Posts Tagged ‘geo:lon=-116.56346239999999’
NAMPA, ID – Our Nampa Disability Lawyers office understand that to be found disabled, an individual must have a medical condition that is “severe”. The impairment can be mental or physical, but must significantly limit the individual’s abilities to do basic work activities. An impairment is not severe if it is a slight abnormality (or a combination of slight abnormalities) that has no more than a minimal effect on the ability to do basic work activities. If you have a mental or physical condition that limits your ability to work, be sure to contact experienced Social Security attorneys or a disability lawyer who can listen to your symptoms and limitations and recognize whether they are severe enough to qualify you for Social Security Disability.
Symptoms such as pain, fatigue, shortness of breath, weakness, or nervousness, will not be found to affect your ability to do basic work activities until it can be shown that these conditions are caused by a medical condition that would be expected to produce these symptoms. This boils down to a credibility issue. Subjective symptoms such as those listed above must be connected to some objective medical evidence such as X-Rays, MRIs, laboratory finds, medical signs, etc.
Nampa Disability Lawyers – Judges Determination
Before a judge can determine that your condition is not severe, he or she must carefully evaluate the medical evidence in your file. Just because a judge finds that your impairments could reasonably be expected to produce the alleged symptoms does not mean that they will find you disabled. The judge will have to make a determination as to the intensity, persistence and functionally limiting effects of your symptoms. The judge must determine if your symptoms limit your ability to function so severely that you cannot do basic work activities.
Most of the time, a judge will find that your condition is severe because all you have to do is show that your limitation or restriction has more than a minimal effect on your ability to do basic work activities, even if the objective medical evidence does not show that your condition is severe. In fact, if the judge cannot clearly show that your condition is NOT severe, they must consider it severe and move on to make a determination about your ability to work.
If you have any questions about your physical or mental limitations, contact a disability attorney who knows Social Security Disability guidelines and can help you with your Social Security Disability application. Finding good disability lawyers to help you with the function report and work history reports is very important. Our Nampa Disability Lawyers are happy to speak with you and provide a free consultation. What’s more, if you decide you need a social security attorney with your case, you won’t pay anything unless we win! Call (208) 466-2972 or click here to speak to our expert disability lawyers in Nampa, Idaho.
Originally posted 2013-01-04 03:23:48.
As any good Social Security Attorney will tell you, there are some conditions that are more difficult to get on disability for than others. One of those conditions is Chronic Fatigue Syndrome or CFS. This is primarily because CFS seems to be a diagnosis that is used to describe a loosely related set of symptoms that can not be explained by any other means, the primary symptom of which is fatigue. If you have been told by your doctor that you have CFS, contact a Nampa Social Security Attorney in our Nampa, Idaho office today to get more information on how you can prepare your case to successfully apply for Social Security Disability Benefits.
In 2014, Social Security released SSR 14-1p entitled “Evaluating Claims Involving Chronic Fatigue Syndrome” to help claimants and their attorneys to better understand how CFS fits into Social Security’s set of medically determinable impairments. SSR 14-1p replaced SSR 99-2p, which was published in 1999 and first established how Social Security would deal with claims of Chronic Fatigue.
One of the key concepts in Social Security Disability that every lawyer must make sure every claim has is a medically determinable impairment or “MDI”. Certain conditions such as chronic fatigue and fibromyalgia are a set of symptoms that can’t otherwise be explained, which makes them difficult to diagnose, except by eliminating other sources of the symptoms. SSR 14-1p helps establish when chronic fatigue can be established as an MDI.
In general, SSR 14-1p defines Chronic Fatigue as a clinically evaluated, persistent or relapsing chronic fatigue that :
- Has a specific onset
- Is not explained by another identifiable condition or illness
- Is not related to exertion
- Is not alleviated by rest
- Results in a significant reduction in your ability to perform important occupational, social or personal activities.
Diagnostic Symptoms: Social Security points to the CDC case definition of Chronic Fatigue states that a person must have four or more of the following specific symptoms for 6 or more months:
- Tiredness after exerting yourself that lasts for 24 hours or more
- Difficulty with memory and concentration
- Soar Throat
- Tender lymph nodes in your neck
- Muscle Pain
- Waking unrefreshed
- Muscle weakness
- Problems sleeping
- Visual difficulties
- Fainting, dizziness or fatigue with prolonged standing
- Difficulty breathing
- Cardiovascular abnormalities
- Stomach Problems
There are also certain conditions that people with Chronic Fatigue also commonly suffer from, including:
- Myofascial pain syndrome
- Temporomandibular joint syndrome
- Irritable Bowell Syndrome
- Interstitial systitis
- Raynauds phenomenon
- Chronic Lymphocitic Thyroiditis
- Sjogren’s syndrome
- New allergies or sensitivities (cold all the time)
Social Security will not simply take your doctor at his word that you have Chronic Fatigue Syndrome. You will need a good Social Security attorney to help Social Security to find evidence of the above signs and conditions and show if you have other conditions that may be causing these signs and conditions. Social Security will require medical signs or laboratory findings that support your diagnosis of Chronic Fatigue before they will consider that it constitutes an MDI.
