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Social Security Disability Insurance Information

Posted Sep 22 2008 11:06am
This is the information I received from the guest speakers yesterday at the support group meeting. They are aware that I am posting this information and ask if anyone reading this has any questions to give them a call, even if you are not local, they still may be able to help you or give you the name of someone who can. I scanned this in to my computer but some things got messed up when changing to text so any typos are mine, not theirs!

West Coast Disability Law Group, LLC

l4622 Victory Blvd., Van Nuys, CA 91411
Phone: (800) 459-3017
Fax: (818) 459-1991
www.westcoastdisability.com


Important Tips For Winning Your Social Security Disability Claim

1. If you are unrepresented, keep a copy and get a receipt of any appeal you file.

All too often, we hear a familiar story. A claimant has applied for benefits, but Social Security has no recollection of this application. The claimant has been forced to refile the application and the resolution of the claim has been significantly delayed.

This scenario can easily be avoided if you get a receipt of your appeal from the Administration. lf you file in person with the Administration, they can stamp your appeal and provide you with a copy. lf you apply online, print out the confirmation document. lf you apply by mail, follow up with the Administration and ask them to forward you a receipt. Thus, if the Administration later claims that you have never applied for benefits, you have concrete proof that you did.

2. See a doctor regularly and seek out a county facility or free clinic for treatment if you have lost your medical insurance.

In order to be entitled to benefits, your impairments must be medically documented. This means there must be legible medical documentation supporting your claim. The judge may believe that you do have severe pain, but if there is no concrete proof, the judge must deny you benefits.

Treating regularly with a physician is necessary to establish your impairment. Treating with a specialist who specifically treats your condition can add even greater weight to your claim.
We understand that treatment is expensive and can be difficult with the rising costs of healthcare. If you are no longer insured or in danger of losing your insurance, seek out county facilities and free clinics in your area so there will not be a significant lapse in treatment.

3. Keep track of all the medical providers or facilities you treat with and let your representative know when this information needs to be updated.

The foundation of every disability claim is medical evidence. lf your attorney is not aware of all the providers or medical facilities you treat with, your attorney cannot get the materials to prove your claim. Every time you treat with a new provider or facility, let your attorney know. Make sure you get all the pertinent contact information for the provider, including: name, address, phone number, and fax number. lf possible, get a copy of the medical record of each visit following your appointment. You never know what valuable piece of information could result in a favorable determination.

4. Treat with a medical provider you trust and who is aware of your disability.

If your doctors do not support your claim for disability, you may need to ask yourself whether you legitimately fit the social security ndrinirtrations'deiinition of disability. It is important that you have supportive providers throughout this process. often the Administration or your attorney will contact your providers for support in your claim. lf your provider is not aware of your disability, or does not support your claim, it is very unlikely that you will be able to obtain benefits.

5. If you return to work, let your representative know.

A return to work can drastically change your claim. While there are some regulations that permit you to work at certain levels, your attorney needs to be aware of your work status. Not only is it important for your attorney to explain to you how work affects your case, the attorney needs this information to help formulate a legitimate theory to win your claim. Additionally, if you return to work without notifying the Administration, your claim may result in an overpayment. In an overpayment situation, theAdministration will ask you to pay back the surplus amount that you were paid. If the Social Security Administration finds that you intentionally misled them to receive additional benefits, they may impose additional civil penalties.

6. Pay attention to the time frame you have to appeal a denial.

The Social Security Administration has strict deadlines for entering an appear. Generally it is 60 days from receipt of the denial, but this can vary. The Administration is not very understanding when a deadline is missed and may make you refile your application. This is easily avoidable if you read each denial letter carefully, often the appeal time frame is not on the first page, so read every page of the denial. As soon as you receive a denial, let your attorney know. Though the Administration is supposed to copy your representative on all correspondences, this does not always happen. Notifying your attorney can ensure that a deadline is not missed.

7. Get a copy of your medical record following each visit so the Administration has accurate information regarding your medical condition.

Getting a copy of your medical records following each visit can save you a lot of administrative costs that your doctor may charge. To prove your claim, we will request a copy of your medical records from each treating provider and facility. While West Coast Disability Law Group, LLP does not charge a fee for representation unless we win your case, your doctors may require that you pay nominal copy fees for release of your medical records. While you are responsible for these charges, you may be able to avoid them. Ask for a copy of your visit record following your appointment with your doctor. This could result in drastically reduced copy fees.

8. Let your representative know if your doctor is not supportive.

If your doctor is not supportive, you may be wasting your time applying for benefits. Make your
representative aware of any providers who do not support your claim. If we legitimately do not think we can prove your case, we will let you know. The Social Security claims process is lengthy and we will honestly approach you if we think your case is unwinnable.

9. Fill out all paperwork your representative or the Administration gives you honestly and accurately.

To effectively represent you, we must have accurate details in regards to your claim. While we recognize that you may not recall every detail of your treatment or work histories, try to fill out all required paperwork as accurately as possible. Never intentionally change information to make your case look stronger. The Administration may impose civil penalties for such fraudulent behavior.

10. If the Social Security Administration schedules you for a consultative examination, please attend.

The Social Security Administration may send you to one or more of their doctors for a consultative evaluation at no cost to you. We understand that you are probably more comfortable with your own provider for regular treatment, but you must attend this evaluation. Failure to attend may result in a denial due to your lack of cooperation with the Administration's requests.

