Articles Posted in Social Security Disability

What is the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)? IBS describes a set of symptoms which include abdominal pain. To be sure, it can cause, in some cases severe pain and result in disability. However, IBD is considered by the medical profession to be the far more serious disease. Generally, IBS is relatively common, occurring in one in five persons while IBD occurs only in about 1 in 200 persons.

IBD usually includes either Crohn’s disease [painful ulcers in their small and large intestines and sometimes inflammation in the rectum] or ulcerative colitis [which is a disease that results in ulcers in the rectum and large intestine]. IBD is normally diagnosed by endoscopy, biopsy, appropriate medically acceptable imaging, or operative findings. On the other hand, IBS is a “rule out” diagnoses. That means that a physician has decided that his/her patient has IBS after all other tests have ruled out other diseases.

SSA has a listing [5.06] for IBD. That means if the disabled person has IBD based upon the criteria set out by SSA, then a finding of disability will be made. Unfortunately, SSA does not have a listing for IBS. Which means that it is much more difficult, although by no means impossible, to be awarded disability for IBS.

Treatments which are used to attempt to relieve pain are important facts to be considered by the Administrative Law Judge in accessing claims for Social Security Disability based on pain. Some treatments are effective and some are not effective. Most pain relieving treatments do not totally “do away” with the pain. Treatments may include: the use of heat; massage; whirlpool; traction; prescribed exercise; bed rest; a TENS unit; biofeedback; trigger point injections; nerve blocks; acupuncture; chiropractic treatments; cranial sacral therapy; behavior modification; counseling/psychotherapy; herbs, vitamins, etc; and attendance at a pain clinic or enrollment in a pain program.

Pain medication is in a class by itself as a factor for the consideration of the extent to which pain is debilitating. The use of pain medication has advanced in recent years to a specialty in the medical profession. The use or non-use of pain medication alone will not determine the outcome of a claim for disability based on pain. However, is is a factor which the federal regulations require an Administrative Law Judge consider. Often times pain medications causes side effects which impairs the ability to function [drowsiness; dizziness etc.] Side effects are also facts which must be considered in accessing whether the person can perform sustained work functions.

Obviously, no one but you can know the extent of your pain, how it feels or how long it lasts. There is no definitive medical test which can conclusively measure pain.

SSA allows pain to serve as a basis for disability. According to 20 CFR § 404.1529(b)(c) and SSR 96-7P, the ALJ must first evaluate whether a medically determinable both impairment exists which could reasonably be expected to produce pain, and then assess the credibility of the claimant’s allegations about the intensity and persistence of her pain. Aidinovski v. Apfel¸27 F.Supp2d 1097, 1103 (N.D. Ill. 1998). The factors which the ALJ must consider include: (1) objective medical evidence; (2) prior work record; (3) daily activities; (4) location, duration, frequency and intensity of pain; (5) precipitating and aggravating factors; (6) use of medication; (7) other treatments and measures used to relieve pain; (8) observation of testimonial evidence by the claimant; and (9) the consistency of the claimant’s statements.

So even if the medical record does not substantiate your complaints of pain the factors set out above will be considered to determine whether you are disabled because of pain.

The mental condition known as “anxiety” can also serve as the basis to obtain Social Security disability benefits. What is anxiety? How serious does anxiety have to be in order to qualify as a disability?

“Anxiety” is a normal reaction to stress. It is part of mental makeup which is designed to help us cope with difficult situations. For example, speaking in public, playing in competitive sports even taking an examination. Normally, experiences of stress are brief and mild. During the experience of stress, our senses become sharper and our focus more intense. But for some, experiences of stress last much longer, is far too intense and begins to interfere with normal daily activities. These people encounter what many view as normal and routine activities with dread and an irrational fear. It is then that anxiety crosses the line to an anxiety disorder.

It is estimated that 40 million adult Americans suffer with some form of anxiety disorder. There are several different types of anxiety disorders. The specific type depends upon the presentation of clinical features. While no two anxiety disorders are alike they do have in common a dread and irrational fear of the common place. Among the more specific diagnosis are: panic disorder; obsessive-compulsive disorder (OCD); post-traumatic stress disorder (PTSD) and social anxiety disorder.

On June 17, 2010, the U.S. Treasury issued a proposed rule to require that all payments to claimants whose claims for disability benefits are filed on or after March 1, 2011 be paid by direct deposit, thereby eliminating paper checks.

Many claimants have chosen already to receive their payments by direct deposit. For those who have chosen this option, direct deposit would continue.

Under the proposed rule, individuals who have not chosen to do direct deposit of their payments to an account at a financial institution would be enrolled in the Direct Express® Debit MasterCard® card program, a prepaid card program established pursuant to terms and conditions approved by Financial Management Services.

The Social Security Administration (SSA) has listed the condition commonly known as “depression” as a basis to obtain Social Security disability benefits. Depression is actually under a broader category of mental impairments called “Affective Disorders”. So what are “Affective Disroders”?

