Sphincter of Oddi Dysfunction

[Guest guest]

How would someone go about getting disability for pancreatitis? When do you

know if it's severe enough? I've been off work almost 4 months this past year

due to being ill with pancreatitis. Sphincter of Oddi dysfunction to be exact.

I'm being treated at Mayo Clinic and my doctor has been great. My home doctor

is also very supportive. Does anyone have any answers. My last attack (which

I'm still off work for) caused my amylase to hit 1500 and my lipase was over

28000. The pain has been unrelenting, worse in the mornings after not taking

pain meds for several hours I can hardly get out of bed or even sit up. Does

anyone else have most of their pain located in their back? I've never submitted

anything to one of these sites before. I'm 39, a non drinker, but have high

triglycerides which they're treating. I guess that's all. Thanks for any help

you have to offer.

[Guest guest]

Social Security Disability Information

What is Social Security Disability?

Disability is the " inability to to do any substantial gainful activity " by

reason of a medically determinable physical or mental impairment:

.. which can be expected to result in death; or

.. which has lasted or can be expected to last for a period of not less than

twelve months.

The claimant must have a severe impairment that makes the claimant unable to

do the claimant's previous job or any other substantial gainful activity

which exists in the national economy. Further, recent law has generally made

a requirement of Citizenship. To determine if the claimant can do any other

work, the Social Security Administration will consider the claimant's

residual functional capacity, age, education and work experience. A

determination by another agency that an applicant is disabled will impact a

claim. If found disabled by some other non- governmental or governmental

agency, the evidence toward that finding is important.

The Social Security Administration determines disability by a five step

process:

The claimant must have no substantial gainful activity.

The claimant must have a severe impairment. If work is not being performed,

Social Security will initially look at any physical or mental impairments to

determine whether one is disabled or blind.

The analysis generally ends if the claimant meet or equal a listing of

impairments. The listings are medically determinable criteria, for a

presumptive finding of disability. If the claimant does not meet or equal a

listing, the analysis goes to steps 4 and 5.

The claimant's impairment must prevent the claimant from working previous

employment over the past fifteen years.

The impairment must be so severe that any other work which exists in the

national economy cannot be performed.This analysis at steps four and five

depend on the claimant's residual functional capacity

There are several forms of Social Security disability, including Disability

Insurance Benefits, Widow's Benefits, and Supplemental Social Security

Income (SSI). Social Security, however, no longer grants disability based

solely on drug or alcohol addiction or, generally, to non-citizens. There

are also children's benefits, which have been subject to recent changes.

Social Security may also be available to those disabled by Chronic Fatigue

Syndrome or Fibromyalgia. The claimant needs to provide evidence to Social

Security. Social Security will generally not pay for getting all the medical

evidence they need to decide a case.

Impairment

Any impairment must be a medical, anatomical, physiological or psychological

abnormality that can be shown by a medically acceptable clinical and

laboratory diagnostic technique. Physical or mental impairments must be

established by medical evidence consisting of signs, symptoms and laboratory

findings, not only by the claimant's symptoms. Symptoms are a description of

physical or mental impairments. An individuals statement alone is not enough

to establish that there is a physical or mental impairment. Signs are

anatomical, physiological or psychological abnormalities which can be

observed separate from a statements (symptoms). Signs must be shown by

medically acceptable clinical diagnostic techniques. Psychiatric signs are

medically demonstrable phenomena which indicates specific abnormalities of

behavior, affect thought, memory, orientation and contact with reality. They

must also be shown to be observable facts that can be medically described

and evaluated. Laboratory findings are anatomical, physiological, or

psychological phenomena which can be shown through the use of medically

acceptable laboratory diagnostic techniques. Some of the techniques include

chemical tests, electrophysiological studies, electrocardiogram,

electroencephalogram and psychological tests. The kind of evidence that

needs to be supplied to Social Security must show an impairment and how

severe it is during the period it is said that one is disabled. Remember,

the Social Security Administration will only consider the impairments that

one says they have or about which they receive evidence, with a possible

exception of those who suffer from Chronic Fatigue Syndrome " CFIDS " or

perhaps Fibromyalgia. Social Security can help get medical evidence and

reports when giving SS permission to request such from your doctors.

In almost every case, no matter what the disease is, the answer is the

same - " Maybe, it just depends upon how badly you are affected by the

disease. " One example might be cancer. The word " cancer " is scary to anyone,

but there are many cancers which can be treated and cured very quickly, with

little or no lasting effect. On the other hand, of course, there are cancers

which cause great suffering and ultimately death. The question in each

individual case is " How sick is this particular individual with cancer and

how long is this person going to remain sick? " Skin diseases are another

example. The vast majority of skin diseases, while annoying, would not be

considered to be disabling. On the other hand, there are some uncommon, very

severe skin problems which are clearly disabling. In extreme cases,

psoriasis, which is not rare, may be disabling. Thus, almost without

exception, the mere fact that an individual has a disease with a certain

name does not guarantee that the individual either will or will not be found

disabled. It all depends upon how sick the person is.

Listings for Adults

The listings are medically determinable criteria you generally must be very

ill to meet or equal these listings. If you do not meet or equal a listing,

you go to the next step. Included below are the adult listings. While these

listings were updated recently, this page cannot verify that the listings

are exact and to date. The listings may be looked up at 20 C.F.R. Section

404 Subpart P Appendix I:

Part A . Sec.

1.00 Musculoskeletal System.

2.00 Special Senses and Speech.

3.00 Respiratory System.

4.00 Cardiovascular System.

5.00 Digestive System. including liver disease 5.05 (see below)

6.00 Genito-Urinary System.

7.00 Hemic and Lymphatic System.

8.00 Skin.

9.00 Endocrine System and Obesity.

11.00 Neurological.

12.00 Mental Disorders. (see below)

13.00 Neoplastic Diseases, Malignant.

14.00 Immune System.

Residual Function

Residual Function: The residual functional evaluation based on your age,

education and work experience, that helps them make this determination in

steps four and five, and it is defined by the limitations that your

impairments have on you. The impairments may be assessed either from a

physical or mental standpoint. The evaluation is made ultimately by Social

Security. However, when your treating physician(s) hold an opinion on how

you are functioning, particularly if the treatment is over a long period

with sustained contact, Social Security will give the opinion(s) great

weight.