Medical Signs—Social Security will look for one or more of the following medical signs that last longer than 6 months:
- Swollen or tender lymph nodes on physical examination
- Sore throat (nonexudative)
- Tender Points
- Other, less persuasive, signs such as Frequent viral infections, Sinusitis, Ataxia, Extreme pallor, Pronounced weight change
Laboratory Findings—Your Disability Attorney should point out the following to Social Security to indicate your diagnosis of Chronic Fatigue is legitimate:
- An elevated antibody titer to Epstein-Barr virus capsid antigen equal to ore greater than 1:5120, or early antigen equal to or greater than 1:640
- Abnormal MRI of the brain
- Abnormal exercise stress test
- Abnormal sleep studies
In addition to those discussed above, your attorney may be able to point to other medical signs and laboratory findings that Social Security may accept in deciding your Chronic Fatigue diagnosis constitutes an MDI. The key is that your doctor explains carefully what medical sings and laboratory findings he has considered in making his diagnosis. A diagnosis of Chronic Fatigue will be much stronger the more conditions that have been ruled out as possible causes for your signs and symptoms.
Contact a Nampa Social Security Attorney today for a free case evaluation and find out if you meet the criteria for Social Security Disability.
Originally posted 2014-10-24 01:13:41.
As you prepare to file for Social Security disability, it is important for you to choose the correct onset for your disability. Your alleged onset date is the date that you claim you could no longer work because of your disability. There are several important factors to consider when choosing this date, so please contact a Social Security attorney with our Nampa or Boise office for a free case evaluation and to discuss what an appropriate onset date for you would be.
Your onset date you choose is very important. Among other things, it will determine how much back pay or past due benefits you will receive. If you are applying for Social Security Disability Insurance (SSDI), you want your onset date to be back as far as possible because you can get paid back benefits up to twelve months. The ideal period is seventeen months, because there is a five month waiting period after you become disabled where you cannot receive benefits. If you are approved for SSI you can only get paid benefits from the month you apply.
As a general rule, the farther back your onset date is, the more back benefits you receive. However, it is not always in your benefit to push back your onset date. In some cases, mostly with younger workers, an earlier onset date can actually decrease monthly benefits. This would happen if you were a young worker whose earnings after the earlier onset date were relatively high compared to your earnings in prior years. And, as your disability attorney will tell you, if you go further back than your medical records support, you can also loose credibility.
Another thing to keep in mind is that Social Security might not always agree with your onset date. An onset date that you set is called the alleged onset date, or AOD. An onset date that the Social Security administration determines is called an established onset date, or an EOD. If Social Security disagrees with the onset date you have provided, then they will establish an EOD. To do this, they must have medical evidence that contradicts your AOD.
If the Social Security administration does change your onset date, it will probably cause you to lose some back benefits that you would have otherwise received. If this happens, your disability attorney can appeal the decision by asking the DDS (disability determination services) to reconsider the EOD. Be careful, though. If you appeal the decision, the DDS or the Social Security administration can always decide that your onset date was sooner than even the EOD, costing you more money. It’s a good idea to consult a Social Security disability attorney before appealing. The EOD and AOD are not always different. If your claim is approved, then the AOD becomes the EOD.
Your onset date is often the date you last worked, but that doesn’t mean you have to set the onset date the day you lost your job. Your last job might not have been substantial gainful activity, or it could have been an unsuccessful work attempt. In either case, your onset date might be earlier than you think. In most cases, you will need to show that any work done after your onset date was not substantial work activity or gainful work activity, it was done under special conditions, it was subsidized, or that it was an unsuccessful work attempt.
Work that lasted no longer than sixth months and that you were forced to stop because of your disability may qualify as an unsuccessful work attempt. You can have more than one unsuccessful work attempt after your onset date, and earnings will not be considered when the Social Security administration is deciding whether or not your work is substantial gainful activity or not. If you don’t know whether your last job was an unsuccessful work attempt or if you have gone over the substantial gainful activity limit, you can talk to a Social Security attorney in our Nampa or Boise office. You need to be careful when setting your onset date. You want it to be as far back as possible, but you don’t want to place it incorrectly either.
If you have questions about onset dates, unsuccessful work attempts or substantial gainful activity, you can contact a Social Security attorney with our Nampa or Boise office. They can help you make all the right decisions when it comes to your Social Security disability claim.
Originally posted 2014-10-06 19:31:37.
