PROFESSIONALS We need information from you that will help us to determine the existence, severity, and duration of the person's impairment(s).

    Your report should include a thorough medical history, and all pertinent clinical and laboratory findings (both positive and negative) from your examination of the person. Copies of laboratory results should be provided if available. Also, provide the results of any mental status examination, including any psychometric testing.

    Longitudinal clinical records and detailed historical notes discussing the course of the disorder, including treatment and response, are very useful for us since we are interested in the impact of the illness over a period of time. Additionally, any information you are able to provide contrasting your patient's medical condition and functional capabilities since the onset of illness with that of his or her prior status would be helpful.

    You should also include a statement of your opinion about what work-related activities the person can still do despite his/her impairment. Tell us your opinions about both physical and mental functions and, to the extent possible, the reasons for your opinions, such as the clinical findings and/or your observations of the person. These opinions should reflect the person's abilities to perform work-related activities on a sustained basis, i.e., 8 hours/day and 5 days/week. Your descriptions of any functional limitations you noted throughout the time you treated the patient are very important. Examples of work-related functions include:

    1. Physical work-related functions: Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, and handling.

    2. Mental work-related functions: The ability to understand, remember, and carry out simple instructions, the ability to use appropriate judgment, and the ability to respond appropriately to supervision, co-workers, and usual work situations, including changes in a routine work setting.

    SSA can pay a reasonable amount for reports (or copies) of medical evidence requested from physicians/psychologists, hospitals, and other non-Federal providers of medical services.

    The Effects of Being Disabled
    Drugs * Anxiety * Bladder Problems * Lack of Concentration * Colostomys and Illeostomys * Confusion * Depression * Diarrhea * Dizziness * •Drowsiness * Eye-Hand Coordination * Fatigue * Grasping * Headaches * Memory Loss * Numbness * Pain * Poor Stress Tolerance * Skin Conditions

    END

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    Will My Benefits be Cut Off?

    The biggest fear for most people who receive Social Security disability benefits is that they will be cut off benefits. What are the chances of this happening?

    Social Security is supposed to review most people receiving Social Security disability benefits at least every three years. Even recipients who are permanently disabled are supposed to be reviewed at least every seven years. In recent years, Social Security has been so short of money that there have been few reviews. This will probably change in the next few years. Congress is putting pressure on Social Security to review more cases. Congress may even give Social Security the money it needs to do this.

    One of the reasons Social Security has been reluctant to do more continuing disability reviews is that it is difficult to cut off disability benefits. Social Security must prove that a person has improved. When Social Security has done reviews, it has found that more than 90% of the people it reviews have not improved. There is some chance that Congress will change the standard to make it easier to cut off disability enefits.

    What can people who are now receiving Social Security disability benefits do to protect themselves against being cut off?

    1) If you get better and feel like going back to work, of course, go back to work. Just let Social Security know you have gone back to work. Social Security won't cut off or even reduce your regular Social Security disability benefits until you have been back at work for a year.

    2) If you can't go back to work, at least keep seeing your doctors on a regular basis.

    3) If you get a notice that you are being reviewed, don't panic, the odds are excellent that your benefits will be continued.

    4) If Social Security does try to cut you off, call us right away. Don't delay. Your benefits can continue while you appeal, if you file your appeal within ten days after you receive the notice cutting off your benefits.

    5) Try to save some money. You may need the money to pay attorney fees and to keep going if Social Security tries to cut you off. This information is not legal advice, but for information purposes only. This information is from AOL SSD BB-C. Hall

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    Putting together your SS packet

    Have you ever heard the saying "Too much is never enough?"

    I think this must have been in reference to SS.........overload them with paper work, and they will still ask for more. Send them everything but in an organized info pack.

    My son and a friend helped me put my SS info pack together. It took a lot of time and energy, but it worked. I used (2) three inch binders and sectioned everything with tabs.

    1. Cover sheet with name, SS#, date I stopped working and diagnosed diseases listed.

    2. A list of ALL medications including over the counter meds and even eye drops for Sjogrens, etc. Next to each I listed what they were prescribed for, doctor who prescribed them, dosage and any side effects I experienced. Behind this sheet I included the drug info sheet. It is usually given with the prescription or you can locate information on the Internet.

    3. Disease information sheets which explained each of my diagnosed diseases, their symptoms, prognosis, etc. I highlighted the important parts of each. You can get this information from your doctors or Internet sites.

    4. Statements on how my illness had changed everything in my life. There were 3 written statements: Myself, son and a close friend.

    5. Doctor statements and Residual Functional Capacity Questionnaires. Each of my doctors (5) filled out a RFCQ and on their letterhead stationary type a statement about my diseases, symptoms, prognosis, that the diseases would last longer than 12 months and I could NOT engage in any substantial gainful activity.

    6. All Medical records-doctor notes, labs, hospitals, tests and x-rays. The doctors were sectioned by type, with most important first. Most recent records were first. Important factors were highlighted in all medical records.

    7. Copies of all applications and letters sent to SS. Also copies of SS criteria for each of my diseases.

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    Hope this information helps and if you have anything additional to add, please feel free to e-mail me.

    Linie Moore


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