Entitlement to Disability means verifying what you say is true (and that means medical records)

Someone recently wrote in a forum that they had decided to apply for disability earlier this year and were quite frustrated at not having heard an answer yet. They concluded their statements by writing that they had paid into the social security system for many years and were entitled to their disability benefits.

Well, to address that, yes, if a person has paid into the federal system via fica tax payments or through self-employment taxes, then title II social security disability benefits can be viewed as something to be entitled to.

However, being entitled, that is being qualified in the most basic way as a result of having earned sufficient quarters of coverage for SSD (social security disability) is only the first step. To actually receive SSD benefits, one has to verify that what is indicated on the disability application (actually, the disability report form) is...true.

This is why disability examiners actually refer to the conditions marked down by a person filing for disability as allegations. And the date that the claimant states they became disabled is referred to as an AOD, or alleged onset date. Because until the allegations and the onset date are actually proven, in the view of the social security administration they are simply allegations and nothing more.

How does one prove their allegations, i.e. prove that they became disabled on such-and-such-a-date as a result of certain physical or mental impairments? Medical records. It all boils down to the medical record documentation (although in the case of child disability claims, substantial record documentation can be in the form of school records, achievement and IQ testing, and teacher's questionaires).

The following page provides additional on this topic: Social security disability and medical records






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How is Social Security Disability Different from SSI
Disability qualifications and criteria SSA SSI Benefits
Backpay, does everyone approved for disability get back pay
If you are approved for disability will you get a backpay lumpsum?

Will A Diagnosis of Cancer Get You Approved For Disability?

Although a diagnosis of cancer is very traumatic, it is not a guaranteed approval for Social Security disability.

Usually an individual’s cancer has to A) be inoperable versus being controlled with treatment, B) have distant metastases, or C) be recurrent after radical surgical procedures or irradiation.

However, there are certain type of cancers that may garner an immediate approval for disability. For example, metastatic brain or spinal cord carcinoma, inflammatory breast cancer, mesothelioma of the pleura, oat cell cancer (small cell cancer) of the lungs, primary cancer of the liver, bile ducts, or gall bladder, and cancer of the pancreas are types of carcinoma that meet a listing for disability. Consequently, they are most often an immediate approval for disability benefits.

When making a disability determination and evaluating the level of impairment resulting from a malignant tumor, Social Security considers the location of the neoplastic (cancerous) lesion, the formation and development of the tumor, the degree of involvement, the response to treatment, and the severity of residual symptoms (post treatment).

Documentation must include a diagnosis of cancer that can be verified by symptoms, lab findings, and signs, along with a statement that includes the origin of the cancer and whether the malignant tumor is a primary, recurrent, or a metastatic tumor. Additionally, if an individual has had a biopsy, Social Security can use the operative report that includes the gross and microscopic examination of the tissues along with any other pertinent observations as part of their case documentation.

In cases where an individual has had a malignant tumor that involved a lesion with metastases only to a regional lymph node that has been completely removed with little danger of recurrence or metastases, Social Security disability examiners will use the usual criteria to establish an individual’s disability. Meaning, they will gather the claimant's medical information and evaluate their residual functional capacity, work history and education when making a disability determination.

However, if an individual’s carcinoma has spread beyond the regional lymph nodes, they most likely be approved for disability benefits based on meeting a neoplastic disease listing.

No Social Security disability approval can be considered permanent if there is a chance for medical improvement. Disability approvals based on cancer are no different. In fact, if the original tumor and any metastatic disease appear to have disappeared and have not been evident for three years or more, the impairment no longer meets the disability criteria for a neoplastic disease.

However, even if an individual's cancer has disappeared and has not been evident for three years or more, they may still be able to receive disability benefits.

Remember, Social Security disability is based upon residual functional capacity (what an individual is able to do in spite of the limitations imposed by the condition or the residual effects of treatment). Therefore, if an individual still has significant post-treatment residual symptoms that severely restrict their ability to perform substantial gainful activity, they may continue to receive disability benefits.






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Will a Disability Lawyer Pay for Your Medical Records or Make You Pay?

Here's the thing. Not all disability representatives and disability lawyers work the same way. Some will advance the cost of obtaining medical records for their clients and some won't.

