Chronic Heart Failure and disability

Chronic Heart Failure

Chronic heart failure (CHF) is a potentially lethal condition where the heart cannot pump a sufficient amount of blood, which can then cause blood to accumulate in the vessels leading to the heart and can cause congestion or accumulation of fluid in various parts of the body. The precise part of the heart that fails impacts the damage caused. For instance, if the left chambers of the heart fail, blood backs up into the lungs, causing lung congestion. If the right chambers of the heart fail, blood backs up into the legs and the liver, causing congestion and swelling, called edema. CHF is usually accompanied by an enlargement in the size of the heart.

Symptoms of heart failure can be mild or moderate, including shortness of breath, fatigue, and weakness, especially with exercise. CHF can also cause heart palpitations and dizziness. Treatment of CHF can be very difficult and involves rest, proper diet, and a variety of medications.

The Social Security Administration (SSA) will evaluate whether a patient with CHF qualifies for disability under its listing for “chronic heart failure” which appears as listing 4.02. To qualify for disability benefits under the SSA’s listing for chronic heart failure, you must have been diagnosed with severe continuing heart failure despite being on heart medication. It is important to note that the SSA’s listing does not require that you have fluid retention at the time of evaluation to begin receiving disability benefits, but your medical records should show that you have suffered some fluid retention at some point in time. More specifically, the following typically must be shown to meet a disability listing:

• Your medical records must show the following evidence of either systolic or diastolic heart failure.
– Systolic failure: the heart’s ejection fraction (the percentage of blood pumped out of the heart with each heartbeat) is 30% or less during a normal period, or the heart’s left ventricular end diastolic dimensions are larger than 6.0 cm.
– Diastolic failure. thickness of left ventricular wall septum 2.5 cm or larger on imaging, an enlarged left atrium 4.5 cm or larger, and normal or elevated ejection fraction during a normal period.

To receive benefits under the listing, you must also be able to demonstrate one of the following symptoms:
• Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less
• If an exercise tolerance test would be too risky, persistent symptoms of heart failure that very seriously limit your daily activities are required to be shown, or
• At least three episodes of heart failure and fluid retention within the past 12 months, requiring emergency room treatment or hospitalization for at least 12 hours.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.


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Can I receive SSI for my spinal stenosis and back pain?

Spinal Stenosis and SSDI benefits
Spinal stenosis is the term for the narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings where spinal nerves leave the spinal column. If the narrowing progresses to the point that the nerves passing through these areas are compressed, this compression can cause severe pain. Spinal stenosis usually occurs as a person ages and the spinal disks become drier and start to bulge. Spinal stenosis may also be caused by arthritis of the spine, bone diseases, congenital birth defects, herniated or slipped disks, severe injuries or even tumors on the spine.

Typically, stenosis symptoms get worse over time and, while they often start by affecting only one side of the body or the other, they can grow to encompass both sides. These symptoms include: numbness, cramping, pain in the back, buttocks, thighs, calves, neck, shoulders, or arms, weakness of part of a leg or arm. Symptoms are more likely to be present or get worse when you stand or walk. They will often lessen or even totally disappear when you sit down. It for this reason that most people with spinal stenosis cannot walk for a long period of time.

Spinal stenosis can be treated with anti-inflammatory medications and pain medications, some of which specifically target nerve pain. Physical therapy and cortisone injections can also be prescribed. In some cases, surgery might be recommended to remove the bony tissue that is compressing the nerves.

The Social Security Administration (SSA) discusses Disorders of the Spine, including spinal stenosis, under Section 1.04 of the Blue Book. In order to meet or medically equal listing 1.04 with respect to obtaining Social Security Disability benefits, your medical records might show the following:

• You must be diagnosed with spinal stenosis.
• Your records must show that your condition has caused nerve root compression and that this compression has resulted in pain, limited range of motion of the spine, and muscle weakness. The SSA will require a straight-leg raising test to prove this.
• You must also demonstrate evidence of pseudoclaudication (leg pain that becomes worse with walking) that is severe enough that it results in an inability to effectively walk, and should include the results of all imaging studies (meaning, an MRI or CT scan).

It’s important that your medical records also document the precise treatments you have received and your reaction to those treatments. It’s critical that your doctor make sure to list all limitations spinal stenosis has caused in your everyday life, further demonstrating the need for disability benefits.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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SSA disability medical listing for Crohn’s disease

Crohn’s Disease and disability

Crohn’s disease affects about 600,000 men and women in the United States and Canada alone. Currently, there is no pharmaceutical or surgical cure for Crohn’s disease. Instead, all existing treatment is geared toward controlling symptoms, maintaining remission and preventing relapses.

Crohn’s disease is a type of inflammatory bowel disease (IBD). Crohn’s is also known as granulomatous enteritis or colitis or regional enteritis. Crohn’s primarily causes breaks in the lining of the small and large intestine, but it can affect the digestive system at any point from the mouth to the anus. In severe cases, bowel obstructions and perforations may occur.

Symptoms of Crohn’s include abdominal pain, diarrhea, fever, loss of appetite, and weight loss. These symptoms tend to fluctuate between periods of rest and activity so they may not always be present or as severe. It can be difficult to diagnose the disorder as symptoms are similar to other intestinal disorders such as irritable bowel syndrome.

Flare-ups of Crohn’s disease are treated with drugs such as antibiotics for infections and anti-inflammatory drugs to control inflammation. Severe Crohn’s cases may require multiple surgeries to control or maintain remission of the disease.

