Tag Archives: chronic heart failure

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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Senate Committee Reveals Trouble with the Quality of Disability ALJ Decisions

Senate Committee Reveals Trouble with the Quality of ALJ Decisions

A recent article in the Washington Times discussed the increasing stress that the Social Security Disability system is operating under and how that stress has led to troubling problems affecting millions of Americans.

Investigators working for a Senate subcommittee examined hundreds of cases in which disability benefits were approved and found that those making the decisions frequently ignored warning signs such as incomplete or inconsistent information. Senators have said this review demonstrates the need for an overhaul of the existing system. One Senator said that the decisions from some administrative law judges (ALJs) were so bad that the final verdict seemed almost entirely arbitrary.

Though the first phase of this investigation involved looking over applications that were approved but should not have been, the Senate committee says it will next turn its attention to those cases that were denied and may have been denied wrongfully. Those in charge say they worry that they will discover the system is not helping many of the people it was designed to protect.

For its part, the Social Security Administration says it has work to do to fix problems in the system. However, they claim that outlier decisions occur far less often than they used to and the decisions of many ALJs are affirmed with much more regularity then ever before.

That may sound good, but problems still abound. The massive report showcased one ALJ from Oklahoma who has issued more than 1,000 decisions each year since 2006. Judge W. Howard O’Bryan Jr. peaked in 2008 with 1,846 decisions and regularly approved 90 percent or more of the claims. This compares to an average ALJ approval rate of about 60 percent. The investigation revealed that his decisions were notable only for their “poor quality” and how Judge O’Bryan often regurgitated the same boilerplate language in each case decision.

One case that apparently prompted the investigation, involved a man living as an adult “baby,” meaning he slept in an adult-sized crib and wore diapers. The man was collecting disability benefits despite having demonstrated carpentry skills and his ability to work with a reality TV show and a website for other adult “babies.”

The case of the adult “baby” highlighted another problem according to the Senate subcommittee and that is how out of date the list of jobs given to ALJs are. The list has not been updated since the 1970s and excludes many computer-related jobs that some people (possibly other adult “babies”) with disabilities might be able to perform.

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 get both worker’s compensation and Social Security disability benefits?

Can I get both worker’s compensation and Social Security disability benefits?

Workers’ compensation pays benefits to employees who suffer an injury at work or experience a work-related illness. Benefits for workers’ compensation include medical treatment and money for the partial replacement of lost wages. For an employee who cannot work while recovering from an injury or work-related illness, workers’ compensation can pay temporary total disability benefits. In cases in which the injury or work-related illness has long-term or permanent consequences, an employee can receive permanent disability benefits. When an employee dies as the result of an injury or work-related illness, then the employee’s dependents can receive survivor benefits. In general, workers’ compensation is a program run by state governments.

Similarly, Social Security Disability Insurance (“SSDI”) provides benefits to insured workers with disabilities, or in other words, to those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died. Generally, SSDI is administered by the federal government.

A person can receive workers’ compensation and SSDI benefits at the same time, but workers’ compensation benefits might reduce the amount of SSDI benefits. Under the Social Security Administration’s rules, a person who receives workers’ compensation benefits and Social Security disability benefits at the same time may not receive combined benefits that amount to more than 80 percent of the person’s average current earnings before the person became disabled. For example, if a person earned $4,000.00 per month before becoming disabled, then the person would be eligible to receive $2,200.00 per month in SSDI benefits after becoming disabled. If that same person were also to receive $2,000.00 per month in benefits from workers’ compensation, then the person’s SSDI benefits would be reduced to $200.00 per month to comply with the Social Security Administration’s 80 percent rule.

If you have a current or potential worker’s compensation claim and are interested in applying for SSDI benefits, or if you simply want to be sure that you are receiving the maximum SSDI benefits for which you are eligible, then you should consider speaking with an attorney who has experience with Social Security law in order to minimize the off-set. Call the Nationwide Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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Receiving SSI or SSDI for Chronic Pain.

I Have Chronic Pain, Can I get Disability?

If you suffer from chronic pain you understand just how variable the condition can be. For some the pain is continuous, for others it is intermittent, some suffer terribly while others live with less severe pain. Chronic pain is broadly defined as pain that cannot be eliminated by standard medical treatment, pain that persists after an injury or illness has resolved, or pain for which no origin can be determined.

