Avoidance of Back Pain

I'm not a medical doctor, but in my past work as a disability examiner and also from my own experiences with severe back pain (e.g. hearing my back go "crunch" and then being in bed for five days straight on pain killers and muscle relaxants), I've gained some insight into degenerative disc disease, and, of course, quite a bit of empathy for those who suffer with debilitating back pain.

Back pain is one of the top reasons Americans visit their doctors. From pulled muscles, burning sensations, sciatica and muscle spasms or sprains, to ruptured discs, or spinal stenosis, back pain can be debilitating. Overdoing exercise, being overweight or being inactive and then overdoing an activity are the most common reasons for back pain.

To avoid back pain, always stretch before taking on an activity that may cause back stress, like yard word or heavy lifting. If you know about the activity ahead of time, stretch for a few days before to get your muscles limber. If lifting, always use a pulling motion instead of pushing, keep your back straight and bend your knees. If you feel discomfort, stop and stretch. If the discomfort is too much, stop altogether.

If you are unable to avoid back pain, relieve minor pain with an ice pack followed by a warm compress and if needed, take an over-the-counter pain reliever.

If the back pain is severe and is accompanied by weakness, difficulty in urination or a radiating pain in the back that moves to the legs, see your doctor immediately.










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Working and Applying for Social Security Disability

Are Alcoholism and Anxiety Connected?

Though it may seem common knowledge that alcoholics deal with anxiety, researchers are searching for a medical reason that the two may be inextricably linked.

In their search, researchers from UIC conducted animal laboratory tests that showed how a protein in the neurons in the amygdala, the area of the brain associated with anxiety, affects alcohol withdrawal symptoms. Normally, the neuron sends signals through dendritic spines to communicate, but when exposed to alcohol dendritic spines increase in the amygdala, creating an anti-anxiety effect through a protein called Arc and a hormone called BDNF.

They also found that when the animals were withheld alcohol they developed high anxiety and when they raised the BDNF and Arc levels back to normal, the animals were okay. Lowered Arc and BDNF in the amygdale showed increased anxiety.

The researchers believe this proves that molecular processes taking place within the neurons are responsible for anxiety and alcoholism. They also believe that people with anxiety may use alcohol to deal with the anxiety and then in turn, they feel more anxiety when they are going through the withdrawal period of alcohol.

This may help to explain why alcohol relieves stress, but then continued alcohol use is required to keep stress levels down.









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Working and Applying for Social Security Disability

Working and Applying for Social Security Disability

Working and applying for social security disability or SSI disability can present certain issues and problems, depending on the specifics of the situation. What are some of those scenarios? Here are two of the more common ones.

A) A person is working and earning more than the allowable amount set forth by the social security administration (known as SGA or substantial gainful activity). If this is the case, of course an individual will be unable to receive disability benefits. They will be able to apply for disability; however, with their earnings in excess of the allowable limit, they will quickly receive what is known as a technical denial. What do I tell people who are considering filing for disability, yet are still working and earning too much money? I simply tell them this: if your medical condition or mental condition progresses to the point where you are unable to continuing working, contact social security immediately and file a claim.

Note--an important point to remember is that an individual can still work and file for disability as long as they are not earning more than the current SGA amount (see the link to the definition in the second paragraph above).

B) A person is considering leaving their job because they can no longer perform the requirements of their job. Should they file for disability? The answer depends on a number of variables, including their ability to perform other types of work (which may include their ability to transer their existing job skills to other forms of work). In all candor, it may be to a person's advantage to apply for disability once they leave their job (due to a disabling condition) for the following reasons:

1) Disability applications and appeals take a very very long time to process.

2) An individual who is no longer able to perform the duties of their most recent job may not have a clear idea as to whether or not they can return to their job at some point, or transition to some form of other work.









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Can you get a second Social Security Disability Hearing if a judge denies you?

This is a complex multi faceted question. Many individuals attend more than one Social Security hearing in their lifetime. How does this happen? Well the controlling factor for multiple Social Security disability decisions including multiple hearing decisions is the date an individual is last insured for Social Security disability.

