Social Security Issues New Ruling For Chronic Fatigue Syndrome

SSR 14-1p clarifies the policy on how SSA develops evidence to establish that a person has a medically determinable impairment (MDI) of Chronic Fatigue Syndrome (CFS) and how this impairment is evaluated in disability claims and continuing disability reviews under titles II and XVI the Social Security Act (Act).  

Under the CDC case definition, the hallmark of CFS is the presence of clinically evaluated, persistent or relapsing chronic fatigue that:

  1. Is of new or definite onset (that is, has not been lifelong);
  2. Cannot be explained by another physical or mental disorder;
  3. Is not the result of ongoing exertion;
  4. Is not substantially alleviated by rest; and
  5. Results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

The CDC case definition requires the concurrence of 4 or more specific symptoms that persisted or recurred during 6 or more consecutive months of illness and did not pre-date the fatigue:

  • Postexertional malaise lasting more than 24 hours (which may be the most common secondary symptom);
  • Self-reported impairment(s) in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities;
  • 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; and
  • Waking unrefreshed.

Within these parameters, the CDC case definition, CCC, and ICC describe a wide range of other symptoms a person with CFS may exhibit:

  • Muscle weakness;
  • Disturbed sleep patterns (for example, insomnia, prolonged sleeping, frequent awakenings, or vivid dreams or nightmares);
  • Visual difficulties (for example, trouble focusing, impaired depth perception, severe photosensitivity, or eye pain);
  • Orthostatic intolerance (for example, lightheadedness, fainting, dizziness, or increased fatigue with prolonged standing);
  • Respiratory difficulties (for example, labored breathing or sudden breathlessness);
  • Cardiovascular abnormalities (for example, palpitations with or without cardiac arrhythmias);
  • Gastrointestinal discomfort (for example, nausea, bloating, or abdominal pain); and
  • Urinary or bladder problems (for example, urinary frequency, nocturia, dysuria, or pain in the bladder region).

People with CFS may have co-occurring conditions, such as fibromyalgia (FM), myofascial pain syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis, Raynaud’s phenomenon, migraines, chronic lymphocytic thyroiditis, or Sjogren’s syndrome. Co-occurring conditions may also include new allergies or sensitivities to foods, odors, chemicals, medications, noise, vibrations, or touch, or the loss of thermostatic stability (for example, chills, night sweats, or intolerance of extreme temperatures).

A person can establish that he or she has an medically determinable impairment (MDI) of CFS by providing appropriate evidence from an acceptable medical source, laboratory findings and mental limitations.   In cases in which CFS is alleged, SSA generally needs longitudinal evidence because medical signs, symptoms, and laboratory findings of CFS fluctuate in frequency and severity and often continue over a period of many months or years.  This evidence can be obtained from acceptable medical sources, nonmedical, and lay persons to document severity and functional limitations.

New Federal Effort To Encourage Child Development and Behavioral Screening

As many as one in four children through age 5 is at risk for a developmental delay or disability.  A new federal effort to encourage healthy child development, universal developmental and behavioral screening for children was announced recently.  The program, titled “Birth to 5:  Watch Me Thrive”, also aims to provide support for the families and providers who care for them.  The program hopes that earlier screening and intervention will cut down on special education costs later on.

Birth to 5: Watch Me Thrive! will help families and providers:

  • Celebrate milestones. Every family looks forward to seeing a child’s first smile, first step, and first words. Regular screenings help raise awareness of a child’s development, making it easier to expect and celebrate developmental milestones.
  • Promote universal screening. Just like hearing and vision screenings assure that children can hear and see clearly, developmental and behavioral screenings track a child’s progress in areas such as language, social, or motor development.
  • Identify possible delays and concerns early. With regular screenings, families, teachers, and other professionals can assure that young children get the services and supports they need, as early as possible to help them thrive alongside their peers.
  • Enhance developmental supports. Combining the love and knowledge families have of their children with tools, guidance, and tips recommended by experts can make the most of the developmental support children receive.

Please see the U.S. Department of Health and Human Services website for further information.

Eligibility For Social Security Disability With Fibromyalgia

Fibromyalgia is a complex medical condition characterized by widespread pain. Fibromyalgia syndrome affects the joints, muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management.

A recent Social Security Ruling, SSR 12-2p, issued in 2012, addresses when fibromyalgia should be found as a medically determinable impairment.  This ruling provides guidance on how SSA develops evidence to establish that a person has a medically determinable impairment. A claimant for disabilty benefits will be found eligible if they satisfy either of two sets of criteria set forth in SSR 12-2p:

The 1990 ACR Criteria for the Classification of Fibromyalgia

A claimant may be found to have a medically determinable impairment of fibromyalgia if he or she has all three of the following:

  1. A history of widespread pain – pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back) – that has persisted (or that persisted) for at least 3 months.
  2. At least 11 positive tender points on physical examination (of 18 tender point sites).  A tender point is positive if the person experiences any pain when applying pressure.  The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.

The 18 tender point sites are located on each side of the body at the:

  • Occiput (base of the skull);
  • Low cervical spine;
  • Trapezius muscle (shoulder);
  • Supraspinatus muscle (near shoulder blade);
  • Second rib (top of rib cage);
  • Lateral epicondyle (outer aspect of the elbow);
  • Gluteal (top of the buttock);
  • Greater trochanter (below the hip); and
  • Inner aspects of the knee.

3.   Evidence that other disorders that could cause the symptoms or signs were excluded.

The 2010 ACR Preliminary Diagnostic Criteria

  1. A history of widespread pain;
  2. Repeated manifestations of six or more Fibromyalgia symptoms, signs, or co-occurring conditions, especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety disorder, or irritable bowel syndrome;
  3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.