Before I go on, what do I mean by "advance the cost"? I mean this: you get a disability attorney or a non-attorney representative to assist you with your claim. And in the course of moving your case through the appeal system, or getting prepared for a hearing before an administrative law judge, they send out requests for medical record updates (many people are surprised to learn that the social security administration stops getting updated medical records after the reconsideration appeal has been denied meaning that you or your representative are given the task of doing this before appearing at a hearing). In so doing, the individual representing you decides to pay for the medical records upfront, the idea being that when the case is over the representative will bill you for the costs that were incurred in obtaining the records.

That's what I mean by advance the costs. Disability lawyers and representatives who do this save their clients from a sizeble burden. After all, their clients are filing for disability, i.e. they are not working and drawing a paycheck.

Of course, this becomes a financial burden for the representative...who may or may not be reimbursed for the cost of obtaining the medical records and paying the cost upfront for his or her client. It's a risk to take for the representative. I've spoken to some reps who advance costs for records who state that they probably don't get reimbursed by their clients about 20 percent of the time.

Not surprisingly, of course, not every disability attorney and representative pays for medical records upfront. This places the financial burden of getting the case properly prepared squarely on the shoulders of the claimant, at a time when they can least afford it.

What happens if the claimant doesn't have the money to pay for the medical record updates? I guess different representatives handle this situation differently, perhaps case-by-case, but it certainly has the "potential" making the case far weaker as it heads to hearing.

What's the point of this post? If you're getting representation, one of the things you should be sure to pay attention to is the fee agreement since that details the costs of representation, including costs other than the actual fee itself, such as the cost of obtaining records, if the rep in question is not in the practice of advancing costs.

Should you take a pass on a disability lawyer who would make you pay for your own medical records upfront rather than advance the costs and bill you when the case is done with? I can't really say, because there may be some really good reps out there who don't advance costs.

But...if you're looking at two different disability reps and one advances costs and the other doesn't...which one do you think you'll choose? Which one will you be able to afford to choose?






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Applying for Social Security Disability and Liver Disease

Here's an excerpt from the page on Disability Secrets that discusses the disability impairment manual's approval criteria for individuals filing on the basis of liver disease. It should be noted, of course, that the vast majority of applicants for social security disability and SSI apply on the basis of several impairments that are physical, mental, or a combination of both types. It should also be noted that for claimants who are not approved on the basis of satisfying the approval criteria for a condition that is listed in the impairment manual, the possibility still exists for the claimant to be approved for benefits via a medical vocational allowance, a type of approval that is made after consideration is given to both a claimant' medical record documentation and work history (including the types of jobs worked, length of time such jobs were worked, the skills involved in such jobs, and the physical and mental requirements of such jobs.

Social Security evaluates liver impairments under the Digestive System impairment listing. Section 5.05 specifically evaluates chronic liver disease (including biliary, portal, and postnecrotic cirrhosis, chronic hepatitis, or Wilson’s disease)...Individuals who suffer from liver disease must have confirmation of their conditions by a liver biopsy independent of any Social Security disability evaluation with one of the following symptoms

The rest of the page can be viewed at this link: Social Security Disability and liver disease

News links and postings from Disability Secrets involving liver disease

1. Liver disease linked to pollution?

Excerpt: "the researchers determined that one in three adults has liver disease in the United States, and that some of the cases of liver disease can be attributed to chronic low-level environmental pollution"

2. New testing for liver disease that does not involve a biopsy

Excerpt: "If the new blood test goes to market, liver disease patients can forgo minor surgery and replace it with a simple pin-prick to the finger"

3. Obese children and liver transplants

Excerpt: "Too much body fat is causing a dramatic rise in nonalcoholic fatty liver disease, which leads to liver failure, cirrhosis of the liver, and even liver cancer"

4. Normal Working People and Alcoholic Liver Damage

Excerpt: "A new study by the University College London found that ‘normal working people’ have an usually high amount of liver damage"





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Giving Medical Evidence Records for a Social Security Disability Case, scenario 1

Two are at least two separate scenarios we can work with here. One is when you gather medical evidence at the very start of your claim (meaning you may not have actually filed a disability application yet).

The second scenario is when your claim has been initiated. In the second scenario, your claim may be pending, meaning still being worked on, you may already have been denied, and you may have representation.

In this article, we'll deal with the 1st scenario.

The first scenario

1. If you have not yet filed a claim for disability, contact social security and get an appointment set up for your disability interview.

