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Idaho Disability Lawyers

Chronic Fatigue

As any good disability lawyer 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 Boise disability lawyer in our Boise, Idaho office today to get more information on how you can prepare your case to successfully apply for Social Security Disability Benefits.

social-security-disability-attorney-justice-300x199In 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 a disability 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 :

  1. Has a specific onset
  2. Is not explained by another identifiable condition or illness
  3. Is not related to exertion
  4. Is not alleviated by rest
  5. 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
  • Headaches
  • 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:

  • Fibromyalgia
  • Myofascial pain syndrome
  • Temporomandibular joint syndrome
  • Irritable Bowell Syndrome
  • Interstitial systitis
  • Raynauds phenomenon
  • Migraines
  • Chronic Lymphocitic Thyroiditis
  • Sjogren’s syndrome
  • New allergies or sensitivities (cold all the time)

Disability lawyers know that 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
  • Hypotention
  • Abnormal exercise stress test
  • Abnormal sleep studies

In addition to those discussed above, your disability lawyer 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 our Boise disability lawyers today for a free case evaluation and find out if you meet the criteria for Social Security Disability.


Social Security Attorneys Boise

Social Security Disability Doctors

Social Security Disability Attorneys

Disability Attorneys

When you’re trying to get on Social Security disability, your health care professional(s) play a very important role. Not all treating sources are equal when it comes to establishing your disability.  Social Security has what it calls “acceptable medical sources.”  Its important that you have at least one acceptable medical source and that you are seeing this person regularly.  For more information on what kind of medial professionals are acceptable to Social Security, see our post on Acceptable Medical Sources.  If you have questions, please contact one of our Boise Social Security Attorneys.

Social security gives a great deal of weight to the opinions of your treating physician.  This is because your treating physician sees you regularly, so he or she is most familiar with the nature of your disability and how severe it is.   For this reason, it is important that you see your treating physician regularly and often.  Its also important that you make the most out of these visits.

Disability Lawyers

Social Security Attorneys Boise

Your physician will never be asked to decide if you are disabled or not—Social Security believes it is their job to decide this.  However, he or she will usually be asked to give a statement regarding their opinion of how your symptoms will limit your ability to work. Then Social Security will consider these limitations and decide what jobs, if any, you can do.

When you visit your doctor, it is important that you tell him or her all about your symptoms and how they limit you in your daily activities. Be sure to tell your doctor about the duration, location, frequency and intensity of your symptoms and what the aggravating factors are. Also describe things like the side effects of any medications that could keep you from working and if the medication is effective or not. When you do this, what you say will make it into the doctor’s records.  For helpful more tips on maximizing the benefit of your doctor’s visits, see our posts on6 Ways To Make The Most Of Your Doctors Visits – Part 1 and Part 2.

If your doctor doesn’t have enough medical evidence in his records for Social Security to decide if you are disabled or not, they may request that you have additional tests or examinations. These tests are not to provide medical treatment to you. Instead, they are meant to give Social Security a recent idea of your condition and limitations. Consultative exams might be psychiatric or physical in nature. Whichever it is, be sure to give them all of your symptoms and describe all of your limitations.  If you do have to have tests or exams done by a consulting physician, you won’t have to pay the fee. One thing to keep in mind, however, is that these examinations must be done by a physician, osteopath or psychologist (in some circumstances other health professions can be used).

A state agency doctor’s opinion may also be used to determine the outcome of your disability claim. They include osteopaths, psychologists with a Ph.D., and licensed medical doctors. You do not meet these doctors. They make their decision by reviewing and evaluating your medical evidence to see if your impairments meet Social Securities requirements, assessing the severity of your symptoms and how badly they affect your ability to work, and by assessing your remaining physical and mental functions. Medical consultants might also look at ways to get more medical evidence.

If your case goes before an administrative law judge (ALJ), the judge may request the testimony of a medical expert on a complex medical issue. Medical experts differ from medical consultants in that they don’t say whether you should be allowed Social Security disability benefits or not. Their only job is to testify at hearings. Typically they respond to the judge’s questions and give answers for hypothetical situations created by the judge or your disability attorney.

If you have any questions regarding the role of health care professionals in receiving Social Security benefits, please contact one of our Social Security attorneys. They can help you understand the process and know what to say to your doctors to maximize the chances of you winning your hearing.