This the is the third part of an article entitled Medical Source Statements, which discusses how your Nampa Social Security Attorney can use these statements to help win your Social Security disability claim. You may want to also read the other parts of this article, starting with “Medical Source Statements — Part I” before continuing. For more information, contact a Social Security Attorney in our Nampa Idaho office. This article covers SSR 96-2p, which is entitled “Giving Controlling Weight to Treating Source Medical Opinions” and provides your Nampa Social Security attorney with the criteria judges must use to evaluate the opinions of your doctors.
Social Security must evaluate every medical opinion they receive. (20 C.F.R. ßß 404.1527(d)) The judge may not skip or simply mention a medical opinion. Rather, every medical opinion triggers the requirement of evaluation. It is not unusual for a single treating source to provide medical opinions about several issues; for example, at least one diagnosis, a prognosis, and an opinion about what the individual can still do. Although it is not necessary in every case to evaluate each treating source medical opinion separately, judges must always be aware that one or more of the opinions may be controlling while others may not. (20 C.F.R. ßß 404.1502).
Your Doctors Opinion On What You Can Do (Residual Functional Capacity)
What you can still do despite your impairment(s) is called your residual functional capacity or RFC. 20 C.F.R. ßß 404.1545 defines residual functional capacity as
(a) General — (1) Residual functional capacity assessment. Your impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what you can do in a work setting. Your residual functional capacity is the most you can still do despite your limitations. We will assess your residual functional capacity based on all the relevant evidence in your case record. (See ß 404.1546)
Social Security has reserved certain determinations for itself to make. One of these is what your residual functional capacity is. In spite of being reserved to Social Security judges, your residual functional capacity is something on which your treating doctor may legitimately give a medical opinion. And if a treating source gives a medical opinion concerning your residual functional capacity, that opinion may be entitled to controlling weight.
Multiple Limitations in a Treating Source Statement
Your doctors (and other acceptable medical sources) may give medical opinions on more than one of your limitations. The judge is not required to address each of these individually, unless one opinion is entitled to controlling weight while another may not be. For example, the record may be well established that you have difficulty sitting for long periods of time. There is an MRI showing you have severe stenosis in your lower back and your medical records clearly demonstrate physical examinations documenting your lack of flexion and pain. Your doctors opinion on how long you can sit may be entitled to controlling weight while his opinion on your ability to use your fingers my be entitled to little or no weight because he never treated your hands. For this reason, be sure to discuss all of your severe symptoms with your doctor every time your go—even if you sound like a broken record.
SSR 96-2p has a requirement that the judge must provide specific reasons for the weight he or she gives to the treating source’s medical opinion and the reasons must be sufficiently specific to make clear not only the weight given but the reasons for that weight. If your doctor’s opinion is not contradicted by another doctor, the judge must provide clear and convincing reasons for rejecting it. Even if your doctor’s opinion is contradicted by another doctor, the judge may not reject this opinion without providing specific and legitimate reasons supported by substantial evidence in the record.
The opinion of an examining physician is weighted more heavily than the opinion of a nonexamining physician, and the judge must provide clear and convincing reasons for rejecting the uncontradicted opinion of an examining physician, and even if contradicted by another doctor, can only be rejected for specific and legitimate reasons that are supported by substantial evidence in the record. Andrews v. Shalala, 53 F.3d 1035, 1043 (9th Cir. 1995).
The opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of either an examining physician or a treating physician.
The ALJ Must Provide Legitimate Reasons for Discounting a Treating Source Opinion
Courts have ruled that a Social Security judge my not discount a treating physician’s medical opinion without providing specific and legitimate reasons for doing so. See Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir. 2001). The ALJ may not reject the opinion of a treating physician, even if it is contradicted by the opinions of other doctors, without providing specific and legitimate reasons supported by substantial evidence in the record. An examining physician’s opinion only constitutes substantial evidence if the physician relied on independent clinical findings that differ from the findings of the treating physician. Moreover, even if a treating physician’s opinion is no longer entitled to controlling weight because there is substantial evidence in the record contradicting the opinion, the opinion is still entitled to deference and must be weighed using all the factors provided in 20 C.F.R. ß 404.1527. In many cases, a treating source’s medical opinion will be entitled to the greatest weight and should be adopted, even if it does not meet the test for controlling weight.
In the Ninth and Eleventh circuits, where an ALJ has failed to properly reject a treating (or examining) source’s opinion, the federal court will accept that source’s opinion as true, as a matter of law. If the records is fully developed, the court will reverse the ALJ’s decision and remand for immediate payment of benefits, instead of for a rehearing. The record is fully developed if:
- At step three of the sequential evaluation, the treating source’s medical opinion establishes that the claimant’s impairment meets or equals a listed impairment; or
- At step five of the sequential evaluation, the treating source’s medical opinion establishes that a claimant has an RFC which is disabling under the grids or based on VE testimony; or
- At step five of the sequential evaluation, the treating source’s medical opinion establishes the claimant’s inability to sustain a regular and continuous work schedule.
