Saturday, June 20, 2009

PAUL PROTO: Winning a Social Security disability case based on “hidden disabilities”

Written by Paul Proto, Tampa Social Security Disability Examiner

Many claimants suffer from medical conditions that cause disabling symptoms but are difficult to diagnose and/or document. These conditions are known as “hidden disabilities”. Medical conditions such as Fibromyalgia, Chronic Fatigue Syndrome and Lyme disease are some examples of these medical conditions. These cases must be presented with emphasis on different factors than cases that lend themselves to clear “medically acceptable objective, laboratory and clinical diagnostic techniques”.

As a result of an increased number of these types of claims, more attention has been required not only by the Social Security Administration but by the medical community at large. Some solutions have been developed to establish eligibility of symptom-based disabilities. Some of these solutions are the result of studies initiated by the medical community.

As more and more people develop similar symptom complexes more investigation is required to determine the cause of the particular illness.

This has been the case with Chronic Fatigue Syndrome and Fibromyalgia. The investigation and research into these conditions by the medical community led the Social Security Administration to publish a ruling on the method for evaluating these disabilities.

In a Ruling entitled, “Policy Interpretation Ruling: Titles II And XVI: Evaluating Cases Involving Chronic Fatigue Syndrome” (CFS) (SSR 99-2p) the Social Security Administration indicated that a medical condition could be determined to qualify as a “medically determinable impairment” in the absence of strict objective evidence as long as there were other signs and findings as well as a history of treatment that supported the claimant’s allegation of inability to work. This Ruling contains a list of specific symptoms. The claimant must have 4 or more of these symptoms documented through treatment by their doctors as well as other signs of the disease such as “self-reported impairment in short-term memory or concentration…; sore throat; tender cervical or axillary lymph nodes; muscle pain; multi-joint pain without joint swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and postexertional malaise lasting more than 24 hours.”

The treating doctor must also have observed the following “signs” upon examination sometime over the course of treatment.

1.) Palpably swollen or tender lymph nodes on physical examination;

2.) Nonexudative pharyngitis;

3.) Persistent, reproducible muscle tenderness on repeated examinations, including the presence of positive tender points;

The advent of this ruling demonstrates that an individual may be found disabled even if strict objective evidence is not available based on the disease suffered by that individual.

Other solutions for determining eligibility for symptom-based disability are derived by consideration of clinical factors as opposed to objective findings.SSA considers the history of treatment for consistent and resistant symptoms. Maintaining treatment with a doctor for care of symptoms can be very persuasive toward proving disability. These monthly visits legitimize your disabling symptoms. Greater emphases on clinical findings are part of this as well. Clinical findings include the presence of muscle spasms to corroborate back pain. Clinical findings of elevated blood pressure often accompany severe pain.

Keep in mind that claims are not approved for having this or that illness, but for being unable to work. You need to show that you are unable to perform full-time work on a regular basis due to a medical condition. Eligibility for benefits does not require that you show that you are bedridden or totally incapacitated.

Paul Proto

President - Federal Benefits Advisory Group

Phone 813-325-6159


Go to Paul's Home Page

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