If an individual is still insured (an individual's work activity allows them to receive up to four quarters of coverage per year, which in turn leads to insured status for Social Security disability and retirement) for Social Security disability at the time of their hearing denial, they are free to file again and go through the process once more.

This can continue until the individual has a disability hearing that is past their date last insured, or DLI (to find out what your DLI is, you would need to contact a social security office). Once the individual receives a denial at this level, there can be no further disability claims unless the individual returns to work to extend their date last insured.

Now what are some exceptions to the above information? Some individuals appeal their claim to the Appeals Council if their hearing is denied, and on rare occasions the Appeals Council allows their disability claim, although it is more likely that the Appeals Council will return the case to the decisional administrative law judge to reconsider their ruling. Consequently, this may require a second hearing for the disabled individual.

Of course, if an individual is applying for Supplemental Security Income disability there is no limit to the amount of hearings an individual may receive, although the disabled individual must go through the entire Social Security disability process each time.

This is also true for individuals who were insured but are no longer insured for Social Security disability.








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When should you get a Representative for Social Security Disability or SSI?

Frankly, if your are able to attend an initial disability interview (at a social security office) or fill out and return your reconsideration appeal (the request for reconsideration is the first appeal in the process) paperwork, then you may not need representation yet. Often, individuals filing for disability just assume their case will go better if they have a representative or lawyer at the initial or reconsideration level.

Is this true? It can be for some individuals. As a disability examiner and in working in claimant representation, I have found that too many individuals fail to properly submit paperwork and miss important deadlines when they are not represented. And, far too often, claimants simply give up.

However, having said that, a person is not required to have representation at the disability application or reconsideration appeal level. At the disability hearing level, though, very few individuals would advise any claimant to go in unrepresented. Even administrative law judges will typically advise claimants who show up alone, without the benefit of an attorney or non-attorney representative, to have their hearing rescheduled and to come back at a later date.

Prior to the hearing level, however, things are different. The initial claim and the reconsideration level appeal are sent to a state disability agency for a decision (in most states, the agency that makes disability decisions for the social security administration is called Disability Determination Services). At this agency, a claimant's medical records are gathered and evaluated, and a disability examiner who has been assigned to the case will render a decision after consulting with a physician or psychiatrist (depending on the type of case) who is assigned to the examiner's processing unit.

At this level of decision-making, representatives (attorney or otherwise) are not permitted to make arguments to the adjudicator (who, at this level, is the disability examiner). With this in mind, some would argue that representation is unnecessary. But I would argue otherwise and here's why.

If a claimant gets denied on a disability application that has been filed with the social security administration (either for SSD benefits or SSI benefits), then they stand an 85 percent chance on averge of being denied on the reconsideration appeal, meaning they will have to request a hearing in front of an administrative law judge in order to win benefits.

In other words, if you get denied on a application, you might as well expect to go to a hearing---where you will do much better if you have representation.

So, when should you get a lawyer? You can get one at any time, but if you get denied you should certainly consider getting one immediately.








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I Did All The Work On My Disability Case - Why Should I Pay My Lawyer?

I have encountered situations over the years where a social security disability or SSI claimant would be of the opinion that their disability lawyer had done nothing to earn their fee after a case had been won. And a number of these individuals have openly stated, "Why should I pay my disability lawyer? He didn't do anything".

Well, how valid is this sentiment? In some cases, I suppose, it may be very valid. Here are some examples I can think of.

A) The attorney did not request medical record updates and for this reason did not properly present his case.

B) The attorney did not read the claimant's social security disability file and so failed to grasp what mistakes were made by the social security administration at earlier steps in the process (and, thus, why the case should now be approved).

C) The attorney failed to properly prepare the claimant for the social security hearing.

All of these occurrences are entirely valid for giving a claimant the feeling that they have received inferior service. However...even when inferior (perhaps "piss poor" would be a good description) representation has been provided, a claimant who has signed a fee agreement with a representative is still obligated to pay the fee, provided that the case was won. In other words, two wrongs don't make a right (though, I can certainly understand if any of the scenarios listed above had actually occurred).