Originally posted 2014-02-12 15:45:44.

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Vocational Rehabilitation

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.

Social Security Attorneys Nampa

Vocational Rehabilitation–Social Security Attorneys —

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.


Social Security Attorneys Boise

Completing The Function Report II

In almost every case, Social Security (SSA) will ask you to complete a Function Report—Adult (SSA Form 3373).  The form is designed to gauge the severity of your condition by how it limits your activities of daily living.  For this reason the form is sometimes called an ADL Report.  This questionnaire asks how your condition limits your activities in a typical day and it asks about your ability to perform activities such as sitting, standing, walking, lifting and so forth. The tips provided here offer you a general strategy for completing the Function Report.  There are no stock answers, but the advice here should help you to better communicate the nature and severity of your condition.  Please see the article titled “How To Complete The Function Report.”  If after reading this, you still have questions, please contact on our Social Security Attorneys.

Social Security Attorneys Boise

Social Security Attorneys

Some claimants think that the disability attorney is the best person to complete the Function Report.  This is not the case.  You don’t need to be eloquent and you don’t need any special writing skills to complete the Function Report.  This is your opportunity to come across as honest and genuine, with all of your flaws showing, spelling errors and poor handwriting included.  But if your handwriting is so bad it can hardly be read, try getting a friend to help you out.  If part of your disability involves your hands and your inability to finger and manipulate objects, you may not be able to complete the form yourself anyway and this should be noted on the form by whoever completes it for you.

How do your illnesses, injuries, or conditions limit your ability to work?

In answering some questions, less is more.  But when you answer this question, be sure to provide plenty of details.  If you are under 50 (and maybe even if you are over 50), you need to remember that it is not just your last job that you must show you can’t do, but ANY job.  No matter what your age, provide details about your inability to perform job functions such as lifting, carrying, pushing, pulling, fingering, handling, sitting, walking, etc.  Describe difficulties you have with memory and concentration, how pain affects your ability to function and what you are like on “bad” days.

Question 6, what do I do all day?

The best approach is to answer question 6 after you’ve answered all the other questions on the Function Report–Adult. The questionnaire asks a lot of specific questions. If you describe something in answer to a specific question, you don’t need to repeat it when answering question 6. If you spend time in bed or in a recliner, be specific and list that you are in bed or a recliner and for what length of time.

If you do things for only a few minutes at a time and then rest, be sure to explain that. Be careful how you word things so as to avoid giving the wrong impression.  Some disabled people have been known to honestly put down that housework takes them “all day” when what they mean is that it takes them a long time to do a few simple chores that used to take them a few minutes.  But instead they give the impression that you are working all day.

A description of how you organize your life around your disability can win your case.  Be sure to write down the special accommodations that you make for yourself, such as needing to lay down after an hour of sitting in a recliner, laying down flat on a board to relieve pain, avoiding certain social situations, only showering occasionally, etc.

Beware of underestimating or overestimating your capacity. If you can lift 30 pounds, one time but then spend the next two days in bed, do you have the capacity to lift 30 pounds? No, you don’t. Lifting 30 pounds is overdoing it. You need to keep this in mind when you estimate how much you can lift, how far you can walk, how long you can sit, etc.  For example, you may state “If I sit longer than 30 minutes, without walking around, I may end up in bed for several hours.” When estimating your sitting, estimate for sitting in a work chair, not a recliner. How long can you sit in a work chair in a normal work situation before you need to get up?   Standing tolerance should be estimated based on standing in a slow moving line.

Important Points:

  • ·Be sure to give the most honest answers you can.  Your best asset is your credibility.  If the adjudicator does not believe you, you will be denied your benefits.
  • ·List only the side effects you are actually having from medications, not the possible ones listed by the drug manufacturers.  Be sure to discuss side affects from your medications with your doctor.
  • ·Everything you have been asked in the Function Report is good to go over with your doctor on your regular visits.  You don’t need to go over every single thing each visit, but be sure to report to your doctor your troubles with your daily activities EVERY time you have an appointment.
  • ·Before you send your completed Function Report–Adult to SSA, make a copy for yourself.

If you have questions about specific conditions and how you should complete your Function Report, contact the Social Security Attorneys in our office today.

Originally posted 2014-01-30 23:22:25.