2. Prior to the interview, contact your medical treatment sources and ask them to supply you with copies of your medical records at least as far back as the time your condition became disabling which, to social security's point of view, is when your condition caused you to cease working completely, or caused your gross monthly earnings to dip below the allowable earnings limits known as SGA, or substantial gainful activity.

3. Be mindful of the fact that getting records from hospitals and doctor's offices can sometimes take a while. However, in some instances, patients can get their records faster than either social security or an attorney's office, particularly if they do some personal followup on the request.

4. Hopefully, however, if the timing works right, you'll have your records by the time you sit down for your social security disability interview or SSI disability interview (which, for all intents and purposes, are exactly the same thing since the social security administration does not process applications in either program differently from each other).

5. The benefit of submitting your medical records at the time you file your claim is potentially "time saved". Disability examiners, the individuals who process SSDI and SSI disability claims for the social security administration are rated by efficiency (as well as soundness of decisions). That means that the faster they get claims moved off their desk and out of the agency (which is Disability determination services, or DDs), the better they look.

Cases, of course, that come in with the medical records attached can shave off a ton of processing time by eliminating the need to request records and then wait weeks or months for them to arrive. This assumes, certainly, that the records submitted by a claimant at the time of application contain both current records and records going back far enough to address the claimant's alleged onset date.

6. Tip: if you manage to get your medical evidence together in time to submit them at the time of application, make sure you make a separate full copy.

Why? Because you need to have one full copy to keep and one full copy to give to the social security employee who takes your disability claim. Will the field office claims representative copy what you bring in (a big pile of medical records) if you neglected to make a separate copy and would like the originals back? Yes, but that may take, as one employee stated "a while", and will, of course, be done at their convenience. And that makes perfect sense. Social security field office workers tend to be very very busy individuals and copying large piles of paper simply takes time away from interviewing claimants and processing cases. As I said, make a full copy of your records before arriving at the social security office and give this copy to the social security representative.





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Are the eyes the windows to detecting metabolic issues?

Everyone needs to have a yearly eye exam, just to make sure that the health of their eyes is being taken care of, but comprehensive eye exams could be way more important than you think. A new study has found that our yearly eye exams can do much more than tell us if our sight is okay, it can also let us know if we have high blood pressure, high cholesterol and even diabetes.

The study was conducted by the Columbus Research Foundation, an organization dedicated to advances in medical care for the Western Georgia-Eastern Alabama area, and Vision Service Plan, the nation's largest provider of eye care coverage. The study found that a whopping 98 percent of patients who had corneal arcus also had metabolic issues. Corneal arcus is a grayish-white ring occurring in the periphery of the cornea due to a lipid infiltration of the corneal stroma.

The study involved 2,000 patients and found that patients with corneal arcus had high rates of metabolic disease. Sixty-four percent of patients with corneal arcus had high blood pressure, 66 percent had a high body mass index, and 21 percent had high cholesterol. In addition, almost 90 percent had high blood sugar – a number so high it cannot be overlooked.

In light of this study, more research will be done to determine the link between corneal arcus and metabolic conditions, especially corneal arcus and high blood sugar. The study suggests that comprehensive eye exams could be used for metabolic condition screenings.





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Applying for Social Security Disability and Schizophrenia

Here's an excerpt from the page on this site that deals with the schizophrenia listing in the social security disability list of impairments, otherwise known as the blue book. This is the manual used by both disability examiners and administrative law judges to determine if claimants are eligible for disability based on equaling or meeting the criteria established for a specific physical or mental impairment.

Schizophrenia is a medical condition listed in the official Social Security official list of impairments, or the blue book, as it is more commonly called. Schizophrenia falls under heading 12.03, Schizophrenic, Paranoid, and Other Psychotic Disorders, and the criteria that must be proven to meet this listing are complex, to say the least. In fact, the description of schizophrenia listed in the blue book is complicated enough to make this condition a perfect example of why so many who file for Social Security Disability (SSD) or SSI can benefit from legal representation at the hearing level where a federal judge presides.

The rest of the page can be viewed at this link: Social Security Disability and Schizophrenia

Here are some other pages from the site that may be relevant and useful.

