Getting Disability Benefits Under Social Security with HCV
Jacques Chambers, CLU, Benefits Consultant
Social Security offers several types of monthly benefits for a
disabled person, Social Security Disability Insurance (SSDI),
Supplemental Security Income (SSI) as well as disability benefits for disabled
widows, children, and adult children disabled since
childhood. While each program has its own requirements for
non-medical eligibility, they all use the same definition of total disability
and the same method to determine if a person is "disabled enough" to be eligible
for disability benefits.
Under Social Security a person is considered disabled if: (1) Due to
a medical condition he/she is unable to perform the tasks of a job for which
he/she is suited, AND (2) That condition either has or will last for at least
twelve months or is expected to result in death.
Well over 50% of the initial applications for disability benefits are
denied, not because the disability definition is that difficult to
meet, but primarily because the applicant didn't understand the
disability determination process and didn't give Social Security
the information they needed to award benefits.
The problem of being denied Social Security benefits appears to
affect people with HCV even more, for several additional reasons:
To Social Security, HCV is a relatively new disabling condition and
they really haven't develop an organized approach to reviewing
HCV claims;
The symptoms of HCV can vary from none at all to completely
debilitating, so the diagnosis of HCV alone doesn't have much
impact in determining disability; and,
Many of the most common symptoms of HCV are "subjective" in
that they can't be readily measured in a laboratory test. Examples are
fatigue, headaches, memory loss, and depression. Therefore, medical records
alone often don't adequately describe the functional problems the applicant has
trying to work.
A person dealing with HCV rarely suddenly awakens one day to find himself or
herself unable to continue working. Typically, it's a
gradually deteriorating ability to work. Work becomes more and more difficult;
finding the energy to work is more and more
time-consuming. Some reach the point where they only work and spend the
remainder of their time in bed trying to regain enough strength to return to
work.
If you believe that the time to apply for Social Security Disability
is approaching, especially in the next few months there are two
things you can do before stopping work and applying that can greatly increase
your chances of getting your claim approved the first time around:
(1) Learn how Social Security processes a claim for disability; and, (2)
Assemble and review the "medical evidence" which they will
use to determine if you are disabled by their definition.
Learn How Social Security Processes a Claim for Disability
Social Security has put a lot of information about the disability
process on their website at www.ssa.gov.
For example, in examining a disability claim there are five questions that a
Disability Analyst seeks the answers to:
1. Are you working?
2. Is there a medical problem that impacts your ability to
work to any degree?
3. Is your condition found in the Listing of Impairments?
(more on that below)
4. Can you do the work you did previously?
5. Can you do any other type of work?
To be eligible for benefits, the answer to #1 must be "No,"
and the answer to #2 must be "Yes."
If the answer to #3 is "Yes," your claim will be approved. If
not, then both #4 and #5 must be "No."
To facilitate the process and to maintain some uniformity throughout the
country, Social Security publishes a book called, Disability Evaluation Under
Social Security, or "The Blue Book" which includes a Listing of Impairments. If
your medical condition is listed in that Listing of Impairments, and it meets
the criteria given, then your claim is routinely approved.
The Listing, unfortunately, does not directly deal with Hepatitis C,
although there is a listing for Chronic Liver Disease that includes
chronic active hepatitis.
However, because the symptoms can vary substantially, they also
include some guidelines on how severe the condition must be:
"5.05 Chronic liver disease (e.g., portal, postnecrotic,
or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With:
Esophageal Varices (demonstrated by endoscopy or other appropriate medically
acceptable imaging) 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
Performance of a shunt operation for esophageal varices. Consider
under a disability for 3 years following surgery; thereafter,
evaluate the residual impairment; or
Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater
persisting on repeated examinations for at least 5 months; or
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
Hepatic encephalopathy. Evaluate under the criteria in Listing 12.02; or
Confirmation of chronic liver disease by liver biopsy (obtained
independent of Social Security disability evaluation) and one of the
following:
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
Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on
repeated examinations for at least 3 months; or
Hepatic cell necrosis or inflammation, persisting for at least 3
months, documented by repeated abnormalities of prothrombin time and enzymes
indicative of hepatic dysfunction."
http://www.ssa.gov/disability/professionals/bluebo
ok/AdultListings.htm
If your medical condition meets one of these criteria, your claim
should be approved. However, it will help if your physician states
the condition in a letter to Social Security, using terms and results as shown
in the Listing.