Fortunately, the scenarios I mentioned don't happen too often. The vast majority of disability representatives take their job seriously and strive to win cases. After all, if they keep showing up at the same hearing office unprepared, they'll soon take on a poor reputation that may affect how they interact with the judges that hear cases---and also affect their ability to get referrals from previously represented claimants.








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Will Social Security disability cover sleep apnea as a disability?

Social Security will evaluate sleep apnea just as they would any other medical and/or mental condition. You may be wondering how Social Security evaluates disabling impairments. Social Security disability is awarded based upon functional limitations rather than specific medical conditions, consequently sleep apnea is considered a medical condition by Social Security.

However, Social Security disability examiners must consider how your sleep apnea limits your functional ability in order to determine the severity of your condition by Social Security disability rules and regulations.

It is most likely (in most cases) that sleep apnea will not be a severe enough condition to warrant an allowance for Social Security disability, although sleep apnea in conjunction with other cardiovascular or pulmonary conditions may result in a Social Security disability allowance.

Just how does Social Security evaluate any medical and/or mental condition? Social Security uses a five step sequential evaluation. This evaluation considers the severity of your conditions, your work history, education, the length of time you have been or expect to be out of work, and your ability to be retrained for a job that is compatible with your limitations.







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VA System Needs to be Updated

The Veteran’s Affairs Department (VA) has no problem admitting that they need to continually update their rating schedule, but it does argue against the need to update the entire retirement and disability systems. Fortunately, the subcommittee on memorial affairs and disability assistance is not backing down. They say that the system is ‘archaic’ and does not meet the needs of today’s veterans.

Members of the subcommittee state that the system needs improvements, from updating neurological criteria to showing progress in medical and science. They are worried that the system does not serve those with post traumatic stress disorder, or those who are disabled at a young age and suffer from a loss of quality of life.

The system has made progress, but 35 percent of the rating schedule codes have not been updated since 1945. One of the biggest issues they point out is that a veteran who is 100 percent disabled physically can still work and keep his compensation, whereas a veteran who is disabled 100 percent due to a mental disorder loses his compensation if he can find work.

Many are requesting and suggesting changes in this system to better serve Veterans, especially those with post traumatic stress disorder. While the VA is still showing no signs of changing the entire system, the debate is ongoing.







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Worker’s Compensation Rights

As a worker who has been hurt on the job and is receiving workers compensation, you have certain rights to protect the stability of your job. If you’ve been out of work on workers compensation and your employer tries to fire you or eliminate your position, it is best to know your rights.

Your employer is not allowed, under the workers compensation statute, to eliminate your job because you are receiving worker’s compensation. It is against the law. However, your company can eliminate your position if they deem your position null and void. If they are eliminating the position altogether, they may have a case.

When a position is being eliminated while a worker is exercising their rights to worker’s compensation, certain questions need to be asked. First and foremost, you’ll need to know if you are the only one being eliminated and whether or not someone else will be doing your position. Next, you’ll need to ask for documentation to determine why the position is being eliminated. Lastly, you might want to look into whether the company has treated others in their company similarly when they were exercising their rights to workers compensation.

If they are eliminating more than you, for example a whole department, then they are protected to do so, because it is more probable that you are not being targeted for worker’s compensation, but that the company is making changes that have nothing to do with your case.

There are many things to take into account when determining if your rights are being violated. Many states have different laws, so consult your local worker’s compensation laws to determine if you are being treated fairly.







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Worker’s Compensation Dental Treatment Non-Existent

Have you ever had to use your workers compensation for dental reasons? Many would think that if you were dentally injured on the job that it would be easy to get treatment and worker’s compensation, but that is not always the case. In fact, there are few dentists who want to treat patients with workers compensation, due to not receiving fair fees for their work.

A survey was done on 50 Maryland dentists, asking them if they would take workers compensation cases. Most said ‘No’, though a few said they would with a written guarantee of payment. They stated that most insurance companies challenge their fees, pay them less and that dentistry needs to be included in the medical fee guide. Further research shows that this already exists, but no one is using it. The fee guide currently serves as a ‘cap’ and not a way to fairly reimburse dentists for their services. Dentists also stated that they are not paid in a timely manner for worker’s compensation cases.

