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…]

Breakthrough In Down Syndrome Research at UMass Medical

I read a very interesting article recently on the UMass Medical School website regarding Down Syndrome research.  Scientists at UMass have found a way to block or neutralize the extra chromosome that causes developmental problems and intellectual disabilities in people with Down Syndrome.   The discovery “may one day help establish potential therapeutic targets for future therapies.”  To read the entire article, see the UMass website.  Please  refer to Nature to read the details of the study.

What Is a Medical-Vocational Allowance In Social Security Disability?

A medical vocational allowance is the term used by Social Security (SSA) when your condition does not meet the criteria in SSA’s listings but it is determined that you are still unable to work.

To be approved for Social Security disability benefits, SSA will evaluate your claim using the five step sequential evaluation process.  At steps 1 and 2, SSA addresses whether you are performing substantial gainful activity and if  you have a severe impairment.  At step 3, SSA evaluates your claim to determine if you meet a listing.  To meet a listing, you must meet specific criteria to be found disabled.  The criteria is different  for each listing as it applies  to different conditions and, unfortunately, most claimants do not meet a listing.

If you do not meet a listing, SSA will further evaluate your claim under steps 4 and 5  to determine the impact your disability has on your ability to work.  SSA will examine your illness, conditions and limitations to determine if you can do your past work, and if not, if there are any other jobs that you could still perform based upon your age, education and work history.  This is called your residual functional capacity.  If it is determined that there are no jobs that you could perform based on your residual functional capacity, then your claim will be approved under a medical vocational allowance.

Autism Legislation

Massachusetts Advocates for Children posted an interesting summary of the Massachusetts legislative priorities for Autism Commission related bills.  One is particularly interesting in that it would require the Board of Education to provide a mechanism for Special Education teachers to receive an Autism Endorsement.  The endorsement will address the specific competencies needed for teachers to address the complex and unique needs of students with autism.  If passed, starting in 2016, IEP Teams for students with autism would include a teacher with an Autism Endorsement to ensure that the school can fully address the complex communication, behavioral, sensory, social, and academics needs of youth in the least restrictive environment.

To see a summary of the Bill, click here for the Massachusetts Advocates for Children website.

Redetermination For Children’s Disability at 18

Many parents have asked what happens to their child’s disability benefit when they turn 18.  Do they automatically lose the benefit?  The answer is no.

At age 18, the child must go through a process called a redetermination of benefits to determine whether or not their benefits should continue.  The reason for this process is because the standard to determine disability is different for adults as it is for children.  As a child, the Social Security Administration (SSA) determines limitations based on functioning over six domains of function.  When the child turns 18, SSA must examine the child’s limitations and how it affects their ability or capacity to work.

So how does SSA determine a child’s ability to work at age 18 with little or no work experience.  SSA will assess the child’s ability to work or enter the workforce based on limitations observed in school, part-time work or volunteer position, and discussing the child’s limitations with persons that may have made observations regarding the ability to work.

Documentation will be needed to show these limitations and may include:

  • Medical records
  • School records
  • Teacher statements
  • Counseling records
  • Statements by employers, charities, internships and volunteer opportunities
  • Statements by family

Qualifying For Disability Benefits With Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.  Because there is no medical test to diagnose CFS, you may need to undergo a variety of tests to rule out other medical conditions with similar symptoms.

You can qualify for disability benefits based upon a diagnosis for chronic fatigue syndrome (CFS) if it impacts your ability to work.  You must be out of work, or expected to be out of work, for at least twelve (12) months.  Social Security (SSA) will then analyze your claim using the five step sequential evaluation process.  For a detailed discussion on the five step sequential evaluation process, see other posts here.  Essentially, SSA will evaluate whether you can perform your past work, and if not, will then analyze whether there are any jobs you can transition to.

