Inflammatory arthritis is a disability often causing inflammation – and distinct pain, in joints.

Inflammatory arthritis is a disability often causing inflammation – and distinct pain, in joints.  It frequently is associated with swelling and tenderness.  It is associated with disorders such as Rheumatoid arthritis, Sjogren’s syndrome, Psoriatic arthritis, gout and psuedo-gout, lyme disease, and inflammatory bowel syndrome. The pain and other symptoms may result in difficulty with many forms of movement, and may effect one’s ability to work.

The Social Security Administration (SSA) evaluates inflammatory arthritis under listing 14.09 of the Impairment Listing Manual.  The regulation references persistent inflammation or persistent deformity of …weight-bearing joints resulting in the inability to ambulate effectively or … the inability to perform fine and gross movements effectively or inflammation or deformity in one or more major peripheral joints with involvement of two or more organs/body systems with one of the organs/body systems involved at least to a moderate level of severity; and at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) or … ankylosing spondylitis or other spondyloarthropathies, or … repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level: Limitation of activities of daily living, limitation in maintaining social functioning, limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. You can view that listing at:   https://www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm#14_09

There are severity requirements outlined in this listing, but even if not met, it is still possible that you may be entitled to disability benefits dependent upon your ability to function and maintain work skills.

As with most all claims, it is vitally important to get appropriate medical treatment.  Without these medical records, your case is typically much less convincing.  While medical services and insurance is not always available, urgent situations should result in hospital ER treatment in order to show the reality of your symptoms.

If you have Degenerative Disk Disease and are unable to work as a result of your diagnosis, you may be entitled to Social Security Disability benefits. The Social Security Administration (SSA) classifies Degenerative Disk Disease as a disorder of the spine under Listing 1.04 of the Impairment Listing Manual.

When filing a claim for disability benefits with a diagnosis of Degenerative Disk Disease, it is important to have medical records showing evidence of the following criteria, set forth in Listing 1.04:

1. Nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); OR

2. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours; OR

3. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively.

Many people don’t have an exact fit to the SSA’s criteria for DDD as listed in the regulation.  Under those circumstances, SSA will evaluate your Residual Functional Capacity, assessing the degree to which your functioning is limited by your impairments.  This RFC assessment may also be applicable with a combination of diseases.

Our law office frequently deals with cases involving Degenerative Disk Disease, or DDD and combinations of other disabilities.  Seeking the services of an experienced Social Security Disability attorney to help obtain and present evidence to SSA about your condition can be vital to your claim for benefits. Feel free to call should you have any questions.

No doubt that receiving a diagnosis of cancer is both traumatic and overwhelming. You may be unable to work and keep up with their normal everyday lifestyles as a result. Depending on the nature of the cancer, you may be eligible to qualify them to receive Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income benefits (SSI).

Certain cancers make an applicant immediately eligible to start receiving benefits. Based on the cancer diagnosis alone, the following types of cancers garner immediate approval: metastatic brain or spinal cord carcinoma, inflammatory breast cancer, mesothelioma of the pleura, small cell cancer of the lungs, primary cancer of bile ducts, liver, or gall bladder, and pancreatic cancer.

Further, if the applicant’s cancer has spread beyond the regional lymph nodes it is likely that the applicant will be approved by meeting the neoplastic disease listing. http://www.socialsecurity.gov/disability/professionals/bluebook/13.00-NeoplasticDiseases-Malignant-Adult.htm

The Social Security Administration (SSA) makes a decision based on the applicant’s medical record and documentation to prove hospital admissions and discharges, physician office notes, imaging studies, and blood work. Specifically, SSA looks for the cancer’s origin, whether it is primary, recurrent, or a metastatic malignant tumor.  It may review biopsy operative results as well.

For individuals suffering from a type of cancer that is not listed above, there is still potential for disability benefits. Often, it reduces down to the fact that an individual must prove that their functional capacity is limited, and prevents working, because of the effects of the cancer and treatment. Even those in remission may show SSA that there is significant post-treatment symptoms that still restrict their ability to work.  This analysis is fairly typical in many of the cases we see at Margolius, Margolius and Associates.  It exemplifies those difficult situations where the reality of the disability is not quick to prove, but nevertheless is deserving of approval of benefits.  Feel free to call should you have any questions.