1. Mental Illness and Social Security Disability

Excerpt: "Disability examiners are not licensed psychiatrists, and do not always understand the full scope of the limitations imposed by certain mental illnesses. For instance, some disability examiners do not recognize the cyclical nature of mental illnesses"

2. How Do You Pass a Social Security Mental Exam?

Excerpt: "Consultative mental examinations (CE appointments) are often used if an individual has no current mental health treatment notes or no record of mental health treatment at all. As you might imagine, these types of examinations are typically a poor substitute for a documented history from a mental health professional"

3. Not alleging mental conditions on a social security disability application

"Why do some claimants fail to disclose all their conditions when they file an initial claim for benefits. The reasons probably vary. In some cases, a claimant may believe that, though they are treated for a mood disorder, or other psychiatric impairment, the severity of the condition may not warrant an approval for disability benefits"





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Applying for Social Security Disability or SSI with Chronic Pain

Here's a link to this site's page on chronic pain and filing for disability benefits with the social security administration. As a disability examiner, I found that it was fairly difficult for claimants to become approved at the initial claim and reconsideration levels if their chief allegation was chronic pain and they listed nothing else. Fortunately, in this regard, it is the rare case in which an applicant lists only one condition. Typically, most individuals who file for disability list a number of various conditions both physical and mental. It's important to remember, and I tend to state this repeatedly, it is not the condition with which social security is concerned, but, rather the effect the condition has on the claimant and the claimant's ability to engage in work activity--a past job or another type of job that they might be suited for--that affords them a substantial and gainful income. For social security disability eligibility purposes, a claimant's condition must be severe enough to rule out the possibility of engaging in this type of work activity for at least 12 full months.

Here is an excerpt of page on chronic pain and social security disability, followed by a link to the page itself:

Part of the problem that a claimant with chronic pain may face when filing for disability benefits is the fact that disability examiners (examiners make decisions on initial claims) and administrative law judges look for objective signs of residual functional capacity ("residual functional capacity" is what you can still do even with your condition). Pain, of course, tends to be subjective and difficult to measure.

Social Security Disability SSI and Chronic Pain


Here are links to other pages on the site that provide information relating to chronic pain.

1. Experiencing and understanding chronic pain

Excerpt: "Brain imaging has shown that individuals who experience chronic pain have different brain activity patterns and respond differently to pain than those who do not suffer from chronic pain"

2. Chronic pain changes how the brain works

Excerpt: "Both test groups perform well, however functional magnetic resonance imaging showed that chronic pain sufferers had to use much more of their brain to process the simple task"

3. Chronic pain management

Excerpt: "Chronic pain comes primarily from two sources – cancer and nerve damage, according to Dr. Uday Doctor, Texas Orthopedic Hospital’s chief of pain management"

4. Pain and depression

Excerpt: "Researchers decided that when a patient is depressed the level of chronic pain they feel is amplified. When taking anti-depressants, patients were able to reduce their levels of pain"





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Social Security Disability Regulations

A questioner recently asked what are the Social Security regulations for disability?. Well, there are actual regulations; however, I think what the individual was really asking was “How do you qualify for disability?”.

Basically, the process works like this: an individual initiates an application for disability by contacting Social Security via phone, internet, or in person to file an initial disability claim. If you contact your local Social Security office or call the toll free Social Security number, you can schedule a disability interview that can be completed by phone or in person with a Social Security claims representative. You may also use the Social Security online disability application process to file for Social Security disability, although if you choose to use the online application method you will be unable to file for your potential entitlement to Supplemental Security Income disability program (SSI).

Most likely, if your file your application online you may still have to complete a disability interview with your local Social Security office by phone or in person, if you have not completed the disability form online, returned your signed medical release forms, or not clearly indicated that you do not wish to file for SSI.

Once you have completed your initial disability interview, your disability claim is forwarded to a state disability agency for a medical determination. Disability examiners at this agency gather medical records from the medical sources that you provided at your initial interview. If the disability examiner feels there is enough medical information in the records provided by your treating physicians, they will make a medical determination.

However, if the disability examiner finds that your medical records are not sufficient to make a Social Security medical determination, they may require you to attend a consultative examination with a physician who is paid by Social Security to evaluate your medical and/or mental conditions. These consultative physicians prepare a report for Social Security that addresses your medical and/or mental conditions and their opinion as to whether you are able to perform substantial work activity.

If your initial disability claim is denied, you may have to begin the Social Security disability appeal process to win your disability benefits. The Social Security appeal process begins with a request for reconsideration and generally ends with an administrative law judge hearing.

Although you can appeal an administrative law judge decision to the Appeals Council, many disability applicants file new initial claims while their cases are being reviewed by the Appeal Council. Most administrative law judge decisions, of course, are not overturned by the Appeals Council and a large percentage simply back as "request for review denied".