What a " medical functional capacity assessment " describes. This assessment

describes an individual medical ability to do work-related activities such

as sitting, standing, moving about, lifting, carrying, handling objects,

hearing, speaking a mental impairment, the medical assessment will include

your ability to reason or make occupational, personal or social adjustments.

The medical evidence must be complete enough to allow the Social Security

Administration to determine the nature and limiting affects of impairments

for any period in question, the probable duration of individual impairments

and an individual residual functional capacity to do work-related physical

or mental activities. Information from other sources may help an individual

to understand how an impairment affects ability to work. Some other sources

that may help are: public and private social welfare agencies, observations

by non-medical sources and other practitioners such as chiropractors,

audiologists, etc. If a family medical doctor writes a letter that an

individual is totally and permanently disabled, it will not help one receive

benefits that is for Social Security to conclude. The report must contain

all of the items covered under what a medical report should include (i.e,

history, clinical findings, laboratory findings, diagnosis, treatment,

medical assessment). It must be complete. Social Security will use the

doctor's reports as evidence to make their determination, but not for its

conclusion.

Burden of Proof

The burden is, generally speaking, on the claimant. Attention should be

brought to the Social Security administration illustrating everything that

shows disability. The Social Security Administration will consider all

relevant information they receive from the applicant. If the information is

not present in the claimant's file (or the tape of the testimony) then it is

not considered. The opinion by a claimant's frequently treating doctor, with

objective tests for impairment, over a long period of time is given more

evidentiary value than the opinion of consultative examiners. Specialists

are given more weight than generalists on specified topics of impairments.

Once the claimant shows that the impairment limits to the extent that the

claimant cannot perform past relevant work, than the burden shifts to Social

Security to show that the claimant cannot perform any significant and

competitive work in the national economy.

Evidence

The claimant should provide Social Security with information about age,

education and training, work experience, daily activities both before and

after the date of disability, efforts to work and any other evidence showing

how impairments affect the ability to work. The Social Security

Administration accepts evidence from reports from acceptable medical

sources.

The medical sources that are acceptable are: licensed physicians,

osteopaths, certified psychologists, optometrists for measurement of visual

acuity and visual fields (they may need a report from a physician to

determine other aspects of eye disease); and individuals authorized to send

them a copy or summary of the medical records of a hospital, clinic,

sanitarium, medical institution, or health-care facility.

Generally, the copy should be certified as accurate by the custodian or by

any authorized employee of the Social Security Administration, Veteran's

Administration or State Agency. Generally, Social Security will not return

an uncertified copy or summary for certification unless there is some

question about the document. These reports should contain the claimant's

medical history, clinical findings such as the results of physical or mental

status examinations, laboratory findings such as blood pressure, x-rays,

etc., diagnosis (statement regarding disease or injury based on its signs

and symptoms), treatment prescribed with response and prognosis and a

medical assessment (except in statutory blindness claims, and disability

claims for widowers and surviving wives).

Remember, Social Security gives greater evidentiary weight to opinions of

treating sources who have cared consistently over a long period to that of a

single consultative examination. However, specialists examining a claimant

in their area of expertise are given more weight than generalists. Further,

objective evidence of impairment, such as a positive MRI scan, are given a

greater weight to opinions based on subjective findings, eg., complaints of

pain. The medical opinions are best described in terms of functioning. For

instance, many hours at one time can the comfortably claimant sit, stand or

walk, or in combination of these positions? How much can the claimant

occasionally, frequently, or continuously lift or carry? Can the claimant

use hands for grasping, pushing, pulling, or fine manipulation? Can the

claimant use feet for pushing and or pulling leg controls? Can the claimant

bend, squat, crawl, climb, or reach? Is the claimant restricted from

activities involving unprotected heights, moving machinery, weather changes,

automobiles, exposure to dust, fumes, and gases? Can the claimant understand

and remember instructions? Can the claimant persistently sustain

concentration? Can the claimant socially interact? Can the claimant adapt?

Are the functional limitations materially related to a problem with drugs or

alcohol (if so, benefits may be restricted)?

Who pays for getting all the medical evidence Social Security needs to

decide a case? Generally, individuals are responsible for submitting

evidence to support claims for disability. However, Social Security will

help by asking sources questions on one's behalf. The Social Security

Administration will generally not pay for this information. There are rare

situations when Social Security will pay for this information. The

situations when Social Security will pay for medical evidence. If the

evidence in the file shows that there may be a disability but it does not

contain the medical findings to make a disability determination and Social

Security must have this additional information. If, Social Security finds

one or more of your medical sources has the information but they will not

give Social Security the information until they are paid for it, Social

Security may pay for the report. Generally, Social Security may pay when a

hospital or clinic charges a small fee to cover its copying and mailing

costs and the only way to get the information would be to have an individual

take a special examination at Social Services expense. The evidence may be

submitted to any Social Security Office to the office of any State Social

agency, or to one of Social Security's employees authorized to accept

evidence at another place such as an Administrative Law Judge. If your

doctors do not provide Social Security with the medical and other evidence

they need and request, Social Security will make its decision about your

case based on the information provided in your file. A religious or personal

reason not to take a medical examination, test or treatment requested by

Social Security may be a valid excuse not to have it. However, if medical

sources cannot give social Security sufficient medical evidence about

impairment to determine a disability, they may ask that a physical or mental

examination be taken. These examinations are called consultative

examinations. Social Security pays for the consultative examinations. They

may also pay for transportation to the place of the requested examination.

Social Security Questions & Answers

Q: I understand that to get Social Security disability benefits, your

disability must be expected to last at least a year. Does this mean that you

must wait a year after being disabled before you can get benefits?

A: You do not have to wait a year after the onset of the disability before

you can get benefits. You should file as soon as you can after becoming

disabled and benefits begin after a 5-month waiting period. The waiting

period begins with the month Social Security decides your disability began.

Q: I have been receiving Social Security disability benefits for the past

four years and my condition has not improved. Is there a time limit on

Social Security disability benefits?

A: No. You will continue to receive a disability benefit as long as your

condition keeps you from working. But, your case will be reviewed

periodically to see if there has been any improvement in your condition and

whether you are still eligible for benefits. If you are still eligible when

you reach 65, your disability benefit will be automatically converted to

retirement benefits.