Down syndrome is caused by an individual having an extra chromosome. In the United States, 1 in every 691 babies are born with Down syndrome, making it the most common genetic condition. The genetic condition affects each child’s course of development differently. Some of the most common physical traits are small stature, slanted eyes, and low muscle tone. https://ndss.org/about

If your child has been diagnosed with non-mosaic Down syndrome and meets SSA’s financial requirements, he or she will automatically start receiving SSI payments. You can prove your child’s non-mosaic Down syndrome disability by a laboratory test or by obtaining a report from your child’s physician. The specific laboratory test needed is called a karyotype chromosomal analysis. If the laboratory results are unavailable, you will need to obtain a physician report stating that your child has the chromosome disorder consistent with the karyotype analysis or that the child has Down syndrome with the distinctive facial or other physical features. For a more detailed overview of the needed medical evidence please visit SSA’s website at https://www.ssa.gov/disability/professionals/bluebook/110.00-MultipleBody-Childhood.htm#110_06

Your child may be eligible to receive SSI benefits right away. Generally, the Social Security Administration takes anywhere between three to five months to make a decision on whether your child is disabled and eligible to receive SSI benefits. However, SSA will start making payments right away if you can show that your child is suffering from non-mosaic Down syndrome.

Other conditions that make your child eligible for immediate SSI payments include HIV infection, total blindness, total deafness, cerebral palsy, low birth weight, and severe intellectual disorder. https://www.ssa.gov/pubs/EN-05-10026.pdf

Many people suffer from anxiety, and some have anxiety levels that are disabling.  The Social Security Administration evaluates mental disorders under a specific type of regulation called “12.06.”  To qualify as an anxiety disorder under 12.06, anxiety must be either the predominant disturbance or experienced as a result of an individual’s attempts to master symptoms. In order for an anxiety disorder to be sufficiently severe for the SSA to render a finding of disabled, the requirements in section A and B or in A and C of 12.06 must be satisfied.

There are 5 ways in which an individual can satisfy section A through production of medically documented findings. The first is generalized persistent anxiety accompanied by at least 3 of these 4 symptoms: motor tension, autotomic hyperactivity, apprehensive expectation, or vigilance and scanning. The second is a persistent irrational fear of a specific object, activity, or situation which results in a compelling need to avoid that object, activity, or situation. The third is recurrent severe panic attacks occurring at least once a week. The fourth is recurring obsessions or compulsions which are a source of marked distress. The fifth is recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress. At least 1 of the foregoing must be shown through medically documented evidence in order to satisfy section A.

In addition to satisfying the section A requirements, an individual must satisfy the requirements in either section B or section C in order for SSA to determine that a condition is sufficiently severe to meet Listing 12.06. Section B requires that an individual show that his or her condition results in at least 2 of the following: a marked restriction of activities of daily living, marked difficulties in maintaining social functioning, marked difficulties in maintaining concentration, persistence or pace, or repeated episodes of decompensation, each of extended duration. “Marked” in this context means more than moderate and less than extreme. If an individual does not meet the requirements of section B, SSA will look to section C. This section requires that an individual show that a disorder results in the complete inability to function independently outside of one’s home.

If your anxiety disorder does not meet or equal the listing of 12.06, it does not necessarily mean you will be found not disabled. You may have a combination of impairments for example.  All disabilities often get evaluated in something called a Residual Functional Capacity.  For more on this, please see other blog entries or call our office.  https://www.ssa.gov/Regardless, getting treatment for any disability,  is not only good for you, but is good evidence for us.  If possible, see someone about your anxiety or other disabilities.

The final rule that makes changes to the listing for Congenital Disorders that Affect Multiple Body Systems (Listing 110.00) went into effect on April 5, 2013. The disorders evaluated under this listing and affected by the changes include non-mosaic Down syndrome and catastrophic congenital disorders such as anencephaly, cyclopia, Patau syndrome, and Edwards’ syndrome, among others.

Non-mosaic Down syndrome is listed under 110.06. The evidence the Social Security Administration (SSA) looks at when evaluating a claim under 110.06 centers around laboratory findings, specifically a report of karyotype analysis, the determinative test to establish non-mosaic Down syndrome. However, if you do not have a karyotype analysis documenting that you have non-mosaic Down syndrome, you may still be found disabled under 110.06B or 110.06C. To meet a listing under 110.06B, SSA needs a physician’s report that states that your karyotype evidence is consistent with prior karyotype analysis, and that you have the distinctive facial or other physical features of Down syndrome. Under 110.06C, a claimant may be found disabled even without having information about prior karyotype analysis if SSA receives a physician’s report stating that you have the distinctive facial or other physical features of Down syndrome and evidence that your functioning is consistent with a diagnosis of non-mosaic Down syndrome.

Also effected by the new rule are catastrophic congenital disorders, which SSA evaluates under listing 110.08. Listing 110.08 is broken down into two parts: A and B. To determine whether you meet one of these listings, SSA requires one of the following:

1. A laboratory report of the test that documents your disorder, signed by aphysician.

2. A laboratory report of the test that documents your disorder that is not signed by a physician and a report from a physician saying that you have the disorder.