If you've assumed that the appeal process is time-intensive, you've guessed right. Even if you just have to appeal your disability claim to the disability hearings appeal level, it can take months or even years to receive disability benefits. And, unfortunately, there are some applicants that must go through the Social Security disability process more than one time.





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Is Smoking Linked to Multiple Sclerosis?

A new study by Dr. Alberto Ascherio and his colleagues at Harvard School of Public Health in Boston has found that smoking may be linked to a quicker progression of Multiple Sclerosis. The study was published in the Archives of Neurology, a medical journal published by the American Medical Association on a monthly basis. The researchers found that the disease is quicker to get worse if the patient smokes.

Multiple Sclerosis is a chronic disease that attacks the brain, optic nerves and spinal cord – the central nervous system. Mild symptoms include numbness in the limbs, but severe symptoms can include loss of vision or paralysis.

The study included almost 900 patients, with 72 patients progressing and relapsing-remitting. Twenty of the patients were smokers, 20 were ex-smokers and 32 of 500 had never smoked in their lives. Smokers were over 2 times (2.4 to be exact) more likely to have primary progressive Multiple Sclerosis than non-smokers and smokers with relapsing-remitting of Multiple Sclerosis were two and half times more likely to develop secondary progressive Multiple Sclerosis.

The researchers also followed over 1,400 MS patients for three years, with nearly 18 percent of those patients being smokers. They found that smokers had more severe disease, more brain atrophy, more injured brain tissue, and more disability.

The researchers aren’t clear on what determines this increase of progression, but they are guessing that the toxic smoke could affect the nervous system and that the immune system could be weakened as well. They did notice that those who currently smoked experienced the most adverse effects, which makes them wonder if quitting smoking could slow the progression down and help. In the end, they decided their findings suggested that quitting smoking may delay progression of Multiple Sclerosis and reduce their risk of related diseases.





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How does Social Security Disability Consider Your Medical History?

Approvals for disability benefits, and denials, are based on a number of factors, both medical and vocational in nature. However, the process really does begin with an applicant's medical history.

As soon as a disability claims examiner receives a social security disability or SSI disability claim from a social security field office, the first substantial act the examiner will perform in processing the case will be to request the claimant's medical records. These requests are based on information provided by the claimant at the time of application, and, obviously, this underscores how important it is that a claimant provide detailed information regarding their diagnoses, dates of treatment, and places of treatment. Leaving out a single source of medical treatment can potentially disadvantage a claim. For example, if older sources of treatment are not listed by a claimant when they file for disability, this may make it difficult for the social security administration to substantiate the claimant's alleged onset date (when they claim their disability began). If recent medical treatment sources are not listed, this may make it difficult to prove that the claimant is currently disabled.

What information is looked for in a claimant's medical history? Essentially, anything that confirms a diagnosis of a condition as well as the existence of functional limitations.

Social Security disability and SSI disability cases are based on the notion that a claimant must be totally disabled to qualify for disability benefits; however, for the social security administration "totally disabled" means being unable to work (either at a job a person has performed in the past, or at some other form of work) at a certain level. That level is known as SGA or substantial gainful activity, something that is defined in terms of a gross monthly income limit. An applicant who works and earns this amount or more will not be eligible to receive disability benefits.

One significant problem that surfaces in the processing of social security disability and SSI claims is the fact that most physician's treatment notes devote relatively little time and attention to notating the impact of a patient's condition on their ability to function, or engage in normal daily activities, including work activity.

Despite this fact, however, every individual who files for disability will have their functional capacity rated by both a disability examiner and either a medical consultant or a psychological consultant who is attached to the disability examiner's processing unit. Obviously, since this residual functional capacity rating is being delivered by an individual who is not a medical professional (the disability examiner) and by a physician or psychologist who has never treated, or even met, the claimant, the validity of the rating is somewhat questionable. Which may be borne out by the great divergence in approval rates between the first two levels of the social security disability system and the third level of the system where decisions are made by administrative law judges.

How does social security consider your medical history? It's probably safe to say that the information contained in your medical records is the chief determinant of the decision you receive on your claim.

However, disability decisions are medical and vocational (work-related) in nature. Meaning that a claimant's work history, the identification of the jobs worked by a claimant, the demands of those jobs, and the skills associated with each job, can have an enormous impact on the outcome of a case.





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