GETTING DISABILITY BENEFITS FOR ARTHRITIS

 

Arthritis is a painful and often debilitating condition. There are many types of arthritis, and getting a Social Security disability benefit depends on the type of arthritis you have and the severity of symptoms.

Social Security rarely pays a claim for osteoarthritis (OA) because it is so common, and it rarely is severe enough to keep an individual from working. The exception might be when severe OA causes major dysfunction of a weight bearing joint, especially in claimants over the age of 50.

Rheumatoid arthritis is more commonly found to be disabling.

When applying for SSDI benefits, keep in mind that SSA’s focus with respect to the medical requirement is whether you can work and earn a certain level of income. The real issue is proving that you can't work. You need to gather sufficient documentation and other evidence to support your position. The most important source of information is your medical records, which should include:

• Your doctor’s diagnosis of a specific form of arthritis;
• Physician notes on how your condition imposes physical limitations;
• Documentation on the different treatments you have tried to alleviate your arthritis pain, such as surgery,physical therapy, and prescription medications; and,
• X-rays, MRIs, and other objective lab tests that show the damage to joints, discs or spine.

Perhaps the most difficult evidence to get is "physician notes on how your condition imposes physical (work) limitations." Which physical activities are limited and to what extent? In other words, how are you limited in sitting, standing, walking, lifting, pushing and pulling? This information is often not found in medical records and claimants must go to their doctor looking for it. The combination of all your physical restrictions is called a Residual Functional Capacity or RFC. The more restrictions you have, the more likely you are to be approved for disability benefits.

Your disability attorney knows specifically what evidence Social Security needs and will assist you in getting it.

PUT YOUR IMPAIRMENT INTO VOCATIONAL TERMS and WIN DISABILITY

 

 The challenge is to translate your medical impairment(s) into job-related restrictions. 

You may have enough medical evidence to prove that you have a severe condition.  But this is not enough to get a Social Security disability benefit.

Disability benefits are not paid on medical evidence alone.  Benefits are based on VOCATIONAL EVIDENCE.

You must prove that your severe medical impairments restrict your ability to function in the workplace. 

Exertional functions include:  sitting, standing, walking, lifting, carrying, pushing and pulling.  You need to prove that your medical condition restricts your ability to regularly perform these functions.

Other limitations include restrictions in bending, crouching, crawling, kneeling, reaching, using the hands, or using the feet (such as foot controls).  

Mental impairments may come with such functional restrictions as:  memory loss, inability to follow simple instructions or complete simple tasks, inability to finish tasks on time--or decreased ability to focus or stay on task.  Or, you may have decreased ability to respond appropriately to supervisors, co-works or the general public.

A claimant may have back pain; however, many individuals with back pain can perform some type of work.  A person might prove that she has severe migraines, yet many people who have severe migraines can continue work with proper treatment.  

3 factors that always must be considered in placing a vocational (work-related) restriction on impairments are:

• SEVERITY - How bad are the symptoms of your impairment?
  

• FREQUENCY - How often do the severe symptoms occur?

• DURATION - How long do the severe symptoms last?

Let me use the example of degenerative disk disease of the spine.  You have an MRI that shows degeneration at several levels.  This causes pain and difficulty with bending and standing.  Social Security must know the following:

How long are you able to sit?

How long are you able to stand and walk?

What is your lifting limit (on the job)?

How often are you able to bend?  (Constantly, frequently, occasionally or never?

Since many individuals with back pain are still able to perform some type of job, you must prove that your condition severely restricts your ability to perform all of your past jobs AND any other job which exists in today's national economy. 

The challenge is to translate your medical impairment(s) into job-related restrictions. 

 

HOW AN ATTORNEY-ADVOCATE CAN HELP YOU WIN

It's a known fact that claimants with an attorney/advocate get approved more often for Social Security disability benefits.

 Represented claimants win 60 percent of cases.

Unrepresented claimants win only 31 percent of cases.

How does the advocate help you get approved?

There are several things your advocate will do that are essential to winning your benefits:

1.  Gathering Medical Evidence.  You must have complete records from every doctor, clinic, hospital, emergency room, psychiatrist, counselor or other practitioner.  Your advocate will obtain these records and will often spend weeks in doing so.  Hundreds of dollars may be spend in gathering records.

2.  Analyze the Records - to find an acceptable legal theory of the case.  This means, How does the law support your case?  How can the law be used to get you approved?

3.  Prepare a Brief for the Judge.  A brief gives a clear, concise summary of the case and why it should be approved.  It tells the judge where to look in the exhibited evidence to find proof.

4.  Attend the Hearing.  Your advocate attends the hearing with you.  The judge will appreciate having someone present who understands the legal issues and can discuss them.

5.  Seek Maximum Benefits and Backpay.  Your advocate will make sure you get all the benefits you're entitled to under the law, including past due benefits and Medicare insurance.

6.  File Necessary Appeals.  If you get an unfavorable decision, your advocate will file appropriate appeals to have your case reconsidered.