3. A report from a physician that states that you have the disorder and that you had definitive testing that documented your disorder.

If SSA does not have definitive laboratory evidence, you may still be found to meet 110.08A or B if SSA has a report from a physician that states that you have the disorder and that you have the typical clinical features of that disorder, and other evidence that supports that diagnosis.

As former Commissioners of the Social Security Administration (SSA), we write to express our significant concerns regarding a series recently aired on This American Life, All Things Considered, and National Public Radio stations across the U.S. (“Unfit for Work: The Startling Rise of Disability in America”). Our nation’s Social Security system serves as a vital lifeline for millions of individuals with severe disabilities. We feel compelled to share our unique insight into the Social Security system because we know firsthand the dangers of mischaracterizing the disability programs via sensational, anecdote-based media accounts, leaving vulnerable beneficiaries to pick up the pieces.

Approximately 1 in 5 of our fellow Americans live with disabilities, but only those with the most significant disabilities qualify for disability benefits under Title II and Title XVI of the Social Security Act. Title II Old Age, Survivors, and Disability Insurance (DI) benefits and Title XVI Supplemental Security Income (SSI) benefits provide critical support to millions of Americans with the most severe disabilities, as well as their dependents and survivors. Disabled beneficiaries often report multiple impairments, and many have such poor health that they are terminally ill: about 1 in 5 male DI beneficiaries and 1 in 7 female DI beneficiaries die within 5 years of receiving benefits. Despite their impairments, many beneficiaries attempt work using the work incentives under the Social Security Act, and some do work part-time. For example, research by Mathematica and SSA finds that about 17 percent of beneficiaries worked in 2007. However, their earnings are generally very low (two-thirds of those who worked in 2007 earned less than $5,000 for the whole year), and only a small share are able to earn enough to be self-sufficient and leave the DI and SSI programs each year. Without Social Security or SSI, the alternatives for many beneficiaries are simply unthinkable.

The statutory standard for approval is very strict, and was made even more so in 1996. To implement this strict standard, Social Security Administration (SSA) regulations, policies, and procedures require extensive documentation and medical evidence at all levels of the application process. Less than onethird of initial DI and SSI applications are approved, and only about 40 percent of adult DI and SSI applicants receive benefits even after all levels of appeal. As with adults, most children who apply are denied SSI, and only the most severely impaired qualify for benefits.

Managing the eligibility process for the disability system is a challenging task, and errors will always occur in any system of this size. But the SSA makes every effort to pay benefits to the right person in the right amount at the right time. When an individual applies for one of SSA’s disability programs, the agency has extensive systems in place to ensure accurate decisions, and the agency is home to many dedicated public servants who take their ongoing responsibility of the proper stewardship of the programs very seriously. Program integrity is critically important and adequate funds must be available to make continued progress in quality assurance and monitoring. In the face of annual appropriations that were far below what the President requested in Fiscal Year 2011 and Fiscal Year 2012, the agency has still continued to implement many new system improvements that protect taxpayers and live up to Americans’ commitment to protect the most vulnerable in our society. It is true that DI has grown significantly in the past 30 years. The growth that we’ve seen was predicted by actuaries as early as 1994 and is mostly the result of two factors: baby boomers entering their highdisability years, and women entering the workforce in large numbers in the 1970s and 1980s so that more are now “insured” for DI based on their own prior contributions. The increase in the number of children receiving SSI benefits in the past decade is similarly explained by larger economic factors, namely the increase in the number of poor and low-income children. More than 1 in 5 U.S. children live in poverty today and some 44 percent live in low-income households. Since SSI is a means-tested program, more poor and low-income children mean more children with disabilities are financially eligible for benefits. Importantly, the share of low-income children who receive SSI benefits has remained constant at less than four percent.

Yet, the series aired on NPR sensationalizes this growth, as well as the DI trust fund’s projected shortfall. History tells a less dramatic story. Since Social Security was enacted, Congress has “reallocated” payroll tax revenues across the OASI and DI trust funds – about equally in both directions – some 11 times to account for demographic shifts. In 1994, the last time such reallocation occurred, SSA actuaries projected that similar action would next be required in 2016. They were right on target.

We are deeply concerned that the series “Unfit for Work” failed to tell the whole story and perpetuated dangerous myths about the Social Security disability programs and the people helped by this vital system. We fear that listeners may come away with an incorrect impression of the program—as opposed to an understanding of the program actually based on facts.

