Amputation and Lower Extremity Surgery
Amputation cases are usually covered under the Medical Listings for benefits under Social Security guidelines. Under the medical guidelines, amputations of any combination of an arm below the elbow or leg beneath the knee should qualify you for benefits. So, if you have the misfortune to lose two arms or two legs or one arm and one leg, you should most assuredly qualify. I did have a client get turned down after losing an arm and a leg in a motorcycle accident. I took a Polaroid photo of him without his artificial limbs and drove him down to the Social Security office where I penned his appeal and attached the Polaroid and demanded I see the Disability Claims manager. I had him approved on the spot.
Cases involving surgeries to the lower extremity involve medical proof. In these types of cases we look for bilateral knee surgery or one sided knee surgery with some involvement of the hip, back, other knee or ankles to prove these cases medically. Often these kinds of cases are ignored at the initial intake level by the SSA because proof is scant. We have found that even old knee surgery records when combined with new X-rays or MRI reports can show the requisite evidence of degenerative disc disease, degenerative arthritis in both the good and surgical knees and herniated disks so as to obtain an award of benefits for our clients. In these cases, we also look for evidence of ankle fusions and other conditions of overcompensation that causes problems with walking over uneven surfaces, climbing steps or stairs or standing in excess of fifteen minutes without producing discomfort or pain. Disability in these cases may be shown medically and vocationally, so each case must be built and developed on its own merits. Less severe cases may also produce an award of disability benefits depending on the age and education and work history of the claimant.
Cardiac Problems and Stroke
In cardiac cases, the burden of showing that, due to Cardiac problems and with circulation and Stroke, a claimant could not work even at a sedentary occupation on a continuing basis for eight hours per day, five days per week because of a combination of impairments. In cardiac cases, we generally look at EF, or ejection fraction tests with a rating of 35 or below. At 30, the person qualifies for SSD because he/she would meet a Medical Listing. At measures above 35, up to 50, ALJs look for surgeries, and other ailments where the combination of impairments significantly impacts the person‘s ADLs, activities of daily life, so that walking at a reasonable pace, or sitting for prolonged periods is affected. This is especially true in heart cases where a person must keep his legs elevated to heart level to assist in circulation, as there are no jobs in the competitive job market that would allow for such a situation for more than an hour per day. Luckily, in these cases, if a claimant has a good cardiologist who helped him by completing a Cardiological RFC form downloaded from our website, there is a better chance of winning.
Typically, where the cardiological conditions are so severe that a claimant is unable to sustain or maintain substantial gainful activity on a routine and continuing basis for an 8-hour work-day, 40 hour work-week or an equivalent work schedule, such an individual would be found disabled. People with severe heart conditions usually lack the circulatory ability and stamina to work full time in a competitive work environment and are extremely limited in their ability to walk without becoming winded, dizzy or tired. Other symptoms and impairments further exacerbate this underlying problem. The bottom line is that if these conditions result in a claimant not being able to work a full range of sedentary work, the claimant would be disabled for the purposes of receiving SSDI or SSI benefits.
In a Carpal Tunnel or trigger finger case, the proof can be difficult without objective testing. In Carpal Tunnel, a condition which is diagnosed and tested by a neurologist. Surgery is often performed, but scar tissue builds in the “snuff box” of the wrist and makes things like lifting anything in excess of five pounds or twisting lids off of jars, using a screwdriver, simple things most people take for granted difficult. These sort of injuries can be caused from repetitive use of keyboards or vibrating hand tools. Sometimes they are idiopathic, meaning that they sometimes arise on their own. They may also include the elbows where the condyles get inflamed with repetitive motion. Either way, if a claimant cannot use his or her hands in a repetitive fashion for more than two hours in an eight-hour day, then there are no jobs available for him or her. Having to take frequent unscheduled breaks and being away from tasks can also bode against getting hired or staying hired. Hence the assistance of your neurologist and family physician will be most helpful in completing our forms to determine what our clients can and cannot do in a hypothetical work situation.