If your condition does not meet any of these criteria, all is not
lost. It is still possible to have your claim approved if the
symptoms you exhibit are as severe as one of the listings. If your symptoms
clearly show that the answers to questions #4 & 5 are both no, your claim will
also be approved.
Usually, however, more medical evidence will be required to get the
claim accepted. In that case, you should make sure you submit all the medical
evidence that you can with the application.
Assemble and Review Your Medical Evidence
The most important evidence in determining disability is the records of your
medical providers. This could be more than the records of
your primary care physician and specialist. It may also include the
records of your therapist, chiropractor, acupuncturist and other medical
practitioner. "Non-medical establishment" providers won't
carry the weight of "regular" doctors, but they can support your claim by
documenting your symptoms and your efforts to relieve them.
Disability determination focuses on your symptoms and how they
prevent you from working so it is a good idea to make sure your physicians enter
your symptoms into the record with each visit, even if it is repetitive.
To greatly speed up processing time, it is also recommended that you take copies
of your medical records when you go to your initial
interview with Social Security.
While the medical records of your providers are the primary source of evidence
in reviewing your claim, there are other documents and
records that can help your claim as well.
These include:
Questionnaires - Once you apply for disability benefits, the
Disability Analyst will send you questionnaires to get specific
information. They may be about Pain, Fatigue, your daily activities,
or other conditions or symptoms. These questionnaires are your
opportunity to transform the medical data from your physicians into
actual descriptions of the problems your condition cause you when
working and in your daily routine. You should not skimp on these or rush through
them quickly. Take your time, add extra sheets of paper, well-labeled, and
thoroughly describe in detail exactly how your symptoms impact your routine.
Letters from Physicians - Ask each of your doctors to write a
thorough summary of your condition. They should focus on relating the medical
conditions and test results to the symptoms you are experiencing. To adequately
do the job, each letter should be several pages long, not just a couple of
paragraphs
Third Party Testimony - These are letters from friends, family,
or co-workers that describe their observations of your problems trying to
function. These should be anecdotes and descriptions of what they have observed
in your performance. One of the best is a copy of a "write-up" by your
supervisor on your deteriorating
performance from your personnel file. Not everyone will have one of these as
many people work that much harder to make sure their performance doesn't
deteriorate.
Letters from a spouse or housemate co-worker on how your activities and
abilities have changed due to your condition are good also. A description
through anecdotes of how your ability to function has deteriorated should be
their goal. While these alone won't get your claim approved, they do help
provide a good picture of how your medical condition affects your activities.
Symptom Diary - This can be an especially helpful tool when the
symptoms are primarily subjective. Psychologically it is not fun to
do, but it can help confirm the impact of the symptoms on your
activities. A symptom diary is simply a daily log, in which you enter
the symptoms you experienced during the day, their severity including how long
they lasted, and their impact on your daily activities such as requiring you to
rest, cancel planned appointments, etc.
This seems like a lot of work just to get benefits that you deserve,
but, remember, Social Security is so big that they can't be bothered
with "what's fair" or "what you deserve." You need to know their rules and "play
the game" by them. Making the effort with the
initial application can avoid having to drag through a year or more of appeals
and sharing your award with an attorney, which will save you time, money, and
lots of stress.
[Jacques Chambers, CLU, and his company, Chambers Benefits
Consulting, have over 35 years of experience in health, life and disability
insurance and Social Security disability benefits. For the past twelve years, he
has been assisting people with their rights, problems, and other issues
concerning benefits and disability. He can be reached at
jacques@... or through his website at:
http://www.helpwithbenefits.com
---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.481 / Virus Database: 277 - Release Date: 05/13/2003