Though the suffering is real, many with the disorder have trouble convincing the Social Security Administration that their pain prevents them from working. The difficulty of quantifying pain presents unique difficulties for those with chronic pain seeking to receive disability benefits. Given this, it is important to note that simply telling the SSA that you have disabling chronic pain is not enough, it must be clearly demonstrated through testimony and medical evidence.

It may surprise some to know that chronic pain is not a listed disorder in Social Security’s listing of impairments that may automatically qualify you for disability benefits. This does not mean that hope is lost, as there are many other diagnoses that are often related to chronic pain, including:

• inflammatory arthritis;
• somatoform disorders;
• back injury;
• chronic renal disease; and
• inflammatory bowel disease.

If you do not qualify under another a listing category, then you will have to qualify for disability benefits through a “residual functional capacity” (RFC) assessment. An RFC assessment mean that the process for deciding whether disability benefits will be awarded boils down to two important questions:

1) Do you have objective evidence that demonstrates a medically determinable impairment that could reasonably be the source of your pain?

AND


2) If you are able to demonstrate such an impairment, how intense and persistent is the pain and how does it limit your ability to perform basic work activities?

For an impairment to be “medically determinable” it must be an anatomical, physiological or psychological abnormality that can be shown through clear evidence from reliable medical sources. Such sources include testimony from doctors, medical records and lab results. Without these tangible sources, your testimony alone will not be enough to prove your disability before the SSA.

When determining the level of pain, the SSA evaluates both the intensity of the pain and how the pain affects the individual’s ability to do basic work activities. An individual’s statements are important here as the SSA knows that some pain is more severe than can be demonstrated through medical evidence alone. Testimony describing the pain and how it impacts your daily life is considered with the rest of the relevant evidence in the case record when making a decision.

The SSA also considers the following factors when assessing your pain:
• The location, duration, frequency and intensity of the individual’s pain;
• The type, dosage, effectiveness and side effects of any medication the individual takes or has taken to alleviate pain;
• Treatment, other than medication, the individual receives or has received for relief of pain;
• Any measures, other than treatment, the individual uses or has used to relieve pain.

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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Can I get disability for my chronic fatigue syndrome?

Chronic Fatigue Syndrome & Social Security Disability

chronic_fatigueAccording to information from the National Institutes of Health, chronic fatigue syndrome (CFS) is a condition that can cause severe and ongoing tiredness that cannot be improved by simply resting and that does not result from another underlying disorder. The exact cause of the condition remains a mystery, but some have theorized that exposure to the Epstein-Barr virus might be to blame. Age, gender, prior illnesses, and stress are also believed to play a role. Symptoms of CFS can be wide ranging and include sore throat, headache, low-grade fever, painful joints, memory or concentration problems, swollen glands, and generalized muscle weakness.

According to the Social Security Administration’s Fact Sheet, you must prove that the symptoms of your CFS prevent you from working in order to qualify for disability benefits. To make this determination, the SSA will use the medical evidence you have provided in support of your claim to evaluate whether your symptoms reach the level of severity necessary to qualify for disability.

The diagnosis of CFS requires that you experience at least four of the following symptoms for at least six months:

• memory or concentration problems that cause a serious reduction in your level of activity;
• frequent sore throats;
• tender lymph nodes in the neck or under the arm;
• muscle pain;
• pain in multiple joints without redness or swelling;
• headaches of a different magnitude then those that you had prior to the onset of CFS;
• sleep that never leaves you feeling refreshed; and
• a general feeling of being unwell that lasts at least 24 hours following a period of exertion.

Your medical records must contain documentation that satisfies the above criteria for a diagnosis of CFS and that shows these symptoms did not begin prior to the onset of your chronic fatigue. If your medical records show that the symptoms predate your CFS then your disability claim will likely be denied given that something else may be to blame for your condition.

CFS can be an especially tricky disease to document clinically. Medical tests don’t always capture the severity of the illness and how terribly it can impact a person’s quality of life. It is important to understand going into the process that the SSA will not approve a disability claim based on the description of symptoms alone, though how symptoms affect your daily life is considered in the decision.

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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