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Social Security Attorneys Boise

Joint Abnormalities

Social Security Attorneys Boise

Social Security Attorneys Boise

Joint abnormalities are often the basis for receiving Social Security disability benefits.  Some Social Security listings require “gross deformity” to meet the listing.  If you have difficulty with a major joint such as hips, knees, ankles, shoulders, elbows, wrists or hands, contact one of our Boise Social Security Attorneys for a free evaluation of your condition.  You can ask question of an actual attorney rather than a paralegal or secretary.

Gross anatomical deformity of a joint means that the joint disfigurement, enlargement, instability, slippage, etc. can be observed on physical examination. Here are some of the terms that are used to describe joint deformity: ankylosis (bony fixation), subluxation (slippage out of alignment), instability (inability to maintain alignment), and contracture (soft tissue fixation). The deformity may be visually observable or detected by touch or by secondary effects such as the loss of range of motion.  Range of motion (ROM) should be determined passively, i.e., with the doctor moving the limb as active range of motion, i.e., the patient moving the limb is less reliable because it is hard to tell if the patient is giving best efforts.  Except in extreme cases, shoulder and hip deformity must be seen through imaging such as x-ray.

There are several conditions that can cause joint deformity.  Arthritis, for example, can be sufficiently severe that bone growth on both sides of a joint fuses the joint together (bony ankylosis).  Other conditions may result in fibrous ankylosis, where the joint is fixed because of hardening of tissues (ligaments, tendons, skin) around the joint, as a result of traumatic damage, disease process, or disuse. With fibrous ankylosis, tissue looses its elasticity and the joint can no longer move.

The inability to manipulate hands is particularly disabling.  Several conditions can result in the inability to finger or hand objects.  For example, Volkmannís ischemic contracture is where the hand becomes fixed in a bent position on the wrist, and the hand become claw-like. This may be the result of a crushing injury around the elbow that interrupts blood supply to the forearm muscles.  Another condition is the Dupuytrenís contracture where the fingers become fixed because the ligaments and tendons on the bottom of the hand become hardened and the hand will not open.

It is extremely important to understand that a full range of normal motion does not mean a claimant does not meet a listing because abnormal motion can greatly impair function even if the normally expected range of motion is present. In fact, ligament laxity is a condition where there is too much motion and it can be quite disabling because of abnormal forward (anterior), backward (posterior), or sideways (lateral) motion.  It is important that doctors do not simply note “full ROM”.  They also need to report the presence or absence of abnormal range of motion.

X-ray, CT and MRI can be helpful, but the right imaging must be used. For example, a plain X-ray might be sufficient to rule out a bony arthritic process, but would not show soft tissue damage (e.g., fibrous ankylosis) that would be visible on a MRI. To meet a listing there must be evidence of joint involvement (joint space narrowing, bony destruction, or ankylosis), whether or not there is soft tissue damage resulting in instability.

Joint deformity of itself is not enough to meet the listing.  If the deformity is in the hip, knee, or ankle joint, the claimant must not be able to effectively ambulate. The nature of ineffective ambulation is discussed by the SSA in Listing 1.00B2b.  If the joint deformity is in shoulder, elbow, or hand-wrist joint in each upper extremity, the nature of ineffective function is defined by the SSA in Listing 1.00B2c.

For more information on how a joint deformity may qualify you for Social Security Disability benefits, contact one of our Social Security Disability Attorneys in Boise Idaho.

Originally posted 2014-01-27 14:04:17.


Social Security Attorney Nampa

Apply For Disability

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.Boise Disability Lawyers

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.


Social Security Attorneys Nampa

Arthritis

Arthritis

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.

 

Social Security Attorney Nampa

Social Security Attorney Nampa

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.

Criterion

Definition

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

Criterion

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.

 

Our Social Security attorneys can take the worry out of your disability application.

Our Social Security attorneys can take the worry out of your disability application.

Psoriatic Arthritis

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.

Osteoarthritis

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.

Infectious Arthritis

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

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

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.

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Spinal Disorders

Social Security Attorney Nampa


Spinal Disorders – Social Security Attorney Nampa

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.

  1. 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.