Bipolar, Schizophrenia, PTSD
Psychiatric disability cases are very difficult to prove unless one has been treating with a psychiatrist. Most of the younger clients we have, especially those who suffer from Bipolar Disorder and Schizophrenia cannot afford proper mental health care. This is especially true in the more rural areas in which our clients live. In our region and most of our geographical areas, we have found that there are portions of rural Polk County, Marion, Citrus, Sumter and Pasco counties that are underserved by our psychiatric medical community. This is not the doctor’s fault, as the indigent health care systems has not the assets to hire medical doctors who specialize in psychiatry and the VA aggressively hired many of the physicians who had been in private practice away into the VA in the major cities. This is a good thing as our Veteran clients and those suffering from PTSD need it. The down side to this is that the county mental health facilities are understaffed and overburdened. Nurse practitioners now fill the shoes that used to be filled by Psychologists and Psychiatrists. The SSA does not give great weight to the opinions of licensed social workers or psychiatric nurse practitioners. Moreover, the Social security Administration will have your file sent out early on to their own “experts” who will down play your symptoms and treatment and render an opinion that a claimant can do simple repetitive work on a full time basis thereby allowing the SSA to deny your claim. This is why it is so important to have a regular treating psychiatrist on board in your case. If there would be any time to borrow from family to pay for the treatment by a psychiatrist, it would be before, during and after the filing of a Social Security Disability claim. Fortunately, in cases where psychiatric care was obtained after our services were retained and the treating psychiatrist completed a Psychiatric Residual Functional capacity form for our client we have been successful. If you do not have access to a physician, do not be afraid to report to the emergency room if you are in crisis. It may be the only bonifide way to help document your mental illness and prove your case.
PTSD cases involve a myriad of symptoms. They are dangerous to the claimant and to the claimant’s family if left untreated. If they are untreated, the cases are virtually impossible to prove. That is why treatment is not an option. It is mandatory. In many cases PTSD is combat created. It can be chronic and severe at times. It can be mixed with a number of other psychiatric illnesses, like depression, bipolar disorder, borderline personality disorder, personality disorder with antisocial behavior, to name but a few. It is also diagnosed with drug and alcohol abuse that were just as much as a symptom as a cause for exacerbation. So, see your psychiatrist and stay off alcohol and street drugs, if you want to have a shot at getting your SSSDI or VA benefits. PTSD even affects those who did not see combat or the gore of combat back in the hospitals and the morgues. War hurts us all. Even those who were in uniform and held behind suffer “soldier’s remorse’, similar to the “Why didn’t God take me?” or “It should have been me who died, not my closest friend, or son, or daughter”. Civilians get PTSD too, from accidents, deaths of loved ones….”Why couldn’t I have stopped this from happening”. It is all PTSD. It is all treatable. Do not suffer.
Psychiatric medication cases can also be proved based on the severity of symptoms and the amount of psychiatric medications required to sedate patients and prevent significant symptoms so as to allow their psychiatric condition to be tolerated Psychiatric medications can affect alertness. Our clients who have medications that affect their ability to focus or concentrate or whose medications cause unavoidable sleep for more than an hour per eight hour day have provable cases as long as they have objective evidence confirming the diagnosis of the underlying condition. If their psychiatric pyhsician puts significant restrictions that would apply in an ordinary work situation on the claimant, then the case becomes easier to prove, just as long as there are no significant and ongoing illegal drug and alcohol abuse issues..
Herniated Lumbar Disc, Cervical Disc, Degenerative Disc Disease
Back claims can be tough to prove. Depending on a person’s age, literacy and the severity of the back problem, the outcome can be completely different. A younger individual, under 50 with a bad back who has a high school diploma and can still do sedentary work, may not be disabled, where the same person at age 55 may actually be disabled with the same back. Many variables apply however as do certain “Grid” rules that create a veritable nightmare for the claimant or the practitioner. Often Administrative law judges look to see if a claimant has had surgery. An ALJ once told me “surgery is the litmus test for a back disability case. If anyone would put their life on the line to make the pain go away, that person is not a malingerer but a brave man or woman. I cannot discount that when that sort of case comes before me. You combine that along with a good earnings potential throughout life and I’ll grant that claim. That kind of person wants to work”. I have found that surgery is an important factor as are positive findings on MRI, (meaning pedicles, severe DJD, or degenerative joint disease, disc herniations, disc protrusions, extruded discs, stenosis, lordosis, kyphosis, scoliosis) and positive findings on nerve conduction studies and EMGs. These are objective findings that support a claimant’s underlying painful condition. Positive straight leg raise tests in supine and seated position are helpful too and at first blush establish a strong case from a weak one. Additionally, we look for arthritic knees and ankle joints for further proof of our cases as the combination of a severe back with arthritis in the lower extremities may meet a medical listing for disability purposes.