To be approved for disability benefits, you must suffer from at least four of the following symptoms for a period exceeding six months:

  • muscle pain
  • pain in multiple joints without redness or swelling
  • memory or concentration problems that cause a serious reduction in your activities
  • frequent sore throats
  • tender lymph nodes in the neck or under the arm
  • headaches of a different quality than before onset of chronic fatigue
  • sleep that does not refresh you, and
  • a general feeling of being unwell that lasts at least 24 hours following a period of exertion.

SSA will review your medical records, test results and any other evidence that you submit to determine your eligibility for benefits.  It may also be helpful to have your treating physician provide a statement detailing your limitations.

Medical Source Statements In Disability Cases

Medical Source Statements are very important in your disability case.  A Medical Source Statement is a statement or opinion by a physician or other medical provider detailing the functional capacity of a disability claimant.  While your medical records will document diagnoses, tests, medications and communication or statements between you and your doctor, most likely your medical records will be lacking as to how your disability affects your ability to work on a sustained basis.  These statements are most effective if they are carefully drafted to meet or satisfy the applicable regulation specific to your medical condition.  Even persons with the same condition/disability may need different medical source statements edited to their specific needs.  This should be done on a case-by-case basis.   Please contact my office to discuss medical source statements in further detail.

Can I have family or a friend testify at my disability hearing?

I was asked by a client recently if they could bring someone to their disability hearing to testify on their behalf. The answer is yes and this type of witness is often called a “lay witness”.

The most appropriate person to testify would be someone that sees you regularly and can testify as to your limitations and what you are going through on a daily basis. It is critical that this witness testify as to observations made of you, not just what you tell them. In addition, your lay witness must be able to describe the pain you experience, if any, and any other limitations you have that prevent you from working.

Your lay witness should have a basic understanding of the disability hearing. Your lawyer will discuss and let you and your witness know what to expect. Testimony during the hearing should not be prepared or memorized. There is nothing that can hurt your case more than testimony that is exaggerated or that is not considered credible by the Administrative Law Judge.

If you have any questions, or would like to discuss your case further, please don’t hesitate to contact my office.

Am I Eligible For Social Security Disability – Part 5

In our final part of our 5 part series, we are discussing the process you must go through to be approved for social security disability benefits.  We’ve already discussed the first four steps, which address working, the severity of your impairment, if your medical condition meets or equals a listed impairment by the Social Security Administration, and whether you can perform your past work.  In this series, we will discuss step 5 of the sequential evaluation process which addresses if you can perform any other type of work.  The 5 step sequential evaluation process is noted below for reference:

  1. Are you currently working?  Does your impairment prevent you from performing substantial gainful activity?
  2. Is your condition severe?
  3. Does your medical condition meet or equal a listed impairment?
  4. Can you perform your past work?
  5. Can you do any other type of work?

Step 5

Step 5 of the sequential evaluation process analyzes whether you are able to adjust to other types of work.  The work must be of the type that exists in significant number in the national economy.  The analysis will factor in your past work, your age, remaining work capacity and education level.  If the SSA finds that you cannot adjust and take on other types of work, the SSA will likely find that you are disabled.  If you were denied at any step, please contact Sharry Law Office for a free case evaluation and discuss your appeal.

Evaluating Functional Equivalence In Childhood Disability

In children’s disability cases, if the child’s impairment is not severe enough to meet a Social Security “listing”, meaning an approval for disability benefits, then an assessment must be done to determine if the impairment functionally equals a listing.  For functional equivalence, the child must have one “extreme” or two “marked” limitations in the six domains of functioning. 

The six domains of functioning are:

  1. Acquiring and using information
  2. Attending and completing tasks
  3. Interacting and relating with others
  4. Moving about and manipulating objects
  5. Caring for oneself, and
  6. Health and physical well-being.

The evaluation of how functioning is affected will be done during all of the child’s activities; meaning activities done at home, at school, and in the community.   First, Social Security will identify which of the child’s activities are limited, and which domains are involved in those activities.  They will then determine whether the child’s impairment(s) could affect those domains and account for the limitations.  Second, Social Security will then rate the severity of the limitations in each affected domain(s).  If SSA finds one extreme limitation, or two marked limitations, the child will be approved for disability benefits.