Social Security Attorneys Nampa Idaho

Musculoskeletal Examinations

Musculoskeletal Examinations

Your chances for receiving your disability for neck, back or joint condition depends on the quality of the medical evidence you can present to Social Security.  Not every doctor visit is the same.  You should request a full physical examination at each visit that includes important observations that will support your complaints of pain and limitation.  Contact one a Social Security Attorney in our Nampa Idaho office for an evaluation of your situation and what steps you can take to get your disability claim on track.

If you suffer from spinal symptoms, your examination should include observations from your doctor regarding the following:

  • gait
  • range of motion of the spine given quantitatively in degrees from the vertical position (zero degrees)
  • straight-leg raising from the sitting and supine position (zero degrees),
  • appropriate tension signs
  • motor and sensory abnormalities
  • muscle spasm
  • deep tendon reflexes

Be aware that your doctor will also include observations during the examination such as how you get on and off the examination table, your Inability to walk on the heels or toes, to squat, or to arise from a squatting position. Your doctor should note atrophy by taking  circumferential measurements of both thighs and lower legs, or both upper and lower arms, as appropriate.  Atrophy also requires a measurement of the strength of the affected muscles based on a grading system of 0 to 5, with 0 being complete loss of strength and 5 being maximum strength. A specific description of atrophy of hand muscles should include measurements of grip and pinch strength.

Your condition will change over time and may respond to treatments.  It is not enough to have a single evaluation, no matter how extensive, or to have several evaluations over a period of time, and then stop seeing your doctor.  Social Security will want to see over the period of time you are claiming disability that your condition persists.

Major Joints

Major joints refers to the major peripheral joints, which are the hip, knee, shoulder, elbow, wrist-hand, and ankle-foot.  It dos not include peripheral joints such as fingers or forefoot or axial joints such as the spine.  The wrist and hand are considered together as one major joint, as are the ankle and foot.  If your condition involves a major joint, you will want to have regular examinations as for these joints covering the aspects described above.

Treatment

If you have a severe musculoskeletal condition that will qualify you for disability, you will almost certainly have tried several unsuccessful treatments.  Your record should include, medical treatment (including surgical treatment) with documentation of its effectiveness in terms of the signs, symptoms, and laboratory abnormalities of the disorder, and in terms of any side effects from the treatment that create their own limitations.

Treatment and adverse consequences of treatment will vary widely. For example, a pain medication may reduce your pain to some degree, but will have side effects such as  drowsiness, dizziness, or disorientation, that may make it impossible to work. Each case is different and must be document with objective observations from your doctor.

Hopefully your doctor’s note will contain a specific description of the drugs or treatment given (including surgery), dosage, frequency of administration, and a description of the complications or response to treatment.  Because some effects of treatment may be temporary, review of your condition over a long period of time will be critical in establishing the nature of your condition.

If for whatever reason you have not received ongoing treatment, whether because of financial concerns or because you simply failed to see the need to continue seeing your doctor because you were not seeing improvement from your recommended treatment, etc, you need to begin seeing a doctor regularly while you await your hearing.

You need to do everything in your power to find a low-cost or no-cost clinic so that you can continue to documents your condition.  In such cases, evaluation will be made on the basis of the current objective medical evidence and other available evidence. Even though may not receive treatment your doctor’s objective observations form a significant basis for showing an impairment that meets the criteria of one of the musculoskeletal listings.

Contact one of our Social Security Attorneys Nampa Idaho to discuss the specifics of your case.  You will receive a consultation with an actual local Social Security Attorney.

 

 

Originally posted 2014-01-05 04:24:19.


Social Security Attorneys Boise Idaho

Completing The Function Report

Social Security Attorneys Boise IdahoHow To Complete The Adult Functional Report

One of the most important forms you will complete in your Social Security Disability Application is the Function Report.  You will actually see this type of report more than once.  When you initially apply, Social Security will send you SSA Form 3373 (the “Function Report-Adult”).  The Function Report is intended to determine what abilities you have and focuses on you daily activities.  One of our Social Security Attorneys Boise Idaho can help you to complete the form in a way that accurately reflects your physical and mental capacities.

Important:  When it comes to describing your limitations, be as detailed as necessary to illustrate the severity of your condition. Otherwise, less is more when completing the Function Report.  Use your worst days as a reference, but be sure to indicate that your answer is based on a worst day.  We find that the Function Report is cited most often to deny claims and medical records are what will get your claim approved.  Your goal in completing the Function Report is to give Social Security an accurate sense of what you CAN NOT do (not what you can do) in a way that fosters your credibility.

