Disabling Condition: Cardiovascular Problems

Posted on September 6, 2010 by Editorial Board

Conditions covered include chronic heart failure (heart’s pumping action is compromised), ischemic heart disease (reduced blood flow to the heart muscle), recurrent arrhythmias (heart/rate/rhythm disorder, too fast, slow, irregular), symptomatic congenital heart disease (structural defects leading to malfunction, aneurysm of aorta or major heart branches (swelling due to wall weakness), chronic venous insufficiency (leg veins cannot pump enough oxygen poor blood back to the heart), peripheral arterial disease (obstruction of large peripheral arteries) heart transplant.

Heart problems

  1. Have you had a heart attack?
  2. Have you had a coronary artery bypass?
  3. Are you on beta-blocker therapy?
  4. Have you had an ECG/EKG?
  5. Have you had treadmill testing?
  6. If you have chest pain is it with/without exertion?
  7. Do you have shortness of breath with/without exertion?
  8. Have you been treated by a cardiologist?  If so, do you know your classification on the NYHA scale, I, II, III, IV?
  9. How many pillows do you sleep on at night?
  10. Do your ankles swell?
  11. Do you need to elevate your legs?

Our heart is a big pumping muscle, in the middle of our chest, constantly sending blood circulating throughout the body to enrich us with oxygen or to acquire oxygen from the lung.  This back and forth; push and pull; filling and depleting has a natural rhythm that we can detect at any time.

Blood flow which is slowed or obstructed can cause cardiac deficiencies (bad news) but can also be treated (good news) with medications, angioplasty (placing stents/balloons in the veins to clear blockage)  and/or bypass surgery (rerouting the blood flow by grafting healthy veins acquired from the leg).

What if there has been a heart attack (myocardial infarction, i.e. MI)?  An MI results in heart tissue death (which is permanent) because of inadequate oxygen supply.  But like a stroke, the damage can be minimal (some people don’t even know they have had one) or very significant causing lasting damage.  After a heart attack, it is not unusual for the individual to develop an anxiety disorder.  The symptoms of a panic attack are strikingly similar (shortness of breath, chest pain, sweating, dizziness).  Unfortunately, cardiologists often ignore “non-cardiac” symptoms and fail to refer their patient for appropriate treatment.  But if you have panic attacks, treatment from a psychologist or psychiatrist can help establish disability for that condition if it does not improve despite treatment.

Sometimes the heart is also defective and cannot maintain a normal or consistent rhythm.  A pacemaker (electronic devices that “jump start” the heart) is usually curative but not always.  When arrhythmias persist and occur 3 times a year despite treatment, Social Security will find the condition disabling.

Sometimes the heart is weak and/or not otherwise amenable to long lasting treatment.  Social Security will evaluate the effectiveness of treatment when considering whether the heart is too damaged and results in disability.   In 2008 Social Security added a new criteria finding disability for individuals who have had 3 revascularizations (angioplasty or bypass) in a year.

The heart relies on veins to carry the oxygen rich and oxygen poor blood back and forth.  The hardest working veins are those which have to take the oxygen poor blood from our legs/feet back up to the heart (working against gravity).   Conditions like chronic venous insufficiency or peripheral arterial disease can result and are considered by Social Security as cardiac disorders.  These conditions can be found disabling when swelling is extensive causing skin breakdown or cramp-like leg pains (often mistaken for peripheral neuropathy caused by diabetes).  A doppler study can effectively measure the severity of these symptoms (called claudication).

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Disabling Condition: Special Senses & Speech

Posted on September 6, 2010 by Editorial Board

Special senses and speech can be disabling, conditions covered include loss of visual acuity (acuteness or clearness of vision) contraction of the visual fields (when the eye is fixed on a central point or loss of vision away from the center), loss of visual efficiency (problems with gathering information, i.e. tracking, focus, teaming) disturbance of labyrinthine-vestibular function (Meniere’s disease) loss of hearing, loss of speech.