Unfortunately the patients, not the dentists, are suffering the most due to this issue. Many are unable to get dental help and have to pay out of their own pockets, even when their dental disaster happened at work, such as a car accident that results in broken teeth.

The Maryland General Assembly is considering a bill that requires the Workers Compensation Commission to appoint dentists to its Medical Fee Guide Committee. Hopefully, with any luck, this bill will be heard loud and clear.









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Workers Compensation Issued Improper Payments

A report from the Government Accountability Office (GAO) found that a program managed by the Labor Department to compensate on-the-job injuries (workers compensation) issued over $13 million in improper payments in 2006.

The report stated that the Labor programs relied on self-reported data from the claimants that did not include proper verification, a deficiency in performance goals that would help prevent over and under payments and a failure to assemble information on improper payments to federal employees injured on the job.

The Labor Department disagreed with their findings and issued a statement about their commitment to accurate workers compensation payments. They believe the report exaggerated the number of errors and overlooked a variety of improvements that were made in the program. They estimate they paid out $703,000 in improper payments, which is nowhere near the $13 million that the GAO estimates. They also disagree on the reasons for mistakes.

The GAO report found, most importantly, that none of their performance goals addressed compensation overpayments, underpayments or how to handle them at all. They found that performance goals concentrated on the quick processing of claims and customer service.

The Labor was reported as saying, “The GAO's interpretation of the accountability review error rate is inaccurate."









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Will Worker’s Compensation Take Care of You?

It is fair to say that most of us feel fairly protected while at work. We simply know, because of workers compensation, that if we are injured while on the job that we will be compensated fairly and that we will not have to take care of our medical bills. Unfortunately, that is not true for everyone, including a person we'll refer to as JS.

JS was hit by a drunk driver in 2003 while driving during a routine daily task to mail letters for her employer. The driver went to prison for two years, but JS feels like she’s still in prison.

At first her company’s third-party administrator paid for the bills, but after about five months the payments started being delayed and by the end of the first year, her treatments were being denied. She said she hasn’t received an acceptable reason and although she returned to work after about five months, the issues from the accident seem to keep mounting. At first she sustained a broken pelvis and fractured jaw from the accident, but now she has had to stop attending college and goes to two or three medical appointments a month for things such as chest pain, and gallstones (due to extreme amounts of weight loss from the fractured jaw).

Now, she is battling the California workers compensation system, along with many others that, for one reason or another, are not getting the workers compensation they deserve in California.

A Workers Compensation Story









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Pilot Project for Disabilities Criticized

A new pilot project is being tried out at three military medical facilities and one VA medical center, in hopes of eliminating duplication in the military and VA systems. Why the need for this? The current systems are slow, with much duplication between the two separate systems, resulting in double the work and double the hassle for service members.

The pilot system was created in an effort to help make service members’ disabilities run smoother and more effectively, but many are criticizing the project. The biggest ‘slam’ on this new project is pointing out that these systems, though quicker, are still bad systems that are outdated and not in line with the needs of service members today.

The biggest criticism came straight from the Army Surgeon General, Lt. Gen. Eric Schoomaker, who spoke up at a hearing before the House Armed Services Subcommittee stating that both systems were outdated models that did not work with today’s issues. He was quoted as saying, “When you speed up a bad process, all you have is a fast, bad process”.

According to Lt. Gen. Eric Shoomaker, there needs to be many changes in the way things are handled, updated to today’s issues for service members.

There has been no word yet whether the system will be put into play permanently.







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Veterans Affairs Department Tries to Improve Claim Processes

Everyone knows that the VA process for disability claims is a mess. The VA is not using new technologies, they are still using a paper environment and they are using systems set in place in the 1940’s. If you’ve dealt with the VA, you know exactly what I’m talking about.

The department received over 800,000 disability claims in 2007 and is backlogged with almost 400,000 claims.

Fortunately, they have plans to update, with the help of IBM Global Business Services.

Last September, IBM was hired to analyze the VA’s benefits processes and make recommendations for improving productivity.