Cervical Disc cases happen more frequently in women than in men due to the anatomical structure of the female neck. Cervicsal neck problems can mimic carpal Tunnel and can manifests in problems with lifting even more than five pounds sometimes and prevent a claimant from over head lifting and repetitive bending, pushing, pulling and both fine and gross motor movements with one or both hands. These limitations, if confirmed medically as to RFC can result in a favorable decision for the claimant sometimes even without surgery.
Residual Functional Capacity in back claims, usually involve some or most of the positive findings mentioned above. They also involve the inability to walk over uneven surfaces without a cane. Clients have cane prescriptions they bring to me as well as the applications for parking permits their physicians fill out for them. This is actual medical evidence, so you need to bring it in. Also, an RFC completed by your treating physician is most helpful, as it is ultimately up to your physician how much you can repetitively lift, carry, push or pull in a hypothetical situation. These and other issues are addressed on our forms. For example, did you know that if you had evidence of a bad low back and you have to lie down for an hour in the morning and a half hour at lunch and an hour in the afternoon, to alleviate your back pain, there are no jobs available for you out in the competitive economy? Did you know that if you can only work six hours out of an eight-hour day, there are no jobs out there in the national economy? Did you know that for all but the most skilled work, that should you have to leave work unexcused or be absent two or more times per month, that that is beyond the tolerances for absence in the economy in general and that for each and every one of these conditions that keep you from working forth hours per week, eight hours per day, that you may very well be disabled?
In cases involving Fibromyalgia, one should consult with a medical specialist to obtain a definitive diagnosis. Fibromyalgia is a pernicious disease that affects the connective or separating tissue that rides on the outside of the muscle. It is most frequently diagnosed in women. If you have ever taken chicken and cleaned it, you would notice that there is a thin sheen over the muscle tissue. That is the same membrane in humans that is affected by fibromyalgia. Fibromyalgia is most prevalent in females, but there are male cases involving the diagnosis, though they are more rare.
Fibromyalgia cases like this one can be very difficult to prove, especially if the claimant has not seen a specialist, namely a rheumatologist. Even then, during each office visit, the rheumatologist must palpate and note the palpable spasm and trigger points that he finds throughout the body. Without going into too much detail, there are eighteen such points that will reflect muscle tightness or spasm, if there is to be made a proper fibromyalgia diagnosis. If this is not done, then the case gets difficult, as most people diagnosed with the disease are relatively young, under fifty and presumed able to work. There may also be other diseases, like arthralgias, arthritis, psoriatic arthritis, that accompany the disease and exacerbate it.
Diabetes can be and often is a debilitating disease. It can affect one’s legs, and arms with neuropathy. It can be painful. It can be extremely fatiguing, especially once a claimant has been placed on Insulin. When blood sugars go uncontrolled, exhaustion results. There can be sores that occur in the lower extremity that are hard to cure and that require the elevation of legs above the waste level for up to half an eight hour work day making employability impossible. Blurriness of vision can cause headaches and the inability to concentrate for large parts of an eight hour work day. Advanced Diabetes can cause kidney failure and constant trips to the restroom making continued and sustained employment impossible. Generally, if one with Diabetes does continue to work and earn a living, that person is not disabled obviously. However, if you lose your job because of your leaving work early or absenteeism or become unemployed and cannot find work because of the probable absenteeism your diabetes caused, you can and should file for SSI or SSDI. Generally, most non-sheltered jobs tolerate unscheduled lateness, or work absences of up to only two per month. Any more than two per month over a period of six months or more is not tolerated in the competitive economy or labor force. With unskilled job, where workers do simple repetitive tasks, the tolerance for absenteeism is even less, the tolerance for unexcused tardiness or absenteeism is about once per month.
Chron’s Disease, IBS (Irritable Bowel Syndrome), Incontinence
Chron,s disease, IBS and Urinary incontinence are difficult diseases to have. From the outside people will hardly notice that you have one of these conditions. However, when they notice that you are going to the bathroom every hour or more, they can see something is wrong. Benefits in these sorts of cases depend on a proper work-up and diagnosis as well as the completion of the appropriate RFC. Suffice it to say that even if you are capable of moderate exertion at the workplace, having to go to the bathroom to take care of business where you miss more than ten minutes per hour of productive time at work over the course of the day will prevent you from working in anything but “sheltered” employment. Hence, with these limitations one would be vocationally disabled and entitled to disability benefits.