Q: I had a serious back injury four years ago and received disability

benefits for about 18 months until I could return to work. Unfortunately, my

back problems have recurred and I don't know how much longer I will be able

to continue working. When I initially applied for benefits, I waited several

months before I received my first check. If I reapply for benefits, will my

wait be as long as it was the first time?

A: Maybe not. It depends on what the new medical reports say and whether

additional evidence is required. A worker who becomes disabled a second time

within five years after benefits stop can have his or her checks start

again, beginning with the first full month of disability if the new claim is

approved.

Q: My brother had an accident at work last year and is now receiving Social

Security disability benefits for himself, his wife, and daughter. Before his

accident, he helped support another daughter by a woman to whom he has never

been married. Is the second child entitled to some benefits as well?

A: Yes, even though your brother wasn't married to the second child's

mother, Social Security pays benefits to all of his children, even if they

were born out of wedlock. Each child is entitled to equal benefits.

Q: What are Medicaid and Medicare?

A: If you qualify for disability insurance benefits you will be eligible for

Medicare after two years and five months. If you qualify for SSI you will be

eligible for Medicaid. Even if you have not yet been approved for SSI you

may qualify for Medicaid through the state. Medicaid is an assistance

program under which money from Federal, State and local taxes pays medical

bills for certain eligible needy and low-income people. For more information

you may contact the Social Security Administration.

Do I need an attorney?

You have the right to have an attorney represent you in your Social Security

case. Although attorney representation may not be absolutely essential in

all cases, statistics have shown that people represented by an attorney have

been more successful than people without attorney representation. Whether

you hire an attorney is entirely up to you; but you should consider the

advantages by examining what an attorney can do for you in your Social

Security case.

By law, an attorney can only charge you 1/4 of the past benefits if you win

the case, up to a maximum of $4,000. Every case is different. Your

attorney's role depends on the particular facts of your case. However, a few

things your attorney may do are:

Gather medical and other evidence.

Analyze your case under Social Security Regulations.

Contact your doctor and explain Social Security Regulations to obtain a

report consistent with those regulations.

Refer you to additional doctors for further medical reports to support your

claim.

Send you to a vocational expert for a report on your ability to work.

Suggest that the Social Security Administration send you to a doctor for a

consultative examination.

Obtain documents from your Social Security file.

Review actions taken by the Social Security Administration.

Ask that a prior application for benefits be reopened.

Seek waiver of a time limit.

Request subpoenas to insure the presence of crucial witnesses or documents

at your hearing.

Advise you how best to prepare yourself to testify at your hearing.

Protect your right to a fair hearing by objecting to improper evidence and

procedures.

Cross-examine adverse witnesses at your hearing.

Present a closing statement at your hearing arguing that you are entitled to

benefits under Social Security Regulations.

Submit a written summary of the evidence and argument to the Administrative

Law Judge.

If you win, make sure that the Social Security Administration correctly

calculates benefits. If you lose, request review of the Hearing Decision by

the SSA Appeals Council. If necessary, represent you in a federal court

review of your case.

Factors affecting your disability claim

No one can say with absolute certainty whether or not a social security

disability claim will be allowed. There are certain factors that can be

predicted, with reasonable certainty, to increase the likelihood of a

favorable decision and the actual payment of disability benefits. It is to

those factors that the body of this chapter is addressed. As previously

mentioned, disability for purposes of receiving social security benefits is

determined by whether or not the claimant's disability and other factors fit

neatly into the scheme of one of the GRID TABLES " . The overwhelming majority

of disability claims that are approved, are based on one of the Grid Tables.

The following factors directly impact on which table's standards the

claimant's disability will be determined.

A. Age of Claimant

The age of the claimant is the single most important determining factor in

whether or not the claim for disability benefits will or will not be

approved. Theories: Claimants age 50 or over that due to education and

skills are unsuited for sedentary work, often win for that reason. Those who

have a history of sedentary work and are below age 50 have a far more

difficult time in obtaining a favorable ruling unless they can show that

they are unable to sit due to the weight placed on the hip. The hip is the

largest joint in the body and hip pain can be disabling if it is severe.

Appearance: Claimants suffering from severe hip impairments will display a

seriously altered and or labored gait. Administrative Law Judges will

observe the claimant's walk, limp and any devices such as canes, walkers

etc. necessary to walk or stand.

B. Education Of The Claimant

Education has very little to do with whether or not a claimant is allowed

disability benefits unless the claimant is functionally illiterate ie:

unable to read and write well enough to function in a modern society at the

same level as the majority of the citizens. This is possibly the greatest

injustice done to those applying for social security disability. There are

countless hard working people in the construction or other labor intensive

areas that are not illiterate, but do not have a high school education and

are unable to compete and qualify for jobs with those who do have a high

school education.

C. Work Experience

The claimant's prior work history has a major impact on the determination of

the their disability. You are only required to prove that you are unable to

perform the same type of work that you have done in the past fifteen (15)

years. This can have a dramatic impact on your chances of winning your

disability claim. It is essential that the evidence show that you cannot

perform the same type of work you have done in the past. Putting together

the necessary information to ensure that your evidence will show to the

Administrative Law Judge that you are unable to perform the same type of

work you have previously done is one of the many things that you can do to

increase your chances of winning your disability case. (more will be said

later about how to gather the necessary evidence)

D. Physical Limitations

It is not the disease or injury that makes a person disabled as it applies

to social security disability. It is rather the physical limits the disease

or injury causes in the claimant that determines disability. A claimant may

have a disease such as cancer that has a horrible name and sends shivers up

your spine, but it is not the fact that the claimant has cancer that

qualifies them for disability benefits. Disability is determined based on

how the cancer has placed physical limitations on the claimant. Many people

have cancer. Not all people with cancer are disabled.

E. Mental Illness

By the date of the hearing before an Administrative Law Judge there are

probably very few social security claimants that stick with the process

through the hearing before an Administrative Law Judge that do not have some

degree of psychiatric problems. You will have endured months if not years of

physical pain, financial devastation, and the day to day difficulties that

are part and parcel of having a serious condition that disables you and no

doubt has turned your life upside down. It is virtually inconceivable that

anyone could survive the process up to the hearing level without at least

having some degree of depression as a reaction to their circumstances. In

cases where the Administrative Law Judge could go either way in his

decision, reactive depression brought on by your circumstances may well be

the extra disabling factor that convinces the Administrative Law Judge to

rule in your favor.