The results are in and they have recommended:

1) a paperless environment

2) electronic signatures

3) e-authentication

4) electronic workflow management

5) electronic content management

6) a secure online portal for claims and online transactions

7) hiring more employees

Government officials say this upgrade is not enough. They would also like to see improvements with disability claims processing, adjustments to the program’s design, new structure and divisions of labor and most importantly, an update to the disability rating schedule which has not been corrected since 1945.








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Designer t-cells suppress multiple sclerosis in mice

A new study published in the Proceedings of the National Academy of Sciences states that there might be a new way to suppress auto immune diseases, including multiple sclerosis.

The drug has only been tested on mice so far, but many are thinking that it looks promising. It works by stimulating the development of t-cells, and has been proven to suppress autoimmune diseases in mice in three different models.

The drug is called FYAK and is relative of Copaxone, a medication used to treat multiple sclerosis.

Other than being used to treat multiple sclerosis, it was also found very effective in treating uveitis in mice, a common cause of blindness.

Although it could be years before the drug is proven harmless and successful, a company near Harvard is currently testing the drug on humans in a Phase I clinical trial.








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Multiple Sclerosis on the Rise in Children

Multiple Sclerosis, a disease where the immune system attacks the nervous system, affects around 400,000 people in the United States alone. Unfortunately, that number is on the rise for children. It is currently thought that one in five of all MS cases start in childhood. MS suffers are oftentimes hard to diagnose, with symptoms ranging from double vision or blurred vision, headaches and movement issues to speech slurring and other indications.

In response to this growing issue, the National Multiple Sclerosis Society helped fund the CPODD – Center for Pediatric Onset Demyelinating Disease – located in the Children’s Hospital of Alabama. The Center, located in Birmingham, offers a long list of clinical services, from neurological evaluation and diagnosis, MRIs testing and analysis and neuro psychological evaluation and care, to vision care, pediatric urology evaluation and physical and other therapy for comprehensive rehabilitation.

The CPODD is one of only six Pediatric Multiple Sclerosis Centers of Excellence in the country. The other five are:

• Pediatric MS Center of the Jacobs Neurological Institute, State University of New York at Buffalo
  
  
  
• Mayo Clinic Rochester, Minnesota
  
  
  
• National Pediatric MS Center at Stony Brook University Hospital, Long Island
  
  
  
• Partners Pediatric MS Center at the Massachusetts General Hospital for Children in Boston
  
  
  
• University of California, San Francisco Regional Pediatric MS Center
  

Hopefully new therapies will arise from these centers and the future of MS will be brighter than ever, especially for the children.









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Restricting Insulin Can Cause Women to Die Early

A recent study shows that women with Type 1 diabetes who do not take their recommended amount of insulin are at a risk for early death.

The study, conducted at Joslin Diabetes Center in Boston, Massachusetts, studied over 230 women and teens with type 1 diabetes over a period of eleven years, with some of the women cutting back on their daily injections of insulin. What they found was that those who cut back on their insulin had more complications with things like kidney disease and food problems, and were prone to dying at an earlier age.

Those who took their insulin regularly lived on average until age 58, while those restricting their insulin were more prone to die by age 45.

The study was done to address the problem of women and teens restricting their insulin so they may eat more and not gain weight. This is a terrible issue with many who are battling eating disorders, such as bulimia.

While it is true that skipping insulin injections can allow one to eat more and not gain weight, the study has proven that this method of restriction is highly dangerous and reduces life expectancy.












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Just a few comments

There is a new class emerging in America. Once prosperous, or at least middle class, these families are being forced to obtain large amounts of money through refinancing their homes simply to make ends meet. Whether these families are forced into poverty by illness, loss of a job, or simply the rise of food, gas and energy costs, being forced into refinancing has created a larger than life debt scenario for many that are unable to keep up with their monthly mortgage payments.

In North Carolina alone (my own state of residence), the number of homes foreclosed upon rose 140% between 2006 and 2007. OnTrack, a money management and debt repayment service company located in Asheville, North Carolina, reported that those who sought their services rose from 282 in January 2007 to 346 in January 2008.