Once it is established that a person has a medically determinable impairment, SSA will evaluate the case under the sequential evaluation process to determine whether the person is disabled.  SSA will consider the severity of the impairment, whether the impairment medically equals the requirements of a listed impairment, and whether the impairment prevents the person from doing his or her past relevant work or other work that exists in significant numbers in the national economy.  For more information on the 5-step sequential evaluation process for Social Security Disability, please click here for our post.

How Will the Affordable Care Act Affect Individuals With Disabilities?

As we are now entering the implementation of the Affordable Care Act (“Obamacare”, “ACA”), it will be interesting to see how each State decides coverage for their residents.  Although the Act has several mandates, it appears that each State has some latitude in how the Act is implemented.  The Affordable Care Act requires that health insurance plans sold to individuals and small businesses provide a minimum package of services in 10 categories called “essential health benefits.” These categories include hospitalization, maternity and newborn care, ambulatory care, and prescription drugs, to name a few.  But rather than establishing a national standard for these benefits, the Department of Health and Human Services (HHS) decided to allow each state to choose from a set of plans to serve as the benchmark plan in their state. Whatever benefits that plan covers in the 10 categories will be deemed the essential benefits for plans in the state.  Although flexibility and State by State choice according to local issues sounds reasonable on the surface, a federal benchmark definition of “essential health benefits” may have been a better choice given the complexity and magnitude of regulation this Act may require. [Read more…]

Applying For Disability With PTSD

Post Traumatic Stress Disorder (PTSD) is a disorder which occurs after experiencing a physically or psychologically traumatic event.  Examples may include, but are not limited to, an accident, physical or sexual abuse, or natural disaster.  Veterans may experience events that are both physically and psychologically traumatic in the course of combat during their military career.  PTSD can cause sleeplesness, anger, anxiety, nightmares, flashbacks, hypervigilance and fear.  Treatment for PTSD can include medication, counseling, cognitive-behavioral therapy and pyschotherapy.

As with any Social Security Disability claim, you must ensure that all of your limitations are documented.   This may be accomplished in your medical records, supplemented with opinion or medical source statements by your treating physicians, or by any other means which can prove your inability work.  Some of the limitations associated with PTSD that could impact your ability to work include fatigue, memory loss or concentration issues.  Some claimants may not be able to perform certain types of work if they have issues with concentration, working closely with coworkers or the general public, or would need to take time off due to medical appointments, sickness or counseling sessions.

Please call our office if you have any questions regarding filing for disability benefits with Post Traumatic Stress Disorder.

How Will The Government Shutdown Affect Social Security?

I have been asked this question several times over the past week.   There have been delays in dealing with the local Social Security office, and services have been limited.  If you have a disability hearing before an Administrative Law Judge scheduled, however, there does not appear to be any delays or rescheduling due to the Government shutdown.   Please refer to the SSA website for a detailed list of the services still provided during the shutdown.

Qualifying For SSI and SSDI Disability

If you are disabled and can’t work, there are numerous programs and assistance to help you.  Two of those programs at the federal level are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).  Although there are several differences between the SSI and SSDI disability programs, there is one similarity.  The definition of disability is the same and medical disability is assessed the same way under both programs.

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) is the disability program for those individuals that have not worked or have not worked enough recently to be insured for benefits. It pays monthly cash benefits to people who are age 65 or older, those who are blind, or those who have a disability and have $2,000 or less in assets and have no or limited income. Both adults and children can apply for SSI.

[Read more…]

New Bill Would Expedite Disability Benefits For The Terminally Ill

Congress introduced a bill recently that would expedite SSDI benefits for the terminally ill.  SSDI benefits provide cash assistance for individuals that have paid FICA taxes and found disabled by the Social Security Administration.  This bill would ensure that those individuals with a short life expectancy receive the benefit that they deserve when they need it.  Under existing law, there is a five-month waiting period before and individual can receive SSDI benefits.  The “Expedited Disability Insurance Payments for Terminally Ill Individuals Act of 2013” would allow people whose medical condition results in a life expectancy of six months or less to receive:

  • 50% of SSDI benefits within the first month of diagnosis
  • 75% of monthly benefits for the second month
  • Full benefits for the third and all following months up to one year

[Read more…]

Can I Work With Peripheral Neuropathy?

Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness.  Peripheral neuropathy often causes weakness, numbness and pain, usually in your hands and feet, but it may also occur in other areas of your body.  Some forms of neuropathy involve damage to only one nerve and are called mononeuropathies. More often though, multiple nerves affecting all limbs are affected-called polyneuropathy.

Can you get disability benefits for peripheral neuropathy?  Like any other condition or impairment, the peripheral neuropathy must severely limit a claimants ability to work. The listing that applies for  peripheral neuropathy is found at listing 11.14 under neurological disorders.  To meet the criteria, there must be significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements, or gait and station.

[Read more…]

Disability Benefits For Children With Congenital Heart Defects

Congenital heart defects (CHD) are Americas #1 birth defect, affecting nearly 1 out of every 100 babies. CHD are the leading cause of all infant deaths in the United States.

Defects can range from a hole in the heart and obstructed blood flow to conditions such as HLHS where multiple parts of the left side of the heart do not develop completely.  Surgeries can range from catheterizations to major open heart bypass surgeries and transplants.  Symptoms may include bluish skin, shortness of breath and fatigue.

SSI disability benefits are available to children with Congenital Heart Defects.  There are several CHD listed on SSA’s compassionate allowance list.  Children may also meet several listings to qualify for benefits.  The listings are:

104.6 – Congenital Heart Disease

To qualify under listing 104.6, the child must have cyanotic heart disease with chronically low blood oxygen, demonstrated by one of the following:

[Read more…]