History Of The Case

The theory of the case is the reason or logic that supports your claim for

disability. For each theory that supports the claimant's disability, there

is also probably a theory that will deny them their disability

determination. It is important to recognize those theories that would be

against your case and be prepared to show how they do not apply in your

case.

The Effects of Being Disabled

Drugs * Anxiety * Bladder Problems * Lack of Concentration * Colostomys and

Illeostomys * Confusion * Depression * Diarrhea * Dizziness * .Drowsiness *

Eye-Hand Coordination * Fatigue * Grasping * Headaches * Memory Loss *

Numbness * Pain * Poor Stress Tolerance * Skin Conditions

Getting Started

The first step in trying to be placed on Social Security disability is to

see your Doctor. Ask the Doctor if in his or her medical opinion you are

disabled from being gainfully employed or disabled from your present job. If

the Doctor states that you are disabled, the next step is to go to your

local Social Security office and get the disability forms. At this time you

can also request a phone interview instead of going into the SS office for

the interview.

You will need the proper documentation:

Your Social Security card (or a record of your number);

Your certified birth certificate;

Children's birth certificates (if they are applying);

Marriage certificate (if signing up on a spouse's record)

Your most recent W-2 form, or your tax return if you're self- employed;

Your military discharge papers if you had military service.

Try to collect all your own medical records. This is very important, because

most of the time ALL your medical records are not sent to SS.

Always keep a copy of any of the applications or letters you write to SS.

You may need these later.

In most circumstances, the initial SSD request will be denied. You will be

notified by mail of the result. If you receive a letter informing you of

your rights and you disagree with the decision rendered in your case, you

can appeal the decision. Careful attention must be given to the appeal

process. Any mistakes can render the appeal invalid. If that happens, you

may have to start from the very beginning by filling out an application, and

again submit it and wait for the determination. If the claimant receives 2

SS denials, an appeal can be filed within 60 days and the next step is the

Law Judge hearing.

Administrative Law Judge (ALJ)

If an appeal is taken, a hearing will be scheduled for your case. At this

stage, having an attorney represent you can be helpful. Testimony will be

given by the applicant. Testimony will also have to be submitted by the way

of medical documentation and deposition transcripts of the treating Doctors.

Additionally, friends, family, and acquaintances can testify as to the

disability of the applicant. A vocational expert can also be used to show

that the applicant's pain would affect job performance and therefore render

the applicant unemployable.

Once the applicant is before a Administrative Law Judge who will hear the

applicants testimony, the Administrative Law Judge only will decide if the

applicant is disabled. Even when a doctor testifies before the

Administrative Law Judge, the finding the applicant to be disabled is a

conclusion that only the Administrative Judge can render. The testimony

presented to the Administrative Law Judge must be evaluated by that judge to

determine the credibility of the witnesses, including medical testimony. If

the Administrative Law Judge finds the testimony credible, he or she will

issue a decision stating something to the affect, " in consideration of all

the probative evidence including testimony of the witnesses and treating

doctors to the claimants pain and on the observations of the claimant

themselves, I find the claimant's allegations to be disabled to be

credible. " It is a this point that one will start to receive disability

benefits.

If the Administrative Law judge finds that the allegations are not credible,

then the claimant and/or applicant loses. At this point another appeal can

be taken to get another hearing. At this next hearing, new evidence may be

presented as to the applicants disability. Finally, an appeal may be taken

to the appeals Council. The observations of the Administrative law judge

weighs heavily with the Appeals Council. The Appeals Council will not hear

testimony. They will only review the record and not get a chance to see the

applicant.

The overall procedure can be lengthy. Numerous hearings can be held by an

administrative judge that can last for years. Besides the applicants

presentation of the case, the government, the other side in these cases, can

present it's own testimony showing that the applicant is not disabled and

should not be entitled to disability benefits.

What will I testify about at the ALJ hearing?

1. Medical Condition

2. Medical History

3. Physical Abilities

4. Mental Abilities

5. Education and Training

6. Work Experience

7. Daily Activities

1. Medical Condition The judge will ask how your medical condition makes you

feel. You should tell the judge about the symptoms you experience such as

pain, dizziness, numbness, nausea or paralysis as well as you can. Before

the hearing, you should make notes to yourself about what conditions you

have and how they affect you. Don't leave anything out. For example, if your

case involves pain, you might be asked:

Is the pain burning, stabbing, crushing, sharp, throbbing, radiating or

aching?

Do your activities affect the pain?

What do you do to relieve pain?

What medicine do you take for pain?

How well does the medication work?

Are there any side effects from the pain medication?

2. Medical History The judge may ask you how often you see your doctor, what

sort of treatment your doctor provides, what medication you are presently

taking, how often you take each medication and whether there are any side

effects.

You may also be asked to describe the symptoms and treatment of your medical

condition since it began. You may be asked what your doctor has told you

about your problem, but the judge won't ask you medical questions about your

disability.

3. Physical Abilities If you have a physical disability, the judge will ask

you a lot of questions about what you are able to do. For example:

How far you can walk before resting

How long you can sit and stand at one time during an eight-hour day

How much you can lift.

4. Mental Abilities The judge will ask about your ability to understand,

carry out and remember instructions, to use good judgment, to respond

appropriately to supervision, co-workers, usual work situations, and changes

in your work setting.

5. Education and Training The judge will ask you how far you went in school,

if you have had any training in the military, if you can read and write, and

if you have had any job training.

6. Work Experience The judge will ask you about the jobs you have had during

the past 15 years. If your condition caused you to miss a lot of work or

caused you to stop working, you should explain this.

7. Daily Activities The judge will ask you a lot of questions to find out

how your disability affects you. For example:

How do you spend your time during the whole day;

How well you usually sleep;

If you take naps during the day;

What things you do around the house, such as cooking, housework, or

gardening;

If you go shopping;

If you drive a car;

What hobbies and activities you have now.

You may also be asked how your daily routine has changed since you became

disabled. For example, what kinds of activities did you do before you became

disabled that you can't do now?

The nature, location, onset, duration frequency, radiation, and intensity of

any pain;

Precipitating and aggravating factors (e.g., movement, activity, environment

conditions);

Type, dosage, effectiveness, and adverse side-effects of any pain

medication;

Treatment, other than medication, for relief of pain;

Functional restrictions; and

The claimant's daily activities.