Substantial evidence is “more than a mere scintilla.” It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. This means that the evidence that is inconsistent with the medical opinion does not have to be overwhelmingly convincing. It only needs to be enough that a reasonable mind would accept a conclusion that is contrary to the conclusion expressed in the medical opinion.
Any kind of medical or nonmedical evidence can satisfy the substantial evidence test. A treating source’s medical opinion on what an individual can still do despite his or her impairment(s) will not be entitled to controlling weight if substantial, nonmedical evidence shows that the individual’s actual activities are greater than those provided in the treating source’s opinion.
This article on 96-2p is continued on the link below. Be sure to ask a Nampa Social Security Attorney in our office about getting a medical source statement to your doctors.
Originally posted 2014-08-25 17:18:59.
If you have found this article first, please read Medical Source Statements –Part One before continuing. For more information, contact a Nampa Social Security Attorney in our office. This article covers SSR 96-2p, which is entitled “Giving Controlling Weight to Treating Source Medical Opinions” and provides your Social Security attorney with the criteria judges must use to evaluate the opinions of your doctors.
What If The Treating Source Opinion Is Not Entitled To Controlling Weight?
Even if a treating physician’s opinion is not entitled to controlling weight, your Social Security Attorney should attempt to show that your treating source medical opinions are still entitled to deference and must be weighed using all of the following factors:
- Examining relationship. Generally, Social Security gives more weight to the opinion of a source who has examined you than to the opinion of a source who has not examined you.
- Treatment relationship. Social Security looks at the length of the treatment relationship and the frequency of examinations as well as the nature of the treatment relationship. Generally, Social Security gives more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, picture of your medical impairment(s) over time and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations.
- Supportability. The better the explanation a source provides for the opinion given and the more evidence there is to support a medical source opinion, such as medical signs and laboratory findings, the more weight Social Security will give that opinion.
- Consistency. Generally, the more consistent an opinion is with the record as a whole, the more weight Social Security will give to that opinion.
- Specialization. Social Security generally gives more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist.
- Other factors. Social Security will also consider any factors you or others bring to their attention that tend to support or contradict the opinion.
SSR 96-2p is very helpful to you and to your Social Security attorney in proving your disability. A judge must always give good reasons in his or her decision for the weight he or she gives to your treating source’s opinion. If your are denied disability, the decision denying benefits must contain specific reasons for the weight given to the treating source’s medical opinion, supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source’s medical opinion and the reasons for that weight.
Remember: Social Security only has to give serious consideration to acceptable medical sources such as doctors. Other common treating sources are not entitled to this consideration. These “other sources” not entitled to such serious consideration include nurse-practitioners, physicians’ assistants, naturopaths, chiropractors, audiologists, and therapists, school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers, social welfare agency personnel, and non-medical sources (for example, spouses, parents and other caregivers, siblings, other relatives, friends, neighbors, and clergy). Ask one of our Nampa Social Security attorneys if you have a question about whether your treating source is “Acceptable”.
Treating source means your own physician, psychologist, or other acceptable medical source who (1) provides you, or has provided you, with medical treatment or evaluation and (2) who has, or has had, an ongoing treatment relationship with you. Social Security will consider that you have an ongoing treatment relationship with an acceptable medical source when the medical evidence establishes that you see, or have seen, the source with a frequency consistent with accepted medical practice for the type of treatment and evaluation required for your medical condition. Social Security may consider an acceptable medical source who has treated or evaluated you only a few times or only after long intervals (e.g., twice a year) to be your treating source if the nature and frequency of the treatment or evaluation is typical for your condition. Social Security will not consider an acceptable medical source to be your treating source if your relationship with the source is not based on your medical need for treatment or evaluation, but solely on your need to obtain a report in support of your claim for disability.
This article on 96-2p is continued on the link below. Be sure to ask a Nampa Social Security Attorney in our office about getting a medical source statement to your doctor.
Click To Go To Part Three Of Social Security Attorney Medical Source Statements
Originally posted 2014-06-02 13:59:28.
Vocational rehabilitation, also known as VR, is the process that helps restore a disabled person to work he or she is capable of doing mentally, physically and vocationally. It is a public program run by states. Its purpose is to help people with disabilities become gainfully employed again. If you would like to know if vocational rehabilitation is right for you, contact one of our Boise or Nampa Social Security attorneys
You don’t have to be on Social Security Disability to qualify for vocational rehabilitation. If you have a mental or physical disability, you can be evaluated by vocational rehabilitation to see if you qualify for assistance. Going through vocational rehabilitation prior to your disability hearing also shows the judge that you are trying and can lend credibility to your description of your limitations. Sometimes a failed work attempt can help to illustrate the nature and severity of your condition. If you happen to find a job that you can do despite your limitations, so much the better.