There are several things to keep in mind when complete the Function Report that will help you to complete it in a way that is most beneficial to your case.  Below are few of those things:

Be completely honest.  Many times we understate our problems and difficulties because nobody likes a whiner.  When you are competing the Function Report is not a time to be stoic.  Tell things as they really are.

Don’t overstate your limitations.  Some people have the tendency to overstate their symptoms.  Be careful to avoid exaggerations.  Your credibility critical to your success.  If the adjudicator thinks he can’t fully trust you, he will discount your claim.

Hobbies.  Don’t list hobbies and activities that you once did but no longer participate in.  If you no longer participate in a hobby or activity because of your limitations and want to use this to illustrate the severity of your condition, make sure that you are very clear as to what your limitations are and put this in response to Question 10 and not Question 18.

If you need more space to illustrate how your life has changed because of your disability, use the comments section at the end.  Give specific symptoms and limitations that prevent you from doing things you loved to do once or how your mental and physical symptoms have caused issues in your social life, personality, important relationships, etc.

House Work and Yard Work. Only list the things that you do NOW.  Don’t list anything that you did even a few months ago, but no longer do.   If you are no longer doing housework or yard work, simply indicate how your limitations prevent you from doing work of any kind.  If you are able to do some chores, don’t feel you need to make a complete list of every little thing you do.  The best way to respond to these types of questions is to pick one light chore that you do and list all of the difficulty you have with doing that chore.Social Security Attorneys  In Banner Ad

For example, you may do dishes.  Don’t simply list “I do dishes.”  Indicate that you do dishes and then indicate all of the limitations that you have.  For example:  “I do dishes when my symptoms are not too severe.  When I can do dishes, I can only stand for 10 minutes and then I have to rest.  My husband has to take care of any large pots and pans.  I can load the dishes in the top of the dishwasher, but I can’t bend over to load the bottom.”  In the above example you would refer directly to the condition, such as back pain, that is causing your limitations.

Important Details to Provide.  When you are describing your symptoms and limitations, provide information as to the frequency, intensity and duration of your symptoms. You can also provide information on how much you can lift, how long you can sit, how long you can stand, how often you have to lay down, elevate your feet, etc.  If you have bad days, be sure to describe what your symptoms are like on these days and how many bad days you have in a month.

Social Security Attorney Boise

Our Social Security Attorneys can help you to navigate your disability application.

Good days, bad days and your credibility. Most people applying for disability don’t have constant symptoms.  They have good days and bad days.  This can lead to conflicts between your answers on the Function Report and other evidence in your file that can lead Social Security to discount your credibility.  If you don’t indicate to Social Security that your answer to a particular question is based on your bad days, Social Security will compare your answer to other evidence in the file that does not seem to indicate your condition is as severe as you describe and begin to question your credibility.

For example, on a good day you went shopping or for a drive and mention this in passing to your doctor who then puts something in the records like “Feeling better, enjoying shopping”.  But in your Function Report you indicate that you can’t do any shopping because you were thinking about your bad days when you have to stay in bed.  So be sure that you use the phrases “On bad days…..” and indicate how often you have bad days.  You can indicate in response to any question that on your bad days you can’t do anything, but on your good days your can perform certain limited functions.

For example,  in response to question 12, you could indicate that on bad days you do not bathe or shower and your spouse has to help you put your shoes on and button your clothing.  Or on Question 13 you can indicate that on bad days you can not prepare a meal and your roommate will help you out, but on good days you are able to prepare a sandwich or soup.

Your mental capacity.  Mental limitations are particularly difficult to establish.  Your credibility is your best asset here.  If your disability is largely due to cognitive limitations such as concentration, remembering, etc, you will want to provide as many anecdotes as you can that demonstrate your limitations.  For example, “I have to have my brother help me each month with bills because I make too many mistakes with inverting numbers on the checks,” or “I find that I have to re-read something several times before I can get the meaning,” or “my wife has taken over my medications because I can’t remember what I have taken, and I can’t even remember to write it down.”

The Function Report can be a trap for the unwary.  Be sure to speak with one of our Social Security Attorneys In Boise Idaho before you complete your form for detailed advice with respect to your specific disability.

Originally posted 2014-01-03 18:58:00.

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