Evaluations by " SS blue book "

(Liver disease, depression & arthritis criteria)

" The Blue book " , does not accurately assess " severity of impairments " . Much

of the info is outdated, and many illnesses are not discussed. Yet, SSA only

evaluates the medical evidence against the severity of the listed

impairment. No gray area, just a either/ or for approval. True, SSDI is a

total disability program. But how many public or private employers will cope

with a disabled worker whose impairment will interfere with the performance,

conduct or attendance standards of the position. Even if it is a sedimentary

job?

SSA law judges apply the actual law in arriving at disability

determinations. The claimant must demonstrate a severe impairment as shown

by the medical evidence.

The " Blue Book " is actually a reprinting of a small portion of Social

Security's regulations on disability. Probably less than half of people who

get on Social Security disability benefits do so as a result of " meeting a

listing " which is what the " Blue Book " contains. Actually, both state

agencies and the ALJs are supposed to be applying the same law. The reasons

for the differences in approval rates are complex, but to my mind the

biggest reason is that state agency allowances are subject to " Quality

Assurance " (QA) reviews. As a result of these reviews the state agencies

cannot allow someone unless they are in terrible shape. The ALJs are not

subject to these QA reviews.

From the SS blue book:

5.05 Chronic Liver Disease(e.g., portal, postnecrotic, or biliary cirrhosis;

chronic active hepatitis; 's disease). With:

A. Esophageal Varices (demonstrated by X-ray or endoscopy) with a documented

history of massive hemorrhage attributable to these varices. Consider under

disability for 3 years following the last massive hemorrhage; thereafter

evaluate the residual impairment; or

B. Performance of a shunt operation for esophageal varices. Consider under a

disability for 3 years following surgery; thereafter evaluate the residual

impairment; or

C. Serum bilirubin of 2.5 mg. per deciliter (100ml.) or greater persisting

on repeated examinations for at least 5 months; or

D. Ascites, not attributable to other causes, recurrent or persisting for at

least 5 months, demonstrated by abdominal paracentesis or associated with

persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

E. Hepatic encephalopathy. Evaluate under the criteria in 12.02; or

F. Confirmation of chronic liver disease by liver biopsy (obtained

independent of Social Security disability evaluation) and one of the

following;

1. Ascites not attributable to other causes, recurrent or persisting for at

least 3 months, demonstrated by abdominal paracentesis or associated with

persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

2. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated

examinations for at least 3 months; or

3. Hepatic cell necrosis or inflammation, persisting for at least 3 months,

documented by repeated abnormalities of prothrombin time and enzymes

indicative of hepatic dysfunction.

Please note Prothrombin time (PT) in Primary biliary cirrhosis

Primary biliary cirrhosis is a cholestatic, not a hepatotoxic disease, so

the PT does not increase much in PBC. The PBC hepatocytes (the pinkstaining

liver cells which make up most of the organ) are undamaged until very late

stage. Instead, the little bile ducts that drain the liver are destroyed and

fibrous tissue occludes the blood vessels to the liver.

12.04. Affective Disorders:

Characterized by a disturbance of mood, accompanied by a full or partial

manic or depressive syndrome. Mood refers to a prolonged emotion that colors

the whole psychic life; it generally involves either depression or elation.

The required level of severity for these disorders is met when the

requirements in both A and B are satisfied.

A. Medically documented persistence, either continuous or intermittent of

one of the following;

1. Depressive syndrome characterized by at least four of the following:

a. Anhedonia or pervasive loss of interest in almost all activities; or

b. Appetite disturbance with change in weight; or

c. Sleep disturbance;. Or

d. Psychomotor agitation or retardation; or

e. Decreased energy; or

f. Feelings of guilt or worthlessness; or

g. Difficulty concentrating or thinking; or

h. Thoughts of suicide; or

i. Hallucinations, delusions or paranoid thinking; or

2. Manic syndrome characterized by at least three of the following:

a. Hyperactivity; or

b. Pressure of speech; or

c. Flight of ideas; or

d. Inflated self-esteem; or

e. Decreased need for sleep; or

f. Easy distractibility; or

g. Involvement in activities that have a high probability of painful

consequences which are not recognized; or

h. Hallucinations, delusions or paranoid thinking;

OR A. Bipolar syndrome with a history of episodic periods manifested by the

full symptomatic picture of both manic and depressive syndromes (and

currently characterized by either or both syndromes); AND B. Resulting in at

least two of the following:

1. Marked restriction in activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Deficiencies of concentration, persistence or pace resulting in frequent

failure to complete tasks in a timely manner (in work settings or

elsewhere); or

4. Repeated episodes of deterioration or decompensation in work or work-like

settings which cause the individual to withdraw from that situation or to

experience exacerbation of signs and symptoms (which may include

deterioration of adaptive behaviors).

1.02. Active Rheumatoid Arthritis and Other Inflammatory Arthritis.

With both A and B:

A. History of persistent joint pain, swelling and tenderness involving

multiple major joints (see 1.00D) AND with signs of joint inflammation

(swelling and tenderness) on current physical examination despite prescribed

therapy for at least 3 months, resulting in significant restriction of

function of the affected joints, and clinical activity expected to last at

least 12 months; and

B. Corroboration of diagnosis at some point in time by either:

1. Positive serologic test for rheumatoid factor; or

2. Antinuclear antibodies; or

3. Elevated sedimentation rate; or

4. Characteristic histologic changes in biopsy of synovial membrane or

subcutaneous nodule (obtained independent of Social Security disability

evaluation).

1.03. Arthritis of a Major Weight-Bearing Joint (due to any cause): With

history of persistent joint pain and stiffness with signs of marked

limitation of motion or abnormal motion of the affected joint on current

physical examination. With:

A. Gross anatomical deformity of hip or knee (e.g., subluxation,

contracture, bony or fibrous ankylosis, instability) supported by x-ray

evidence of either significant joint space narrowing or significant bony

destruction and markedly limiting ability to walk and stand; or

B. Reconstructive surgery or surgical arthrodesis of a major weight-bearing

joint and return to full weight-bearing status did not occur, or is not

expected to occur, within 12 months of onset.

1.04. Arthritis of One Major Joint in Each of the Upper Extremities (due to

any cause): With history of persistent joint pain and stiffness, signs of

marked limitation of motion of the affected joints on current physical

examination, and X-ray evidence of either significant joint space narrowing

or significant bony destruction. With:

A. Abduction and forward flexion (elevation) of both arms at the shoulders,

including scapular motion, restricted to less than 90 degrees; or

B. Gross anatomical deformity (e.g., subluxation, contracture, bony or

fibrous ankylosis, instability, ulnar deviation) and enlargement or effusion

of the affected joints.