There are several types of services, including assessments that evaluate your mental and physical condition, as well as your skills and abilities. The rehabilitation can also include counseling and guidance, training, transportation, job placement and any other things you might need to get back working. Of course, your plan will be structured around you needs. If your disability has left you unable to do a certain job, and you need to make a career change, vocational rehabilitation can help provide training for you. Keep in mind that not everyone gets the same services. Some people will need lots of help, while others need only minor assistance.
Once you know what type of job or career you want within your physical and mental capabilities, a vocational rehabilitation counselor will help you choose an appropriate career path. All plans are individualized according to your needs. Depending on your financial situation, you may be responsible for some of the costs of your rehabilitation plan. However, you will be able to receive the help you need even if you can’t pay. The Social Security Administration can even pay for these services when the claimants meet certain conditions, and work incentives allow the Social Security Administration to continue to pay you even after you have returned to work.
One thing to note is that not everyone who receives disability benefits is eligible for vocational rehabilitation. There are some cases where the Social Security Administration will not refer a claimant to a vocational rehabilitation agency. The first case is if you have an illness that will end in death, or if you have a mental or physical impairment that that is so bad that training, work adjustment and employment are impossible. Similarly, if your disability involves loss of memory or understanding, they won’t consider you.
Another factor they consider is your age. If you are at an advanced age and either have an impairment that is so severe that it would be hard for you to adjust, or a poor work history of performing hard labor, and you don’t have a lot of education or transferable skills, then Social Security will not refer you.
Most claimants will cooperate during their rehabilitation program. However, there are always exceptions, and Social Security can suspend benefits if a person refuses to cooperate with the rehabilitation agency without a good reason. If you are offered services by a rehabilitation provider, you should accept if you want to continue receiving disability benefits.
If you wish to apply for vocational rehabilitation then contact the VR office nearest to you. You need to make an appointment and complete their application forms. If you have questions or need help with getting Social Security Disability benefits, please contact one of our Boise or Nampa Social Security attorneys. The disability application process can be confusing, but we are here to help answer your questions and make the process as simple as possible.
Originally posted 2014-02-03 15:46:14.
Apply For Disability
Getting Social Security disability benefits is a long process, but it doesn’t have to be hard or confusing. If you have any questions about the disability process or for help with applying, please contact one of our Social Security Attorneys. An experienced disability lawyer could greatly increase your chances for success.
When you are preparing to apply for Social Security disability, it is important that you go to the doctor and document your symptoms as often as possible. Start doing this as early as you can. The more evidence you have of your disability and the longer you have been going to a doctor and describing your symptoms, the better chance you will have. Make sure that you are describing all of your symptoms every time that you go to the doctor. Also keep in mind that this doesn’t just include doctor’s visits and medical records. Start keeping a journal where you take brief notes on how you feel each day and how it is affecting your daily life. Keep track of how your disability is affecting your job. Make note of what part of your condition is keeping you from working. Then you can give all this information to the Social Security Administration when you file your claim.
When it comes to actually applying for Social Security disability, you can submit your application to the Social Security website at www.ssa.gov/applyforidsability , over the phone, or in person at your local Field Office. There are several forms that you will have to complete, including the Disability Benefit Application, the Adult Disability Report (or the Child Disability Report) and the Authorization to Disclose Information to the Social Security Administration. To process your claim, Social Security will need a lot of information about you, including all of your doctors and your birth certificate (you will have to prove your age), and a list of medications. To prove that you are disabled, you will also need medical records, test results and information from your doctors regarding your disability. Unfortunately, at initial stage over sixty percent of applicants are denied. If you are denied, make sure you appeal.
Many cases go before an Administrative Law Judge (ALJ). At the hearing, the judge may question any witnesses that you bring to the hearing and will explain any issues in your case. After the hearing the judge studies all the evidence that has been submitted to him and issues a written decision. It is at the hearing level that our disability attorneys can help you most. We are very successful in arguing cases before disability judges.
If you want help with any part of your claim, you can contact one of our Social Security disability attorneys. Applying for Social Security disability can be a complicated process, and what you don’t know can hurt you. We will help you navigate through this complicated process and will be there to guide you through every step of the process, including helping you collect your medical records, filing out paper work that Social Security send you, and by giving you the do’s and don’ts. We can help you know what to say and what not to say to your doctor. If you get denied in the initial level, we can help you with your reconsiderations and hearing requests. We have over a ninety percent approval rate at the hearing level. If you have any questions or need help with any step of this long process, please contact one of our Social Security disability attorneys and get the help you need today!
