Tag Archives: heart ssi listing

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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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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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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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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Can I draw early social security retirement and disability at the same time?

Can I draw early retirement benefits from Social Security and receive Social Security Disability Insurance benefits at the same time?

Lately, a number of my clients have asked me whether they can receive early retirement benefits from Social Security and, at the same time, also receive Social Security Disability Insurance (“SSDI”) benefits. Believe it or not, the answer is “yes” in many cases.  Suppose that Susan B. Anthony, who is currently 62 years old and lives in Troy, Ohio, worked for 30 years at the Spacely Sprockets factory in Wilmington. She has leukemia, and as a result of her condition, she had to stop working on June 1, 2010. At that time, she did not apply for SSDI benefits. Now that she has reached age 62, she would like to begin drawing early retirement benefits from Social Security. She also wants to apply for SSDI benefits.

Normally, were Susan to elect to draw early retirement benefits, the amount she would receive would be reduced by 25% compared to drawing benefits at full retirement age. For example, if Susan would have received a monthly retirement benefit of $1,000.00 had she retired at age 66 (the full retirement age for someone born in 1949), then her monthly early retirement benefit would be $750.00. If she were married, then her spouse’s benefit would be reduced by 30%. Furthermore, Susan’s monthly benefit would not increase once she reached full retirement age—the 25% reduction would be permanent.

In Susan’s case, however, she stopped working as the result of her disability. Because her disability forced her to stop working before she reached full retirement age (again, Susan is currently 62; her full retirement age would have been 66), Susan could effectively receive her full retirement benefit if her application for SSDI benefits is approved.

Assume that Susan began drawing her early retirement benefits shortly after her 62nd birthday, which was July 1, 2011. She then applied for SSDI benefits. On her application, she listed June 1, 2010, as the date on which her disability began. A decision on an application for SSDI benefits usually takes several months, and can sometimes take longer. Suppose, therefore, that the Social Security Administration approves Susan’s application for SSDI benefits on December 1, 2011, and that it determines that Susan’s disability began on June 1, 2010.

In this scenario, Susan would be paid her SSDI benefits retroactively from January, 2011, through July, 2011—when she started receiving her early retirement benefits. Then, for August, 2011, through December, 2011, Susan would be paid the difference between her early retirement benefit, which she already received, and her full retirement benefit. From December, 2011, onward, Susan would receive SSDI payments in the amount of her full, monthly retirement benefit. Effectively, because Susan’s early retirement was the product of her disability, the Social Security Administration treats her as if she had stopped working at her full retirement age.

Keep in mind that the foregoing example only applies when the Social Security Administration approves an application for SSDI benefits. For instance, had her application for SSDI benefits had been denied, Susan would have received only her reduced, early retirement benefit.

In addition, the amount of Susan’s monthly benefit would also have been different had the Social Security Administration determined that her disability began on a later date. Had the Social Security Administration determined that Susan’s disability began on September 1, 2011, then Susan would be treated as if she retired two months early (i.e. full retirement age less, less two months). In other words, if the date on which Susan’s disability officially began (as determined by the Social Security Administration) came before the date on which she stopped working, then she would be treated as if she had stopped working at her full retirement age. On the other hand, if the date on which her disability officially began came after the date on which she stopped working, then she would be treated as if she had retired early.

Drawing Social Security early retirement benefits and receiving SSDI benefits at the same time is possible. For some, this is the best option. For others, waiting until full retirement age to begin drawing benefits is the best option. If you have questions about early retirement and SSDI benefits please contact the Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation.

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