The cost of living continues to go up and at the same time people are seeking assistance now more than ever for things like medicine, energy costs, housing assistance and other needs. Many of these people are first-time assistance seekers, who have fallen into bad circumstances. These hard working families used to be stable, functional families doing well, but many have found themselves in this position due to health issues.

The government systems of Medicare, Social Security benefits and other systems set in place to help those with disabilities are not sufficiently helping the situation. Many have to wait months or years to see benefits, if ever, while families spiral into more debt making them America’s ‘New Poor’.

So...what's the solution. I don't have one. However, here's the problem. Better leadership is now not only needed, it is required for the future well-being of the United States and its citizens. However, this "need" does not simply apply to the office of President, but also, and, actually, more importantly, to that institution known as Congress. For it is Congress and the 535 elected members of both houses that continue to waste the people's time and the nation's resources while they remain committed largely to their own goals. And who should expect that it would be anything different, considering the fact that members of Congress have their own retirement system, one that is not part of the social security system, and have healthcare that provides coverage substantially superior to what the average citizen has.

Solution? Again, I can offer no specifics. But suffice it say, the citizens of the USA need to become politically much more active and better educated about the system in which their representatives operate and also about their representatives. And when their representatives fail them, they need to fire them.

In short, not only do you get the system you deserve, you get the one you were too lazy to do anything about in the first place.










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The Social Security Disability Five Step Sequential Evaluation Process

Social Security uses a five-step sequential evaluation process to determine if an individual has the ability to work in spite of their alleged medical and/ or mental impairments.

The five steps of the sequential evaluation process are as follows:

The first step in this evaluation process is to look at work activity, if there is any. If you have stopped working or are working below the substantial gainful activity (work earnings) monthly amount you can move on to the next step.

The second step of the sequential evaluation is to determine if you have a severe medical and/or mental impairment, or combination of impairments, that has prevented substantial work activity for the past twelve months---or you're expected to be unable to work for twelve months or more due to your medical impairments. If you meet this step, you move to the next step.

The third step of this process is to determine if your medical and/or mental impairments meet a listing in the Social Security listing book. If you have an impairment or impairments that meet or equal a listing, you will be found disabled at this step. If your mental and/or medical impairments do not meet or equal a Social Security disability impairment manual listing, you move on to the fourth step of the sequential evaluation process.

Social Security evaluates your ability to perform the physical and mental qualification of your past work. If you can meet the physical and mental demands of your past work you will not be found disabled.

However, if you are not able to meet the mental and physical demands of your past work, Social Security evaluates your past work, educational level, age, and residual functional capacity in an effort to A) determine if your impairment prevents the performance of all work or B) if you are able to make an adjustment to some type of other work.

If Social Security determines that you are able to make that adjustment you will be found "not disabled". However, if Social Security determines that you are unable to make an adjustment to other work, you will receive a disability medical allowance based upon medical and vocational (education, age, work activity) factors. In other words, you will be approved.











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Massage may be more than Relaxation for Migraine Sufferers

Millions of people suffer from the devastating painful effects of migraine headaches, and there is no denying the pain that accompanies a migraine. While many migraine sufferers have over the course of time developed their own individual migraine coping methods, there are times when their coping strategies fail to relieve the pain of migraine headaches. If all of your coping strategies have failed you may wish to consider the benefits of a massage.

Some studies seem to indicate that massage therapy has the potential to relieve or prevent migraine headaches. Massage therapy for migraines does not replace the use of medication or a physician’s care, however it may be useful in conjunction with conventional medical treatment. Dr. Audrey L. Halpern, neurologist and headache expert, suggested that the two most common causes of migraine headaches are muscle spasms and stress, and that the upper neck and shoulder area should be the area of concentration. Of course, individual response massage therapy varies and in some cases individuals actually find that neck movement triggers their migraines.

Additionally, Dr. Halpern suggested that full body massages might also be useful because they help elevate serotonin levels and reduce stress. If you are not able to afford the cost of regular massages, you may wish to try simple at home massage techniques such as hand and foot reflexology for your migraines.












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