1.05. Disorders of the Spine:

A. Arthritis manifested by ankylosis or fixation of the cervical or

dorsolumbar spine at 30 degrees or more of flexion measured from the neutral

position, with X-ray evidence or;

1. Calcification of the anterior and lateral ligaments; or

2. Bilateral ankylosis of the sacroiliac joints with abnormal apophyseal

articulations; or

B.Osteoporosis, generalized (established by X-ray) manifested by pain and

limitation of back motion and paravertebral muscle spasm with X-ray evidence

of either:

1. Compression fracture of a vertebral body with loss of at least 50 percent

of the estimated height of the vertebral body prior to the compression

fracture, with no intervening direct traumatic episode; or

2. Multiple fractures of vertebrae with no intervening direct traumatic

episode; or

C. Other vertebrogenic disorders (e.g., herniated nucleus pulposus, spinal

stenosis) with the following persisting for at least 3 months despite

prescribed therapy and expected to last 12 months. with both 1 and 2:

1. Pain, muscle spasm, and significant limitation of motion in the spine;

and

2. Appropriate radicular distribution of significant motor loss with muscle

weakness and sensory and reflex loss.

1.08. Osteomyelitis or Septic Arthritis (established by X-ray);

A. Located in the pelvis, vertebra, femur, tibia, or a major joint of an

upper or lower extremity, with persistent activity or occurrence of at least

two episodes of acute activity within a 5-month period prior to

adjudication, manifested by local inflammatory, and systemic signs and

laboratory findings (e.g., heat, redness, swelling, leucocytosis, or

increased sedimentation rate) and expected to last at least 12 months

despite prescribed therapy; or

B. Multiple localizations and systemic manifestations as in 1.08 A above.

1.09. Amputation or Anatomical Deformity of (i.e., loss of major function

due to degenerative changes associated with vascular or neurological

deficits, traumatic loss of muscle mass or tendons and X-ray evidence of

bony ankylosis at an unfavorable angle, joint subluxation or instability):

A. Both hands; or

B. Both feet; or

C. One hand and one foot.

1.10. Amputation of One Lower Extremity (at or above the tarsal region):

A. Hemipelvectomy or hip disarticulation; or

B. Amputation at or above the tarsal region due to peripheral vascular

disease or diabetes mellitus; or

C. Inability to use a prosthesis effectively, without obligatory assistive

devices, due to one of the following;

1. Vascular disease; or

2. Neurological complications (e.g., loss of position sense); or

3. Stump to short or stump complications persistent, or are expected to

persist, for at least 12 months from onset; or

4. Disorder of contralateral lower extremity which markedly limits ability

to walk and stand.

1.11. Fracture of the Femur, Tibia, Tarsal Bone, or Pelvis: With solid union

not evident on X-ray and not clinically solid, when such determination is

feasible, and return to full weight-bearing status did not occur or is not

expected to occur within 12 months of onset.

1.12. Fractures of an Upper Extremity: With nonunion of a fracture of the

shaft of the humerus, radius, or ulna under continuing surgical management

directed toward restoration of functional use of the extremity and such

function was not restored or expected to be restored within 12 months after

onset.

1.13. Soft Tissue injuries of an Upper or Lower Extremity: Requiring a

series of staged surgical procedures within 12 months after onset for

salvage and/or restoration of major function of the extremity, and such

major function was not restored or expected to be restored within 12 months

after onset.

The article entitled " Traditional Management of Liver Disorders " by M.

Messner and P. Brissot. They work in the Liver Unit, Pontchaillou Hospital,

Rennes, France. 1990 In the article they quote, " Bed rest is an important

component of the management of acute and chronic liver disorders, together

with the avoidance of fatique. " Another place, " Bed rest reduces functional

demands on the liver and is thus advisable in acute liver disorders. " If

fatigue is one of your major symptoms, it should be stated in your

application for SSD, and need for bed rest. Make sure you have your doctor

document everything..........all your symptoms and any new problems.

How Betty made it through the system

I applied for SSD and was approved on the first try and received one year

retroactive payments in 6 weeks. HOW???? The key is in the documentation by

your doctor. It is not sufficient to send office records to SS. You must

accompany them by a letter or a report with the key information that they

are looking for. This key information should clearly outline the following:

1. ALL DIAGNOSIS: The first listed should be the one most responsible for

your disability and then in descending order according to the degree of

responsibility for your disability.

2. DURATION OF ILLNESS FOR EACH DIAGNOSIS

3. WHY YOU ARE UNABLE TO WORK. THIS MUST BE SPECIFIC.

Examples: " This patient cannot do any work which requires decision making or

number figuring due to his/her cognitive dysfunction causing poor judgment

and severely impaired organizational skills. "

Example 2: " This patient is unable to do any work requiring the use of

his/her hands due to severely impaired fine and gross motor skills due to

swelling and pain in digital joint. " Etc.

REMEMBER THE ACTUAL SYMPTOM THAT AFFECTS THE PERFORMANCE AND THE TYPE OF

PERFORMANCE YOU ARE UNABLE TO PERFORM IN SPECIFICS IS IMPORTANT.

4. ACTIVITIES OF DAILY LIVING THAT ARE IMPAIRED.

Example: " This patient at times is incapable of caring for his/her children

without assistance because of the safety hazard due to short term memory

loss, inability to concentrate on more than one task at a time and

distractibility. "

Example 2: " Cooking proposes a safety hazard for this patient because of

his/her frequent involvement of his/her hands and the fact that he/she has

several times dropped hot pans while attempting this task.

AGAIN BE SPECIFIC ABOUT THE TASKS THAT YOU ARE UNABLE TO PERFORM. DO NOT BE

AFRAID TO DOCUMENT EVERY ACTIVITY THAT HAS BEEN JEOPARDIZED DUE TO YOUR

IMPAIRMENT.

STATEMENT REGARDING TIME FRAME OF DISABILITY. Example: " Due to the frequent

severe exacerbationa of this patients condition, it is unreasonable at this

time to expect that he/she will be able to return to work anytime in the

near future. Attempts to control his/her flare ups have been unsuccessful

and at this time I believe that his/her condition is chronic. It is my

opinion that this patient would be a liability to any employer, and would

have a very difficult time at best maintaining gainful employment due to

his/her incapabilities.