Originally posted 2014-01-15 17:20:05.
If you suffer from a form of arthritis that causes a major joint dysfunction that is so severe that you can no longer work, you may qualify for Social Security Disability benefits. For major joint dysfunctions, Social Security will look first to see if you meet a listing, either under 1.02 or 14.09. Listings a difficult to meet. Please contact a Nampa Social Security Attorney for more information.
A major joint dysfunction is described in Social Security listing 1.02 and is typically demonstrated by gross anatomical deformity and chronic joint pain and stiffness which limits motion. You will need to have objective evidence in the form of MRI, CT or X-ray showing that you have a deformity, joint space narrowing, etc. that could reasonably cause the pain and limited range of motion that you are experiencing.
If your condition involves a hip, knee or ankle, it will have to be so severe that you can no longer ambulate effectively as defined in 1.00B2b of the listing. If your condition involves shoulder, elbow, or wrist, it must result in your inability to perform fine and gross movements 1.00B2c of the listing.
Rheumatoid Arthritis (RA)
Women are 2-3 times more likely than men to suffer from RA. Because RA begins gradually, it is sometimes difficult to pinpoint when it has become disabling. What causes RA is still somewhat of a mystery, but the immune system plays a significant role in the progression of the disease once it has started. RA causes dissolution of the bones known as erosion, which shows up on X-ray and MRI. RA will also generally involve both sides of the body (both hands, both knees, etc), though RA does seem to spread from joint to joint and wear and tear and injury can create an ideal opportunity for the spread of RA.
American College of Rheumatology 1987 – 88 Diagnostic Criteria
For the Classification of Acute Arthritis of Rheumatoid Arthritis.
|1. Arthritis of three or more joint areas||At least three joint areas simultaneously having soft tissue swelling or fluid (not bony overgrowth alone) observed by a physician (the 14 possible joint areas are right or left PIP, MCP, wrist, elbow, knee, ankle, and MTP joints)|
|2. Morning stiffness||Morning stiffness in and around the joints lasting at least 1 hr before maximal improvement|
|3. Rheumatoid nodules||Subcutaneous nodules over bony prominences or extensor surfaces, or in juxta-articular regions, observed by a physician|
|4. Arthritis of hand joints||At least one joint area swollen as above in wrist, MCP, or PIP joint|
|5. Symmetric arthritis||Simultaneous involvement of the same joint areas (as defined in criterion 2) on both sides of the body (bilateral involvement of PIP, MCP, or MTP joints is acceptable without absolute symmetry)|
|6. Serum rheumatoid factor||Demonstration of abnormal amounts of serum rheumatoid factor by any method that has been positive in less than 5 percent of normal control subjects|
|7. Radiographic changes||Typical X-ray changes of RA on PA view of hand and wrist, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to the involved joints (osteoarthritis changes alone do not qualify)|
|Abbreviations: MCP, Metacarpophalangeal; MTP, metatarsophalangeal; PA, posteroanterior (back to front); PIP, proximal interphalangeal; RA, rheumatoid arthritis.|
|For classification purposes, a patient is said to have RA if he or she has satisfied at least four of the seven criteria. Criteria 1 through 4 must be present for at least 6 weeks. Patients with two clinical diagnoses are not excluded. Designation as classic, definite, or probable rheumatoid arthritis is not to be made.|
American College of Rheumatology Classification of
Global Functional Status in Rheumatoid Arthritis
|Class I||Completely able to perform usual activities of daily living (self-care, vocational, and avocational)|
|Class II||Able to perform usual self-care and vocational activities, but limited in avocational activities|
|Class III||Able to perform usual self-care activities, but limited in vocational and avocational activities|
|Class IV||Limited in ability to perform usual self-care, vocational, and avocational activities|
|Usual self-care activities include dressing, feeding, bathing, grooming, and toileting. Avocational (recreational and/or leisure) and vocational (work, school, homemaking) activities are patient-desired and age- and sex-specific.|
The American College of Rheumatology decided upon a new diagnostic criteria for rheumatoid arthritis in 2010 that require synovitis in at least 1 joint, the absence of another diagnosis that would explain the synovitis, and a total score of at least 6.
