I have been diagnosed with a serious medical disorder. Is my diagnosis, alone, sufficient to win my case?

The answer to this question is “No”, unless your diagnosis is for a disease or condition that is so extremely serious that it is included in the Compassionate Allowances (CAL) initiative. (See the “Compassionate Allowances (CAL)” link for a list of medical conditions that are included under CAL.) For all medical disorders other than those covered by CAL, you cannot win your case on the basis of a diagnosis alone. The reason for this is that the rules and regulations used by the Social Security Administration (SSA) are based on the assumption that, at least for most medical conditions, the same disease or condition can affect different people in different ways and with different degrees of severity. Some people with ruptured discs in their back may experience very limited pain and can continue to work in a light duty or sedentary job, while another person who has been diagnosed with the same condition may experience continuous pain that precludes all employment. Even though the diagnosis is the same, the severity of the symptoms can vary greatly. Therefore, in the usual case, you need more information than a simple diagnosis. You need specific medical information about the extent and severity of your disease or medical condition.

The need for specific information about the extent and severity of your medical disorders is shown in steps #3, #4 and #5 of the five (5) step sequential evaluation process that is used by the Social Security Administration (SSA) for deciding disability claims. (See “The Five (5) Step Sequential Evaluation Process” link.)

At step #3 of this process, the SSA determines whether or not your impairment satisfies or “meets” one of the Listing of Impairments (the listings). The listings is a detailed description of several specific impairments, i.e., medical disorders, for each of the major body systems (The SSA uses the general word “impairment” to denote any mental or physical disorder or disease.) For example, there is a “listing” for “disorders of the spine”, for “chronic pulmonary insufficiency”, for “chronic heart failure”, for “hematological disorders”, and etc. Each listing is written to describe a level of impairment that is so severe that it would clearly prevent any person from performing any type of work. If your impairment(s) is as severe as the listing that applies to your impairment, then the SSA will immediately conclude that you are disabled without any further analysis. This is referred to as satisfying or “meeting” a listing. (See the “Five (5) Step Sequential Evaluation Process” link regarding the Listing of Impairments.) The Social Security rules explicitly state that you need more than a simple diagnosis in order to meet a listing. You need medical evidence with information sufficient to satisfy the criteria of that specific listing. The Regulations state the following:

• Can your impairment(s) meet a listing based only on a diagnosis? No. Your impairment(s) cannot meet the criteria of a listing based only on a diagnosis. To meet the requirements of a listing, you must have a medically determinable impairment(s) that satisfies all of the criteria in the listing. C.F.R. section 404.1526 (d) .

If the SSA decides that your condition is not sufficiently severe to meet a listing, then the SSA will proceed to steps #4 and #5 of the evaluation process. At these steps, the SSA must decide whether or not you can perform your past work or any other work in the national economy. The SSA answers these questions by determining your Residual Functional Capacity (RFC). Your RFC is defined as “the most you can still do despite your limitations”. Your RFC is the capabilities that you still have in spite of your impairments. The SSA determines your RFC by considering the severity of all of your impairments and the severity of the symptoms and limitations that are caused by those impairments. In order to be able to show the SSA the full extent of your limitations and disabilities, you need medical evidence that addresses more than just the diagnosis of your impairment. You need medical evidence that shows the severity of your medical disorders, how your medical disorders affect you, how they limit your activities, and how they will cause you problems in a work setting. (See the following links: “The Five (5) Step Sequential Evaluation Process”, “What medical records do I need for my Social Security disability case?” and “The Medical Source Statement”.)

Obviously, your diagnosis is extremely important. But this is just where you get started in trying to prove your case. You need more. You need medical evidence that can satisfy the Five (5) Step Sequential Evaluation Process.

The rules and regulations used by the SSA are very complex. You need the help of a lawyer in the preparation and presentation of your case. If you have any questions or would like to obtain a case evaluation, I would be happy to speak with you. I do not charge for my initial consultation.

lawyerbriantrandall.com

The Medical Source Statement (MSS)

A Medical Source Statement (MSS) from your doctor is very valuable in trying to prove your disability claim. A Medical Source Statement (MSS) is a detailed statement in which your doctor gives his or her opinion regarding your medical disorders, the severity of your symptoms, and the specific limitations and problems that you would have in performing common workplace activities as a result of your medical disorders. In an MSS, your doctor should address issues such as your ability to walk, lift and carry objects, continuously stand in one place or sit in one place, use your hands and fingers, climb stairs, bend over, stoop, perform overhead work, your ability to see and hear, follow specific directions, concentrate for long periods without interruption, your need for frequent and lengthy rest periods throughout the day, the likelihood that you would have frequent absences from work as a result of your medical condition, and any other limitations that may apply in your specific case. Your MSS should address your specific health problems and your unique symptoms and limitations. Your doctor(s) should address every mental or physical limitation that you have that would interfere with your ability to function in a work setting. In my practice, I use different MSS forms for different types of medical problems, which I send to the claimant's doctor(s).