Seeing

  1. Have you had your vision tested?
  2. Have you had laser surgery?

Hearing

  1. Have you had a hearing test?
  2. Do you wear hearing aids and if not, should you and if so why don’t you have them?
  3. Do you have dizziness/balance problems and if so have you been referred for Meniere’s disease testing?
  4. Do you have ringing in your ears (tinnitus)?

Speaking

  1. Is your voice hard to hear?
  2. Is your voice audible but not understandable to others?
  3. Are you able to communicate but not for very long?

Vision, hearing and speech loss are easily measured with noninvasive and relatively inexpensive tests.  Social Security will pay for these and we often request them to help establish a level of severity.  But the caloric testing for Meniere’s disease is not a test that Social Security will purchase.  Meniere’s is usually diagnosed by a specialist upon review of testing as well as documentation of attacks.  As such, the medical record often establishes frequency.  Unfortunately, Social Security does not indicate what frequency is disabling.

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Disabling Condition: Musculoskeletal Problems

Posted on September 6, 2010 by Editorial Board

Disabling Musculoskeletal conditions include muscle and bone impairments causing loss of use, surgical correction of weight bearing joints with loss of use, spinal cord disorders, amputation with loss of use, unhealed fracture of leg/arm bones or loss of use and injury such as burn causing loss of use.

Back problems (neck, and/or low back usually)

  1. Have you had any objective studies (x-rays, MRIs, CT Scan/Myelogram/Discogram, EMG)?
  2. Have you seen specialists such as orthopedic surgeons or neurosurgeons?
  3. Have you had surgeries?
  4. Have you had bladder dysfunction after low back injury/surgery?
  5. After low back surgery have you had pain in the hip/buttocks region affecting your ability to stay in one position for more than 20 minutes (possible arachnoiditis)?
  6. Have you had post surgical objective studies?  If so, do they still show problems, i.e. another herniated disc, scar tissue, etc.?
  7. Do you have spasms or do you fall down?
  8. Have you had epidural steroid injections for pain?  Do they help/last?

Arm/hand problems (carpal tunnel syndrome, shoulder impingement)

  1. Do you have trouble with fine motor use (writing, picking up paper clips, opening a liter of coke)?
  2. Do you have trouble with gross motor use (holding a cup of coffee)?
  3. Do you have sensory (numbness, tingling, loss of feeling) or motor loss (less strength, weakness, muscle is smaller)?
  4. Do you have trouble with over head reaching?
  5. Do you wear wrist splints?
  6. Have you had surgeries?
  7. Have you had post surgery EMGs?

Weight bearing Joints (knee, hip ankle)

  1. Have you had objective studies?
  2. Have you had surgical repair?
  3. Have you had post surgical objective studies?
  4. Do you use assistive devices?
  5. If your weight is a factor, have you had any prescribed treatment to reduce your weight?

The musculoskeletal system (also known as the locomotor system) is an organ system that gives humans the ability to move.  It provides form, stability, and movement to the human body.  As such, disorders or diseases will affect functioning and restrict movement.  Weight bearing joints (hips, knees ankles) for instance are critical to walking and standing.  Spinal cord disorders can limit these functions but also can affect bending, stooping, sitting, etc.  And disorders of our upper extremities (shoulder, arm and hand) will affect gross (large) and fine (smaller) movement.

For most of these conditions, functional loss will need to be established in order for Social Security to consider the conditions disabling.  It is always best to have functional loss considered in the medical records but if lacking, seek an opinion statement from a treating source and/or document functional loss with other witness statements.

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What’s Important in Epilepsy and Social Security Law?

Posted on September 6, 2010 by John R. Heard

What exactly is “epilepsy,” or “seizure disorder”?  Are they the same thing? Are there different types of epilepsy or seizures?  Is a medical doctor’s diagnosis of epilepsy or seizure disorder enough to win my disability case?  Are the rules for an adult the same as for a child?  What if the medicine is working and the number of seizures per month or year have been drastically minimized or stopped all together?  Can I still win my case since I still have the diagnosis?

