Social Security Issues New Ruling For Chronic Fatigue Syndrome

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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.

Filed Under: Chronic Fatigue Syndrome

Eligibility For Disability Benefits With Traumatic Brain Injury

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Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities. TBI typically occurs when there is injury to the brain following some type of trauma to the head.   The top causes o f TBI are car accidents, firearms and falls and these injuries usually cause internal bleeding or swelling in the brain.

TBI can be categorized as mild or severe.  A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes.  Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours.

You may be eligible for disability benefits if you are not performing substantial gainful activity and meet or equal a social security listing.  Although there is no specific listing for traumatic brain injury, listing 11.18 for cerebral trauma directs cases to be assessed under listings 11.02, 11.03, 11.04 or 12.02 as applicable.

11.02 Epilepsy – convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment.With:

A. Daytime episodes (loss of consciousness and convulsive seizures) or

B. Nocturnal episodes manifesting residuals which interfere significantly with activity during the day.

11.03 Epilepsy – nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern including all associated phenomena, occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment.With alteration of awareness or loss of consciousness and transient postictal manifestations of unconventional behavior or significant interference with activity during the day.

11.04 Central nervous system vascular accident. With one of the following more than 3 months post-vascular accident:

A. Sensory or motor aphasia resulting in ineffective speech or communication; or

B. Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C).

12.02 Organic mental disorders: Psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities.

The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.

A. Demonstration of a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following:

1. Disorientation to time and place; or

2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or

3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or

4. Change in personality; or

5. Disturbance in mood; or

6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or

7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., Luria-Nebraska, Halstead-Reitan, etc;

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration;

OR

C. Medically documented history of a chronic organic mental disorder of at least 2 years’ duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:

1. Repeated episodes of decompensation, each of extended duration; or

2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or

3. Current history of 1 or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

If you do not meet or equal the above listings, you can still qualify for disability benefits if 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.

Filed Under: Traumatic Brain Injury

SSA To Expedite Disability Process For Veterans

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Social Security Administration (SSA) has announced that effective March 17, 2014, it will expedite disability claims for veterans receiving VA service-connected compensation benefits and who have a rating of 100% “Permanent and Total” disability from the Veterans Administration.  This process does not apply to non-service connected pension benefits.  The VA disability only expedites the process, it does not guarantee an allowance for Social Security Disability benefits.  The veteran must still meet eligibility criteria similar to other claimants.  The veteran’s VA Notification letter indicating that the veteran’s rating of 100% Permanent and Total disability will be the required proof.

Filed Under: Social Security Disability, Veterans

Qualifying For Disability With Crohn’s Disease

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Crohn’s disease, also known as Colitis, is a chronic inflammatory disorder of the digestive system that creates ulcers along the digestive tract.  Crohn’s disease primarily causes breaks in the lining of the small and large intestines.  In severe cases, these ulcers can scar, narrow, and obstruct the bowel. Symptoms of Crohn’s often include abdominal pain, persistent diarrhea, bloody stool, vomiting, diminished appetite and weight loss.  Treament plans for Crohn’s disease may include antibiotics, anti-inflammatories or even surgery for severe cases to repair damages to the digestive tract.

Crohn’s disease can qualify for disability benefits if the symptoms are severe enough to meet or equal a Social Security listing.  Crohn’s disease is evaluated under the listing for inflammatory bowel disease.

5.06  Inflammatory bowel disease (IBD) documented by endoscopy, biopsy, appropriate medically acceptable imaging, or operative findings with:

A. Obstruction of stenotic areas (not adhesions) in the small intestine or colon with proximal dilatation, confirmed by appropriate medically acceptable imaging or in surgery, requiring hospitalization for intestinal decompression or for surgery, and occurring on at least two occasions at least 60 days apart within a consecutive 6-month perio

OR

B. Two of the following despite continuing treatment as prescribed and occurring within the same consecutive 6-month period:

1. Anemia with hemoglobin of less than 10.0 g/dL, present on at least two evaluations at least 60 days apart; or

2. Serum albumin of 3.0 g/dL or less, present on at least two evaluations at least 60 days apart; or

3. Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or

4. Perineal disease with a draining abscess or fistula, with pain that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or

5. Involuntary weight loss of at least 10 percent from baseline, as computed in pounds, kilograms, or BMI, present on at least two evaluations at least 60 days apart; or

6. Need for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nutrition via a central venous catheter.

If you do not meet or equal the Social Security listing for inflammatory bowel disease, you still may qualify for benefits if you prove there are no jobs you can still perform given your age, education and residual functional capacity.  Please call our office if you have any questions or to discuss your particular case.

Filed Under: Crohn's Disease

New Program To Help Veterans

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An interesting Worcester Telegram & Gazette article was recently posted  outlining a new Veterans Inc.  program aimed at connecting veterans with resources to deal with mental health issues they may be dealing with.  A grant will be used to promote initiatives designed to assist Massachusetts military veterans, seniors or residents with mental health issues.  This program has already reached out to more than 100 veterans in a 6 month period.

Filed Under: Veterans

How Will the Affordable Care Act Affect Individuals With Disabilities?

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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…]

Filed Under: Affordable Care Act

Filing For Disability Benefits With Depression

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Depression is one of the leading causes of disability.  If it is not the sole condition or impairment listed on disability applications, it is often one of several conditions or the unfortunate result of longstanding, chronic pain.  The symptoms of depression often include sadness, hopelessness, fatigue and decreased energy, and issues with concentration.  Major depression may include suicidal ideations, suicide attempts and inpatient psychiatric treatment.  Although it’s not know what causes depression, many factors including biological, genetic and environmental may be to blame.  Life events, trauma and stress also contribute to the severity of depression.

To qualify for disability benefits if you are diagnosed with depression, you must either meet or equal a listing published by the Social Security Adminstration (SSA).  The “listings” are published by SSA and set forth the criteria you must meet to be deemed disabled.  If you do not meet or equal a Social Security listing, you can still qualify for disability benefits under the Medical-Vocational allowance.  See our other post for a discussion on the Medical-Vocational allowance.

[Read more…]

Filed Under: Depression

Applying For Disability With PTSD

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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.

Filed Under: Post Traumatic Stress Disorder

How Will The Government Shutdown Affect Social Security?

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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.

Filed Under: Social Security

Planning With Special Needs Trusts

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When your estate plan includes family or friends with special needs, care must be taken.  As the Supplemental Security Income (SSI) program is means tested, beneficiaries are allowed only $2,000 in countable assets to retain eligibility.  Although Social Security allows beneficiaries to have one house and one car, any other assets over $2,000 will be countable and affect eligibility.  Therefore, if you leave money to a loved one who is receiving SSI or Medicaid benefits, there is a good chance it will affect their eligibility.  More importantly, it may affect the medical insurance they receive as part of their benefits.

One option to consider when your estate plan includes special needs family members is a Special Needs or Supplemental Needs Trust.  With this option, instead of leaving your assets directly to your loved one, you leave it to the Special Needs Trust for their benefit.  If the trust is properly drafted, the beneficiary can benefit from the assets without affecting their eligibility for Medicaid or SSI.  This type of Special Needs Trust is a Third Party Special Needs Trust.  Another type of Special Needs Trust is the Self-Settled Special Needs Trust, which will not be discussed as part of this post.

[Read more…]

Filed Under: Special Needs Trust
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