YOUR TESTIMONY AT A DISABILITY (SSDI) HEARING

During a Social Security appeal hearing, the claimant will give sworn testimony before an Administrative Law Judge (ALJ).  Questions will be asked by the ALJ and by the claimant's own attorney or representative, if there is one.

There are things to do and things not to do in giving testimony.  The following tips are universally true for hearings:

1.  Be specific.  Avoid general, undefined terms.  A little bit, not very often, just a little while, or once in a while are undefined.  Those terms mean different things to different people.  They tell the ALJ nothing.  Instead of "not very often," you might say "about 3 times a week," or "once or twice a day."  Instead of "not very much," you might say, "I can only lift about 10 pounds."  The use of measurable terms like minutes, hours, days, weeks, feet, yard, etc. adds meaning and value to your testimony.

2.  Never lie or exaggerate.  You should know that the ALJ knows a great deal about you before the hearing starts.  He or she had read your medical file, your work history, your detailed earnings or wage reports, and a lot more.  If you smoke or drink, the judge knows it.  Anything you have told your doctor is probably in the record, open for the ALJ to read.  Aside from the fact that you are under oath, it is always in your best interest to be truthful and open.

3.  You must be able to state why you stopped working.  One of the first questions will always be, "Why did you stop working at the ABC Company" (your last job).  The judge is trying to figure out if you stopped working because of a medical condition (disability) or some other reason.  Other reasons are not covered by Social Security.  Here are some reasons for leaving the job that lead to denial of benefits (just examples):

• The plant closed down due to the recession.
• I didn't get along with the boss so I just walked away.
• My car broke down and I had no way to get to and from work.
• My son, mother or (someone else) got sick and I had to stay home and care for them.
• I quit to look for a better job but I just never found one.

None of the above has anything to do with disability and are not paid for by Social Security.  Before your hearing, think about your answer to this question:  "How did your last job end?"  "Why did you leave your last job?"

4.  Be able to answer this question:  "In your own words, tell me why you believe you are unable to work."  The key word is unable.  You want to explain your symptoms or limitations of function which make it impossible for you to perform work 8 hours per day, 5 days per week on a continual basis.  So, you are going to talk about knee pain, back pain, chronic headaches, fatigue, weakness....etc.  The following are NEVER reasons not to work:

• I can't find a job
• Nobody will hire me because......(whatever reason)
• I can't live on minimum wage
• They tell me I'd just be a liability to the company...

5.  Never answer a question you don't understand.  The tendency is to make up an answer just to keep things moving.  But if you do this, it will hurt (maybe kill) your case.  If you don't understand the question, ask that it be explained before you try to answer. 

6.  Understand that the requirements of a job may be asked two very different ways:

A.  How did you perform this job back in the day when you were working?  How much bending, lifting, standing or walking did your job require--back when you were working full-time.  In other words, what were the demands of that job when you did it?

B.  A very different question:  How much do you think you can lift, bend, walk, etc. now (now that you are disabled).  Key word:  NOW.  Note:  This question may not be clear.  Here's where to get the question clarified before you answer it.
________________
THE FORSYTHE FIRM
Social Security Disability Counselors
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

CALL US:  (256) 799-0297

SOCIAL SECURITY JUSTICE STARTS HERE 


  

 

WHAT IS NOT IN YOUR MEDICAL RECORD? A MOST IMPORTANT QUESTION!

Most individuals going before Social Security to try for disability benefits don't know what's in their medical record.  Even fewer people know what is not in their medical record.

Medical records are what Social Security will base their decision on.  Other factors will be considered but if the medical evidence doesn't support the claim, it will be denied.

Here are some essential things not found in the record of denied claims:

1)  A Residual Functional Capacity (RFC) determination from the claimant's treating physician.  The RFC estimates the claimant's functional limitations:  how long he/she can sit, stgand, walk; maximum weight that can be lifted, how often the claimant can work without taking a break, etc.  Social Security never obtains this from doctors.  They will make up an RFC to suit themselves and it is almost never favorable to the claimant, resulting in a denied claim.  Be sure that your doctor provides an RFC.

2)  A Medical Source Statement (MSS) from a treating physician.  The MSS is like a Residual Functional Capacity form but may not be as detailed.  This written statement outlines why the claimant is unable to work an 8-hour day, 5 days per week on a "regular and continuous basis."  Caution:  A doctor's statement which simply says, "In my opinion this patient is totally disabled and cannot work," is not worth the paper it is written on.  It does not explain why the patient can't work; it fails to give the limitations that would prevent all work.  For example, the MSS might add:  This patient cannot sit for more than 4 hours per day and would be limited to standing/walking no more than 2 hour per day."  Or, "The patient will need to take a break once an hour because of chest pain and shortness of breath."

3)  An explanation of why the claimant stopped working.  Ideally, we'd like to have a written statement by the former employer or supervisor that outlines the claimant's difficulty in performing his or her past work.  An effective letter would say something like this, for example:  "I observed that Mr. _____ would have difficulty bending and reaching overhead.  He seemed to tire easily and often required extra breaks during the day.  He often complained of pain to a point that he had to leave work early and he called in too sick to report to work at least 3 times per month."