As former Commissioners of the agency, we could not sit on the sidelines and witness this one perspective on the disability programs threaten to pull the rug out from under millions of people with severe disabilities. Drastic changes to these programs would lead to drastic consequences for some of America’s most vulnerable people. With the lives of so many vulnerable people at stake, it is vital that future reporting on the DI and SSI programs look at all parts of this important issue and take a balanced, careful look at how to preserve and strengthen these vital parts of our nation’s Social Security system.

Sincerely,

Kenneth S. Apfel

Michael J. Astrue

Jo Anne B. Barnhart

Shirley S. Chater

Herbert R. Doggette

Louis D. Enoff

Larry G. Massanari

Lawrence H. Thompson

How your assets and income may affect your eligibility to receive Supplemental Security Income benefits.

Current income and assets do not affect one’s eligibility to receive Social Security Disability benefits (SSDI) because it is paid for out of workers’ tax contributions.

If you do not qualify for SSDI benefits but are suffering from a disabling condition, you may qualify for Supplemental Security Income (SSI). SSI is another federal program but works differently than SSDI. SSI is need-based program for those individuals with little to no income and low resources.

How much can you own in assets and still qualify for SSI? As of 2013, the cap on income and assets for an individual is $2,000 and for a couple is $3,000. However, there are certain assets that do not count towards an individual’s and couple’s assets. For example, the house that you live in and the car you drive for transportation will not count toward your amount of assets.

Also, the Social Security Administration (SSA) calculates the income limit for SSI program based on the federal benefit rate (FBR). Currently, the FBR is $710 per month for individuals and $1,066 for couples. Therefore, to qualify for SSI, your countable monthly income cannot exceed the FBR. The SSA only counts a portion of your monthly income when determining if you are eligible for SSI benefits. This can make it difficult for you to figure out whether your income falls under the SSI limit. Speaking with an attorney can help you determine if your income and assets fall within SSI limits and whether you are eligible to receive SSI benefits.

If you have had or are facing the possibility of having a liver transplant, it is a strong possibility that you will be eligible for Social Security Disability benefits as a result of this procedure. A Liver Transplant is a condition that qualifies an individual to receive disability benefits under the Social Security Administration’s listing manual. Put simply, a person who receives a liver transplant will automatically be presumed to be disabled for a period of 1 year following the operation, and will receive disability benefits. After the year is up, you still may be eligible to receive your benefits, but the Social Security Administration will need to reevaluate your disability claim. The Social Security Administration will look to see if you have any continuing medical issues that effect your ability to work, and they do this by examining any complications from your transplant, any rejection episodes, and the adequacy of your liver function following surgery. For more information, see Social Security Listing 5.09 and 5.00(D)(12). These can be accessed online here: http://www.ssa.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_09.

Although a Liver Transplant typically qualifies a person to receive benefits, it is still a good idea to consult with an attorney about your case. The reality is that a majority of first-time applications for disability benefits are denied, and this could be a result of an error in paperwork or forms that go along with a claim for benefits. Many applicants denied their first time could have saved themselves a great deal of annoyance by consulting with an attorney at the beginning of their claim.

Each year the Social Security Administration (SSA) publishes an updated version of The Red Book, which serves as a source of information regarding employment related provisions of the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. The most recent version of The Red Book was released in January 2013 and is available on SSA’s website at: http://www.socialsecurity.gov/redbook/. New to the 2013 Red Book are several Automatic Adjustments, including changes to the income threshold for Substantial Gainful Activity (SGA) and the Federal Benefit Rate (FBR), among other important numbers that disability claimants and professionals who serve those with disabilities should be aware of.

An individual who currently receives or is filing for SSI or SSDI should be aware of the effect working, or attempts to work, will have on their benefits or claim. One topic discussed in the 2013 Red Book is the Trial Work Period (TWP). The TWP allows disabled individuals to test their ability to work, without the possibility of losing their benefits. The TWP starts when you begin working or performing services. In order to qualify as the performance of “services”, monthly earnings must be more than $750 per month, or you must work more than 80 hours a month in self-employment. If an individual meets these requirements for 9 months out of a rolling 60 month period, then the TWP is complete. The 9 months do not need to be consecutive. During this TWP, an individual will continue to receive full disability benefits, regardless of the level of income earned, so long as a disabling impairment continues. If an individual completes the TWP, he or she would then enter the Extended Period of Eligibility (EPE), during which the claimant will continue to receive benefits if not working at the SGA level. It is important to note that only SSDI claimants are eligible for the TWP.

For a full explanation of the many employment support provisions of the SSI and SSDI programs, view the 2013 Red Book at http://www.socialsecurity.gov/redbook/.