An MSS from your doctor is valuable because it allows the Social Security Administration (SSA) and Social Security Judge to consider your treating doctor’s opinion about your specific limitations and your inability to engage in specific work related activities. The limitations and work restrictions that result from your health problems are the most important factor in the overall decision regarding whether or not you are disabled. The opinion of your treating doctor regarding this issue is, usually, afforded a great deal of weight by the SSA and the Judge. (See the “Five (5) Step Sequential Evaluation Process” link.)

There is no limit on the number of MSSs that can be submitted to the SSA and to the Social Security Judge for consideration. You can submit an MSS from any of your doctors who are willing to provide one.

A letter from your doctor that simply states that your doctor believes you to be disabled does not have as much persuasive power with the SSA or with the Social Security Judge as a detailed statement. Such a simple letter from your doctor, without any details or supporting evidence, is seen by the SSA as an unhelpful, legal conclusion. The SSA and the Judge consider it to be their responsibility to reach the final conclusions about your disability. If a simple letter stating that you are disabled is the most that you can get from your doctor, then you should obtain it and submit it to the SSA and the Social Security Judge for their consideration. However, you should also try to obtain a more detailed statement from your doctor about your health problems, your symptoms and the specific workplace limitations that you are experiencing as a result of your medical problems.

Although there are certain basic issues that should always be addressed in an MSS, the specific issues that need to be addressed in your case will depend on the nature of your medical disorders and the other circumstances of your case, including the information that is contained in your medical records. You should seek the advice of an experienced attorney regarding this issue.

lawyerbriantrandall.com

Phone: 864-420-0612

Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome (RSDS/CRPS)

RSDS or CRPS is a chronic pain syndrome that can result from trauma to an extremity or some other part of the body. It can arise as the result of the trauma of surgery, some other disease process, or even from a minor injury. Symptoms include burning pain, swelling and extreme sensitivity of the skin, especially in the arms, hands, fingers, shoulders, legs and feet. The exact causal mechanism of RSDS/CRPS is not known, however it is thought to be related to damage to the sympathetic nervous system.

In 2003, the Social Security Administration (SSA) published a special Ruling that sets forth guidelines regarding how they will evaluate disability claims based on RSDS/CRPS. This Ruling is published as SSR 03-2p. This Ruling states that RSDS/CRPS may be considered a “medically determinable impairment” and may provide the basis for a finding of disability if it is “documented by appropriate medical signs, symptoms, and laboratory findings”.

According to this Ruling, in order to establish RSDS/CRPS as a medically determinable impairment, the claimant must suffer persistent pain in the affected region of the body and, in addition, one or more of the following signs must also be present in the affected region:

1. Swelling,
2. Autonomic instability – seen as changes in skin color or texture, changes in sweating (decreased or excessive sweating), skin temperature changes, or abnormal pilomotor erection (gooseflesh),
3. Abnormal hair or nail growth (growth can be either too slow or too fast),
4. Osteoporosis, or
5. Involuntary movements.

Anyone seeking disability on the basis of RSDS/CRPS would need to carefully review this Ruling with their attorney in order to make sure that their medical evidence satisfies the stated criteria. After reviewing this Ruling, there might be a need to request additional information from your doctor(s) in order to meet the specific evidentiary requirements.

The rules and regulations used by the Social Security Administration (SSA) are very complex. If you are attempting to obtain social security disability benefits based on RSDS/CRPS, you need the help of an experienced attorney. More information is contained in my website, lawyerbriantrandall.com. If you have any question, I can be reached at 864-420-0612.

lawyerbriantrandall.com

In 2012, the Social Security Administration (SSA) issued "Social Security Ruling 12-2". This Ruling is intended to provide general guidance as to how the SSA will evaluate a claim for disability that is based on fibromyalgia. The Ruling states that a fibromyalgia diagnosis may be considered a medically determinable impairment if "it is established by appropriate medical evidence". The Ruling explicitly states that more medical evidence is needed than a mere diagnosis from your doctor.

The Ruling sets forth two (2) separate sets of criteria that can be used for the establishment of fibromyalgia as a medically determinable impairment. The following four (4) factors are identified as significant:

1. A history of widespread pain. The pain must occur both above and below the waist and on both sides of the body. The pain must have persisted for at least 3 months, although it may fluctuate in intensity and may not always be present.
2. Evidence that other disorders have been excluded as a cause of the symptoms.
3. A physical examination that shows at least 11 positive tender points at certain tender point sites.
4. Repeated manifestations of 6 or more common fibromyalgia symptoms, such as fatigue, waking unrefreshed, irritable bowel syndrome, depression, anxiety, and memory or concentration problems

Anyone seeking disability on the basis of fibromyalgia will need to carefully review this Ruling with their attorney in order to make sure that their medical evidence satisfies at least one (1) of the stated criteria. After reviewing this Ruling, there might be a need to request additional information from your doctor(s) in order to meet the specific evidentiary requirements. The rules and regulations used by the SSA are very complex. If you are attempting to obtain disability benefits based on fibromyalgia, you need the help of an experienced attorney.

Additional information can be found on my website, lawyerbriantrandall.com. If you have any question, please contact me at 864-420-0612.

lawyerbriantrandall.com