These are some questions often asked by those suffering from epilepsy or by the families who care about them when seeking disability.  This article (Part I) will begin to answer some of these questions among others and provide some basic information regarding winning or losing a disability case when dealing with epilepsy (seizures).

Epilepsy deals with the generation of electrical signals in the brain, thus causing seizures.  To be diagnosed with epilepsy, a person would need to have had at least 2 or more seizures.

In order to understand epilepsy better, it is important to further distinguish between the different groupings within epilepsy.  Normally, seizures are divided into two types, “Partial seizures,” and “Generalized seizures.”

PARTIAL SEIZURES (also called Focal Seizures): result from abnormal activity in only one part of the brain.  There are two types.

  • Simple Partial Seizures – does not involve a loss of consciousness, may change a person’s emotions, or how things look, smell, taste, sound or feel.  They may also involve some involuntary movement of a part of the body, such as an arm or leg, or other sensory type symptoms.
  • Complex partial seizures – these affect consciousness by basically losing awareness for a period of time.  They can result in staring and certain involuntary movements, such as chewing, rubbing hands, or walking around in circles.

GENERALIZED SEIZURES:  result from abnormal activity in all of the brain. There are four types.

  • Petit Mal (also called Absence seizures) – similar to complex partial except they can cause a short loss of consciousness, they also involve staring and subtle body movements
  • Grand Mal (also called Tonic-clonic seizures) – the most extreme type, involve a loss of consciousness, the complete shaking of the body along with body stiffening, and often a loss of bladder control.
  • Myoclonic seizures – usually involve sudden movements in the arms and legs
  • Atonic seizures (drop attacks) – the body’s muscles suddenly give out and the person falls or collapses

When dealing with Social Security law, epilepsy is simply categorized into two big groups and does NOT consider etiology (the original cause of the seizure).  The first group involves “convulsive” epileptic seizures (the body shaking/convulsions, etc.), and the second group involves “non-convulsive” epileptic seizures (where the seizure does not include convulsions).

“Convulsive epilepsy” (1st group in Social Security law) includes grand mal or psychomotor (psychomotor is the same as “complex partial” seizures above – see definition).  Requirements to meet this listing include a documented detailed description of a typical seizure pattern, including all associated phenomena, and seizures happening at least 2 or more times per month, while having been on a continued prescribed treatment for a minimum of 3 months, PLUS ONE of the following two things:

  • If daytime episodes, a loss of consciousness and convulsions, OR
  • If nighttime episodes, having lingering/lasting effects which significantly interfere with activity during the day

“Nonconvulsive epilepsy” (2nd group in Social Security Law) includes petit mal (Absence seizures), also psychomotor (complex partial) or any Focal type seizures (see list above).  Requirements to meet this listing include a documented detailed description of a typical seizure pattern, including all associated phenomena, and seizures happening at least 2 or more times per week, while having been on  a continued prescribed treatment for a minimum of 3 months, PLUS one from each of the following 2 groups.

  • an altered awareness, OR
  • a loss of consciousness,

AND

  • “transient postictal manifestations of unconventional behavior (this has to do with the short period of time immediately following a seizure when the brain is recovering and may include symptoms like drowsiness, nausea, confusion, headaches, or other disorienting symptoms), OR
  • a significant interference  with activity during the day

Because there is abnormal activity in the brain cells, seizures can affect how the brain coordinates things and instead produce symptoms as previously described, like uncontrollable jerking movements of the arms and legs, staring spells, temporary confusion, and/or complete loss of consciousness and thus affecting a child or adult’s ability to perform their daily activities.

Posted in Neurological Disorders, The Listings (Step 3) | Comments Off on What’s Important in Epilepsy and Social Security Law?