American College of Rheumatology Diagnostic Criteria 2010
For the Classification of Acute Rheumatoid Arthritis
Score or Comment
|1. At least 1 joint with clinical synovitis (swelling)||This criterion is for newly presenting patients. Patients with erosive disease typical of RA with a history compatible with prior satisfaction of the 2010 criteria should be classified as having RA. Patients with longstanding disease in whom disease is inactive (with or without treatment) who in the past have satisfied the 2010 criteria should be classified as having RA.|
|2. Synovitis not better explained by another disease||For example, diseases like systemic lupus erythematosus, psoriatic arthritis and gout may need to be considered.|
|3. Joint involvement||Joint involvement means any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis. The distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded. Categories of joint distribution are classified according to the location and number of involved joints, with scoring based on the highest possible category based on the pattern of joint involvement.1 large joint = 0 (large joints are shoulders, elbows, hips, knees, ankles)2-10 large joints = 11-3 small joints = 2 (with or without large joint involvement; small joints are metacarpophalangeal, proximal interphalangeal, 2-5th metatarsophalangeal, thumb interphalangeal, and wrist joints)4-10 small joints = 3 (with or without large joint involvement)>10 joints = 5 (at least 1 small joint; the other joints can include any combination of large and additional small joints, as well as other joints not specifically listed elsewhere, such as temporomandibular, acromioclavicular, sternoclavicular, etc.)|
|4. Serology .||At least 1 test result is needed. Negative means to international unit (IU) values no higher than the upper limits of normal (ULN) for the reporting laboratory or assay. Low-positive means IU values that are higher than the ULN but less or equal to 3 times the ULN for the laboratory or assay. High-positive refers to IU values more than 3 times the ULN for the laboratory or assay. Where rheumatoid factor (RF) is only available as positive or negative, a positive result should be scored as low-positive for RF. ACPA refers to anti-citrullinated protein antibodyNegative RF and negative ACPA = 0Low-positive RF or low-positive ACPA = 2High-positive RF or high-positive ACPA = 3|
|5. Acute-phase reactants||At least one test result is needed for classification. Normal/abnormal is determined by local laboratory standards. CRP = C-reactive protein; ESR = erythrocyte sedimentation rate.Normal CRP and normal ESR = 0Abnormal CRP or abnormal ESR = 1|
|6. Symptom duration||Duration of symptoms refers to patient self-report of the duration of signs or symptoms of synovitis (e.g., pain, swelling, tenderness) of joints that are clinically involved at the time of assessment, regardless of treatment status.Less than 6 weeks = 06 weeks or more = 1|
|7. Scoring||A score of 6 or greater is diagnostic of RA. Although patients with a score of less than 6 are not classifiable as having RA, their status can be reassessed and the criteria might be fulfilled cumulatively over time.|
Treatment of RA consists of adequate rest, protection of joints from stress, physical therapy, and drugs. Surgery is sometimes done to help correct joint deformities. It should be stressed that although RA evaluated under this listing 1.02 requires gross joint deformity, such deformity is not required by listing 14.09 for the inflammatory component of rheumatoid arthritis.
The common deformities of the hands seen with RA are ulnar deviation, swanneck deformities, and boutonniere deformity. Drugs used to treat RA include non-steroidal, anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen, steroids, gold, methotrexate, etanercept, and others as appropriate. Flare-ups of activity may occur at unpredictable intervals despite treatment; the frequency, duration, and severity of these flare-ups are linked to the behavior of the disease in the individual person.
With modern medicines, many RA patients are able to keep their function if treatment is started early in the onset of the disease, but there is still no fully curative treatment of this disorder. SSA has no standardized guidelines for assessing functional limitations in RA or any other musculoskeletal disorder.
Psoriatic arthritis is equally common between men and women, although the cause is not known. Psoriatic arthritis can produce joint inflammation and is more likely to affect the hand joints nearest the fingertips, and commonly only affects the joints on one side of the body. For example, there may be arthritis in the left hand and knee but none on the right side. Psoriatic arthritis can cause damage to the spine and sacroiliac joints of the pelvis.
There are no diagnostic tests for psoriatic arthritis and sometimes it is confused with gout. In psoriatic arthritis patients, X-ray may show asymmetric joint abnormalities, inflammation of the sacroiliac joint, and in the spine (spondylitis), ankylosis (fusion) of bone in involved joints, erosions of bone with formation of new bone, and resorption (dissolution) of bone in the fingertip bones. Sometimes there is severe finger deformities, but Psoriatic arthritis typically involves mild abnormalities. Less than 5% develop deforming arthritis.
Osteoarthris is the most common form of arthritis. It is not a systemic disease process and is limited to the joints. It progresses slowly and typically starts with damage to joint cartilage, such as from high impact activity, and it is more likely to be associated with advancing age. Trauma to a joint, such as a fracture into a joint space, is frequently followed by development of OA.
Osteomyelitis (bone infection) is a serious condition and most often occurs as a result of trauma producing open wounds that allows the entry of bacteria into the body, as a result of surgical procedures, or as a result of bacteria circulating in the blood stream (“bacteremia)” and results in bone destruction and joint deformity. With modern antibiotics, acute osteomyelitis can be treated more effectively, so that chronic osteomyelitis is not as common as it was in the past.