“Affective Disorders” is a psychiatric term used to describe a mental condition with multiple sides or faces which affects a person physically, mentally, socially and behaviorally. Commonly included within this disorder are major depressive disorders, bipolar disorders and anxiety disorders. Major Depressive Disorder (also known as “monopolar depression” as opposed to “bipolar depression”) has as its hallmark an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities.

In order to meet the listing for depression (Listing 12.04), SSA must first find that the disease has at least 4 of the following 9 symptoms are present: 1. anhedonia, or pervasive loss of interest in almost all activities; 2. appetite disturbance with change in weight; 3. sleep disturbance; 4. psychomotor agitation or retardation; 5. decreased energy; 6. feelings of guilt or worthlessness; 7. thoughts of suicide; 8. difficulty concentrating or thinking; or 9. hallucinations, delusions or paranoid thinking.

Over the next several blog entries, the topic of mental illnesses in Social Security Disability Cases will be discussed. Many people have asked whether depression, anxiety (which includes panic disorders, post traumatic stress, obsessive/compulsive disorder and agoraphobia) and bi polar disorder can serve as the basis for an award of social security disability. The short answer is yes, mental disorders can make a person disabled.

According to the National Institute Mental Health, mental disorders are the leading cause of disability in the U.S. That said, a diagnosis by itself does not necessarily mean that a person is disabled. For example, an estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. That is over 57 million citizens. However, not every one of these person is disabled.

Make no mistake, the federal regulations for social security disability do allow for a finding of disability for mental illnesses. The blogs that follow will explore what the criteria is for a finding of disability based on mental disorders.

Over the years, I have heard people remark that so and so received disability benefits because of a drug or alcohol addiction. In fact, many believe that the law provides for the granting of disability to addicts. The law is far more complicated.

Before 1994, a person could receive disability benefits if he or she were disabled because of an addiction. In 1994, Congress required that persons whose addiction was material to being disabled must undergo treatment, that their benefits be limited to 36 months (during that treatment) and that the benefits could be suspended if there was non-compliance with treatment.

In 1996, Congress again changed the law for folks whose addiction was a “contributing factor material to the finding of disability.” Disability benefits for these people were prohibited. The bottom line is that if a drug or alcohol addiction exists and if that addiction were to stop the person could return to work, then no disability benefits can be awarded. If it is impossible to state which limitations remain after stopping, then it is appropriate to find that the drug/alcohol addiction is not material.

The Federal Register published on December 14, 2009 a change to the Endocrine Listing (Listing 9) proposed by the Social Security Administration (SSA). SSA proposed that the impairments set out in Listing 9 be eliminated. Listing 9 includes not only thyroid disorders but also diabetes. The elimination proposal by SSA is based upon what SSA considers to be “advances in medical treatment in the detection” of endocrine disorders. As a consequence of these advances SSA believes that these types of disorders no longer meet the 12 month durational requirement.

SSA has also indicated that it has been advised by medical experts that the current listing regarding diabetes reflects “only inadequate glucose regulation.” SSA has been told by these experts that adequate glucose regulation is achievable with improved treatment options. If SSA ultimately decides to change the regulation as proposed, then severe impairments such as diabetes and thyroid disorders will no longer serve as a basis to obtain Social Security Disability benefits on on their own. If endocrine disorders cause problems of listing-level severity in other organs or glands, SSA will “evaluate these effects under other body system listings.”

Importantly, current beneficiaries who have received an award of Social Security disability benefits based upon endocrine disorders will not be terminated. They will, however, continue to be evaluated for medical improvement by continuing disability reviews but under the original listing upon which their initial entitlement was based.

Fibromyalgia is a terrible condition which causes pain, fatigue, difficulty sleeping, morning stiffness, headaches, painful menstrual periods, tingling or numbness of hands or feet, and difficulty thinking and remembering. Some people with this condition may also experience irritable bowel syndrome, pelvic pain, restless leg syndrome, and depression. Fibromyalgia is also a condition which frequently forms the basis of claims for Social Security Disability.

The Social Security Administration does not specifically include the condition of fibromyalgia on its list of diseases and conditions which may cause a person to be disabled. That said, many people have been award Social Security disability benefits because the condition of fibromyalgia was found to so severely affect them that they were no able to work. The first step toward a successful social security disability case is to obtain a diagnosis.

There are no recognized tests or imaging studies that can confirm or exclude the condition of fibromyalgia. Rather, fibromyalgia is a “rule out” diagnosis. That means that your physician orders tests for conditions that can be discovered by tests. Once those conditions are shown not to exist, your physician may conclude that your constellation or grouping of symptoms is fibromyalgia. In addition to the “rule out” diagnosis the American College of Rheumatology has established diagnostic criteria with a history of widespread pain for at least three months and pain in at least 11 of 18 tender point sites. The key to getting a diagnosis is not to give up. Often, fibromyalgia victims are not well understood by physicians. It is important to consult a physician who has the experience, the training and the patience to diagnosis this condition.