Social Security does consider Crohn’s disease to be a significant impairment that may prevent an individual from performing substantial gainful activity. Given this, it is possible for a person to receive disability benefits on the basis of Crohn’s disease alone.

Social Security evaluates Crohn’s disease using the disability guidebook impairment listing 5.06 Inflammatory bowel disease (IBD). To qualify under the IBD listing, you need to have a diagnosis of IBD, plus a listed complication, such as untreatable anemia, a bowel obstruction, an abscess or fistula, significant, unintentional weight loss (of more than 10% of your body weight), or a tender abdominal mass with pain and cramping.

As is almost always the case, if you do not have one of the requisite complications, you can also qualify if you can show that your symptoms make it impossible to work your prior job, and that with your job skills and education, there are no other types of jobs you could learn to do that you would be capable of doing.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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Receiving disability for bi-polar disorder and anxiety

Getting disability due to mental limitations such as bipolar disorder.

There are many possible symptoms of bipolar disorder that can affect a person’s ability to work. In a manic episode the individual may experience over confidence, racing thoughts, increased energy, irritability, sleeplessness, inability to concentrate, denial of condition, drug abuse, bad judgment, euphoria, or aggressive behavior. In a depressive episode symptoms may include hopelessness, suicidal thoughts, sleep difficulties, helplessness, guilt, difficulty with memory, difficulty with concentration, irritability, physical symptoms of pain, overly sad, weight gain or loss, and decreased energy.

Thankfully, bipolar disorder is recognized by the Social Security Administration as a legitimate basis for the payment of disability benefits. If you are a claimant who has been diagnosed with bipolar disorder symptoms, there are two primary theories for receiving benefits.

The primary theory for those suffering from bipolar is to argue that your condition is so severe that it meets the listing as defined by the Social Security Administration in Listing 12.04. To qualify this way you will need supporting documents in the form of a written declaration attesting to the fact that you experience specific systems that result in difficulties with your mental functioning.

To qualify under the listing, the following requirements must be met:

• persistent conditions of depression (at least four medically documented): loss of interest; change in appetite; sleep disturbance; decreased energy; feelings of guilt; difficulty thinking; thoughts of suicide; hallucinations or paranoid thinking
• persistent conditions of manic behavior (at least three medically documented): hyperactivity; inflated self esteem; decreased need for sleep; easy distractibility; involvement in high-risk activities for pain; hallucinations or paranoid thinking
• inability to maintain (at least two of the following): daily activities without restriction; social functioning; concentration or pace; a period of time without episodes
• medically documented history of two years of chronic affective disorder limiting the ability to perform basic daily activities as a result

Another common avenue utilized to win your case based on bipolar disorder relies more on the work limitations that your doctor has identified. This is the approach known as ‘residual functional capacity’ where you must assert that your condition has caused your capacity to work to become so diminished that you are not able to perform even simple, unskilled work.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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SSA policy is that drug dealing can be considered “substantial gainful activity”

SSR 94-1c – Substantial gainful activity rules

The case that this SSA policy ruling is based involves a claimant that applied for disability benefits under the Supplemental Security Income (SSI) program, claiming that he was disabled due to asthma, multiple allergies, and previous drug addiction. His application was initially denied and he later requested a hearing before an administrative law judge (ALJ).

At the hearing before the ALJ, the claimant testified that he was then using between $200 and $300 worth of drugs each day and that he supported his drug habit through stealing and panhandling. Based on his own testimony, the ALJ concluded that the claimant’s stealing constituted substantial gainful activity (SGA) worth an average of approximately $5,600 per month.

The ALJ went on to say that due to the poor area in which the claimant panhandled, stealing this much required a substantial amount of physical and mental activity. The ALJ concluded that because the claimant was engaging in such SGA, he was not disabled and, therefore, not eligible for any disability benefits. The Appeals Council declined to review the ALJ’s decision which led the claimant to appeal the decision to federal district court which upheld the previous decision. Finally, the case made its way to the Court of Appeals for the Seventh Circuit.

The claimant argued that his stealing and panhandling, illegal activities, should not be considered SGA. Assuming that such actions are not SGA, the claimant said that the decision was therefore inappropriate. Using a very novel approach, the claimant further said that if his “work” was to be considered SGA, then the cost of the drugs he uses should be deducted from his income as an impairment-related work expense.

The Court of Appeals found no reason why his stealing and panhandling could not be considered SGA given that no provision in the Social Security Act requires SGA to be lawful. The Court said that the rules say work activity is “substantial” if it “involves doing significant physical or mental activity” and is “gainful” if it is “the kind of work usually done for pay or profit, whether or not a profit is realized.”

The Court ultimately found that given that neither the Act nor the regulations recognizes a distinction between lawful and unlawful activity for purposes of determining SGA, illegal activity can constitute SGA.

The Court rejected the claimant’s argument that the cost of narcotics must be deducted from his income as an impairment-related work expense. The court noted that to be considered an impairment-related work expense under the rules, a drug must “reduce or eliminate” the symptoms of a claimant’s impairment, or “slow down its progression.” Here, it was clear that the use of drugs was the basis of the disability, and the continued use of the drugs only exacerbated the claimant’s medical condition. As a result, the Court of Appeals affirmed the decision of the district court denying the claimant’s application for disability benefits.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Nationwide Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.


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