EXPLANATION:  When asking your doctor to provide a Residual Functional Capacity (RFC) or Medical Source Statement (MSS), be sure to explain that you don't need a special examination or evaluation.  These forms simply ask for the doctor's opinion of your functional abilities based on the doctor's experience and observations.  Some doctors misunderstand and want to refer the claimant to a rehabilitation doctor for a special exam, which is not what the RFC/MSS is all about.

This is a lot for a disabled claimant to try to coordinate.  If he or she has an attorney/representative, they will handle this.  A primary job of the representative is to be sure all medical evidence is obtained and this includes a valid RFC/MSS, if possible.
_____________
THE FORSYTHE FIRM
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
SOCIAL SECURITY JUSTICE STARTS HERE 

CALL US:  (256) 799-0297
 

3 THINGS YOU CAN DO TO WIN SOCIAL SECURITY DISABIITY

Winning Social Security Disability (SSDI) benefits takes some luck but it takes more than just luck.  There are 3 things you can do that will dramatically increase your odds of winning a disability check for the rest of your life:

1.  Figure out what rules you are playing by.  Social Security has a rule book and those who get paid play by the book.  

What do I mean "figure out the rules"?  I mean, decide why you are legally disabled and which of Social Security's rules will allow you to collect a benefit. Are you disabled due to a physical impairment, a mental impairment, or both? Figure out which rule legally allows a favorable decision.  Do you meet a published Listing?  Do you meet one of their Grid rules?  Or, do you meet the criteria for a Step Five decision? Without a roadmap, you can't know where your Social Security journey will end and you can't plan the trip!

2.  Look at your medical evidence.  Social Security's decision will primarily be based on what is in your medical file (called "the medical evidence"):

Does Social Security have all of your medical records?  Have you checked to be sure?  You'd be surprised how sloppy they can be and how much evidence they fail to get.  Are there doctors, clinics, hospitals, counselors or other treatment providers that you (yes YOU) need to get and submit to your Social Security file?  Do your records make it crystal clear as to:  the type of impairments you have, the severity of your impairments, and how your medical condition limits your ability for perform the FUNCTIONS of full-time work.  If your medical records do not contain a "Residual Functional Capacity" statement from your doctor, you are nowhere near ready for Social Security to make a decision.  Medical records are the single most important part of winning a claim or appeal.  Do you know what is in your records?  The most important question:  What is NOT in your medical records?

3.  Ask for professional help.  It is important to admit that you are not a Social Security disability expert.  Pretending to be may lose your benefits forever.

Ninety percent of claimants going into the Social Security appeal process are professionally represented.  Before a judge will even hold a hearing, he or she will ask you about an attorney or representative.  The judge will even agree to postpone your hearing until you find representation.  This should tell you how important the judge thinks it is to have qualified legal counsel.  Take advantage of it.
     A representative cannot charge you a fee unless you win and unless you collect back pay from the Government.  The law protects the claimant by not permitting any legal fee to be paid (or charged) unless you win your claim!  Your attorney/representative can perform a vital service in the areas of 1 and 2 above (deciding which rules should give you a favorable decision; and making sure the medical evidence is ship-shape before the hearing).
___________
The Forsythe Firm
Social Security Disabiity Representation
"Across from Bridge Street"
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
Free Consultations by Calling (256) 799-0297

SOCIAL SECURITY JUSTICE - START HERE    

 

SUCCESSFUL SSDI CLAIMS DON'T JUST HAPPEN: THEY ARE PLANNED

So you've been denied disability benefits?  You're wondering what to do next.

First, let me say that successful Social Security Disability (SSDI) claims don't just happen.  They are planned and executed.  They are masterfully prepared by people who know what they are doing.

Denials happen all on their own and require no planning or hard work.  But putting together a successful SSDI claim or appeal requires hard work, detailed planning and the artful combination of pieces of the puzzle.

What's at stake in your SSDI disability claim?

1. a monthly benefit check which can be up to $2,667 per month
2. back pay for all the months you have already been disabled
3. Medicare insurance to pay for future medical bills
4. a check for each of your dependents (children)

 The denial letter you just received in the mail is not the end; it is just the beginning of your journey toward getting benefits.

An attorney or qualified Social Security disability advocate should examine your case to determine how to pull it together and win it.  Your doctor may need to submit an opinion, called a Medical Source Statement.  You may need to pursue a published Listing or a Medical-Vocational Guideline.   There may be a dozen flaws in your denial that should be appealed and corrected.

A denied claim is not dead for 60 days!  During the first 60 days following a denial, you are given a second chance to present your case and turn things around.  By taking swift, calculated action during this 60-day period, you can potentially win your case and even get back pay for the denied period.

About 85 percent of Social Security disability claims are denied before they are approved!  Yes, over 8 out of 10 get denied.  Not the end, just the beginning.  Use the 60 days you are given to turn things around.  It's what I do for a living.

In fact, there is a large legal industry in America which does nothing but take denied SSDI claims and turn them into victories that pay benefits!  

Contact a Social Security disability specialist for a free consultation.  It's better than starting all over.
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
(256) 799-0297        Free Consultations