Gout is usually found in men. Gouty arthritis can almost always be treated with diet and medication. A swollen and painful joint treated with Colchicine will usually return to normal in several days. It is unusual for gout to produce listing level symptoms.
Systemic Lupus Erythematosis (SLE)
SLE is an incurable autoimmune disease, with 90% of cases occurring in women, particularly young women. SLE can affect almost any body system, including joints, although it is unusual for joint deformities to develop in SLE. However, systemic lupus erythematosus can result in the degenerative bone condition of osteonecrosis (ON) that can affect shoulder, hip, knee, and ankle joints and is associated with alcohol and tobacco use, kidney disease, and the corticosteroid drugs sometimes used to treat the SLE.
Scleroderma is a hardening of the skin and is caused by a connective tissue disorder. Connective tissue includes skin, ligaments, bone, muscle, and tendons. Scleroderma can affect a variety of organ systems in addition to skin, such as gastrointestinal, heart, muscles, kidneys, and lungs. Scleroderma is incurable, and there is no effective way to slow it down.
Polymyositis And Reiteris Syndromes
Polymyositis and Reiterís syndromes are less common forms of disease process that can affect multiple body systems including joints.
Severe arthritis can qualify you for Social Security Disability Benefits. Contact a Nampa Social Security Attorney for more information.
Originally posted 2014-01-14 04:59:52.
Disorders Of The Spine
Back problems is probably the most common complaint of people applying for Social Security Disability Benefits. If you have a disorder of the spine, you know how debilitating the pain can be and how many limitations it puts on your ability to lift, move, sit, etc. If you have back problems, you may meet Social Securities Listing in 1.04. Contact a Nampa Social Security Attorney and find out if your condition will meet or equal a Social Security Disability listing.
To meet the listing for a back problem, your condition must result in limitations because of distortion of the bony and ligamentous architecture of the spine and associated impingement or “pinching” on nerve roots or spinal cord. This pinching on nerve tissue may result from a herniated disk, spinal stenosis, arachnoiditis, or other similar conditions.
- Herniated disk or herniated nucleus pulposus is a disorder frequently associated with the pinching of a nerve root. Nerve root compression results in a specific neuro-anatomic distribution of symptoms and signs depending upon the nerve root(s) compromised. This means that a doctor can determine where in your back your nerves are being pinched based on where your pain radiates to.
If you have pain in areas typically associated with a specific area of the spine, and you have imaging such as an MRI or CT scan that shows nerve compression in that area, you have a very good chance of receiving disability if your syptoms are severe enough to keep you from working.
2. Spinal Arachnoiditis is a condition characterized by intermittent ill-defined pain and something called dysesthesia (typically burning, tingling or numbness). This condition may also cause bladder or bowel incontinence.
Although the cause of spinal arachnoiditis is not always clear, it may be associated with chronic compression or irritation of nerve roots or the spinal cord. For example, there may be evidence of spinal stenosis, or a history of spinal trauma or meningitis. A diagnosis is made after surgery and an examination of tissue from your back, or from an MRI.
3. Lumbar spinal stenosis is a common condition seen in degenerative disk disease, or as a result of congenitally narrow nerve canals or openings. If you have spinal stenosis. You may have a condition called Pseudoclaudication. This is pain and weakness that often makes it hard to walk and typically affects both legs. The pain is not usually associated with any particular location in the back and is often a dull, aching pain, usually in the low back and radiating into the buttocks region. The pain is made worse with walking or standing but better by leaning forward.
4. Other Conditions such as osteoarthritis, degenerative disc disease, facet arthritis, fracture my also cause symptoms similar to the conditions listed above.
Abnormal curvatures of the spine, (specifically, scoliosis, kyphosis and kyphoscoliosis) can result in difficulty walking, breathing, cardiac difficulties or other symptom that may be severe enough to qualify your for disability.
If you have a condition that requires surgery, the timing of your surgery is important. If you have a surgery before a decision is to be made, your current condition may not be taken into account, and whoever is making the decision will wonder if you will still be disabled after you heal from the surgery. It is always helpful if you have reached what is called your maximum medical improvement by the time a decision needs to be made. For a spinal condition, you have reached your maximum medical improvement when there have been no significant changes in physical findings or on appropriate medically acceptable imaging for any 6-month period after your last surgical procedure or other medical intervention.
Effects of obesity. Obesity can significantly effect your musculoskeletal system, and disturbance of this system can be a major cause of disability in individuals with obesity. The combined effects of obesity with musculoskeletal impairments can be greater than the effects of each of the impairments considered separately. An experienced Social Security Attorney can use the affects of your obesity to help establish your disability.
If you would like a consultation with an experienced Social Security Attorney Nampa, please contact our Nampa Idaho office. You may also contact our Boise Idaho office at 208-957-2966.
Originally posted 2014-01-06 19:46:22.