11. Ask questions to your representative if you do not understand something.

We understand how complicated the Social Security claims process is. However, we are experienced attorneys who handle these matters every day of the week. Do not be intimidated to ask your attorney questions. No question is silly, stupid, or embarrassing. As attorneys, we are expected to know the law. You are not. You hired us for our expertise, please allow us to address your questions and concerns.

SSA's Listings of Impairments

The Social Security Administration (SSA) has created listings of impairments in 14 areas of disability. The SSA impairment listing is quite detailed and is one way the SSA determines disability claims for Social Security Disability (SSD) and Supplemental Security Income (SSl). lf a claimant's disability meets or equals a listed impairment to a requisite severity, he or she may be found disabled for purposes of Social Security Disability or SSI benefits on that medical basis alone.

Even if an individual does not meet one of these impairment listings, they may still be found disabled.

The following disability areas are on the SSA Impairment Listing:

1. Musculoskeletal System
- major dysfunction of a joint
- spinaldisorders
- amputation
- soft tissue injuries (e.g. burns)
- fractures
2. Special Senses and Speech
- vision disorders
- hearing impairments
- loss of speech
3. Respiratory System
- chronic pulmonary insufficiency
- asthma
- cystic fibrosis
- chronic lung infections
- sleep related breathing disorders
-lung transplant
4. Cardiovascular System
- chronic heart failure
- heart disease
- chronic venous insufficiency
- peripheral arterial disease
5. Digestive System
- obstruction of the esophagus
- chronic liver disease
- chronic colitis
- weight loss due to any persisting gastrointestinal disorder
- liver transplant
6. Genitourinary System
- renal function impairments
- nephrotic syndrome
7. Hematological Disorders
- chronic anemia
- sickle cell disease
- myelofibrosis
- aplastic anemias
- coagulation defects
8. Skin Disorders
- ichthyosis
- bullous disease
- chronic infections of the skin or mucous membranes
- dermatitis
- burns
9. Endocrine System
- thyroid disorders
- diabetes mellitus (with neuropathy, acidosis, or retinitis proliferans)
10. Impairments that Affect Multiple Body Systems
- down syndrome
11. Neurological Disorders
- epilepsy
- brain tumor
- parkinsonian syndrome
- cerebral palsy
- cerebral trauma
- multiple sclerosis
- amyotrophic lateral sclerosis
- muscular dystrophy
- peripheral neuropathies
12. Mental Disorders
- organic mental disorders
- schizophrenia
- affective disorders
- anxiety disorders
- personality disorders
- mental retardation
- autism
13. Malignant Neoplastic Diseases
- cancer -such as soft tissue tumors, lymphoma, multiple myeloma, and leukemia
L4. Immune System
- lupus
- sclerosis
- inflammatory arthritis
- HIV infection
*Please note: The disease examples listed above under each impairment category are not exhaustive.*

SSA's Listings Addressing Brain Tumors

The Social Security Administration ("Administration") has certain guidelines when evaluating the effects of brain tumors. Specifically, the Administration has created benchmarks for evaluating Social Security Disability and Supplemental Security Income entitlement. lf an individual's impairment meets, or is equivalent to any of the listings laid out below, the Administration will direct a finding of disability. Please note, however, individuals suffering from brain tumors can still be found disabled even if their conditions do not exactly fit the Administration's criteria in the below Listings of lmpairments. In such instances, age and vocational background are crucialfactors in such claims.

Currently, the Social Security Administration uses distinct evaluations depending on whether the brain tumor is malignant or benign. Malignant brain tumors are assessed under the 1-3.13 Nervous System section of the Malignant Neoplastic Diseases classification. Benign brain tumors are evaluated under Neurological Listing 11.05, which is specifically titled Benign brain tumors.

1.) MALIGNANT BRAIN TUMORS

13.13 Nervous system. (See 13.00K6.)1

A. Central Nervous System Neoplasms (brain and spinal cord), as described in 1 or 2:

1. Highly malignant tumors, such as Grades lll and lV astrocytomas, glioblastoma multiforme,
ependymoblastoma, medulloblastoma or other primitive neuroectodermal tumors (PNETs) with
documented metastases, diffuse intrinsic brain stem gliomas, or primary sarcomas.

2. Any central nervous system neoplasm progressive or recurrent following initial antineoplastic therapy.

OR

B. Peripheral nerve or spinal root neoplasm, as described in 1 or 2:


1. Metastatic.
2. Progressive or recurrent following initial antineoplastic therapy.

2.) BENIGN BRAIN TUMORS

11.05 Benign brain tumors
Evaluate under LLO2,11.03, L1.04 or the criteria of the affected body system.

1 Complications, such as neurological or psychological symptoms, resulting from malignant brain tumors will be assessed under the affected body system

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 motorfunction in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.ooC).

3.) WHAT DOES THE SOCIAL SECURITY ADMINISTRATION MEAN WHEN IT SAYS THAT BOTH MALIGNANT AND BENIGN TUMORS SHOULD BE ASSESSED UNDER THE CRITERIA FOR THE AFFECTED BODY SYSTEM?

Sometimes an individual may meet a listing other than the specific listing designated for an impairment due to complications and other body systems that the impairment affects. Often with both malignant and benign brain tumors, an applicant may not meet the criteria for either 13.1-3 or 11.0S. However, an individual may be having psychological effects from the organic changes in the brain, which could qualify the individual under the 12.02 Organic Mental Disorder listing. This listing is outlined below due to its prevalence in brain tumor cases.

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 medicallv
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.9., 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 LQ. 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 1or more years' inability to function outside a highly supportive living
arrangement, with an indication of continued need for such an arrangement.
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