Epilepsy cases that are reasonably controlled by medication are not usually the subject of disability awards. However, where there is MRI evidence generally suggestive of an underlying pathology for Epilepsy and the seizures are uncontrolled so that seizure activity occurs at least one day per month on the average and post seizure (post-tical) periods of sleepiness or fuzzy headedness last for an additional day, then an award of disability benefits is possible. This is so because, in a competitive work environment, if an employee has absences in excess of two days per month, this is beyond the tolerances normally accepted in the competitive labor market. The less skilled the claimant is, the more likely that that absence level will be reduced to one day or more.
Cases that involve chronic pain can be difficult cases to prove unless there is an underlying pathology that has been objectively measured or diagnosed. The most successful cases unfortunately involve failed back syndrome or failed neck syndrome and these conditions normally can occur after a surgery or multiple surgeries to the affected areas. It has been our observation that back pain or neck pain alone will not normally justify an award of benefits unless some other condition is shown in combination with back and neck pain. Cases involving central disc herniations in the neck and low back, severe Spondylosis, Spondylosithesis and extreme Lordosis and cases where surgery is not an option for any reason including financial reasons can be exceptions to this as the amount of pain medications required to sedate patients and allow the pain to be tolerated can affect alertness. Our clients who have medications that affect their ability to focus or concentrate or whose medications cause unavoidable sleep for more than an hour per eight hour day have provable cases as long as they have objective evidence of the underlying condition and their pyhsician puts significant restrictions that would apply in an ordinary work situation.
Though obesity is no longer a listed impairment must be considered if it exists in a disability claim. The effects of obesity can be significant in causing and contributing to impairments in numerous body systems, such as musculoskeletal and cardiovascular components of ones habitus. If obesity has a significant effect when combined with other impairments like skeletal or cardio-vascular, the other impairments can be greater than the effects of each impairment considered separately. So the aggregate effect of obesity and all other body systems has to be evaluated and if the effects caused by the obesity on the rest of the body is severe, then benefits may well be awarded.
Drug and Alcohol Addiction
In cases involving psychiatric issues and involve alcohol and drug use, we are very careful about the clients we can represent. Continued alcohol and/or drug abuse is often fatal to a Social Security disability claim Usually cases involving drug or alcohol abuse get turned down at step five of the five step analytical process an ALJ must undertake to determine if a claimant is eligible for benefits. At step five, the ALJ must determine if the claimant is able to do any other work that may otherwise be available to him/her based on past work, transferrable job skills, age and education.
A finding of “disabled” under the five step inquiry does not automatically qualify a claimant for disability benefits. Under provisions added by the Contract With America Act, Pub. L. No. 104-121, 110 Stat.847 (March 1996), an individual shall not be considered to be disabled if drug addiction would be a “contributing factor material to the Commissioner’s determination that the individual is disabled.” (42 U.S.C. section 423 (d) (2)(C), 1382c(a)(3)(J)
Ultimately, cases involving alcohol or drug use are problematic at best and impossible to prove at best. For over twenty years, alcohol and/or drug addiction have not been legal bases for awarding SSDI or SSI benefits. Moreover, these days, if either drugs or alcohol is the primary cause of the claimant’s mental illness, he or she cannot get SSDI or SSI benefits. It gets worse. Even if the claimant is truly mentally ill, but drugs or alcohol interfere with his response to medication or treatment, benefits are denied. We often see this in cases where a client is hospitalized involuntarily because of alcohol or drug abuse and remains there for days or weeks. So, if the claimant is otherwise even marginally functional, but if these periods of decompensation are triggered by drugs or alcohol, the benefits will not be paid. Even in severe mental illness cases, if benefits are paid, the claimant will not receive them, as an alternative payee will be used, alcohol and drug abuse notwithstanding.
Child Disability Cases
Many of our cases involve a child and adult child filing. In a “child claim”, for a child under 18, the child must have at least a two severe or marked limitation in two or more of the following. 1. Acquiring and using information, 2. Attending or completing tasks, 3. Interacting or relating with others 4. Moving or manipulating objects, 5. Caring for personal needs like making food, feeding, using the toilet properly, 6. Caring for health and being healthy. This is often found in the Childhood RFCs that we send out for our clients. It is also shown by written statements from third parties and by the introduction into evidence of the child’s school records, particularly his or her truancy records, IDEP placement records and IQ testing.
Adult Child Cases
In an adult child case, the proof of the case is more about the potential for employment or lack thereof based on medical records and residual mental or physical capacity. Fortunately we had sent both the childhood RFCs and the adult RFCs to the claimant’s various physicians. The presence of an RFC in the case, conscientiously filled out and completed by our client’s treating physician was invaluable.