NOW YOU ASK?????HOW DO I GET MY DOCTOR TO WRITE SUCH A LETTER? Ask him. You

have to remember that your doctor can only document what you tell him.

Forget your " I can do it " attitude if you really can't. Tell your doctor all

the things that you cannot do and why. Ask him to write this letter and

document your complaints and restrictions. He can only pass on the

information he has. Also be sure he attaches any documentation he may have

to support your claim.

Example: neuro-psych testing results, occupational therapy evaluation, blood

work etc.

If your doctor refuses to do this then get what is called an " Independent

Medical Evaluation. " It is an opinion by an uninvolved doctor. You will meet

with this doctor and relate to him all the information regarding your

disability. He will review your medical records and then make a decision on

whether he can substantiate your claim. The key phrases above will help to

clearly define your need for disability. Bob has a lot of experience with

patients he has examined for disability and firmly believes that cases are

approved or denied based on the way the information is documented.

Remember, stress, including financial stress just makes conditions flare. If

you have been denied ask for a hearing this letter so they have the

information needed to approve your claim.

's step-by-step approach

's disease was Marfan, but the process is basicly the same for any

disease.

The response we got from the Social Security article in the last issue of

Connective Issues was overwhelming. We'll continue to keep you up-to-date on

Social Security information as we receive it.

To further assist you in your attempts to obtain Social Security benefits,

here are tips provided by . She applied for Social Security for her

husband on March 30, 1994, and received her first check on October 3, 1994.

" Determination and over-preparation helped me a lot, despite the fact that

most people I came in contact with only told me about the red tape and

horror stories of dealing with Social Security, " says . " Encouragement

is something that is in short supply going through this process, but it can

be done successfully. "

Here is 's step-by-step approach to obtaining Social Security benefits.

1. Make a timetable that gives yourself some flexibility and try to follow

it.

2. Call Social Security to make an appointment; schedule it for at least two

weeks away.

3. Compile an up-to-date medical file; it is essential. Ask your specialists

for copies of all records pertaining to disability validity, x-rays, labs,

etc. (Some doctors' offices do not release x- rays; they have to come from

the hospital.) If you are seeing another specialist for another problem, get

those records as well. Give the doctor's office a deadline for providing you

with the materials you need (at least three days before your meeting with

Social Security is scheduled).

4. In addition to your medical records, ask your doctor to write a letter

for you that includes your prognosis (the length of time you will be

disabled) and the restrictions that prohibit you from gainful employment.

5. Make four copies of everything, including your records and the doctor's

letter.

6. Go to Social Security with your entire package, as well as the other

information that Social Security needs. Make sure you get the name and phone

number of the representative handling your case.

7. Follow up with your representative by phone to make sure she has all the

information she needs. Volunteer to provide her with additional information

on Marfan syndrome. Maintain a positive attitude; you have done your

homework. If it is an election year, go meet your senators and congressmen

or their aides in person in their local district office. Don't be

discouraged; you have a legitimate right to try to get disability benefits.

Because you have provided Social Security with all the information they

need, they should be able to reach a decision more quickly. However, if they

don't, here's what you can do. 8. Make an appointment with a specialist,

preferably at a hospital with a Marfan clinic or at a teaching hospital, and

have the physician write another letter about your condition.

9. Refer to the Federal Guidelines for Disability which relate to Marfan

syndrome and are used by the Social Security Administration

10. Network with any politicians you can.

If you are denied by Social Security:

1. Call your senators and congressmen to make an appointment to meet with

them. Send them all of your medical records, letters and a booklet about

Marfan (or other disease) and follow up with them by phone. On the phone,

you can offer additional information about your ??? disease.

2. Bring in your newest doctor letter, any recent medical records, the

letter from the NMF, and any additional information you have.

3. If all else fails, your congressmen can tell you which lawyers in your

area have good track records in disability cases. " This approach is not

about overloading your local social security office and congressmen with a

pile of paperwork. The emphasis should be on good, solid documentation for

your case, " says . " In my experience, the doctors have always been

cooperative, and the congressmen show interest (because you are their

constituent). By becoming well-informed and educated about Marfan syndrome

and the social security system, you can really help your cause. "

Providing Medical Evidence to Social Security

A Guide for Health Professionals

(You may want to print this out and give it to your doctor. This is what

your doctor needs to know when filling out statements & records for SS. The

following was WRITTEN FOR doctors and other medical professionals.)

When an individual applies for Social Security disability benefits, we must

decide whether he or she is disabled under the law. We base our decision on

information you provide and other evidence, including information provided

by the individual. The following guidelines will help you understand the

kind of information we need to evaluate claims filed

DEFINITION OF DISABILITY Under Social Security law, an individual is

considered disabled if he or she is:

-- unable to do any substantial gainful work activity because of a medical

condition (or conditions), that has lasted, or can be expected to last, for

at least 12 months, or that is expected to result in death;

-- or, in the case of an individual under the age of 18, if he or she

suffers from any medically determinable physical or mental impairment of

comparable severity.

The medical condition(s) must be shown to exist by means of medically

acceptable clinical and laboratory findings. Under the law, symptoms alone

cannot be the basis for a finding of disability, although the effects of

symptoms may be an important factor in our decision whether a person is

disabled.

If the medical evidence alone shows that a person is clearly disabled or not

disabled, we decide the case on that information. Otherwise, we go on to

consider other factors, such as functional capacity in light of the person's

impairment(s), age, education, and work background. For a child under age

18, we generally consider the child's ability to function independently,

appropriately, and effectively in an age-appropriate manner.

WHAT WE NEED FROM THE MEDICAL PROFESSIONALS We need information from you

that will help us to determine the existence, severity, and duration of the

person's impairment(s).

Your report should include a thorough medical history, and all pertinent

clinical and laboratory findings (both positive and negative) from your

examination of the person. Copies of laboratory results should be provided

if available. Also, provide the results of any mental status examination,

including any psychometric testing.

Longitudinal clinical records and detailed historical notes discussing the

course of the disorder, including treatment and response, are very useful

for us since we are interested in the impact of the illness over a period of

time. Additionally, any information you are able to provide contrasting your

patient's medical condition and functional capabilities since the onset of

illness with that of his or her prior status would be helpful.

You should also include a statement of your opinion about what work-related

activities the person can still do despite his/her impairment. Tell us your

opinions about both physical and mental functions and, to the extent

possible, the reasons for your opinions, such as the clinical findings

and/or your observations of the person. These opinions should reflect the

person's abilities to perform work-related activities on a sustained basis,

i.e., 8 hours/day and 5 days/week. Your descriptions of any functional

limitations you noted throughout the time you treated the patient are very

important. Examples of work-related functions include:

1. Physical work-related functions: Walking, standing, sitting, lifting,

pushing, pulling, reaching, carrying, and handling.

2. Mental work-related functions: The ability to understand, remember, and

carry out simple instructions, the ability to use appropriate judgment, and

the ability to respond appropriately to supervision, co-workers, and usual

work situations, including changes in a routine work setting.

SSA can pay a reasonable amount for reports (or copies) of medical evidence

requested from physicians/psychologists, hospitals, and other non-Federal

providers of medical services.

The Effects of Being Disabled

Drugs * Anxiety * Bladder Problems * Lack of Concentration * Colostomys and

Illeostomys * Confusion * Depression * Diarrhea * Dizziness * .Drowsiness *

Eye-Hand Coordination * Fatigue * Grasping * Headaches * Memory Loss *

Numbness * Pain * Poor Stress Tolerance * Skin Conditions

END

Will my benefits be cut off?

The biggest fear for most people who receive Social Security disability

benefits is that they will be cut off benefits. What are the chances of this

happening?

Social Security is supposed to review most people receiving Social Security

disability benefits at least every three years. Even recipients who are

permanently disabled are supposed to be reviewed at least every seven years.

In recent years, Social Security has been so short of money that there have

been few reviews. This will probably change in the next few years. Congress

is putting pressure on Social Security to review more cases. Congress may

even give Social Security the money it needs to do this.

One of the reasons Social Security has been reluctant to do more continuing

disability reviews is that it is difficult to cut off disability benefits.

Social Security must prove that a person has improved. When Social Security

has done reviews, it has found that more than 90% of the people it reviews

have not improved. There is some chance that Congress will change the

standard to make it easier to cut off disability enefits.

What can people who are now receiving Social Security disability benefits do

to protect themselves against being cut off?

1) If you get better and feel like going back to work, of course, go back to

work. Just let Social Security know you have gone back to work. Social

Security won't cut off or even reduce your regular Social Security

disability benefits until you have been back at work for a year.

2) If you can't go back to work, at least keep seeing your doctors on a

regular basis.

3) If you get a notice that you are being reviewed, don't panic, the odds

are excellent that your benefits will be continued.

4) If Social Security does try to cut you off, call us right away. Don't

delay. Your benefits can continue while you appeal, if you file your appeal

within ten days after you receive the notice cutting off your benefits.

5) Try to save some money. You may need the money to pay attorney fees and

to keep going if Social Security tries to cut you off. This information is

not legal advice, but for information purposes only. This information is

from AOL SSD BB-C. Hall

Putting together your SS packet

Have you ever heard the saying " Too much is never enough? "

I think this must have been in reference to SS.........overload them with

paper work, and they will still ask for more. Send them everything but in an

organized info pack.

My son and a friend helped me put my SS info pack together. It took a lot of

time and energy, but it worked. I used (2) three inch binders and sectioned

everything with tabs.

1. Cover sheet with name, SS#, date I stopped working and diagnosed diseases

listed.

2. A list of ALL medications including over the counter meds and even eye

drops for Sjogrens, etc. Next to each I listed what they were prescribed

for, doctor who prescribed them, dosage and any side effects I experienced.

Behind this sheet I included the drug info sheet. It is usually given with

the prescription or you can locate information on the Internet.

3. Disease information sheets which explained each of my diagnosed diseases,

their symptoms, prognosis, etc. I highlighted the important parts of each.

You can get this information from your doctors or Internet sites.

4. Statements on how my illness had changed everything in my life. There

were 3 written statements: Myself, son and a close friend.

5. Doctor statements and Residual Functional Capacity Questionnaires. Each

of my doctors (5) filled out a RFCQ and on their letterhead stationary type

a statement about my diseases, symptoms, prognosis, that the diseases would

last longer than 12 months and I could NOT engage in any substantial gainful

activity.

6. All Medical records-doctor notes, labs, hospitals, tests and x-rays. The

doctors were sectioned by type, with most important first. Most recent

records were first. Important factors were highlighted in all medical

records.

7. Copies of all applications and letters sent to SS. Also copies of SS

criteria for each of my diseases.

Sphincter of Oddi Dysfunction

> How would someone go about getting disability for pancreatitis? When do

you know if it's severe enough? I've been off work almost 4 months this

past year due to being ill with pancreatitis. Sphincter of Oddi dysfunction

to be exact. I'm being treated at Mayo Clinic and my doctor has been great.

My home doctor is also very supportive. Does anyone have any answers. My

last attack (which I'm still off work for) caused my amylase to hit 1500 and

my lipase was over 28000. The pain has been unrelenting, worse in the

mornings after not taking pain meds for several hours I can hardly get out

of bed or even sit up. Does anyone else have most of their pain located in

their back? I've never submitted anything to one of these sites before.

I'm 39, a non drinker, but have high triglycerides which they're treating.

I guess that's all. Thanks for any help you have to offer.

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[Guest guest]

Hello,

My 13 yr old daughter's chronic pancreatitis is idiopathic. But her

pain is almost always in her back, sometimes in her abdomin. I think

that is pretty common with pancreatitis. I hope you get to feeling

better soon. My daughter had a pretty bad flare up last week and she

is eating this week, some. But just cannot seem to get to feeling

better. She feels the same way in the mornings, takes her hours

before she can really move around. Talk to ya soon,

-- In pancreatitis@y..., " Curt&Mardi Sauve " wrote:

Sphincter of Oddi dysfunction to be exact. I'm being treated at

Mayo Clinic and my doctor has been great.

Does anyone have any answers. My last attack (which I'm still off

work for) caused my amylase to hit 1500 and my lipase was over

28000. The pain has been unrelenting, worse in the mornings after

not taking pain meds for several hours I can hardly get out of bed or

even sit up. Does anyone else have most of their pain located in

their back?

Thanks for any help you have to offer.

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